[A case report: descending necrotising mediastinitis in a 10-year old boy].
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Anti-Bacterial Agents↗
Biomedical subjects
K Böök
Publications and source records attributed to K Böök.
Inhalation of nitric oxide reduced pulmonary hypertension after cardiac surgery in a 3.2-kg infant.
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Administration, Inhalation↗
Clinical experience of pacemaker treatment in children.
Pacemaker treatment is more complicated in children than in adults, mainly because of electrode problems. A pacemaker system was implanted in 23 children aged 2 days-14 years (mean 4.8 years, with 11 less than or equal to 3 years) at the Karolinska Hospital since 1983. The indications for pacing were peroperative atrioventricular block (AVB) in 13 cases, congenital AVB in five, sinoatrial disorder in four and slow ventricular arrhythmia in one case. The initially implanted electrode was epicardial in ten children (in the first 2 years of the study) and endocardial in the other 13. Eight of the ten epicardial electrodes had to be replaced by endocardial within a mean of 2.5 years. There were 18 reoperations, the reasons being increased threshold/exit block--all epicardial leads (8 cases), electrode failure (1), 'stretching' of the electrode secondary to body growth (4), local infection (3) and generator replacement (2). The reoperation rate was unacceptably high in children with epicardial electrodes. Endocardial pacing is the method of choice even for small infants.
Adolescent↗
Repair of complete atrioventricular canal. 15 year's experience.
Corrective surgery for complete atrioventricular canal was performed over a 15-year period on 72 patients, 49 of whom had Down's syndrome: 46 were without major associated cardiac anomalies and 15 had previously undergone pulmonary artery banding. The pressures in the right and left ventricles equilibrated in 77% of the patients. The early mortality rate was 18% and the late mortality 7%. At follow-up 4% of the patients had severe mitral incompetence and 6% had severe tricuspid incompetence. The mean reduction of pulmonary artery pressure was 40 mmHg. The mean peak systolic pressure ratio between pulmonary artery and aorta was 0.73 before repair and had fallen to 0.38 at follow-up catheterization, when 88% of the patients were asymptomatic. Early repair in the first year of life is nowadays preferred in order to avoid progressive pulmonary vascular disease. Although the alternative of first-stage pulmonary artery banding gave lower (13%) mortality at the corrective operation, it cannot be recommended if atrioventricular valvular incompetence is significant.
Cardiac Catheterization↗
[The man behind the syndrome: Max Wilms. A famous pathologist and a skillful surgeon].
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General Surgery↗
Key enzymes of myocardial energy metabolism in papillary muscle of patients with mitral valve disease--relation to left ventricular function.
Metabolic adaptations were studied in papillary muscle from 18 patients undergoing open-heart surgery for mitral valve disease. Analyses were made of myoglobin (MG), the enzymes lactate dehydrogenase (LD) with its isoenzymes, glyceraldehyde phosphate dehydrogenase (GAPDH), phosphofructokinase (PFK), citrate synthase (CS) and creatine kinase (CK) with its isoenzymes MB (CK-MB) and mitochondrial CK (CK-MIT). Myocardial function was assessed with left ventricular angiography. Positive and significant correlations were found between enzymes of oxidative metabolism, i.e. CS on the one hand and MG (r = 0.76), LD1 (r = 0.68), CK-MIT (r = 0.86) and CK-MB (r = 0.65) on the other. Indicators of glycolysis--PFK, GAPDH and LD3--varied independently of CS. LD3% was directly related to GAPDH (r = 0.66). In a sub-group of 12 patients with isolated mitral regurgitation due to myxomatous valve degeneration, LD3% rose (r = 0.72) with increasing myocardial derangement which, however, showed no relationship with any other marker. Thus the capacities of oxidative and glycolytic pathways did not co-vary. Volume load appeared not to affect oxidative capacity, while the anaerobic fraction of glycolysis was increased.
Aged↗
[A congress on Fallot's tetralogy].
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Child↗
Importance of MHC antigen expression on solid tumors in the in vitro interaction with autologous blood lymphocytes.
In 54 patients with lung and 14 with ovarian carcinomas the quantitative variations of the major histocompatibility complex (MHC)-determined class I and class II antigens of the tumor cells were related to their in vitro interaction with blood lymphocytes, to the lymphoid infiltration of the tumors, and to the metastatic state of the disease. The tumor cell-lymphocyte interaction was measured by the proliferative response in mixed lymphocyte tumor cell culture and by the cytotoxic activity of the lymphocytes. The results showed that (1) none of the 23 tumors from patients with disseminated disease were lysed; (2) class I-negative tumors were not damaged; (3) lymphoid infiltration was present in a higher proportion of class II-positive tumors; and (4) both MHC-positive and -negative tumors were found among the disseminated tumors. The requirement of class I expression in the lytic interaction substantiates our earlier conclusion concerning the cytotoxic T lymphocyte nature of lymphocyte-mediated auto-tumor lysis. The lack of auto-tumor lysis in patients with metastases suggests impairment of lymphocyte function in advanced stages of the disease.
Adenocarcinoma↗
Coenzyme Q10 and key enzyme activities in papillary muscle related to left ventricle function in mitral valve disease.
Coenzyme Q10 (CoQ10) was studied in papillary muscle from 18 patients (52-67 years, 2 females) subjected to open heart surgery due to mitral valve disease. In addition the enzyme activities of lactate dehydrogenase (LD) with its five isozymes, citrate synthase (CS) and mitochondrial CK (CK-MIT) were determined. Myocardial function was assessed by means of left ventricle (LV) angiography. CoQ10 averaged 0.39 (range 0.26-0.59) micrograms x mg-1 dw. On an individual basis CoQ10 was related to CS activity although not as closely as CK-MIT (r = 0.45, p less than 0.05 versus r = 0.86, p less than 0.001). The ratio (CoQ10) x (CS activity)-1 was calculated to represent mitochondrial quality. The level of LD3 fraction increase was used to mark for the degree of metabolic stress in the heart. LD3 fraction was negatively related to the quality index (r = -0.71, p less than 0.001). Thus, those with a low CoQ10 per unit of CS activity had also a high LD3 isozyme fraction. In a subset of 12 patients with isolated mitral regurgitation due to myxomatous valve degeneration, CoQ10 and the ratio CoQ10 over CS decreased with the degree of LV function impairment (r = -0.58, p less than 0.05 and r = -0.68, p less than 0.05, respectively). The quality index takes into account not only enzyme activity but also the potential for control of free oxygen radicals.
Aged↗
Protein synthesis assessed by ribosome analysis in human papillary muscle in relation to oxidative capacity: a comparison with skeletal muscle.
Protein synthesis as assessed by the concentration and size distribution of ribosomes was determined together with citrate synthase activity in papillary muscles obtained at open heart surgery from patients with mitral valve disease. The results were compared with corresponding data from the quadriceps femoris muscle of patients undergoing cholecystectomy. Citrate synthase activity was six times higher in papillary muscle than in skeletal muscle. The total ribosome concentration per mg DNA was similar in the two types of muscle. Compared with skeletal muscle, in papillary muscle polyribosomes constituted a higher proportion of the ribosomes (p less than 0.001), and there was a tendency towards larger polyribosome aggregates. It is proposed that the high concentration of polyribosomes in papillary muscle is related to the high oxidative capacity of that tissue.
Citrate (si)-Synthase↗
Key enzymes of myocardial energy metabolism in patients with valvular heart disease: relation to left ventricular function.
Endomyocardial biopsies were taken from the apex of the left ventricle in 15 patients operated on for aortic valve disease or ischaemic heart disease and from papillary muscles in six patients operated on for mitral valve disease. Activities of cardiac phosphofructokinase (PFK), total lactate dehydrogenase (LD), its isoenzyme LD1, aspartate aminotransferase (ASAT), total creatine kinase (CK), its isoenzyme MB, citrate synthase (CS) and myoglobin content (MYO) were related to the angiographically determined left ventricular function. Activities of total LD, PFK and PFK/CS ratio were lower in patients with decreased, than in those with normal, left ventricular function. Myoglobin content and activities of CS and ASAT were not related to left ventricular function. It is suggested that depressed left ventricular contractility is associated with a decreased glycolytic capacity while the oxidative capacity is mainly unaltered.
Aged↗
Lysis of autologous tumor cells by blood lymphocytes activated in autologous mixed lymphocyte tumor cell culture--no correlation with the postsurgical clinical course.
Mixed lymphocyte tumor cell cultures (MLTC) were initiated with cells collected at the time of surgery from 62 patients with the following diagnoses: 12 squamous cell carcinoma, 14 adenocarcinoma of the lung, 17 osteosarcomas, and 16 soft tissue sarcomas. The lytic effect generated against autologous tumor cells was tested on the 7th day. These patients had been part of previous evaluation, which revealed that the lysis of autologous tumor cells by freshly collected lymphocytes correlated with the postsurgical clinical course. Patients with long survival exhibited autotumor lysis without previous activation. Blood lymphocytes of about half of the primarily nonreactive patients were stimulated for lytic function in MLTC. However, this parameter showed no correlation with the clinical course.
Aged↗
Lysis of autologous tumor cells by blood lymphocytes tested at the time of surgery. Correlation with the postsurgical clinical course.
Lymphocyte-mediated lysis of autologous tumor cells (autologous lymphocyte cytotoxicity ALC) was tested at the time of surgery in 108 patients (46 squamous cell carcinomas of the lung, 25 adenocarcinomas of the lung, 19 soft tissue sarcomas and 18 osteosarcomas). The clinical course of these patients in relation to the test results has been published previously. The group was evaluated again after an extended observation time, now with a mean of 80.2 months (range 36-108). The test was rarely positive in patients with metastasis (2 out of 28 experiments). There was a correlation between the ALC results and the postsurgical clinical course for patients without detectable metastasis in that (1) a negative test was invariably a bad prognostic sign, i.e., all 32 patients with negative ALC died within 3 years (mean survival time 16.1 months). (2) The remission and survival times were longer for the ALC positive patients (p less than 0.001). (3) All 37 individuals who are alive at present without recurrence belong to the reactive group. The ALC results correlated with the clinical course in 88% of patients. The correlation was highest for the groups of soft tissue sarcoma and adenocarcinoma of the lung. There was no correlation between killing of K562 cells and ALC, or between lymphoproliferative response to PHA and ALC reactivity.
Adenocarcinoma↗
Echocardiographic findings in a patient with left ventricular pseudoaneurysm.
A 57-year-old woman, treated for a large anterior transmural myocardial infarction, was readmitted after 8 weeks because of progressive cardiac failure. Chest X-ray showed cardiomegaly with an atypical cardiac silhouette. Two-dimensional echocardiography disclosed a large left ventricular pseudoaneurysm. The patient underwent resection of the false aneurysm with repair of the left ventricular wall and recovered gradually. Different methods for diagnosing pseudoaneurysm are discussed.
Echocardiography↗
Myoglobin content in human skeletal muscle and myocardium: relation to fibre size and oxidative capacity.
Myoglobin, muscle fibre diameter, and citrate synthase activity were measured in leg muscle of untrained and trained men and in the myocardium from the apex of the left ventricle and from papillary muscle in patients subjected to open heart surgery. The citrate synthase (CS) activity was 60% higher in trained than in untrained skeletal muscle. In the myocardium it was around four times greater than in untrained skeletal muscle but there was no difference between the apex of the left ventricle and papillary muscle. The fibre diameter varied almost threefold between the different groups of muscles with the largest diameter in untrained skeletal muscle and the with the largest diameter in untrained skeletal muscle and the smallest in papillary muscle. The myoglobin content in trained skeletal muscle did not differ from that of untrained muscle. In the left ventricle it was only 40% of that found in untrained muscle while papillary muscle had almost twice as high a myoglobin content as did the left ventricle. The ratio between myoglobin and fibre diameter, however, was of similar magnitude in skeletal muscle and the left ventricle while it was twice as high in papillary muscle as in the other muscles. In conclusion, the diffusion distance in terms of fibre diameter decreased with increased oxidative capacity (CS activity), when comparing the statistical means of the four different groups. The capacity for oxygen diffusion in relation to oxygen demand measured as the ratio of myoglobin to fibre diameter appeared to be of similar magnitude in skeletal muscle and left ventricle but was higher in papillary muscle.
Adult↗
Microbial flora associated with pulmonary neoplasms.
The microbial flora associated with various tumors of the lung was studied in 19 patients. Biopsy specimens taken from the resected bronchus and from peripheral lung tissue at thoracotomy were cultured for aerobic and anaerobic microorganisms prior to administration of prophylactic antibiotics. Bacterial growth was obtained in bronchial and/or pulmonary biopsy culture in eight patients, with additional growth of fungi (Candida parapsilosis) in one of them. The microflora was of oropharyngeal origin, with streptococci and staphylococci predominating. The remaining 11 patients were culture-negative. The results of the study suggest that a prophylactic antibiotic regimen consisting of antistreptococcal and antistaphylococcal drugs is appropriate.
Aged↗
Human creatine kinase. Isoenzymes and logistics of energy distribution.
A simple procedure to estimate creatine kinase of mitochondrial origin (CK-mit) was tested in homogenates from human myocardial and skeletal muscle. Thereafter CK-mit was estimated as the difference between the activity remaining after immunoinhibition with anit-CK-M and chromatographic isolation of CK-MB. This method was applied to selected human myocardial and skeletal muscle biopsies. These biopsies were selected on the basis of citrate synthetase activity so as to give a large range in oxidative capacity. CK-MB and CK-mit were correlated and both CK-MB and CK-mit correlated to citrate synthetase activity. The isoenzymes CK-MB and CK-mit were thus associated with the oxidative capacity of the tissue. The results confirm the energy shuttle hypothesis for CK with CK-MB located at target organelles.
Citrate (si)-Synthase↗
Correlation between lymphocyte-mediated auto-tumor reactivities and the clinical course. II. Evaluation of 69 patients with lung carcinoma.
T-cell-enriched lymphocyte populations of 69 lung carcinoma (44 squamous cell, 23 adeno-, and two large cell carcinoma) patients were investigated at the time of surgery for proliferative response to, and/or cytotoxic potential against, freshly separated autologous tumor cells. Tumor-free period and survival time of the patients were correlated with the reactivity obtained in the in vitro tests. The observation time varied between 20 and 78 months (mean 52). Tumor-free period and survival time were longer and survival rate higher in the group with lymphocyte reactivity toward their tumors. In the non-reactive group, all patients but one died within 3 years. Almost all patients had cytotoxic lymphocytes against K562, the three who did not belonging to the category with short survival time.
Adenocarcinoma↗