Power suction via biopsy channel: a new, more effective technique.
Explore the source record for details and available documents.
Biomedical subjects
Publications and source records attributed to R I Goldberg.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
A novel globo-series disialoganglioside, disialosyl galactosyl globoside (Structure 1 below), defined by new monoclonal antibody (mAb) RM2, was isolated and characterized as having terminal structure identical to that of ganglio-series ganglioside GD1 alpha (Structure 2) and a common mucin-type epitope (Structure 3) widely distributed in glycoproteins such as glycophorin A. While these three structures share a common nonreducing tetrasaccharide terminus, mAb RM2 showed strong specific reactivity only with Structure 1, not with Structures 2 or 3. Another mAb, QSH2, reacted strongly with Structure 3 but did not cross-react with Structures 1 or 2. Conformational molecular models based on minimum energy hard sphere exoanomeric calculations suggest that Structure 1 presents a unique surface topology distinct from that of Structures 2 or 3. Our findings suggest the novel concept that reactivity of a common carbohydrate epitope with different antibodies or ligands is highly dependent on the type of carrier glycosylceramide or carrier O-linked peptide. [formula: see text]
We previously proposed specific interaction of Le(x) (Gal beta 1-->4 [Fuc alpha 1-->3]-GlcNAc beta 1-->3Gal) with Le(x) as a basis of cell adhesion in pre-implantation embryos and in aggregation of F9 teratocarcinoma cells, based on several lines of evidence (Eggens et al., J. Biol Chem (1989) 264:9476-9484). We now present additional evidence for this concept, based on autoaggregation studies of plastic beads coated with glycosphingolipids (GSLs) bearing Le(x) or other epitopes, and affinity chromatography on Le(x)-columns of multivalent lactofucopentaose III (Le(x) oligosaccharide) conjugated with lysyllysine. Comparative adhesion studies of Le(x)-expressing tumour cells vs their Le(x)-non-expressing variants showed that only Le(x)-expressing cells adhere to Le(x)-coated plates and are involved in tumour cell aggregation, in analogy to F9 cell aggregation. The major carrier of Le(x) determinant in F9 cells is not GSL but rather polylactosaminoglycan ('embryoglycan'), and we demonstrated autoaggregation of purified embryoglycan in the presence of Ca2+, and reversible dissociation in the absence of Ca2+ (addition of EDTA). Defucosylated embryoglycan did not show autoaggregation under the same conditions. Thus, Le(x)-Le(x) interaction has been demonstrated on a lactosaminoglycan basis as well as a GSL basis. A molecular model of Le(x)-Le(x) interaction based on minimum energy conformation with involvement of Ca2+ is presented.
Pancreatitis is a major cause of morbidity and mortality secondary to endoscopic retrograde pancreatography (ERP). One factor that may cause post-ERP pancreatitis is the type of contrast media utilized during the procedure. The purpose of this prospective, double-blind, randomized study was to evaluate the effects of three contrast agents of differing osmolality and ionicity on changes between pre- and post-ERP chemical changes in serum amylase and lipase and development of clinical symptoms of acute pancreatitis. Our study of 53 patients showed that those who received Omnipaque a non-ionic, relatively iso-osmolar contrast agent, had a significantly lower serum amylase (p = 0.0038) and serum lipase (p = 0.0002) in post-ERP serological markers, compared with patients who received the ionic agents, Hypaque meglumine 60% or Hexabrix. In addition, the development of clinical symptoms of pancreatitis was less in patients who received Omnipaque than in those who received Hexabrix or Hypaque (1 vs. 3 vs. 4). No significant difference was found between patients who received ionic agents. No patient who received Omnipaque needed hospitalization, whereas one (6%) patient who received Hexabrix was hospitalized compared to three (20%) hospitalized patients who received Hypaque. When the initial cost and cost of hospitalization were compared, the non-ionic contrast medium was also found to be more cost-effective for the patient. In summary, the risk of post-ERP acute pancreatitis was significantly lower for patients who received the non-ionic contrast agent than for those who received the ionic agents.
Percutaneous endoscopic gastrostomy (PEG) is now a well-established technique for providing long-term enteral feeding. The procedure is being increasingly utilized and, although generally well tolerated, it may be associated with complications. We report two patients in whom a replacement Foley balloon tip catheter migrated into the small bowel and caused obstruction. The diagnosis, management, and preventive measures of tube migration are discussed.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
We studied the binding and biological activities of gold-insulin complexes to develop a complex with properties identical to native insulin. Stabilizing amounts of insulin absorbed to 5-, 10-, or 15-nm gold particles resulted in complexes with 40-327 insulin molecules per gold particle and 4-111 times the biological activity of unlabeled insulin, based on the molar concentration of gold complex. These data suggested that these complexes behaved as multivalent ligands. Gold-insulin complexes were prepared with 5% of the stabilizing insulin concentration and were stabilized with bovine serum albumin. This resulted in a complex with 5-7 insulin molecules per 10-nm gold particle, which stimulated glucose oxidation in rat adipocytes and competed with [125I]-insulin for binding to the insulin receptor identically to unlabeled insulin on an equimolar basis. The organization and distribution of insulin receptors occupied by this monovalent-behaving gold-insulin complex were virtually identical to previous observations using monomeric ferritin-insulin. Since multivalent ligands may affect receptor binding, re-distribution, and intracellular processing, the use of electron-dense probes that resemble the unlabeled ligand in biological and binding properties is appropriate when studying receptor dynamics of in vivo or in vitro biological systems. The gold-insulin complex developed in this study should serve this function.
Rapid solid phase gastric emptying (SPGE) resulting in decreased satiety is postulated to be a contributing factor to obesity. Twenty-six morbidly obese patients with a weight range of 189-523 lb were entered into the Garren-Edwards gastric bubble program. SPGE studies were performed pre-bubble implantation and repeated within 2 wk after bubble implant. There was no significant difference between study patients pre-bubble insertion emptying time and the normal population curve. Emptying time was found to be significantly increased, post-bubble implant, compared with pre-bubble implant over five time periods of testing. The Garren-Edwards gastric bubble has been used as a method for inducing early satiety for the morbidly obese patient. It has been postulated that delay of SPGE would be associated with satiety. Our patients experienced satiety despite their more rapid SPGE. Thus, the satiety which was experienced by our subjects was not on the basis of delayed SPGE, as previously thought.
A retrospective review of endoscopic procedures using the Nd-YAG laser was carried out for patients treated between September 1984 and November 1986. Two hundred twenty two procedures were performed on 104 patients (58M:46W) during this 26 month period. The study encompasses a unique period of time in this center, as it includes the initial use of the endoscopic laser technique, the learning curves associated with its application, and finally, the time when its use became routine. Treatment of tumors was the indication in 47 per cent of the cases. Gastrointestinal bleeding of benign cause was the indication in nearly half of the patients; arteriovenous malformations were the most common causes of bleeding. Laser photocoagulation of hemorrhoids was performed in 11 cases. Upper endoscopy was the route in 33 per cent of procedures. Anoscopy, flexible sigmoidoscopy, and colonoscopy were the routes in the remainder. The time spent on the procedure and the energy delivered were found to be variables of the type of lesion and the endoscopic route. Nd-YAG laser endoscopy can be used safely and effectively for a variety of bleeding and obstructive gastrointestinal conditions. Appropriate certification for granting of privileges to laser endoscopists is of utmost importance.
Age has been assumed to be an independent risk factor in patients undergoing colonoscopy. However, this has never been specifically studied. We evaluated 302 patients 65 yr old or older, to determine the incidence of complications. We found that the risk is comparable to that of the heterogeneous patient population previously reported, except for a slightly increased incidence of delayed bleeding subsequent to polypectomy. In addition, the presence of cardiac, pulmonary, liver, or kidney disease was not found to be associated with an increased incidence of complications. Neither was there an increased risk of complications in patients undergoing colonoscopy, who had previously undergone abdominal or pelvic surgery. In summary, older patients experience the same risks as younger patients, except for post-polypectomy delayed bleeding, which may be related to atherosclerosis of the blood vessels, and appears to be more common in elderly patients.
Explore the source record for details and available documents.