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Biomedical subjects

P Steiner

Publications and source records attributed to P Steiner.

At least 19 recordsLinked to original sources

Identification of a Myc-dependent step during the formation of active G1 cyclin-cdk complexes.

Activation of conditional alleles of Myc can induce proliferation in quiescent cells. We now report that induction of Myc in density-arrested fibroblasts triggers rapid hyperphosphorylation of the retinoblastoma protein and activation of both cyclin D1- and cyclin E-associated kinase activities in the absence of significant changes in the amounts of cyclin-cdk complexes. Kinase activation by Myc is blocked by inhibitors of transcription and requires intact DNA binding and heterodimerization domains of Myc. Activation of cyclin E-cdk2 kinase in serum-starved cells occurs in two steps. The first is induced by Myc and involves the release of a 120 kDa cyclin E-cdk2 complex from a 250 kDa inactive complex that is present in starved cells. This is necessary, but not sufficient, to generate full kinase activity, as cdc25 phosphatase activity is limiting in the absence of external growth factors. In vivo cdc25 activity can be supplied by the addition of growth factors. In vitro recombinant cdc25a strongly activates the 120 kDa, but only poorly activates the 250 kDa cyclin E-cdk2 complex. Our data show that two distinct signals, one of which is supplied by Myc, are necessary for consecutive steps during growth factor-induced formation of active cyclin E-cdk2 complexes in G(o)-arrested rodent fibroblasts.

Animals

[Coronary arteries and coronary artery bypass in CT: options, limitations and perspectives].

Computed tomography examination of coronary arteries and aortocoronary bypass grafts would theoretically be a noninvasive alternative to the selective coronary angiography and could, therefore, potentially be used as a screening method for coronary heart diseases. Especially since the introduction of fast and ultrafast CT-methods (spiral-CT and electron beam-CT) many investigations have focused on this subject. On the basis of our own work as well as the experience of other authors, this article summarizes the options, limitations, and clinical relevance as well as the future perspectives of modern computed tomography techniques for the visualization of coronary arteries, coronary artery calcifications, myocardial perfusion, and aortocoronary bypass patency.

Coronary Angiography

[Magnetic resonance tomography diagnosis of plexiform fibrohistiocytic tumor].

A case report on a 30-year old female patient who underwent resection of a haemangiopericytoma followed by radiation therapy in 1988 is presented. 6 months ago a space-occupying lesion was detected within the radiation field, which was classified as a plexiform fibrohistiocytic tumour (PFT). On MRI PFT showed the similar signal intensities as the muscles in T1, as well as T2-weighted images. After gadolinium-DTPA no enhancement within the tumour could be measured. Based on its exclusively dermal and subcutaneous location, and its signal behaviour uncommon for a malignant soft tissue mass, PFT must be included in differential diagnosis in any examining for local tumour recurrence.

Adult

Acute isoniazid neurotoxicity in an urban hospital.

OBJECTIVES: To describe the presentation and treatment of acute isoniazid (INH) neurotoxicity appearing at an inner-city municipal hospital. DESIGN: Case series. PARTICIPANTS: Seven patients (eight patient visits) with an age range of 5 days to 14.9 years. RESULTS: At our institution, no children appeared with acute INH neurotoxicity in the period 1985 through 1990, whereas seven patients were treated from 1991 through 1993. This paralleled the rise in the number of children with tuberculous infection and disease seen at our institution, from an average 96 per year to 213 per year during these two time periods. All seven patients were receiving INH daily for tuberculosis (TB) prophylaxis. Accidental ingestion (five episodes) and suicidal attempts (three episodes) accounted for these visits. The total amount ingested range from 14.3 to 99.3 mg/kg (mean, 54 mg/kg). All but one patient presented with afebrile seizures. One patient presented twice with seizures. Acute INH neurotoxicity was not suspected on the first admission; however, when readmitted 4 weeks later with another seizure, the diagnosis of acute INH neurotoxicity was made. INTERVENTION: Intravenous pyridoxine was used in five episodes. Because it was not a stocked item in our pediatric emergency cart (as well as at another hospital, necessitating a transfer of a patient with refractory seizures to our hospital), the average delay was 5.8 hours (range, 1.3 to 13 hours) before it was given. Two patients with refractory seizures failed to respond to anticonvulsants, and their seizures were controlled only after parenteral pyridoxine. CONCLUSIONS: We have seen an increased incidence of acute INH neurotoxicity because of the resurgence of TB in New York City. Others as well may see a similar rise based on local trends in TB infection and disease. Acute INH toxicity should be suspected in children presenting with seizures with or without fever. In patients with a known access to INH, seizures should be considered to be caused by INH toxicity unless proved otherwise. Parenteral pyridoxine, the specific antidote for INH-induced refractory seizures, should be readily available in every emergency department in the areas similarly experiencing increasing trends of TB.

Acute Disease

The role of assisted ventilation in survival after respiratory failure in children with AIDS.

OBJECTIVES: To determine the role of assisted ventilation in children with the acquired immunodeficiency syndrome and acute respiratory failure, and to identify any measurement or variable that predicted survival. DESIGN: Retrospective study. SETTING: Kings County (New York) Hospital Center, a tertiary-level inner-city municipal hospital. PARTICIPANTS: Twenty-three children with acquired immunodeficiency syndrome who were endotracheally intubated and mechanically ventilated because of acute respiratory failure. MEASUREMENTS/MAIN RESULTS: There were 24 episodes of acute respiratory failure, as one patient survived a first episode and died during the second episode 2 years later. We failed to identify any measurement or variable that predicted survival. During 12 episodes (50%), the patients survived and were weaned from the ventilator. CONCLUSIONS: Our findings indicate that a decision to avoid intubation and assisted ventilation in a child with acquired immunodeficiency syndrome and acute respiratory failure should not be made based merely on the presumption of a lethal outcome.

Acquired Immunodeficiency Syndrome

Experience with flexible fiberoptic bronchoscopy with bronchoalveolar lavage as a diagnostic tool in children with AIDS.

OBJECTIVE: To report our experience with flexible fiberoptic bronchoscopy with bronchoalveolar lavage in children with the acquired immunodeficiency syndrome and acute lower respiratory tract disease. DESIGN: Retrospective study. SETTING: Children's Medical Center of Brooklyn, NY, a tertiary-level inner-city hospital. PARTICIPANTS: Eighty-five children with acquired immunodeficiency syndrome and acute lower respiratory tract disease. INTERVENTION: One hundred five flexible fiberoptic bronchoscopies with bronchoalveolar lavages. MEASUREMENTS/MAIN RESULTS: Infective agents were recovered in 88 procedures (84%). Potentially pathogenic bacteria were identified in 56 (56.6%) of 99 procedures. Viruses were found in 28 (29%) of 96 lavages, and fungi in 37 (41.6%) of 89 specimens. Pneumocystis carinii was identified in 22 (22.2%) of 99 specimens. Mycobacteria were isolated from 14 (14%) of 100 specimens. A serious complication occurred in only one procedure (0.95%). CONCLUSION: Flexible fiberoptic bronchoscopy with bronchoalveolar lavage is a safe and effective diagnostic procedure that identified infective agents in 80% of children with acquired immunodeficiency syndrome and concomitant acute lower respiratory tract disease.

Acquired Immunodeficiency Syndrome

Gastric lavage is better than bronchoalveolar lavage for isolation of Mycobacterium tuberculosis in childhood pulmonary tuberculosis.

We compared the sensitivity of gastric lavage (GL) with bronchoalveolar lavage (BAL) for isolating Mycobacterium tuberculosis (Mtb) from 20 children with a presumptive diagnosis of primary pulmonary tuberculosis. GL was performed on three consecutive mornings after an overnight fast. BAL was performed on the same day as the last GL. Specimens were submitted for smears and culture for Mtb. None of the acid-fast stained smears was positive. Cultures of BAL fluid on 2 patients (2 of 20 or 10%) were positive for Mtb. Cultures of the gastric aspirates from the same 2 patients were also positive for Mtb. Eight additional patients had positive GL cultures with negative BAL cultures, resulting in a total of 10 of 20 (50%) patients with positive GL cultures for Mtb. The results of our study indicate that GL done on three consecutive days is better than BAL for the bacteriologic diagnosis of childhood pulmonary tuberculosis.

Bronchoalveolar Lavage Fluid

Patients with dementia involving families to maximize nursing care.

Incorporating family members in the care of patients with dementia provided pertinent psychosocial data, led to mutual decision-making regarding care, and produced changes in the responses of the residents with dementia, as well as in the family and nursing staff. The experimental group experienced increases in psychosocial nursing diagnoses with planning and interventions to meet the problems, more extensive problem description, and an active focus on interaction and change in the nurse's notes. As a result of collaborative nursing and family involvement, personal articles were brought from home; family collateral visits and interaction increased; families were more involved in the unit, medical center, and support groups; and p.r.n. medication use was decreased. As health-care technology prolongs the life of patients with chronic illness and sequelae such as dementia, nurses will need to continue to include families as collaborators in providing quality care.

Aged

Detection of Bordetella pertussis associated with the alveolar macrophages of children with human immunodeficiency virus infection.

In humans, infection with Bordetella pertussis is considered to be localized to an epithelial surface. However, an intracellular state in cultured cells and in the macrophages of infected animals has been shown. By using indirect immunofluorescence with a monoclonal antibody, it was found that 3 of 20 bronchoalveolar lavage specimens from children with human immunodeficiency virus infection had B. pertussis associated with pulmonary alveolar macrophages. None of the cultures from the patients grew B. pertussis. The B. pertussis appeared to be intracellular.

Bordetella pertussis

Interleukin-1 beta and tumor necrosis factor-alpha synergistically stimulate nerve growth factor synthesis in rat mesangial cells.

Recent evidence indicates that cytokines are potent inducers of nerve growth factor (NGF) expression both in peripheral tissues and the central nervous system and that NGF, in addition to its neurotrophic action, also acts as an immunoregulatory agent. It was of interest to investigate whether inflammatory cytokines affect NGF production in renal mesangial cells, which play a crucial role in the modulation of the local immune function in the glomerulus. Our results show that the simultaneous addition of interleukin-1 beta (IL-1 beta) and tumor necrosis factor-alpha (TNF-alpha) elicited a marked (13-fold) increase of NGF protein released by cultured rat glomerular mesangial cells within 24 h, whereas IL-1 alpha in combination with TNF-alpha, as well as the cytokines alone, did not promote the synthesis of NGF. The synergistic effect was dose dependent (maximal at 1 nM) and due to enhanced gene expression, since the cytokine treatment caused a fivefold increase in NGF mRNA after 8 h. Stimulation of NGF synthesis was abolished by mepacrine and dexamethasone, indicating that phospholipase A2 may be involved in NGF regulation. Moreover, pretreatment of the cells with the lipoxygenase inhibitor nordihydroguaiaretic acid (NDGA) abolished induction of NGF by cytokines; in contrast, the specific cyclooxygenase inhibitors indomethacin and diclofenac failed to modify NGF production. These data suggest that a lipoxygenase metabolite produced in response to IL-1 beta and TNF-alpha acts as a mediator in NGF gene expression. In conclusion, these findings support a model in which a cytokine cascade including NGF may play an important role in the pathophysiology of inflammatory renal diseases.

Alkaloids

Childhood asthma mortality: the Brooklyn experience and a brief review.

Pediatric asthma mortality is a perplexing and increasingly serious problem. Although many possible etiologic factors have been suggested, clear relationships are yet to be delineated. In addition to reviewing the literature, we studied the clinical and pathologic features of 14 local pediatric asthma deaths that occurred over a 7-year period. Thirteen of 14 children were African-American. Nine of 14 children (64.3) were older than 10 years of age, and 11 of 14 (78.6) were males. Based on a history of clinical features, 10 of the 14 children were characterized as severe asthmatics. Despite the fact that the majority of the children were regarded as severe asthmatics, only 1 of 14 had been evaluated with pulmonary function testing, and only 2 of 14 were receiving corticosteroids. Furthermore, only 2 of 14 were regarded as having good medical follow-up for their asthma. Ten of 14 children died suddenly secondary to asthma. One child was possibly abusing sympathomimetic inhalers, and none had evidence of toxic serum levels of theophylline. Six of 14 children (all adolescents) who died suddenly were negative on urine toxicology screening for cocaine, heroin, etc. Pathologic findings available for 10 children revealed mainly mucus plugging of the airways and collapse of various segments of the lungs, as well as pneumonia and pneumothorax in one child. In this group of children with sudden deaths (except for one child with pneumothorax), no other cause of death could be found.

Adolescent