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Biomedical subjects

E Steinbach

Publications and source records attributed to E Steinbach.

At least 19 recordsLinked to original sources

High performance DNA sequencing, and the detection of mutations and polymorphisms, on the Clipper sequencer.

The Visible Genetics Clipper sequencer is a new platform for automated DNA sequencing which employs disposable MicroCel cassettes and 50 microm thick polyacrylamide gels. Two DNA ladders can be analyzed simultaneously in each of 16 lanes on a gel, after labeling with far-red absorbing dyes such as Cy5 and Cy5.5. This allows a simultaneous bidirectional sequencing of four templates. We have evaluated the Clipper sequencer, by cycle-sequencing of an M13 single-stranded DNA standard, and by coupled amplification and sequencing (CLIP) of reverse-transcribed human immunodeficiency virus (HIV-1) RNA standards and clinical patient samples. (i) Limitations of instrument. We have examined basic instrument parameters such as detector stability, background, digital sampling rate, and gain. With proper usage, the optical and electronic subsystems of the Clipper sequencer do not limit the data collection or sequence-determination processes. (ii) Limitations of gel performance. We have also examined the physics of DNA band separation on 50 microm thick MicroCel gels. We routinely obtain well-resolved sequence which can be base-called with 98.5% accuracy to position approximately 450 on an 11 cm gel, and to position approximately 900 on a 25 cm gel. Resolution on 5 and 11 cm gels ultimately is limited by a sharp decrease in spacing between adjacent bands, in the biased reptation separation regime. Fick's (thermal) diffusion appears to be of minor importance on 6 cm or 11 cm gels, but becomes an additional resolution-limiting factor on 25 cm gels. (iii) Limitations of enzymology. Template quality, primer nesting, choice of DNA polymerase, and choice between dye primers and dye terminators are key determinants of the ability to detect mutations and polymorphisms on the Clipper sequencer, as on other DNA sequencers. When CLIP is used with dye-labeled primers and a DNA polymerase of the F667Y, delta(5'--> 3' exo) class, we can routinely detect single-nucleotide mutations and polymorphisms over the 0.35-0.65 heterozygosity range. We present an example of detecting therapeutically relevant mutations in a clinical HIV-1 RNA isolate.

Bacteriophage M13↗

Effect of 17-norleucine-VIP on gastroduodenal motility relative to serum VIP concentration and blockade of NOS.

Mechanical and electrical activity in the antrum, pylorus, and duodenum was evaluated in the conscious dog, instrumented with seven strain gauges and five platinum electrodes. 17-Norleucine-vasoactive intestinal peptide (17-N-Leu-VIP) or 17-N-Leu-VIP plus NG-nitro-L-arginine methyl ester (L-NAME) was injected intra-arterially close to the pylorus to identify influences of nitric oxide (NO) on effects of VIP. VIP concentration was measured by radioimmunoassay in serum samples collected from the cubital and portal veins before and up to 2 h after VIP injection. VIP (0.004-0.006 mg.kg-1.10 min-1) abolished phasic contractions in the interdigestive state for 16.8 min and in the digestive state for 14.4 min, whereas whole serum VIP concentration rose above 42.4 +/- 13 pmol/l. Administration of L-NAME did not significantly influence the effects of VIP. Aftereffects of VIP, consisting of a reduced motility index, lasted 33 +/- 10.6 min in the interdigestive state and 44.5 +/- 42 min in the digestive state. This VIP aftereffect in the interdigestive state was shortened in time by the addition of L-NAME. The results overall suggest that NO release is a factor only in the aftereffects of VIP.

Animals↗

Intrinsic corporoantropyloric coordination of motility and gastric emptying.

This study examined changes in gastric motility after interruption of the intramural nervous circuitry from the proximal portion of the stomach to the antrum by a circumferential gastric myotomy. Seven extraluminal strain gauge force transducers and five platinum electrodes were implanted along the antropyloroduodenal region, and gastric emptying was studied by X-ray after a 280-g solid meat meal mixed with barium. The motility index increased aboral to the myotomy by 106 and 69% in the distal antrum and pylorus, respectively, in the first postprandial 30-60 min because of the loss of an inhibitory neural influence from the proximal part of the stomach. Destabilization of the basic electrical rhythm occurred in 50% of the dogs. This was apparent as tachyarrhythmia or bradyarrhythmia and an early postprandial 2-11% decrease in slow-wave frequency and a 100% increase in slow-wave amplitude. Coordination of corporoantropyloric contractions was disorganized. Frequent segmenting and antidromic contractions were associated with reduced periods of optimal emptying and disturbed intragastric chyme transport into the constricted antrum. A 10-30% gastric emptying delay of approximately 50 min was a consequence of myotomy despite an increased antroduodenal motor gradient after myotomy. The overall results suggest that intact intramural innervation and muscular continuity are essential for coordination of corporoantropyloric motility and normal gastric emptying.

Animals↗

[Use of cartilage transplants in middle ear surgery. A histologic long-term study of cartilage implants].

30 autogenic and allogenic (homologous) cartilage grafts removed from the middle ear after an average time of 9 years and a maximal time of 25 years were studied by light microscopy. Half of the grafts showed signs of cellular vitality. Degeneration and avital cells are predominant in all grafts. Persisting residual vitality does not influence resorption and matrix necrosis in other areas of the graft. More than two thirds show structural changes by cellular resorption, infraction and vascularisation. These changes appear mainly independent of the time elapsed after transplantation. 5 grafts show bone new formation. Circumscript necrosis of the cartilage matrix was seen in 12 grafts. The study indicates that in comparison to ossicles or alloplastic material cartilage is less advisable to be used for the reconstruction of the ossicular chain due to the unpredictable degradation and loss of form stability.

Cartilage↗

[Therapy of Frey's syndrome with an anhidrotic gel].

In recent years we treated 53 patients suffering from Frey's syndrome with an antihidrotic gel. The active ingredient we used was aluminiumtrichloridhexahydrate. In addition to presenting a historic review we will also demonstrate and discuss our results. The study concludes, that this gel is effective in treating Frey's syndrome.

Adolescent↗

Effects of erythromycin in the dog upper gastrointestinal tract.

The effects of erythromycin on motor and electrical behavior of the antrum, pylorus, and duodenum were determined in chronically instrumented, awake dogs. Erythromycin infusion resulted in an abrupt, powerful increase in motility. The motility index increased 18-fold in the antrum, 15-fold in the pylorus, and 8-fold in the duodenum. Bradyarrhythmia with a 30% decrease in slow-wave frequency occurred in all animals. Retrograde giant contractions in association with retching and vomiting occurred in 88% of the dogs. Neostigmine was less potent than erythromycin in increasing motility. Hexamethonium given intra-arterially during erythromycin infusion abolished motility for 7.2 +/- 2.9 min and intra-arterial atropine did so for 51 +/- 25 min. Hexamethonium or atropine restored the electrical slow-wave frequency. The results provide evidence that erythromycin action involves cholinergic pathways including ganglionic transmission.

Animals↗

[Ear ossicle transplants for reconstruction of sound transmission in the middle ear. A histologic long-term study].

In this study 130 ossicular middle ear transplants were studied. 33 remained in the middle ear for 10 years or longer, one for 21 years. The majority of the grafts show 5% to 40% bone new formation. Absence of vital bone or subtotal host bone replacement is exceptional. The amount of bone new formation appears independent the implantation time. 75% of the grafts show no bone resorption. In 15% sound transmitting might be impaired due to resorption. Grafts with a high degree of bone new formation show less resorption. 21% of the ossicles have signs of inflammation. Inflammation boosts bone turnover with resorption on one hand and new for resorption. Cholesteatoma is the main cause of resorption and inflammation. The critical phase for resorption of the graft are the first two to three years after transplantation. No considerable difference was found between autografts and allografts (homografts). Histological and metabolical properties of the ossicles seem to be responsible for the stability of the graft. Ossicular grafts have a good longterm stability which makes them very suitable for reconstruction of the ossicular chain.

Bone Resorption↗

[Intratemporal facial neurinoma].

Two patients with intratemporally localised facial nerve schwannomas developed conductive hearing loss beside persisting facial nerve palsy. Tympanotomy revealed a tumour of the facial nerve that was totally removed. In one case reconstruction was performed with great auricular nerve interposition. The long-term follow-up (12 years) showed a good functional result. Facial nerve schwannomas present problems in detection, and reconstruction methods are not safe with regard to long-term prognosis.

Adult↗

[Extra-temporal localized facial neuromas].

Nine facial nerve schwannomas were observed in more than 1,350 operations on the parotid gland. Eight patients had a pre-operative diagnosis of pleomorphic adenoma without facial palsy. One patient who underwent extensive surgery without preservation of the facial nerve for a tumour present for more than 10 years had a pre-operative facial palsy. Facial nerve function recovered totally or partially in six peripheral schwannomas. In two cases with main trunk schwannoma no reinnervation was observed despite end-to-end anastomosis or interposition of the great auricular nerve. Histology showed eight typical schwannomas and one neurofibroma. Neurofibromas are extremely rare in the parotid gland. Clinical and operative experience with parotid gland schwannomas shows that recovery of facial nerve defects is mostly incomplete. Reconstructive methods should be used, but the long-term prognosis is uncertain.

Adult↗

Cholesteatoma--pathology and treatment.

(1) The prerequisite for development of cholesteatoma is a cholesteatoma bed, that is a loose subepithelial connective tissue layer which acts as a nutrient bed and makes papillary growth of squamous epithelium possible. (2) The formation of cholesteatoma is facilitated by disturbed tubal function with reduced ventilation of the middle ear. (3) The progression of cholesteatoma, especially the bone destruction, is due to enzyme-activated cell groups. The epidermal layer in the postero-superior area of the tympanic membrane has a higher papillary content and during an inflammatory process there is a marked vascular reaction. This particular area has a special nutritional zone and the epidermis is especially well nourished [Lange, 1925]. The main artery to the tympanic membrane travels along the handle of the malleus and gives off branches. In our animal experiments epithelial cones grew into this well-nourished subepithelial zone and formed cholesteatoma. The importance of tubal function as regards cholesteatoma formation can be seen in everyday clinical practice. In stapedectomy patients, the lateral attic wall is usually removed to allow full visualisation of the stapes, but retraction pockets in this area are never seen at subsequent follow-up. However, if the lateral attic wall is removed during surgery for chronic otitis media, reconstruction with cartilage or ceramic is necessary to prevent retraction. This adds weight to the hypothesis that tubal dysfunction is an important aetiological factor in cholesteatoma. This is further supported by the 30 times greater incidence of retraction pockets in patients with cleft palate.

Animals↗

[When should removed adenoids be studied histologically?].

Two children with nasopharyngeal rhabdomyosarcoma are used to discuss the relevance of the histopathological investigation of adenoid tissue. Histopathological investigation should only be omitted if there is complete agreement between symptoms, intra-operative findings and macroscopic findings. Histopathology is advised for very large adenoids, alteration of consistency and in older children or young adolescents.

Adenoidectomy↗

[Surgically treated diseases of the parotid gland in childhood and adolescence].

Between 1969 and 1986 parotid gland surgery was performed on 86 children and adolescents in the ENT clinic of the University of Tübingen. Chronic recurrent parotitis was found to be the most common chronic inflammatory disease in our young patients. Total parotidectomy was done on 24 children. Because of the high incidence of potential complications the indication for a total parotidectomy in chronic parotitis should be carefully considered. A more hopeful attitude applies to the cystic tumours (haemangioma, lymphangioma and branchiogenic cysts). A solid tumour of the parotid gland in children and adolescents, however, necessitates surgical extirpation without delay because one-third of these tumours are malignant.

Adolescent↗

The formation of ultrastructural epithelial and subepithelial connective tissue changes in experimentally induced cholesteatomas in guinea pigs.

Histoacryl-induced cholesteatomas were produced in guinea pigs at the posterosuperior part of the external ear canal adjacent to the tympanic membrane. Semithin and ultrathin tissue sections were used to study primary formation of the cholesteatoma as well as the influence of the altered epithelium upon the bordering zone of connective tissue. Quantitative and qualitative tissue changes were analyzed by electron microscopy and showed degradation and new formation of collagen and activation of fibroblasts. Our findings are similar to those previously reported on human cholesteatomas and indicate that the bordering subepithelial tissue seems to be influenced through the basilar membrane.

Animals↗

Paraganglioma of the tympanic membrane.

Von Haller, in 1743, first described the carotid body and was so impressed with the richness of its innervation that he called it 'ganglion minutum', thinking it to be a sympathetic ganglion. Valentine, in 1840, saw a peculiar structure in the tympanic canaliculus in which a nerve cell was present and called it 'gangliolum tympanicum'. Almost 100 years later, in 1941, Stacey Guild reported the presence of some structures near the wall of the jugular bulb and described them as 'glomus jugulare'. Following this report, Rosenwaser (1945) and Otani were able to make a correct classification of these tumours in the middle ear. There have been innumerable reports of them and various authors have called them by various names. We report here a case of paraganglioma which was localized entirely to the tympanic membrane without involving any other part of the middle-ear cleft.

Diagnosis, Differential↗

The effects of fibrin tissue adhesive on the middle ear.

This study investigated the effects of fibrin glue ('Tissucol', Immuno Pty. Ltd.) in the middle and inner ear. Small amounts of the adhesive were used in 36 operations performed on 18 rabbits. The light microscopic examination of these ears four, eight and 12 weeks after surgery showed that the adhesive was well tolerated and that it did not have any toxic effect on the middle ear or membranous labyrinth. The fibrin tissue adhesive can therefore safely be used to facilitate reconstructive middle-ear surgery and, with the aid of fascia, also for the closure of labyrinthine fistulae; or to achieve a definite seal of oval window niche after stapes surgery.

Animals↗