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Biomedical subjects

E Müller

Publications and source records attributed to E Müller.

At least 289 records · Page 16Linked to original sources

Synthesis, inactivation, and localization of extracellular and intracellular Escherichia coli hemolysins.

Extra- and intracellular Escherichia coli hemolysin expressed by two cloned hly determinants, both under the control of the activator element hlyR, were analyzed. One determinant carried all four hly genes (hlyC, hlyA, hlyB, and hlyD), whereas the other carried only the two genes (hlyC and hlyA) required for synthesis of active hemolysin but not those essential for its secretion. It was shown that the total amounts of HlyA protein and of hemolytic activity are similar in both cases in logarithmically growing cultures. The E. coli strain carrying the complete hly determinant released most hemolysin into the media and accumulated very little HlyA intracellularly. The active extracellular hemolysin (HlyA*) was inactivated in the stationary phase without degradation of the HlyA protein. In contrast, the hemolysin which accumulated intracellularly in the E. coli strain carrying hlyA and hlyC only was proteolytically degraded at the end of the logarithmic growth phase. Immunogold labeling indicates that active intracellular HlyA bound preferentially to the inner membrane, whereas that part of the extracellular HlyA which remained cell-bound was located exclusively at the cell surface. It was shown by fluorescence-activated cell sorter analysis that active extra- and intracellular HlyA* bound with similar efficiency to erythrocytes, whereas hemolytically inactive HlyA protein did not bind to these target cells.

Biological Transport↗

[Adult respiratory distress syndrome in legionella pneumonia--successful treatment with extracorporeal CO2 elimination procedures].

We report on successful treatment of an 46-year-old patient with ARDS (Adult Respiratory Distress Syndrome), caused by legionella-pneumophilia-pneumonia. The treatment with conventional artifical mechanical ventilation had failed. The new method of extracorporeal CO2-Elimination and low frequency positive pressure ventilation (ECCO2-R-LFPPV), introduced by L. Gattinoni (2) was in that case of severest ARDS very helpful. Supported by antimicrobial therapy with Erythromycin and Rifampicin the lung function could be improved to "restitutio ad integrum". Changes in chest radiographs, clinical parameters of ventilation, gas exchange and haemodynamics as well as the results of sequential pulmonary studies are demonstrated and discussed.

Carbon Dioxide↗

[Personal experiences with extracorporeal CO2 elimination in patients with severe ARDS--a current review].

The method of extracorporeal CO2 elimination (ECCO2-R) as described by Luiciano Gattinoni and Theodor Kolobow is compared with earlier extra corporeal methods such as extracorporeal membrane oxygenation. The physiological fundamentals of the method, as well as indications and contraindications are explained. - The results of more than 100 patients treated worldwide are discussed together with the present problems of the method. In cases of severe ARDS stage IV, ECCO2-R definitely reduces mortality.

Carbon Dioxide↗

[The synergism of Actinobacillus pleuropneumoniae and influenza A virus in experimentally-infected mice].

Models for infecting mice with Influenza A-Virus (A/PR 8/34, H0N1) and Actinobacillus pleuropneumoniae (serotype 9) were developed in Han: NMRI-mice. After infecting mice with sublethal doses of one of the infectious agents, or both together as a mixed infection, animals were subsequently exsanguinated and the lungs washed by bronchoalveolar lavage. Clinical symptoms were recorded daily, examination of lung lavage fluid and sera as well as histology of the lungs were done. An increase in mortality, weight reduction and total cell yield of lung lavage fluid was observed after mixed infection. Compared to mixed infections total protein content and elastase in sera and lung lavage fluid after singular ones were raised not as much. In lung lavage fluid the total cell yield was increased more marked. These alterations indicate a synergistic effect of viruses and bacteria, developed by mixed infection as well as a bacterial infection on top of a viral one. Histopathologically the lung alterations were found to depend on the infectious agent and the mode of infection.

Actinobacillus↗

[Ketanserin versus sodium nitroprusside in the treatment of hypertension following coronary surgery. Effect on intrapulmonary right and left shunt and arterial oxygenation].

Twenty patients requiring management of postoperative arterial hypertension following coronary artery bypass grafting (CABG) were randomly treated with either ketanserin (n = 10) or sodium nitroprusside (SNP) (n = 10). After surgery all patients were mechanically ventilated in the intensive care unit (F1O2:0.5; PEEP: +5 cm H2O). During the therapy with either drug F1O2 was adjusted to achieve normal blood oxygen tensions (F1O2 always greater than 0.3). Samples of arterial and mixed-venous blood were obtained simultaneously before administration of either drug and at each time point. Data acquisition followed over 12 h. Both drugs led to a significant decrease in arterial blood pressure, although 2 patients had to be withdrawn from the ketanserin group because there was no adequate decrease in systolic arterial pressure. A significant increase in heart rate was noted only in patients receiving SNP. In the SNP-treated patients F1O2 had to be increased because of a marked decrease in paO2, resulting in a significant increase in alveolar-arterial oxygen difference (A-aDO2). In 3 patients SNP had to be stopped because of an increase in intrapulmonary shunt (Qsp/Qt) more than 30%. No significant changes in Qsp/Qt, A-aDO2, or paO2 were seen in the ketanserin-treated patients.

Blood Pressure↗

[The effect of urapidil and sodium nitroprusside on intrapulmonary right-left shunt and arterial oxygenation in the treatment of hypertension following coronary surgery].

20 patients who developed arterial hypertension following coronary artery bypass grafting were randomly treated with either sodium nitroprusside (SNP) or urapidil. Both drugs led to a significant decrease in blood pressure. A significant tachycardia was noted only in the SNP-group. A decrease in peripheral and pulmonary vascular resistance was seen in both groups. Following application of SNP, alveolarterial oxygen difference and venous admixture increased significantly, whereas PaO2 showed a significant decrease. Three patients had to be taken out of the SNP group because of an increase of venous admixture. Alveoloarterial oxygen difference and venous admixture showed no significant changes following application of urapidil.

Antihypertensive Agents↗

Investigations on the dose-dependent pharmacokinetics of adriamycin and its metabolites.

Four tumor patients with a normal liver function were each given twice 30 mg/m2 adriamycin (ADR) and then once 70 mg/m2 ADR in the form of 3-min intravenous bolus injections at three-week intervals. In addition to the first and third ADR administrations, the patients were each given p.o. 875 mg of antipyrine. During the six-week study period, the kinetics of antipyrine displayed a high degree of intra-individual constancy. Its CL varied between 75 and 119 percent intra-individually. The kinetic parameters of CL, AUC/dose, VDss, MRT and t1/2 gamma of ADR did not differ between dosages of 30 and 70 mg/m2. The ADR-dose-standardized AUC10-40 min of adriamycinol (ADR-OH), its concentration time product at the times of its highest concentration in plasma, did not display any dependence upon the ADR dose. The AUCADR-OH/dose quotient, however, was found to be significantly higher (p less than 0.05) at 70 mg/m2 than at 30 mg/m2. The MTR and the t1/2z of ADR-OH showed a trend towards prolongation at 70 mg/m2. The ADR-dose-standardized AUC of the aglycones showed no dependence upon the ADR dose while the ADR-dose-standardized AUC10-40 min of the aglycones was significantly lower at a high ADR dose (p less than 0.05) than at a small ADR dose. The results suggest that in the ADR dose range studied the ADR pharmacokinetics is dose-independent and linear, and the rate at which ADR-OH, its main metabolite is formed, is also dose-independent. In contrast, the elimination of ADR-OH seems to be capacity-limited.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

[Epidural anesthesia and local administration of high-dose prostaglandin in obstetrics. A dangerous combination].

The use of high epidural anesthesia for cesarean section has generally been accepted as a safe and comfortable means of intra- and post-operative pain relief in recent years. However, the accompanying vasomotor blockade of the lower body and the sometimes impaired cardiac reflex activity restrict the use of concomitant--even local--medication. Described are the deleterious side effects on hemodynamic stability and patient comfort of an intramyometrically administered synthetic prostaglandin E (PGE2)-compound (dinoprostone) given to three female patients under high epidural anesthesia during cesarean section. Differentiation of the various symptoms is made in relation to their epidural or PGE origin or to a combination of the two. A striking therapeutic resistance of the hypotension of a sufficiently volume-expanded patient to even large doses of ephedrine is discussed as representing possible PGE-mediated suppression of peripheral norepinephrine release.

Adult↗

[To what extent are oscillometric data of a simple resistor-volume model physically recordable?].

To obtain data on the volume-dependence of the oscillatory parameters of the Siregnost FD 5, we investigated the course of iso-volume and iso-resistance lines in a simple mechanical resistor-volume model in the different coordinate systems, initially in the absence of additional superimposed stationary flow. While the P-psi diagram reveals no uniform course, and no preferential relationship of changes in resistance to P or Ros, or of changes in volume to psi, such a relationship develops on transformation to the Rre-phi and the Rre-X diagram. Rre proves to contain not only the purely resistor component, but also a reactance-proportional or inversely volume-proportional component, which is apparently due to internal friction resulting from volume compression. On the other hand, reactance is almost totally derivable from volume compression. With reference to the theoretical Franken model and others (1981), we discussed the influence of various physical factors on the impedance of a tube segment, and the different volume-dependence of impedance of closed- and open-ended cylindrical tubes. Further work on the theoretical consideration of the forced oscillation technique will examine the influence of additional superimposed stationary flow, which has a considerable effect on the resistor-volume model. Furthermore, the critical value of Reynold's number may be expected to be exceed in the FD 5 reference tube already at low respiratory flow.

Airway Resistance↗

[Theoretical and experimental studies of the diagnostic relevance and comparability of mechanical oscillation parameters].

The practical application of the forced oscillation technique for the analysis of the mechanics of respiration is hampered by the fact that the measured frequency-dependent impedance values R(f) and X(f) cannot be related directly to the parameters airway resistance Raw and pulmonary compliance CL. Furthermore, various derived oscillatory parameters are employed which are not directly comparable even with one another. In order to be able to estimate the diagnostic relevance and comparability of the impedance curves R(f) and X(f), their form-specific characteristics R = R(5)-R(20) and X(5), as also the equipment-specific parameters Ros (Siregnost FD5) and Rfo (custo vit), the relationships of these oscillatory parameters to Raw and CL were simulated in a structural model of the respiratory system, and tested in the real system. It was shown that already from frequencies of f greater than 10Hz upwards, R(f) no longer reacts to an increase in resistance in the peripheral region of the lung, and at 20 Hz indicates only the upper airway component of a global obstruction demonstrated body-plethysmographically with Raw. The diagnostic information on peripheral airway obstruction is contained in both components R(f) and X(f) of the respiratory impedance; with increasing obstruction and increasing frequency, it progressively reverts to the X(f) curve. Therefore, by including X(f) in the resistance evaluation for the parameters Ros and Rfo, the underevaluation of R(f) as compared with Raw can in part be compensated for, although an overe stimation at low Raw values with Ros and a large scatter of the Rfo values in the case of large Raw figures has to be accepted.(ABSTRACT TRUNCATED AT 250 WORDS)

Airway Resistance↗

[Practical experiences with 2 oscillatory measuring procedures, Siregnost FD 5 and custo vit, in the assessment of chronic airway obstruction].

In patients with chronic obstructive airway disease, comparative examinations using body plethysmography were performed with a view to evaluating the effectiveness of two forced oscillation techniques, fixed-frequency and poly-frequency techniques in estimating disorders of respiration mechanics. At slight and moderate elevations in bronchial flow resistance, a better agreement was found between the custo vit resistance figure and body plethysmography. A differentiation of healthy subjects from patients with low-grade obstruction by means of the FD 5, requires the establishment of the phase angle (phi), too, while in the case of the custo vit unit, this is possible by demonstrating the frequency dependence of the impedance. Patients with more severe disease with secondary emphysematous changes, reveal a clear difference between the phase signal (psi) primarily measured on the FD 5, and the phase angle. Forced oscillation usefully supplements spirometery in the respiratory basic diagnostic work-up employed through-out treatment. Fixed-frequency techniques require the determination of the phase angle for assessment of peripheral obstructions; the advantage of the poly-frequency technique can be seen in the largely specific demonstration of the frequency dependency of the resistance.

Airway Resistance↗

[Oscillometric differentiation of lung fibrosis and lung emphysema].

In three groups of healthy subjects and patients with pulmonary fibrosis or pulmonary emphysema, the secondary periodical oscillatory phenomena observed under conditions of normal breathing and a slow VC manoeuvre on the Siregnost FD 5 were broken down into a volume- and a flow-synchronous component, as also a third component with no correlation with either volume or flow, and which can be observed in the primary parameters Ros and psi, as also the secondary parameters Rre and phi. While both fibrotic patients and healthy subjects revealed a volume-inverse phase behaviour, patients with pulmonary emphysema revealed a volume-proportional phase behaviour. This difference in volume dependence is explained by the difference in elastic recoil in patients with fibrosis as compared with those suffering from emphysema, and the associated different influence on the filling of the lungs with air and blood.

Adult↗

[Report of a trial of polyfrequent oscillo-resistometry with the custo vit equipment].

With the aim of determining the significance of the principle of the multi-frequency forced oscillation technique employed by the custo vit to determine the airway resistance, measurements were performed on a number of test subjects, employing a unit available with three different software modifications. A comparison with the resistance values obtained with other equipment (whole-body plethysmograph, Siregnost FD5), revealed the diagnostic usefulness of the technique of frequency-dependent resistance. It was also confirmed that the phase angles, also obtainable with the custo vit, play a considerable role in the significant differentiation of the degree of obstruction. The differences in comparison with other methods are critically examined, and proposals made for a further improvement of the forced oscillation technique employed by the custo vit.

Airway Resistance↗

[Experiences with the use of oscillating high frequency ventilation].

Our investigations have demonstrated that the effect of oscillatory high-frequency ventilation (HFO) on gas exchange in dogs is directly proportional to the oscillatory flow amplitude VM. Because of the equation: VM = PM/Z, gas exchange is increasing with rising oscillatory amplitude of the ventilation pressure PM and decreasing with rising impedance Z of the respiratory system. This system consists of endotracheal tube and the lungs of the dog investigated. The impedance Z = square root of R2 + X2 (resistance R and reactance X) achieves a minimal value near at the resonant frequency (reactance X = 0, in healthy intubated dogs near at 5 Hz) and increases with rising oscillatory frequency. Thus the oscillatory high-frequency ventilation is most effective near to the resonant frequency of the respiratory system. The results presented allow the conclusion that the application of high-frequency ventilation can be optimized by monitoring the respiratory mechanics parameters.

Animals↗

Both alpha-tubulin genes are transcriptionally active in Stylonychia lemnae.

Macronuclear DNA of the hypotrichous ciliate Stylonychia lemnae contains two size-classes of molecules coding for alpha-tubulin. Analysis of their coding regions demonstrates that these two size-classes represent two different functional alpha-tubulin genes, alpha 1 and alpha 2; a comparison of these regions shows a 97% homology in their nucleotide sequence and 98.5% in their amino acid sequence. S1-mapping experiments indicate that both alpha 1- and alpha 2-tubulin genes are transcribed. The 5' and 3' noncoding regions flanking the alpha 1- and alpha 2-tubulin genes differ in both length and nucleotide sequence within one strain. When different strains are compared, however, identical non-coding regions and slightly varying coding regions can be found in DNA molecules containing the alpha 1-tubulin genes.

Amino Acid Sequence↗

Carboxyl-terminal amino acid sequences of two variant forms of the gamma chain of human plasma fibrinogen.

The gamma chain of human fibrinogen has been shown to be heterogeneous; three forms of various sizes are normally present in plasma. To further characterize the two less prevalent elongated variants, we have purified the three forms of the gamma chain, isolated unique tryptic fragments, and sequenced the variant portions of each chain. The intermediate-sized form (gamma 55) has a sequence identical to the longest variant (gamma 57.5) from residue Val-408 to Pro-423, which is the C terminus of the gamma 55 chain. The gamma 57.5 chain extends an additional four amino acids. The C-terminal amino acid sequence and corresponding nucleotide sequence of the gamma 55 chain show marked similarity with an elongated gamma-chain variant of rat fibrinogen. In addition, a remarkable similarity in both amino acid and nucleotide sequence was noted between the human gamma 55 chain and the C-terminal extension in human and bovine A alpha chain of fibrinogen, which are encoded by the cDNA but are posttranslationally cleaved and are not found in plasma. The findings suggest an evolutionary conservation in the C-terminal amino acid sequence found in both the fibrinogen A alpha and gamma chains in several species.

Amino Acid Sequence↗

[Results of surgical treatment of pelvic fractures in polytraumatized patients].

High-speed accidents involving automobiles and two-wheeled vehicles with resultant entrapment and crush injuries have led to an ever-increasing incidence of pelvic fracture within the realm of multiple trauma. Between the years 1982 and 1986 ninety-eight cases of pelvic fracture were operatively stabilised by the Department of Surgery and the Outpatient Department of the Technical University, Klinikum Rechts der Isar, Munich, West Germany. This paper is a report on fifty-five of these patients who were discovered to have suffered additional multitrauma. Independent from those patients found to have sustained multitraumatisation, twenty-four cases of isolated acetabulum fracture as well as four instances of pelvic ring fracture and one fracture of the pelvic brim were also documented. Combinations of the above mentioned fractures were uncovered in twenty-six patients. With fifty-four of the fracture injuries, osteosynthesis was carried out while in one case primary alloarthroplasty was deemed necessary. Following a mean post-treatment period of twenty-six months forty-five of the patients were objectively evaluated for results of treatment according to the methodology of Merle d'Aubigne. 70% of those patients assessed were rated with a "good" result. At the time of follow-up thirty-five (78%) of the forty-five reexamined individuals reported to be once again employed. Early operative treatment along with internal stabilisation and prompt initiation of physiotherapy have proved decisive in obtaining a favourable postoperative result.

Adolescent↗