Tacrolimus for steroid- and OKT3-resistant rejection in kidney recipients.
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Adult↗
Biomedical subjects
R Petersen
Publications and source records attributed to R Petersen.
Automated peritoneal dialysis with 'on-line'-prepared bicarbonate-buffered dialysate: technique and first clinical experiences.
BACKGROUND: Automated peritoneal dialysis (APD) has the possibility of increasing the dialysis efficacy by using higher fill volumes, frequent dialysate exchanges, and tidal techniques. It is then possible to treat patients adequately without residual renal function. The drawbacks of the required high amounts of dialysis solution of up to 30 litres per session are the high costs of lactate-based dialysate bags and difficulties for the patients in handling these bags. So far, bicarbonate-based peritoneal dialysate, which may be more biocompatible, is only available for CAPD in double-chamber bags. In APD this could be overcome by 'on-line' preparation of bicarbonate-buffered dialysate using advanced technologies originally designed for on-line preparation of substitution fluid for haemofiltration. METHODS: Four patients without residual renal function were treated with APD five times weekly in a crossover study design. Patients received standard lactate-based (35 mmol/l) treatment (25 litres per session each) in weeks 1 and 3. In week 2 on-line-produced bicarbonate-buffered (37 mmol/l) dialysate was used. This dialysate was prepared by an AK 100 Ultra haemodialysis machine. The machine was modified for adding glucose from a 50% concentrate to the desired concentration of 1.7%. Electrolytes, pH, pCO2, and dialysis efficacy parameters were measured. Microbiological testing was carefully performed. RESULTS: Creatinine clearances, Kt/V, and pCO2 did not vary between the different treatment phases, whereas the pH showed a distinct increase during the bicarbonate phase. Repeated determinations of endotoxins and culturing showed no contamination of the dialysate. The composition of the produced dialysate was reproducible with respect to pH, pCO2, sodium, calcium and bicarbonate, whereas the glucose concentration varied by +/- 20%. CONCLUSIONS: On-line preparation of PD fluid with the AK 100 Ultra is easy and safe to handle. APD with dialysate containing 37 mmol/l bicarbonate provides improved acid base balance and possibly improved biocompatibility, and may lead to a significant cost reduction. Further development in order to provide smaller machines and more precise ways of achieving a desired dialysate glucose concentration is necessary.
Adult↗
Gemella morbillorum--spondylodiscitis in a patient with a renal graft.
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Discitis↗
Enhancing work outcome for three persons with traumatic brain injury.
A case study approach is used to illustrate how three survivors of severe traumatic brain injury were able to gain and maintain employment with the assistance of a supported employment programme. Emphasis on the different types of accommodations, including the design and implementation of compensatory strategies, is provided for each case. Finally, on overview of steps that can be taken to enhance the use of such strategies on the job is presented.
Adult↗
Antiproteinuric efficacy of fosinopril after renal transplantation is determined by the extent of vascular and tubulointerstitial damage.
BACKGROUND: Angiotensin converting enzyme (ACE) inhibitors have been successfully used for treatment of proteinuria after renal transplantation (RTx). Factors possibly responsible for the great inter-patient variance of the antiproteinuric effect (APE) have not yet been investigated in renal-transplanted patients. METHODS: 28 patients after RTx with a persistent proteinuria of more than 1.25 g/d were treated prospectively with does of fosinopril (10-15 mg/d) which were not effective on systemic arterial blood pressure. Prior to initiation of fosinopril, renal graft biopsy was performed in all patients and renal graft artery stenosis was excluded by duplex ultrasound. Serum creatinine and proteinuria were measured prior to, as well as 3 and 8 months after initiation of ACE inhibition, mean arterial pressure was controlled via 24-h measurement and repeated spot measurements. Reduction of proteinuria was correlated with renal histology, serum creatinine, creatinine clearance, mean arterial blood pressure, sodium excretion before therapy and the relative changes of these parameters during therapy respectively. RESULTS: Therapy had to be stopped in 8/28 patients due to side effects including rise of serum creatinine (n = 4). Three patients were excluded due to non-compliance. In the remaining patients (n = 17) proteinuria was reduced from 2.94 +/- 1.66 to 1.82 +/- 1.39 and 2.48 +/- 3.05 g/d after 3 and 8 months respectively, in the mean +/- SD. There was a significant inverse correlation between the APE and the extent of benign nephrosclerosis, interstitial fibrosis and tubular atrophy. No correlation of the APE to any of the other parameters could be demonstrated. CONCLUSIONS: Fosinopril can be administered effectively in a subgroup of proteinuric renal transplant recipients. However, because of a high proportion of patients developing side effects, careful monitoring is obligatory. Our results show that the lesser the degree of chronic morphological injury, the greater is the antiproteinuric effect. Thus, the degree of pre-existing histologically proven damage of the graft may serve as an indicator for the antiproteinuric efficacy of ACE inhibitor therapy after RTx.
Angiotensin-Converting Enzyme Inhibitors↗
pH-dependent stability and conformation of the recombinant human prion protein PrP(90-231).
A recombinant protein corresponding to the human prion protein domain encompassing residues 90-231 (huPrP(90-231)) was expressed in Escherichia coli in a soluble form and purified to homogeneity. Spectroscopic data indicate that the conformational properties and the folding pathway of huPrP(90-231) are strongly pH-dependent. Acidic pH induces a dramatic increase in the exposure of hydrophobic patches on the surface of the protein. At pH between 7 and 5, the unfolding of hPrP(90-231) in guanidine hydrochloride occurs as a two-state transition. This contrasts with the unfolding curves at lower pH values, which indicate a three-state transition, with the presence of a stable protein folding intermediate. While the secondary structure of the native huPrP(90-231) is largely alpha-helical, the stable intermediate is rich in beta-sheet structure. These findings have important implications for understanding the initial events on the pathway toward the conversion of the normal into the pathological forms of prion protein.
Circular Dichroism↗
Resolution of CNS lesions following treatment of experimental allergic encephalomyelitis in macaques with monoclonal antibody to the CD18 leukocyte integrin.
Experimental allergic encephalomyelitis (EAE) in macaques is an acute inflammatory and demyelinating disease of the central nervous system (CNS) which has been studied extensively as a model of the human demyelinating disease multiple sclerosis (MS). The in vivo administration of monoclonal antibodies against CD18, the common beta-chain of a leukocyte integrin, at the onset of clinical disease, significantly prolonged the survival of nine of 11 macaques (82%) and in some cases completely reversed the clinical appearance of disease. Treatment with anti-CD18 mAbs dramatically reduced the extent of inflammation in brain lesions as determined by magnetic resonance imaging (MRI). These improvements confirm that anti-CD18 mAbs are powerful anti-inflammatory agents in vivo and suggest that such mAbs may provide effective treatment of both demyelinating and inflammatory CNS diseases in man.
Animals↗
Radio frequency electromagnetic exposure: tutorial review on experimental dosimetry.
Radio frequency (RF) dosimetry is the quantification of the magnitude and distribution of absorbed electromagnetic energy within biological objects that are exposed to RF fields. At RF, the dosimetric quantity, which is called the specific absorption rate (SAR), is defined as the rate at which energy is absorbed per unit mass. The SAR is determined not only by the incident electromagnetic waves but also by the electrical and geometric characteristics of the irradiated subject and nearby objects. It is related to the internal electric field strength (E) as well as to the electric conductivity and the density of tissues; therefore, it is a suitable dosimetric parameter, even when a mechanism is determined to be "athermal." SAR distributions are usually determined from measurements in human models, in animal tissues, or from calculations. This tutorial describes experimental techniques that are used commonly to determine SAR distributions along with the SAR limitations and unresolved problems. The methods discussed to obtain point, planar, or whole-body averaged SARs include the use of small E-field probes or measurement of initial rate of temperature rise in an irradiated object.
Animals↗
[Value of the emergency therapeutic endoscopy in gastrointestinal hemorrhage].
The experience in therapeutic digestive endoscopy is presented using injection technique with adrenalin-polidocanol of gastrointestinal hemorrhage lesions. One hundred and twenty nine patients were treated endoscopically; the medium age was 60 years; in almost 80% of the cases, peptic ulcer disease were found. The effectiveness was 91.4% when one session procedure was used and in some cases two sessions were applied, giving a final total arrest of hemorrhage of 95.3%. The total mortality still remain high (16.3%) even without bleeding, due to coexisting poor general conditions of the patients. The technique of endoscopic injection is reviewed and the final results of our work are presented.
Adult↗
Experimental allergic encephalomyelitis in non-human primates: MRI and MRS may predict the type of brain damage.
Volume-localized proton spectroscopy and T2-weighted MRI were performed on 23 monkeys with experimental allergic encephalomyelitis (EAE). The purpose of this study was to determine the relationships between temporal changes in lesion activity (measured on T2-weighted MRI), MRS [N-acetyl aspartate (NAA), creatine (CR), choline (CHO)], and the histologic definition of disease determined post-mortem. Animals were scanned in the same areas of the brain once a week before and after sensitization to myelin basic protein (BP). Histologic lesion types were predicted by a combination of preceding MRI and MRS measurements. Acutely fatal EAE lesions were large and monophasic as visualized by MRI, and increased CHO (p < 0.02, n = 16) and CHO/CR ratio (p < 0.001, n = 16) were detected by MRS at disease onset. Chronic EAE lesions were preceded by multiple inflammatory attacks as visualized by MRI and consistently low levels of NAA (p < 0.02, n = 13) and NAA/CR (p < 0.01, n = 13) which occurred after the initial attack. MRI negative brain regions (from animals that were sensitized to BP) were associated with low CHO/CR (p < 0.1, n = 5). The temporal correlation of MRI lesion activity and absolute MRS proton metabolites shows promise for predicting the subsequent duration and histologic type of lesions in EAE in non-human primates.
Animals↗
Sleep-wake cycle abnormalities in fatal familial insomnia. Evidence of the role of the thalamus in sleep regulation.
Alterations in sleep organization were longitudinally studied in 6 new cases of fatal familial insomnia (FFI) by 24 h polygraphic recording. All patients showed an early reduction in sleep spindles and K complexes, and a drastic reduction in total sleep time and disruption of the cyclic sleep organization. Complete abolition of NREM sleep and persistence of only brief residual periods of REM sleep without atonia were features characteristic of the 3 patients with a short (less than 1 year) clinical course, and lacking in the 3 cases with a longer (more than 2 years) disease course. In the latter, sudden transitions from waking to NREM or REM sleep occurred, sometimes recurring periodically. Our findings confirm that impairment of sleep-wake regulation is a consistent distinctive feature of FFI.
Adult↗
Prognosis of vibration induced white finger: a follow up study.
OBJECTIVES--To follow up 102 patients with vibration induced white finger (VWF). METHODS--102 subjects with VWF were reexamined one to 13 years after the condition had first been diagnosed. Information about symptoms, occupation, vibration exposure, smoking habits, age, and the prevalence of other diseases was present in the medical records from the first examination and was collected by a questionnaire and an interview at the second examination. The decrease in systolic blood pressure in a finger during cold provocation (FSP%) was measured in the same finger at both examinations. RESULTS--At the second examination, 22% stated that the frequency of attacks had decreased. The improvement was most frequent in subjects with little or no exposure to vibration during the previous two years, in non-smokers, and in subjects without other circulatory diseases than VWF. 32% stated that the frequency of attacks had increased. The aggravation was most notable in smokers and subjects who also had circulatory diseases other than VWF. The number of finger phalanges that blanched on cooling averaged 15.8 at the first examination and 14.4 at the second examination. Working with high vibration hand held tools during the previous two years was related to an aggravation, with more finger phalanges affected at the second examination. Presence of other circulatory diseases had the same effect. In non-smokers the number of affected finger phalanges had decreased at the second examination. The FSP% had increased (improvement) in 43%, decreased (aggravation) in 12%, and was unchanged in 45%. The increase in FSP% was more pronounced in the older than in the younger subjects. The decrease of FSP% was more frequent among the younger subjects and subjects with a short follow up. CONCLUSION--As the FSP% in nearly half of the subjects had improved, it is concluded that VWF has a good prognosis in patients with mainly moderate to severe VWF after one to 13 years of observation. The improvement in FSP%, however, was not reflected in the subjective experience of the development of attacks of VWF. Continued work with high vibration hand held tools, smoking, other circulatory diseases, and low age at the time of diagnosis had an unfavourable influence on the prognosis.
Adult↗
Brainstem auditory evoked potentials during a helium-oxygen saturation dive to 450 meters of seawater.
When divers are exposed to extreme atmospheric pressures they may exhibit symptoms of the high pressure nervous syndrome (HPNS). Although clinical HPNS symptoms are well described, little is known about the underlying pathophysiologic mechanisms. Special HPNS signs like vertigo and tremor suggested sensory-motor hyperexcitability resulting from brainstem dysfunction. We therefore studied brainstem auditory evoked potential (BAEP) repeatedly in four divers during an experimental deep helium-oxygen saturation dive to 450 meters of seawater (msw). Wave I (auditory nerve response) latency decreased whereas interpeak latencies (IPLs) I-III and I-V, which indicate respective cochleo-pontine and cochleo-mesencephalic transmission time, prolonged during the dive. IPLs III-V also prolonged the dive, but with greater variability among divers. Two divers showed a marked reversal of the normal attenuation effect of increased stimulus presentation rates on IV and V amplitudes during compression, an effect that subsided during the stay at bottom depth. This finding might indicate a relative enhancement of synaptic excitability and is presumed to be a feature of HPNS. Wave I latency reduction might at least partly be caused by accelerated sound conduction in dense helium. Additionally, an upward shift of middle ear resonance frequencies in helium can induce a basal shift of the main cochlear portion responding to the wide band clicks. This effect may reduce wave I latency due to greater relative input from the basal high frequency-short latency-cochlear neurons. Pressure-induced decrease of nerve conduction velocity, delay of synaptic transmission, and inhibitory modulation of midbrain auditory afferents possibly contributed to observed interpeak latency prolongations. Clinical HPNS signs, such as tiredness, dizziness, postural and intentional hand tremor, ataxia, and opsoclonus, were noted in three divers after reaching 300 msw and continued throughout the 37-h stay at bottom depth.
Adult↗
Preferential deadenylation of Hsp70 mRNA plays a key role in regulating Hsp70 expression in Drosophila melanogaster.
Following a standard heat shock, approximately 40% of Hsp70 transcripts in Drosophila melanogaster lack a poly(A) tail. Since heat shock disrupts other aspects of RNA processing, this observation suggested that heat might disrupt polyadenylation as well. We find, however, that as the temperature is increased a larger fraction of Hsp70 RNA is polyadenylated. Poly(A)-deficient Hsp70 RNAs arise not from a failure in polyadenylation but from the rapid and selective removal of poly(A) from previously adenylated transcripts. Poly(A) removal is highly regulated: poly(A) is (i) removed much more rapidly from Hsp70 RNAs than from Hsp23 RNAs, (ii) removed more rapidly after mild heat shocks than after severe heat shocks, and (iii) removed more rapidly after a severe heat shock if cells have first been conditioned by a mild heat treatment. Poly(A) seems to be removed by simple deadenylation rather than by endonucleolytic cleavage 5' of the adenylation site. During recovery from heat shock, deadenylation is rapidly followed by degradation. In cells maintained at high temperatures, however, the two processes are uncoupled and Hsp70 RNAs are deadenylated without being degraded. These deadenylated mRNAs are translated with low efficiency. Deadenylation therefore allows Hsp70 synthesis to be repressed even when degradation of the mRNA is blocked. Poly(A) tail shortening appears to play a key role in regulating Hsp70 expression.
Animals↗
Chronic interstitial nephropathy after plasma cutting in stainless steel.
Chromium is nephrotoxic in experimental animals. In subjects with acute chromium intoxication acute nephritis has been reported and renal function has been affected in chromium exposed workers with a high urinary chromium concentration. Chronic kidney disease after long term occupational exposure to chromium has, however, not been reported previously. A case report is presented concerning a 48 year old man who was diagnosed with chronic interstitial nephropathy. He had worked for nine years as a plasma cutter of stainless steel and had thereby been exposed to smoke containing chromium. At the time of diagnosis his blood chromium concentration was seven times higher and his urinary chromium concentration six times higher than reference values. Taking into account the nephrotoxicity of chromium and the high chromium burden of this patient it is considered likely that his exposure to smoke from plasma cutting of stainless steel was the cause of his chronic interstitial nephropathy.
Chromium↗
Down-regulation of MHC-expression on dendritic cells in rat kidney grafts by PUVA pretreatment.
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Animals↗
Fatal familial insomnia and the widening spectrum of prion diseases.
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Adult↗
First clinical use of the Possis synthetic coronary graft.
The Possis polytetrafluoroethylene Permaflow coronary graft incorporates a Venturi resistor within the graft. Insertion is constructed by creating an anastomosis to the superior vena cava with subsequent anastomoses in sequence to coronary arteries requiring grafting. Finally, the graft is sewn to the aorta. The Venturi resistor controls flow through the aortocaval fistula, maintaining systemic pressure proximal, permitting systolic and diastolic flow to the grafted coronary arteries while maintaining constant flow through the graft. Animal studies demonstrated long-term patency. This graft was implanted in a patient with unstable angina pectoris and inadequate native conduit. Catheterization 6 weeks postoperative revealed patency of all anastomoses.
Aged↗