Structure of skeletal muscle in heart transplant recipients

OBJECTIVES

This study sought to define the ultrastructural characteristics of skeletal muscle in heart transplant recipients (HTRs) in relation to exercise capacity compared with that in age-matched control subjects.

BACKGROUND

Muscle structural features seem to play an important role in the limitation of exercise capacity of HTRs long after transplantation.

METHODS

The structure of the vastus lateralis muscle was analyzed by ultrastructural morphometry in 16 HTRs and 20 healthy control subjects. Maximal oxygen consumption (peak Vo2) was determined by an incremental exercise test.

RESULTS

Peak Vo2 was significantly lower (by 35%) in HTRs. Fiber size, volume density of mitochondria and intramyocellular lipid deposits were not significantly different between HTRs and control subjects. In contrast, the capillary density and the capillary/fiber ratio were both significantly reduced in HTRs (by 24% and 27%, respectively).

CONCLUSIONS

A normal volume density of mitochondria and a reduced capillary network are the main characteristics of muscle ultrastructure in HTRs by 10 months after transplantation. The muscle structural abnormalities and reduced exercise capacity might be related to immunosuppressive therapy with cyclosporine and corticosteroids as well as deconditioning.

The impact of microbiological diagnostics on the antimicrobial treatment of hospitalised patients with infectious disease

We evaluated a total of 160 treatment protocols from the unit of internal medicine (n = 100) and the intensive care unit (n = 60) of the Bonn University Hospital to detect the influence of microbiological diagnostics on the individual antimicrobial treatment. Ninety-six of hundred patients in regular care were set on empirical antibiotic treatment within 24 to 48 hours after onset of symptoms. In 91% of the cases cure or substantial improvement was achieved via the initial therapy. Microbiological survey revealed multi-resistant pathogens which could be handled using a specific treatment in six of the remaining patients. In contrast, sixty patients in intensive care proved to benefit significantly from microbiological diagnostics. In one quarter of the cases microbiological findings supported the decision on a reasonable escalated therapy, and in another quarter the initial therapeutic schedule could be confirmed. At any rate, about one third of the infections remained bacteriologically inexplicable in spite of excessive microbiological research. Thus, the results of this retrospective evaluation confirm the common practice of an initial antibiotic treatment without bacteriological investigation in less severe and in severe infections. Microbiological screening may help to decide on effective routine antibiosis in patients with less severe infections. We recommend comprehensive individual microbiological diagnostics in patients with severe nosocomial pneumonia or sepsis and in patients at high risk for Candida superinfections. Due to steadily increasing economic pressure, it is necessary to reflect on the expenditure for microbiological diagnostics. The cost-effectiveness-ratio may be optimised mainly in patients with less severe infections and in regular care. The number of microbiological surveys and expenditures in ICU patients appeared adequate as compared to the individual benefit.

RRR-alpha-tocopheryl succinate enhances TGF-beta 1, -beta 2, and -beta 3 and TGF-beta R-II expression by human MDA-MB-435 breast cancer cells

The proliferation of MDA-MB-435 human breast cancer cells was inhibited by RRR-alpha-tocopheryl succinate (vitamin E succinate, VES). Conditioned media (CM) from VES growth-inhibited cells contained potent antiproliferative activity, part of which is contributed by transforming growth factor-beta (TGF-beta) isoforms. Antibody neutralization analysis, employing TGF-beta isoform-specific antibody reagents, showed that TGF-beta 1, -beta 2, and -beta 3 were present in the CM from VES-treated cells. Culturing MDA-MB-435 cells with VES did not alter the levels of constitutively expressed 2.4-kb TGF-beta 1, 3.0- and 4.0-kb TGF-beta 2, or 1.2- and 3.5-kb TGF-beta 3 mRNA transcripts. Inhibition of DNA synthesis by MDA-MB-435 cells was increased by combinations of suboptimal levels of VES and purified TGF-beta 1. VES-treated MDA-MB-435 cells exhibited enhanced binding of radiolabeled TGF-beta 1, and Western immunoblotting analyses showed that VES treatment enhanced TGF-beta type II receptor protein expression. TGF-beta type I receptor protein levels were not modified by VES treatments. Although the mRNA transcript for the 5.5-kb TGF-beta type II receptor was upregulated after four hours of treatment with VES, this treatment did not modify the 6.5-kb TGF-beta type I or the 6.5-kb TGF-beta type II receptor mRNAs. Results demonstrate that biologically active TGF-beta 1, -beta 2, -beta 3 and levels of TGF-beta type II receptor expressed by human breast cancer cells are enhanced by VES treatment.

[Results of surgical treatment of acute traumatic aortic rupture]

Between 1967 and 1994 48 patients have been treated at our institution for acute rupture. Two patients died before operation, in two cases the operative attempt had to be abandoned with irreversible cardiopulmonary arrest, and in 44 patients surgical correction could be performed, The rupture was complete in 14 cases and incomplete in 30. In 25 patients surgery consisted of direct suture, in one patient an aortoplasty was performed, and in 18 patients a dacron tube interposition was necessary. In 7 cases the clamp and repair technique was applied, and in 37 cases extracorporeal circulation was installed. The hospital mortality amounted to 18% and was mainly contributable to the concomitant injuries. Two patients presented with paraplegia at admission, both died; postoperative paraplegia occurred in two instances, once after 48 hours. The late results were in the majority of the cases influenced by orthopedic or neurological sequelae, only one patient had to be reoperated for a false aneurysm. Our results and the review of the literature lead to the following conclusions: In spite of an optimized emergency care system, many patients with aortic rupture die before any surgical intervention. The installation of extracorporeal circulation can decrease the incidence of postoperative paraplegia; in our experience the administration of heparin does not increase the risk of bleeding from concomitant injuries. Direct suture represents the correction of choice. The long-term results are excellent.

[Angioscanner analysis using Imatron C100 in 44 cases of hepatic tumors]

We studied 44 patients with focal benign (n = 13) or malignant (n = 31) liver tumors prouved by histology or follow-up. The flow mode was acquired by electron beam CT (EBCT) after injection (35 cc at 6 ml/sec): 20 slices with a 400 ms exposure time. We looked for abnormal vessels and density curves inside the tumor, liver and aorta. We describe arterial vascularization in most cases (type 1) and particularly in all the hepatocarcinomas (n = 15) associated with abnormal vessels, and also in rare tumors (n = 4). For benign lesions like angiomas (n = 9) we showed surrounding the mass arterial vascularization in add to the typical aspect (type 3); for nodular hyperplasia (n = 3) arterial blush was associated with the last part of the tumoral curve at the same level as liver. Most often metastasis (n = 13) had no central vascularization and a slight peripheral density increased (type 2). Flow mode by EBCT allows a good density curves analysis particularly at arterial time.

[Evaluation of coronary risk in patients with subrenal abdominal aortic aneurysm]

Atheroma lesions are often found in multiple localizations. In addition, operative mortality for aneurysms of the non-ruptured sub-renal aorta is mainly related to coronary risk. In an attempt to reduce coronary risk, coronarography was performed in all patients (n = 297) from January 1989. Operation for the aneurysm was performed in 192 patients (reasons for not operating were small size of the aneurysm, other contraindication). There were 5 deaths, all related to coronary artery disease. Coronary bypass was performed in 42 patients either before (n = 38) or at the same time (n = 4) as the operation for the aneurysm of the aorta. There were no operative deaths. These results clearly demonstrate the importance of search and treatment of associated coronary lesions in all patients with an aneurysm of the subrenal abdominal aorta. Coronary lesions should be treated whenever morphology allows.

RRR-alpha-tocopheryl succinate inhibits proliferation and enhances secretion of transforming growth factor-beta (TGF-beta) by human breast cancer cells

The RRR-alpha-tocopheryl succinate form of vitamin E inhibits the proliferation of estrogen receptor-positive and estrogen receptor-negative human breast cancer cell lines in a dose-dependent manner in vitro. Analyses of cell-conditioned medium from RRR-alpha-tocopheryl succinate growth-inhibited cells revealed the presence of a potent antiproliferative activity. Characterization of the antiproliferative activity as transforming growth factor-beta (TGF-beta) was established by 1) growth inhibition of the TGF-beta-responsive Mv1Lu-CCL-64 mink lung and murine CTLL-2 cell lines, 2) combination of physical characteristics including heat stability, acid stability, and Bio-Gel P-60 column chromatography elution profile, and 3) neutralization of the antiproliferative activity in the conditioned media by antibodies specific for TGF-beta.

Osteosarcoma after chemotherapy: evaluation with contrast material-enhanced subtraction MR imaging

A new magnetic resonance (MR) technique, gadolinium-enhanced subtraction MR imaging, was developed to evaluate the response of patients with osteosarcoma to chemotherapy. Ten patients, who had received chemotherapy for osteosarcoma of the lower extremity, underwent MR imaging 3 days before surgery. After routine MR imaging was performed, subtraction MR was performed in the plane in which the tumor was best visualized. With gadopentetate dimeglumine (0.1 mmol per kilogram) on a standard MR console, subtraction images were created by subtracting precontrast images from gadolinium-enhanced T1-weighted images. The time of maximal tumoral vascular uptake was 1 1/2 minutes after injection, and, therefore, the subtracted image obtained at this time was used for evaluation of viable tumor. Independently, radiologists and histopathologists examined their respective studies for viable tumor to differentiate responders from nonresponders. Four of 10 osteosarcomas were classified as good responders because they appeared as nonenhancing masses, with or without enhancing thin lines, or small nodules (< or = 3 mm wide). At histopathologic examination, all were good responders with less than 3% viable tumor. Six of 10 osteosarcomas were classified as nonresponders because they appeared as enhancing high-signal-intensity masses measuring more than 3 mm in width. Five tumors had between 18% and 43% viable tumor cells.

Factor analysis of dynamic magnetic resonance imaging in predicting the response of osteosarcoma to chemotherapy

RATIONALE AND OBJECTIVES

The response of osteosarcoma to preoperative chemotherapy was assessed using dynamic magnetic resonance imaging (MRI) processed by factor analysis of medical image sequences (FAMIS).

METHODS

Forty-nine dynamic image sequences, acquired after a bolus injection of gadolinium in 10 patients, were processed by FAMIS: FAMIS is a means whereby physiologic contrast enhancement kinetics, called factors, and their spatial distribution, termed factor images, are estimated. Tumor volumes were measured on static MRIs, and factor images were compared with histologic maps of the resected specimens.

RESULTS

A substantial increase in tumor volume reflected a poor response to chemotherapy. Viable tumor was precisely depicted by the early vascular factor image, reflecting rapid uptake by tumor vessels. This early uptake disappeared in all five patients who responded to chemotherapy, whereas it persisted in four of five nonresponders.

CONCLUSION

FAMIS of dynamic MRI is proposed as a possible means of predicting the response of osteosarcoma to chemotherapy.

What is the place of pulmonary embolectomy today?

From 1.1970 to 31.12.1989, 134 patients with pulmonary embolism were treated by pulmonary embolectomy (74 women and 60 men) of mean age 55 years (23-78 years); 93 (69%) of these patients developed embolism during the postoperative period following surgery for another condition. In 12 cases the embolectomy was performed without circulatory assistance by a modified Trendelenburg operation after an average delay time of 2 hours. In 122 cases, extracorporeal circulation (ECC) was used, preceded in 64 cases, by a femoral-femoral bypass (the average delay interval of operation being 16.9 hours). At operation, 23 patients were in complete circulatory failure needing external cardiac massage, 34 were in cardiogenic shock with systolic arterial pressures (SAP) less than 60 mmHg, 42 maintained their arterial pressure between 60 and 100 mmHg, and only 35 were seen with SAP higher than 100 mmHg under vasopressive drugs. No haemodynamic and angiographic investigations could be undertaken in 31 patients because of their dramatic clinical state. In the other 103 patients who had invasive angiographic investigations performed the pulmonary bed was obstructed from 65% to 90% (mean 79.4%) according to Miller's index. The mean arterial pulmonary pressure was 51.2 mmHg. The survival rate at the 30th postoperative day showed 113 patients were alive (84.3%) with 7 among the 12 operated by the Trendelenburg's modified method and 106 among the 122 operated under ECC. The main causes of the 21 deaths were: peroperative 8, neurological 4, cardiac 4, respiratory 1, recurrent embolism 1, acute thrombosis of the IVC 1. Our results of pulmonary embolectomy can be compared favorably to those obtained by thrombolysis.(ABSTRACT TRUNCATED AT 250 WORDS)

Traumatic lesions of the thoracic aorta. A report of 73 cases

In a 24 year period we treated 73 traumatic lesions of the thoracic aorta; 36 of these were acute ruptures and 37 post traumatic pseudo-aneurysms. All these cases were associated with violent, sudden deceleration and in 68 instances the cause of this was a traffic accident. Fifty two patients (70%) had severe associated lesions involving the cranium, abdomen, thorax or leg fractures and dislocations but in 5 patients the aortic rupture was the only injury observed. Thirty four patients with acute aortic lesions were operated upon; 30 with extracorporeal circulatory assistance (CA) and 4 with aortic cross clamping alone. Twenty one were repaired by direct suture, 13 by prosthetic graft interposition and there were 8 deaths (23.5%) and one case of post-operative paraplegia. Thirty six traumatic aneurysms were operated upon; 34 with CA and 2 with cross clamping. Only two were repaired by direct suture, 5 by prosthetic angioplasty and 29 required prosthetic interposition grafts; there were no deaths or paraplegias in this group. Aortic rupture demands early diagnosis and immediate surgery. Associated abdominal injuries are easily missed and therefore exploratory laparotomy should be considered after every acute aortic repair.

Concepts of remission, curability and lineage involvement in relationship to the problems of minimal residual leukaemia

Minimal residual leukaemia (MRL) is due to chemotherapeutic failure. Chemoincurability in chronic myeloid leukaemia and in myelodysplastic syndrome is the norm and is the result of tumour defect arising within the marrow stem cell compartment. We propose that this is indeed the state of affairs in the majority of adult acute leukaemias and such tumours derived from stem cells are chemoincurable. The proportion of acute leukaemias which belong to this category can only be cured by allogeneic bone marrow transplantation though conventional chemotherapy and autotransplant may result in prolonged periods of remission and a return to a preleukaemic state in some patients. A proportion of the acute leukaemias occurring predominantly in children are presently curable by chemotherapy. It is hypothesized that these chemocurable leukaemias derive from the compartment of haemopoietic progenitors already irreversibly committed to a single lineage. Some recent studies using markers of the leukaemic clone to determine the origin of in vitro myeloid colony forming cells support this concept. Intrinsic and/or acquired genetic chemoresistance represents a supplementary restriction to the chemocurability of acute leukaemias. New methods of detecting MRL are sensitive enough to detect up to one leukaemic cell in 10(6) bone marrow mononuclear cells. However, it is possible that even such sensitive techniques will not be sufficient to determine whether patients in complete remission continue to harbour leukaemic cells in the stem cell compartment when the marker of interest might not be expressed.(ABSTRACT TRUNCATED AT 250 WORDS)

Mapping point mutations in the Drosophila rosy locus using denaturing gradient gel blots

Mutations within the rosy locus of Drosophila were mapped using blots of genomic DNA fragments separated on denaturing gradient gels. DNA sequence differences between otherwise identical small rosy DNA fragments were detected among the mutants as mobility shifts on the blots. Mutations were mapped to within a few hundred base pairs of rosy sequence in 100 of 130 mutants tested--a 77% detection rate. The sequence changes in 43 rosy mutations are presented; all but six of these were single base changes. Thirty-four of 36 sequenced mutations induced by the alkylating agents N-ethyl-N-nitrosourea and ethyl methanesulfonate were transitions. All of the mutations mapped in the rosy transcription unit. Twenty-three of the 43 sequenced mutations change the predicted rosy gene polypeptide sequence; the remainder would interrupt protein translation (17), or disrupt mRNA processing (3).

The effect of different doses of Ph1 on chromosome pairing in hybrids between tetraploid Agropyron elongatum and common wheat

Chromosome pairing at first meiotic metaphase was studied in F1 hybrids between tetraploid cytotypes of Agropyron elongatum and common wheat lines of the cultivar Chinese Spring, carrying zero, one, and two doses of Ph1. The bivalentization gene system of A. elongatum could not compensate for the absence of Ph1: hybrids deficient for this gene exhibited pairing between the Agropyron E1 and E2 chromosomes, between the wheat A, B, and D chromosomes, and between the Agropyron and the wheat chromosomes. In hybrids with one or two doses of Ph1, pairing was restricted to the Agropyron E1 and E2 chromosomes. It was concluded that E1 and E2 are distant homologues, thus further supporting the autoploidy nature of tetraploid A. elongatum. The genomic relationships in other polyploid species of the genus Agropyron is discussed in the light of this evidence.Key words: chromosome pairing, Triticum, common wheat, Agropyron.

The effect of different Agropyron elongatum chromosomes on pairing in Agropyron – common wheat hybrids

Chromosome pairing at first meiotic metaphase was studied in hybrids between the common wheat cultivar Chinese Spring (CS) and an induced autotetraploid line derived from diploid Agropyron elongatum. The latter was found to carry genes for homoeologous pairing. To determine the chromosomal location of these and other genes that control pairing, disomic addition lines of A. elongatum in the cv. Chinese Spring were crossed with tetraploid cytotypes of A. elongatum, and pairing was then compared in the resulting hybrids and in hybrids between cv. Chinese Spring and tetraploid A. elongatum. The elongatum chromosomes were classified into those that suppress (6E), promote (5E, 3E, and possibly 1E), or have no effect on pairing (4E). The effect of chromosomes 2E and 7E was not studied. Chromosomes 5E and 3E differed in their effect on the degree and pattern of chromosome pairing. These findings are compared with the available data on the control of pairing in A. elongatum and in other Triticinae species.Key words: chromosome pairing, pairing promoter, Triticum, common wheat, Agropyron.

Genetic control of meiotic chromosome pairing in tetraploid Agropyron elongatum. I. Pattern of pairing in natural and induced tetraploids and in F1 triploid hybrids

Meiotic chromosome pairing was studied in natural and induced tetraploid Agropyron elongatum, as well as in triploid hybrids between natural tetraploid and diploid cytotypes. The natural tetraploids showed a highly regular, diploid-like pairing, while the induced ones showed an average of two to three multivalents per cell. A high level of pairing was exhibited by the triploid hybrids, 4.15 bivalents and 2.82 trivalents per cell, supporting the assumption that the natural tetraploid is of an autoploid origin. Frequencies of meiotic configurations of the induced tetraploid and of the F1 triploid hybrids deviated significantly from the expected values based on a model assuming random pairing within one homologous group in autoploids: the observed data were characterized by fewer multivalents than expected, indicating a tendency towards bivalentization. This tendency is fully realized in the natural tetraploid. The presence of a pairing-control system in these autoploids, most probably a genetic one, that determines bivalent rather than multivalent pairing is suggested.Key words: Agropyron, pairing, bivalentization, tetraploid, multivalents.

Chromosomal pairing at meiosis of F1 hybrid and backcross derivatives of Triticum aestivum × hexaploid Agropyron junceum

The degree and pattern of chromosomal pairing at first meiotic metaphase were analyzed in several lines of hexaploid Agropyron junceum (2n = 42; genome J1J1J2J2EE), in the F1 hybrid between this species and common wheat, and in the backcrossed progeny of the hybrid to common wheat. Hexaploid A. junceum exhibited a strict bivalent pairing despite the relatedness of its genomes. Chromosomes of the J1 and J2 genomes of Agropyron paired in the F1 hybrid and in the backcross derivatives, in the presence of the Ph1 gene of common wheat. It was concluded that the corresponding chromosomes of the J1 and J2 genomes are distant homologues. It is assumed that the strict bivalent pairing in A. junceum is brought about by a gene system, similar to that found in several autotetraploid species.Key words: Agropyron junceum, Triticum aestivum, common wheat, wheat × Agropyron hybrids, chromosome pairing, bivalentization.

[Incidence of acquired infection in the surgical departments of 5 hospitals]

A program for monitoring nosocomial infections was implemented in the surgical units of five hospitals. The overall incidence of infections after clean surgery varied from 6.6% to 15% depending on the units. Surgical wound infections were in the 2.8 to 5% range, which corresponded to 30-66% of nosocomial infections. The main septic complication of surgery in 2 of the 5 units was urinary tract infection, with an incidence of 1.6 to 7.8%. Bacteriaemia complicating urinary tract infections and intravenous catheter infections accounted for 4% to 16% of all infections. Staphylococcus aureus was responsible for 40 to 77% of surgical wound infections and Escherichia coli for 30 to 50% of urinary tract infections. After a 4-5 months period of monitoring, the incidence of nosocomial infections was reduced by 32 to 68% depending on individual units.

[Acebutolol test in moderate arterial hypertension. Action on systolic time intervals]

The antihypertensive effect of acebutolol, a new cardioselective beta-blocking drug, is studied in 31 patients with mild essential hypertension. Administration of acebutolol (2,000 mg) in 48 hours produced a significant decrease in blood pressure, heart rate, plasma renin activity (P.R.A.) and an increase in systolic time intervals (pre-ejection period and isovolumetric contraction time). The blood pressure drop is highly correlated to the initial P.R.A. values, but is not related either to the initial heart rate, or to the systolic time intervals values.

Right ventricular involvement in obstructive cardiomyopathies: haemodynamic studies in 13 cases

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