[Use of a newly developed piezoelectrically driven drilling machine for MR-guided bone biopsies]

PURPOSE

Development and clinical testing of an MR-compatible bone biopsy system, to enable the sample collection from osteosclerotic or subcortical lesions for histological investigation under MR control.

MATERIALS AND METHODS

A piezoelectrically driven drilling machine was constructed and tested in connection with an MR-compatible bone biopsy set in a vertical open MR scanner (0.5 T) on a phantom and 10 patients with ambiguous bone lesions. Images were obtained using T(1)-weighted spin-echo sequences and, in case of real-time imaging, a fast spoiled gradient-echo sequence.

RESULTS

The influence of the enabled motor (RF-interference) leads to a reduction of the signal to noise ratio of the images, but can be minimised by appropriate measures. The observed slight field distorsions do not affect the image quality during real time acquisition in a substantial manner. No complications occurred. The extracted biopsy material was sufficient and of good quality.

CONCLUSIONS

In spite of slightly restricted image quality, the described drilling machine combined with the bone biopsy set is well suited for MR-guided bone biopsies, which require the application of a motor driven drill. Its application within an interventional MR scanner is safe and its handling simple and manageable.

[Gonarthritis due to Salmonella enteritidis in a patient with systemic lupus erythematosus]

Extraintestinal manifestations of Salmonella infection occur more frequently in immunocompromised patients than in healthy persons. About 25 % present as septic arthritis. Particularly patients with SLE are predisposed. We report a case of a 16-year old girl with systemic lupus erythematosus who developed septic arthritis of the left knee. Delayed diagnosis because of similar symptoms of arthritis due to lupus and purulent arthritis led to a destruction of the joint despite systemic antibiotic treatment. Seven months later an endoprosthesis was implanted with good outcome. Early diagnosis, adequate antibiotic therapy and, if necessary, surgical intervention are essential for successful treatment. In patients with SLE suffering from fever or arthritis it is necessary to think of infections particularly due to salmonella.

Coherent external and internal phonons in quasi-one-dimensional organic molecular crystals

We have directly time resolved coherent phonon oscillations in quasi-one-dimensional organic crystals of MePTCDI ( N-N'-dimethylperylene-3,4,9,10-dicarboximide), using femtosecond pump-probe experiments. We observe both higher-energy oscillations caused by intramolecular vibrations (internal phonons) and, for the first time in a quasi-one-dimensional organic system, lower-energy modulations which are related to coherent lattice phonons (external phonons). For internal A(g) vibrations, the coherence decay time of about 2 ps is almost independent of the mode. In contrast, the damping time of the external phonons increases strongly with decreasing energy.

Hsp70 plasma membrane expression on primary tumor biopsy material and bone marrow of leukemic patients

A tumor-selective cell surface localization of heat shock protein 70 (Hsp70), the major heat-inducible member of the Hsp70 group, correlates with an increased sensitivity to lysis mediated by human natural killer (NK) cells and, therefore, might be of clinical relevance. With the exception of mammary carcinomas, an Hsp70 plasma membrane expression was found on freshly isolated human biopsy material of colorectal, lung, neuronal, and pancreas carcinomas, liver metastases, and leukemic blasts of patients with acute myelogenous leukemia. Since normal tissues and bone marrow of healthy human individuals do not express Hsp70 on the cell surface, Hsp70 can be considered as a tumor-selective structure in vivo. Furthermore, we demonstrate that autologous, Hsp70-positive leukemic blasts can be killed by NK cells stimulated with low doses of interleukin 2 plus recombinant Hsp70 protein.

[Basic principles of medical assessment of the locomotor system]

Rendering a medical expert opinion on the musculoskeletal system is an extraordinary responsibility. Nearly all physicians are confronted with this medical task in their daily clinical practice. Difficulties encountered and misjudgments made in formulating an expert opinion are certainly primarily a result of insufficient knowledge of the sociomedical basis. Proper organization and compliance with a standardized structure are especially important for an expert opinion. Intensified teaching of the principles and importance of the medical expert opinion during medical training will not only result in optimization and acceleration of the sociomedical procedures, it will also awaken pleasure in this many-sided activity.

Adoptive transfer of human natural killer cells in mice with severe combined immunodeficiency inhibits growth of Hsp70-expressing tumors

In vitro, tumor-selective Hsp70 plasma membrane localization correlates with increased sensitivity to lysis mediated by a subpopulation of human natural killer (NK) cells that adhere to plastic following cytokine stimulation. In the present study, we analyzed the capacity of adoptively transferred human NK cells in SCID/beige mice for local tumor control and prevention of metastatic dissemination of Hsp70-expressing CX(+) and non-expressing CX(-) tumors following orthotopic (o.t.) injection. Both tumor sublines were derived by cell sorting of the original cell line, CX2, and thus exhibit an identical MHC and adhesion molecule expression pattern but differ with respect to Hsp70 plasma membrane expression. Viability of adherent, human NK cells in SCID/beige mice up to 18 days and the capacity to migrate have been demonstrated. Growth of Hsp70-expressing and non-expressing CX(+) and CX(-) tumor cells was completely suppressed when 10 x 10(6) NK cells were injected into the i.p. cavity on day 4 after inoculation of 2.5 x 10(6) tumor cells. Although a single injection of 5 or 2.5 x 10(6) NK cells was not sufficient to suppress tumor growth completely in all mice, the reduction in size of CX(+) tumors was significantly greater than that of CX(-) tumors. To mimic the clinical situation, ex vivo stimulated NK cells were injected i.v. on day 4 after o.t. injection of tumor cells. Under these conditions, growth of Hsp70-expressing primary tumors and metastases was suppressed. If CX(-) tumor cells were injected, 3 of 9 mice developed Hsp70-negative primary tumors. However, none of these mice developed distant metastases. In summary, our data indicate that Hsp70 acts as a recognition structure for adherent NK cells in a SCID/beige mouse model.

Hsp70 plasma membrane expression on primary tumor biopsy material and bone marrow of leukemic patients

A tumor-selective cell surface localization of heat shock protein 70 (Hsp70), the major heat-inducible member of the Hsp70 group, correlates with an increased sensitivity to lysis mediated by human natural killer (NK) cells and, therefore, might be of clinical relevance. With the exception of mammary carcinomas, an Hsp70 plasma membrane expression was found on freshly isolated human biopsy material of colorectal, lung, neuronal, and pancreas carcinomas, liver metastases, and leukemic blasts of patients with acute myelogenous leukemia. Since normal tissues and bone marrow of healthy human individuals do not express Hsp70 on the cell surface, Hsp70 can be considered as a tumor-selective structure in vivo. Furthermore, we demonstrate that autologous, Hsp70-positive leukemic blasts can be killed by NK cells stimulated with low doses of interleukin 2 plus recombinant Hsp70 protein.

A new model of thermal inactivation and its application to clonogenic survival data for WiDr human colonic adenocarcinoma cells

Based on the analysis of clonogenic survival data for human colonic adenocarcinoma cells (WiDr) after a single heating, a new model is proposed to describe cell survival after hyperthermia quantitatively. The effects of heat are explained as heat-induced cell damage assuming a first-order (single-hit) and a second-order (cumulative damage) process. Thus cell survival at a specified temperature can be described by the linear-quadratic (LQ) model. The proposed model is based on an alternative definition of the (single) thermal dose, given as the (normalized) product of heating time and a specified nonlinear function of the increase in temperature (relative to a threshold temperature) to be interpreted as the thermal dose rate. In further analogy to the modeling of the effects of low-dose-rate radiation, an inherent capacity of the cells to repair sublethal damage is assumed, and these effects are quantified by the usual g factor measuring incomplete repair effects. The model defines thermal dose-response and isoeffect dose relationships, enabling a direct (i. e. single-step) analysis of the available thermal response data. Additionally, the analysis of our data based on heating times in the range from 0 to 360 min and temperatures from 41 to 46 degrees C and covering a broad spectrum of different densities of cells seeded for colony formation did not yield any evidence of the existence of a breaking point usually derived from Arrhenius plots based on the single-hit, multitarget model and the Arrhenius equation. The model includes no specific assumptions describing the development of thermotolerance, which can be assumed to be negligible under our experimental conditions. The proposed thermal dose-response model correlates satisfactorily with the in vitro survival data for WiDr adenocarcinoma cells.

[Arterial complications caused by using an axillary crutch]

BACKGROUND

Of all upper extremity emboli, up to twenty percent arise from an arterial, not a cardiac source.

METHOD

We report about a patient with recurrent embolism, caused by an axillary crutch-induced aneurysm of the axillary artery.

RESULT

After revascularisation by embolectomy and axillo-brachial vein graft bypass, the patient was free of symptoms.

CONCLUSION

Angiography and duplex scanning were necessary for the correct diagnosis.

M2-receptor subtype does not mediate muscarine-induced increases in [Ca(2+)](i) in nociceptive neurons of rat dorsal root ganglia

Multiple muscarinic receptor subtypes are present on sensory neurons that may be involved in the modulation of nociception. In this study we focused on the presence of the muscarinic receptor subtypes, M2 and M3 (M2R, M3R), in adult rat lumbar dorsal root ganglia (DRG) at the functional ([Ca(2+)](i) measurement), transcriptional (RT-PCR), and translational level (immunohistochemistry). After 1 day in culture exposure of dissociated medium-sized neurons (20-35 micrometer diam) to muscarine was followed by rises in [Ca(2+)](i) in 76% of the neurons. The [Ca(2+)](i) increase was absent after removal of extracellular calcium and did not desensitize after repetitive application of the agonist. This rise in [Ca(2+)](i) may be explained by the expression of M3R, which can induce release of calcium from internal stores via inositoltrisphospate. Indeed the effect was antagonized by the muscarinic receptor antagonist atropine as well as by the M3R antagonist, 4-diphenylacetoxy-N-(2 chloroethyl)-piperidine hydrochloride (4-DAMP). The pharmacological identification of M3R was corroborated by RT-PCR of total RNA and single-cell RT-PCR, which revealed the presence of mRNA for M3R in lumbar DRG and in single sensory neurons. In addition, RT-PCR also revealed the expression of M2R, which did not seem to contribute to the calcium changes since it was not prevented by the M2 receptor antagonist, gallamine. Immunohistochemistry demonstrated the presence of M2R and M3R in medium-sized lumbar DRG neurons that also coexpressed binding sites for the lectin I-B4, a marker for mainly cutaneous nociceptors. The occurrence of muscarinic receptors in putative nociceptive I-B4-positive neurons suggests the involvement of these acetylcholine receptors in the modulation of processing of nociceptive stimuli.

Thermosensitivity of multidrug-resistant human gastric and pancreatic carcinoma cells

Often, tumour cells acquire drug resistance phenotypes, which include the classical multidrug resistance (MDR) phenomenon accompanied by the synthesis of the P-glycoprotein (Pgp) and atypical MDR phenotypes mediated by different, in part unknown, mechanisms. To investigate the susceptibility of tumour cells exhibiting different kinds of MDR to treatment with heat, the hyperthermic survival of established human gastric and pancreatic carcinoma cell lines were studied and sublines exhibiting a classical and an atypical MDR phenotype were derived, respectively. Arrhenius analysis of this panel of gastrointestinal tumour cells revealed that both the classical and the atypical MDR variants exhibited no breaking points (T*) in contrast to the parent tumour cells. The activation enthalpies E(A) were about 40% lower at T > T* in comparison to the E(A) at lower temperatures. Classical MDR variants of both gastrointestinal tumour cell types exhibited a similar E(A) value, whereas the E(A) of atypical MDR gastric carcinoma cells was 1.6-fold higher than the E(A) of corresponding pancreatic carcinoma cells. In comparison to the parent lines, the drug resistant variants exhibited a 2.1-fold (gastric carcinoma, classical MDR), 2.7-fold (gastric carcinoma, atypical MDR) and 1.4-fold (pancreatic carcinoma, classical MDR) increase of activation enthalpies and a nearby unchanged E(A) in pancreatic carcinoma cells exhibiting an atypical MDR.

Discovery of High Proper-Motion Ancient White Dwarfs: Nearby Massive Compact Halo Objects?

We present the discovery and spectroscopic identification of two very high proper-motion ancient white dwarf stars, found in a systematic proper-motion survey. Their kinematics and apparent magnitude clearly indicate that they are halo members, while their optical spectra are almost identical to the recently identified cool halo white dwarf WD 0346+246. Canonical stellar halo models predict a white dwarf volume density that is 2 orders of magnitude less than the rho approximately 7x10-4 M middle dot in circle pc-3 inferred from this survey. With the caveat that the sample size is very small, it appears that a significant fraction, approximately 10%, of the local dark matter halo is in the form of very old, cool, white dwarfs.

[Open lumbar intervertebral disk operation. Technique and results]

Various operative techniques are available for the treatment of lumbar disc herniation. The conventional lumbar discotomy is currently considered to be the standard procedure. Several large statistical studies have shown that the results in the majority of cases are very good and the complication rate is low if it is carried out correctly. A particular advantage of this technique is that almost all indications can be handled with a procedure that can be extended if necessary. Despite the availability of newer refined techniques (microdiscectomy or percutaneous procedures), the open lumbar discotomy still has an outstanding role in the management of lumbar disc herniation. Failure results more frequently from false indications or inadequate preoperative planning and less from technical variations.

Open lumbar disc operation. Technique and results

Various operative techniques are available for the treatment of lumbar disc herniation. The conventional lumbar discotomy is currently considered to be the standard procedure. Several large statistical studies have shown that the results in the majority of cases are very good and the complication rate is low if it is carried out correctly. A particular advantage of this technique is that almost all indications can be handled with a procedure that can be extended if necessary. Despite the availability of newer refined techniques (microdiscectomy or percutaneous procedures), the open lumbar discotomy still has an outstanding role in the management of lumbar disc herniation. Failure results more frequently from false indications or inadequate preoperative planning and less from technical variations.

[Therapy studies of the Austrian Breast Cancer Group (ABC)]

The Austrian Breast Cancer Group (ABC) consisting of more than 60 participating centers in Austria has randomized more than 5800 patients in 11 randomized trials since 1984. At present, roughly 30% of all patients with the diagnosis primary breast cancer are accrued in protocols throughout the country. Due to specific activities, the breast conservation rate raised from an initial 20% to more than 60% in the last years. Multicenter trials are not only the basis for progress in medicine but also tools for quality control and quality improvement.

Long-lasting contamination of a vitrectomy apparatus with Serratia marcescens

OBJECTIVE

To investigate the contamination of a vitrectomy apparatus with Serratia marcescens.

DESIGN

Descriptive microbiological and molecular environmental study.

SETTING

An 1,800-bed university hospital.

RESULTS

S. marcescens was found inside the vitrectomy apparatus at the pressure transducer. Molecular typing by randomly amplified polymorphic DNA-automated laser fluorescence analysis and pulsed-field gel electrophoresis identified a single pattern for all strains isolated from the apparatus. Surprisingly, the contaminating strain was identical to two strains of S. marcescens isolated nearly 2 years earlier from two patients who were involved in a small outbreak of acute postoperative endophthalmitis following cataract surgery at another hospital. The emergency vitrectomies in these patients were performed at our hospital with the same apparatus that was found to be contaminated 2 years later.

CONCLUSION

Performing a systematic environmental search for the assumed bacterial reservoir within the system of the vitrectomy apparatus finally made it possible to find and eliminate the nidus for the gram-negative rod. Molecular typing demonstrated that all isolates belonged to a single genotype, and revealed unexpectedly a link to two vitrectomies performed 2 years earlier. The data support the hypothesis that the source of the contamination was one of these patients, and thus contamination of the apparatus was present for almost 2 years.