[Emporiatric consultation and immunizations].
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Communicable Disease Control↗
Biomedical subjects
M Günther
Publications and source records attributed to M Günther.
Immunogenicity and safety of hepatitis A vaccine in liver and renal transplant recipients.
Organ transplant recipients with chronic hepatitis B or hepatitis C virus infection may be at increased risk of fulminant hepatitis A. Liver transplant (LTX) recipients, renal transplant (RTX) recipients, and healthy controls received 2 doses of hepatitis A vaccine 6 months apart. Anti-hepatitis A virus (anti-HAV) seroconversion after the primary dose occurred in 41% of the LTX patients, 24% of the RTX patients, and 90% of the controls. After the booster dose, the respective rates were 97%, 72%, and 100% (P<.001). RTX patients also had significantly lower geometric mean titers (GMTs) of anti-HAV than LTX patients and controls. In the RTX group, the seroconversion rate and GMT were inversely associated with the number of immunosuppressive drugs received by the patients. The vaccine was well tolerated. Hepatitis A vaccine can be recommended to LTX and RTX patients, but the patients should receive a full course of 2 doses before imminent exposure.
Adult↗
The mechanical effectiveness of erect and "bent-hip, bent-knee" bipedal walking in Australopithecus afarensis.
It is universally accepted that the postcranial skeleton of the early hominid Australopithecus afarensis shows adaptations, or at least exaptations, towards bipedalism. However, there continues to be a debate concerning the likely form of terrestrial bipedality: whether gait was erect, like our own, or "bent-hip, bent-knee" like the bipedalism of living chimpanzees. In this study we use predictive dynamic modelling to assess the mechanical effectiveness of AL-288-1 under both hypotheses, on the basis of data on segment proportions from the literature. AL-288-1's proportions are incompatible with the kinematics of chimpanzee bipedalism, but compatible with the kinematics of either erect or "bent-hip, bent-knee" human gait. In the latter case, neither the ankle nor the knee joint would have contributed substantial mechanical work to propulsion of the body, and net energy absorption is predicted for these joints, which would have resulted in increased heat load. Such an ineffective gait is unlikely to have lead to selection for "bipedal" features in the postcranial skeleton.
Animals↗
[Infiltrating intramuscular lipoma].
Intramuscular lipomas are rare, benign unencapsulated tumors. They are also called infiltrating lipomas because of their infiltrative growth pattern which, deeply localized, seizes the skeleton muscle. The only obvious symptom is a palpable mass. Microscopically, monovacular fat tissue shows up between the muscle fiber. In extreme cases the preexisting muscle can be totally replaced by fat tissue. A precise pathohistological examination is needed to avoid the mistaken diagnosis of a well-differentiated liposarcoma. Late diagnosis, the extent and the localization of the tumor often do not allow for an R0 resection and influence the postoperative recurrence rates, which lie between 3 and 62%. R0 resections are not desirable when postoperative severe loss of function can be expected. Malfunctions will slowly take place and can greatly be compensated, in contrast to a radical procedure with immediate loss of function.
Aged↗
Determination of the origin of single nucleated cells in maternal circulation by means of random PCR and a set of length polymorphisms.
Non-invasive prenatal diagnosis on fetal nucleated erythrocytes from the maternal circulation is hampered by the small number of nucleated erythrocytes and the uncertainty as to whether they are of fetal or maternal origin. To overcome the latter limitation, single nucleated erythrocytes were separated and enriched from maternal blood by a triple density gradient and a monoclonal antibody (CD71) in combination with a magnetic activated cell sorter. Single nucleated cells were microscopically examined, individually collected with extended Pasteur pipettes, and each transferred into separate caps for the polymerase chain reaction (PCR). The DNA of the single nucleated erythrocytes was amplified at least 50-fold with a random PCR technique, viz., primer extension preamplification. Precise differentiation between maternal and fetal nucleated erythrocytes was achieved via PCR by using primers flanking highly polymorphic nucleotide repeats (DIS53, ACTBP2 and D21S11) and with a XY-specific primer pair (amelogenin). A total of 134 putative nucleated erythrocytes were analyzed from blood samples of 19 pregnant women. With the help of the polymorphic repeats, 25% were assigned as being of maternal origin, 26% of fetal origin, and 48% were uninformative. In cases with male fetuses, the amelogenin primers revealed 30% of cells to be fetal nucleated erythrocytes, the remaining 70% being of maternal origin. The results indicate that the combination of random PCR and PCR-mediated polymorphism analysis on the DNA of single nucleated erythrocytes is a useful technique for non-invasive prenatal diagnosis.
Amelogenin↗
Bounds on new Majoron models from the Heidelberg-Moscow experiment.
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Journal Article↗
CBV during exchange transfusion in infants with erythroblastosis.
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Blood Volume↗
Somatostatin receptor scintigraphy in the staging of small cell lung cancer.
The aim of this study was to evaluate somatostatin receptor scintigraphy (SRS) in the staging of patients with small cell lung cancer. Prior to chemotherapy, 20 patients were investigated up to 24 h following an injection of 200 MBq 111In-octreotide. Following chemotherapy and restaging, four patients were re-evaluated. Primary tumour was detected in 18 of 23 studies, which exhibited increasing target-to-back-ground ratios over time. Lymph node metastases and distant metastases were detected in 7 of 27 and 8 of 31 sites, respectively. Thus, the overall sensitivity for detecting metastases was less than 26%. SRS did not result in any upstaging of patients. We conclude that in patients with small cell lung cancer, functional imaging by SRS has no impact on clinical decision making.
Aged↗
Ketamine and strychnine treatment of an infant with nonketotic hyperglycinaemia.
UNLABELLED: Non-ketotic hyperglycinaemia (NKH) is a severe seizure disorder associated with high glycine levels. Glycine is a major inhibitory neurotransmitter in the CNS, but has also modulating effects at one of the glutamate receptors, the N-methyl-D-aspartate-(NMDA) receptor. Based on this knowledge we treated a female newborn suffering from severe NKH with the NMDA receptor blocker ketamine in association with strychnine and magnesium supplementation. This treatment led to cessation of seizures, reappearance of swallowing and sucking and improved the neurological status. Some pharmacokinetic data of strychnine and ketamine in the infant are given. CONCLUSION: Ketamine in combination with strychnine may be beneficial in non-ketotic hyperglycinaemia.
Amino Acid Metabolism, Inborn Errors↗
[Obstetric prognostic factors of newborn infants with very low birth weight (< or = 1,500 gram) with reference to survival rate and early childhood development].
Prognostic factors influencing survival in 235 very low birthweight prematures (< or = 1500 g) born between 1986 and 15.11. 1993 at the Department of Obstetrics and Gynaecology, University Hospital of Cologne, were retrospectively evaluated. Chromosomal anomalies and severe congenital malformations were excluded. Of 180 singletons 84 were classified as appropriate-for-gestational-age (AGA) and 96 as small-for-gestational-age (SGA). By interrogating the attending paediatricians data regarding the early development of 62/65 surviving singletons born between 1986 to 1990 were recorded (follow-up rate 95%). Survival was significantly correlated to singleton pregnancy (p < 0.05), female sex (p = 0.001) and in the AGA-prematures to prenatal corticoid prophylaxis. With similar mean birthweight SGA-singletons showed a three weeks higher mean gestational age; the mortality showed an inverse correlation to birthweight and gestational age being 11% higher in the AGA-group compared with the SGA-group (32% versus 21%). At the age of between 11 months and 6 years severe handicaps and developmental retardations were found more often in previous AGA-prematures (6/26) than in previous SGA-prematures (4/36); type and degree of later handicap were not correlated to birthweight. According to our results survival rates of very low birthweight prematures are strongly influenced by singleton pregnancy, by fetal sex, by gestational age and in the AGA-group by prenatal corticoid prophylaxis; mortality shows an inverted correlation to birthweight and gestational age, whereas the later prognosis of survivors does not seem to be influenced by birthweight or gestational age.
Adult↗
Measurements of sodium and potassium in newborns and prematures by ion-selective electrodes and flame photometry: influence of lipid and protein content of blood.
The alternative use of flame photometry and ion selective electrodes for electrolyte determinations in neonatology led to the question how the two methods agree. 104 routine blood samples were taken as matched pairs for a comparison of sodium and potassium determinations. Pre-analytical error was avoided by the mode of blood collection. The influence of the protein and lipid content of blood on the differences between the methods was determined by calculating its water content and making a post-correction of the flame values. Thus the differences for sodium could be reduced, whereas the differences for potassium slightly increased. As long as the imprecision of sodium determination is a meaningful methodological problem, the influence of the protein and lipid content of neonatal blood is not the main factor for differences between ISE and flame photometry.
Bilirubin↗
Transforming growth factor beta 1 regulates tissue inhibitor of metalloproteinases-1 expression in differentiated human articular chondrocytes.
OBJECTIVE: To investigate the role of interleukin-6 (IL-6) and transforming growth factor beta 1 (TGF beta 1) in the regulation of tissue inhibitor of metalloproteinases-1 (TIMP-1) synthesis in human articular chondrocytes. METHODS: Articular cartilage was obtained from human knee joints 24 hours after death. Chondrocytes were isolated by collagenase digestion and embedded in low-gelling-temperature agarose. After stimulation by cytokines, total RNA was isolated and analyzed by Northern blotting. TIMP-1 protein levels were determined using a competitive enzyme-linked immunosorbent assay. RESULTS: Human chondrocytes in agarose culture expressed messenger RNA (mRNA) for the IL-6 receptor (gp80) and its signal-transducing subunit gp130. In contrast to the findings in a previous study, IL-6 did not stimulate TIMP-1 expression in these cells, whereas TGF beta 1 was an important inducer of TIMP-1 mRNA and protein synthesis. CONCLUSION: Our findings suggest that TGF beta 1 has a protective effect on the extracellular matrix of human articular chondrocytes.
Adolescent↗
Clinical experiences with high-frequency oscillatory ventilation in newborns with severe respiratory distress syndrome.
OBJECTIVE: To generate hypotheses about which subgroups of newborns with severe respiratory distress syndrome might benefit most from high-frequency oscillatory ventilation. DESIGN: Retrospective analysis of a case series of newborns with severe respiratory distress syndrome who were treated in our department with high-frequency oscillatory ventilation. SETTING: Referral center for neonatal and pediatric intensive care medicine. PATIENTS: All newborns (n = 18), admitted between June 1991 and February 1993, of various gestational ages (26 to 41 wks), with severe respiratory distress syndrome caused by various underlying pulmonary diseases who did not respond to conventional therapy and who thus were treated with high-frequency oscillatory ventilation. MAIN OUTCOME MEASURES: Survival until discharge from our unit and persistent improvement of gas exchange. RESULTS: Eight (44%) of 18 patients survived; ten (55%) patients died. Four (22%) survivors showed marked clinical improvement with the initiation of high-frequency oscillatory ventilation. Four (22%) survivors did not respond to high-frequency oscillatory ventilation. The responder group consisted of term or near-term neonates (gestational age at least 35 wks) with pulmonary disease that was complicated by persistent pulmonary hypertension. The group of premature neonates with a gestational age of < 35 wks did not respond to high-frequency oscillatory ventilation. CONCLUSIONS: As a result of our analysis, we hypothesize that term newborns with severe respiratory distress syndrome complicated by persistent pulmonary hypertension and hypercarbia can benefit from high-frequency oscillatory ventilation. Premature neonates with ventilation-induced lung injury are not likely to respond to high-frequency oscillatory ventilation.
Female↗
The soluble interleukin-6 receptor is generated by shedding.
The ligand-binding subunit (gp80) of the human interleukin-6 receptor (IL-6R) was transiently expressed in COS-7 cells. The metabolically labeled protein was shown to be quantitatively released from the membrane within 20 h. We identified the protein released from the transfected COS-7 cells after purification to homogeneity and N-terminal sequencing as a soluble form of the gp80/IL-6R. Shedding of the gp80 protein was strongly induced by 4 beta-phorbol-12-myristate-13-acetate, indicating that the process was regulated by protein kinase C (PKC). This was further corroborated by the finding that co-transfection of a PKC expression plasmid led to enhanced shedding of the gp80 protein. Since shedding of gp80 could not be prevented by treatment of the cells with inhibitors of all known classes of proteases, a novel protease seems to be involved. As a control, an unrelated membrane protein (vesicular stomatitis virus glycoprotein) was transfected into COS-7 cells and analyzed for shedding. Since the turnover of this protein was not mediated by shedding, we conclude that the release of gp80 from COS-7 cells is a specific process. The shed gp80 protein specifically binds IL-6, and this complex shows biological activity on human hepatoma cells. Human peripheral blood monocytes released a soluble form of the gp80 protein into the culture medium upon PMA treatment indicating that PKC-regulated shedding is the physiological mechanism of generation of the soluble IL-6R.
Cell Line↗
[Laparoscopic training in urology. An essential principle of laparoscopic interventions in the retroperitoneum].
The main problem with clinical introduction of laparoscopic techniques in urology is that despite experience with endoscopy no significant endoscopic training is given. Laparoscopic nephrectomy, in particular, is a rather complicated procedure and needs an adequate training concept: The beginner should have the possibility of practising in vitro in a closed "pelvi-trainer" to learn video-optical coordination and orientation; then it is necessary to get used to handling the instruments and practise the different steps of the procedure (i.e. clipping of vessels, sacking of the kidney) either in phantom models or in explanted animal organs. On this basis, we performed laparoscopic nephrectomy in an animal model (n = 18 porcine kidneys). We were able to standardize the technique of creating a pneumoperitoneum, the positioning of the animal, the site and size of the trocars, and preparation and clipping techniques (i.e. Endo-GIA) and entrapment of the kidney (testing different organ bags). A step-by-step approach was used for the introduction to clinical application. For simulation and training of video-assisted preparation techniques in patients and step-wise introduction to laparoscopy (instruments, endocoagulation, trocars), we created a "lap-tent", which was placed over the wound after exposition of Gerota's fascia. Further preparation was performed under laparoscopic conditions (without pneumoperitoneum) with a limited time allowed (1 h). Thereafter, we started with time-limited laparoscopy and laparoscopic lymphadenectomy prior to pelvic surgery (prostatectomy, cystectomy) to introduce the staff to the technique of pneumoperitoneum and placement of the trocars and to the use of the instruments in general. Based on this step-by-step training concept, after a 6-months period we were successful in introducing transperitoneal laparoscopic nephrectomy (TLN) to our clinical routine. So far, we have performed 20 laparoscopic nephrectomies, 1 nephro-ureterectomy, 4 tumour nephrectomies (inducing adrenalectomy), 2 adrenalectomies, and 6 modified retroperitoneal lymphadenectomies. In the lesser pelvis we have experience with 20 laparoscopic varicocelectomies, 23 pelvic lymphadenectomies, and 5 diagnostic laparoscopies for cryptorchidism (February 1993).
Adrenalectomy↗
Perinatal outcome in fetuses with loss of end-diastolic blood flow velocities in the descending aorta and/or umbilical arteries.
Continuous- and pulsed-wave Doppler velocimetry was used as an additional method of antenatal surveillance in high-risk pregnancy care. During a 30-month period with 4,169 deliveries 226 patients (5.4%) with complicated pregnancies (intrauterine growth retardation, diabetes, hypertension) were investigated. The results had only marginal influence on obstetrical management. In 38 fetuses absence of end-diastolic blood flow velocities (AEDF) was detected in the descending fetal aorta and/or umbilical arteries. Mean birth weight of these fetuses was 1,441 +/- (SD) 690 g at a mean gestational age of 31.8 +/- 6.8 weeks at birth. Twenty fetuses (53%) were growth-retarded (less than 3rd centile). Six fetuses died in utero and 7 during the perinatal period (34% mortality). There was a significant deterioration of perinatal outcome with AEDF in the umbilical arteries at the last antenatal Doppler scan. With AEDF in the descending fetal aorta the Doppler parameter Vmean and with AEDF in the umbilical arteries the pulsatility index yielded additional prognostic information. Doppler velocimetry of the fetal and umbilical vascular system could be of additional value for antenatal surveillance in high-risk pregnancies.
Adult↗
Analgesia and sedation in neonatal intensive care using fentanyl by continuous infusion.
To determine the effects of fentanyl in newborn and premature infants, we compared two groups of 20 newborn and premature babies under artificial ventilation for severe respiratory distress syndrome: a prospective group receiving fentanyl for analgesic and sedation and a historical control group, who did not receive fentanyl. Fentanyl serum levels during steady state were determined by radioimmunoassay. Average time of infusion was 86 +/- 47 h with a mean dosage of 0.68 +/- 0.24 micrograms/kg/h. The fentanyl group needed much less sedatives and catecholamines. Heart rate and blood pressure were not significantly changed by fentanyl. Meconium was excreted later, and higher values of bilirubin were reached earlier than in the control group. Although fentanyl proved to be helpful in the neonatal intensive care unit, the administration should remain under strict indication.
Bilirubin↗
[Changes in serotonin-containing EC-cells in the lamina epithelialis mucosae of the small intestine in young children with growth disorders caused by intestinal diseases].
Duodenal jejunal biopsy material from children with growth retardation due to enteric disease was investigated. The disease dependent mucosa types were classified into three groups according to Shmerling (1970). 5-hydroxytryptamine was demonstrated with an impregnation technique and histochemically, as well, in EC-cells in the crypt epithelium. The EC-cell content in specimens with subtotal villus atrophy (type III) was higher significantly compared to normal mucosa (type I). The findings were discussed with regard to the possible role of 5-hydroxytryptamine in the pathogenesis of the growth retardation due to enteric disease in children.
Biopsy↗