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Biomedical subjects

J Grote

Publications and source records attributed to J Grote.

At least 37 records · Page 2Linked to original sources

Induction of inducible nitric oxide synthase expression by neopterin in vascular smooth muscle cells.

The pteridine compounds neopterin and 7,8-dihydroneopterin serve as valuable indicators for the stimulation of the cellular immune system. Whether they exhibit distinct biochemical functions in the immunological process is at present under discussion. We show that neopterin, but not 7,8-dihydroneopterin, is a stimulus for iNOS gene expression in rat vascular smooth muscle cells in vitro. At a concentration of 20 microM, neopterin leads to an iNOS mRNA expression of 2.5 amol iNOS cDNA/micrograms total RNA. When cells were coincubated with 20 microM neopterin and 5 micrograms/ml lipopolysaccharide derived from Escherichia coli, at least an additive effect on iNOS mRNA expression could be detected (iNOS cDNA concentration was 5.0 amol/micrograms total RNA). We speculate that neopterin enhances the macrophage-induced extracellular toxicity. This might be of relevance in situations associated with excessive release of cytokines, neopterin, and nitric oxide, as observed in septic shock.

Animals↗

The pulmonary epithelial cell line L 2 as a new model for an inducible nitric oxide synthase expressing distal airway epithelial cell.

Nitric oxide released in large amounts by inducible nitric oxide synthase (iNOS)-containing pulmonary cells plays an important role in many aspects of lung function in health and disease. The aim of this study was to establish a permanent non tumor-derived alveolar epithelial cell line that exhibits the typical characteristics of an iNOS-expressing cell. Therefore, the pulmonary epithelial cell line L2 (adult rat) was incubated with lipopolysaccharide derived from Escherichia coli (serotype 0111:B4) and different cytokines. The strongest effect on iNOS gene expression and nitric oxide release could be detected when L2 cells were coincubated with interferon-gamma + tumor necrosis factor-alpha. iNOS complementary DNA concentration was 25 amol/microliters at 9h, and nitrite/nitrate levels were 99.43 +/- 3.97 nmol/10(6) cells at 24h, respectively. Our results show that L2 cells can be regarded as an appropriate model for investigating iNOS gene expression and nitric oxide functions in alveolar epithelial cells.

Animals↗

Digoxin dialdehyde reductive aminations. Structure proof of the perhydro-1,4-oxazepine product.

Digoxin dialdehyde reportedly undergoes reductive amination with primary amines to form a perhydro-1,4-oxazepine; however, no structural proof has been published to substantiate this belief. A digoxin perhydro-1,4-oxazepine derivative has been isolated from the reductive amination of digoxin dialdehyde and its structure determined by mass spectroscopy and NMR measurements. Comparison of the NMR, mass spectroscopy, and HPLC of two compounds obtained from the degradation of the digoxin reductive amination product with synthesized perhydro-1,4-oxazepine diastereomers showed them to be identical. We conclude that, under appropriate conditions, reductive amination products can be obtained, but caution that other products may be produced as well, especially under the conditions of bioconjugation to proteins.

Amines↗

Multiplane transoesophageal echocardiography detection of a papillary fibroelastoma of the aortic valve causing myocardial infarction.

Primary aortic valve tumours are rare. A patient is reported with a papillary fibroelastoma attached to the edge of the right coronary aortic cusp. This tumour was diagnosed by multiplane transoesophageal echocardiography after the patient experienced an acute inferolateral myocardial infarction. Multiplane transoesophageal echocardiography was useful to visualize and identify the precise point of attachment of the tumour, enabling cardiac surgeons to plan aortic valve repair rather than replacement.

Aortic Valve↗

Papillary fibroelastoma of the aortic valve presenting with myocardial infarction.

We describe the case of a 56-year-old woman who presented with myocardial infarction. Noninvasive and invasive investigations revealed coronary embolism from a papillary tumor attached to the right coronary cusp of the aortic valve as the underlying process. The tumor, which histologically proved to be a papillary fibroelastoma, was excised surgically and the resulting defect in the aortic valve leaflet was closed with a patch of autologous pericardium, effectively reconstructing the aortic valve. The current literature on intracardiac papillary fibroelastoma as a source of embolism and its surgical treatment is summarized.

Aortic Valve↗

Evaluation of endocarditis and its complications by biplane and multiplane transesophageal echocardiography.

Echocardiography is currently the method of choice for the diagnosis of endocarditis-associated vegetations or complications such as abscess formation. Thereby, the transesophageal approach (TEE) is clearly superior to precardial echocardiography and, at present, biplane TEE can be considered as the standard TEE technique. Compared with the monoplane technique, biplane TEE provides additional qualitative and quantitative information concerning the presence and amount of valvular destruction. Multiplane TEE facilitates (and abbreviates) the examination procedure, and may be helpful for easier detection of small initial abnormalities, those developing on native valves with preexisting lesions, or on prosthetic valves. It allows more accurate measurements and three-dimensional reconstruction of vegetations and abscess areas and provides more anatomical details of the disease. However, it remains to be shown by future studies if multiplane TEE will identify endocarditis-associated lesions more frequently than the biplane technique doses.

Echocardiography, Transesophageal↗

Assessment of left atrial appendage function by biplane transesophageal echocardiography in patients with nonrheumatic atrial fibrillation: identification of a subgroup of patients at increased embolic risk.

OBJECTIVES: This study was conducted to identify a subgroup of patients with nonrheumatic atrial fibrillation with an increased risk for cardiogenic embolism by assessing left atrial appendage function. BACKGROUND: Patients with nonrheumatic atrial fibrillation have an increased risk for thromboembolic complications. The left atrial appendage is the most likely source for thrombus formation. It is likely that the appendage function (contraction, filling dynamics) is related to the pathogenesis of thrombus formation. METHODS: Twenty-nine patients with nonrheumatic atrial fibrillation (group I) underwent biplane transesophageal echocardiography. The maximal and minimal areas during a cardiac cycle and the peak emptying and filling velocities of the appendage were measured in both scan planes. For comparison, two additional groups were also analyzed. Group II consisted of 12 patients with chronic atrial fibrillation due to significant mitral stenosis, and group III consisted of 30 patients who were in sinus rhythm. RESULTS: Patients with nonrheumatic atrial fibrillation showed two distinct appendage flow patterns: either well defined peak filling and emptying waves (> or = 25 cm/s) with visible fibrillatory contractions of the appendage wall ("high flow profile") or irregular, very low, peak filling and emptying waves (< 25 cm/s) associated with almost no visible appendage contractions ("low flow profile"). The left atrial appendage function in the first subgroup resembles that seen in patients with sinus rhythm, whereas the appendage function in the latter subgroup resembles more the "static pouch" seen in patients with rheumatic atrial fibrillation. Events suggestive of cardiogenic embolism occurred in six patients from group I, five of whom were in the low flow profile subgroup (p < 0.05). The spontaneous echo contrast phenomenon was observed in 80% of the low flow profile subgroup but in only 5% in the high flow profile subgroup (p < 0.05). Three thrombi confined to the left atrial appendage were detected by transesophageal echocardiography in group I; all three of the patients were in the low flow profile subgroup. CONCLUSIONS: The assessment of left atrial appendage function by transesophageal echocardiography may be helpful to identify subgroups of patients with nonrheumatic atrial fibrillation with an increased risk of thrombus formation.

Atrial Fibrillation↗

Transesophageal echocardiographic assessment of superior vena cava thrombosis in patients with long-term central venous hemodialysis catheters.

In some patients with end-stage renal failure, arteriovenous fistulas cannot be created due to poor vessel conditions. Alternatively, hemodialysis (HD) can be performed using long-term central venous catheters. However, these dialysis catheters are associated with a presently unknown risk of superior vena cava (SVC) thrombosis. We examined 20 patients (11 female, 9 male, age 29-83 years) 1-48 (mean 15) months after transjugular insertion of a permanent single lumen silicone rubber HD catheter. All patients underwent both transthoracic (TTE) and biplane transesophageal (TEE) echocardiography. TTE visualized the catheter only when its tip was localized in the right atrium (2 patients), but did not succeed in adequate imaging of the SVC. In contrast, TEE allowed high quality imaging of the SVC in all patients and detected a SVC thrombosis in 6 patients; in 3 of them, caval thrombosis was subtotal. One additional patient showed a thrombus attached to the catheter tip alone. Dwelling time of catheters since insertion in the SVC was not significantly different in patients with and without thrombosis. Reduced blood flow during HD was observed in 5 of 7 patients with catheter-associated thrombi but also in 4 of 13 patients without evidence for caval thrombosis by TEE. It is concluded that thrombotic occlusion of the SVC is frequent in patients with long-term central venous access; it does not necessarily correlate with clinical signs but can easily be detected by TEE. Patients with long-term central venous hemodialysis catheters should undergo transesophageal echocardiography at regular intervals.

Adult↗

Comparison of transthoracic and transesophageal echocardiography for detection of abnormalities of prosthetic and bioprosthetic valves in the mitral and aortic positions.

Two-dimensional echocardiography is the diagnostic procedure of choice for evaluation of prosthetic valve abnormalities. However, transthoracic echocardiography (TTE) may be limited owing to acoustic shadowing and poor acoustic windows. Some of these limitations may be overcome by transesophageal echocardiography (TEE). One hundred twenty-six patients with 148 prosthetic valves (113 bioprostheses and 35 mechanical devices) were studied by M-mode and 2-dimensional TTE and TEE. Prosthetic valve morphology was confirmed by surgery or autopsy in all cases; 124 prostheses were classified as diseased (33 endocarditis, 8 thrombi, and 83 degeneration defined as leaflet thickening > 3 mm with restricted motion) and 24 as normal. Prosthetic valve endocarditis and thrombi were correctly identified by TTE in 12 of 33 (36%) and 1 of 8 (13%) prostheses, respectively, but could be diagnosed by TEE in 27 of 33 (82%; p < 0.001) and 8 of 8 (100%; p < 0.01), respectively. Compared with TTE, TEE had a higher sensitivity for morphologic prosthetic valve abnormalities in patients with either bioprostheses (88 [87%] vs 66 [65%] of 101 prostheses; p < 0.01) or mechanical devices (19 [83%] vs 5 [22%] of 23 prostheses; p < 0.01) and in patients with a prosthesis in either the aortic (49 [77%] vs 32 [50%] of 64; p < 0.01) or mitral (58 [97%] vs 39 [65%] of 60; p < 0.001) position. Overall, sensitivity and specificity were 57 and 63%, respectively, for TTE, and 86 and 88%, respectively, for TEE.(ABSTRACT TRUNCATED AT 250 WORDS)

Aortic Valve↗

Membrane physiological reactions of human arteriosclerotic coronary arteries to hypoxia.

Human coronary arteries were taken from heart transplant patients. Arteriosclerotic arteries were more depolarized and constricted over the whole PO2 range between 535 and 0 mm Hg. During oxygen deficiency, control preparations showed a maximal hyperpolarization of delta V = 10.9 mV and a maximal relaxation of delta T = 0.466 g. Arteriosclerotic arteries, however, became hyperpolarized by merely delta V = 7.1 mV and relaxed by delta T = 0.258 g. In normal coronary arteries, indomethacin reduced the hypoxic hyperpolarization and dilation at 30 mm Hg PO2 by about 51%. The reduction was 26% in arteriosclerotic vessels. The complete removal of the endothelium caused a 49% (74%) restriction of dilatory vascular reactivity. The relationship was quite similar for a carbogen Krebs solution. The hyperpolarizing and dilatory contribution by prostacyclin was 32% in normal and 12% in arteriosclerotic coronary arteries. The remainder could be attributed to the basal release of the endothelial dilator endothelium-derived hyperpolarizing factor (EDHF). Thus, it may be concluded that in arteriosclerotic blood vessels, prostacyclin (PGI2) synthesis and release are predominantly diminished. Finally, we found that the ratio PGI2/EDHF in the voltage and tension changes strongly shifted to the PGI2 side with a declining oxygen concentration. This is true for normal and arteriosclerotic vessels. In accordance with the activation curve for vascular smooth muscle, the hyperpolarization leads to relaxation via a closure of Ca2+ channels. Hyperpolarization of 2.5 mV reduces the tension developed by one-half.

Calcium Channels↗

[Acoustic quantification--a new online procedure for automatic recording of left ventricular areas and area changes in the echocardiogram].

Initial experiences were obtained with a new technique for automatic quantification of left ventricular areas and area changes in two-dimensional (2D) echocardiograms (acoustic quantification, AQ). AQ is based on integrated back-scatter-analysis in real-time. Practicality and reliability of AQ were studied in 50 non-selected patients. AQ measurements of left-ventricular (LV) cavities were compared with off-line measurements which were obtained by analysis of videotaped images. Thirty-two (64%) and 39 (78%) patients could be studied by AQ from parasternal and apical views, respectively. LV areas measured from parasternal views or apical views showed a good correlation with corresponding values obtained by off-line analysis (r = 0.78 to 0.91). In addition, LV fractional area changes measured by AQ showed an excellent correlation with off-line measurements (parasternal: r = 0.86; apical: r = 0.84). During infusion of dobutamine (n = 3; 5, 10, 20 micrograms/kg/min, 10 min each dose), reduction of LV cavity areas could be continuously monitored and quantified by AQ for each cardiac cycle. In five of six patients who underwent transesophageal echocardiography, AQ could easily detect LV contours in the transgastric short axis view. Although AQ is not practicable in all patients, this new technique appears to be a promising and reliable approach for real-time, automatic boundary detection in 2D echocardiograms.

Adolescent↗

Myocardial oxygen supply in coronary artery disease.

In patients with coronary artery disease investigated during cardiac catheterisation, myocardial blood flow and myocardial oxygen consumption were significantly decreased as compared to control patients without signs of coronary artery disease. At the same time left ventricular function was impaired. In addition to regional contraction abnormalities observed in 77% of the patients, mean heart index and mean left ventricular work were diminished and mean enddiastolic pressure elevated. Among the coronary artery disease group, patients with normal blood pressure had a significantly higher left ventricular enddiastolic pressure than patients with hypertension.

Coronary Circulation↗

Vasodilatation evoked by K+ channel opening.

In arterial smooth muscle with normal tone or predepolarized and precontracted by noradrenaline, iloprost effects a dose-dependent hyperpolarization and relaxation. The hyperpolarization is due to K+ channel opening. In hypoxic vasodilatation, which is likewise induced by membrane hyperpolarization, a share of 20-30% falls to prostacyclin and 70-80% to an endothelium-derived hyperpolarizing factor.

Animals↗