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Biomedical subjects

P Carl

Publications and source records attributed to P Carl.

At least 19 recordsLinked to original sources
PubMed2002

[Acceptance of silicone testicular prostheses in long-term follow-up].

The loss of a testicle is a psychological trauma, in particular for young men. The cosmetic defect can be corrected by implantation of a silicone testicular prosthesis (STP). The recurring discussion regarding the problems of silicone implants mainly concerns breast implants. STPs are made of equivalent material. Since we have been using STPs for 20 years, we wanted to research the opinion of our patients regarding these issues. Between 1978 and 1998, 51 STPs were implanted--37 times by groin incision and 14 times by scrotal incision--in 51 patients. The average age of the patients at the time of the operation was 23.3 years (14.3-55.4). Three implants had to be removed early. A questionnaire was distributed to all patients with STPs; 39 of the questionnaires were returned completed. The results--10.1 years postoperative--showed no serious late complications, an acceptance rate of 97% by the patients and about 50% by their female partners. Therefore, we will continue to offer the option for implantation of STP to our patients.

Adolescent↗
PubMed2001

Caring for the critically ill patient. High-dose antithrombin III in severe sepsis: a randomized controlled trial.

CONTEXT: Activation of the coagulation system and depletion of endogenous anticoagulants are frequently found in patients with severe sepsis and septic shock. Diffuse microthrombus formation may induce organ dysfunction and lead to excess mortality in septic shock. Antithrombin III may provide protection from multiorgan failure and improve survival in severely ill patients. OBJECTIVE: To determine if high-dose antithrombin III (administered within 6 hours of onset) would provide a survival advantage in patients with severe sepsis and septic shock. DESIGN AND SETTING: Double-blind, placebo-controlled, multicenter phase 3 clinical trial in patients with severe sepsis (the KyberSept Trial) was conducted from March 1997 through January 2000. PATIENTS: A total of 2314 adult patients were randomized into 2 equal groups of 1157 to receive either intravenous antithrombin III (30 000 IU in total over 4 days) or a placebo (1% human albumin). MAIN OUTCOME MEASURE: All-cause mortality 28 days after initiation of study medication. RESULTS: Overall mortality at 28 days in the antithrombin III treatment group was 38.9% vs 38.7% in the placebo group (P =.94). Secondary end points, including mortality at 56 and 90 days and survival time in the intensive care unit, did not differ between the antithrombin III and placebo groups. In the subgroup of patients who did not receive concomitant heparin during the 4-day treatment phase (n = 698), the 28-day mortality was nonsignificantly lower in the antithrombin III group (37.8%) than in the placebo group (43.6%) (P =.08). This trend became significant after 90 days (n = 686; 44.9% for antithrombin III group vs 52.5% for placebo group; P =.03). In patients receiving antithrombin III and concomitant heparin, a significantly increased bleeding incidence was observed (23.8% for antithrombin III group vs 13.5% for placebo group; P<.001). CONCLUSIONS: High-dose antithrombin III therapy had no effect on 28-day all-cause mortality in adult patients with severe sepsis and septic shock when administered within 6 hours after the onset. High-dose antithrombin III was associated with an increased risk of hemorrhage when administered with heparin. There was some evidence to suggest a treatment benefit of antithrombin III in the subgroup of patients not receiving concomitant heparin.

Adult↗
PubMed2001

Forced unfolding modulated by disulfide bonds in the Ig domains of a cell adhesion molecule.

Cell adhesion molecules (CAMs) mediate cell attachment and stress transfer through extracellular domains. Here we forcibly unfold the Ig domains of a prototypical Ig superfamily CAM that contains intradomain disulfide bonds. The Ig domains of all such CAMs have conformations homologous to cadherin extracellular domains, titin Ig-type domains, and fibronectin type-III (FNIII) domains. Atomic force microscopy has been used to extend the five Ig domains of Mel-CAM (melanoma CAM)--a protein that is overexpressed in metastatic melanomas--under conditions where the disulfide bonds were either left intact or disrupted through reduction. Under physiological conditions where intradomain disulfide bonds are intact, partial unfolding was observed at forces far smaller than those reported previously for either titin's Ig-type domains or tenascin's FNIII domains. This partial unfolding under low force may be an important mechanism for imparting elasticity to cell-cell contacts, as well as a regulatory mechanism for adhesive interactions. Under reducing conditions, Mel-CAM's Ig domains were found to fully unfold through a partially folded state and at slightly higher forces. The results suggest that, in divergent evolution of all such domains, stabilization imparted by disulfide bonds relaxes requirements for strong, noncovalent, folded-state interactions.

Antigens, CD↗
PubMed2001

New insights into red cell network structure, elasticity, and spectrin unfolding--a current review.

The red cell membrane's well-recognized ability to withstand the stresses of circulation clearly has its origins in various levels of spectrin-actin network structure. We highlight recently obtained insights into this sub-structure and also briefly explain the implications to membrane components that interact with the network. Novel insights into the resilience of this cytoskeleton are being provided by experiments that range from atomic force microscopy (AFM) tests of single, unfoldable spectrin chains to micropatterned photobleaching of a pipette-deformed network. Continued progress in atomic level structure determinations of non-erythroid spectrin and related repeats are further complemented by theoretical efforts--computational approaches most notably--that have begun to correlate molecular scale aspects of structure with micro-mechanical measures. All of this recent activity in the biophysics of red cell structure-function challenges and refines some of the most basic tenets in cell membrane response.

Actin Cytoskeleton↗
PubMed2000

[Leukocyte adhesion on a fibrinogen-coated surface under static conditions: experimentation and creation of a model].

The adhesion of polymorphonuclear leukocytes (PMNs) on the vascular endothelium is a complex process that occurs during different biological and pathological events and involves numerous molecules. The adhesion cascade is induced after PMN stimulation by various molecular or cellular signals. Fibrinogen is one of the substrates for CD11b/CD18 B2-integrins expressed at the PMN surface; fibrinogen-neutrophil binding is induced by inflammatory reactions. In order to understand this process, we have carried out studies on the basis of preliminary experiments on red blood cells and synthetic particles. The modelization of quiescent PMNs adhesion on a fibrinogen substrate was investigated with a sedimentation cell chamber. Two different physiological conditions were tested: the activated state of PMN by a synthetic pro-inflammatory activator (FMLP). The activated state of PMNs was both quantified by flow cytometry and controlled by fluorescence microscopy. The results suggest that quiescent neutrophils deposit in accordance with the ballistic deposition model. This random adsorption model differs from random sequential adsorption (RSA) in that the cells arriving at the surface are able to roll along cells previously adsorbed introducing the notion of gravitational attraction of cells. The preliminary results obtained with stimulated PMN do not allow to choose between one of this two deposition models. Nevertheless, the qualitative and quantitative effects of FMLP on neutrophils were demonstrated by modifications of adhesion molecules expression.

Antigens, CD↗
PubMed1999

Occurrence of withdrawal in critically ill sedated children.

OBJECTIVES: To record the number of children with withdrawal symptoms after the administration of sedatives for mechanical ventilation, and to discuss the possible connection with the administration of midazolam. DESIGN: Retrospective data collection from case records and charts. SETTING: Medical and surgical intensive care unit (ICU) in a university hospital. PATIENTS: Children 6 months to 14 yrs of age who required sedation for mechanical ventilation (n = 40). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Kind and amount of sedatives and analgesics, duration of administration, and occurrence of withdrawal symptoms. The frequency of withdrawal symptoms was 35% (14/40) of the sedated children. A total dose of midazolam of >60 mg/kg was strongly significantly associated with occurrence of withdrawal. Statistical analysis to determine the occurrence of withdrawal associated with the administration of morphine was not possible. CONCLUSIONS: Signs and symptoms of a withdrawal reaction were observed in several children. The occurrence of withdrawal was statistically related to high doses of midazolam, but it was not possible to determine the influence of morphine. If large doses of midazolam and opioids have been administered, there may be justification for reducing the dose gradually instead of abruptly, or using longer-acting benzodiazepines or opioids on discontinuation of sedation.

Adolescent↗
PubMed1999

Modelisation of leukocyte adhesion on a fibrinogen coated surface in static conditions.

The adhesion of polymorphonuclear leukocytes (PMNs) on the vascular endothelium is a complex process that occurs during biological and pathological events and involves a large family of molecules. This phenomenom could be approached by a modelisation study of the adhesion of PMNs on a biological substrate, fibrinogen. Two different physiological conditions were tested such as the activated state of PMNs with a synthetic pro-inflammatory activator (N-Formyl-Methionyl-Leucyl-Phenylalanine, FMLP). The activated state of PMNs was both quantified by flow cytometry and controlled by fluorescence microscopy. The results suggest that quiescent PMNs deposit in accordance with the ballistic deposition model. The preliminary results obtained with FMLP-stimulated PMNs show a different deposit process compared to quiescent PMNs but do not allow to determine exactly a deposition model.

Activated-Leukocyte Cell Adhesion Molecule↗
PubMed1997

[Sedation of children on respirators. A questionnaire study on therapeutic strategies and withdrawal problems].

The purpose of this study was to identify the patterns of use of sedative agents and withdrawal problems in the paediatric intensive care unit (PICU). A questionnaire survey was mailed to 46 Danish intensive care units. Only 24 of these treated paediatric patients needing mechanical ventilation. The agents most frequently employed were morphine and midazolam. There was general satisfaction with the used drugs. The majority of departments noted that there was no protocol for sedation in their PICU. The majority of departments (70.8%) did not consider drug withdrawal to be a problem, but those departments who treated most children considered drug withdrawal to be a problem.

Analgesics, Opioid↗
PubMed1997

[Nitric oxide treatment of children with impairment of oxygenation].

It is well-known that inhaled nitric oxide improves the perfusion of ventilated regions, thus reducing intrapulmonary shunting and improving arterial oxygenation. However, most cases describe treatment of neonates and adults, only few studies describe effects of inhaled nitric oxide in children with severe impairment of oxygenation. Four cases of severe hypoxaemic respiratory failure in children treated successfully with inhaled nitric oxide are described.

Administration, Inhalation↗
PubMed1997

Indications for surgical management of genitourinary tuberculosis.

The incidence of tuberculosis has risen in many parts of the world, and more attention is being focused on genitourinary tuberculosis (GT), the second most common extrathoracic form of tuberculosis. Although chemotherapy is the mainstay of treatment, ablative surgery as a first-line management may be unavoidable for sepsis or abscesses. In cases with hydronephrosis and progressive renal insufficiency caused by obstruction, renal drainage (by stenting or nephrostomy) must be performed immediately. In all other situations triple-drug chemotherapy should be undertaken for at least 6 months and stable conversion obtained before ablative or reconstructive surgery is planned. Nephrectomy or partial nephrectomy is indicated for nonfunctioning or poorly functioning kidneys, particularly if continuous flank pain or hypertension is present. Stenosis of the ureter usually can be managed by temporary stenting and adjuvant corticosteroid therapy. Today the indications for augmentation are rare, but bladder replacement may be combined with ureter replacement using segments of intestine.

Adolescent↗
PubMed1997

[Diagnosis and therapy of kidney traumas].

A dynamic helical CT scan following initial ultrasound provides reliable radiological staging for kidney traumas and immediate diagnosis of most abdominal injuries. It also proves useful for pediatric traumas. Using mainly CT data we apply a classification system proposed by the American Association for Surgery of Trauma (grade I-V). The diagnostic steps and subsequent management are demonstrated by flow-chart. Most renal traumas may be treated conservatively but persistent bleeding or persistent urinary extravasation may necessitate surgical intervention. In cases of exploration of the kidney, the use of fibrin adhesive, alloplastic mesh capsule and DJ stents enables the reconstruction of the kidney. Exploration of the renal injury should never be omitted if urgent laparotomy is indicated for associated injuries.

Adult↗
PubMed1997

A comparison of volume control and pressure-regulated volume control ventilation in acute respiratory failure.

BACKGROUND: The aim of this study was to test the hypothesis that a new mode of ventilation (pressure-regulated volume control; PRVC) is associated with improvements in respiratory mechanics and outcome when compared with conventional volume control (VC) ventilation in patients with acute respiratory failure. We conducted a randomised, prospective, open, cross over trial on 44 patients with acute respiratory failure in the general intensive care unit of a university hospital. After a stabilization period of 8 h, a cross over trial of 2 x 2 h was conducted. Apart from the PRVC/VC mode, ventilator settings were comparable. The following parameters were recorded for each patient: days on ventilator, failure in the assigned mode of ventilation (peak inspiratory pressure > 50 cmH2O) and survival. RESULTS: In the crossover trial, peak inspiratory pressure was significantly lower using PRVC than with VC (20 cmH2O vs 24 cmH2O, P < 0.0001). No other statistically significant differences were found. CONCLUSIONS: Peak inspiratory pressure was significantly lower during PRVC ventilation than during VC ventilation, and thus PRVC may be superior to VC in certain patients. However, in this small group of patients, we could not demonstrate that PRVC improved outcome.

Journal Article↗
PubMed1994

Ileal bladder augmentation combined with ileal ureter replacement in advanced urogenital tuberculosis.

We report a case of active tuberculosis associated with a right nonfunctioning kidney and nearly total loss of bladder capacity. Percutaneous nephrostomy and right nephroureterectomy were performed while the patient was undergoing triple drug therapy. Definitive surgical treatment consisted of ileal bladder augmentation and ileal ureter replacement. Normal urodynamics of the upper urinary tract and normal voiding with complete return of bladder capacity were achieved. Metabolic acidosis was treated successfully by sodium hydrogen carbonate.

Aged↗