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Biomedical subjects

P Barton

Publications and source records attributed to P Barton.

At least 19 recordsLinked to original sources

A skeletal muscle-specific enhancer regulated by factors binding to E and CArG boxes is present in the promoter of the mouse myosin light-chain 1A gene.

The mouse myosin light-chain 1A (MLC1A) gene, expressed in the atria of the adult heart, is one of the first muscle genes to be activated when skeletal as well as cardiac muscles form in the embryo. It is also transcribed in skeletal muscle cell lines at the onset of differentiation. Transient transfection assays of mouse skeletal muscle cell lines with DNA constructs containing MLC1A promoter fragments fused to the chloramphenicol acetyltransferase (CAT) gene show that the first 630 bp of the promoter is sufficient to direct expression of the reporter gene during myotube formation. Two E boxes located at bp -76 and -519 are necessary for this regulation. MyoD and myogenin proteins bind to them as heterodimers with E12 protein and, moreover, transactivate them in cotransfection experiments with the MLC1A promoter in nonmuscle cells. Interestingly, the effect of mutating each E box is less striking in primary cultures than in the C2 or Sol8 muscle cell line. A DNA fragment from bp -36 to -597 confers tissue- and stage-specific activity to the herpes simplex virus thymidine kinase promoter in both orientations, showing that the skeletal muscle-specific regulation of the MLC1A gene is under the control of a muscle-specific enhancer which extends into the proximal promoter region. At bp -89 is a diverged CArG box, CC(A/T)6AG, which binds the serum response factor (SRF) in myotube nuclear extracts, as does the wild-type sequence, CC(A/T)6GG. Both types of CArG box also bind a novel myotube-enriched complex which has contact points with the AT-rich part of the CArG box and adjacent 3' nucleotides. Mutations within the CArG box distinguish between the binding of this complex and binding of SRF; only SRF binding is directly involved in the specific regulation of the MLC1A gene in skeletal muscle cell lines.

Animals

Biliary sludge after liver transplantation: 2. Treatment with interventional techniques versus surgery and/or oral chemolysis.

OBJECTIVE: Interventional treatment of biliary sludge in liver transplant recipients includes transhepatic biliary drainage and saline irrigation, catheter chemolysis and/or basket extraction, and endoscopic intervention. The purpose of this study was to compare these interventional procedures with oral chemolysis and with surgical treatment of biliary sludge in order to evaluate the effectiveness of interventional procedures as an alternative to surgery in the treatment of this complication. MATERIALS AND METHODS: We retrospectively evaluated the outcome of several forms of treatment for biliary sludge occurring after liver transplantation in 49 cases. Treatments included oral chemolysis with chenodeoxycholic acid (n = 35), percutaneous transhepatic biliary drainage (n = 13) followed by irrigation with heparinized saline solution (n = 4), intraluminal chemolysis with glycero-octanoate-carnosine and bile salts-EDTA (n = 3) and/or basket extraction (n = 5), and endoscopic intervention (n = 2) or surgery (n = 26). Oral chemolysis was attempted in all cases of biliary sludge if no other complications were present. If this conservative treatment failed and the sludge was limited to the main bile ducts, interventional procedures were attempted. Surgical removal of the sludge (n = 15) or retransplantation (n = 5) without any attempt at prior nonsurgical treatment was performed if concomitant complications were present (n = 14) or if the extent of the sludge was considered too time-consuming for an interventional attempt (n = 6). The six patients in whom nonsurgical treatment failed underwent surgery. Treatment was considered successful if cholangiograms obtained after therapy showed no more evidence of sludge. Treatment was considered a failure if biliary sludge was shown after therapy by means of cholangiography, surgery, or autopsy. RESULTS: Complete disappearance of biliary sludge as a result of oral chemolysis was achieved in 14 (40%) of 35 cases. Interventional procedures were performed in 15 of the patients in whom oral treatment failed. After percutaneous transhepatic biliary drainage, the sludge was successfully removed by chemolysis with glycero-octanoate-carnosine in three cases, by basket extraction in one case, and by a combination of chemolysis and basket extraction in three cases. In two other cases, underlying recurrent tumor was treated palliatively with percutaneous transhepatic biliary drainage or endoscopic stenting. Irrigation with heparinized saline solution failed in four cases, and percutaneous or endoscopic basket extraction failed in one case each. Surgical treatment was successful in 18 (86%) of 21 cases, and retransplantation was successfully done in five patients. In all, interventional techniques were used in 43% of the patients with biliary sludge who could not be treated successfully with oral chemolysis, and the overall success rate was 60%. CONCLUSION: Interventional techniques are effective therapeutic alternatives for treating biliary sludge occurring after liver transplantation and should be considered before surgical procedures. An indication for interventional procedures in biliary sludge is lack of success of oral chemolysis and an absence of other complications that require surgery or retransplantation.

Adolescent

Biliary sludge after liver transplantation: 1. Imaging findings and efficacy of various imaging procedures.

OBJECTIVE: Biliary sludge (inspissated, thickened bile or collective collagen tissue from destroyed [or necrotic] bile duct walls) can be found a few days to several years after liver transplantation, mainly in the common and main hepatic bile ducts. The purpose of this study was to review the imaging findings of biliary sludge occurring after liver transplantation and to determine the relative merits of various imaging procedures (cholangiography, CT, and sonography) for establishing the diagnosis. MATERIALS AND METHODS: Cholangiograms, sonograms, and CT scans obtained in 352 patients with 400 liver transplants were reviewed retrospectively for evidence of biliary sludge. In all patients, T-tube cholangiograms were routinely obtained 7 and 30 days and 3 months after transplantation. Thereafter, in the absence of findings, the T-tube was removed. In all patients, sonograms were obtained immediately, 2 and 7 days after transplantation. Additional cholangiograms were obtained when biliary complications were suspected (T-tube cholangiograms in 215 patients, percutaneous transhepatic cholangiograms in 79 patients, and endoscopic retrograde cholangiograms in five patients after T-tube removal). Additional sonograms were obtained in 289 patients and CT scans in 238 patients when complications were suspected. The findings of these various imaging studies were analyzed and compared with each other, with the clinical course of the patient, and with surgical and histologic findings to determine the relative merits of each imaging method for the diagnosis of biliary sludge. Criteria for the diagnosis of biliary sludge were filling defects or pluglike obstruction seen on cholangiograms or material filling the bile ducts seen on sonograms or CT scans. The radiologic diagnosis of biliary sludge was certified by gross specimens obtained at surgery (n = 21) or autopsy (n = 2) or by complete disappearance of the radiologic findings with specific oral or interventional treatment (n = 28). RESULTS: Biliary sludge was diagnosed on the basis of radiologic findings in 51 (13%) of 400 transplanted livers. Cholangiograms (T-tube in 34, percutaneous transhepatic cholangiography in seven, a combination of T-tube and percutaneous transhepatic cholangiography in eight, and a combination of endoscopic retrograde and percutaneous transhepatic cholangiography in two cases) showed biliary sludge in all 51 cases. Cholangiographic findings included filling defects in 34 (67%) and obstruction of the bile duct with pluglike appearance in 17 (33%) of the 51 cases. Dilatation of bile ducts was present in 32 (63%) of the 51 cases. The presence of biliary sludge was certified in 50 of these cases, with one case turning out to be a sutural granuloma at autopsy. On sonograms, biliary sludge was shown as echogenic material in the main bile ducts in only 16 (31%) of the 51 cases, with dilatation of bile ducts in 12 of them. In 10 others (20%), sonograms showed dilatation of the bile ducts but did not show the sludge itself. CT scans did not show the sludge in any of the 12 cases in which they were obtained. CONCLUSION: Our results show that cholangiography is the only accurate imaging method for diagnosing biliary sludge after liver transplantation. Sonography is limited and CT is of no value for this purpose. In the absence of a T-tube, endoscopic retrograde or percutaneous transhepatic cholangiography should be used. Otherwise, T-tube cholangiography is the method of choice. Filling defects and obstruction of the bile ducts with pluglike material are characteristic findings of biliary sludge seen on cholangiograms.

Adolescent

Differential regulation of the atrial isoforms of the myosin light chains during striated muscle development.

We have isolated a cDNA that encodes the human regulatory myosin light chain isoform predominant in adult atrial muscle. The cDNA contains an open reading frame of 175 amino acids and encodes a hydrophilic protein of a largely helical structure with two potential phosphorylation sites. The protein is different from any other regulatory myosin light chain so far described and is the product of a previously uncharacterized single copy gene. An isoform-specific probe was used to analyze the expression of this isoform in adult muscle and in cardiac and skeletal muscle development in vivo and in vitro. Parallel analysis of the corresponding human alkali myosin light chain (predominant in adult atrium) showed that both isoforms are expressed in early heart development, in both atrium and ventricle. Although the atrial alkali light chain is expressed throughout embryonic striated muscle development, the regulatory myosin light chain was not detected in skeletal myogenesis in vivo or in vitro. Thus the atrial isoforms are not universally or exclusively "paired" and can be independently regulated. We propose that the manner in which these particular isoforms fulfill the functional requirements of the muscle at different developmental times may have direct impact on their regulation.

Adult

Renal transplant hemodynamics in children: prospective analysis of colour coded versus pulsed Doppler sonography.

In 30 children with renal allografts the diagnostic validity of pulsed Doppler (PD) versus colour coded Doppler (CD) sonography was assessed prospectively. 46 PD examinations were performed calculating the resistive index (RI) in the segmental arteries in comparison to 46 CD scans, where renal blood flow throughout the grey-scale image was displayed. In addition, point-spectral analysis with calculation of the RI was also performed on the CD scans. The time for examination ranged from five to ten minutes for the PD and from three to five minutes for the CD study. Concordant findings for the PD and CD technique were generally obtained (normal blood flow pattern on PD-excellent visualization of renal blood flow on CD, reduced or reversed diastolic flow on PD-poor visualization of renal blood flow on CD). There was close correlation of the RI values obtained by the PD and CD scans. CD sonography facilitated point-spectral analysis in shortening the time for examination. The ability to visualize focal hemodynamic alterations provided a higher diagnostic accuracy in comparison to PD sonography.

Adolescent

[X-ray measurement of the level of rectal carcinomas and its dependence on the functional status of the pelvic floor].

The influence of the various functional states of the pelvic floor on the radiological assessment of the tumour levels and the distant tumour-free distance in rectum neoplasms was investigated. The parameters "anal canal length", "anorectal angle" and "impression of the puborectalis muscle" were measured in lateral distant views of the rectum in a series of healthy controls (n = 160). In addition, these parameters and the "distant tumour-free distance" were measured in patients with rectal cancer (n = 40). For each patient the lateral distant view at rest, during contraction and during maximal relaxation (straining) of the pelvic floor, were available for retrospective analysis. Depending on the various functional states of the pelvic floor, the differences between the same parameters were statistically significant (p less than 0.001). The average difference between the distal tumour-free distances during contraction and straining was 1.5 cm. Therefore, measurements of this distance in one lateral distant view exclusively may result in an inaccurate assessment of the tumour level. For the individual planning of extreme sphincter-saving surgery in low rectal cancer based on lateral distant view, the view at rest appears to be the most suitable. However, additional x-rays during contraction and maximal relaxation of the pelvic floor, respectively, should be available to identify the view at rest for an accurate assessment of the tumour level and to avoid misinterpretations which would have falsely influenced the planning of rectum surgery in 20% of our cases.

Adult

[Percutaneous CT-guided catheter drainage of intrathoracic fluid accumulations].

To verify the value of percutaneous CT-guided drainage of thoracic fluid collections we studied the outcome in 39 patients retrospectively. 24 (61.5%) of the fluid collections were located in the pleural space, 10 (25.6%) in the lungs and 5 (12.8%) in the mediastinum. 11 CT-guided drainages after a previous attempt were necessary in 9 patients, because of recurrent (n = 6) or residual (n = 5) fluid collections. 70% of the drainage procedures were done using Seldinger's, 30% using trocar technique, mainly with 8.3-12 F catheters. The mean duration of drainage was 10.7 days. In 28 patients (71.8%) the percutaneous CT-guided drainage was curative. In 9 cases (23.1%) the patient's course was stabilised and surgery could be applied electively. 2 patients (5.1%) died because of their underlying end-stage malignancy. None of the drainage procedures changed the patient's course to the worse. There was only 1 pneumothorax with no need of any treatment; no other complication occurred. Our results suggest that percutaneous CT-guided drainage of thoracic fluid collections is a safe and straightforward alternative to surgical treatment.

Adult

[Color-coded Doppler sonography of the thyroid: an advance in carcinoma diagnosis?].

There are several papers suggesting that colour-coded Doppler sonography is a useful diagnostic tool for the differentiation of malignant and benign lesions of the thyroid gland. This hypothesis (hypervascularization of malignant nodules) is reconsidered by preoperative examination of 65 patients by using colour-coded Doppler sonography and scintigraphy. Among these patients 21 carcinomas and 2 malignant lymphomas of the thyroid gland were found histologically. Colour-coded Doppler sonography was true positive in 10 cases, true negative in 28 cases, false positive in 14 cases and false negative in 13 cases. Our conclusion is that colour-coded Doppler sonography cannot be used unconditionally for the detection of carcinoma of the thyroid gland.

Adult

[The screening of renal artery stenoses. The initial results with the value of color Doppler sonography].

The value of colour Doppler sonography in the diagnosis of renal artery stenosis has been studied retrospectively. 17 patients were examined (34 main renal arteries and 7 accessory renal arteries; ages 37 to 84 years; 7 males and 10 females). We studied 1) ability to study the main renal arteries, 2) visibility of accessory renal arteries and 3) the sensitivity and specificity of colour Doppler sonography for the diagnosis of renal artery stenosis. The results were compared with intraarterial angiography. Demonstration of the main renal arteries with colour Doppler sonography was possible in 23 of the 34 vessels. Not a single of the 7 accessory renal arteries was demonstrated by colour Doppler sonography. Of 8 angiographically demonstrated stenoses (more than 50% narrowing) 2 were missed by colour Doppler sonography. One stenosis was correctly diagnosed and 5 were incorrectly evaluated by sonography. 16 out of 18 angiographically normal main renal arteries were correctly evaluated by colour Doppler sonography but 2 showed a false positive finding. This results in a sensitivity of 17% and a specificity of 89% per kidney. Colour Doppler sonography cannot be recommended as a screening method for renal artery stenosis in view of its limited accuracy.

Adult

A variant of glycophorin A resulting from the deletion of exon 4.

We have isolated a variant form of glycophorin A which has a 39 bp deletion corresponding to nucleotides 233 to 270 of the coding sequence, which is exon 4 of the glycophorin A gene. The remainder of the sequence is identical to that of the M phenotype of glycophorin A.

Amino Acid Sequence

Sonographic demonstration of septicaemia with gas-forming organisms after liver transplantation.

Sepsis with gas-forming organisms, e.g. Clostridium perfringens and anaerobic streptococci occurred in three of 120 liver-transplant recipients (2.5%). The diagnosis was made in all three patients by bedside ultrasound, before blood cultures revealed bacterial growth. Floating high amplitude echoes within the extra- and intrahepatic portal veins and persistent small high amplitude echoes in the non-dependent portion of the liver are indicative of portal venous gas and should prompt further laboratory investigations.

Adult

[Imaging of peripheral arteriovenous malformations using color-coded Doppler sonography].

By using colour coded Doppler sonography and duplex Doppler sonography, the presence of AV-shunts could be demonstrated correctly in 15 patients with arteriovenous malformations (angiographic correlation was obtained in 10 cases). The feeding vessels could not be identified exactly in all cases by using duplex Doppler sonography; correct identification of the feeding vessels was possible in only 2 patients by using colour coded Doppler sonography. In one patient, a soft tissue tumour could be diagnosed sonographically (histology: malignant synovialoma). Therefore, colour coded Doppler sonography serves as an important supplement to angiography in the diagnostic evaluation of arteriovenous malformations, but cannot replace it.

Adolescent

[The patency of the external and internal carotid arteries in patients with occlusion of the common carotid: detection using color-coded Doppler sonography].

Common carotid artery occlusion is not necessarily associated with thrombosis of the ipsilateral internal carotid artery. Noninvasive imaging of the carotid bifurcation with colour-coded Doppler sonography demonstrated patency of the external and internal carotid arteries distal to a common carotid occlusion in 4 patients which could be proven surgically. Identification of internal carotid artery patency could be demonstrated by angiography in two of the patients while in the other two cases angiography was inconclusive. Thus, CCDS provided a correct diagnosis of the internal carotid patency in these patients with common carotid occlusion.

Adult

[Correlation of the x-ray morphology with the histopathological staging and grading of colorectal cancer].

In a retrospective study stage grouping as well as histopathological grading (G category) of colorectal carcinomas was compared to radiographic findings at double contrast barium enema. A good correlation of tumour stage according to Dukes and the pT category and histopathological grading could be established to radiographic morphology. Apple core lesions and eccentrically obstructing neoplasms as well as saddle-like tumours exhibited worse staging and grading categories in comparison to polypoid lesions; plaque-like tumours are probably in between. It can therefore be assumed that the radiographic appearance of colorectal carcinomas may be a valuable tool to indicate stage group and G-category and thus offer information about patient prognosis.

Adult

[Computed tomography in acute mediastinitis].

Acute mediastinitis (AM) has become a rare disease since the introduction of antibiotics but still has an unchanged high mortality-rate if the diagnosis is not readily established, and adequate therapy is performed. Clinical signs of AM are often uncharacteristic, plain chest films do not allow a reliable diagnosis because of lack of sensitivity as well as specificity. In a retrospective study the CT-results of 23 patients clinically suspect for AM were evaluated in order to determine the diagnostic value of CT-findings were compared to operation, percutaneous drainage procedures and clinical course. In 15 patients the diagnosis of AM was established correctly by CT, 8 patients were reported normal. Diffuse infiltration of mediastinal fatty tissue was found in 3 patients, mediastinal fluid collections were demonstrated in 12 (infected hematomas = 4, abscess formation = 8). The extension of inflammatory changes could be exactly assessed by CT in all patients.

Abscess

Sustained behavioral recovery from unilateral nigrostriatal damage produced by the controlled release of dopamine from a silicone polymer pellet placed into the denervated striatum.

This study was conducted to determine if the behavioral asymmetry associated with unilateral nigrostriatal dopamine (DA) depletion could be alleviated by placing a small DA-releasing silicone polymer matrix pellet into the denervated striatum of rats. Animals that received DA-releasing pellets showed a 50% reduction in apomorphine-induced rotational behavior, and this effect persisted for the 2-month duration of the experiment. The results suggest that the controlled release of DA from an intrastriatal polymer matrix can produce a long-lasting reduction in some of the symptoms associated with DA depletion.

Animals

[Angiography following liver transplantation].

39 angiographic studies performed on 34 out of 150 patients following a total of 159 orthotopic liver transplantations until the year 1989 were reviewed in retrospect. All of the studies were carried out within a period of two months after transplantation (1-45 days). Angiographic techniques remain the "gold standard" for the assessment of vascular problems after liver transplantation. Arterial complications were seen in fourteen cases (8.8%); complications confined to the portal and inferior caval veins were found in six (3.8%) and twelve cases (7.5%), respectively. Angiography yielded normal postoperative findings in nine patients.

Adolescent