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Biomedical subjects

W Gerlich

Publications and source records attributed to W Gerlich.

At least 19 recordsLinked to original sources
PubMed1991

[The importance of autologous blood transfusion in the Federal Republic of Germany. Results of a survey carried out in 1989].

The study was designed to evaluate the role of autologous blood transfusion in current clinical practice. METHODS. Standardized questionnaires were distributed to the anesthesia departments of 421 randomly selected hospitals in the 'old' Federal Republic of Germany and West Berlin in August 1989. The questionnaires contained 26 questions relating to (1) the particular hospital, (2) preoperative autologous blood donation (PABD), (3) preoperative plasmapheresis, (4) isovolemic hemodilution, (5) intra- and postoperative autotransfusion, (6) general practice followed in blood transfusion, and (7) blood salvage in children. RESULTS. In all, 207 completed questionnaires (49%) were returned, 12% of which came from university hospitals, 25% from hospitals with more than 500 beds, 58% from hospitals with fewer than 500 beds and 5% from smaller specialized hospitals. Over half (52%) of the responding hospitals were running their own transfusion services or were located in the vicinity of a regional blood bank. The overall proportion of surgical procedures requiring perioperative blood transfusions was 10%. PABD was performed "not at all" in 24% of the hospitals, "rarely" in 28%, "occasionally" in 24%, "frequently" in 10%, and "routinely" in 13%. PABD was standard in 75% of the departments of orthopedic surgery, in 68% of the departments of cardiac surgery, and in 33% of the departments of vascular surgery. In two-thirds of the hospitals reporting the use of PABD, the anesthesia departments were in charge of the autologous blood service. For 64% of the hospitals, liquid storage of whole blood was reported as the standard technique. Patients normally not eligible for homologous blood donation according to established donor criteria were accepted for autologous blood donation at most "occasionally" in 60% of the hospitals, but "frequently" or "mostly" in 36%. Preoperative autologous plasmapheresis was performed when major intraoperative blood loss was anticipated in 12% of the hospitals. Isovolemic hemodilution was performed "not at all" in 30% of the hospitals, "rarely" in 17%, "occasionally" in 25%, "frequently" in 14%, and "mostly" in 12%. The reasons most frequently given for not performing hemodilution were "too time-consuming" (41%) and "too little blood-saving effect" (32%). Autotransfusion devices were available in 40% of the hospitals. Others deemed such devices "badly needed" (5%) or "desirable" (43%), while 45% found them "not necessary." The principal use of intraoperative autotransfusion was in cardiac surgery (79% of the departments), orthopedics (47% of the departments) and vascular surgery (45% of the departments). In 29% of the responding hospitals autotransfusion devices were also used for postoperative autotransfusion ("seldom" in 7%, "occasionally" in 10%, "frequently" in 6%, "mostly" in 6%). In the absence of cardiopulmonary disease, hemoglobin concentrations below 8-10 g/dl were considered an indication for blood transfusion. In patients with compromised cardiopulmonary function the lowest acceptable level was 10-12 g/dl. Blood salvage techniques are obviously rarely used in children. Experiences with PABD in children were reported by 14.5% of the hospitals, experience with isovolemic hemodilution by 22% and with intra- and postoperative autotransfusion in 18% and 12.5% of the hospitals, respectively. Preoperative plasmapheresis was performed in children in 3.5% of the hospitals. CONCLUSIONS. Although the present sample is not representative on a national level, our findings allow the conclusion that the simple techniques of both preoperative autologous blood donation and isovolemic hemodilution are unduly neglected in surgical and anesthetic practice, whereas even smaller hospitals are fairly well equipped with sophisticated autotransfusion devices.

Blood Transfusion, Autologous↗
PubMed1989

Unsatisfactory specificities and sensitivities of six enzyme immunoassays for antibodies to hepatitis B core antigen.

To examine the consistency and comparability of anti-hepatitis B core antigen (anti-HBcAg) assays, four blood donation centers of the Red Cross in the Federal Republic of Germany tested 4,080 unselected blood donors with six different tests in parallel. Confirmation testing of reactive samples was done in the National Reference Center for Viral Hepatitis. Depending on the test kit used, 4.1 to 9.9% of serum samples were initially positive and 2.9 to 7.5% were repeatedly positive. Sixteen percent of serum samples were positive in at least one test but only three percent were positive in all six tests. Statistical analysis of frequency distribution of optical densities for each test suggested that there should be a correction of the cutoff values. This reduced the number of false-positive results by half, but a significant proportion of discrepant results could not be resolved. The lack of specificity and consistency requires cautious interpretation of isolated anti-HBcAg results in clinical specimens. Screening of predominantly anti-HBcAg-negative populations (e.g., blood donors) by the current anti-HBcAg test kits will almost necessarily give unsatisfactory results.

Blood Donors↗
PubMed1986

Treatment of hepatitis B surface antigen (HBsAg)-positive chronic hepatitis with recombinant leucocyte alpha-A interferon.

A total of 32 individuals with HBsAg-positive and anti-delta-negative chronic hepatitis were treated with recombinant alpha-A interferon in phase I and phase II studies. In 5/32 patients HBsAg could be eliminated and in 19/32 individuals HBeAg became negative including all those who also eliminated HBsAg. Side-effects were tolerable in most patients and were readily reversible upon discontinuation of interferon therapy. In conclusion, treatment of HBsAg-positive chronic hepatitis with interferon seems to be a promising therapeutic approach. Future studies will have to establish the optimal dose, duration of treatment and factors predicting a favourable outcome of the treatment.

Drug Evaluation↗
PubMed1979

[Experiments for the development of a hepatitis B vaccine: immunogenicity of HBsAg in guinea pigs (author's transl)].

Hepatitis B surface antigen (HBsAg) was purified from human plasma by gel chromatography, isopyknic centrifugation, and zonal centrifugation. The final product had about 60% of the original activity and was essentially free from hepatitis B virus particles (HBV) and plasma proteins. Treatment with formaldehyde concentrations up to 0.1% for inactivation of residual infectivity did not significantly reduce antigenicity in vitro and immunogenicity in guinea pigs. Adsorption to aluminum hydroxide resulted in 16-fold higher concentrations of antibody against HBsAg (anti-HBs) than did injection of soluble HBsAg. After two injections of 0.2 microgram HBsAg, which was treated with 0.1% formaldehyde and absorbed to aluminum hydroxide, the median titer of anti-HBs in guinea pigs was 4 IU/ml (normal value in human hepatitis B convalescents: about 0.1) for 1 year without further injections. When guinea pigs received 12 equivalents of homologous anti-HBs serum before the first injection of adsorbed HBsAg, the same anti-HBs titers were found after the booster injection as in animals which had not been passively immunized. A simultaneous application of an experimental HBsAg vaccine and hepatitis B immunoglobulin would probably decrease the potential risk of HBV infections caused by the vaccine itself and also produce rapid protection. To establish absence of HBV as completely as possible, the vaccine should be produced from anti-HBe-positive plasma by efficient purification procedures and it should be inactivated by formalin.

Aluminum Hydroxide↗
PubMed1979

Detection of antibodies to Sendai virus by enzyme-linked immunosorbent assay (ELISA).

An enzyme-linked immunosorbent assay (ELISA) for the detection of antibodies to Sendai virus, a paramyxovirus, is described. The assay was found to be about 20-fold more sensitive than the hemagglutination inhibition assay. Differentiation between virus specific IgG and IgM is possible. The test appears to be especially useful in the study of early events in antibody formation in vivo as well as in vitro.

Animals↗
PubMed1979

Antibody-dependent cell-mediated cytotoxicity (ADCC) and cell-mediated cytotoxicity (CMC) to HBsAg-coated target cells in patients with hepatitis B and chronic hepatitis (CAH).

A new technique using HBsAg-coated Chang cells as target cells was developed in order to measure cell-mediated immune reactions to HBsAg. The specificity of cytotoxic reactions was tested in experiments using Chang cells conjugated with human serum albumin. Antibody-dependent cell-mediated cytotoxicity (ADCC) specific for the HBsAg-coated target cells was demonstrated up to dilutions of anti-HBsAg serum of 10,000 : 1, when lymphocytes from the peripheral blood of normal individuals were added to the target cells. Spontaneous cell-mediated cytotoxicity (CMC) to HBsAg-coated target cells was demonstrated for lymphocytes from patients with hepatitis B and from patients with chronic active hepatitis (CAH), but not for lymphocytes from healthy controls. The CMC of hepatitis B lymphocytes to HBsAg-coated target cells was inhibited in the presence of antiserum to HBsAg. In experiments using purified lymphocyte populations evidence is presented that the CMC is T-cell dependent. HLA-restriction of the CMC was not observed. The described cytotoxicity test system has the advantage that target cells conjugated with defined antigens are used and that relevant control target cells are available.

Antibody-Dependent Cell Cytotoxicity↗
PubMed1979

[Studies on the serological manifestation of the hepatitis B-virus-infections in the Republic of Liberia (author's transl)].

The prevalence of hepatitis B virus infections was examined in four groups from Liberia using radioimmunoassays for HBsAg, anti-HBs and anti-HBc. At the age of 15-19 years 90% have been infected, at the age of 40 years 100%. In a rubber plantation 30% had HBsAg, in the remaining 3 groups only 13% were HBsAg-positive. In the first group onchocerciasis was also a more frequent finding. However the parasitic infection was not the cause of the HBs-antigenemia. The HBsAg-concentration is mostly lower in the positive Liberians than in German HBsAg-carriers. Apparently the HBV caused frequently latent infections with low production of viral antigens in Liberia.

Adolescent↗
PubMed1978

[Asymptomatic chronic-persisting hepatitis B in a young child as source of infection of hepatitis B within a family (author's transl)].

Five members of an eight-member family fell ill with an acute icteric hepatitis B of the same subtype within eleven months. In all probability the source of the infection was a just over one-year-old fostered child with asymptomatic chronic persisting hepatitis B and signs of massive viraemia (usually high HBs antigen concentration, high virus-specific DNA-polymerase activity and positive HBe antigen test). No relation could be demonstrated between HLA constellation and illness in the family members. Since no specific treatment is available, the only possible prophylactic measure is to isolate the child in the present environment, to avoid further cases of the disease.

Acute Disease↗
PubMed1978

The seroepidemiological pattern of acute viral hepatitis. An epidemiological study on viral hepatitis in the Hannover region.

The natural incidence of the etiologically distinct types of viral hepatitis was determined by investigating acute phase sera of symptomatic hepatitis cases occuring in the Hannover area in 1975 for the presence of hepatitis B surface antigen, antibodies to hepatitis A, hepatitis B core and surface antigens, and by measuring the IgM serum levels. Fourteen different seroepidemiologic patterns were recognized. Although there was a high prevalence of hepatitis A antibody in the population, the frequency of hepatitis A was low (n = 56) suggesting that the hepatitis A virus does not play a major role in symptomatic hepatitis in the Hannover area at present. Spread of the hepatitis A virus was mostly associated with person-to-person contact or tourist travel in southern Europe. Hepatitis B was the predominant type of hepatitis (n = 211). Hepatitis non-A, non-B was observed infrequently (n = 62). A high percentage of patients with hepatitis B and hepatitis non-A, non-B reported parenteral exposure to potentially contaminated materials. No other findings, however, suggested an infectious etiology of hepatitis non-A, non-B.

Antibodies, Viral↗
PubMed1978

[Differing results of direct and indirect solid phase radioimmunoassay for HBsAg in acute hepatitis (author's transl)].

In 54 patients suffering from acute viral hepatitis the indirect solid phase radioimmunoassay (ind-SPRIA) for HBsAg was positive in 9 cases the direct solid phase radioimmunoassay (d-SPRIA) being negative. In 2 further cases ind-SPRIA was positive during several weeks but d-SPRIA only once. AntiHBc could be detected in 9 of these patients. In 7 patients the usual decrease of the transaminase activity was followed by a second elevation with prolongation of disease. The unknown factor detected by ind-SPRIA suggests a special form of acute hepatitis.

Adult↗
PubMed1977

Radioimmunoassay for LCM virus antigens and anti-LCM virus antibodies and its application in an epidemiologic survey of people exposed to syrian hamsters.

A specific and sensitive solid-phase radioimmunoassay has been developed for the detection of LCM virus antigens and anti-LCM virus antibodies. The test was performed in a microtiter system using polyvinylcholoride wells coated with anti-LCM virus rabbit hyperimmune serum. LCM virus antigens were allowed to bind to this antibody and afterwards detected by 125J-labeled anti-LCM virus-gamma-globulin. Anti-LCM virus antibodies were assayed by specific inhibition of these bound antigens. Since this technique is rapid and easy to perform the solid-phase radioimmunoassay is a valuable test for detecting LCM virus infections. Selected at random, 208 girls with, and 208 girls without, contact to Syrian hamsters were investigated for anti-LCM virus antibodies. Five (2.4%) of the hamster-exposed girls had anti-LCM virus antibodies (RIA-titer 1:8-1:32) in contrast to none of the control group (P=0.03).

Animals↗