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Biomedical subjects

D Uehling

Publications and source records attributed to D Uehling.

16 recordsLinked to original sources

In vivo antitumor activity of two new seven-substituted water-soluble camptothecin analogues.

The development of camptothecin-like compounds as inhibitors of topoisomerase I for the treatment of resistant tumors has generated clinical excitement in this new class of drugs. We have developed two novel water-soluble camptothecin analogues which are specific inhibitors of topoisomerase I and are potent cytotoxins with significant antitumor activity. We added water-solubilizing groups off position 7 in the B ring of either 10,11-ethylenedioxy- or 10,11-methylenedioxy-20(S)-camptothecin. These water-soluble camptothecin analogues were demonstrated to be nanamolar inhibitors of the topoisomerase I enzyme in the cleavable complex assay. The compounds, GI147211 [7-(4-methylpiperazinomethylene)-10,11-ethylenedioxy-20(S)-camp tot hecin], and GI149893 [7-(4-methylpiperazinomethylene)-10,11-methylenedioxy-20(S)-cam pto thecin], were compared to topotecan, a known water-soluble inhibitor of topoisomerase I. Both GI compounds were found to be slightly more potent than topotecan as inhibitors of topoisomerase I in the cleavable complex assay and were 1.5-2 times more soluble. Tumor cell cytotoxicity assays using 5 separate cell lines demonstrated that both GI compounds were 5-10 times more potent than topotecan, although by comparison all three topoisomerase I inhibitors were unaffected by the multidrug resistance P-glycoprotein. The antitumor activity of all three topoisomerase I inhibitors was compared concomitantly in two human colon xenograft models. In both models, GI147211 and GI149893 were able to induce regression of established HT-29 and SW-48 colon tumors by as much as 60%. The antitumor activity of both compounds were also demonstrated in the MX-1 and PC-3 xenografts. Microscopic examination of selected tissues indicated that drug-induced toxicity was primarily limited to the gastrointestinal tract and was comparable among the three compounds. Further clinical development of this class of compounds is ongoing.

Animals↗

Urinary tract malformations in identical twins.

We describe 3 sets of twins with discordance for urological malformations. Zygosity was documented by HLA and blood group typing. It is suggested that evaluation of the identical twin of an affected patient should include the entire urinary tract because of the potential for different lesions.

Blood Grouping and Crossmatching↗

Aniridia and Wilms' tumor in a child constitutionally mosaic for 11p-;12q+: a new chromosomal change also present in Wilms' tumor cells of the blastema type.

A child with congenital aniridia was assessed closely, by repeated abdominal ultrasound examinations, beginning at birth. The Wilms' tumor subsequently discovered and removed was analyzed karyotypically and found to have some cells with a terminal deletion of chromosome 11; in other cells this deletion was associated with a duplication in the long arm of chromosome 12. These findings were identical to those observed in the patient's peripheral blood mononuclear cells. This case further substantiates the association between changes in chromosome 11 and Wilms' tumor and demonstrates how chromosomal abnormalities in early infancy may lead to the development of Wilms' tumor.

Cells↗

Long-term clean intermittent self-catheterization in renal transplant recipients.

Eight renal transplant recipients with neurogenic bladders or lower urinary tract dysfunction were managed with clean intermittent self-catheterization after transplantation instead of urinary diversion. A total of 85 treatment months was reviewed. Of the patients 5 continue to do well after 10 to 17 months of intermittent catheterization and 3 suffered immunological graft failures. In selected renal transplant recipients with lower urinary tract dysfunction clean intermittent catheterization is a reasonable alternative to urinary diversion.

Adolescent↗

Renal transplantation using ileal conduits in 5 cases.

We report our experience with 5 cases of renal transplantation into ileal conduits and review the literature. In 2 cases a modified surgical procedure was used, which combines a groin extraperitoneal approach for the vascular portion of the operation and a peritoneal window for the anastomosis between the urinary collecting system and the ileal loop. Of our 5 patients 3 are alive with functioning grafts, 1 has undergone retransplantation and 1 with a functioning kidney died of sepsis originating in a decubitus ulcer. Two patients had conduit-related complications. In our literature review of 16 reports 52 per cent of 68 patients were alive with functioning grafts and 32 per cent had conduit-related complications, usually involving urosepsis, calculous disease or stenosis. With a high index of suspicion, and an aggressive diagnostic and therapeutic approach to these problems, a good prognosis can be expected when transplantation is performed in these patients.

Adolescent↗

Cryptorchidism in the Prader-Willi syndrome.

Among 30 male children seen for the Praer-Willi syndrome 21 had at least 1 undescended testis (70 per cent). In 14 of the 30 patients both testes were undescended (45 per cent). Of 18 patients observed for a period 4 (22 per cent) had late spontaneous descent of 6 testes. Gonadotropin treatment facilitated descent in 3 of 4 patients. Testicular biopsy showed a Sertoli-cell-only appearance in 4 patients. The usual indications for orchiopexy of undescended testes may need to be modified in patients with the Prader-Willi syndrome.

Adolescent↗

Unsterile intermittent catheterization for meningomyelocele.

Twenty-five children with meningomyelocele have been managed by clean unsterile intermittent catheterization (UIC). There were 17 satisfactory results, three total failures, and three partial failures under this regimen. Experience, problems, and causes of failure are discussed. UIC offers a definitive form of management for some types of neurogenic bladder.

Adolescent↗

Prediction of renal allograft rejection by direct lymphocyte blastogenesis assay.

In an effort to better predict renal allograft rejection, lymphocyte blastogenesis (DLBA) was determined in 65 patients after transplants. Of 47 clinically diagnosed rejection episodes 45 had an associated DLBA peak which preceded the clinical diagnosis by an average of 4 days; 11 recipients had DLBA peaks not associated with rejection episodes. Of 14 recipients with multiple DLBA peaks during postoperative periods of nonfunction, none did well. The blastogenesis assay was not a reliable enough predictor of graft rejection to be used as an indication for early elevation of corticosteroid dosage.

Graft Rejection↗

Quantitation of urinary immunogloublins by a double antibody technique.

A double antibody method for quantitation of urinary immunoglobulins that is sensitive enough to avoid the need for urine concentrations has been developed. The first antibody is goat antiserum monospecific for the heavy chains of IgA, IgG, and IgM. The second, and precipitating, antibody is developed in rabbits made tolerant to human IgG. Normal values for male and female children and adults are presented. Elevated levels of urinary IgA and IgG were found after urinary tract infection.

Adult↗

Detection of urinary tract infections in 3- to 5-year-old girls by mothers using a nitrite indicator strip.

A program to detect urinary tract infections among 3- to 5-year-old girls was conducted in Madison-Dane County, Wisconsin using local pharmacies as the distribution site for test kits. Screening was conducted at home by mothers with a nitrite dip-strip on three consecutive first morning specimens. Twenty-one percent of the target population participated during a one-month study period. Eighteen cases were found among 1,573 participants (1.1%). In addition, 243 girls other than those in the target area or age group participated and yielded eight additional cases, for a total of 26 cases among 1,816 total participants. The rate of false-positive nitrite tests was 0.3%. Newspapers were the most effective means of alerting the public to the program. The only factors which were associated with less awareness or participation were low socioeconomic and rural residence. Past history of infection, minor urinary symptoms, and pyuria were common among the bacteriuric girls. Immunoglobulin-coated bacteria suggestive of tissue invasion were present in one third of the cases. Vesico-ureteral reflux was present in five and caliectasis in two of 23 girls studied. Despite the likelihood that some bacteriuric girls, particularly those infected with gram-positive organisms were not detected, screening at home appears to be a highly efficient method of detecting urinary tract infections in large populations of preschool children.

Bacteriuria↗