Serum concentration of D-dimers as a marker of the activation of the fibrinolytic system in patients undergoing bronchoscopic and thoracoscopic investigations

BACKGROUND

Hypercoagulability is common even after minimally invasive surgical techniques and is pathogenetically linked to postoperative thrombotic and cardiac complications. The activation of the coagulation and fibrinolytic systems after bronchoscopic and thoracoscopic investigations has not yet been elucidated.

OBJECTIVE

The aim of our study was to evaluate whether bronchoscopic and thoracoscopic investigations activate the fibrinolytic system.

METHODS

This study assessed cross-linked fibrinogen degradation products (D-dimer) in 120 patients after bronchoscopy with and without biopsies and/or bronchoalveolar lavage and after thoracoscopy with biopsies of the parietal pleura.

RESULTS

Both bronchoscopy and thoracoscopy induced a minor but significant increase in D-dimers in most patients, reversible mostly within 24 h. In rare cases, distinct increases lasting at least 24 h occurred.

CONCLUSIONS

The slight and temporary increase in serum D-dimers induced by bronchoscopy and thoracoscopy is nonsignificant in most patients; however, in some cases, the coagulation/fibrinolytic systems may become markedly activated.

[Precurarization of succinylcholine with cisatracurium: the influence of the precurarization interval]

PURPOSE

To determine the influence of two different pretreatment intervals, i.e. 3 and 6 min, on the efficacy of 0.01 mg/kg cisatracurium in preventing succinylcholine-induced fasciculations and myalgia.

METHODS

A total of 60 adult patients were randomized and received either 0.01 mg/kg cisatracurium (0.2*ED(95)) i.v. (Cis 3 group: pretreatment interval 3 min, Cis 6 group: pretreatment interval 6 min) or normal saline i.v. (placebo group) prior to injection of succinylcholine. The incidence and severity of fasciculations and myalgia and side-effects of precurarization were assessed.

RESULTS

The incidence of muscle fasciculations was only reduced in the Cis 6 group (45%) compared with the Placebo group (85%), p<0.05. Cisatracurium was associated with a higher incidence of paralytic symptoms in both pretreatment groups (Cis 3: 75%, Cis 6: 80%) compared with the Placebo group (30%), p<0.05.

CONCLUSION

Cisatracurium is only effective in preventing succinylcholine-induced fasciculations when a longer pretreatment interval, i.e. 6 min instead of 3 min, is chosen. Precurarization led to signs of paralysis in both pretreatment groups in the majority (75-80%) of patients without reducing the incidence or severity of postoperative myalgia.

Mycobacterium tuberculosis gene-amplification in breath condensate of patients with lung tuberculosis

The applicability of Mycobacterium tuberculosis-gene-amplification test (NAT) in breath condensate (BC) was examined in lung tuberculosis (TB). Ten patients with bacteriologically confirmed lung TB have been examined by ligase chain reaction (LCx). In BC the NAT were negative in all patients as well as the examination of acid fast smears and of solid phase or liquid media cultures were. This indicates that the use of NAT in BC can not replace or complement sputum or materials obtained invasively in patients with lung TB.

Microwave single walled carbon nanotubes purification

A new single walled carbon nanotubes (SWCNTs) purification procedure has been developed; it consists in a combination of air treatment and acid microwave digestion leading to a high purity SWCNTs material; the procedure reaches high metal removal percentages and the operation time is drastically reduced compared to conventional acid reflux treatments.

Influence of mucolytic therapy on respiratory mechanics in patients with chronic obstructive pulmonary disease

Mucus hypersecretion is a hallmark of chronic obstructive pulmonary disease (COPD) and is regarded as contributing to airflow limitation in these patients. The value of mucolytic therapy is still a matter for debate. We investigated the short-term influence of an inhalative mucolytic drug mercapto-ethane sulfonate (Mesna) on the lung function, respiratory mechanics and viscous respiratory load in patients with COPD in a randomized, placebo controlled, double-blind, cross-over study in 10 patients with moderate, stable COPD. Resistance, static compliance and frequency dependent dynamic compliance and viscous respiratory work, FVC, FEV(1), PEFR, MEF(75), MEF(50), MEF(25), TLC and RV were measured. These lung function parameters did not show any significant differences between the treatment groups. In conclusion, an inhalative treatment with an active mucolytic drug of patients with mild COPD does not improve respiratory mechanics and respiratory load.

[Umbilical metastasis of a gallbladder carcinoma: "Sister Mary Joseph's nodule"]

HISTOLOGY AND CLINICAL FINDINGS: A 63-year-old man presented with a firm and crusting umbilical mass which had developed within several weeks. The tumor was 1.5 cm in diameter. There were no other diseases in the patient's history. Physical examination was normal except the umbilical tumor.

INVESTIGATIONS

Histologic examination revealed a malignant epithelial tumor corresponding to a metastasis of an adenocarcinoma which could be a carcinoma of the gallbladder or the pancreas. Initially the following clinical examination of the patient showed no pathological findings: gastroscopy and coloscopy gave no hint for a primary carcinoma. Computed tomography of the abdomen revealed a thickened gallbladder wall with an irregular intraluminal contour suspicious of a gallbladder carcinoma. During surgery the gallbladder showed a clearly thickened wall. There were numerous carcinomatous lesions on the peritoneum. A cholecystectomy was performed and the umbilical metastasis was excised.

DIAGNOSIS, TREATMENT AND COURSE

Histologic examination revealed a metastatic adenocarcinoma of the gallbladder with tumorous infiltration of the liver tissue and a solitary metastasis in the skin (>>Sister Mary Joseph's nodule<<). During wound healing there were no complications and the patient was demitted 10 days after surgery. Following a recovery phase at home a palliative chemotherapy was planned. Because the patient's general condition worsened he was readmitted to the hospital. He presented with a considerable anemia and an icterus. Sonography revealed a hilar tumor measuring 4 cm in diameter. The intrahepatic bile ducts were congested. A stent was inserted by endoscopic retrograde pancreaticocholangiography. During the following weeks the patient's general condition worsened rapidly and he died 9 months after the skin metastasis had occurred.

CONCLUSION

A rapidly developing umbilical mass (>>Sister Mary Joseph's nodule<<) is suspicious of an underlying metastatic adenocarcinoma. The necessary examination and therapy including excision of the umbilical metastasis is warranted without delay.

[Paraneoplastic pityriasis rubra pilaris in metastatic adenocarcinoma without diagnosable primary]

HISTORY AND ADMISSION FINDINGS

A 75-year-old woman, without a history of severe illness, developed an erythematosquamous skin disease on hands and forearms. After continued spreading of these cutaneous lesions, she was admitted to hospital, presenting with a generalised desquamating erythrodermia and marked pruritus.

INVESTIGATIONS

Skin biopsy showed cornocutaneous signs with alternating ortho- and parakeratosis, typical for pityriasis rubra pilaris. Laboratory findings showed a chronic to acute inflammation with leukocytosis, granulocytosis in the differential blood count, raised C-reactive protein in a range from 54.7 to a maximum of 157.2 mg/l and a protein electrophoresis with elevated alpha1- and alpha2-fraction.

TREATMENT AND COURSE

The erythrodermia only temporarily receded under systemic therapy with acitretin and prednisolone. The patient developed intermittent septic fever accompanied by reduction or loss of consciousness. The general condition of the patient worsened considerably. Out of a rapidly progressing pleural effusion malignant cells similar to adenocarcinoma were isolated. Because CA15-3 was elevated we conducted an extended search especially for a breast carcinoma, but found only pathologically enlarged axillary, mediastinal and abdominal lymph nodes in conventional X-ray, CT, ultrasound and endoscopic procedures. The patient died from paraneoplastic pulmonary embolism. At autopsy, the widespread metastatic dissemination from poorly differentiated adenocarcinoma was confirmed. A necrosis in the right breast containing tumour cell remnants could probably be regarded as the primary neoplasm. Immunohistochemically no definite proof of breast nor gastro-intestinal carcinoma could be found.

CONCLUSIONS

This case presents a rare paraneoplastic cutaneous manifestation as pityriasis rubra pilaris triggered by a poorly differentiated adenocarcinoma. The primary neoplasm could not definitely be identified, neither pre nor post mortem.

Temporal characteristics of slot machine play in recreational gamblers

The present study examined the temporal characteristics of play exhibited by recreational slot machine players. 12 women (M = 24 yr., range 22-28) played a computerized version of a slot machine with probability of payoff, i.e., a winning spin, ranging from .2 to .6. Intertrial intervals or the time between the termination of one trial to the initiation of the next trial varied within subjects as a function of wins and losses. Winning trials were associated with larger intertrial intervals and losing trials with smaller intertrial intervals for 10 of the 12 women. No differences were found across probability levels between subjects. Results are discussed in terms of the post-reinforcement pause that occurs on specific schedules of reinforcement.

Reproducibility of HTS-SQUID magnetocardiography in an unshielded clinical environment

A new technology has been developed which measures the magnetic field of the human heart (magnetocardiogram, MCG) by using high temperature superconducting (HTS) sensors. These sensors can be operated at the temperature of liquid nitrogen without electromagnetic shielding. We tested the reproducibility of HTS-MCG measurements in healthy volunteers. Unshielded HTS-MCG measurements were performed in 18 healthy volunteers in left precordial position in two separate sessions in a clinical environment. The heart cycles of 10 min were averaged, smoothed, the baselines were adjusted, and the data were standardized to the respective areas under the curves (AUC) of the absolute values of the QRST amplitudes. The QRS complexes and the ST-T intervals were used to assess the reproducibility of the two measurements. Ratios (R(QRS), R(STT)) were calculated by dividing the AUC of the first measurement by the ones of the second measurement. The linear correlation coefficients (CORR(QRS), CORR(STT)) of the time intervals of the two measurements were calculated, too. The HTS-MCG signal was completely concealed by the high noise level in the raw data. The averaging and smoothing algorithms unmasked the QRS complex and the ST segment. A high reproducibility was found for the QRS complex (R(QRS)=1.2+/-0.3, CORR(QRS)=0.96+/-0.06). Similarly to the shape of the ECG it was characterized by three bends, the Q, R, and S waves. In the ST-T interval, the reproducibility was considerably lower (R(STT)=0.9+/-0.2, CORR(STT)=0.66+/-0.28). In contrast to the shape of the ECG, a baseline deflection after the T wave which may belong to U wave activity was found in a number of volunteers. HTS-MCG devices can be operated in a clinical environment without shielding. Whereas the reproducibility was found to be high for the depolarization interval, it was considerably lower for the ST segment and for the T wave. Therefore, before clinically applying HTS-MCG systems to the detection of repolarization abnormalities in acute coronary syndromes, further technical development of the systems is necessary to improve the signal-to-noise ratio.

[Primary pulmonary manifestation of extramedullary acute myelocytic leukemia]

We report on a 49 year old female with primary extra-medullary manifestation of a acute myeloid leukemia in the lungs without leukemic signs. The disease was diagnosed by detection of leukemic blast cells in bronchoalveolar lavage. Chemotherapy with the TAD-VP-scheme resulted in partial remission. The patient died in systemic early relapse. To our knowledge this is the first description of primary isolated extra-medullary manifestation of a acute myeloid leukemia in the lungs.

[Non-tubercular mycobacterial infection of the lungs due to Mycobacterium smegmatis]

Nontuberculous mycobacteriosis due to M. smegmatis is a rarity. We report on the case of a 51 year old male HIV-seronegative patient without predisposing bronchopulmonary disease, but with a state after gastrectomy and splenectomy who developed unproductive cough, night sweat and weight loss. The chest radiograph and thoracic CT showed wide-spread bilateral patchy infiltrations. Histological examination of transbronchial biopsies revealed chronic carnificating pneumonia. A perhoracic fine-needle biopsy showed caseating epitheloid cell granulomas with acid fast bacilli. These were identified as M. smegmatis by PCR with subsequent sequencing. Acid fast bacilli could not be detected microscopically neither in sputum nor in bronchial secretions, however M. smegmatis has been repeatedly detected by culture in these materials. In neither material tubercle bacilli have been detected by nucleic acid amplification (NAT) or culture. Immunologic investigations revealed a reduced number of CD4+ lymphocytes and a reduction of interferon alpha- and -gamma-synthesis by peripheral blood mononuclear cells. Treatment with Rifabutin, Ethambutol, Clarithromycin and Ofloxacin resulted in complete clinical and roentgenological resolution.

Brain nitric oxide synthase expression is enhanced in the human cervix in labor

OBJECTIVES

To determine whether brain nitric oxide synthase (bNOS) is expressed in human cervix, define its localization, and examine the possibility that it contributes to the nitric oxide (NO) pool and has a role in human cervical ripening.

METHODS

Human cervical biopsy tissues were collected from four groups: (1) nonpregnant patients, (2) term nonlabor (cesarean delivery) patients, (3) term labor patients with cesarean deliveries, and (4) term labor patients (vaginal delivery). The mRNA expression was assessed using reverse-transcribed polymerase chain reaction and in situ hybridization. The protein expression was determined using Western blot and its localization was shown using immunostaining.

RESULTS

Both bNOS mRNA and protein are present in human cervical tissue. They were localized to stroma cells and epithelial cells by in situ hybridization and immunostaining. bNOS protein expression in the labor group was significantly higher than in the nonlabor group (P <.05).

CONCLUSION

bNOS is expressed in the human cervix and enhanced expression is observed in labor, suggesting its possible role in contributing to the NO pool in the human cervix, in cervical ripening, and in labor.

Separate mechanisms for behavioral, cardiovascular, and hormonal responses to dextroamphetamine in man

The neurochemical specificity of physiological, biochemical, and psychological responses to dextroamphetamine was tested by pretreating volunteers with haloperidol (0.014 mg/kg IM), propranolol (0.1 mg/kg IV), thymoxamine (0.1 mg/kg IV), or placebo prior to 0.3 mg/kg IV amphetamine. Healthy volunteers (N = 12) participated in the studies, but not all volunteers received each drug combination. Haloperidol prevented dextroamphetamine-induced behavioral excitation, but did not significantly affect plasma norepinephrine or pressor responses, whereas propranolol inhibited norepinephrine and pressor responses without influencing excitation or other behavioral responses. Thymoxamine did not affect any of the responses measured. None of the agents significantly affected plasma cortisol or growth hormone responses. The prolactin rise following dextroamphetamine was potentiated by haloperidol. The results are consistent with the hypothesis that behavioral excitation after dextroamphetamine occurs through a dopaminergic mechanism, and pressor responses through a noradrenergic mechanism.

Differential mediator release from basophils of allergic and non-allergic asthmatic patients after stimulation with anti-IgE and C5a

The differentiation between allergic and non-allergic asthma is a common and important challenge for the clinician. Until now, no in vitro diagnostic characteristics have been described to distinguish between these types. To examine the diagnostic value of a basophil stimulation test, we compared anti-IgE- and C5a-induced mediator release from peripheral blood leucocytes in different types of bronchial asthma. Peripheral blood leucocytes (PBL) from 10 aspirin-sensitive asthmatics (ASA), 12 non-allergic asthmatics without aspirin intolerance (NAA), seven allergic asthmatics (AA), and nine healthy controls were prepared by dextran sedimentation. After priming with interleukin-3 (IL-3) PBL were stimulated with anti-IgE and C5a, and the release of histamine (HR) and sulfidoleukotrienes (LTR) in the supernatant was compared. Additionally, purified leucocyte fractions were studied to determine the cellular source of mediator release. Upon stimulation with anti-IgE LTR was slightly, but not significantly, lower in ASA and NAA compared to AA and controls. In contrast, C5a-triggered LTR was significantly higher in ASA (14.4 +/- 12.88 pg/105 cells) and NAA (22.9 +/- 22.61 pg/105 cells) than in AA (9.6 +/- 3.29 pg/105 cells) and controls (7.5 +/- 7.19 pg/105 cells) (P < 0.05). This difference between ASA and NAA vs. AA and controls was even more pronounced when determining the quotient C5a-/anti-IgE-induced LTR (P < 0.001). At an optimal cut-off point of 1.0, calculated by relative operating characteristics (ROC) analysis, the positive predictive value for a donor to belong to ASA or NAA was 0.94. No significant differences could be found in HR between the asthmatic patient groups and healthy controls in either condition. As cellular source of LTR and HR the basophil could be determined. Determination of anti-IgE- and C5a-induced LTR from basophils allows us to discriminate between allergic and non-allergic asthmatic patients. For diagnostic purposes the quotient C5a-/anti-IgE-induced LTR is more significant than considering a single parameter. ASA cannot be distinguished from NAA.

Interstitial lung disease induced by endogenous Candida albicans

We report on a 64-year old woman with an interstitial lung disease which had characteristics of hypersensitivity pneumonitis. Severe febrile attacks with impairment of ventilation and diffuse poorly defined radiodensities and ground glass opacities on chest x-ray occured repeatedly. Laboratory data showed hypoxemia, leukopenia and circulating Candida albicans (C.a.)-antigen. Bronchoalveolar lavage revealed an increase in neutrophils. Transbronchial biopsies showed lymphocytic alveolitis, bronchiolitis obliterans and epitheloid cell granulomas. IgG and IgA and the lymphocyte proliferation assay were positive with C.a.-antigen. C.a. was detected in the feces. Intradermal skin test with C.a. showed a positive immediate and late phase reaction and inhalative provocation test with C.a.-antigen was positive. After antimycotic treatment the symptoms resolved completely and long-lasting. We conclude that the disease was induced by C.a.-antigen reaching the lungs from the intestinal tract via the bloodstream.

Genome-wide location and function of DNA binding proteins

Understanding how DNA binding proteins control global gene expression and chromosomal maintenance requires knowledge of the chromosomal locations at which these proteins function in vivo. We developed a microarray method that reveals the genome-wide location of DNA-bound proteins and used this method to monitor binding of gene-specific transcription activators in yeast. A combination of location and expression profiles was used to identify genes whose expression is directly controlled by Gal4 and Ste12 as cells respond to changes in carbon source and mating pheromone, respectively. The results identify pathways that are coordinately regulated by each of the two activators and reveal previously unknown functions for Gal4 and Ste12. Genome-wide location analysis will facilitate investigation of gene regulatory networks, gene function, and genome maintenance.

Influence of oxygen concentration on argon plasma coagulation-induced tissue damage in isolated pig tracheas

BACKGROUND

Argon plasma coagulation (APC) is used during bronchoscopy to restore passage of central airways. Concern has been raised about the possibility that elevated oxygen concentration may increase the tissue damage by APC.

OBJECTIVE

to examine the extent of tissue damage at different concentrations of oxygen in isolated pig tracheas.

METHODS

The APC-induced tissue damage was investigated macroscopically and microscopically in isolated and artificially ventilated pig tracheas at oxygen concentrations of 21, 50, 75 and 100%.

RESULTS

There was deep coagulation of all tissue layers reaching the adventitia independent of the oxygen concentration up to 75% O(2). With 100% O(2), only tissue damage increased and combustion occurred.

CONCLUSIONS

APC-induced tissue damage in ex vivo pig tracheas was independent of the oxygen concentration relevant for clinical practice.

Binding of tumor antigen mucin (MUC1) derived peptides to the heat shock protein DnaK

The human epithelial mucin encoded by the gene MUC1 is a tumor-associated antigen expressed on breast, pancreatic, colon and ovarian cancer cells recognized by cytotoxic T-cells and antibodies. Underglycosylated as well as glycosylated mucin-peptide epitopes are promising targets for vaccination against cancer. Heat shock proteins of 70 kDa (HSP70), also highly expressed in tumor cells, can function as chaperones for peptides and proteins and are involved in antigen processing. The involvement of HSP70 molecules in mucin antigen binding, processing and presentation has not yet been examined. Here we present first results concerning the relative binding affinities of various mucin-derived peptides to the bacterial 70 kDa heat shock protein DnaK. Interestingly, longer mucin peptides reveal a higher affinity to DnaK than short peptides. The non-glycosylated mucin-derived peptides of 5-8 amino acids length were able to compete with a high affinity (unrelated) reference peptide at millimolar concentrations. Glycosylation of the investigated short peptides lowers their binding affinity to DnaK, depending on the position of the carbohydrate. The binding affinity is not influenced by free charges at unprotected ends. The peptide (MUC1)5 consisting of five repeating units has an affinity enhanced by a factor of three as compared to the peptide with only one repeating unit. Mucin-peptide-HSP-complexes could be the basis of developing new kinds of tumor vaccines.

Use of the blue MACS: acceptance by clinical instructors and self-reports of adherence

BACKGROUND AND PURPOSE

The purpose of this study was to evaluate clinical instructors' (CIs') acceptance of and self-reported adherence to instructions for use of The Blue MACS (5th edition) for evaluating the clinical performance of physical therapist students.

SUBJECTS AND METHODS

One hundred twenty-four usable survey instruments were returned by CIs.

RESULTS

Twenty-two items from The Blue MACS were collapsed into a score representing acceptance, and 10 items were collapsed into a score representing reported adherence to instructions. Ninety-six percent of the CIs surveyed expressed a positive opinion of the instrument. Ninety-eight percent of the CIs reported at least moderately consistent adherence to instructions.

CONCLUSION AND DISCUSSION

The instrument was regarded as a useful tool, and most CIs reported using the instrument according to the instructions. A positive opinion of the clinical performance assessment instrument is desirable to facilitate its use by CIs. Consistent use by different CIs is desirable to promote accurate communication among students, CIs, and the educational institution.