Biomedical subjects
Publications and source records attributed to A Lev.
Primary abdominal actinomycosis is very unusual. Only five previous cases have been reported in the English literature. We describe the case of a 57-year-old diabetic woman with primary abdominal actinomycosis, refractory to several antimicrobial regimens and surgical procedures. We conclude that primary abdominal actinomycosis in such a diabetic woman is an intractable disease.
The present study examined the effects of elastase, in concentrations present in respiratory secretions, on airway smooth muscle contractile responses in vitro and the magnitude of the airway epithelial inhibition of smooth muscle tension. Experiments were performed on 126 full-thickness tracheal strips from 25 rabbits. Isometric tension responses to acetylcholine (10(-8) to 10(-4) M) and potassium chloride (10 to 110 mM) were examined before and after a 5-min exposure to either porcine pancreatic elastase (PPE) or human neutrophil elastase (HNE). PPE (5 to 40 micrograms/100 microliters) reduced the tension response to acetylcholine but had no effect on the tension response to potassium chloride. PPE and HNE (20 micrograms/100 microliters) produced similar effects. Mechanical removal of the epithelium per se significantly (P less than 0.005) decreased the ED50 response to acetylcholine but did not affect maximal tension. However, the airway epithelial inhibitory effect on the acetylcholine tension response was similar in the presence and absence of PPE (20 micrograms/100 microliters). These data suggest that the diminution of tracheal smooth muscle tension responses to receptor-mediated agonists induced by elastase is a direct effect on the muscle and is not mediated by an effect of elastase on the respiratory epithelium.
Twelve patients suffering from superficial transitional cell carcinoma of the bladder underwent treatment combining simultaneous mitomycin C topical instillation and local endocavitary hyperthermia as a preoperative adjunct to transurethral resection in a preliminary clinical study. A specifically designed system to deliver and monitor local bladder hyperthermia was used. The feasibility, the subjective tolerance and the side effects of the combined treatment were the main target of our investigation. Endoscopic and histologic features, assessed before, during and after this combined approach, showed selective damage to neoplastic areas with minimal changes in the normal urothelium. Local intravesical concurrent chemotherapy and hyperthermia administration is found to be a safe and well-tolerated approach for superficial bladder tumor treatment. The preliminary results encourage further studies to define the limits and prospects of this regimen, in both superficial bladder tumor ablation and prophylaxis of recurrences.
Repeated treatments of localized deep microwave hyperthermia were given to a series of dogs by means of a 915 MHz, water-cooled skirt-type applicator. The applicator was inserted into the rectum and directed toward the prostate in order to heat it by means of the absorbed microwaves while keeping the rectal wall at a lower temperature by surface cooling of the applicator itself. Sessions were given for different lengths of time ranging between ninety minutes and five hours, during which the prostate temperature was kept at 42.5 degrees C (+/- 0.5 degrees C) or 44.5 degrees C (+/- 0.5 degrees C). Three-dimensional temperature distributions in the prostate were measured accurately and verified by a Luxtron Fluoroptic Unit. Temperatures were constantly monitored in the rectal wall and in the prostatic urethra. Thorough and systemic follow-up was done before, during, and after each treatment, and the observations are reported. Two interesting preliminary observations were made: (1) differential blood counts showed significantly monocytosis following the treatments and lasted for at least one week, and (2) values of creatinine phosphokinase (CPK) and serum glutamic oxaloacetic transaminase (SGOT) were found to rise irreversibly in those animals which were later found to have definite histopathologic evidence of localized necrotic damage.
The effect of local deep microwave hyperthermia (LDMWH) on normal and Zymosan-induced arthritis has been evaluated in 12 rabbits (24 joints). LDMWH, four treatments to each joint (twice weekly for a period of 2 wk), was generated by an antenna operating at 915 MHz for 60 min, reaching an intraarticular temperature of 42.5 +/- 0.5 degrees C. A surface cooling system was used with the microwave apparatus. Two weeks after the last treatment, all animals were sacrificed. The application of LDMWH on normal joints induced a limited proliferation of the synovial lining cells with a minimal perivascular infiltration of mononuclear and neutrophil cells. However, no histologic damage to the skin, muscles, bone, cartilage or bone marrow adjacent to the heated joints could be noted. Induction of Zymosan arthritis (2 wk before LDMWH) was characterized by pannus formation and granulomatous reaction accompanied by fibrinoid deposits and disseminated necrotic foci in the synovial intima. The LDMWH treatment on the examined arthritic joints brought about a reduction in the degree of granulomatous reaction concomitant with the appearance of some fibrocytes and fine collagen fibrils. These findings suggest that LDMWH can be safely applied, even repeatedly, without morphologic evidence of damage to any normal mesenchymal tissue. Moreover, it reduces the inflammatory process in experimentally induced synovitis.
Local hyperthermia of the prostate was used to treat 72 patients who had an indwelling catheter because of urinary retention caused by benign prostatic hypertrophy. One month after completion of treatment 50% of patients were able to dispense with the catheter and 1 year later 40% remained catheter-free. The best results were achieved in patients who underwent 6 to 10 treatment sessions in conjunction with cyproterone acetate 50 mg tid administered during the treatment period only.
The tracheobronchial epithelium produces factor(s) that modulate the constrictor and relaxant response of airway smooth muscle. The present study sought to determine whether the tracheobronchial epithelial inhibitory effect on trachealis smooth muscle tension is under muscarinic receptor control. Studies were performed on 195 strips from 13 rabbits. In strips in which the epithelium was intact, pirenzepine (an M1 receptor antagonist) produced a dose-related (10(-8) and 10(-7)M) rightward shift (P less than 0.01 for each) and gallamine (an M2 antagonist) produced a progressive (10(-8) and 10(-7)M) leftward shift of the acetylcholine concentration responses (P less than 0.01 for each). In strips in which the epithelium was removed mechanically, neither pirenzepine nor gallamine had any effect on the acetylcholine responses. In acetylcholine precontracted (5 x 10(-6) M) muscle strips with epithelium intact, addition of pirenzepine (10(-7)M) produced a significant (P less than 0.01) reduction in steady-state tension, whereas administration of gallamine tended to increase tension, (P = NS). Neither pirenzepine nor gallamine had any effect on steady-state tension in strips in which the epithelium was removed. These results indicate that the magnitude of the tracheobronchial epithelial inhibitory effect on smooth muscle tension is under muscarinic control. Specifically, M1 receptor blockade augments and M2 receptor blockade inhibits the magnitude of the tracheobronchial epithelial effect.
Local deep microwave hyperthermia (LDMWH) may be considered as a therapeutic tool for joint diseases because it has the advantage of heating the target organ e.g. synovium, while sparing the adjacent tissues, as demonstrated in animals. The effect of this new microwave device has been evaluated on seven rheumatoid arthritis patients with knee effusion. The hyperthermia apparatus consists of a 915 MHz power source with a cooling system to the skin. LDMWH was operated for one hour, twice a week for two weeks. Intra-articular knee temperature reached the level of 40.6 +/- 1.1 degrees C within 15 minutes, raised to 41.2 +/- 0.7 degrees C after 30 minutes and to 41.3 +/- 0.9 degrees C at one hour. The skin temperature over the heated knee joints remained at 24.3 +/- 1.1 degrees C during treatment. All patients noted a sensation of warmth in the treated knee. Aspiration of synovial fluid was performed before and immediately after each treatment. Walking time was improved (p = 0.04) and significant decrease in pain (p = 0.01) was noted following treatment. Synovial fluid leukocyte count and prostaglandin E2 level, knee circumference and range of motion did not change. Severity of pain, walking time, knee circumference and range of motion remained stable in the six weeks following the last hyperthermia application. No adverse reaction could be observed. These results suggest LDMWH to be safe and successful as an adjuvant treatment of chronic inflammatory joint effusions.
The tracheobronchial epithelium produces inhibitory substance(s) that alter the tracheal smooth muscle tension. This study examined the effect of changes in extracellular Ca2+ and temperature in vitro on the tension response of rabbit trachealis muscle to mechanical removal of the epithelium. Tension during acetylcholine- and KCl-induced contractions was examined at 0, 0.75, 1.5, 2.5, and 5 mM bath Ca2+ concentrations and at 37, 30, 23, and 41 degrees C bath temperature. At most extracellular Ca2+ concentrations (i.e., 0.75, 1.5, 2.5, and 5 mM), epithelial removal shifted the acetylcholine concentration response approximately one-half log to the left (P less than 0.001 for each condition) but had no effect on the responses to KCl (P = NS). Reductions in bath Ca2+ to 0 mM eliminated the epithelial inhibitory effect on the acetylcholine response. In contrast to the effects of reductions in Ca2+, cooling the airway to 30 and 23 degrees C progressively diminished the magnitude of the epithelial inhibitory effect. Our results indicate that the influence of the tracheal epithelium on tracheal smooth muscle responses to constrictor agonists is substance specific and can be diminished by reductions in tracheal temperature and extracellular Ca2+ concentration.
Superficial heating of the joint is widely used in various rheumatic conditions and is considered as decreasing the intra-articular temperature. This study shows that heating the joint with hot pack significantly increases the articular temperature from 35.2 +/- 1.5 degrees C (mean +/- SD) to 36.4 +/- 1.0 degrees C (p less than 0.001), while intra-cavity temperature of the contralateral unheated knee joint did not change significantly. Since such elevation of temperature of one degree C is liable to enhance the inflammatory process, the use of superficial heating has to be carefully reconsidered in acute and chronic inflammatory joint diseases.
There is now a growing body of clinical evidence suggesting a therapeutic approach to cancer and prostatic hypertrophy by using hyperthermia. It is proposed that such a hyperthermic modality can produce thermal synovectomy in inflammatory arthritis. Heating the joint cavity up to 42 deg C can inhibit the enzymatic effect of collagenase, oxygenase, and other enzymes playing a role in the inflammatory process. If this hypothesis is correct, therapeutic intervention using hyperthermia may offer hope for the treatment of isolated inflammatory joint diseases.
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A new method is described for the treatment of diseases of the prostate with local hyperthermia applied transrectally by microwaves. A series of 500 treatment sessions given to 74 patients with 14 controls, is reported. Thirty patients had advanced cancer of the prostate, 37 had benign hyperplasia and were unsuitable for surgery, and 21 had chronic prostatitis. Marked objective and subjective improvement was noted in the majority in twenty-four months of follow-up.
The respiratory parameters of some of the patients with acute respiratory failure deteriorates while using conventional ventilation. These patients suffer unilateral lung disease and the failure to respond favourably to therapy is due to increased intrapulmonary shunt. There is a reflex vasodilation in the injured lung. Functional residual capacity is reduced in the injured lung and the compliance decreases. Gas flow is then deviated to the other lung, thus increases alveolar collapse and decreases regional compliance in the injured lung. These events cause severe hypoxemia. We present here two cases with unilateral lung disease that failed to respond to conventional mechanical ventilation. Asynchronized differential lung ventilation was found to be the therapeutic answer to the problem. We discuss the pathophysiology of unilateral lung injury and the physiology of differential lung ventilation.
The Prostathermer (TM), a system designed to deliver hyperthermic treatment to the prostate gland, was used to treat six patients with benign prostatic hypertrophy and urinary retention. The 99-D model consists of a microwave generator operating at 915 MHz, an applicator with a built-in water cooling system, temperature probes and an IBM PC-XT type computer. The treatment regimen differed from patient to patient in the number of treatments (range 5-10), frequency per week (range 1-2), and average radiofrequency (RF) transmission. Sustained controlled heating of the prostatic tissue up to 39.4 to 45.2 degrees C was carried out for 60 min in each session. Five patients were relieved of their indwelling catheters and at follow-up 6 months after termination of therapy they were well by objective and subjective criteria. No complications were encountered. This is preliminary report of our results of treatment with 47 hyperthermic sessions in six patients.
Collagen has a stimulatory effect on the differentiation of skeletal muscle cells in culture. Putative collagen-binding proteins were isolated from detergent-solubilized cultures of the L6 rat muscle cell line and primary clonal cultures of human skeletal muscle satellite cells, using gelatin-Sepharose affinity chromatography. In addition to fibronectin, which has been reported by others to be synthesized by cultured muscle cells, we found that muscle cultures synthesized gelatin-binding proteins of lower apparent molecular weight. Only one of these proteins was secreted into the growth medium and bound to type I collagen. Binding of this protein to gelatin and collagen-Sepharose was resistant to repeated washing with 1 M NaCl and nonionic detergent. The secreted gelatin-binding protein had an apparent molecular weight of 63,000-72,000, depending upon the conditions of electrophoresis. The lack of reactivity of the secreted protein with polyclonal antisera against fibronectin, the lack of effect of protease inhibitors on its appearance in the medium, and the rapid de novo production of the protein during pulse labeling with radioactive methionine indicated that it was not a fibronectin fragment. The rate of synthesis of the secreted gelatin-binding protein increased markedly during the myogenesis of rat and human cultures.
Eleven patients suffering severe traumatic respiratory insufficiency were mechanically ventilated using a new system which combined high-frequency positive-pressure ventilation (HFPPV) with low-rate conventional mechanical ventilation (LRCMV). Ten similar patients were ventilated by conventional mechanical ventilation (CMV) with PEEP. HFPPV patients were fully conscious and cooperative during ventilation and did not need sedatives or muscle relaxants. Arterial oxygenation was significantly (p less than .005) better in HFPPV than CMV patients (89.91 +/- 10.24 vs. 78.43 +/- 11.13 torr, respectively), and pulmonary shunt was also better in the HFPPV group (13.1 +/- 4.7% vs. 20.4 +/- 6.4%, p less than .01). Moreover, inspired oxygen concentrations were lower (PaO2/FIO2 197.8 +/- 51.3 in the HFPPV group vs. 130 +/- 46.6 in the CMV group, p less than .005) and the time required for mechanical ventilation was shorter (4.2 +/- 0.91 vs. 6.1 +/- 0.8 days, p less than .1). All HFPPV patients immediately began breathing spontaneously when they were disconnected from the ventilator. We suggest this method as a better ventilatory mode for patients suffering traumatic respiratory insufficiency.
Heating the joint to high temperatures using a microwave device may inhibit metabolic activity of the synovial tissue and enable higher penetration of antiinflammatory drugs into the joint cavity. To measure the temperature distribution of local thermotherapy, the hind joints of eight rabbits were heated by a 915 MHz microwave power source, using a special applicator. Temperatures of 44.0 +/- 2.8C, 36.1 +/- 3.8C, 39.6 +/- 2.3C, and 35.2 +/- 1.5C were measured after heating in the joint cavity, cartilage, muscle, and skin, respectively. The only significant increase in the temperature was recorded in the heated joint cavity (p less than 0.01). This new microwave device can be a therapeutic tool in treating joint diseases because of its advantage of heating the target organ only, eg, synovium, while sparing the adjacent tissues.