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PubMed1987

Theory and methods of local tissue-pO2 monitoring in experimental angiology.

The platinum-multiwire-surface electrode after Kessler and Lübbers gives the opportunity of direct measuring of the local tissue-pO2-pressure; this 8-wire electrode with a Pt-wire-diameter of 15 microns operates on the polarographic principle. Each Pt-wire has a hemispheric collecting area of about 30 microns. Pressure ischemia by compression of capillaries is prevented by proportioning the weight (2.1 g) of the electrode. Data output is done by continuous pO2 measuring; pO2 histograms. During the continuous pO2 measurement the electrode stays on the tissue measuring point thus enabling the direct record of quickly proceeding reactions. The pO2-histogram exhibits the statistical distribution of the local partial oxygen pressures in a studied organ, a quasi sample inquiry is performed in the tissue, based on minimum 100 single values that are obtained by repeated manual repositioning of the electrode. By this, values are obtained on the level and distribution of local pO2 in the tissue so that condition and function of the microcirculation can be objectively assessed. Immediate alterations in the local tissue pO2 suggest regulatory adjustment after hemodynamic changes. Technical problems connected with pO2 measurement in clinical use (sterilization, data acquisition and presentation) are described. The presented technique gives the chance to exactly assess the effects of vasoactive drugs on the microcirculation and to quantify the results of operations, for example after bypass-surgery.

Blood Vessels↗
PubMed2001

Cooperative coactivation of estrogen receptor alpha in ZR-75 human breast cancer cells by SNURF and TATA-binding protein.

SNURF is a small RING finger protein that binds the zinc finger region of steroid hormone receptors and enhances Sp1- and androgen receptor-mediated transcription in COS and CV-1 cells. In this study, we show that SNURF coactivates both wild-type estrogen receptor alpha (ERalpha) (4-fold)- and HE19 (ERalpha deletion of activation function 1 (AF1)) (210-fold)-mediated activation of an estrogen-responsive element promoter in ZR-75 cells. In mammalian two-hybrid assays in ZR-75 cells SNURF interactions were estrogen (E2)-dependent and were not observed with the antiestrogen ICI 182,780. ERalpha interacted with multiple regions of SNURF; SNURF interactions with ERalpha were dependent on AF2, and D538N, E542Q, and D545N mutations in helix 12 abrogated both SNURF-ERalpha binding and coactivation. Moreover, peptide fusion proteins that inhibit interactions between helix 12 of ERalpha with LXXLL box-containing proteins also blocked ERalpha coactivation by SNURF. However, cotransfection of SNURF with prototypical steroid receptor coactivators 1, 2, and 3 that contain LXXLL box motifs did not enhance E2 responsiveness, whereas TATA-binding protein (TBP) and SNURF cooperatively coactivated ERalpha-mediated transactivation. The results are consistent with a unique model for cooperative coactivation of ERalpha that requires ligand binding, repositioning of helix 12, recruitment of TBP, and interaction with SNURF, which binds both ERalpha and TBP.

Blotting, Western↗
PubMed1995

Effects of clinorotation and microgravity on sweet clover columella cells treated with cytochalasin D.

The cytoskeleton of columella cells is believed to be involved in maintaining the developmental polarity of cells observed as a reproducible positioning of cellular organelles. It is also implicated in the transduction of gravitropic signals. Roots of sweet clover (Melilotus alba L.) seedlings were treated with a microfilament disrupter, cytochalasin D, on a slowly rotating horizontal clinostat (2 rpm). Electron micrographs of treated columella cells revealed several ultrastructural effects including repositioning of the nucleus and the amyloplasts and the formation of endoplasmic reticulum (ER) whorls. However, experiments performed during fast clinorotation (55 rpm) showed an accumulation (but no whorling) of a disorganized ER network at the proximal and distal pole and a random distribution of the amyloplasts. Therefore, formation of whorls depends upon the speed of clinorotation, and the overall impact of cytochalasin D suggests the necessity of microfilaments in organelle positioning. Interestingly, a similar drug treatment performed in microgravity aboard the US Space Shuttle Endeavour (STS-54, January 1993) caused a displacement of ER membranes and amyloplasts away from the distal plasma membrane. In the present study, we discuss the role of microfilaments in maintaining columella cell polarity and the utility of clinostats to simulate microgravity.

Actin Cytoskeleton↗
PubMed2005

The Ahmed Glaucoma Valve in refractory glaucoma: experiences in Indian eyes.

PURPOSE: To evaluate the efficacy of the Ahmed Glaucoma Valve implant in refractory glaucomas in Indian eyes. MATERIALS AND METHODS: A retrospective review was conducted on the charts of 122 eyes of 122 patients with refractory glaucoma treated with Ahmed Glaucoma Valve implant placement at Guru Nanak Eye Centre, New Delhi between January 1996 and December 1999. The main outcome measure was success at the last follow-up. Success was defined as an intraocular pressure (IOP) of 22 mmHg or less and 5 mmHg or more and at least a 30% reduction in IOP without visually devastating complications or additional glaucoma surgery. RESULTS: The mean postoperative IOP (17.29+/-3.79 mmHg) was significantly (P<0.001) lower than the mean preoperative IOP (31.47+/-7.86 mmHg) at last follow up (mean 12.51+/-8.37 months; range 3-24 months). The cumulative probability of success by Kaplan-Meier analysis was 85.95% at 12 months and 82.83% at 24 months. The mean number of postoperative antiglaucoma medications (0.75+/-0.80) was also significantly lower (P<0.001) than the mean preoperative number of antiglaucoma medications (2.83+0.72). The most common complication was corneal-tube contact, which occurred in five (4.10%) eyes. Retinal detachment occurred postoperatively in one eye with the clinical diagnosis of neovascular glaucoma secondary to Eale's disease. Two patients had tube extrusion requiring repositioning and reinforcement with scleral patch graft. CONCLUSIONS: Ahmed Glaucoma Valve implantation is an effective and relatively safe therapy for the treatment of refractory glaucoma in Indians.

Adolescent↗
PubMed2003

[H1 histamine antagonists].

Histamine is an important mediator for early phase allergic reactions that are involved in atopic diseases, mediated by specific IgE antibodies. After allergenic contact, its liberation induces unpleasant symptoms like itching, several manifestations as local vasodilatation, bronchoconstriction, mucus hypersecretion. Antagonists of H1 histamine receptors are the most prescribed drugs, due to their symptomatic effects at the levels of nasal or conjunctival mucosa, and the skin. Their major indications cover allergic rhinitis, either seasonal or perennial, and idiopathic chronic urticaria, as a first line medication. The pharmacological evolution allows to distinguish three generations of products differing at the levels of specificity, long acting period, and toxicity. The authors are discussing the respective benefits of two recent molecules presented as 3rd generation molecules: fexofenadine and levocetirizine, while repositioning their use among available treatment strategy.

Acetates↗
PubMed2000

Thioredoxin reductase two modes of catalysis have evolved.

Thioredoxin reductase (EC 1.6.4.5) is a widely distributed flavoprotein that catalyzes the NADPH-dependent reduction of thioredoxin. Thioredoxin plays several key roles in maintaining the redox environment of the cell. Like all members of the enzyme family that includes lipoamide dehydrogenase, glutathione reductase and mercuric reductase, thioredoxin reductase contains a redox active disulfide adjacent to the flavin ring. Evolution has produced two forms of thioredoxin reductase, a protein in prokaryotes, archaea and lower eukaryotes having a Mr of 35 000, and a protein in higher eukaryotes having a Mr of 55 000. Reducing equivalents are transferred from the apolar flavin binding site to the protein substrate by distinct mechanisms in the two forms of thioredoxin reductase. In the low Mr enzyme, interconversion between two conformations occurs twice in each catalytic cycle. After reduction of the disulfide by the flavin, the pyridine nucleotide domain must rotate with respect to the flavin domain in order to expose the nascent dithiol for reaction with thioredoxin; this motion repositions the pyridine ring adjacent to the flavin ring. In the high Mr enzyme, a third redox active group shuttles the reducing equivalent from the apolar active site to the protein surface. This group is a second redox active disulfide in thioredoxin reductase from Plasmodium falciparum and a selenenylsulfide in the mammalian enzyme. P. falciparum is the major causative agent of malaria and it is hoped that the chemical difference between the two high Mr forms may be exploited for drug design.

Animals↗
PubMed1989

[Double fractures of the bones of the crus and their treatment].

The authors have studied 256 patients with double fractures of the bones of the crus, the basis of the analysis of the causes, the mechanism of the origin and the clinico-roentgenologic picture a classification of the lesions and a number of new methods of treatment have been worked out which provide reposition and fixation of the fragments, prevent the development of early and late complications and contribute to reduction of the terms of treatment and disability. The method of treatment of double fractures of the bones of the crus with permanent skeletal traction has been improved. A method of insertion of metal rods into the tibia in cases of double fractures of the tibia with oblique planes of the fractures has been technically substantiated. A method of intraosseous administration of antibiotics and drugs and a method of subcutaneous fasciotomy (a. c. No. 1113098) with a fasciotome of the author's construction has been proposed. The application of a shock-proof clip of our construction (a. c. No. 310659) and slides in the joints (a device with rollers for a hinged plaster cast) contributed to an early recovery of the support function of the injured extremity. The long-term results of the treatment have been studied in 211 patients with double fractures of the bones of the crus and an analysis of rational use of the proposed methods of treatment has been made. To evaluate the results of the treatment the authors have applied clinical, roentgenologic, electrophysiologic, biomechanical and statistical methods of investigation. The results are positive in most cases.

Adult↗
PubMed1997

Evaluation of the safety and efficacy of deep sedation for electrophysiology procedures administered in the absence of an anesthetist.

UNLABELLED: Several procedures performed in the electrophysiology laboratory (EP lab) require surgical manipulation and are lengthy. Patients undergoing such procedures usually receive general anesthesia or deep sedation administered by an anesthesiologist. In 536 consecutive procedures performed in the EP lab, we assessed the safety and efficacy of deep sedation administered under the direction of an electrophysiologist and in the absence of an anesthetist. Patients were monitored with pulse oximetry, noninvasive blood pressure recordings, and continuous ECGs. The level of consciousness and vital signs were evaluated at 5-minute intervals. Deep sedation was induced in 260 patients using midazolam, phenergan, and meperidine, then maintained with intermittent dosing of meperidine at the following mean doses: midazolam 0.031 +/- 0.024 mg/kg; phenergan 0.314 +/- 0.179 mg/kg; and meperidine 0.391 +/- 0.167 mg/kg per hour. In the remaining 276 patients, deep sedation was induced with midazolam and fentanyl and maintained with a continuous infusion of fentanyl at a mean dose of 2.054 +/- 1.43 micrograms/kg per hour. Fourteen patients experienced a transient reduction in oxygen saturation that was readily reversed following administration of naloxone. An additional 11 patients desaturated secondary to partial airway obstruction, which resolved after repositioning the head and neck. Fourteen patients experienced hypotension with fentanyl. All but one returned to baseline blood pressures following an infusion of normal saline. No patient required intubation and no death occurred. Only three patients had recollection of periprocedure events. No patient remembered experiencing pain with the procedure. Hospital stays were not prolonged as a result of the sedation used. IN CONCLUSION: (1) deep sedation during EP procedures can be administered safely under the guidance of the electrophysiologist without an anesthetist present; (2) the drugs used should be readily reversible in case of respiratory depression; and (3) this approach may reduce the overall cost of the procedures in the EP lab, maintaining adequate patient comfort.

Adjuvants, Anesthesia↗
PubMed1996

Massive vulvar edema complicating tocolysis in a patient with twins. A case report.

BACKGROUND: Severe vulvar edema is an extremely rare complication of pregnancy. One other case of tocolysis-induced vulvar edema has been reported, as have five cases of postpartum vulvar edema, associated with an 80% maternal mortality rate. CASE: A multipara with a twin gestation presented with premature labor at 31 weeks. The patient had no history of trauma, lymphatic obstruction, venous obstruction or infection. On the fifth day of tocolysis with magnesium sulfate, nifedipine, terbutaline and betamethasone, edema developed in both labia. The following day the vulvar edema had increased and spread to the sacrum. The patient was normotensive and afebrile. Resolution occurred in spite of continuous tocolytic therapy, which was stopped at 35 weeks. Two days later, on hospital day 27, the patient spontaneously delivered two healthy, male infants. CONCLUSION: The two reported cases of tocolysis-induced vulvar edema were not fatal and resolved after repositioning the patient in one case and by cesarean section in the other. However, since maternal death has occurred with postpartum vulvar edema, the patient with vulvar edema merits special attention. The WBC count should be determined and the patient's circulatory status evaluated to rule out hypovolemia.

Adult↗
PubMed1996

Extraction of fully deployed coronary stents.

Coronary stents are often used because of their potential to improve the acute and long-term results of balloon angioplasty. The Palmaz-Schatz stent has been approved for use by the U.S. Food and Drug Administration largely because of a demonstrated reduction in the incidence of restenosis following its primary implantation. The Gianturco-Roubin design has been approved for use when balloon angioplasty results in threatened or acute vessel closure. In practice, both stent types are being used in settings when the results of balloon angioplasty are either potentially or actually unacceptable. In such circumstances it is imperative that stents be placed accurately and carefully. Occasionally, stent misplacement, embolization, or disruption can occur, and the need arises to recover and/or reposition the wayward prosthesis. This review describes the removal and recovery of fully deployed Gianturco-Roubin stents using an intracoronary snare technique.

Adult↗
PubMed1994

Changes in cervicocephalic kinesthesia after a proprioceptive rehabilitation program in patients with neck pain: a randomized controlled study.

Head repositioning accuracy (HRA) after full range active motion was evaluated in 60 cervicalgic patients. The mean angular error was 7.7 degrees +/- 3.3 (mean +/- SD) and 82% were outside a threshold value of 4.5 degrees. After randomization 30 patients followed a rehabilitation program based on eye-head coupling (RG) and 30 served as a control group (CG). At 10 week follow-up, a greater gain in HRA was observed in the RG (2 degrees +/- 2.7, mean +/- SD) than in the CG (0 +/- 2.6, mean +/- SD) (p = 0.005). Clinical parameters (pain, drug intake, range of motion, and self assessed functional improvement) were also more improved in the RG than in the CG. These data emphasize the role of a neck proprioception alteration in chronic neck pain and suggest that a rehabilitation program based on eye-head coupling should be included in most medical management of cervicalgic patients.

Adult↗
PubMed1978

A new magnetic technique for the treatment of giant retinal tears.

Using surgical techniques similar to those for closed vitreous surgery, we introduced a small magnetic sphere into the intraocular cavity of experimental animals. The sphere was subsequently maneuvered gently over the retina to unfold and reposition it with a small external permanent magnet probe. We used 68 enucleated canine eyes; eight eyes were operated in vivo and then examined microscopically. Retinal damage was caused by friction and excessive pressure when we used external magnets that were too strong or spheres that were too large. When small intraocular magnetic spheres coated with silicone or teflon or encased in a hollow oversize epoxy sphere were used the damage to the retina was minimal, or absent. We suggest using this same technique to treat retinal tumors through the introduction of radioactive material or antitumoral drugs. The intraocular magnetic sphere of this type would be left inside the eye in contact with the lesion for an extended period (seven days to three months) by suturing a small magnet to the sclera over the lesion.

Animals↗
PubMed2003

A randomized trial of the canalith repositioning procedure.

OBJECTIVE: To compare the effectiveness and complications of our adaptation of the canalith repositioning procedure (CRP) with the expectation treatment for benign paroxysmal positional vertigo. STUDY DESIGN: A randomized, controlled trial in the setting of a neurotological clinic in Thailand. METHODS: Fifty-eight patients with posterior benign paroxysmal positional vertigo were randomly assigned to treatment and control groups using a block of four. The treatment group was treated with the modified CRP technique until the nystagmus disappeared. A mastoid oscillator was not used, nor were any instructions given for patients after the maneuver. Both groups recorded the daily grading of symptoms and the amount of anti-vertiginous drugs (cinnarizine) taken. Objective and subjective assessments were made weekly until the nystagmus disappeared or until 4 weeks had passed since treatment began. RESULTS: The rates of effectiveness of CRP treatment and the control treatment for benign paroxysmal positional vertigo were 75.9% and 48.2%, respectively. There was a significant difference in the treatment outcomes of the CRP and control groups (P =.03). The CRP group used significantly fewer drugs than the control group (P =.001). Complications in the CRP group, such as lateral canalithiasis and fainting, were observed in 13.8% of the patients. CONCLUSIONS: The CRP was more effective than the expectation treatment for benign paroxysmal positional vertigo insofar as it provided faster recovery and required less dependence on medication. Complications of CRP were limited to 13.8% of patients.

Adult↗
PubMed1994

[An old remedy newly evaluated: the cervical syndrome].

Among the group of more than 5,000 patients reported here and suffering from headaches the cause of these headaches was to be found in 39.5% of the cases in the cervical spine. Two thirds of these revealed a malpositioning of two vertebrae against each other while the remaining third showed narrowing of the intervertebral foramina. Other cervical pathology comprises less than 6% of a total of more than 17,000 patients diagnosed as having a cervical syndrome. In the first group manual repositioning of the cervical spine brought about 82% of complete normalization of the position of the cervical spine (with concomitant total loss of symptoms) while of the remaining 18% half turned out to be free of symptoms as well. In case of narrowing of i.v. foramina electric blocking of the respective nerves using a very special type of current also lead to loss of symptoms in between 80 and 90% of these cases. Diagnostic aids and special techniques are presented. Thus in cervical causation of headaches clear diagnosis leads to proper and very effective therapy (without drugs). It should be thought of more frequently for the benefit of patients.

Cervical Vertebrae↗
PubMed2005

Wound cleansing for pressure ulcers.

BACKGROUND: Pressure ulcers (also called pressure sores, bed sores and decubitus ulcers) are areas of tissue damage that occur in the very old, malnourished or acutely ill, who cannot reposition themselves. Pressure ulcers impose a significant financial burden on health care systems and negatively affect quality of life. Wound cleansing is considered an important component of pressure ulcer care. OBJECTIVES: This systematic review seeks to answer the following question:What is the effect of wound cleansing solutions and wound cleansing techniques on the rate of healing of pressure ulcers? SEARCH STRATEGY: We searched the Specialised Trials Register of the Cochrane Wounds Group (up to August 2005), and the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2005). We searched bibliographies of relevant publications retrieved. We contacted drug companies and experts in the field to identify studies missed by the primary search. SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing wound cleansing with no wound cleansing, or different wound cleansing solutions, or different cleansing techniques, were eligible for inclusion if they reported an objective measure of pressure ulcer healing. DATA COLLECTION AND ANALYSIS: Two authors extracted data independently and resolved disagreements through discussion and reference to the Cochrane Wounds Group editorial base. A structured narrative summary of the included studies was conducted. For dichotomous outcomes, relative risk (RR), plus 95% confidence intervals (CI) were calculated; for continuous outcomes, weighted mean difference (WMD), plus 95% CI were calculated. Meta analysis was not conducted, because of the small number of diverse RCTs identified. MAIN RESULTS: No studies compared cleansing with no cleansing. Two studies compared different wound cleansing solutions: a statistically significant improvement in Pressure Sore Status Tool scores occurred for wounds cleansed with saline spray containing Aloe vera, silver chloride and decyl glucoside (Vulnopur) compared to isotonic saline (P value = 0.025), but no statistically significant change in healing was seen when water was compared to saline (RR 3.00, 95% CI 0.21, 41.89). One study compared cleansing techniques, but no statistically significant change in healing was seen for ulcers cleansed with, or without, a whirlpool (RR 2.10, 95% CI 0.93 to 4.76). AUTHORS' CONCLUSIONS: We identified only three studies addressing cleansing of pressure ulcers. One noted a statistically significant improvement in pressure ulcer healing for wounds cleansed with saline spray containing Aloe vera, silver chloride and decyl glucoside (Vulnopur) when compared with isotonic saline solution. Overall, there is no good trial evidence to support use of any particular wound cleansing solution or technique for pressure ulcers.

Humans↗
PubMed2006

Electroatriography - time-frequency analysis of atrial fibrillation from modified 12-lead ECG configurations for improved diagnosis and therapy.

Current atrial fibrillation (AF) management guidelines suggest that initially a decision must be made to apply either a rate control or rhythm control strategy in the individual patient. However, patients' selection remains substantially empirical and the strategy initially chosen often proves unsuccessful and alternative therapies must be adopted. Thus, it seems desirable to develop and apply tests that quantify AF disease state and guide AF management. The overall hypothesis of this paper is that time-frequency analysis of AF from modified 12-lead ECG configurations will improve AF management beyond current diagnostic and therapeutic standards. In particular, we present a novel concept in which 12-lead ECG configurations are modified for time-frequency analysis of AF (electroatriography). While five electrodes (VR, VL, VF, V1, V2) are placed in the conventional position, the other four electrodes (V3, V4, V5, V6) are empirically repositioned anterior or posterior over the atria. By applying spatiotemporal QRST cancellation and time-frequency analysis to these recordings in 19 patients with persistent AF, fibrillatory rate dispersion among individual anterior (25+/-14 fibrillations per minute, fpm) and posterior leads (16+/-11fpm) as well as individual anterior/posterior rate gradients ranging between -24 and +116fpm could be identified. Consequently, the portrayed techniques may form the conceptual basis for individualized noninvasive characterization of AF. Initiation of further studies using the described techniques in different AF subsets, for comparisons with intracardiac recordings and outcome of different therapies, e.g. cardioversion, antiarrhythmic drug and ablation therapy may be stimulated.

Aged↗
PubMed1983

Tachyarrhythmias associated with programmable automatic atrial antitachycardia pacemakers.

A multiprogrammable automatic antitachycardia pacemaker (Cybertach-60), connected to a tined "J" wire electrode, was positioned in the right atrial appendage in three patients with recurrent supraventricular tachycardia (SVT). Mechanisms of SVT included atrioventricular (AV) nodal reentry (two patients) and reciprocating tachycardia using an accessory pathway (one patient). Indications for implantation included frequent symptomatic episodes, multiple drug failures, and reproducible termination of the arrhythmia by the automatic pacemaker during electrophysiologic studies. Following discharge, multiple episodes of pacemaker malfunction were recorded. The three types of malfunction included: undersensing with induction of SVT by a single atrial premature depolarization, oversensing of extraneous electromechanical potentials triggering burst pacing which initiated SVT, and inappropriate burst pacing in response to sinus tachycardia with and without initiation of SVT. Treatment with a beta-blocking agent prevented pacemaker triggering by sinus tachycardia, and replacement of the electrode catheter resolved pacemaker triggering by electromechanical potentials. One patient required removal of the pacemaker because undersensing could not be corrected by repositioning the atrial electrode. This report illustrates three potential complications that may result with either normal or faulty sensing when employing automatic atrial antitachycardia pacemakers for control of SVT. It also stresses the importance of careful electrophysiologic evaluation before implantation and meticulous follow-up after implantation.

Adult↗