P-fimbriae vaccines

Protection against acute pyelonephritis was induced by immunization of baboons with purified P-fimbriae ofEscherichia coli as vaccines. To test for cross-protective capacity of two different P-fimbriae vaccines we vaccinated baboons with P-fimbriae purified from eitherE. coli strain ER2 or strain JR1 and subsequently challenged the animals withE. coli strain JR1. All vaccinated animals showed elevated antibody titers to P-fimbriae from both of theE. coli strains used. Both vaccines tended to reduce the time of bacteriuria. They partially prevented pyelonephritis and protected against loss of renal function.     

Pouch versus esophagojejunostomy after total gastrectomy: A randomized clinical trial

This is an interim report of a randomized clinical trial on esophagojeju-nostomy (EJ) versus Hunt-Lawrence-Rodino (HLR) pouch as reconstruction techniques following total gastrectomy and systematic lymphadenectomy for gastric cancer treatment.The randomized trial preceded a pilot study comparing the Longmire-Gütgemann interposition and the HLR. The pilot study included 7 patients, the randomized trial 38 patients (60 planned). The main outcome variables in the pilot study were food resorption, caloric intake, and body weight. Survival probability and general well-being (quality of life) were measured in the randomized trial. A score was composed of disease-specific and socio-personal variables with well-being ranging from 0 (worst) to 14 (best) points.Concerning food resorption in the pilot study, no relevant advantage of the duodenal passage was found. The main postoperative disorder was insufficient food intake. Despite a radical operation, a hospital mortality rate of 16%, and a complication rate of 37%, gastric cancer still has a poor prognosis. In the randomized trial only 15 (39%) of 38 patients were alive 1 year after operation, but the survival probability was higher (58%) after HLR than after EJ (24%) (p<0.05). Hunger and appetite were strongly reduced during the first 6 months after operation. Food intake was less than half of the preoperative values, which was reflected by an average decrease in body weight of 7 kg.Patients dying within the first year after total gastrectomy suffered an irreversible loss of quality of life (scoring 7 points). They had no objective benefit from the operation. Patients surviving this period regained quality of life and exceeded preoperative values, especially after HLR.We conclude that HLR-operated patients who have a chance of surviving for at least 1 year benefit from total gastrectomy in regard to quality of life.Résumé Cet article est consacré au bilan provisoire d'une étude clinique randomisée de l'oesophago-jéjunostomie (EJ) par rapport à l'opération de Hunt-Lawrence-Rodino (HLR) comme technique de reconstruction après gastrectomie totale et lymphadénectomie systématique pour cancer de l'estomac.Le bilan a été établi à partir d'une étude pilote comparant l'interposition Longmire-Gütgemann et la HLR. Cette première étude a porté sur 7 patients et le étude randomisée sur 38 patients (60 sont prévues). Dans l'étude pilote la réabsorption intestinale, le poids et l'absorption calorique furent les variables essentielles pour mesurer l'avenir des malades. Dans le étude randomisée la probabilité de survie et la qualité de la vie ont été ajoutées. L'état général a été représenté par un score comprenant des variables spécifiques de la maladie et socio-personnelles allant de 0 (très mal) à 14 (très bien) points.Dans l'étude pilote le passage duodénal n'a pas montré d'avantage concernant la réabsorption intestinale. Le malaise post-opératoire essentiel a été l'insuffisance de l'absorption calorique. L'opération radicale a une mortalité hospitalière de 16% et comprend un taux de complication de 37%. Le cancer de l'estomac est de prognostic peu favorable. Seuls 15 (39%) des 38 patients ont survécu la première année dans le étude randomisée mais la probabilité de survie après HLR (58%) dépasse celle après EJ (24%) (p<0.05). La faim et l'appétit ont été sévèrement réduits pendant les 6 premiers mois post-opératoires. Comparée à la situation pré-opératoire, la quantitié de nourriture a diminué d'au moins 50% ce qui correspond à une perte de poids de 7 kilos en moyenne.Les malades qui ne survivent pas la première année subissent une perte importante et irréversible de leur qualité de vie. Ceci nous amène à dire qu'ils ne profitent pas de l'intervention chirurgicale contraitement aux autres qui regagnent une qualité de vie égale ou même supérieure aux valeurs pré-opératoires.Au total nous pouvons affirmer que ce sont essentiellement les patients opérés qui ont subi une HLR qui survivent un an ou plus et qui tirent profit de la gastrectomie totale.

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Resumen Este es un informe provisional de un ensayo clínico aleatorizado para comparar la esofagoyeyunostomía (EY) con la bolsa de Hunt-Lawrence-Rodino (HLR) como técnicas de reconstrucción gástrica después de gastrectomía total con linfadenectomía sistemática como tratamiento del cáncer gástrico.El ensayo aleatorizado fue precedido de un estudio piloto para comparar el procedimiento de interposición de Longmire-Gütgemann con la HLR. El estudio piloto incluyó 7 pacientes y el ensayo aleatorizado 38 pacientes (60 fueron planeados). Las principales variables analizadas en el estudio piloto fueron la resorción de alimentos, la ingesta calórica, y el peso corporal. En el ensayo aleatorizado fueron analizadas, además, la probabilidad de supervivencia y el estado de bienestar general (calidad de la vida). Se construyó un puntaje a partir de variables específicas de la enfermedad y sociopersonales para calificar el estado de bienestar general (calidad de la vida) entre 0 (peor) y 14 (óptimo).En el estudio piloto el paso a través del duodeno no demostró ventaja significativa en cuanto a la resorción intestinal. La principal alteración postoperatoria fue la ingesta alimenticia insuficiente. A pesar de una operación radical, una mortalidad de 16%, y una tasa de complicaciones de 37%, el cáncer gástrico mantiene un pronóstico poco favorable. En el ensayo aleatorizado sólo 15 (39%) de 38 pacientes sobrevivían 1 año después de la operación, con una probabilidad de supervivencia mayor (58%) después de la HLR que después de la EY (24%) (p<0.05). El hambre y el apetito aparecieron notoriamente disminuidos durante el primer semestre después de la operación. La ingesta de alimento fue menos de la mitad del valor preoperatorio, lo cual se manifestó en una disminución del peso corporal de 7 kg en promedio.Los pacientes que murieron en el curso del primer año después de la gastrectomía total exhibieron una disminución importante e irreversible de la calidad de la vida (cerca de 7 puntos) y no demostraron beneficio objetivo de la operación, en comparación con los que sobrevivieron tal período, quienes recuperaron una buena calidad de la vida con valores iguales o superiores a los preoperatorios, especialmente después de HLR.Nuestra conclusión es que los pacientes sometidos al procedimiento HLR que sobreviven por lo menos 1 año, se benefician de la gastrectomía total en lo relativo a la calidad de la vida.

     

Modification of blood flow properties by physical stimuli

The pharmacological modification of blood rheology is an accepted means of therapy for circulatory diseases. In the search for modes of physical treatment which induce similar rheological changes, various physical stimuli were tested under differing experimental conditions. Some show no rheological effects; others induce negative, or in some cases positive rheological changes. At present it seems premature to draw clinical conclusions from most of these observations. As regards regular physical training, however, the emerging picture is clearer. Training seems to enhance blood flow in ischaemic diseases partly due to its positive effects on blood rheology.     

Verapamil and hematoporphyrin derivative for tumour destruction by photodynamic therapy.

Forty-six patients with recurrent ovarian cancer were reoperated, and cancer samples for the subrenal capsule assay (SRCA) were collected from 23 of them, whereas this test was not done in the remaining 23 control patients. The SRCA was evaluable in 22 cases (96%). Taken together, no significant difference appeared in the 3 years' survival figures between the groups: seven of 22 patients (32%) with the evaluable SRCA and six of 23 control patients (26%) were alive. However, a further analysis of the data revealed that the SRCA guided the selection of chemotherapy only in 15 patients, whereas tumour samples were resistant to all cytostatics tested in six cases and toxic side-effects limited the clinical application of the test results in the remaining one case. Four of the 11 patients (36%) whose further chemotherapy was strictly chosen based on the SRCA and seven of the 24 patients (29%) whose treatment was based on physician's choice survived at least 3 years. Our conclusion is that the SRCA is of limited value in the selection of second-line chemotherapy in recurrent ovarian cancer.     

Gd-BOPTA/Dimeg: experimental disease imaging.

The novel tissue-specific contrast agent, Gd-BOPTA/Dimeg, was tested in MR imaging of experimental focal liver disease and of acute myocardial ischemia in rats. Directly implanted liver tumors and blood-borne metastases were used as models for focal liver disease and occlusion of the lower anterior descending coronary artery as model for acute ischemia. The studies with implanted tumors, at a dose level of 250 mumol/kg, showed a very high (370%) and persistent (greater than 2 h) increase in the tumor-liver contrast-to-noise ratio (CNR), owing to selective enhancement of normal liver parenchyma signal intensity. While all blood-borne metastases showed a similar late CNR enhancement, some of them experienced early contrast loss due to transient signal intensity enhancement. In myocardial imaging, Gd-BOPTA/Dimeg produced a signal intensity enhancement in normal myocardium and an injured area-normal area CNR enhancement which were both much stronger and more persistent than those produced by Gd-DTPA/Dimeg.     

Cure of arthritis-dermatitis syndrome due to intestinal bypass by resection of nonfunctional segment of blind loop

Summary Many complications that followed jejunoileal bypass operations performed for the relief of morbid obesity were caused by bacterial overgrowth in the excluded blind loop. The arthritis-dermatitis syndrome was one of the common distressing disorders. The pathogenetic mechanism was thought to be an immune-complex-mediated process related to bypass enteritis. Antiarthritic medication was ineffective in most instances, and the skin lesions were refractory to treatment. A 45-year-old woman was suffering from the disorder as described above. She also had diarrhea, a low hematocrit, an elevated white blood cell count, and an increased sedimentation rate. Her nutritional status was satisfactory, presumably because of adaptive hypertrophy of the short functioning small intestinal segment. The patient adamantly refused dismantling of the bypass or any gastric restriction operations. Therefore, the blind loop, the source of her disease, was excised with immediate relief of all ill effects and restoration of normal laboratory findings. The patient has been entirely well since, and her weight has remained stable for one year.     

Tuberous sclerosis with angiomyolipoma and metastasized hypernephroma

This is a case report of a patient with angiomyolipomas in both kidneys which was confirmed in one kidney by open biopsy and histologic examination. Two years after diagnosis of the angiomyolipomatosis, the patient died of metastatic hypernephromas of both kidneys. The tumors had affected the kidneys almost totally; only in the right kidney were remnants of the angiomyolipoma still recognizable. A review of the literature shows how rare is the simultaneous occurrence of angiomyolipomas and hypernephroma.     

Erythrocyte sedimentation rate. History and importance today

ERS-related methods have been used since ancient times. Its scientific basis was disclosed in the 18th century, subsequently forgotten and rediscovered in the 19th century. Fahraeus and his scholar Westergren finally popularized the method. The ESR is a simple test which is determined by a complex interaction of various factors. It is suited predominantly as a screening method for inflammatory diseases. Tests that are easier to interpret, like plasma viscosity, have (so far?) not substituted ESR in German speaking countries.     

Antiaggregatory and anticoagulant effects of oligoamines. 5. Alicyclic di- and triamines

Platelet Aggregation Inhibiting and Anticoagulant Effects of Oligoamines, V: Alicyclic Diamines and Triamines Seventeen oligoamines beeing derivatives of cyclohexane, adamantane, spiro[3,3]heptane and 9,10-ethanoanthracene have been synthesized. Platelet aggregation induced by collagen in vitro is inhibited by eight of them at IC₅₀ ≦ 5 μmol/L. Three compounds depress the formation of fibrin to 25 % of normal at a 50 μmol/L concentration. This was indicated by prolongation of the thromboplastin and partial thromboplastin times. The 500 MHz COSY spectrum of a spiro[3,3]heptane-2,6-dimethanamin (16) confirms that the cyclobutane rings are puckered and that the substituents are in equatorial positions.     

Miscibility of linear and branched polyethylene in the liquid state

HDPE/LDPE blends and the pure components were crosslinked either by irradiation or by di-tert-butyl peroxide in the liquid state. The degree of crosslinkage was characterized by the reciprocal degree of swelling Q^?1 (xylene, 2 h, 140°C). Above a critical degree of crosslinkage corresponding to Q^?1 = 0,2 the DSC curves of HDPE/LDPE blends show only one single crystallization peak on cooling from the melt and only one single melting peak on subsequent heating. This is an unequivocal proof for the single phase structure of HDPE/LDPE blends in the liquid state. Crosslinking with Q^?1 ≥ 0,2 prohibits fractional crystallization and forces the unbranched CH₂ sequences of both components between the crosslinks into one crystal lattice.