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Biomedical subjects

P Kaufmann

Publications and source records attributed to P Kaufmann.

At least 145 records · Page 8Linked to original sources
PubMed1994

Differential lectin binding to the fibrinoid of human full-term placenta: correlation with a fibrin antibody and the PAF-Halmi method.

Placental fibrinoid is thought to contain various glycoproteins originating from cell secretion and tissue degeneration, occasionally merged with fibrin. Information on the characteristics and derivation of the various fibrinoid components, however, is still fragmentary. Therefore, the present histochemical study on acetone-fixed placental tissue sections compared the staining pattern of FITC-conjugated lectins from Ulex europaeus (UEA-I), Bandeiraea simplicifolia (BS-I) and Lycopersicon esculentum (LEA) with the reactivity of a fibrin antibody and a modified paraldehyde-fuchsin stain. Using different color reactions, the latter histological method identified two types of fibrinoid, which correlated well with fibrin-type and matrix-type fibrinoid. Immunohistochemically, fibrin was detected at the intervillous border of the basal plate, in some inner parts and in perivillous fibrinoid. UEA-I bound to endothelial cells and partially to fibrin-type fibrinoid of villi and the basal plate, thus indicating a reaction with immured and disintegrated remnants of endothelial and blood cells. LEA stained fibrin-negative (i.e. matrix-type) fibrinoid homogeneously within the basal plate; the small reactive areas within the perivillous fibrinoid may belong to degenerating trophoblastic residues, because in villi LEA specifically reacted with the syncytiotrophoblast. BS-I heterogeneously labeled matrix-type fibrinoid deposits in the basal plate which surrounded decidual cells and subpopulations of extravillous trophoblast. In cell islands, BS-I also stained fibrinoid surrounding trophoblast cells heterogeneously. The data (1) confirm the existence of two types of placental fibrinoid, fibrin-type and matrix-type fibrinoid, (2) suggest that both types of fibrinoid contain different glycoconjugates, and (3) demonstrate the practical usefulness of the modified paraldehyde-fuchsin method for the identification of the two types of fibrinoid.

Endothelium, Vascular↗
PubMed1994

Autoantibodies to oxidized low density lipoproteins in restenosis following coronary angioplasty.

Oxidized low density lipoproteins (oLDL) play an important role in the pathogenesis of atherosclerosis. Recently, elevated oLDL autoantibodies in serum were shown in patients with severe peripheral atherosclerosis. To evaluate their role in restenosis after percutaneous transluminal coronary angioplasty (PTCA), oLDL autoantibodies were determined in a randomly selected series of 48 males following successful PTCA. Follow-up angiography as well as blood sampling were done 12 months after PTCA; restenosis was defined as > or = 50% reduction in diameter of the coronary artery. Twenty-six patients (mean age: 56 years) showed restenosis (Restenosis Group), whereas 22 (mean age: 53 years) had open vessels (Patent Vessel Group). Both groups did not differ in age, past medical history, fibrinogen and lipid profile as well as in initial angiographic findings. Oxidized LDL autoantibodies were 13 +/- 21 U in the Restenosis Group and 6 +/- 4 U in the Patent Vessel Group, showing no significant difference. Six of 26 patients in the Restenosis Group and 3 of 22 in the Patent Vessel Group (NS) had elevated oLDL autoantibody levels (> or = 10 U). Thus, although there is a trend to elevated oLDL autoantibodies in males with restenosis of coronary arteries, oLDL cannot serve as a strong marker for stenosis following PTCA.

Adult↗
PubMed1994

[Ketoacidotic diabetic metabolic dysregulation: pathophysiology, clinical aspects, diagnosis and therapy].

When glucose utilisation is impaired due to decreased insulin effect, ketones are produced by the liver from free fatty acids to supply an alternate source of energy. This adaptation may be associated with severe metabolic acidosis and tends to occur in patients with type I (insulin-dependent) diabetes mellitus. In addition, hypovolemia is an almost invariable finding with marked hypoglycemia and is primarily induced by the associated glucosuria. Ketoacidosis stimulates both the central and peripheral chemoreceptors controlling respiration, resulting in alveolar hyperventilation (Kussmaul's respiration). With the ensuing fall in pCO2 the patient tries to raise the extracellular pH. A fruity odor of acetone on the patient's breath sometimes suggests that ketoacidosis is present. The classical triad of symptoms associated with hyperglycemia are polyuria, polydipsia, and weight loss. Circulatory insufficiency with hypotension is not uncommon due to the marked fluid loss and acidemia. In more severely affected patients, neurologic abnormalities may be seen, including lethargy, seizures or coma. Some patients also have marked vomiting and abdominal pain. The history and physical examination may provide important clues to the presence of uncontrolled diabetes mellitus. Once suspected, the diagnosis can be easily confirmed by measuring the plasma glucose concentration. Glucosuria and ketonuria can be semiquantitatively detected with reagent sticks. Blood gas analysis and anion gap give objective information as to the severity of the metabolic acidosis. Therapy must be directed toward each of the metabolic disturbances: hyperosmolality, ketoacidosis, hypovolemia and potassium, and phosphate depletion. The mainstays of therapy are the administration of low-dose insulin and volume repletion.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Glucose↗
PubMed1993

[Coronary artery size in chronic mitral valve insufficiency before and following mitral valve surgery].

The increase of coronary artery size in myocardial hypertrophy represents an adaptive mechanism to keep coronary blood flow normal. The relationship between coronary cross-sectional area and left ventricular muscle mass was determined angiographically in 10 patients with severe mitral regurgitation before and 28 +/- 15 months after successful mitral valve surgery. 10 subjects with atypical chest pain without coronary artery disease served as controls (C). Left ventricular muscle mass was increased preoperatively in mitral regurgitation (257 g vs C = 129 g; p < 0.001) and decreased postoperatively (205 g; p < 0.01 vs preop. and vs C). The cross-sectional area of the left coronary (= left anterior descending+left circumflex) artery was augmented preoperatively (26.5 vs C = 14.0 mm2; p < 0.001) and decreased postoperatively (22.9 mm2; p < 0.05 vs preop. and vs C). The cross-sectional area of the left coronary artery per 100 g LV muscle mass was not different in the three groups. The cross-sectional area of the right coronary artery was also increased before surgery (12.7 vs C = 8.8 mm2; p < 0.05) and decreased postoperatively (11.3 mm2; p < 0.05 vs preop. ns vs C). Our data show that in mitral regurgitation the size of the left coronary artery increases proportionally to the increase in left ventricular muscle mass. Also, the right coronary artery shows slight enlargement which is probably due to the pressure overload of the right ventricle. After surgery there is regression but not normalization of the size of the coronary arteries.

Chronic Disease↗
PubMed1993

Aortic dissection due to discontinuation of beta-blocker therapy.

beta-Blockers are known to protect a vulnerable aorta from acute dissection, as well as reducing the risk of recurrent dissection. This case presentation reports the history of a 60-year-old male suffering from acute aortic dissection following discontinuation of beta-blocker therapy. The patient has shown arterial hypertension for about 20 years treated solely by beta-blockers. Two days after stopping the use of metoprolol, a nonselective beta 1-blocker without ISA, the patient developed severe chest pain during exercise. Diagnosis of type I-aortic dissection according to DeBakey was achieved by transthoracal echocardiography and computed tomography. Successful surgery by replacement of the ascending aorta was performed about 1 h following admission to the intensive care unit. During the procedure, tamponade of the left ventricle occurred followed by cardiogenic shock. Postoperative management was complicated by prolonged respiratory therapy and acute gastrointestinal bleeding; 1-year follow-up showed no evidence of disease. Thus, in this case acute dissection may be the consequence of discontinuing the use of metoprolol, possibly due to uncontrolled hypertension or specific response to the beta-blocker.

Aortic Dissection↗
PubMed1993

Differentiation and proliferation patterns in human trophoblast revealed by c-erbB-2 oncogene product and EGF-R.

It is well known that growth factors and proto-oncogenes play a pivotal role in organogenesis as well as in tumor development. The human placenta is a rapidly growing organ which shares some aspects with malignant tumors. We have studied the expression of epidermal growth factor receptor (EGF-R) and the receptor encoded by the c-erbB-2 proto-oncogene in first- and third-trimester human placentas. We compared these expression patterns with that of the proliferation marker Ki-67. By immunohistochemistry, EGF-R was intensively expressed in the villous cytotrophoblast in the first trimester. The apical plasma membrane of the syncytium was weakly stained. In placental villi from the third trimester the reaction product for EGF-R was most intense in single villous cytotrophoblastic cells and along the apical plasma membrane of the syncytium, whereas the basal plasma membrane was much less stained. C-erbB-2 protein product was expressed in the first and third trimesters along the apical membrane of the syncytiotrophoblast. Concerning the extravillous trophoblast in cell islands and cell columns, EGF-R was expressed in the cells proximal to the villous stroma whereas the distal cells were c-erbB-2 positive. The Ki-67 antibody revealed the proliferative character of the villous cytotrophoblast and of the EGF-R-positive extravillous trophoblast. In contrast, most of the c-erbB-2-positive cells were Ki-67 negative. By in situ hybridization, c-erbB-2 transcripts were found in all types of villous and extravillous trophoblast, including those that did not express c-erbB-2 protein product. Our data indicate that EGF-R expression is strongly related to the proliferative trophoblast and, with advancing pregnancy, to the differentiated villous trophoblast.off contrast, expression of c-erB-2 protein product occurs only in more advanced stages of trophoblast differentiation, although transcripts of c-erbB-2 are found in both proliferative and differentiated trophoblast. In addition, the coexpression of EGF-R and c-erbB-2 protein product in the syncytiotrophoblast suggests their involvement in complex regulation of hormones and growth factors.

Cell Division↗
PubMed1992

Effect of aortic valve stenosis (pressure overload) and regurgitation (volume overload) on left ventricular systolic and diastolic function.

In secondary hypertrophy from chronic pressure or volume overload, or both, systolic as well as diastolic abnormalities of left ventricular (LV) function have been described, but their relation has not been defined. In 58 patients with aortic valve disease (28 with aortic valve stenosis, and 30 with aortic regurgitation) and in 11 control subjects, LV biplane cineangiography was performed simultaneously with LV high-fidelity pressure measurements. LV ejection performance was assessed by ejection fraction, and diastolic function by the time constant of LV pressure decay, the early and late peak filling rates, and the constants of chamber (pressure-volume relation) and myocardial stiffness (stress-strain relation). In the entire cohort (n = 69), ejection fraction was inversely related to the time constant of LV relaxation (r = -0.58, p less than 0.001) and to the constant of myocardial stiffness (r = -0.62, p less than 0.001). Despite preserved systolic contractile function (as evaluated from the ejection fraction-mean systolic stress relation), abnormalities in LV diastolic function were present in 9 of 18 patients with pressure overload and 20 of 22 with volume overload. None of the 58 patients with aortic valve disease had a reduced early peak filling rate, whereas a reduction in late peak filling rate was observed in 3 with aortic stenosis, but in none with aortic regurgitation. This, it appears that abnormalities of relaxation and passive diastolic myocardial stiffness precede alterations in myocardial contractility. Assessment of peak filling rates is not helpful to detect diastolic dysfunction in patients with aortic valve disease.

Adolescent↗
PubMed1991

The human placenta: a model for tenascin expression.

Tenascin is a large glycoprotein of the extracellular matrix. Previous reports have demonstrated that it is associated with epithelial-mesenchymal interfaces and is expressed during embryonic and tumour development, wound healing, cell proliferation and it may be involved in immunomodulation. The human placenta shows numerous features related to these aspects. We have investigated the presence of tenascin in the human placenta throughout pregnancy by immunohistochemistry. We used monoclonal (mAb) and polyclonal (pAb) antibodies to tenascin, a mAb to fibrin, a pAb to fibrinogen, and the mAb Ki-67 as proliferation marker. Tenascin was highly expressed in the mesenchymal villi which are considered the basis of growth and differentiation of the villous trees. Moreover, fibrinoid deposits at the surfaces of the villous trees were always separated from the fetal stroma by tenascin. The stroma of villi encased in fibrinoid was also positive for tenascin. This glycoprotein was also expressed in the villous stroma directly apposed to cell islands and cell columns. In the proximal portions of both epithelial structures, cytotrophoblast was Ki-67 positive. These data show that tenascin is expressed during the development of the placenta, particularly in the mesenchymal villi, cell islands and cell columns. These structures are considered to be the proliferating units of the villous trees. Tenascin underlying fibrinoid deposits suggests that it also participates in repair mechanisms. Thus, in the human placenta tenascin expression can be correlated with villous growth, cell proliferation, and fibrinoid deposition. Its role in immunoprotection of fetal tissues in areas where syncytiotrophoblast as barrier is missing or damaged is discussed.

Cell Adhesion Molecules, Neuronal↗
PubMed1991

[Special problems of nutrition therapy in patients with terminal kidney insufficiency with chronic ambulatory hemodialysis].

The treatment of end-stage chronic renal failure with intermittent ambulatory hemodialysis induces additional catabolic stimulus. Thus, the protein requirements of maintainance hemodialysis patients with 1.2 to 1.4 g/kg/day are higher than in the predialysis state. An energy intake of 35 to 38 kcal/kg/day contributes to an optimal anabolic utilization of incorporated protein. The catabolic response in case of complications or stress situations demands supplementation of nutrients.

Dietary Proteins↗
PubMed1991

[Clinical experiences with Wegener's granulomatosis from the nephrologic viewpoint].

Immunosuppressive treatment with cyclophosphamide and prednisolone has markedly improved the prognosis of Wegener's granulomatosis (WG). In patients with WG the detection of anti-neutrophil-cytoplasmic autoantibodies (ANCA or ACPA) has become an important parameter to confirm or even routinely establish the diagnosis of WG over the past few years. From 1985 to 1990 we observed and treated 12 patients (5 males and 7 females) aged 14-64 years (mean 41.1 years) with WG. In the same time span an analysis of 35 patients with rapidly progressive glomerulonephritis showed that the octiology was idiopathic in the majority of cases (54.3%), but nevertheless 8 cases (22.8%) were caused by WG. In 9 out of 10 cases the ANCA test was positive; whereas in 8 out of 10 cases we found a close correlation between the serum level of ANCA and disease activity. However, extraordinarily high serum levels (titres up to 1:2560) were recorded in one patient with WG without any clinical symptoms, whilst another patient with severe symptoms of WG showed a titre of only 1:5. 10 out of 12 patients were successfully brought to remission under cyclophosphamide-cortisone treatment. 4 out of 10 patients with renal insufficiency have been retained on the chronic haemodialysis regimen. 2 patients, aged 31 and 51 years, died within 2-5 months after the onset of clinical symptoms of WG.

Adolescent↗
PubMed1990

[Differential indications: parenteral-enteral nutrition in intensive care patients].

The number of patients admitted to the intensive care unit because of malabsorption is remarkably high. Therefore nutritional therapy plays an important role in the management of intensive care patients. At the beginning of nutritional support the extent of deficiency and severity of nutritional disturbances as well as estimated duration of impossibility for oral alimentation have to be set up. Furthermore advantages and disadvantages of parenteral and enteral nutrition have to be considered to avoid any possible complications.

Critical Care↗
PubMed1990

[Special problems of nutritional therapy in chronic kidney insufficiency in the pre-dialysis stage].

The main objectives of medical and nutritional management of patients with chronic renal failure are to slow down the progression of renal disease and to prevent secondary complications due to hypertension, uremic metabolic disturbances, and bone disease. The importance of nutritional measures for this purpose is increasingly recognized. In the setting of vitamin D and calcium deficiency secondary hyperparathyroidism and retention of phosphate result in renal osteodystrophy. An increase in dietary calcium and avoidance of foods rich in phosphate are important. In some patients supplementation of vitamin D3 may be necessary while calcium homeostasis is monitored during follow up. The dietary protein content can influence the severity of the uremic state. Normal or increased consumption of protein may accelerate the progression of renal disease due to the accumulation of nitrogenous products. In addition, uremia itself may cause loss of appetite and thus accumulation of endogenous nitrogen compounds as a result of protein catabolism. Protein restriction under such circumstances may cause malnutrition and an associated increase in morbidity and mortality. Thus, dietary management must consist of individually designed restriction of total protein intake with ingestion of high value protein. This allows balanced nitrogen metabolism with a reduction in circulating uremic toxins.

Calcium, Dietary↗
PubMed1990

Effect of long-term hypoxia on oxygen transport properties of blood in pregnant guinea pigs.

Pregnant guinea pigs undergoing long-term hypoxia were studied and the results compared with those of control animals (pregnant, but non-hypoxic). Hypoxic animals demonstrated a decrease of O2 affinity (-7%) and an increase of O2 capacity (+35%). In addition, the HCT was found to be higher in the hypoxic group (+41%), causing haemorheological disadvantages; in a shear model study the blood of hypoxic animals had to be exposed to the gas compartment of the rheo-oxymeter up to 62% longer than that of the control group. We have postulated, that this rheological impairement is compensated, since no abnormalities in number and abortion rate of fetuses (due to a possible O2 delivery impairment) were found. Our morphological studies in fact support this opinion, showing e.g. more capillary branchings and loops and a reduction of diffusion distances between maternal and fetal blood in hypoxic guinea pig placentae. The results emphasize the importance of more detailed rheological studies in connection with other investigations for a complete description of compensatory mechanisms.

Animals↗
PubMed1990

Alterations of the fetal capillary bed in the guinea pig placenta following long-term hypoxia.

Oxygen supply is an important regulator of the fetal placental capillarization. To determine the effects of long-term hypoxia on the fetal placental vessel arrangement pregnant guinea pigs were kept under hypoxic conditions (12% O2 for 45 days). Vessel casts showed a significant difference in branching and orientation of the vessels between the controls and the hypoxic animals. The hypoxic group had a less orientated capillary bed with increased branching and coiling. By light- and transmission electron microscopical studies, there was a decreased diffusion distance, a decreased diameter of the fetal capillaries, and an increased number of capillary cross-sections. These results are consistent with the hypothesis that chronic hypoxia is responsible for increased branching and coiling of the capillaries resulting in a dense network of short and narrow capillaries in the placenta.

Animals↗