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Biomedical subjects

W Vogt

Publications and source records attributed to W Vogt.

At least 55 records · Page 3Linked to original sources
PubMed1996

Multicentre evaluation of an immunological rapid test for the detection of troponin T in whole blood samples.

In a multicentre study we assessed the analytical and diagnostic performance of a rapid test (TROPT rapid test, Boehringer Mannheim; in the USA: CARDIACT) for cardiac troponin T compared to quantitative troponin T ELISA and creatine kinase-MB mass determinations. The rapid test requires 150 microliters of heparinized or EDTA whole blood; serum is not suitable. Interference testing with biotin, haemoglobin and 27 standard drugs yielded no significant influence in the physiological range. Skeletal muscle troponin T concentrations > or = 40 micrograms/l gave positive results with the rapid test. We used the rapid test for 369 samples from 203 patients with suspected acute coronary syndromes and compared the results to troponin T ELISA and creatine kinase-MB mass. 90 patients (44%) were primarily classified as having myocardial infarction by the WHO criteria. Twenty-two (20%) of the 113 non-myocardial infarction patients were unstable angina pectoris cases showing increased troponin T ELISA but not increased creatine kinase-MB mass values. Consequently, these were classified as minor myocardial damage cases. The rapid test was positive in 99% of all samples with a troponin T ELISA value > or = 0.30 micrograms/l and negative in 95 to 96% of all samples below this value. Diagnostic sensitivities for the detection of acute myocardial infarction within the first 12 hours after onset of pain were the same, 90%, for the rapid test, troponin T ELISA and creatine kinase-MB mass. After 48 hours, diagnostic sensitivity of creatine kinase-MB mass sharply decreased whereas that of the troponin T assays remained close to 100% beyond 72 hours after onset of symptoms. Diagnostic specificities for acute myocardial infarction (WHO) of all markers remained between 80 and 100% over this time. The diagnostic sensitivity of the rapid test for the detection of high risk unstable angina pectoris patients with minor myocardial damage was nearly the same as for troponin T ELISA. A major advantage of the rapid test is the ease of use and 20 minute turn around time. This facilitates the detection of increased troponin T at alternate sites.

Biomarkers↗
PubMed1995

[Gastric lipoma as an unusual cause of upper gastrointestinal bleeding].

This is a case report of a gastric lipoma causing a severe upper gastrointestinal bleeding. About 200 cases of this very rare benign gastric tumor have been reported so far. Symptoms are not characteristic, but may also mimic malignancy when occurring with bleeding, obstruction or weight loss. Malignant transformation is possible, but extremely rare. Because the tumor is situated under the submucosal layer in 90%, preoperative diagnosis by endoscopic biopsy is almost never possible. The tumor has to be treated by resection. A diagnosis by frozen section during the operation is recommended.

Adult↗
PubMed1995

Oxidation of methionyl residues in proteins: tools, targets, and reversal.

Methionine (Met) is one of the most readily oxidized amino acid constituents of proteins. It is attacked by H2O2, hydroxyl radicals, hypochlorite, chloramines, and peroxynitrite, all these oxidants being produced in biological systems. The oxidation product, Met sulfoxide, can be reduced back to Met by Met sulfoxide reductase. Numerous proteins lose functional activity by Met oxidation. However, functional activation of proteins by Met oxidation has also been observed. Functional changes by Met oxidation in a given protein appear to have pathophysiological significance in some cases. Considering the reversibility of Met oxidation and the functional changes associated with the oxidation, it seems possible that Met oxidation/reduction in proteins may be one means to control homeostasis in biological systems.

Complement C5↗
PubMed1994

Oxidants generated by the myeloperoxidase-halide system activate the fifth component of human complement, C5.

Hypochlorite and taurine chloramine (T-NCI) convert native fifth component of human complement (C5) to an activated state. This is evident from loss of functional properties of native C5 and acquisition of a binding site for C6 which is characteristic of C5b, the physiological activation fragment of C5. The complex of activated C5 with C6 is capable of combining with the components C7, C8, and C9 forming the cytotoxic terminal complement complex C5-9. The activation of C5 and its assembly with the late reacting complement components has been detected by reactive lysis, i.e. hemolysis of unsensitized red cells upon incubation with the activated C5 and the reacting complement components C6-C9. T-NCl does, however, not cleave any peptide bond in C5 as happens in the physiological activation process but converts the intact protein to the activated form. The conversion is accompanied and probably caused by oxidation of methionine residues in the C5 protein to methionine sulfoxide. Since hypochlorite and T-NCl are biological products generated by the myeloperoxidase-halide system of stimulated leukocytes, the activation of C5 by these agents may be one way to complement activation during inflammation and tissue injury.

Complement Activation↗
PubMed1994

Delayed spontaneous opening of a self-expanding metal stent bridging a malignant esophageal stenosis.

We report on a case of an 85-year-old man with dysphagia who suffered from a stenosing esophageal adenocarcinoma that could not be treated by surgery. The tumor demonstrated circumferential growth and extended from 14 to 22 cm from the incisors. There were no esophago-tracheal fistulas. The stenosis could be negotiated with the endoscope. Under fluoroscopic guidance, a self-expanding Strecker stent was placed in the stenosed area with no prior dilatation. After releasing the stent an x-ray revealed a twisted and wrinkled stent which had expanded to only half of its maximum diameter. The patient's symptoms had not improved. Four days later dysphagia resolved when the stent spontaneously corrected its position and was found to be maximally expanded. On the basis of this observation it may be concluded that, at least in some cases, self-correction of an initially unsatisfactory positioning of a Strecker stent may be expected, even after four days.

Adenocarcinoma↗
PubMed1994

Realistic modeling of clinical laboratory operation by computer simulation.

An important objective of laboratory management is to adjust the laboratory's capability to the needs of patients' care as well as economy. The consequences of management may be changes in laboratory organization, equipment, or personnel planning. At present only one's individual experience can be used for making such decisions. We have investigated whether the techniques of operations research could be transferred to a clinical laboratory and whether an adequate simulation model of the laboratory could be realized. First we listed and documented the system design and the process flow for each single laboratory request. These input data were linked by the simulation model (programming language SIMSCRIPT II.5). The output data (turnaround times, utilization rates, and analysis of queue length) were validated by comparison with the current performance data obtained by tracking specimen flow. Congruence of the data was excellent (within +/- 4%). In planning experiments we could study the consequences of changes in order entry, staffing, and equipment on turnaround times, utilization, and queue lengths. We conclude that simulation can be a valuable tool for better management decisions.

Chemistry, Clinical↗
PubMed1994

[Osteosynthesis of ulna pseudarthrosis after Monteggia equivalents].

Stable internal fixation of the ulna is often followed by nonunion if the radial head has been resected in primary treatment of monteggia equivalents. Many patients have to undergo several operations before solid union is achieved. The reason for these disappointing results is the complex instability caused by the absence of the radial head. Our experience led us to use combined osteosynthesis with both an intramedullary compressive screw and a lateral plate. Even secondary replacement of the radial head by a spacer seems to be beneficial in the avoidance of fatigue fractures which might otherwise be caused by screw tracks. Secondary resection of the radial head practically always leads to synostosis. The results of primary treatment of monteggia fracture by the form of osteosynthesis described have proved successfully.

Adult↗
PubMed1993

[Joint bridging external fixation of fractures of the distal lower leg with severe skin damage].

During the 36 months from April 1989 until April 1992, 34 fractures of the lower end of the leg were treated by joint bridging application of external fixation using the so-called ".. Kugelspannfixateur UNIFIX". They were: 24 intraarticular compression fractures, seven bimalleolar dislocation fractures, two shot fractures and one postoperative empyema. All demanded treatment urgently. Because of severe skin lesions or because of medical reasons, neither osteosynthesis nur conventional conservative methods could be used. With the aid of UNIFIX, good alignment was achieved in all cases and practically always maintained as long as necessary. Reduction of joint-bearing fragments was equally good as with ligamentotaxis. All skin lesions healed during the time of fixation. Only two infections of screw tracks were observed. Additional operations like primary minimal osteosynthesis or later reconstructive surgery could be carried out with the fixateur in place. They have improved the results. No severe damage to the subtalar joint was observed. Therefore this principle of treatment can be recommended providing right indication.

Adult↗
PubMed1992

Activation of the fifth component of human complement, C5, without cleavage, by methionine oxidizing agents.

Purified human C5 was incubated with chloramine T (Cl-T) or N-chloro-succinimide (N-Cl-S) in barbital buffer, pH 7.2. The treatment led to C5 activation: Cl-T- and N-Cl-S-treated C5 acquired a binding site for C6; upon incubation with C6 and subsequent addition of C7, C8 and C9 a membrane attack complex formed which lysed non-sensitized guinea pig red cells (reactive lysis). While the physiological activation of C5 follows its specific cleavage, the resulting fragment C5b representing the activated C5 and expressing the C6 binding site, the treatment with the mentioned chemicals does not lead to fragmentation of the C5 protein. So, functionally, the product of the chemical treatment is C5b-like, but chemically, it comprises the whole protein; no C5a is released. Cl-T and N-Cl-S are known to more or less selectively oxidize methionine residues in proteins, dependent on the conditions. Other sensitive amino acid residues are tryptophan and cysteine. Conditions were chosen for treatment of C5 with Cl-T which exclude attack on tryptophan, and we have ensured that human C5 does not contain free cysteine residues. Further, oxidation of about 60% of the methionine residues of C5 by Cl-T was demonstrated by amino acid analysis. So, all evidence points to methionine residue(s) as the site of attack of Cl-T and probably also of N-Cl-S. The oxidation product of methionine, its sulphoxide, may cause a change in structural conformation of C5 which involves expression of the C6 binding site. Earlier it was found that oxidation of C5 by hydroxyl radicals leads to its activation without cleavage. Since the properties of this C5b-like product resemble those of the product of treatment with Cl-T and N-Cl-S, it is suggested that the formerly found activation of human C5 by hydroxyl radicals is also mediated by oxidation of methionine residue(s) in the C5 protein.

Chloramines↗
PubMed1992

Activation of the fifth component of human complement by oxygen-derived free radicals, and by methionine oxidizing agents: a comparison.

The fifth component of human complement, C5, was activated by non-enzymical, chemical treatment in either of two ways: 1) by oxidation with a hydroxyl radical (OH.) generating system consisting of H2O2, FeEDTA, and ascorbate, activation product called C5(H2O2); 2) by oxidation with chloramine T, activation product called C5(Cl-T). Evaluating earlier findings, completed by new results, both products were compared. Both products are C5-like in that they are capable of binding C6 and form the nucleus for the cytotoxic complex C5-9. Both differ from C5b, the natural activation product of C5, as they comprise the whole, uncleaved C5 protein, and do not immediately decay when not bound to C6. In both cases the treatment involves oxidation of methionine residues in the C5 protein. However, while chloramine T specifically attacks only methionine, oxidation by the OH. generating system involves other amino acid residues, in addition. This probably explains the lower yield of C5b-like activity after treatment with H2O2, and other quantitative differences between C5(H2O2) and C5(Cl-T). Whereas the generation of C5(H2O2) may be physiologically relevant, C5(Cl-T) may prove to be a suitable object for the study of changes in the C5 molecule essential for its activation.

Chloramines↗
PubMed1992

[Extreme results in electrolyte determination].

Besides statistical quality control, quality control based on patient specimens is an important tool for quality enhancement and thus for an increased diagnostic certainty in laboratory medicine. One of three possibilities of plausibility judgement is the control of extreme results, that is alert and absurd value check. The aim of our study was to look for extremely high or low findings of the most frequently examined clinical-chemical parameters, to scrutinize their validity according to clearly defined criteria and to find out the underlying actual clinical situations and diseases. In this publication only the results for the electrolytes are discussed. Retrospectively the most extreme values of all results for serum sodium, potassium and chloride concentrations of a 21-month interval were extracted in a large university hospital. The clinical situation was then evaluated by reading the medical reports of these patients. The validity of the findings was judged by previously defined criteria and rated as confirmed, questionable and not confirmed. In all cases the survival time was determined. The most extreme confirmed results were for sodium 191 and 100 mmol/l, for potassium 9.0 and 1.3 mmol/l and for chloride 138 and 65 mmol/l. All these findings were compatible with life, at least for several hours. Even if it is probably impossible to give generally valid extreme ranges. Nevertheless our results should certainly have practical importance in absurd and alert value check.

Chlorides↗
PubMed1992

[Observations on the cost effectiveness of various methods of electrolyte determination].

New analytical methods have to be considered also with respect to their economic efficiency. Here we present the application of an economic analysis based on the rules of applied economics in our institute for clinical chemistry and laboratory medicine. We started with an analysis of laboratory structure and economic efficiency in 1988, which since then has been followed by a continuously performed laboratory controlling system. The results of unit costing show the different cost groups, which add up to the cost of a single electrolyte determination. Regarding the transferability of our data to other laboratories, one has to consider that the main cost groups besides personnel cost are the apportionment of the overhead cost and the depreciation cost; both may vary markedly between each laboratory. Variable cost (reagents and consumables) differ widely from flame photometry to enzymatic electrolyte determination, but they amount only to 3-15% of the total cost.

Blood Chemical Analysis↗
PubMed1992

Cluster analysis in diagnosis.

The purpose of this paper is to survey the usefulness of cluster analysis in the special case of diagnoses. This complex topic is restricted, however, to the application on laboratory characteristics, separately or in connection with clinical data. The article is subdivided into three parts: (a) the fields of a possible use of cluster analysis, detection of diseases or subgroups of diseases, and data reduction by detection of structures; (b) a brief mathematical description of hierarchical and partitioning classification techniques (as a crucial point, the problems associated with these methods are discussed); (c) a critical review of 24 publications of the past 10 years concerning cluster analysis and diagnoses.

Clinical Laboratory Techniques↗
PubMed1991

Formation of mixed aggregates of human polymorphonuclear leukocytes and platelets by C5a-desArg.

Human blood platelets are not aggregated by C5a-desArg. They are brought to aggregation, however, when human polymorphonuclear leukocytes (PMN) are present in the platelet suspension. Then, mixed aggregates form upon activation with C5a-desArg. The platelets do not adhere only to PMN but also stick to each other, indicating that they are activated. This is also evident from their morphology which shows pseudopod formation. The formation of mixed aggregates requires the presence of Ca2+ and Mg2+, it does not occur at temperatures below 20 degrees C. The results suggest that the platelets are activated indirectly, by a mediator released from the PMN upon stimulation with C5a-desArg. When mixed with platelets, PMN partially aggregate already upon addition of Ca2+. This effect is not seen in pure PMN suspensions. C5a-desArg causes additional aggregation which includes the platelets. The indirectly stimulated platelets in turn enhance the aggregation of the PMN in the mixtures incubated with C5a-desArg. This may cause a positive feedback.

Cell Aggregation↗
PubMed1991

Creatine kinase determination: a European evaluation of the creatine kinase determination in serum, plasma and whole blood with the Reflotron system.

We evaluated a new dry-reagent carrier system for the determination of creatine kinase (EC 2.7.3.2) activity, Reflotron CK, with special attention to analytical performance with whole blood. We found a good within series imprecision. The median coefficient of variation was 3.1% for Reflotron CK (blood, serum and plasma) and 0.9% for the automatic analysers (serum and plasma only). The between-days imprecision with Reflotron CK (median CV: less than or equal to 3%) was similar to that for the comparison method on different analysers. Fresh samples of human blood, plasma and serum were examined by Reflotron CK and by a N-acetylcysteine activated creatine kinase method in six different clinical laboratories and in the Evaluation Department of Boehringer Mannheim GmbH. The correlation between these methods was excellent (r greater than or equal to 0.99), the median systematic deviation (bias) for all samples being smaller than -5%. Haematocrits between 0.25 and 0.50, haemolysis up to 6 g/l haemoglobin, and icteric samples with bilirubin concentrations up to 0.2 g/l showed no interference. No drug in therapeutic concentration was found to affect the Reflotron CK results; ascorbic acid, calcium dobesilate and sulphamethoxazole lowered the values only when present in high concentrations. Reflotron CK may be considered as a suitable alternative for decentralized testing sites, especially in situations where creatine kinase results are needed quickly.

Autoanalysis↗
PubMed1991

The influence of preoperative anticoagulation on heparin response during cardiopulmonary bypass.

The effect of preoperative anticoagulant therapy on intraoperative heparin response in patients undergoing cardiac operations was examined in a prospective study. The study included 45 patients with different preoperative anticoagulant treatments: 10 patients received treatment with phenprocoumon (a warfarin analogue) (group M), 12 patients received treatment with intravenous heparin (group Hiv), and 13 patients received treatment with subcutaneous heparin (group Hsc). The control group consisted of 10 patients who did not receive anticoagulant therapy before operation (group C). Preoperative antithrombin III activity was highest in group M (85% +/- 6%) and lowest in group Hiv (70% +/- 15%, p less than 0.05). The activated clotting time, determined 10 minutes after bolus injection of 250 IU (group M) or 375 IU heparin (all other groups), was 529 +/- 109 seconds in group C, greater than 1000 seconds in group M, 483 +/- 99 seconds in group Hsc, and 406 +/- 63 seconds in group Hiv (p less than 0.05). Heparin consumption during cardiopulmonary bypass varied between 4.6 +/- 1.4 IU/kg.min (group Hiv) and 2.6 +/- 0.9 IU/kg.min (group M) (p less than 0.05). Despite this increased heparin consumption, the patients who had received heparin before operation demonstrated increased activation of coagulation at the end of cardiopulmonary bypass (thrombin-antithrombin III complex, 19 +/- 4.1 ng/ml in group M and 61 +/- 7 ng/ml in group Hsc, p less than 0.05; cross-linked fibrin fragments, 257 +/- 92 ng/ml in group M and 875 +/- 152 ng/ml in group Hiv, p less than 0.05). Increased platelet activation was also found in patients with preoperative heparin therapy (beta-thromboglobulin at the end of cardiopulmonary bypass was 585 +/- 88 ng/ml in group M versus 1341 +/- 190 ng/ml in group Hsc, p less than 0.05). Drainage from the chest tube 24 hours after operation was 815 +/- 305 ml in group C, 644 +/- 238 ml in group M, 1133 +/- 503 ml in group Hsc, and 950 +/- 505 ml in group Hiv (p less than 0.05 for group M versus group Hsc). This study suggests that patients who receive heparin therapy before operation face a high risk of insufficient anticoagulation during cardiopulmonary bypass if standard heparin doses are used. Therefore, for patients who receive preoperative heparin therapy, a larger (500 IU/kg) initial bolus of heparin is recommended before cardiopulmonary bypass. On the other hand, patients who undergo preoperative treatment with phenprocoumon receive sufficient anticoagulative effect with a heparin bolus of 250 IU/kg.(ABSTRACT TRUNCATED AT 400 WORDS)

Antithrombin III↗
PubMed1990

Captopril in children with dilated cardiomyopathy: acute and long-term effects in a prospective study of hemodynamic and hormonal effects.

Hemodynamic and hormonal effects of captopril were prospectively studied in 12 children (median age 5.8 years, range 4 weeks to 15 years) with dilated cardiomyopathy. A mean dose of 1.83 mg captopril/kg body weight was administered in three or four single doses depending on age. Left ventricular volume, ejection fraction (EF), cardiac index (CI), and systemic vascular resistance (SVR) were noninvasively determined by two-dimensional (2D) and Doppler echocardiography before and 2 days and 3 months after the onset of treatment. Blood pressure and heart rate were recorded as well. Additionally, on the day hemodynamic measurements were made, plasma renin activity (PRA), serum aldosterone, and plasma atrial natriuretic peptide (ANP) concentrations were determined. Plasma catecholamines were measured before and 2 days after captopril treatment. Concomitant medication was kept constant during the short-term phase of captopril treatment. During long-term therapy, diuretics were reduced according to the clinical status. Stroke volume (SVI) (-7%), end-systolic (ESVI) (-31%), and end-diastolic (EDVI) (-21%) volume indexes were significantly reduced (p less than 0.05) during short- and long-term therapy. The remaining hemodynamic parameters showed only minor, statistically not significant, changes. During short-term therapy, median serum aldosterone levels fell from 138-88.5 pg/ml (p less than 0.05), and plasma ANP decreased from 144-94 pg/ml (p less than 0.05). After 3 months these effects were less marked and statistically no longer significant. Changes in PRA and plasma catecholamines were not statistically significant at any time.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗