Ultraviolet B and blood pressure.
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Adult↗
Biomedical subjects
R Krause
Publications and source records attributed to R Krause.
Decreased incidence of complications in parturients with the arrow (FlexTip Plus) epidural catheter.
PURPOSE: To compare the incidence of complications during placement of Arrow (FlexTip Plus) and Concord/Portex epidural catheters in parturients receiving continuous epidural analgesia. METHODS: Two hundred parturients requesting continuous epidural analgesia were prospectively and randomly assigned to receive either the Arrow (FlexTip Plus) or the Portex epidural catheter. The incidences of paresthesiae, inadvertent venous cannulation and inability to thread the catheter into the epidural space were recorded. RESULTS: A total of 222 attempts at epidural placement occurred in the parturients enrolled. The Arrow catheter displayed a lower incidence of paresthesiae (3/112 vs 39/110, P < 0.0001) and venous cannulation (0/112 vs 11/110, P = 0.0007) than did the Portex catheter. The Portex catheter demonstrated a tendency towards increased inability to be advanced into the epidural space (5/110 vs 0/112, P = 0.057) in comparison to the Arrow catheter. When a Portex catheter would not advance into the epidural space (n = 5), an Arrow catheter was threaded successfully in all five cases without the need to reposition the Tuohy needle. CONCLUSION: Compared with a less flexible catheter, the Arrow decreases the incidence of transient paresthesiae and inadvertent venous cannulation, while improving the ability to thread the catheter into the epidural space. Intravascular injection, transarachnoid migration, and the rare occurrence of epidural haematoma may be further reduced with the use of flexible, soft-tip catheters.
Adult↗
Analysis of Peg1/Mest imprinting in the mouse.
In the mouse, Peg1/Mest is widely expressed in mesoderm-derived tissues. In separate studies, it has been shown to be maternally imprinted, that is, only the paternally inherited allele is active in mice and in humans. Here, we provide evidence that Peg1/Mest is expressed at very low levels in all tissues of adult mice as assessed by RT-PCR. Moreover, by using species-specific polymorphisms in the Peg1/Mest sequence we can demonstrate that in adult mice the gene remains imprinted in all of these tissues.
Animals↗
H19 and Igf2 are expressed and differentially imprinted in neuroectoderm-derived cells in the mouse brain.
Igf2 and H19 are reciprocally imprinted genes that are closely linked and coexpressed in tissues of mesodermal and endodermal origin. Here we report that coexpression of these genes is also found in specific fetal tissues of neuroectodermal origin, that is in the ventral midline region of both the hindbrain and spinal cord. For cells of neuroectodermal origin, complete absence of Igf2 and H19 transcription was previously described. Analysis of allele-specific expression of both Igf2 and H19 in the ventral midline region of the hindbrain shows that H19 is expressed monoallelically, with the paternal allele being silent, whereas Igf2 is expressed biallelically. Furthermore, we observed a strong influence of the parental species background, in that the Mus musculus allele was always expressed at higher levels than the M. spretus allele. This was observed when the M. spretus allele was contributed by the mother or by the father. An analysis of Igf2 methylation by bisulphite genomic sequencing provided no clear answer as to whether Igf2 expression and methylation are linked in a tissue of neuroectodermal origin. Taken together, our results provide novel information on H19 and Igf2 expression and imprinting patterns in the fetal mouse brain. In addition, they indicate that some aspects of Igf2 regulation in cells of neuroectodermal origin do not follow the pattern that exists in mesoderm- and endoderm-derived tissues. Apart from the ventral midline region, H19 and Igf2 were found to be coexpressed in the ectodermally derived Rathke's pouch and in some circumventricular organs of the brain, such as the organum vasculosum of the lamina terminalis (OVLT) and the pineal gland.
Animals↗
Molecular cloning and characterization of murine Mpgc60, a gene predominantly expressed in the intestinal tract.
We have isolated from mouse intestine a full-length cDNA clone that encodes an 86-amino acid precursor protein containing a 26-amino acid signal sequence. As deduced from its sequence, the mature 60-aa protein named MPGC60 belongs to the Kazal type of secreted trypsin inhibitors. The MPGC60 peptide has 58% homology with the PEC-60 peptide isolated from pig intestine. In the gut of adult mice, an increasing rostrocaudal gradient in MPGC60 mRNA levels was observed by Northern analysis. In situ hybridization analysis demonstrated strong Mpgc60 expression in Paneth cells and in a subset of goblet cells in the differentiated gut. During postnatal differentiation of the gut, a strong increase in Mpgc60 expression was detected in both small and large intestine. However, in small intestine activation of the Mpgc60 gene occurred earlier than in the large intestine. Apart from the intestinal tract, MPGC60 mRNA was also detectable in the mesenchyme surrounding the uterine epithelium and in endothelia of some blood vessels. However, in contrast to the situation observed in pig, no Mpgc60 expression was detectable by Northern, in situ and reverse transcriptase polymerase chain reaction (RT-PCR) analysis in cells of the immune system, that is, in monocytes, macrophages, peripheral blood and in spleen. Northern blot analysis on mRNA isolated from porcine and murine intestine showed a single transcript in mouse, but several transcripts in pig. Southern blot and fluorescent in situ hybridisation (FISH) analysis demonstrated the presence of a single gene situated in band A of chromosome 4. This region is syntenic with human chromosome regions 6q, 8q and 9p. The gene responsible for human hereditary mixed polyposis syndrome has been localized to human 6q. This raises the possibility that Mpgc60 is a candidate gene for this human disorder.
Amino Acid Sequence↗
Population biology, evolution, and immunology of vaccination and vaccination programs.
The purpose of prophylactic vaccination is to reduce morbidity and mortality in a population. Many questions related to the design of vaccines and vaccination programs require a population standpoint for their sharp formulation and laboratory and field studies to understand their immunologic background. Practical suggestions of the workshop included increased studies of age-specific immunity, better immunoepidemiologic surveillance, better design of efficacy studies, and more systematic sampling of parasite strains to study the evolutionary pressure exerted by vaccines. Theoretical immunology has much to contribute. One of the realizations of the workshop was the value of a strong interdisciplinary approach in vaccine development, utilizing relevant contributions from immunology, population biology, mathematical modeling, epidemiology, molecular biology, and virology.
Animals↗
Triple versus dual therapy for eradicating Helicobacter pylori and preventing ulcer recurrence: a randomized, double-blind, multicenter study of lansoprazole, clarithromycin, and/or amoxicillin in different dosing regimens.
OBJECTIVE: The efficacy and safety of dual and triple therapies with a proton pump inhibitor and antibiotic(s) for therapy of Helicobacter pylori-associated duodenal ulcer disease have been compared using results from independent studies using different methods and regimens, making interpretation difficult. In a large, double-blind, multicenter study conducted in the United States, we compared a triple therapy regimen with four dual therapy and one monotherapy regimens in the eradication of H. pylori and the prevention of ulcer recurrence. METHODS: Patients with active duodenal ulcer disease or history of duodenal ulcer disease within the past year and H. pylori infection were randomized to receive one of six 14-day treatment regimens: lansoprazole 30 mg, clarithromycin 500 mg, and amoxicillin 1 gm b.i.d.; lansoprazole 30 mg b.id. and either clarithromycin 500 mg b.i.d. or t.i.d.; lansoprazole 30 mg b.i.d. or t.i.d. with amoxicillin 1 gm t.i.d.; or lansoprazole 30 mg t.i.d. alone. No additional acid suppression therapy followed eradication therapy. Primary efficacy endpoints were eradication of H. pylori and ulcer recurrence. RESULTS: Of 396 patients enrolled in the study, 352 met the entry criteria for duodenal ulcer status and H. pylori positivity. At 4-6 wk after the end of therapy, H. pylori was eradicated from 94% (44 of 47) of patients receiving lansoprazole, clarithromycin, and amoxicillin triple therapy, 77% (39 of 51) of those receiving lansoprazole t.i.d./amoxicillin t.i.d., 75% (36 of 48) of those receiving lansoprazole b.i.d./clarithromycin t.i.d., 57% (28 of 49) of those receiving lansoprazole b.i.d./clarithromycin b.i.d., 53% (26 of 49) of those receiving lansoprazole b.i.d./amoxicillin t.i.d., and 2% (1 of 53) of those receiving lansoprazole monotherapy (p < or = 0.05, triple therapy vs each dual therapy and each dual therapy vs monotherapy). Of those patients who were documented as free of ulcer at 4-6 wk after treatment, ulcers recurred within 6 months in 7% of patients receiving triple therapy, as compared with 13-23% of patients receiving dual therapy, and 69% of patients receiving lansoprazole monotherapy. Patients who were H. pylori negative at 4-6 wk after treatment were less likely to have an ulcer recurrence than were patients who were H. pylori positive (11% [10 of 95] vs 47% [20 of 43], respectively, across treatment groups). For triple therapy and dual therapy, a similar proportion of patients reported a drug-related adverse event (23% vs 17-33%, respectively). CONCLUSIONS: In patients with active or a recent history of duodenal ulcer, a 14-day course of lansoprazole-based triple therapy without additional acid suppression therapy is highly effective in the eradication of H. pylori and in preventing ulcer recurrence. Among the dual therapies, higher eradication rates occurred when lansoprazole (with amoxicillin) or clarithromycin (with lansoprazole) was administered t.i.d. vs b.i.d., but the rates were still significantly lower than with lansoprazole triple therapy with all three drugs administered b.i.d.
2-Pyridinylmethylsulfinylbenzimidazoles↗
The beetle Anthrenus verbasci causing proctitis and perianal itching.
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Animals↗
[Safe handling of the laryngeal mask airway in eye surgery].
BACKGROUND: We prospectively used the laryngeal mask airway (LM) in eye surgery to evaluate: 1) the limits of safe handling; 2) the feasibility of its use in long operative procedures, and 3) whether patients with higher anaesthetic risk (hypertension, asthma, children) may profit from the LM. METHODS: In 792 patients leak pressure, cuff volume, duration of anaesthesia, and complications were noted; 33 were children under 10 years of age, 100 had hypertension or severe asthma. In 54 patients cuff volume was increased to measure its influence on leak pressure; in 241 leak pressure was also measured at the end of the procedure; in 31 cuff pressure was measured under standard conditions over time; in 7 dead space was evaluated with the BANALYZER program; and in 300 blind endotracheal suction was attempted through the LM. RESULTS: Limits for the safe use of the LM were a leak pressure < 12 cm H2O combined with insufficient spontaneous ventilation (CO2et > 7 vol.%; n = 14), dislocation with gastric inflation (n = 2), and bronchial secretions (n = 1), as blind suctioning of the trachea through the LM was possible in only 1 out of 300 attempts. These limits could be recognised before the start of the operation in most cases. Laryngospasm or closure of the glottis (n = 36, 4.5%) was treatable and did not necessitate abandoning the use of the LM. Mean leak pressure was 17.7 +/- 4.8 cm H2O, showing a comparable distribution in adults and in children and being improved mainly by position changes of the LM, but not by changes in cuff volume. No gas leak occurred when the individual peak inspiratory pressure was equal to or lower than the measured leak pressure except in children. Dead space was almost halved by the LM compared to a face mask (90 +/- 13 vs. 162 +/- 31 ml; P < 0.05), allowing spontaneous breathing to be adequate even when manual assistance of ventilation was not possible (n = 14, 1.8%). In patients with sufficiently high leak pressures, the LM was safely used for long operations (up to 240 min), as leak pressure did not change over time. When only a low leak pressure could be achieved, deep breaths could be delivered by prolongation of the inspiratory time, thereby preventing atelectasis if tidal volume was limited. Cuff pressure rose to about 100 cm H2O within 60 min and should be monitored. In children, air was aspirated intermittently out of the stomach in procedures longer than 30 min; in adults, we monitored and buffered gastric contents where necessary. In patients at risk, the LM stimulates the circulation and bronchial reactivity less than an endotracheal tube. Children could be discharged earlier from the recovery room (0.45-1.5 h vs. > or = 2 h after neuromuscular relaxation and intubation). CONCLUSION: Limits for the use of the LM in eye surgery are delineated. Within these limits, the LM offers control over the airway comparable to that of an endotracheal tube with less stimulation. The LM has to be applied by an experienced user, and has advantages in eye surgery.
Adolescent↗
Microbial factors in disease emergence illustrated by streptococcal toxic shock syndrome.
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Anti-Bacterial Agents↗
Seven-day triple therapy with lansoprazole, clarithromycin, and metronidazole for the cure of Helicobacter pylori infection: a short report.
BACKGROUND: To refine our understanding of anti-Helicobacter pylori treatment regimens further, we evaluated the efficacy and safety of lansoprazole given in combination with clarithromycin and metronidazole for 7 days in an open-label, multicenter study. MATERIALS AND METHODS: H. pylori-positive patients self-administered lansoprazole, 30 mg; clarithromycin, 500 mg; and metronidazole, 500 mg bid for 7 days. Patients were assessed at pretreatment, at which time the presence of H. pylori was documented by rapid urease test or histology and culture, following study drug administration (week 1) for a brief evaluation only, and at least 4 weeks posttreatment (week 5), including endoscopy with collection of biopsy specimens for culture and histology testing. RESULTS: Of the 60 patients enrolled in the study, 59 had confirmed H. pylori infection, and 51 were included in an intent-to-treat analysis of efficacy. Primary metronidazole and clarithromycin resistance were observed in 84% and 8% of study patients, respectively. One month after the end of therapy, H. pylori infection was cured in 40 of 51 patients (78%); 95% confidence interval, (65%-89%). The triple-therapy regimen was well-tolerated, with only 2 patients (4%) requiring premature withdrawal from the study due to treatment-related adverse events. Taste perversion (15.0%) and diarrhea (11.7%) were the most frequently reported adverse events possibly or probably related to study medication during the treatment period. CONCLUSION: Despite a high prevalence of metronidazole resistance, a 1-week, triple-drug combination of lansoprazole, clarithromycin, and metronidazole is effective treatment for and well-tolerated by patients with H. pylori infection.
2-Pyridinylmethylsulfinylbenzimidazoles↗
[Remembering and acting out].
In the accompanying paper two fifteen-hour psychoanalytical therapies were investigated with regard to the temporal distribution of Luborskian relationship episodes and the facial expressions of both protagonists. The two therapies were taken from a sample of eleven treatments: one had had the most success; the other, the least. The investigation focussed on what type of interaction between the recollective narration of past relationships and the present form of relationships could be expected, and whether the relation between these two would be dependent upon the success of the therapy. The hypothesis that a parallel processing of the narrated episode and the exhibited emotion would occur within the patient could not be confirmed. The frequency of recollective narration correlated negatively--in line with a hypothesis of Freud's--with the frequency of exhibited emotions. In the successful treatment, however, the therapist exhibited the emotions which one would have expected the patient to show. The results are discussed in terms of a theory of the psychotherapeutical process and containing.
Acting Out↗
Toxicity of sulfonamide-reactive metabolites in HIV-infected, HTLV-infected, and noninfected cells.
It has been suggested that the high rates of adverse reactions to sulfonamides among patients with AIDS may be related to an increased sensitivity to reactive drug metabolites among HIV-infected cells. To study this hypothesis, we investigated the toxicity of the hydroxylamine of sulfamethoxazole in HIV-infected and noninfected MOLT-3 cultured human T-lymphoblasts. Toxicity was assessed by trypan blue dye exclusion. The hydroxylamine of sulfamethoxazole produced concentration-dependent toxicity in HIV-infected cells, with marked toxicity seen when HIV-infected cells were incubated with 400 microM of the hydroxylamine (82 +/- 8%); this was significantly greater than the toxicity seen among noninfected cells (p < 0.01). There was no concentration-dependent toxicity seen among noninfected cells or in cells infected with HTLV-I, suggesting that the concentration-dependent toxicity seen was specifically related to HIV infection. HIV-infected cells had significantly lower glutathione concentration than did noninfected cells (p < 0.05). Incubation with the hydroxylamine of sulfamethoxazole produced a concentration-dependent decline in glutathione content that was similar in infected and non-infected cells. Co-incubation with glutathione or N-acetylcysteine significantly reduced the toxicity of hydroxylamine of sulfamethoxazole in HIV-infected cells (p < 0.05). Our data supports the role of reactive sulfonamide metabolites in the pathogenesis of adverse reactions to sulfonamides among patients with AIDS.
Adult↗
Time-course of toxicity of reactive sulfonamide metabolites.
It has been suggested, on the basis of work in cell-free systems, that sulfonamide hydroxy-lamines are metabolized to nitroso metabolites which may be the proximate toxins mediating sulfonamide hypersensitivity reactions. We performed time-course experiments investigating the toxicity of the hydroxylamine and nitroso derivatives of sulfamethoxazole to investigate this hypothesis. The nitroso derivative of sulfamethoxazole was significantly more toxic than the hydroxylamine derivative (P < 0.05). When the LC50 was compared over time, there was a significant decrease in the LC50 of the hydroxylamine of sulfamethoxazole over time, while there was no change in the LC50 of the nitroso derivative. There was an equivalent reduction in toxicity demonstrated when the hydroxylamine or nitroso derivatives were co-incubated with glutathione. This supports the role of the nitroso as a proximate toxin mediating sulfonamide hypersensitivity reactions and suggests an explanation for the high rate of adverse reactions to sulfonamides among patients with AIDS.
Cell Survival↗
Leiomyosarcoma of the inferior vena cava. Report of two cases and a plea for surgical reconstruction.
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Adult↗
[Loss, grief and depression: considerations based on emotion research].
After clearing up the terminology within the field of bereavement the significance of different types of attachment to the lost object for the mental development after the loss is discussed. Similarities and differences of three phase models of the bereavement process are worked out. The heuristic value of these models is set into balance to the danger of their misuse for nailing down somebody about quality and duration of his "Trauerarbeit". Sadness as an affect is described within an general schema for the understanding and description of emotions. According to this schema affects are depicted internally as specific cognitive structures. The one of the grief affect predisposes to traumatic developments. Intercultural data show that identificatory processes are highly important for a benevolent ending of bereavement processes. The actual tendency to consider such phenomena as pathological is cleared up through a comparison of sadness, depression and depressivity. Departing from different types of attachment, bereavement courses and identificatory processes possible malign endings of bereavement processes are described.
Adaptation, Psychological↗
Ectopic pregnancy.
The incidence of ectopic pregnancies has increased dramatically over the past 20 years, resulting in significant maternal morbidity and mortality. This article reviews the epidemiology, pathogenesis, clinical manifestations, diagnostic testing, differential diagnosis, treatment, prognosis, and medico-legal considerations in the evaluation of the patient with a suspected or confirmed pregnancy.
Diagnosis, Differential↗
[Nerve compression syndromes in sports climbers].
Among 119 sports climbers 18 nerve compression syndromes were found. Three climbers with CTS were examined in MR imaging to identify anatomical or pathological structures which could cause the symptoms of CTS.
Adult↗