Biomedical subjects
Publications and source records attributed to U Blum.
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Posttraumatic bilhemia complicating liver trauma has been managed surgically so far. A case report of a biliary-venous fistula resulting from blunt hepatic trauma managed successfully by percutaneous drainage is presented. A catheter was placed in the right hepatic lobe for reducing intrahepatic pressure. This procedure was followed by a dramatic decrease of bilirubin blood level. This management emphasizes the role of interventional radiology in the treatment of complicated blunt hepatic trauma.
Dendritic cells (DC) are professional antigen-presenting cells that can be generated in vitro from CD34+ peripheral blood progenitor cells by recombinant cytokines. These cells have potential implications for immunotherapeutic approaches in the treatment of cancer and other diseases. Physiologically, immature DC in the periphery capture and process antigens, then mature to interdigitating DC and migrate to lymphoid organs, where they activate lymphocytes. However, it is not known if DC generated in vitro have the capacity to traffic in vivo to the lymphoid tissues, such as spleen and lymph nodes. We have investigated whether human radiolabeled DC differentiated in vitro migrate and localize to lymphoid tissues after intravenous and intralymphatic injection. The distribution and localization of the DC were evaluated in five patients with malignant melanoma using serial whole-body gamma camera imaging. Intravenously infused DC demonstrated transient lung uptake followed by localization in the spleen and liver for at least 7 days. DC injected into a lymphatic vessel at the dorsal foot were rapidly detected in the draining lymph nodes where they remained for more than 24 h. These data suggest that DC differentiated in vitro localize preferentially to lymphoid tissue, where they could induce specific immune responses.
Cardiac rhabdomyomas are benign tumours closely associated with tuberous sclerosis. We report on a neonate with a cardiac rhabdomyoma, which simulated tricuspid atresia with duct-depending pulmonary perfusion due to almost complete obliteration of right ventricular cavum. Under infusion of prostaglandin E1 the newborn stabilized and was successfully operated on the 3rd day of life. We conclude that successful tumour resection is possible in neonates with cardiac rhabdomyomas causing relevant hemodynamic obstruction.
We investigated the radiological findings of four patients with malignant pulmonary hemangiopericytomas, comparing plain chest radiography, CT, and MR. The radiographic presentation ranged from a small single lesion to a tumor almost completely occupying a hemithorax. Pathognomonic radiological features of malignant pulmonary hemangiopericytomas could not be established, but characteristic features include a large lobulated well-circumscribed mass with an encapsulated appearance, contrast enhancement of the margin, and no signs of surrounding compression atelectasis. The tumors were associated with late onset or a paucity of chest symptoms. Additional information regarding heterogeneity and effects on adjacent structures was provided by MR and was helpful in suggesting the diagnosis of malignant pulmonary hemangiopericytoma.
We report on the treatment of invasive aspergillosis with the new triazole antimycotic agent itraconazole. All 11 patients suffered from pulmonary invasive aspergillosis. Two patients also had cerebral aspergillosis; in one of these patients the paranasal sinuses were also invaded. Underlying diseases were acute lymphoblastic leukaemia (n = 3), acute myeloid leukaemia (n = 4); one patient underwent allogeneic bone marrow transplantation before he developed aspergillosis; another was transplanted after successful aspergillosis treatment, liver cirrhosis (n = 1), lung infarction after pulmonary embolism (n = 1), chronic bronchitis after pulmonary tuberculosis (n = 1) and AIDS (n = 1). In five cases initial diagnosis was established by means of mycological methods and clinical signs. In six patients invasive pulmonary aspergillosis was initially diagnosed due to the clinical criteria presented in this paper. Secondary mycological confirmation after onset of therapy was achieved in five out of these six patients. All of the patients initially responded to therapy. One female patient experienced a relapse of aspergillosis and died of cerebral involvement and relapsing leukaemia. Two further patients died due to underlying diseases (pulmonary embolism, relapsing leukaemia). Nine patients (82%) were cured of the mycosis, including the patient with cerebral involvement; two underwent surgical resection of residual pulmonary lesions. Itraconazole is a very effective drug for treatment of invasive aspergillosis. Therapeutic efficacy can be optimized by early diagnosis using clinical criteria and prompt start of treatment.
The purpose of this study was to develop a model of renal artery occlusion and to investigate the effects of various thrombolytic agents on an acute occlusion of the renal artery with respect to ischemic tolerance of renal parenchyma. In order to do this, a thrombosis model in dogs (n = 36) was established and a total of 72 dorsal renal arteries occluded using autologous clot material. For the in vitro preparing of a clot, autologous blood (20 mL) was withdrawn and 100 U thrombin immediately added. Then 1 mL of the clot material was injected into the dorsal branch of the exposed renal artery. The dogs were divided into 8 groups (2 control groups, 6 therapy groups with local and systemic thrombolytic therapy). Thrombolysis was performed using urokinase, single-chain urokinase, and recombinant tissue-plasminogen activator. In all cases the clot preparation technique allowed complete and stable occlusion of the renal arteries. Local and systemic application of the thrombolytic agents, however, resulted in complete recanalization of the clot material in all study groups. Recombinant tissue-plasminogen activator turned out to be the most effective agent in terms of recanalization time. The technique described allowed effective and reproducible artery occlusion for in vivo experimental work to study comparatively thrombolytic agents with respect to fibrin specificity, lytic efficacy, and side effects.
Human tumors were transplanted into athymic nude mice. From blood samples in the final stage of their passages we observed that in some of these lines, human lung cancer lines mostly, blood glucose generally decreased with increasing size of the tumor grafts. This observation was the reason for further investigations. Eight out of 13 human lung cancer lines caused a decrease of blood glucose in grafted mice. The extent of decrease was directly correlated with the proliferation of grafts. The results raise hope that the model of human malignant tumors, xenotransplanted and passaged into athymic nude mice, could be helpful in research on IGF and related substances.
The model of human malignant tumors, heterotransplanted and passaged into athymic nude mice, proved to be a valuable tool for nutritional oncology. It showed that several human tumors proliferate in distinct dependence on the available vitamin B6. A surplus of the vitamin causes enhancement of growth. Proliferation is retarded in cases of reduced availability. The amount of vitamin B6 available does not only depend on the dietary supply. The contribution of the intestinal flora may be considerable. Therefore the adverse effect of a diet free of vitamin B6 is distinctly increased by additional application of a vitamin antagonist such as D-penicillamine for instance. It should be emphasized that this happens even in situations in which no clinical symptoms of vitamin deficiency could be observed at all. Our experimental findings may have consequences for those human patients who are stricken with vitamin B6 responsive tumors. A shifting supply of vitamin B6 should at least be avoided. Dietary guidance and a careful use of vitamin antagonists, such as D-penicillamine for instance, may be helpful.
OBJECTIVES: The risk of cardiac surgery in dialysis patients is increased compared with other patient groups. We analyzed early and long term results following various cardiac procedures. METHODS: Between 1981 and 1992, 40 patients underwent cardiac surgery with a mean age of 55.7-years (range 31-71 years). Cardiac procedures: Coronary artery bypass grafting (CABG) n = 20, aortic valve replacement (AVR) n = 6, mitral valve replacement (MVR) n = 4, AVR+CABG n = 1, MVR+CABG n = 1, AVR+MVR n = 2, combined heart and renal transplantation n = 2, atrial septal defect-closure n = 1, pericardial decortication n = 3. The preoperative NYHA functional classes were: NYHA II 5%, III 52.2%, IV 42.5%. Operative mortality was 15% (6/40). Hospital survivors were in NYHA functional classes I (3%), II (88.2%) and III (8.8%). A follow-up study was performed at 35 months (mean, range 1-93 months) postoperatively. RESULTS: There were 11 late deaths. The actuarial survival of all patients was 91% (1 year) and 69% (5 years). Following CABG it was 95% (1 year) and 72% (5 years). Survivors were in NYHA functional classes I 4.7%, II 85.8%, III 9.5%. CONCLUSION: Cardiac surgery in dialysis patients is associated with an acceptable hospital mortality. The quality of life of long term survivors is increased significantly. Thus we advocate surgical treatment in patients with symptomatic heart disease. Early diagnosis and surgical intervention in the NYHA functional class II may lead to a lower perioperative mortality.