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PubMed1990

Assay of preS epitopes and preS1 antibody in hepatitis B virus carriers and immune persons.

The diagnostical significance of the large hepatitis B surface protein with its preS1 attachment site and of anti-preS antibodies are not yet well known. We investigated the epitope of the preS1 attachment site to see whether it is a marker of viremia and whether antibodies against it occur in convalescents and vaccinees. For comparison, sera were also tested for the presence and relative amount of a preS2 epitope. The epitopes were detected by binding to specific monoclonal antibodies (mAb MA18/7 for the preS1 epitope and mAb Q19/10 for the preS2 epitope) at the solid phase of a sandwich enzyme-linked immunosorbent assay. Antibody against the preS1 epitope was detected by inhibition of binding to mAb MA18/7. This mAb inhibits attachment of preS1 antigen to hepatocytes and reacts with a subtype-independent sequential epitope at the surface of hepatitis B virus between amino acid 29-36. This preS1 epitope occurs in most hepatitis B surface antigen (HBsAg) carriers, irrespective of viremia. Free preS2 epitope Q19/10 is present in samples with more than 8 micrograms/ml total HBsAg and it is masked in sera with less HBsAg. Antibodies which compete with mAb MA18/7 for its viral preS1 epitope occur in one third of HBsAg carriers who were negative for hepatitis B e antigen. It also occurs in one third of convalescents and in most good responders to plasma-derived vaccines.

Antibodies, Monoclonal↗
PubMed1976

Left ventricular function after acute myocardial infarction.

10 patients with their first AMI were studied within the first 48 hours and again after 3 weeks. Central and peripheral haemodynamics (CI, SV, SW, TPR) were examined, including indices of contractility (dp/dtmax) and wall stiffness (deltaP/deltaV, relation deltaP/deltaV to P) of the left ventricle. In the early phase CI and SW, as well as LV dp/dtmax were depressed in accordance with symptoms of LV failure. deltaP/deltaV was increased. Elevation of LVEDP correlated well with ventricular gallop rhythm, but less consistently with LV functional disturbance. During convalescence CI increased uniformly, both in digitalized and non-digitalized individuals. In contrast heart rate, aortic pressure, LVEDP and dp/dtmax remained unchanged. The increase of CI, SV and SW was accompanied by a fall of TPR and deltaP/deltaV. LV wall stiffness was still elevated above normal after 3 weeks. The improvement of cardiac pumping during infarct convalescence may have been effected through a fall of TPR and LV wall stiffness. Recovery of depressed contractile performance was generally not observed, and does therefore not seem to contribute to recuperation.

Acute Disease↗
PubMed1979

Enzyme-linked immunosorbent assay of antigens from Candida albicans circulating in infected mice and rabbits: the role of mannan.

Various antisera raised either to antigens of Candida albicans or to sub-lethal infections of blastospores (convalescent sera) were tested for their efficacy in diagnosing systemic disease in artifically infected animals. Globulin from convalescent serum, when conjugated with alkaline phosphatase and used in enzyme-linked immunosorbent assays (ELISA), was the only antiserum type which detected circulating Candida-related antigen in the serum of infected animals. Conjugates made from anti-mannan, anti-blastospore or antimycelial globulin did not detect antigen. Mannan did not appear to be related to an antigen produced in sera of experimentally infected mice. The significance of these results in the diagnosis of systemic candidosis is discussed.

Animals↗
PubMed1992

The inflammatory cytokines in measles: correlation between serum interferon-gamma levels and lymphocyte subpopulations.

Interleukin-1 (IL-1 beta), tumour necrosis factor alpha (TNF-alpha) and interferon gamma (IFN-gamma) were measured in serum from children with measles using an immunoradiometric assay. The IFN-gamma level was increased in 52 out of 54 patients in the acute phase of measles (less than 7 days of illness), and then declined to an undetectable level in the convalescent phase. Neither IL-1 nor TNF could be detected during the course of the illness. The mean serum IFN-gamma level was at its peak on day 4 and could be detected over a 7-day period after the onset of fever, coinciding with the febrile period (6.9 +/- 1.5 days). In the acute phase, the phytohaemagglutinin responses, absolute number of platelets, total lymphocyte counts, CD3+, CD4+, CD8+ cell counts and the CD4/8 ratio were depressed, while stab cell number and lactate dehydrogenase levels were higher than those in the convalescent phase. Using Spearman rank sum test, the IFN-gamma level was correlated negatively with the peripheral lymphocyte (P less than 0.01), CD3+ (P less than 0.05), CD4+ (P less than 0.05) cell counts and the CD4/8 ratio (P less than 0.05) and correlated positively with the stab cell count (P less than 0.01) but not with any other parameter. When the acute phase findings were compared between 28 complicated and 40 uncomplicated patients, the former were younger (P less than 0.01) and had higher maximum body temperature during the illness (P less than 0.05) than the latter, there was no difference in their IFN-gamma levels. These results show that endogenous IFN-gamma appears in the circulation during the acute febrile phase of measles, but does not contribute directly to any complication of the disease.

Acute Disease↗
PubMed1985

A comparative ultrastructural study on the nature of interstitial cell constituents in idiopathic myocarditis and myocardial infarction.

In order to observe the characteristics of interstitial cellular proliferation in cases with myocarditis of possible viral origin, a systematic ultrastructural analysis of the cell components in the interstitium was made employing endomyocardial biopsy at the acute (0-10 days after onset), subacute (11-25 days), and convalescent stages (26-167 days) of the disease in ten cases. For comparison, myocardial specimens from cases with myocardial infarction were taken from early autopsy cases or from tissue obtained during surgery. The dominant interstitial cells observed in the acute stage of myocarditis were fibroblasts (38.3% +/- 17.5%, mean +/- SD), macrophages (23.3% +/- 12.1%), and lymphocytes (18.0% +/- 18.1%); at the convalescent stage, fibrocytes (44.6% +/- 20.2%) and fibroblasts (22.5% +/- 8.0%) were commonly seen. In myocardial infarction, the dominant cells were macrophages (35.0% +/- 16.0%) and neutrophils (26.0% +/- 13.9%) at the acute stage, and lymphocytes (30.0% +/- 17.8%), plasma cells (27.1% +/- 20.0%), and macrophages (26.4% +/- 11.4%) at the late stage. Thus, some differences between the two diseases could be recognized.

Acute Disease↗
PubMed1985

Hemodynamic studies and response to a combined therapy of nitroglycerin ointment and dopamine in patients with acute myocarditis.

Left ventricular performance was assessed in ten patients with acute myocarditis during the acute stage (within the first 3 days after the onset of cardiac symptoms) and during the convalescent phase (3-5 weeks later). In nine, the diagnosis was confirmed by endomyocardial biopsy during the acute stage, when left ventricular function was markedly reduced, i.e., cardiac index 1.53 +/- 0.33 l/min/m2 (mean +/- SD), left ventricular stroke work index 14.1 +/- 3.9 g/beat/m2, pulmonary capillary pressure 25.9 +/- 4.3 mm Hg, and systemic vascular resistance 27.9 +/- 9.4 R units. During convalescence, seven patients improved clinically with normal cardiac function and in three it remained impaired. Cardiovascular response to nitroglycerin ointment in three patients and a combination of dopamine and nitroglycerin ointment in five were compared. Nitroglycerin ointment reduced pulmonary capillary pressure by an average of 28.5% (P less than 0.05) and systemic vascular resistance by 26.8%, while the cardiac index increased by 34.1% (P less than 0.05) and left ventricular stroke work index by 30.3% (P less than 0.01). The combined therapy was more effective, with a reduction of pulmonary capillary pressure by 30.4% (P less than 0.05) and systemic vascular resistance by 27.5% (P less than 0.05), accompanying an increase in cardiac index by 53.5% (P less than 0.005) and left ventricular stroke work index by 63.5% (P less than 0.01), with little change in the double products. This study suggests that serial hemodynamic monitoring accurately evaluates cardiac function, selection of appropriate therapy, and the hemodynamic effects of treatment in patients with acute myocarditis.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1998

[Recovery and duration of work disability after laparoscopic and conventional appendectomy. A prospective randomized study].

To evaluate whether laparoscopic appendectomy shortens the convalescence and the postoperative period until return to work when compared to conventional appendectomy, a prospective randomized trial was performed. The major endpoint of the study was the time until return to work; minor endpoints were postoperative pain, fatigue, operative time and postoperative morbidity. In all, 54 patients with a mean age of 29.5 +/- 10.1 years were randomized to open (n = 28) or laparoscopic appendectomy (n = 26). Age, sex, body mass index (BMI), American Society of Anesthesiology (ASA) rating, job status as well as histologic degree of inflammation of the appendix were comparable in the two groups. Operative time was 59.2 +/- 15.8 min for laparoscopic and 59.8 +/- 24.4 min for conventional appendectomy (P = 0.9). Some 16 laparoscopic appendectomies (62%) were performed by board-certified surgeons, while 23 conventional appendectomies (82%) were performed by residents (P = 0.003). Postoperative morbidity was comparable between the two groups. After laparoscopic appendectomy, pain was rated significantly lower on the first, second and fourth postoperative day when compared to the conventional group. There were no difference in postoperative fatigue between the groups. Time to return to work was 17.0 +/- 6.2 days in the laparoscopic group and 18.2 +/- 6.0 days in the conventional group (p = 0.5). Laparoscopic appendectomy has no advantages in terms of convalescence and time to return to work when compared to open appendectomy and should therefore be limited to selected cases.

Adolescent↗
PubMed1984

Ornithine carbamyl transferase in Reye's syndrome.

Serum levels of ornithine carbamyl transferase activities were determined in the acutely ill and convalescent Reye's syndrome patients and in their parents. Acutely ill Reye's syndrome patients had elevated levels of serum ornithine carbamyl transferase activities as compared to those in controls. The convalescent Reye's syndrome patients and their parents had normal levels of serum ornithine carbamyl transferase activities. These results suggest that an inborn metabolic defect was not responsible for the increase in serum ornithine carbamyl transferase activities in Reye's syndrome.

Child↗
PubMed1992

Randomised controlled trial of laparoscopic versus mini cholecystectomy. The McGill Gallstone Treatment Group.

Laparoscopic cholecystectomy (LC) has gained wide acceptance for treatment of cholelithiasis in preference to open cholecystectomy, though it has not been formally compared with mini cholecystectomy (MC). We have compared these two techniques in a randomised trial. 70 patients with ultrasound-proven cholelithiasis were randomly allocated LC (38) or MC (32); 37 and 25, respectively, underwent the assigned procedure. The mean hospital stay (including 1 preoperative day) was significantly shorter in the LC than the MC group (median 3 [interquartile range 2-3] vs 4 [3-5], p = 0.001) as was duration of convalescence (mean 11.9 [SD 9.1] vs 20.2 [16.5] days, p = 0.04). The rate of return to normal activities was 1.77 times greater in the LC group than in the MC group (95% confidence interval 1.01-3.11, p = 0.03). In regression analysis, the type of cholecystectomy done was the only variable significantly associated with the duration of convalescence. Although there was significant postoperative improvement in all of three quality of life scores in both groups, LC patients improved more quickly than did MC patients. This randomised trial shows the superior effectiveness of LC over MC in treating cholelithiasis.

Adolescent↗
PubMed1994

Analysis of the antigenic profile of measles virus haemagglutinin in mice and humans using overlapping synthetic peptides.

In this study, a panel of 55 synthetic peptides representing 92.2% of the haemagglutinin (H) glycoprotein of measles virus (MV) were used to study the antigenic profile of the H molecule of anti-MV antibodies raised in mice and late convalescent human sera. In addition the immunogenicity of these peptides was tested in two mouse strains. Mouse anti-MV antibodies had different fine specificity of binding to the peptides depending on the mouse strain. Thus in BALB/c (H-2d) mice, anti-MV antibodies recognised six peptides representing residues 103-117; 123-137; 242-255; 293-307 and 463-477. In TO (H-2s) mice, anti-MV antibodies recognised peptides representing residues 49-72 and 463-477. When the immunogenicity of the peptides was tested, 29 were immunogenic in BALB/c mice and 34 were immunogenic in TO mice. Several of the anti-peptide antisera were found to cross-react with MV, depending on the solid phase assay system used but none were able to inhibit virus infectivity in vitro. The reactivity of a panel of late convalescent human sera with the peptides was heterogeneous and the extent of the binding to the peptides was related to the titre of anti-MV. However, human sera recognized certain peptides more frequently than others, in particular peptides at the carboxyl-terminus.

Amino Acid Sequence↗
PubMed1991

In vivo expression of iron regulated outer-membrane proteins in Pasteurella haemolytica-A1.

Pasteurella haemolytica-A1 was grown in vitro under iron-rich conditions, iron-depleted conditions, and in vivo within a chamber implanted in the peritoneal cavity of a rabbit to determine if iron regulated outer-membrane proteins were expressed in vivo. The antigenicity of outer membrane (OM) proteins from bacteria grown under these conditions was assessed by immunoblotting with pooled serum from convalescent bovine calves experimentally infected with P. haemolytica-A1 and serum from the implanted rabbit. Pasteurella haemolytica-A1 grown under iron-depleted conditions showed three distinct OM protein bands (71, 77, and 100 kDa) that were present in much lesser amounts when the organism was grown under iron-rich conditions. These same three bands were evident in OM protein preparations from bacteria grown in vivo. Western blotting indicated that these protein bands were recognized immunologically by the convalescent bovine serum and by serum from the implanted rabbit, in cells grown under the iron-depleted conditions and in vivo, but not if the bacteria were grown under the in vitro iron-rich conditions.

Animals↗
PubMed2006

Laparoscopic radical prostatectomy in men older than 70 years of age with localized prostate cancer: comparison of morbidity, reconvalescence, and short-term clinical outcomes between younger and older men.

OBJECTIVES: To analyze the safety and efficacy of extraperitoneal laparoscopic radical prostatectomy (eL-RPE) in elderly versus younger men with localized prostate cancer. METHODS: Patients undergoing eL-RPE were retrospectively subdivided into group eL-RPE1 (72 men aged 71 yr and older) and group eL-RPE2 (132 men aged 59 yr and younger). Group eL-RPE1 was compared with a group of 70 contemporary, comparable patients aged 71 yr and older undergoing open retropubic radical prostatectomy (group OPEN-RPE). RESULTS: Compared with group eL-RPE2, patients of group eL-RPE1 had a higher pathologic stage (45% vs. 32% stage pT3 or greater, p<0.001) and higher Gleason score (median 7 vs. 6, p<0.001). Prostate-specific antigen recurrence was significantly worse compared with age-matched controls for younger patients with high-stage or high-grade lesions (p<0.001). Importantly operative time, analgesic requirements, hospital stay, convalescence, and complication rates were comparable. Urinary continence rate was significantly better in group eL-RPE2 at 6 mo (67% vs. 91%, respectively, p<0.001). Group eL-RPE1 and group OPEN-RPE patients had statistically similar pathologic stage and Gleason score (each p>0.05), similar operative time (p=0.12), but less blood loss (p<0.001), shorter hospital stay (p<0.001), and more rapid convalescence (p<0.001) occurred in eL-RPE1. CONCLUSIONS: eL-RPE is feasible and efficacious even in elderly patients with unfavorable, large-volume disease. eL-RPE offers the advantages of decreased blood loss, shorter hospital stay, and more rapid recovery over OPEN-RPE. However, the elderly patient must be informed preoperatively about the observed higher incontinence rate.

Age Factors↗
PubMed2004

Development of a safe neutralization assay for SARS-CoV and characterization of S-glycoprotein.

The etiological agent of severe acute respiratory syndrome (SARS) has been identified as a novel coronavirus SARS-CoV. Similar to other coronaviruses, spike (S)-glycoprotein of the virus interacts with a cellular receptor and mediates membrane fusion to allow viral entry into susceptible target cells. Accordingly, S-protein plays an important role in virus infection cycle and is the primary target of neutralizing antibodies. To begin to understand its biochemical and immunological properties, we expressed both full-length and ectodomain of the protein in various primate cells. Our results show that the protein has an electrophoretic mobility of about 160-170 kDa. The protein is glycosylated with high mannose and/or hybrid oligosaccharides, which account for approximately 30 kDa of the apparent protein mass. The detection of S-protein by immunoassays was difficult using human convalescent sera, suggesting that the protein may not elicit strong humoral immune response in virus-infected patients. We were able to pseudotype murine leukemia virus particles with S-protein and produce SARS pseudoviruses. Pseudoviruses infected Vero E6 cells in a pH-independent manner and the infection could be specifically inhibited by convalescent sera. Consistent with low levels of antibodies against S-protein, neutralizing activity was weak with 50% neutralization titers ranging between 1:15 to 1:25. To facilitate quantifying pseudovirus-infected cells, which are stained blue with X-Gal, we devised an automated procedure using an ELISPOT analyzer. The high-throughput capacity of this procedure and the safety of using SARS pseudoviruses should make possible large-scale analyses of neutralizing antibody responses against SARS-CoV.

Animals↗
PubMed2006

[Integral management of the process of laparoscopic cholecystectomy].

INTRODUCTION: One of the most important objectives of public healthcare services is to guarantee integral healthcare to patients; activity is currently focussed on process management. Analysis of a "key" process could have health, social and economic effects if measures to improve the results are designed. The aim of the present study was to evaluate the process of laparoscopic cholecystectomy in our hospital in order to determine its strong and weak points. MATERIAL AND METHOD: We performed a prospective observational study of the laparoscopic cholecystectomy (LC) process in the Jarrio Hospital between January 2001 and December 2002. A working group was formed and a process flowchart was designed by consensus. The different steps of the process were evaluated through the main indicators of quality: accessibility, efficiency, and effectiveness, including cost, the convalescence period, and patient satisfaction. The results were compared with the standards defined by the Andalusian Health Council, bibliographic sources, and hospital commissions. The statistical analysis was performed with 95% confidence intervals of the main results. RESULTS: A series of 86 patients who underwent LC was evaluated. The results for accessibility showed wide variability in delays for specialist consultations, the waiting list for surgery, and urgent diagnostic tests, often exceeding the standards. The laparoscopic approach was more frequent than open cholecystectomy; morbidity and mortality with LC were below the reference standards and compliance with established prophylaxis protocols was close. The efficiency markers showed that the length of hospital stay for elective LC was close to the standard; however, for cholecystitis preoperative length of stay was longer than the standard. Overall patient satisfaction with medical care and non-medical services was high. CONCLUSIONS: Quality analysis of a process allowed us to identify strong points such as the high rate of laparoscopic cholecystectomy -showing good effectiveness and efficiency- the quality of informed consent, and patient satisfaction. Required improvements consisted of shortening preoperative length of stay in acute cholecystitis and waiting lists, informing patients about the length of the convalesce period, eliminating routine type and screen, and admitting patients on the day of surgery.

Acute Disease↗
PubMed1976

La maladie post-operatoire: Is there order in variety? The six stimulus-response sequences.

The search for a unifying concept in all post-traumatic metabolism, symbolized by the phrase "la maladie post-operatoire" has been a fruitful one, not so much because of success, as through its very failure. There is such variety in convalescent patterns that it has made it essential for students of this subject to look more closely at the nature of the stimulus response patterns and bring sharply into focus those recurring phenomena whose mixture together determines the final clinical result. In this brief introductory paper six groups of stimulus-response patterns have been identified and analyzed. The clinician needs an understanding of these patterns in everything that he does for the patient, both within the operating room and on the ward. The student of surgery must make an effort to differentiate amongst the six stimulus-response patterns. If he fails to do so he will be analyzing all surgical recovery as falling under a single sequence, an error that has been all too frequent in the literature. There may be other stimulus response patterns of greater importance which will be added to the list presented here, as research in the coming decades increases our understanding of convalescent biology. This presentation will serve as an introduction to the other papers gathered in this symposium by Dr. Clowes, all of which cast further important light on the details of the stimulus and response in surgical metabolism.

Anaerobiosis↗
PubMed2003

Hand-assisted laparoscopy for large renal specimens: a multi-institutional study.

OBJECTIVES: To present our experience with hand-assisted laparoscopy (HAL) for larger renal specimens. One of the theoretical benefits of HAL is the ability to manage large renal specimens, which we defined as tumors greater than 7 cm, and tumors in obese patients. METHODS: Between March 1998 and October 2000, 106 HAL radical nephrectomies were performed for enhancing renal masses, for which 95 patients had complete preoperative, intraoperative, and postoperative data. Of the 95 patients, 32 underwent HAL for large tumors (7 cm or greater) and 41 had a body mass index of 31 or greater. The demographic and outcome data of these two groups were compared with 63 patients who underwent HAL for tumors less than 7 cm and 54 patients with a body mass index of less than 31. RESULTS: When comparing cohorts by tumor size, the only statistically significant differences were in convalescence and specimen weight. Patients with lesions 7 cm or greater required 21 days to recover compared with 18 days for patients with lesions less than 7 cm. Obese patients had statistically significantly higher American Society of Anesthesiologists classifications, longer operative times (214 versus 176 minutes), and longer convalescences (21 versus 17.5 days) compared with nonobese patients. The estimated blood loss and conversion rate was not different between the groups. Furthermore, no difference was noted between the groups in the incidence of positive margins, local recurrence, or metastatic recurrence at a mean follow-up of 12.2 months. CONCLUSIONS: HAL provides a safe, reproducible, and minimally invasive technique to remove large renal tumors and renal tumors in the obese.

Blood Loss, Surgical↗
PubMed1978

Cholera, non-vibrio cholera, and stomach acid.

Fasting and postprandial stomach acid production were low in 16 of 37 Bangalees convalescing from cholera or non-vibrio cholera. Gastric juice of hypochlorhydric patients did not kill cholera vibrios in vitro, whereas that from normochlorhydric patients rapidly killed vibrios in concentrations up to 10(10)/ml. To determine whether hypoacidity resulted from cholera or was a common predisposing factor, basal and betazole-hydrochloride-stimulated acid production were measured before and after cholera in a second group of patients consisting of American volunteers participating in a vaccine development programme. Cholera did not alter the stomach acid secretion of American volunteers, but low precholera basal acid production predispose to severe cholera. The results indicate that hypochlorhydria observed in convalescent Bangalee cholera patients is not caused by cholera, and must therefore have preceded it. Idiopathic tropical hypochlorhydria may be a major factor accounting for the high incidence of diarrhoea due to acid-sensitive pathogens in developing countries.

Achlorhydria↗
PubMed1979

Antigen-antibody system associated with non-A, non-B hepatitis detected by indirect immunofluorescence.

Ten chimpanzees were infected with non-A, non-B hepatitis by inoculation of patient serum or serum from a chimpanzee previously inoculated with patient serum. Convalescent serum from one of them reacted, in indirect immunofluorescent tests, with some of the hepatocyte nuclei in sections of autologous liver biopsy specimens and specimens from eight of the other chimpanzees. Serum from a convalescent patient reacted in the same way. These positive sera did not react with liver sections from uninfected chimpanzees. No reaction with positive liver sections was given by serum from chimpanzees which were uninfected or had antibodies to hepatitis A or B antigens. These control results suggest that the antigen-antibody system detected has specificity for non-A, non-B hepatitis.

Animals↗