Biomedical subjects
Publications and source records attributed to W Wagner.
We present a case of a 3 8/12 years old boy with histologically proved medulloblastoma. Preoperatively a tumor of the parotid gland was diagnosed, exstirpated and interpreted as a metastasis of medulloblastoma. Therefore the opinion seems to be questionable, that extracranial metastases of medulloblastomas only occur after injury of the dura mater (operation, shunt).
Results of molecular and pathogenic studies of three different bacterial hemolysins (cytolysins) are presented. These exoproteins derive from the two gram-negative bacteria Escherichia coli and Aeromonas hydrophila and from the gram-positive pathogen Listeria monocytogenes. The hemolysin of E. coli is determined by an 8-kilobase (kb) region that includes four clustered genes (hlyC, hlyA, hlyB, and hlyD). This hemolysin determinant is part either of large transmissible plasmids or of the chromosome. The genes located chromosomally are found predominantly in E. coli strains that can cause pyelonephritis and/or other extraintestinal infections. A detailed analysis of the chromosomal hyl determinants of one nephropathogenic E. coli strain revealed the existence of specific, large chromosomal insertions 75 kb and 100 kb in size that carry the hly genes but that also influence the expression of other virulence properties, i.e., adhesion and serum resistance. The direct involvement of E. coli hemolysin in virulence could be demonstrated in several model systems. The genetic determinants for hemolysin (cytolysin) formation in A. hydrophila (aerolysin) and L. monocytogenes (listeriolysin) are less complex. Both cytolysins seem to be encoded by single genes, although two loci (aerB and aerC) that affect the expression and activity of aerolysin have been identified distal and proximal to the structural gene for aerolysin (aerA). Cytolysin-negative mutants of both bacteria were obtained by site-specific deletion and/or transposon mutagenesis. These mutants show a drastic reduction in the virulence of the respective bacteria.
A review of clinical data from 18 pediatric patients with periodic lateralized epileptiform discharges and bilateral independent periodic lateralized epileptiform discharges (PLEDs and BIPLEDs) showed 2 with chronic neurologic illness, 6 with a history of prior seizures, 14 with depressed sensorium at the time of EEG, 5 deaths, and 8 of 13 survivors with neurologic deficits. These findings are similar to the combined data from reports involving adult patients only. Separating pediatric patients with PLEDs from those with BIPLEDs shows some influence from patients with BIPLEDs. Overall, our data do not suggest significant clinical differences for PLEDs between children and adults.
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Reduced thioredoxins from microbial and plant cells, both of cytoplasmic or chloroplast origin, are interchangeable in stimulating such diverse enzyme activities as ribonucleoside diphosphate reductase (E. coli), PAPS sulfotransferase (Synechococcus), and fructose-1,6-bis-phosphatase (from spinach) in vitro. It is suggested that reduced thioredoxins are unspecific, multifunctional cellular proteins while in contrast the oxidized froms require specific enzymes for their reduction.
9-hydroxy-10,12-octadecadienoic acid (9-HODE) is generated by lipid peroxidation (LPO) processes in comparison to other marker compounds in at least 10 fold amount. A 10-25 fold increase of this new marker compound in relation to age matched healthy individuals was observed in the low density lipoprotein (LDL) fraction of ten patients suffering from a hemorrhagic shock. The 9-HODE values dropped to normal levels after recovery. Similarly the 9-HODE content in LDL of patients which had to undergo orthopedic surgery--replacement of their arthritic hip joints by endoprosthesis--were investigated. The rather high HODE values dropped also after recovery reflecting obviously the disappearance of inflammatory processes associated with arthritis.
Frontal sinusotomy was performed on 110 patients undergoing routine endoscopic endonasal ethmoidectomy and the minimum diameter of the frontal sinus neo-ostium was determined intraoperatively. A total of 82 patients could be subjected to follow-up and redetermination of the neo-ostium diameter 13 months later. A postoperative CT was scheduled in 62 cases. The average minimum diameter of the frontal sinus neo-ostium, measured intraoperatively, was 5.6 mm (0-11 mm). After completion of wound healing, 81% of the frontal sinuses could be explored by probing or even inspected by rigid endoscopy. The average minimum diameter of the neo-ostia determined postoperatively was 3.5 mm (0-11 mm). Patients exhibiting aspirin sensitivity or diffuse nasal polyposis showed a more pronounced scarred constriction of the frontal sinus access compared to other cases. Neo-ostia exceeding 5 mm intraoperatively were preserved with a considerably higher percentage than those with diameters of less than 5 mm. Radiologically, the fenestrated frontal sinuses frequently showed continued or even increasing mucosal congestion. No conclusive relationship was found to exist between such post-operative clouding and frontal sinus accessibility (endoscopy and/or probing) or patient complaints. The investigations confirm the safety and reliability of frontal sinusotomy in surgical management of chronic paranasal sinusitis. The mucosa of the frontal sinus often reacts to surgery in the form of persistent or even newly developing mucosal swelling to which a specific pathophysiological significance cannot always be attributed.
We analysed the files of 52 patients with advanced head and neck tumors who were treated in a pilot phase. The therapy consisted of two courses of induction chemotherapy with ifosfamide and cisplatin followed by hyperfractionated-accelerated radiotherapy with a total dose of only 30 Gy. Surgery was performed within the following 7 days with tumor resection and neck dissection. Histologically we found in 50% of the specimens total necrosis of the tumor. The median survival time is calculated to be 22 months. The median follow-up time thus far is 36 months. Hence, therapy results are comparable to other therapy schedules. But side effects, especially late side effects had become minor. Therefore, our therapy regime results in augmentation of the quality of life of these patients.
Patients with locally advanced head and neck tumors were treated +/-amifostine (200 mg/m2, i.v.) before radiotherapy (5x 2 Gy, for 6 weeks). A significant decrease in side effects (p=0.034) using the oral assessment score and duration of mucositis (p=0.02) in the amifostine group was observed. Amifostine is feasible and effective, decreasing acute and late side effects in patients with head and neck tumors.
Neoadjuvant combined radiochemotherapy followed by definitive tumor resection improved survival in patients with locally advanced non-small cell lung cancer (NSCLC). Fifty-four patients (NSCLC IIIa + IIIb) were treated with combined radiochemotherapy within a phase I/II study. Twenty-six patients had been resected after combined neoadjuvant treatment and this group was evaluated concerning long-term survival. The median survival for patients with stage IIIa tumor was calculated to be 26 months and 13 months for patients with IIIb status. Patients with no viable tumor cells in the mediastinal lymph nodes had a significantly better survival probability than patients with residual microscopic lymph node disease (p=0.038). Patients with no viable tumor cells had a 1-year (2-year) survival rate of 100% (60%) versus 58% (42%) for patients with residual microscopic tumor in the mediastinal nodes. No significant difference between the N1- and the N2-status was seen. Hence, response to neo-adjuvant radiochemotherapy seems to be an additional important prognostic factor in patients with advanced NSCLC.
Treating chronic sinusitis may at times require courses of antibiotics much more prolonged than those used in acute sinusitis, but not all patients with radiographic evidence of sinusitis require antibiotics. Chronic sinusitis and chronic asthma frequently occur together and may share a common pathogenesis. This article explores current knowledge about this common respiratory problem and presents an algorithm for its evaluation and treatment.
BACKGROUND: Mucositis is a frequent side-effect of radiotherapy which often causes interruption of therapy and consequently decreases the probability of remission or cure, rhGM-CSF may ameliorate symptoms of mucositis by increasing the immune response via macrophage activation and stimulation of secondary cytokines. PATIENTS AND METHODS: 32 patients with locally advanced head and neck cancer were treated with adjuvant local radiotherapy after surgery (60 Gy in 30 dose fractions). In a pilot study, 16 patients received rhGM-CSF for five days, starting after a radiation dose of 20 Gy. These patients were compared retrospectively with a control group of 16 matching patients. Patients were assessed according to the Oral Assessment Guide (OAG), the Composite Mucositis Score (CMS) and the Common Toxicity Criteria (CTC) for severity of mucositis and pain. RESULTS: When compared with controls, patients on rhGM-CSF treatment showed decreased OAG, CMS and CTC scores. During the following irradiation courses mucositis was less severe in patients previously treated with rhGM-CSF. With regard to pain relief, rhGM-CSF-treated patients demonstrated a statistically significant improvement (p = 0.011), compared with controls. CONCLUSION: rhGM-CSF affected the severity of oral mucositis and reduced the related pain. As rhGM-CSF was well tolerated, this effect will be further investigated in prospective, controlled study.
Thus far, amifostine, a new radioprotective substance, had been given as short infusion 30 minutes before radiotherapy. In our investigation for the first time we have administered the substance as bolus injection (200 mg/m2 dissolved in 10 ml sodium chloride 0.9%). 42 patients with malignancies of the head and neck region, recurrences of rectal carcinomas and bronchial carcinomas had been treated with different solution volumes over different time periods. Using amifostine as a bolus injection had led to a statistically significant decrease in acute toxicity (p = 0.012). In comparison to short infusion (15 minutes) we have documented the same radioprotective impact. Hence, bolus injection of amifostine is feasible and can spare manpower and time in the department of radiotherapy.
Through adjuvant photon radiotherapy, it is possible to improve tumor control as well as avoid ultra radical surgery in patients with soft tissue sarcoma. Similar results have been obtained in cases of incomplete resected G1/G2 sarcoma after applying neutron radiotherapy. We compared the results of a group of patients with soft tissue sarcoma treated with those having received photon therapy (100 patients) or neutron therapy (61 patients). The median dose in the photon treated group was 60 Gy (range 45 to 65 Gy). The neutron therapy group received a median dose of 14.1 Gy (range 5.0 to 18.57 Gy). Patients treated with mixed-beam irradiation received an average dose of 36.5 Gy photon and 8.5 Gy neutrons. The 5-year survival rate of the photon group rated 43.1%. In the neutron group we found 42.5%, respectively. In both groups the results of surgical resection and grading were of high significance according to survival. 4% of the patients belonging to the photon group developed grade III/IV WHO side effects. In the neutron group side effects grade III/IV WHO were observed in 11% of the cases. Comparing treatment results of neutron and photon therapy we demonstrated that incompletely resected G1 and G2 tumor patients show greater benefit in the case of neutron radiotherapy.
Between 1994 and 1999, 515 Astra standard implants were placed and documented prospectively in 107 patients. Of these implants, 364 were placed in original jawbone, 38 in areas augmented with local osteoplasty, and 113 in bone grafts from the iliac crest. The main indications for implantation were an atrophic edentulous alveolar crest (n = 361) and a shortened dental arch (n = 113). Single-tooth implants were excluded. In a special clinical examination, 56 patients with 258 implants were investigated. The average in situ time of the implants was 34.2 months. Failing osseointegration (n = 10), peri-implantitis (n = 10), and implant fracture (n = 1) in 15 patients resulted in the failure of 21 implants (4.1%). Three patients with 8 implants died from malignant tumor. Currently, 27 implants have been lost to follow-up, and 488 implants remain in situ (95.9%). Under analyses with different implant success criteria, the success rate decreased to 85%. Based on the results in this patient population, this implant was found to be a useful alternative to established implant systems for the indications analyzed.
An important reason to improve methods of isolating platelet-rich plasma (PRP) is the potential use of autologous platelet growth factors. In addition to discontinuous plasma separation, a second method for extraction of PRP has now become available, which can be performed directly by the surgeon. In this study, the suitability of the 2 methods of producing PRP was compared. Whole blood was drawn from 158 healthy donors (112 men, 46 women) aged 20 to 62 years (mean 34, SD 10). The PRP was separated by the discontinuous plasma separation method (by the blood bank) or by the so-called "buffy coat" method (the "self-concentration" method, analogous to the PRP Kit, Curasan, Kleinostheim, Germany). Platelet counts differed significantly according to donor blood (median men 237,500/microL, women 272,000/microL), blood bank PRP preparation (median men 1,302,000/microL, women 1,548,500/microL), and self-concentrated PRP (median men 944,000/microL, women 1,026,000/microL). The platelet concentration of the blood bank PRP correlated with the platelet count in the donor whole blood (Spearman's correlation coefficient r(s) = 0.73). However, there was no significant correlation between the platelet count of self-concentrated PRP and donor whole blood (r(s) = 0.22). Significant but irrelevant influences of sex on platelet concentration were found, but no influence of age was detected.
We investigated normal oral epithelium and 20 oral squamous cell carcinomas with antibodies against oncogene products (p21, EGF-R) and intermediate filaments (cytokeratins 4, -10/11, -13, -18, Vimentin). Antigen expressions in oral epithelium and squamous cell carcinomas were associated in different patterns with epithelial maturation. Dedifferentiation of the squamous cell carcinomas was accompanied by quantitative changes in the oncogene products and a more complex pattern of the cellular intermediate filament equipment.
Despite the advantages of sonography we have only little experience regarding the intraoral use of this technique. The reasons for this are related to the size of the ultrasonic transducers and patient compliance. A new miniaturized transducer system is presented which facilitates intraoral sonography. First results obtained above all in the field of tumor diagnosis are reported.