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Biomedical subjects

J B Andersen

Publications and source records attributed to J B Andersen.

At least 19 recordsLinked to original sources

Identification of a Bacillus subtilis secretion mutant using a beta-galactosidase screening procedure.

High-level synthesis of exportable beta-galactosidase (LacZ) fusion proteins in Bacillus subtilis results in a lethal phenotype, and has been suggested as a tool for the selection of secretion mutants. We tested a plasmid-based, inducible lacZ fusion gene system for this purpose, but frequent mutations in cis, which reduced expression of the fusion gene, forced abandonment of the induction-selection strategy. Instead, after modification of the indicator plasmid, a screening procedure for increased basal LacZ activity levels was adopted. This led to the identification of a conditional B. subtilis secretion mutant after nitrosoguanidine mutagenesis. At 42 degrees C, but not at 30 degrees C, this mutant displayed extreme growth retardation when the LacZ fusion protein was produced, and and was also defective in the secretion of subtilisin Carlsberg. The processing kinetics and secretion of a subtilisin Carlsberg-alkaline phosphatase fusion derivative were found to be defective specifically at the non-permissive temperature. The secretion defect was not linked to the secA/div locus.

Bacillus subtilis

[Spontaneous esophageal rupture during the 3rd trimester].

A 30-year-old woman, 35 weeks pregnant, developed spontaneous rupture of the oesophagus following severe vomiting, probably caused by treatment with Ritodrin (Utopar). The symptoms, diagnosis and treatment of spontaneous oesophageal rupture are discussed.

Adult

[Emphysematous pyelonephritis. A serious complication of diabetes mellitus].

Pyelonephritis emphysematous (PE) is a life threatening renal infection which is observed practically exclusively as a serious complication of diabetes mellitus. 95% of the 73 cases which have been reviewed were found in diabetic patients. The symptomatology resembles that of severe acute pyelonephritis but the disease differs from this in that, in PE, emphysema develops in the actual renal parenchyma and/or in the perirenal tissues. The most important single factor in the etiology appears to be ischaemia of the tissues which are employed as growth media for the microorganisms involved. Infections with E. coli, Klebsiella pneumoniae, Aerobacter and Proteus are the most commonly found. Isolated cases with Candida and Cryptococcus neoformans have been observed. The mortality in untreated cases of PE is 100%. With medical treatment alone, the mortality decreases to 73% while, when combined medical and surgical intervention is employed, the mortality can be reduced to 30%.

Diabetes Complications

[Fatal emphysematous pyelonephritis].

A man aged 46 years with diabetes mellitus was admitted with acute right-sided renal symptoms. Pyelonephritis emphysematous without concretions was found. The patient was treated with insulin, fluids, electrolytes and antibiotics and nephrostomy was performed and, subsequently, an internal JJ-catheter in the ureter. The symptoms disappeared and he was discharged on a low dosage of sulphamethizol. After the planned removal of the JJ-catheter, sepsis running a lethal course developed. This emphasizes the importance of adequate prophylactic antibiotic therapy in connection with interventions in the urinary tracts.

Anti-Bacterial Agents

[A comparative study of propofol and diazepam used as sedatives in gastroscopy].

A material of 100 patients aged 18-70 years, ASA groups 1-2, who were otherwise healthy with slight generalized sequelae of their illness but without limitations in their usual habits, who were admitted for gastroscopy were randomized to sedation with either diazepam or propofol. Prior to the examination, 0.2 mg/kg diazepam or 1 mg/kg propofol was administered. If necessary, this was supplemented with half of the initial dosage. No difference were found in the sedation. Patients in the propofol group remembered the surgeon's information significantly better and woke significantly more rapidly. Propofol caused significantly more pain on injection. We consider that propofol can be employed for outpatient gastroscopy.

Adolescent

Induction of beta-1,3-glucanase in barley in response to infection by fungal pathogens.

The sequence of a partial cDNA clone corresponding to an mRNA induced in leaves of barley (Hordeum vulgare) by infection with fungal pathogens matched almost perfectly with that of a cDNA clone coding for beta-1,-3-glucanase isolated from the scutellum of barley. Western blot analysis of intercellular proteins from near-isogenic barley lines inoculated with the powdery mildew fungus (Erysiphe graminis f. sp. hordei) showed a strong induction of glucanase in all inoculated lines but was most pronounced in two resistant lines. These data were confirmed by beta-1,3-glucanase assays. The barley cDNA was used as a hybridization probe to detect mRNAs in barley, wheat (Triticum aestivum), rice (oryza sativus), and sorghum (Sorghum bicolor), which are induced by infection with the necrotrophic pathogen Bipolaris sorokiniana. These results demonstrate that activation of beta-1,3-glucanase genes may be a general response of cereals to infection by fungal pathogens.

Ascomycota

Evidence of long distance airborne transmission of Aujeszky's disease (pseudorabies) virus.

Aujeszky's disease has been the subject of an eradication campaign in Denmark since 1980. A detailed knowledge of the virus strains present in the country was provided by restriction fragment analyses of older clinical isolates, and of isolates from all the virologically confirmed outbreaks since 1985. The introduction of foreign strains into southern border areas was demonstrated during the winters of 1984/85, 1986/87 and 1987/88. An epizootic during the winter of 1987/88 was shown to correlate with an unusual predominance of southerly winds. Both conventional and specific pathogen free herds became infected. A herd level case-control analysis of the outbreaks during the winter of 1987/88 revealed that there was a positive correlation between the risk of infection and the size of the herd. The observations support the hypothesis of airborne transmission of the disease.

Air Movements

[A pharmacologic respiratory stimulant, doxapram, used in acute deterioration in patients with chronic respiratory failure].

In a controlled study with random allocation, the effect of doxapram (Dopram), a respiratory stimulant, was evaluated in 25 patients with acute on chronic respiratory failure requiring ventilator support. Eleven patients were allocated to mechanical ventilation and 14 to treatment with doxapram given as a variable rate infusion. In the doxapram group only four were transferred to mechanical ventilation after 1 1/2 to three days of treatment. In these patients, the problem giving rise to the acute exacerbation, was not under control at the time of ventilator intervention. In the remainder of the group, antibiotics, diuretics and bronchodilators had successfully treated the exacerbation. All patients were discharged alive. In the doxapram-treated group duration of hospitalization was nine days compared to 14 days (median values) in the ventilator-treated group. Only minor side-effects from doxapram were observed, and it is concluded that this respiratory stimulant can be used as a primary drug in patients with acute respiratory failure and chronic airflow limitation.

Aged

Immunotherapy with dog and cat extracts in children.

Hypersensitivity to dogs and cats causes asthma in many children. In this open controlled clinical study we wanted to establish whether immunotherapy can be recommended as a supplement to conventional medical therapy in dog- and cat-induced asthma in children. Twenty-seven children with mean age 10 7/12 years and with allergy to dog or cat according to anamnesis, skin prick test (SPT), specific IgE (RAST) and bronchial provocation test (BPT) entered the study. On the basis of age and bronchial sensitivity they were randomly allocated to either immunotherapy with dog or cat extract (active group, n = 14) or conventional medical therapy (control group, n = 13). Immunotherapy comprised subcutaneous injections with an alum-adsorbed depot extract (Alutard-SQ), and a maintenance dose of 100,000 SQ-U or the maximum tolerated dose. Before entering the study and after 9 months' therapy the patients were evaluated by BPT, SPT, RAST - and IgG4 analyses. The active group showed statistically significant change in bronchial tolerance (P less than 0.02), whereas no such change was found in the control group (P greater than 0.05). The change in skin sensitivity was significantly greater in the active group than in the control group (P less than 0.05), whereas no significant differences were found in RAST and IgG4. However, a significant (P = 0.05) increase in IgG4 was seen in the active but not in the control group. Frequency and degree of side effects in this study were acceptable.

Adolescent

Ventilatory strategy in catastrophic lung disease. Inversed ratio ventilation (IRV) and combined high frequency ventilation (CHFV).

In 105 patients with well-defined catastrophic lung disease, in whom conventional settings were unable to maintain life-sustaining gas exchange, the ventilatory strategy was changed from volume-controlled ventilation with an inspiratory-expiratory ratio (I:E) of 1:2 and PEEP of 15-20 cm H2O to pressure-controlled inverse ratio ventilation with an I:E of 2:1, 3:1 or 4:1 and a set PEEP of 4-8 cm H2O. All patients were ventilated on a Servo 900 B or C ventilator, the primary goal being to decrease the FIO2 below 0.6 and the peak pressure to below 50 cm H2O, while maintaining a PaO2 of 8.00 kPa and a PaCO2 within 10% of the upper limit of normal. In 67 patients the intervention was successful and peak pressure could be reduced to a median of 44 cm H2O (range 37-50). FIO2 could be reduced to a median of 0.50 (range 0.40-0.60). The auto-PEEP effect of IRV increased to a median of 12 cm H2O (range 7-22). No consistent pattern of change in cardiac output was observed. Sixty patients survived more than 3 weeks and 48 were discharged from hospital. The 38 IRV "failures" were changed to pressure-controlled ventilation with superimposed high frequency ventilation (CHFV). In 30 cases the FIO2 could be reduced to a median of 0.60 (range 0.50-0.60) and peak pressures to a median of 50 cm H2O (range 45-60). In 21 patients the PaCO2 increased. Auto-PEEP with CHFV had a median value of 15 cm H2O (range 10-25).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent

Ventilation-perfusion distributions and central hemodynamics in chronic obstructive pulmonary disease. Effects of terbutaline administration.

We studied the effects of intravenous terbutaline on VA/Q distributions and central hemodynamics in 11 patients with mixed-type COPD. Terbutaline caused an increase in VA/Q inequality in patients having PaO2 values greater than 60 mm Hg which resulted in a moderate fall in the PaO2. Patients with PaO2 values less than 60 mm Hg, the highest mean PAPs and the poorest spirometric performances demonstrated no significant changes in VA/Q distributions or PaO2 after terbutaline. Cardiac output increased 40 to 60 percent in all patients after terbutaline with an increase in tissue oxygen delivery. Mean PAP did not change in any patient after terbutaline and pulmonary vasodilatation was indicated by a decrease of calculated static PVR. The decrease of PaO2 after terbutaline in COPD is related to a further deterioration of existing VA/Q relationships. The cause of these effects and lack of such responses in patients with more advanced disease are discussed.

Aged

Zuclopenthixol and haloperidol/levomepromazine in the treatment of elderly patients with symptoms of aggressiveness and agitation: a double-blind, multi-centre study.

A double-blind study was carried out in 48 hospitalized, elderly demented patients with key symptoms of aggressiveness and agitation to evaluate the efficacy and tolerability of zuclopenthixol compared with that of haloperidol/levomepromazine. Patients were allocated at random to receive initial doses of either 4 mg zuclopenthixol daily or 1 mg haloperidol in the morning and 5 mg levomepromazine in the evening over a period of 4 weeks. In Week 4, the mean daily dose was 4.8 mg zuclopenthixol and 1.6/7.6 mg haloperidol/levomepromazine, respectively. After 1 week, the severity of illness was already significantly reduced, and was further reduced after 2 and 4 weeks of treatment in both groups: the reduction, however, was most pronounced in the zuclopenthixol group and after 2 weeks this difference was significant. Side-effects were few. The results of the study indicate that, whilst both zuclopenthixol and haloperidol/levomepromazine were effective and well tolerated in these elderly patients with aggressiveness and agitation, onset of therapeutic effect appeared more rapidly with zuclopenthixol, which furthermore provides the practical advantage that it may be administered once a day.

Aged

ARDS after accidental inhalation of zinc chloride smoke.

Five soldiers were injured by inhalation of hexite smoke (ZnCl2) during military training. Two soldiers, not wearing gas masks breathed hexite for 1 or 2 min, they slowly developed severe adult respiratory distress syndrome (ARDS) over the ensuing 2 weeks. This slow, progressive clinical course has not been previously described. In both patients, an increased plasma zinc concentration was measured 3 weeks after the incident. Intravenous and nebulized acetylcysteine increased the urinary excretion of zinc, and briefly decreased the plasma levels. In an attempt to arrest collagen deposition in the lungs, L-3,4 dehydroproline was administered. Both patients died of severe respiratory failure (25 and 32 days after inhalation). At autopsy diffuse microvascular obliteration, widespread occlusion of the pulmonary arteries and extensive interstitial and intra-alveolar fibrosis was observed. Three soldiers wearing ill fitting gas masks, immediately developed severe coughing and dyspnea. They improved, and 12 months after exposure their lung function tests were nearly normal, but they still had slight dyspnea on exercise.

Acetylcysteine

Hemodynamic effects of high frequency ventilation superimposed on intermittent positive pressure ventilation in dogs.

The hemodynamic effects of high frequency ventilation (HFV) superimposed on intermittent positive pressure ventilation (IPPV) in seven dogs before and after thrombin infusion were investigated. HFV was superimposed on a Servo 900 B ventilator by a Siemens Elema HFV prototype unit. Mean arterial blood pressure, heart rate, central venous pressure, pulmonary artery pressure, cardiac output, right and left ventricular pressures, pleural pressure, arterial blood gases, and right and left ventricular ejection fractions were recorded. Measurements were done during IPPV alone and during HFV superimposed on IPPV. The HFV frequencies were 5, 15, and 20 Hz at a constant minute volume of 5 1. When HFV was started, the IPPV minute volume was reduced to one third of the initial volume. No significant changes in the measured parameters were observed during the different ventilatory modes either before or after thrombin infusion which doubled the pulmonary vascular resistance. It is concluded that high frequency ventilation superimposed on IPPV might be a ventilatory mode that offers cardiovascular stability and reduces the risk of barotrauma.

Animals

Nebulised sodium cromoglycate in the treatment of wheezy bronchitis. A multicentre double-blind placebo controlled study.

The efficacy of nebulised sodium cromoglycate (SCG) used as a prophylactic treatment of wheezy bronchitis in children aged 1 to 4 years was evaluated in a multicentre double-blind placebo controlled, group comparative study. Fifty-four patients completed the 10-week trial (29 treated with SCG and 25 treated with placebo), preceded by 4-8 weeks baseline. Nebulised SCG did not prove significantly superior to placebo in reducing day wheezing, day coughing, or sleep disturbance due to wheezing or coughing at night. Neither was there significant difference in the use of supportive medicine (beta 2-agonist and theophylline) between the groups. Extra doctor visits, hospital admissions, and parental preference did not show significant difference either.

Aerosols