IgE-mediated anaphylactic reaction to purified and recombinant factor VIII in a patient with severe haemophilia A

We report a 51-year-old patient with severe haemophilia A developing a severe life-threatening anaphylactic reaction to recombinant factor VIII (rFVIII). Anaphylactic reactions are a rare but well-known side effect of FVIII products. The nature of these reactions could not be clarified as previous studies failed to demonstrate a specific IgE response. Here, we could prove a grade 3 anaphlyactic reaction as an IgE-mediated response to rFVIII for the first time by Western blotting.

Anisotropic diffusion of single molecules in thin liquid films

Single molecule wide field imaging is applied to study the diffusion in ultrathin liquid films on solid surfaces. The results show a broad distribution of diffusion coefficients. This is tentatively ascribed to an anisotropy of the diffusion coefficient perpendicular to the surface and a slow exchange of molecules between regions of different diffusion coefficients. We have evidence, that these changes as well as the slow motion perpendicular to the surface are related to the molecular layering of the liquid close to the surface.

Feshbach resonances in rubidium 87: precision measurement and analysis

More than 40 Feshbach resonances in rubidium 87 are observed in the magnetic-field range between 0.5 and 1260 G for various spin mixtures in the lower hyperfine ground state. The Feshbach resonances are observed by monitoring the atom loss, and their positions are determined with an accuracy of 30 mG. In a detailed analysis, the resonances are identified and an improved set of model parameters for the rubidium interatomic potential is deduced. The elastic width of the broadest resonance at 1007 G is predicted to be significantly larger than the magnetic-field resolution of the apparatus. This demonstrates the potential for applications based on tuning the scattering length.

[Detection, identification and visualization of the recurrent laryngeal nerve during thyroidectomy--still a surgical dilemma]

OBJECTIVE

Based on their on experience the authors express their opinion on routine detection and visualization of the NLR during radical surgery of the thyroid gland. They describe standard and alternative steps of surgery leading to protection of the recurrent nerve.

MATERIAL AND METHODS

The authors evaluated a group of 735 patients operated during the last thirty nine months which comprised 87% total thyroidectomies, 11.6% total lobectomies, the remainder were almost total operations. The number of visualized nerves was 1367.

RESULTS

Unilateral temporary damage of the NLR leading to temporary pareses of the vocal cords was recorded in 19 patients, i.e. 1.39%, bilateral transient paresis in one case, i.e. 0.07%. Permanent damage of one vocal cord after severing of the NLR occurred in 11 patients, i.e. 0.8%, bilateral lesions of the vocal cords were not recorded.

CONCLUSION

There are no extensive statistics of thyroid operations without reports on damage of the NLR. With the increasing number of radical operations of the gland also the number of departments increased which recommend unequivocally to seek and visualize the NLR. The authors results support this point of view. They use most frequently a modification of Wang's method and consider as the smallest extent of visualization of the NLR the distance between the branching of the inferior thyroid artery and the entry of the NLR into the larynx.

Avalanches in a Bose-Einstein condensate

Collisional avalanches are identified to be responsible for an 8-fold increase of the initial loss rate of a large (87)Rb condensate. We show that the collisional opacity of an ultracold gas exhibits a critical value. When exceeded, losses due to inelastic collisions are substantially enhanced. Under these circumstances, reaching the hydrodynamic regime in conventional Bose-Einstein condensation experiments is highly questionable.

HU-210 shows higher efficacy and potency than morphine after intrathecal administration in the mouse formalin test

The discovery of endocannabinoids opens up new perspectives in experimental pain research. Here we present data for the excellent antinociceptive properties of the synthetic cannabinoid, R(-)-7-hydroxy-delta-6-tetra-hydrocannabinol-dimethylheptyl (HU-210), after intrathecal and oral administration in mice. It is known that cannabinoids depress motor activity. Therefore, these compounds are suspected of influencing antinociceptive tests. Our behavioural tests (RotaRod, tail flick) clearly show that HU-210 affects nociceptive behaviour even at dosages which do not yet influence motor activity. Moreover, spinal microdialysis (5 microl/min) in the dorsal horn of freely moving mice showed an enhancement of prostaglandin production during the formalin test. HU-210 applied via artificial cerebral spinal fluid during microdialysis perfusion increases prostaglandin concentrations under both baseline and formalin test conditions. Indomethacin reduces the HU-210 effect on pronociceptive prostaglandin production but does not reinforce the antinociceptive properties of HU-210. Thus, HU-210 shows antinociceptive properties that are independent of its influence on the prostaglandin pathway.

[Borderline questions in sustaining life-prolonging life. Moral theological viewpoint]

The subject-matter of the main topic of this contribution focuses on the question concerning the criteria for the renunciation of therapy or for the decision to desist from treatment. The normative basis is the recognition of the principle that no one can be medically treated against his or her expressed will. Age in itself is not a morally justified argument to refuse medical treatment such as dialysis, organ transplants or the application of expensive medication. A therapy is to be rejected and also an already begun therapy is to be discontinued when this will neither cure nor ease the illness.

Pescadillo, a novel cell cycle regulatory protein abnormally expressed in malignant cells

Using a culture model of glial tumorigenesis, we identified a novel gene that was up-regulated in malignant mouse astrocytes following the loss of p53. The gene represents the murine homologue of pescadillo, an uncharacterized gene that is essential for embryonic development in zebrafish. Pescadillo is a strongly conserved gene containing unique structural motifs such as a BRCA1 C-terminal domain, clusters of acidic amino acids and consensus motifs for post-translational modification by SUMO-1. Pescadillo displayed a distinct spatial and temporal pattern of gene expression during brain development, being detected in neural progenitor cells and postmitotic neurons. Although it is not expressed in differentiated astrocytes in vivo, the pescadillo protein is dramatically elevated in malignant human astrocytomas. Yeast strains harboring temperature-sensitive mutations in the pescadillo gene were arrested in either G(1) or G(2) when grown in nonpermissive conditions, demonstrating that pescadillo is an essential gene in yeast and is required for cell cycle progression. Consistent with the latter finding, DNA synthesis was only observed in mammalian cells expressing the pescadillo protein. These results suggest that pescadillo plays a crucial role in cell proliferation and may be necessary for oncogenic transformation and tumor progression.

Dobutamine stress echocardiography: improved endocardial border definition and wall motion analysis with tissue harmonic imaging

BACKGROUND

We performed a study to determine whether tissue harmonic imaging (THI) facilitates wall motion analysis at rest and whether these benefits extend through the stages of a dobutamine stress echocardiography (DSE) study. We also assessed the impact of THI on the feasibility of DSE in technically difficult patients. Finally we tested the hypothesis that THI by improving endocardial border definition (EBD) could enhance the interobserver agreement between trainees and experienced operators for interpreting DSE studies.

METHODS

Twenty unselected patients underwent DSE by standard protocol. Parasternal and apical views were obtained with the use of fundamental mode (FND) and THI at baseline, low dose, and peak stress. Segmental EBD was characterized as 1 to 4 (1 = excellent) and segmental wall motion was characterized as 1 to 4/x (1 = normal, x = unable to interpret) by a consensus of 2 experienced observers. A trainee in stress echocardiography independently scored all segments, and these results were compared with the consensus of the experienced readers.

RESULTS

EBD improved with THI in 26 +/- 6.7 of 48 segments per patient (54%, 95% confidence interval [CI] 0.40 to 0.68) and deteriorated with THI in only 2 +/- 2.7 (4%, 95% CI 0 to 0.09). Of the total of 48 segments per patient, a mean of 10 +/- 5.7 (21%, 95% CI 0.10 to 0.31) were of inadequate quality to be interpreted for wall motion on FND, and this changed to 4 +/- 3.4 (6%, 95% CI 0.06 to 0.12) on THI (P <.001). EBD improved in a similar degree in all DSE stages 53%, 54%, and 53% for rest, low dose, and peak stress, respectively. Six of the 20 study patients were deemed unsuitable for DSE on FND, and all were changed to suitable subjects on THI. Of the 205 segments deemed unsuitable for interpretation on FND, 140 (68%) were of the anterior and lateral walls of the LV. Improvement with THI was also more prominent on these walls. The mean coefficient of agreement (kappa) for wall motion analysis was 0.82 +/- 0.14 on FND and improved to 0. 92 +/- 0.09 on THI (P <.001).

CONCLUSIONS

THI dramatically improves EBD and the ability to confidently score segmental wall motion. Interobserver agreement is also significantly enhanced. These benefits extend to the peak stage of a DSE study. Routine use of THI may enhance the diagnostic accuracy of DSE and extend its application to technically difficult patients previously deemed unsuitable.

Expression of the lung resistance protein predicts poor outcome in patients with multiple myeloma

Expression of the lung resistance protein (LRP) is associated with resistance to various anticancer drugs including melphalan and, therefore, may affect the clinical outcome in multiple myeloma (MM). To determine the clinical significance of LRP, we have compared LRP expression in bone marrow plasma cells with clinical parameters including response to chemotherapy and survival of previously untreated patients with MM (n = 72). LRP expression immunocytochemically assessed by means of the LRP-56 monoclonal antibody was positive (> or =10% staining plasma cells) in 44 (61%) samples. There was no correlation between LRP expression and age, sex, type of the paraprotein, serum creatinine, stage, beta2-microglobulin, serum lactate dehydrogenase, or C-reactive protein. However, LRP expression was more frequently observed in patients with a p53 deletion than in those without such a deletion (P = 0.01). The overall response rate for all of the patients evaluable for response to induction chemotherapy (n = 58) was 67%. The response rate was 87% for patients without LRP expression but only 54% for patients with LRP expression (P = 0.01). Kaplan-Meier analysis revealed that patients with LRP expression had a shorter overall survival (median, 33 months) than those without LRP expression (median not reached; P = 0.04). These data show that LRP expression is an important marker for clinical drug resistance and predicts a poor outcome in MM.

Circumnutations without gravity: a two-oscillator model

Helical growth movements termed circumnutations occur in a number of different plant organs. The underlying mechanism are complicated. They consist of an endogenous as well as an erogenous component. Since circumnutations in sunflower hypocotyls occur also under gravity free conditions in Space, gravity is not necessary for them to arise. However, the changes of period and amplitude of circumnutations with the applied gravitational force indicate that gravity plays a modifying role. Models for circumnutations have to take these features into account. It seems natural to study minimum models with at least two oscillating units. Two-oscillator models for circumnutations have already been discussed. We have studied the interaction between two coupled oscillatory units. With this model we could simulate movements of hypocotyls. The results of simulations were compared with experimentally recorded movements of the Arabidopsis hypocotyl.

Examining the immune response in sentinel lymph nodes of mice and men

Recently, it was recognized that an immune response develops along one of two major pathways. One leads to a destructive immune response (type 1), while the alternative leads to a nondestructive immune response (type 2). Our studies in animal models suggest that therapeutic vaccines induce a tumor-specific type 1 immune response while ineffective vaccines induce a type 2 response. These results have led us to examine the immune response in sentinel lymph nodes draining tumor vaccines of patients entered onto clinical trials for melanoma, breast and renal cell cancer.