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Biomedical subjects

S Lentz

Publications and source records attributed to S Lentz.

9 recordsLinked to original sources

[Mutation in factor II and factor V gene in patients with peripheral arterial occlusive disease].

Mutations in factor-V- and factor-II-genes are correlated with an increased risk for venous thrombosis according to the literature. The significance of the mutations in factor- II- and factor-V-genes for the development of the peripheral arterial occlusive disease is not known. Therefore, we investigated the presence of these mutations in 152 patients with documented peripheral arterial occlusive disease and 318 controls without peripheral arterial occlusive disease with polymerase chain reaction (PCR). There was no association between factor-II-mutation and peripheral arterial occlusive disease. The factor-V-mutation, however, was increased in patients with peripheral arterial occlusive disease double fold (12 positive cases in 318 controls, 12 positive cases in 152 patients with peripheral arterial occlusive disease). The significance level was reached (p = 0.05) in statistical analysis but the result did not fall below the significance level as necessary to reach statistical significance (odds ratio 2.19). Nevertheless, from these data we have to discuss a biological relevance of factor-V-mutation in the pathogenesis of peripheral arterial occlusive disease.

Arterial Occlusive Diseases↗

[Chromogenic substrate as antidote against the thrombin inhibitor Melagatran?].

It could be shown in vitro that a chromogenic substrate (Chromozym TH, Roche Mannheim) acts at least partially as antidote against the new thrombin inhibitor Melagatran (AstraZeneca, Mölndal, Sweden). It is discussed that this antidote effect of a chromogenic substrate might be due to a substrate competition of fibrinogen, thrombin inhibitor, and chromogenic substrate for thrombin. Further animal experiments will clarify whether this in vitro observation is of practical relevance in vivo, too.

Antidotes↗

Effect of gamma-interferon on binding of gliadin and other food peptides to the human intestinal cell line HT-29.

gamma-Interferon is one of the main cytokines released during activation of intestinal lymphocytes in coeliac patients. The question has never been addressed whether gamma-interferon influences binding of gliadin and other food peptides to human enterocytes. Therefore, the human intestinal epithelial cell line HT-29 was cultured with gliadin, casein, beta-lactoglobulin and ovalbumin, with or without gamma-interferon, and peptide binding to cells was determined by flow cytometry and fluorescence microscopy. gamma-Interferon stimulated gliadin binding by a factor of 4. Binding was saturable with half maximal binding at 0.15 mg/ml. For maximal binding, an incubation of at least 24 h was necessary. gamma-Interferon increased binding of beta-lactoglobulin and casein, too, but inhibited that of ovalbumin. Binding of gliadin was inhibited by the other peptides. Under the conditions of ongoing mucosal inflammatory reactions and release of gamma-interferon, enhanced binding may trigger intestinal lymphocytes, increase secretion of cytokines and thus induce a vicious circle.

Caseins↗

Reconstruction of pelvic exenterative wounds with transpelvic rectus abdominis flaps: a case series.

Exenterative pelvic surgery is commonly performed for advanced carcinoma of the cervix and selected cases of locally advanced colorectal cancers. Low-lying lesions that are locally invasive in contiguous organs require resection of the perineal body en bloc with the resected specimen. The resulting defect, both in the pelvis and the perineum, creates a difficult management problem. Dead space in the pelvis, especially with adjunctive irradiation, leads to delayed wound healing and prolapse of small bowel into the pelvis. Small bowel obstruction and/or fistula formation are the greatest sources of morbidity in the operative group. Fifteen patients underwent exenterative pelvic procedures (total exenteration, 1 patient; posterior exenteration, 8 patients; abdominoperineal resection, 6 patients). All patients were reconstructed by transpelvic placement of the rectus abdominis muscle (muscle only, 4 patients; muscle with skin grafting, 8 patients; musculocutaneous, 3 patients). Eighty-seven percent received radiation therapy. One patient had Crohn's disease and all others had carcinoma. Healing was complete in 12 of 15 patients at discharge. There were no complications related to pelvic dead space (i.e., bowel obstruction, perineal fistula), with a mean follow-up time of 24.3 months. Small bowel was effectively excluded from the pelvis to the level of the acetabular roof by computerized axial tomography scan. The transpelvic rectus abdominis muscle flap is effective in preventing major morbidity after exenterative pelvic surgery.

Adenocarcinoma↗

Cyclosporin enhancement of cisplatin chemotherapy in patients with refractory gynecologic cancer. A Gynecologic Oncology Group Study.

BACKGROUND: Cyclosporin has been demonstrated to reverse resistance to several antineoplastic agents including cisplatin in vitro. The purpose of this Phase I trial was to study the potential clinical application of cyclosporin modulation of cisplatin and to establish a tolerable dose of cyclosporin when combined with a standard dose of cisplatin of 75 mg/m2. METHODS: A course of therapy consisted of two cyclosporin infusions over 2 hours each, 24 hours apart, with cisplatin given 6 hours after the first dose. Treatment was repeated every 21 days. Cyclosporin was studied in a Phase I fashion at five different levels, from 1-5 mg/kg per dose. Twenty patients with refractory gynecologic cancer received 81 courses of therapy. All patients had received extensive prior chemotherapy containing cisplatin. RESULTS: Grade 4 nephrotoxicity was seen in 4 of 20 patients: 1 treated at 1 mg/kg, 1 at 2 mg/kg, and 2 at 5 mg/kg of cyclosporin. The patient treated at the 1 mg/kg level was a partial clinical responder and tolerated six courses. The patient at the 2 mg/kg level had received 14 prior courses of cisplatin and tolerated only two additional courses before a Grade 4 renal toxicity developed. Grade 4 nephrotoxicity developed in the two patients receiving 5 mg after two courses of chemotherapy. Two of the 20 patients achieved a complete response (CR) and 3 patients achieved a partial response (PR), for a total response rate of 25% (5 of 20). The two women who achieved CR started treatment with symptomatic ascites; one of whom also had multiple pulmonary lesions that were no longer evident after three courses of therapy. CONCLUSIONS: Cyclosporin at a dose of 4 mg/kg per day given for 2 consecutive days in association with 75 mg/m2 of cisplatin can be given with reasonable assurance of safety.

Antineoplastic Combined Chemotherapy Protocols↗

"Medicine on wheels": an opportunity for outreach and housestaff education.

Ambulatory-care teaching programs have been traditionally based in hospital settings. As many patients, in particular the homeless and underinsured, have never reached these settings, we describe a nontraditional outreach health-care program for medical residents. This multidisciplinary program places medical residents on a mobile van to deliver care to a population in New Haven where 18.2% of its families are below the poverty level and have limited or no access to health care at the teaching hospital. On-site urgent care is given along with HIV, pregnancy testing, and blood pressure screening. Health-care follow-up, dental care, alcohol detoxification, and drug counseling are scheduled. A total of 764 adult patients were seen between November 1991 and June 1993 by PGY2 residents on ambulatory rotations. One hundred forty-one patients consented to respond to a questionnaire. Thirty-seven (26%) were homeless with a mean length of homelessness of 15 months. Forty-one percent had been victimized within one year and 33% currently used illicit drugs. The benefits of this unique ambulatory teaching program for medical residents are described.

Adolescent↗

The well-rounded leader.

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Administrative Personnel↗