Clinical impressions.
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Clinical Competence↗
Biomedical subjects
B Hesse
Publications and source records attributed to B Hesse.
The reliability of measuring left ventricular ejection fraction by radionuclide cardiography: evaluation by the method of variance components.
A statistical model based on the method of variance components was applied to obtain confidence statements for single and repeat determinations of left ventricular ejection fraction by radionuclide techniques. With this approach variance caused by individual factors in the measurement procedure is estimated to allow calculation of confidence intervals based on single measurements and the detection limits for changes. Six study groups made up of a total of 143 subjects were examined by both multigated equilibrium and first pass imaging. Under favourable conditions (with an updated gamma camera and experienced observer) the 95% confidence interval with a single measurement of left ventricular ejection fraction by equilibrium imaging was +/- 3 ejection fraction units, compared with +/- 6 units with the first pass technique (one ejection fraction unit = 1/100 of the possible values from 0.00 to 1.00). The minimal significant changes (at the 5% level) in measured equilibrium left ventricular ejection fraction at intervals of 15 min, 3 days, 1, 3, and 4 weeks were +/- 4, +/- 4, +/- 5, +/- 5, and +/- 6 units, respectively. The corresponding minimal detectable changes in a subject's "true" left ventricular ejection fraction for the same intervals were +/- 7, +/- 7, +/- 10, +/- 10, and +/- 12 units respectively. With first pass imaging, only average values for the variation at repeat determination could be calculated. The minimal significant change in measured first pass left ventricular ejection fraction was +/- 7 units, and the minimal detectable change in "true" left ventricular ejection fraction was +/- 14 units. Measurements of left ventricular ejection fraction by equilibrium technique were generally more reproducible than first pass determinations because the variability caused by study acquisition, observer analysis, and residual errors was smaller. The method of variance components appears to be well suited to the evaluation of quantitative biological measurements in clinical use. The popularity of established procedures may obscure the lack of basic information about method evaluation.
Adult↗
The diagnostic value of computerized short-term oesophageal pH-monitoring in suspected gastro-oesophageal reflux.
In 109 consecutive patients suspected of having gastro-oesophageal reflux (GOR) a 3.5-h pH-monitoring in the oesophagus was performed during the daytime. The data were stored in a portable recording system, and three different variables (mean pH, mean acid clearance rate, and number of spikes) were calculated. Compared with a combined endoscopic-histologic score for the diagnosis of oesophagitis, assumed to be due to GOR, the 3.5-h pH-monitoring had a sensitivity of 85% and a specificity of 81%. The data suggest that the short-term pH-monitoring is almost as accurate as the traditional 24-h pH-monitoring and more convenient both for the patient and the gastroenterologic unit.
Adolescent↗
Uniform detection of immunoglobulin-gene rearrangement in benign lymphoepithelial lesions.
The term "benign lymphoepithelial lesion" is used to describe the salivary-gland lymphocytic infiltration and epithelial changes typically found in association with Sjögren's syndrome. We used Southern blot hybridization techniques to examine the immunoglobulin genes in salivary-gland tissue derived from eight patients with benign lymphoepithelial lesions. Three of these patients had intrasalivary non-Hodgkin's lymphoma complicating the lesions, whereas the lesions in the remaining five were all histologically benign. Ten samples from the eight patients all revealed rearrangement of both the heavy-chain and light-chain immunoglobulin genes. In one of the patients in whom non-Hodgkin's lymphoma involved both the salivary-gland lesion and an ipsilateral lymph node, the rearrangements of the heavy-chain and light-chain immunoglobulin genes detected at the two sites were identical. One other patient had two distinct benign lymphoepithelial lesions removed two years apart. The rearrangements of the heavy-chain as well as the kappa light-chain genes detected in these two lesions were entirely different. These data suggest that B-cell clonal expansion has an integral role in the pathophysiology of the benign lymphoepithelial lesion and may explain the increased incidence of lymphoma noted in association with this disorder.
Adult↗
Mitral valve prolapse with mobile polypoid cul-de-sac thrombus and embolism to brain and lower extremity.
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Aged↗
Scintigraphic assessment of oesophageal motility.
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Esophagus↗
[The action of benzydamine on phospholipase activation].
The effects of the antiinflammatory drug benzydamine (Tantum) on phospholipase activities were determined in vitro, employing various enzyme preparations (rat liver plasma membranes, endoplasmic reticulum, lysosomes; human seminal plasma) and stereospecifically radiolabeled phosphatidylethanolamines as substrates. Fatty acid release from the sn-2 position was inhibited at drug concentrations above 10(-5) mol/l. Concerning the mode of inhibition, a mixed type was found for the soluble phospholipase A2. Impaired fatty acid release from the sn-2 position might contribute to the mechanism of antiinflammatory action of benzydamine by rendering less free precursor acid available for the synthesis of eicosanoids. Fatty acid release from the sn-1 position was inhibited at benzydamine concentrations from 10(-6)-10(-2) mol/l only in lysosomes, whereas in plasma membranes and endoplasmic reticulum it was stimulated, maximally (at 10(-3) mol/l) about 25% and 50%, respectively.
Animals↗
Diacylglycerol hydrolysis in rat liver lysosomes.
The matrix of rat liver lysosomes exhibits high hydrolytic activity towards 1,2-diacylglycerol with an optimum at pH 4.0. The lipolytic reaction follows Michaelis-Menten kinetics (apparent Vmax 470 nmol hydrolysed/min per mg protein; apparent Km 71 microM 1,2-dioleoylglycerol). Formation of 1- and 2-monooleoylglycerols indicates an initial attack at both the primary and secondary ester bonds. The lysosomal matrix also catalyses (re)acylation reactions, i.e. the formation of 1,2-diacylglycerol from 2-monoacylglycerol and free fatty acid. However, (re)acylation proceeds at a far lower rate than deacylation of diacylglycerol. Lysosomal diacylglycerol hydrolysis is sensitive towards non-ionic detergents, cationic amphiphilic drugs and the lipase inhibitor RHC 80267.
Acid Phosphatase↗
Renal handling of angiotensins I and II in patients with renovascular hypertension.
Plasma renin (PRC) and angiotensin I (pANG I) and II (pANG II) concentrations were determined at renal vein catheterization in 38 hypertensive patients suspected of renal or renovascular aetiology. Veno-arterial differences in pANG I across the affected kidney in patients with lateralization of the renin secretion indicated release of angiotensin I (ANG I) in considerable amounts. Veno-arterial differences in pANG II of around zero indicated that generation and elimination of angiotensin II (ANG II) were equal in that kidney. Across the contralateral kidney the veno-arterial differences in PRC and pANG II were both close to zero, while negative differences in pANG II indicated the removal of ANG II. In patients without lateralization of the renin secretion the veno-arterial differences in pANG I were close to zero or positive, those of pANG II being close to zero or negative. In 14 of the 38 patients, data were obtained either during maintenance treatment with captopril or after a single dose of this converting enzyme inhibitor. Systemic PRC and pANG I values were extremely high and pANG II values low. The pANG I gradient across the affected kidney was further increased compared with pre-captopril levels, whereas the contralateral kidney still eliminated ANG I.
Adolescent↗
Haemodynamic and humoral effects of lower body negative pressure in normal, sodium-replete man during angiotensin-converting enzyme inhibition with captopril.
The significance of the renin-angiotensin system (RAS) for circulatory homeostasis during gravitational stress (10 min of lower body negative pressure, LBNP, at -40 mmHg) was investigated in eight men on liberal sodium intake. The function of RAS was inhibited by a single oral dose of 100 mg captopril, an angiotensin-converting enzyme inhibitor. Plasma concentrations of renin and angiotensin I were normal before and increased after captopril and during LBNP. Plasma concentration of angiotensin II was normal before captopril, increased during LBNP, and fell to low values after captopril. Systolic blood pressure decreased more during LBNP after captopril than in the control situation. In three cases, the LBNP experiment after captopril had to be interrupted due to marked hypotension. Heart rate and plasma concentration of adrenaline increased above pre-captopril levels. In six subjects, plasma concentration of noradrenaline increased more during LBNP after captopril, less in two subjects, whereas the arginine vasopressin concentration increased more after captopril in all five subjects where measurements were available. The results demonstrate that RAS participates in blood pressure homeostasis also in sodium-replete, normal man. The enhanced increases in heart rate and plasma catecholamines after captopril do not suggest that sympathetic reflex activity during gravitational stress is blunted after captopril, in contrast to the evidence from animal experiments.
Adult↗
The influence of the renin-angiotensin system on adrenergic vasoconstrictor responses in the forearm and splanchnic region in sodium deplete man.
In sodium deplete subjects forearm (FBF) and splanchnic (SBF) blood flows were measured at rest and during lower body negative pressure (LBNP) before and during angiotensin II (ANG II) blockade. Both FBF and SBF were reduced by LBNP. Forearm blood flow and forearm vascular resistance were unaffected by ANG II blockade (intra-arterial saralasin, n = 6; i.v. enalapril, n = 9) both at rest and during LBNP. In contrast, resting SBF increased and splanchnic vascular resistance decreased after i.v. enalapril (n = 10). The low resistance was completely unchanged during the following LBNP. It is concluded that acute ANG II blockade has no influence on the vascular resistance in the human forearm, but increases basal SBF in sodium depleted subjects and 'paralyses' the vasoconstrictor response to LBNP.
Angiotensin II↗
[Heptadactylia of the foot--report of a rare abnormality].
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Humans↗
Effects of antimalarial drugs on phospholipase A and lysophospholipase activities in plasma membrane, mitochondrial, microsomal and cytosolic subcellular fractions of rat liver.
Activities of membrane-associated phospholipases A1 and A2, and membrane-associated as well as soluble lysophospholipases were measured in different subcellular fractions of rat liver, using suspensions of stereospecifically labelled radioactive phospholipids as substrates. Plasma membranes and endoplasmic reticulum were shown to contain phospholipase A1 and lysophospholipase activities, both of which could be stimulated by Ca2+, mitochondria Ca2+-dependent phospholipase A2 and cytosol Ca2+-independent lysophospholipase activities. Each of these lipolytic enzymes could be inhibited by antimalarial drugs (chloroquine, mepacrine, primaquine) at concentrations above 1 x 10(-4) M. Inhibition of the alkaline cytosolic lysophospholipase by these drugs was noncompetitive with respect to the substrate, and the inhibitory potency increased, when the pH was raised.
Animals↗
Urinary excretion of kallikrein before and after operation for aldosterone-producing adenoma.
Urinary kallikrein excretion (UKal), determined by the esterase method, was measured in 10 normotensive volunteers, 10 patients with essential hypertension and in 7 patients with primary aldosteronism before and after operative removal of the adenoma. UKal values were low in 5 of the patients with essential hypertension. Preoperative UKal values in the patients with aldosteronism did not differ significantly from those of the normal subjects, but decreased in all after operation in parallel with changes in urinary excretion of tetrahydroaldosterone and plasma aldosterone concentration. The study supports the assumption of an association between the renal kallikrein-kinin system and the mineralocorticoid state in man.
Adenoma↗
Decrease in beta-receptor density explaining the development of pindolol- and prenalterol-tolerance in orthostatic hypotension.
A 58-year-old woman with diabetic autonomic dysfunction was well treated for orthostatic hypotension with pindolol. After eight months however, symptoms recurred in spite of continued treatment with pindolol. Addition of prenalterol, a beta-blocking agent with very high intrinsic sympathomimetic activity, had a marked clinical effect on her orthostatic hypotension. Before treatment with prenalterol, stroke volume and left ventricular enddiastolic volume markedly decreased during tilt, as demonstrated by radionuclide angiography. After short-term prenalterol treatment, the orthostatic decreases of stroke volume and left ventricular end-diastolic volume were less pronounced. During continued prenalterol treatment, both symptoms and haemodynamic changes recurred in the erect position. Beta-receptor density in her lymphocytes decreased from elevated levels before prenalterol to subnormal levels, when the clinical effect had disappeared. The data suggest that the tolerance development to prenalterol may be explained by the decrease in beta-adrenergic receptor density.
Adrenergic beta-Agonists↗
A combined assay of three lysosomal marker enzymes: acid phosphatase, beta-D-glucuronidase, and beta-N-acetyl-D-hexosaminidase.
A simplified and rapid method for simultaneous activity measurements of three lysosomal marker enzymes, acid phosphatase, beta-glucuronidase, and beta-N-acetyl-D-hexosaminidase is described. The incubation is carried out in a single test tube and stopped by adding an alkaline sodium dodecyl sulfate solution, thus avoiding centrifugations and allowing for higher Triton X-100 concentrations in the incubation media. Two products of the beta-glycosidases (phenolphthalein and 2-nitrophenolate) are measured spectrophotometrically at the respective wavelengths (555 and 420 nm), and one of the acid phosphatase products is quantitatively determined by measuring inorganic phosphate.
Acid Phosphatase↗
[Angioscintigraphy of the iliac arteries. Diagnostic value and observer variation].
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Adult↗
Spontaneous tumors and lifespan of female NMRI mice of the outbred stock Sut:NMRT during a lifetime study.
A group of 150 female NMRI mice of the outbred stock Sut:NMRT was kept until they died naturally, at which time they were necropsied and examined histologically for spontaneous tumors. The natural life expectancy (median) was 782 days. Life expectancy was markedly reduced by mammary and pulmonary adenocarcinoma, and by tumors of the hypophysis. The spontaneous tumor rate was 58%. That is to say, 87 of the 150 mice had spontaneous tumors: 57 animals each had one tumor, 20 animals each had two tumors, and 10 animals each had three tumors. The organs most commonly affected by tumors were those of the lymphoreticular and haematopoietic systems, followed by the respiratory tract in second place and the breast in third place. Data reported in the literature generally show the same organ distribution, but the total tumor rate given is generally somewhat lower as the animals are seldom left alive until they die naturally (spontaneously).
Aging↗