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Biomedical subjects

A Geissler

Publications and source records attributed to A Geissler.

At least 37 records · Page 2Linked to original sources

Membrane potential-driven protein import into mitochondria. The sorting sequence of cytochrome b(2) modulates the deltapsi-dependence of translocation of the matrix-targeting sequence.

The transport of preproteins into or across the mitochondrial inner membrane requires the membrane potential Deltapsi across this membrane. Two roles of Deltapsi in the import of cleavable preproteins have been described: an electrophoretic effect on the positively charged matrix-targeting sequences and the activation of the translocase subunit Tim23. We report the unexpected finding that deletion of a segment within the sorting sequence of cytochrome b(2), which is located behind the matrix-targeting sequence, strongly influenced the Deltapsi-dependence of import. The differential Deltapsi-dependence was independent of the submitochondrial destination of the preprotein and was not attributable to the requirement for mitochondrial Hsp70 or Tim23. With a series of preprotein constructs, the net charge of the sorting sequence was altered, but the Deltapsi-dependence of import was not affected. These results suggested that the sorting sequence contributed to the import driving mechanism in a manner distinct from the two known roles of Deltapsi. Indeed, a charge-neutral amino acid exchange in the hydrophobic segment of the sorting sequence generated a preprotein with an even better import, i.e. one with lower Deltapsi-dependence than the wild-type preprotein. The sorting sequence functioned early in the import pathway since it strongly influenced the efficiency of translocation of the matrix-targeting sequence across the inner membrane. These results suggest a model whereby an electrophoretic effect of Deltapsi on the matrix-targeting sequence is complemented by an import-stimulating activity of the sorting sequence.

Amino Acid Sequence↗

Magnetic resonance monitoring of stent deployment: in vitro evaluation of different stent designs and stent delivery systems.

RATIONALE AND OBJECTIVES: To evaluate MR imaging features of commercially available stents before, during, and after in vitro deployment as a step toward MR-guided stent deployment. METHODS: Fourteen stents were deployed in a phantom under MR monitoring at 1.5 T by using a gradient-echo sequence. Device visibility was rated on a four-point scale (excellent, fair, poor, not visible). RESULTS: The Memotherm stent and the rolling membrane (RM) Wallstent showed excellent stent visibility and at least fair scores for artifact-induced narrowing of the stent lumen. Three stents (Palmaz, AVE, Easy Wallstent) showed excellent visibility of the stent but no visible lumen. Five stents (Strecker, Accuflex, Hemobahn, Passager, Sinus) displayed fair visibility. The delivery catheters of four stent systems (Smart, Vascucoil, Symphony, ZA) displayed severe black hole artifacts. CONCLUSIONS: The imaging features of several stent systems might be suitable for MR-guided intervention. The Memotherm and the Wallstent RM combine good visibility of the stent and the lumen.

Blood Vessel Prosthesis↗

Postpartum cerebral angiopathy associated with the administration of sumatriptan and dihydroergotamine--a case report.

Cerebral angiopathy of the postpartum period is a rare entity, sometimes promoted by vasoconstrictives drug prescription. Its clinical presentation includes headaches, seizures and focal neurological deficits, which develop shortly after a normal pregnancy. The diagnosis is based on clinical findings and angiography, showing multiple narrowing of the intracranial cerebral arteries. This neurological feature is reversible and the clinical outcome is good. We report a case of benign cerebral angiopathy in a 20-year-old woman in the postpartum period, occurring after administration of sumatriptan and ergot derivates.

Adult↗

Economic impact of a rational use of antibiotics in intensive care.

OBJECTIVE: To evaluate the economic impact of a rational policy in antibiotic treatment. DESIGN: Comparative study with a retrospective and a prospective part. SETTING: An 11-bed intensive care unit (ICU) in a general hospital. PATIENTS: All patients admitted to the unit in 1994, 1995 and 1996. INTERVENTIONS: In 1995, a program of cost control was started and a contract of agreed objectives signed with the director of the hospital. This contract included a commitment to refund the eventual savings in order to improve the quality of care. Prescribing protocols were established by consensus as guidelines for a rational policy in antibiotic therapy. MEASUREMENTS AND RESULTS: The cost of antibiotic therapy, the patients' characteristics and the incidence of nosocomial infection were compared prior to and during the program. The expenses for antibiotic drugs decreased by 19% in 1995 and by 22% in 1996. Most of the savings were refunded to the ICU and contributed to the employment of an additional nurse and the purchase of new material. In number of patients, type of disease, mean age, Simplified Acute Physiology Score, occupancy rate, length of stay, omega score, artificial ventilation, readmission within 7 days, mortality and incidence of nosocomial infection, no significant difference was found. CONCLUSIONS: We proved a positive economic impact of a rational policy in antibiotic therapy realized with a contract of agreed objectives. The savings made while applying our program of cost control were used to improve the quality of care.

Anti-Bacterial Agents↗

Separation of structural and dynamic functions of the mitochondrial translocase: Tim44 is crucial for the inner membrane import sites in translocation of tightly folded domains, but not of loosely folded preproteins.

The essential gene TIM44 encodes a subunit of the inner mitochondrial membrane preprotein translocase that forms a complex with the matrix heat-shock protein Hsp70. The specific role of Tim44 in protein import has not yet been defined because of the lack of means to block its function. Here we report on a Saccharomyces cerevisiae mutant allele of TIM44 that allows selective and efficient inactivation of Tim44 in organello. Surprisingly, the mutant mitochondria are still able to import preproteins. The import rate is only reduced by approximately 30% compared with wild-type as long as the preproteins do not carry stably folded domains. Moreover, the number of import sites is not reduced. However, the mutant mitochondria are strongly impaired in pulling folded domains of preproteins close to the outer membrane and in promoting their unfolding. Our results demonstrate that Tim44 is not an essential structural component of the import channel, but is crucial for import of folded domains. We suggest that the concerted action of Tim44 and mtHsp70 drives unfolding of preproteins and accelerates translocation of loosely folded preproteins. While mtHsp70 is essential for import of both tightly and loosly folded preproteins, Tim44 plays a more specialized role in translocation of tightly folded domains.

Adenosine Triphosphatases↗

[Nasogastric tube: intratracheal malposition and entrapment in a bronchial suture].

We report the unrecognized accidental intratracheal insertion of a nasogastric tube, following endotracheal intubation in a patient scheduled to undergo right lower lobectomy for carcinoma. After surgery, which had an unremarkable course, the trachea was extubated. However, the gastric tube was entrapped and attempts to withdraw it elicited fits of coughing. A chest X-ray showed the tube malpositioned in the right bronchus. A fibreoptic bronchoscopy did not permit removal of the tube extremity which was embedded in the bronchial suture. Finally an additional thoracotomy was required to withdraw the tube securely. The manifestations of the intratracheal position of a nasogastric tube as well as the preventive and diagnostic measures of such a complication are considered.

Aged↗

The accuracy of abdominal ultrasound in the assessment of bowel disorders.

BACKGROUND: Little is known about the sensitivity, specificity, and predictive values of transabdominal ultrasonographic (US) findings in a teaching hospital setting. METHODS: We carried out a prospective study including 227 patients with symptoms suggestive of inflammatory bowel disorder. The Picker 9200 CS equipment (5-mHz curved-array probe) was used to obtain bowel images. Gastrointestinal endoscopy, enteroclysis, bowel enema, computed tomography scan, or bowel surgery was used as reference. RESULTS: Of 227 patients, 168 had pathologic findings of the bowel as final diagnosis. The overall sensitivity of US was 76%, whereas the positive predictive value was 98%. Overall specificity was 95%. The negative predictive value for bowel disorders was only 58%, since US missed pathologic findings in 48 patients. Subgroup analysis showed a sensitivity of 84% for Crohn's disease, 66% for ulcerative colitis, 46% for bowel tumors, and 60% for diverticulitis. Topographic comparisons showed that US detected inflammatory bowel-wall alterations preferentially in the terminal ileum and colon, whereas abnormalities in the duodenum, jejunum, and rectum were frequently missed (sensitivity, 10%-20%). CONCLUSIONS: Positive US findings are useful for the diagnosis of bowel processes. US is highly predictive albeit not disease-specific. Negative US examinations, however, do not exclude pathologic bowel processes. A topographic location of pathologic US findings is mostly confined to the colon.

Adult↗

Magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) of intracranial lipomas.

We show a detailed magnetic resonance (MR) examination of two rare pericallosa lipomas with a fat suppression imaging sequence and proton MR spectroscopy. For comparison, subcutaneous fat and lipids in glioblastomas were examined with H MR spectroscopy in vivo and ex vivo. Fat suppression makes the identification of lipomas simple. It is suggested that H MR spectroscopy shows no differences in the aliphatic chain length of lipoma and subcutaneous fat, whereas lipids in glioblastomas have a much shorter chain length. Chain length of fatty acids in lipoma measured with in vivo MR spectroscopy are in concordance with data from the literature.

Adipose Tissue↗

Surgical management of Candida suppurative thrombophlebitis of superior vena cava after central venous catheterization.

Septic deep venous thrombosis is a major complication associated with central venous catheterization in intensive care units. The most common causative organisms are Staphylococcus aureus, gram-negative bacilli and Candida species. The incidence of Candida infections is increasing, especially in intensive care patients receiving total parenteral nutrition and long-term broad-spectrum antibiotics. Although intravascular catheter-induced septic thrombophlebitis is quite common, superior vena cava obstruction is a rare complication. However, few data exist concerning the best strategy for managing septic thrombophlebitis, especially when medical therapy fails. We report successful surgical management of Candida albicans suppurative thrombosis of the superior vena cava in a young patient.

Adolescent↗

[Economic impact of a prescription protocol in an intensive care unit].

OBJECTIVE: To assess the economic impact of a prescribing protocol for i.v. fluid therapy and artificial nutrition. STUDY DESIGN: Comparative study, before and during use of the protocol. PATIENTS: The study included 555 ICU patients allocated into two groups, before and after starting with the protocol. The groups were comparable for number, pathologies, age, severity score, duration of ICU stay, incidence of nosocomial infections, mortality rate. METHOD: In February 1995, a written literature-based prescribing protocol for fluid therapy (hydroxyethylstarch and albumin), and artificial nutrition (enteral nutrition as first-line therapy) was devised. A cost analysis was made for two 6-month periods: before (August 1994 to January 1995) and after start of protocol (February to July 1995). RESULTS: The prescription of albumin and hydroxyethylstarch decreased (by 33 and 58% respectively), whereas administration of Ringer lactate and gelatine solutes increased simultaneously. This induced a cost saving of 15,000 FF (a 20% decrease in cost). The reduction of parenteral nutrition in favour of early enteral nutrition induced a cost saving of 56,000 FF (31% decrease in cost). CONCLUSION: Our prescribing protocol generated a cost saving of 9% of the pharmaceutical budget and decreased the cost-benefit ratio of our ICU.

Adult↗

Cerebral abnormalities in patients with cirrhosis detected by proton magnetic resonance spectroscopy and magnetic resonance imaging.

Hepatic encephalopathy is a common problem in cirrhosis. The pathogenesis of this complication of advanced liver disease still remains unclear. Magnetic resonance spectroscopy was used to assess prospectively cerebral metabolism in 51 patients with histologically proven cirrhosis (Child-Pugh classes A, B, and C, 18, 18, and 15, respectively) and 36 healthy volunteers. According to the results of psychometric tests, overt hepatic encephalopathy, subclinical encephalopathy, and no encephalopathy were found in 14, 21, and 16 patients, respectively. Myoinositol/creatine ratios in gray (.36 +/- .17) and white (.35 +/- .22) matter voxel were reduced significantly (P < .0001) in cirrhotic patients compared with healthy volunteers (gray matter, .51 +/- .11; white matter, .64 +/- .16). In addition, patients showed a significant reduction (P = .024) in white matter choline/creatine ratio (.77 +/- .27) compared with controls (.92 +/- .25), and glutamine/glutamate level was elevated in cirrhotic patients compared with controls (gray matter, P < .0001; white matter, P = .036). Changes in cerebral myoinositol and glutamine/glutamate levels correlated significantly with the severity of hepatic encephalopathy (P < .0001). However, these metabolic alterations were also detected in patients without hepatic encephalopathy (normal psychometric test results). N-acetyl aspartate/creatine ratios did not differ between patients and controls. Magnetic resonance imaging detected bright basal ganglia in 37 patients, which correlated significantly with portal-systemic shunting and elevation of glutamine/glutamate, but not with the degree of hepatic encephalopathy. In conclusion, magnetic resonance imaging and spectroscopy showed that alterations of cerebral metabolism are common in patients with cirrhosis, even without evidence of clinical or subclinical hepatic encephalopathy.

Adult↗

Focal white-matter lesions in brain of patients with inflammatory bowel disease.

Inflammatory bowel diseases are often associated with extra-intestinal manifestations, such as arthritis and iritis/uveitis. Using magnetic-resonance imaging we found hyperintense focal white-matter lesions in the brain in 20 of 48 (42%) patients with Crohn's disease, in 11 of 24 (46%) patients with ulcerative colitis, but in only 8 of 50 (16%) healthy age-matched controls (relative risk [95% CI] vs controls 2.6 [1.3-5.3] and 2.9 [1.3-6.2], respectively). These findings may represent another extra-intestinal manifestation of inflammatory bowel disease.

Adult↗

Cerebral metabolite patterns in dialysis patients: evaluation with H-1 MR spectroscopy.

PURPOSE: To analyze metabolic changes in the brain of patients undergoing dialysis. MATERIALS AND METHODS: Sixteen patients undergoing hemodialysis, 10 patients undergoing continuous ambulatory peritoneal dialysis (CAPD), and 42 healthy volunteers underwent magnetic resonance (MR) spectroscopy and MR imaging. Spectra were obtained from one occipital gray matter voxel and one parietal white matter voxel. Changes in N-acetylaspartate (NAA), choline (Cho), myo-inositol and glycine (Myo), and creatine (Cr) were analyzed and the results presented as ratios, with Cr as the reference. RESULTS: Three abnormalities were observed in the spectra of the hemodialysis patients: (a) significant elevation of the Cho/Cr ratio in gray matter, (b) significant elevation of the Myo/Cr ratio in gray matter, and (c) significant reduction of the NAA/Cr ratio in gray and white matter. The strongest metabolic alterations were found in cortical gray matter. In CAPD patients, only gray matter Cho/Cr ratio was significantly elevated. An increased frequency of focal white matter lesions was observed on MR images in the dialysis patients. CONCLUSION: Proton MR spectroscopy is useful for in vivo monitoring of metabolic alterations in the brain due to chronic dialysis.

Adult↗

Renal arteries: evaluation with optimized 2D and 3D time-of-flight MR angiography.

PURPOSE: To compare two-dimensional (2D) and three-dimensional (3D) time-of-flight (TOF) techniques in magnetic resonance (MR) angiography of renal arteries. MATERIALS AND METHODS: In 46 patients, MR angiography was performed with 3D tilted optimized non-saturating excitation (TONE), 3D fast imaging with steady precession (FISP), and 2D fast low-angle shot (FLASH) during breath holding. Intraarterial angiography was used as a reference. MR angiograms were evaluated for stenoses, length of renal arteries, accessory arteries, venous overlap, and image quality. RESULTS: The 3D TONE sequence was best for detection of severe stenoses (sensitivity, 100%; specificity, 89%), delineation of accessory arteries, and image quality. Overlap of renal veins was the most important disadvantage of 2D FLASH. Decreased saturation effects, however, can be advantageous in 2D TOF imaging. CONCLUSION: Use of the 3D TONE sequence provided improved image quality and diagnostic value compared with 3D FISP technique. The 2D TOF sequence can be useful in combination with the 3D TONE sequence.

Adult↗

Three-dimensional MP-RAGE--an alternative to conventional three-dimensional FLASH sequences for the diagnosis of viscerocranial tumours?

Imaging with three-dimensional (3D) sequences is a frequently used magnetic resonance (MR) technique in the assessment of ear, nose and throat (ENT) tumours near the skull base. Few reports on the contrast behaviour of 3D magnetization prepared rapid gradient echo (MP-RAGE) sequences and their application in ENT tumours exist in the published literature. This paper discusses whether 3D MP-RAGE is an alternative to conventional 3D gradient echo (3D GE) sequences for the diagnostic evaluation of the visceral cranum. Measurements were performed with a Magnetom SP 63 MR system (Siemens) at 1.5 T. 10 healthy volunteers were examined using 3D FLASH sequences with varied flip angles (90 degrees, 70 degrees, 40 degrees, 20 degrees, 10 degrees) and using 3D MP-RAGE to optimize the signal-to-noise ratio (SNR) of muscle, fat and gland tissue. After this optimization 25 patients with ENT tumours near the skull base were examined with 3D FLASH 40 degrees, 3D MP-RAGE 10 degrees (both before and after application of contrast medium) and with 3D FISP 70 degrees (without contrast medium). SNR and contrast-to-noise ratio (CNR) of tumour, inflammatory disease, brain (white and grey matter), compact bone, fat and muscle were calculated. The advantages of 3D MP-RAGE over 3D FLASH 40 degrees include decreased imaging time with decreased motion artifacts and a relatively high contrast between tumour and surrounding tissues. The tissue contrast yielded by the T1/T2* weighted 3D gradient echo sequence FISP with a flip angle of 70 degrees was not as good as that yielded by 3D MP-RAGE with and without contrast together. In conclusion a combination of contrast enhanced and unenhanced 3D MP-RAGE sequences is the technique of choice for the examination of ENT tumours near the base of the skull.

Adult↗