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Biomedical subjects

D Schuller

Publications and source records attributed to D Schuller.

34 records · Page 2Linked to original sources
PubMed1993

Herpes simplex virus from respiratory tract secretions: epidemiology, clinical characteristics, and outcome in immunocompromised and nonimmunocompromised hosts.

PURPOSE: The purpose of this study was to review the course of patients with herpes simplex virus (HSV) recovered from respiratory tract secretions, and to compare the demographics, clinical characteristics, and outcomes of immunocompromised versus nonimmunocompromised patients. PATIENTS AND METHODS: Retrospective review of medical records of 42 consecutive patients who had respiratory tract cultures positive for HSV-1 between May 1988 and August 1990 at a major university-affiliated hospital. RESULTS: Twenty-seven patients (64%) were not immunocompromised. On the average, the nonimmunocompromised patients were 20 years older (mean age: 67 +/- 15, p = 0.001), had a higher incidence of tobacco smoking (p = 0.04), and were more frequently endotracheally intubated prior to HSV isolation (p = 0.002). Nonimmunocompromised patients more frequently had bronchospasm (44% versus 7%, p = 0.01), leukocytosis (16,400 versus 6,900/mm3, p = 0.001), and difficulty weaning from mechanical ventilation (63% versus 13%, p = 0.002). Mortality was also greater in the nonimmunocompromised group (70% versus 33%, p = 0.02). In addition, for survivors, days of mechanical ventilation (8 +/- 7 versus 2 +/- 4, p = 0.03), length of stay in the intensive care unit (10 +/- 8 versus 2 +/- 4 days, p = 0.004), and length of stay in the hospital (37 +/- 23 versus 16 +/- 14 days, p = 0.04) were all significantly longer for the nonimmunocompromised patients. CONCLUSION: These data suggest that HSV isolation from lower respiratory secretions is associated with a more severe presentation and a worse outcome in immunocompetent patients than in immunosuppressed patients.

Adult↗
PubMed1993

[Langerhans cell histiocytosis].

The authors describe a case of a 4 years old boy. In connection with this case they discuss the latest classification of histiocytosis accepted by the Histiocytosis Society, and the stomatological aspects of the disease (severe gingivitis, necrosis of the gingivae, ulceration, and high degree of tooth mobility). The new classes of the disease: Langerhans cell's histiocytosis, Non-Langerhans cell's histiocytosis, malignant histiocytosis.

Antineoplastic Agents↗
PubMed1993

A new immunoassay for soluble fibrin enables a more sensitive detection of the activation state of blood coagulation in vivo.

A novel sandwich immunoassay for measurement of soluble fibrin in plasma has been developed. For immunization we used the synthetic heptapeptide Gly-Pro-Arg-Val-Val-Glu-Arg representing the amino terminus of the alpha-chain of human fibrin. A monoclonal IgG1 antibody was obtained by conventional hybridoma technology. To increase convenience, the sandwich immunoassay was developed for the Enzymun-Test systems which are based on streptavidin pre-coated tubes. The new assay was designed with the same fibrin specific antibody both in biotinylated and in peroxidase-labelled form. Fibrin in native plasma samples could only be detected after pre-incubation of the plasma with chaotropic ions. Test results were calculated using a standard curve comprising six fibrin standards (0-50 micrograms/ml). Precision of the method was satisfactory; intra-assay CVs using plasma samples ranged between 5.0% (23.7 micrograms/ml) and 12.4% (0.2 microgram/ml). CVs of interassay precision measurements using standards as samples range between 7.3% (25.0 micrograms/ml) and 11.4% (1.0 micrograms/ml). The lower detection limit was 0.12 microgram/ml. Investigations of normal range in 70 age-matched healthy individuals resulted in a mean of 1.12 micrograms/ml. Linearity was excellent; recovery of high fibrin plasma after dilution with normal plasma was always between 100 and 107%. Fibrin specificity was due to the monoclonal antibody 2B5 used and no cross reactivity with fibrinogen, fibrinogen split products or fibrin D-dimer was observed. Fibrin fragment E1 (studied by Dempfle CE, et al. Blood Coag Fibrinol 1993; 4: 79-86) and fragments X and Y showed moderate cross reactivity in the assay and caused some overestimation of fibrin at high fibrin split product concentrations.(ABSTRACT TRUNCATED AT 250 WORDS)

Amino Acid Sequence↗
PubMed1992

Improved outcome based on fluid management in critically ill patients requiring pulmonary artery catheterization.

We performed a randomized, prospective trial to evaluate whether fluid management that emphasized diuresis and fluid restriction in patients with pulmonary edema could affect the development or resolution of extravascular lung water (EVLW), as well as time on mechanical ventilation and time in the intensive care unit (ICU), in critically ill patients requiring pulmonary artery catheterization (PAC). PAC was performed on 101 patients. A total of 52 patients were randomized to an EVLW management group using a protocol based on bedside indicator-dilution measurements of EVLW. The other 49 patients were randomized to a wedge pressure (WP) management group in whom fluid management decisions were guided by WP measurements. A total of 89 patients had pulmonary edema (defined as EVLW greater than 7 ml/kg ideal body weight). Except for a clinically unimportant difference in mean age, the two groups were entirely comparable at baseline. The study groups were managed differently, as evidenced by cumulative input-output of 2,239 +/- 3,695 ml (median = 1,600 ml) in the WP group versus 142 +/- 3,632 ml (median = 754 ml) in the EVLW group (p = 0.001). EVLW decreased significantly, and ventilator-days and ICU days were significantly shorter only in patients from the EVLW group. No clinically significant adverse effect occurred as a result of following the EVLW group algorithm. Thus, a lower positive fluid balance, especially in patients with pulmonary edema regardless of cause, is associated with reduced EVLW, ventilator-days, and ICU days.

Algorithms↗
PubMed1991

Fluid balance during pulmonary edema. Is fluid gain a marker or a cause of poor outcome?

STUDY OBJECTIVE: To evaluate the importance of fluid balance and changes in extravascular lung water (EVLW) on survival in the ICU and short-term outcome in patients with pulmonary edema. DESIGN: Retrospective analysis of data (sorting by survival and "treatment received") from a recent randomized controlled trial of fluid restriction in this population. SETTING: Medical ICU of a university-affiliated, tertiary-care medical center. PATIENTS: Eighty-nine patients (from the previously mentioned study) requiring pulmonary artery catheterization with abnormally high EVLW (greater than 7 ml/kg). MEASUREMENTS AND RESULTS: When analyzed by survival, the survivors had no significant fluid gain or change in EVLW but decreased wedge pressure and body weight, compared to nonsurvivors. When analyzed by fluid balance, patients who gained less than 1 L of fluid by 36 hours into the study had a better rate of survival (74 percent) than the rest (50 percent; p less than 0.05). Also, the median duration of days on the ventilator, ICU days, and days of hospitalization was approximately half as long for each variable in the group with less than 1 L of fluid gain. Even accounting for baseline differences in the severity of illness, fluid balance was an independent predictor of survival (p less than 0.05). When analyzed by whether or not EVLW decreased by more than 15 percent between the first and last measurement, only patients with ARDS or sepsis had decreased days on the ventilator and ICU days. CONCLUSIONS: These data support the concept that positive fluid balance per se is at least partially responsible for poor outcome in patients with pulmonary edema and defend the strategy of attempting to achieve a negative fluid balance if tolerated hemodynamically.

Extravascular Lung Water↗
PubMed1990

Noncorrelative c-myc and ras oncogene expression in squamous cell carcinoma cells with tumorigenic potential.

The distribution of heterogeneous cell types within human tumors was examined, and the biological behavior of tumors and different tumor cell lines was evaluated following implantation into surrogate hosts. In situ hybridization and immunohistochemistry were used to examine the expression of oncogenes and localization of the squamous cell carcinoma cell surface-associated antigens. Increased levels of H-ras mRNA and p21 protein were present in six tumors, but enhanced c-myc mRNA expression was observed in just two tumors. The distribution of oncogene mRNA and SCC antigen-positive cells was not uniform throughout the tumor. Isolation of cells from the tumors was accomplished by cell culture, growth in soft agar, and growth in the nude mouse. One nontumorigenic immortalized cell line, SCC-83-01-82, isolated by passage through soft agar, was treated with 50 micrograms/ml of methyl methane sulfonate (MMS). These MMS-converted cells subsequently expressed a tumorigenic phenotype. In situ hybridization of the tumors that developed in nude mice revealed increased c-myc and H-ras mRNA expression. Serial passage of the MMS-converted tumors in vivo was accompanied by consistent enhanced c-myc expression. However, the levels of H-ras and keratin mRNA expression decreased with passage in vitro. Northern blot analysis of c-myc and H-ras mRNA levels from the original SCC cell line showed no change in expression following MMS treatment. The data suggest that SCC-83-01-82 is a premalignant cell line established from a mixed cell population in the tumor mass. It can be converted to a malignant phenotype by treatment with MMS, and the persistence of malignancy is under molecular control other than changes in the level of c-myc and ras gene expression.

Animals↗
PubMed1990

Nontumorigenic squamous cell carcinoma line converted to tumorigenicity with methyl methanesulfonate without activation of HRAS or MYC.

Plasticity of human tumor populations could account for the reason why many tumorigenic human cell lines lose this feature when grown in culture. Methyl methanesulfonate (MMS) was used to convert premalignant squamous cell carcinoma (SCC) cell line SCC-83-01-82 to a malignant phenotype. The MMS-treated SCC-83-01-82 cells (MMS-SCC-83-01-82) produced progressively growing tumors in 5 of 11 splenectomized BALB/c nude mice within 3-5 months. A cell line, designated SCC-83-01-82 CA, was established in vitro from one of the mouse tumors and was repassaged successively. This SCC-83-01-82 CA cell line was aggressively tumorigenic. A tumor greater than or equal to 2.0 cm in size was present within a month, as opposed to the 3-5 months required for the tumors produced by the MMS-SCC-83-01-82 cells. Examination of frozen cross sections by in situ hybridization revealed that focal areas of the tumor produced by the MMS-SCC-83-01-82 cells expressed MYC and HRAS mRNA. However, by the third passage in vivo, the levels of expression of the corresponding genes in the mouse tumors were undetectable. Blot-hybridization analysis of the RNA from the MMS-SCC-83-01-82 cells and the subsequently derived tumors and cells did not indicate any consistent overexpression of MYC, HRAS, or KRAS. Restriction fragment length polymorphism analysis of both MYC and HRAS genes revealed neither rearrangement nor amplification of MYC nor point mutation in the 11th or 12th codon of HRAS. The data suggest that alterations in MYC and HRAS were not directly involved in either the initial transformation or MMS-induced tumorigenic conversion of the SCC-83-01-82 cell line. Persistence of tumorigenicity after reisolation of the MMS-converted premalignant SCC-83-01-82 cells did not disappear immediately following the treatment with MMS.

Animals↗
PubMed1989

Comparative stages of expression of human squamous carcinoma cells and carcinogen transformed keratinocytes.

The mouse monoclonal antibody OSU 22-3 was prepared using cells from a squamous cell carcinoma (SCC) as an immunogen. This antibody reacts with an antigen found on squamous cell carcinomas but does not react with normal keratinocytes. This antibody and two antibodies that react with normal keratinocytes were used as markers of malignant and normal phenotypes. These markers were used to evaluate several spontaneous and carcinogen initiated SCC tumors and to identify the expression of an antigen associated with a malignant phenotype. A variety of subpopulations in carcinogen initiated tumors and spontaneous SCC tumors were noted. The subpopulations that reacted only with MoAb OSU 22-3 exhibited features of anchorage independent growth and cellular invasiveness, and formed progressively growing tumors in nude mice. Other SCC spontaneous tumor cell subpopulations reacted with the antibodies associated with normal keratinocytes. These cells did not proliferate in vitro and did not form tumors in the nude mouse. There were other carcinogen transformed cells which reacted with MoAb OSU 22-3 but not with the antibodies associated with normal keratinocytes. These cells exhibited anchorage independent growth and cellular invasiveness but did not form tumors in nude mice. We conclude from this work that human SCC tumors contain multiple cell populations. These cell populations have varied growth properties and express surface antigens that may indicate their malignant vigor. Carcinogen transformed keratinocytes do exhibit some of the characteristics of SCC tumor phenotypes but not the property of malignant progressively growing cells on a routine and consistent basis. This feature is transiently and inconsistently expressed in a surrogate host by populations prepared from spontaneous SSC tumors.

Animals↗
PubMed1975

Trisomy 18. A temporal bone report.

Since Edwards first described the trisomy 17-18 syndrome in 1960, the findings in the temporal bones of only four patients with this condition have been reported. They varied widely, ranging from a normal temporal bone, to severe malformations of both the middle and inner ear structures. This study describes the temporal bone findings in a patient with this syndrome. Many of the abnormalities described previously were present as well as the following unreported findings: complete bony atresia of the external canal, an aberrant tensor tympani muscle that did not insert into the malleus but rather attached to a dehiscent area in the Fallopian canal, wide short utricular and saccular ducts, and a widely patent cochlear aqueduct. There was also a developmental arrest of the membranous structures within the cochlea that probably occurred during the 12th week of fetal life.

Autopsy↗