Mapping of an autoreactive epitope within glutamate decarboxylase using a diabetes-associated human monoclonal autoantibody and an epitope cDNA library.

Glutamate decarboxylase (GAD65) is a major autoantigen in insulin-dependent diabetes (IDDM) and the neurological disorder Stiff-Man-Syndrome (SMS). We derived a human monoclonal autoantibody (MICA 2) from peripheral blood of a patient newly diagnosed with IDDM, which reacted with GAD65 in Western blots. This indicated that a linear epitope is recognized by MICA 2.

[Work capacity, severe disability and needs for disability services in Thüringen with respect to demographic change].

Considerable changes are taking place in germany in respect of age groups (fewer youngsters, more old people), and this is bound to be reflected by the demography of the working population (15 to 64 years) during the next 50 years. It is shown in this contribution how the expected changes in age distribution in Thuringia will probably be reflected by the number of pensioners who are incapable of gainful employment or of exercising their original job for which they were trained. The proportion of younger persons who had to be pensioned because of inability to work or major disablement or severe need of nursing care, will decrease until 2040 A.

[Development and outcome of motivational support during inpatient education of insulin-dependent diabetic patients--a pilot project].

At the Ulm University Hospital 43 type-1-diabetes patients took part in a structured in-patient diabetes education program during a 12-day hospitalization period. 27 of the patients received an additional motivational support program which addressed psychological and social impediments related to the topics of the structured diabetes education program. 16 patients underwent the structured diabetes education program only.

[Effect of orthograde intestinal irrigation with Prepacol and polyethyleneglycol solution on duration of postoperative ileus after colorectal resections].

In a prospective randomized study in 100 patients undergoing conventional (n = 66) or laparoscopic (n = 34) colorectal resection, mechanical lavage with 2 l of a polyethylene glycol (PEG) solution (group A, n = 50) combined with a laxative was compared with lavage with 4 l of PEG alone (group B, n = 50). The influence of bowel preparation on postoperative ileus was investigated. The efficacy of bowel preparation was determined intraoperatively by a surgeon blind to the type of preparation.

Decay kinetics of N,N,N',N'-tetramethylbenzidine photocations in frozen micellar solution of cetyltrimethylammonium bromide.

After UV irradiation of rapidly frozen solutions of N,N,N',N'-tetramethylbenzidine (TMB) in dilute aqueous micellar cetyltrimethylammonium bromide at 80 K, the ESR signal corresponding to the TMB+ cation was detected indicating photoionization. This signal was monitored as a function of time at various temperatures between 80 K and 260 K. On a timescale of a few days the signal decayed to a plateau value that was stable for months.

T-cell-receptor repertoire in chronic plaque-stage psoriasis is restricted and lacks enrichment of superantigen-associated V beta regions.

Preferential usage of certain T-cell receptors by the lymphocytic infiltrate in psoriasis might indicate the involvement of an antigen in the pathogenesis of this disease. However, to date there are no data on the complete T-cell-receptor V alpha and V beta repertoire in psoriatic patients. We therefore compared the usage of T-cell-receptor variable regions in blood and skin of 10 patients with chronic plaque-stage psoriasis by means of semiquantitative polymerase chain reaction.

Postoperative intestinal motility following conventional and laparoscopic intestinal surgery.

Objectives: To evaluate the influence of conventional vs laparoscopic right-sided colectomy on postoperative motility of the stomach, small bowel, and large bowel, and to study the effects on postoperative intestinal motility of anesthesia only and of laparotomy vs laparoscopy only.

Design: Prospective randomized study in a canine model.

Setting: Animal research laboratory.

Use of laparoscopic techniques in oncologic right colectomy in a canine model.

Background: The purpose of this study was to evaluate the feasibility of laparoscopic oncologic righ colectomy (RC) with intraperitoneal ileocolic anastomosis (ICA) in a canine model.

Methods: In 21 dogs a laparoscopic RC with transection of the main right colic artery and removal of adjacent lymph nodes (LN) was carried out using an Nd:YAG contact laser and endoscopic stapler. Two weeks after surgery, all animals were killed.

Structural and functional comparison of anchorin CII (cartilage annexin V) and muscle annexin V.

Annexin V has been isolated from chicken muscle and cartilage either by EDTA extraction or by plasma membrane purification and solubilization with detergent to obtain the hydrophilic and hydrophobic variants. The hydrophobic variant of the cartilage annexin V associated with phosphatidylserine-containing liposomes in a Ca(2+)-independent manner, whereas the EDTA-extracted molecule required Ca2+ for association with the liposomes. The collagen-binding assay used is based on the principle of a cell attachment assay using mildly pepsinized collagen type II or intact collagen type I as the solid-phase substrate.

Laparoscopic oncologic proctosigmoidectomy with low colorectal anastomosis in a cadaver model.

The purpose of this study was to demonstrate that a standardized approach to laparoscopic proctosigmoidectomy in a cadaver model with (1) initial proximal ligation of the inferior mesenteric (IM) vascular pedicle, (2) complete mobilization of the splenic flexure, and (3) intraperitoneal stapled colorectal anastomosis can be accomplished in complete accordance with oncologic surgical principles. Using nine cadavers in the fresh state, six abdominal wall cannulas were placed so as to allow good access to the left colon and rectum. After identifying the left ureter and gonadal vessel, the IM pedicle was divided close to the aorta and the left mesocolon was separated from the retroperitoneal structures.

Laparoscopic oncologic abdominoperineal resection.

Purpose: Although the use of laparoscopic techniques in colorectal surgery has recently become a focus of major interest in intestinal surgery, there is no proof that an oncologic abdominoperineal resection can be accomplished using laparoscopic techniques. The hypothesis of this study is that a standardized technique for laparoscopic oncologic abdominoperineal resection according to accepted oncologic surgical principles can be developed in a cadaver model. The end points of this study were intraoperative complications, success in performance of proximal vascular ligation of the inferior mesenteric artery, complete removal of the mesorectum including all lymph nodes adjacent to the named rectal arteries, and wide clearance of pelvic side walls.

Animal models as educational tools in laparoscopic colorectal surgery.

Laparoscopic colectomies have been shown to be feasible in patients with low morbidity. Thus, many surgeons, as they begin to perform laparoscopic surgery on other areas of the abdomen, may consider performing laparoscopic colectomies. Although certain basic skills like suturing and knot tying can be practiced in training models, the preclinical performance of intraperitoneal bowel mobilization and anastomosis, dissection of mesentery, and control of bleeding can only be practiced and perfected in live animal models.

Monopolar electrosurgery and Nd:YAG Contact Laser in laparoscopic intestinal surgery.

In a prospective randomized study using a canine model, we compared the use of monopolar electrosurgery (EC) (n = 23) and the Nd:YAG Contact Laser (CL) (n = 21) on intra- and postoperative morbidity in laparoscopic large-bowel resection. In EC, cutting was performed with scissors and coagulation was performed with electrosurgery. In CL, cutting and coagulation were carried out with the Nd:YAG Contact Laser.

Laparoscopic oncologic total abdominal colectomy with intraperitoneal stapled anastomosis in a canine model.

The purpose of this study was to evaluate the feasibility of performing an oncologic type of colectomy using laparoscopic techniques with intraperitoneal stapled ileorectal anastomosis in a canine model. In 21 dogs, laparoscopic oncologic colectomy was carried out using dissection with a contact Nd:YAG laser. The right, middle colic, and inferior mesenteric arteries were transected close to their origins, and all adjacent mesenteric lymph nodes were removed.

[Laparoscopic ileocecal resection in Crohn disease].

Patients with Crohn's ileocolitis may undergo laparoscopic ileocolectomy if an abscess or fistula is not present. At the beginning of the procedure, the mesentery and right mesocolon is dissected from the retroperitoneum without mobilization of the lateral attachments. The ileocolic vessels are identified and clipped.

Somatic pain threshold and reactive hyperemia in autonomic diabetic neuropathy and silent myocardial ischemia.

In 31 patients with coronary artery disease (autonomic neuropathy, n = 11; diabetes without neuropathy, n = 10; silent myocardial ischemia without diabetes, n = 10) difference in somatic pain threshold and plethysmographically determined reactive hyperemia induced by forearm skeletal muscle ischemia was investigated. There was no difference in reactive hyperemia after passive maximum forearm ischemia in the three groups indicating identical vascular reactivity. After symptom-limited ischemic work however, reactive hyperemia was significantly higher in patients with silent myocardial ischemia as compared to diabetic patients.

TAP2 gene polymorphism segregates with DR-DQ in DR/DP recombinant siblings.

RING 11, a second transport-associated gene (TAP2), has been recently identified in the DR-DP interval of the human class II region. Two predominant alleles, TAP2A and TAP2B, differing by 17 amino acids at the C-terminus of the ATP-binding domain are present in the Caucasoid population at frequencies of 79% and 21%, respectively. In the rat, polymorphism of the TAP genes were found to influence peptide loading of MHC class I molecules and, in humans, it was speculated that variation in peptide loading of HLA-B27 molecules might be also linked to factors altering antigen presentation presumably encoded in the HLA region.

Our approach to the management of congenital presacral tumors in adults.

This study reviews the recent overall experience in one colorectal surgery department with congenital presacral tumors in adults. 24 patients greater than 21 years of age, who underwent curative resection between January 1980 and August 1992, were analyzed retrospectively. The growths were divided into two broad categories: developmental cysts and chordomas.

Altered CYP21 genes in HLA-haplotypes associated with congenital adrenal hyperplasia (CAH): a family study.

Disorders of the CYP21 gene, which is located within the major histocompatibility complex on the short arm of chromosome 6, are the leading causes of congenital adrenal hyperplasia (CAH). The coding gene and a highly homologous pseudogene are tandemly arranged with the two genes for the fourth component of complement (C4A and C4B). To analyse the prevalence rates of mutations of the CYP21 genes and the segregation of the CYP21 genes with their corresponding human leucocyte antigen (HLA)-haplotypes, 21 families with one or two children with the severe form of 21-hydroxylase deficiency were studied.

[Histopathological changes of gallbladder and liver parenchyma in symptomatic cholelithiasis].

In a retrospective study of 1101 patients (302 men, 799 women; mean age 56,7 [19-88] years) with symptomatic cholelithiasis who had undergone elective cholecystectomy and intraoperative liver biopsy, histological examination revealed inflammatory changes in the gallbladder in 96.7%, chronic fibrotic cholecystitis in 94.5% and a severe form of cholecystitis in 8.

Laparoscopically assisted ileocolectomy in Crohn's disease.

Laparoscopically assisted intestinal surgery has been described in a variety of different intestinal diseases but not in inflammatory bowel disease. The study shows that laparoscopically assisted ileocolectomy is feasible in patients with Crohn's disease with low morbidity.

Does methodic long-term follow-up affect survival after curative resection of colorectal carcinoma?

Records of 487 patients in long-term follow-up after Ro resection of colorectal carcinomas between January 1, 1980 and December 31, 1989 were analyzed. Every patient underwent regular examinations according to a defined schedule after curative resection of colorectal carcinoma. The date of evaluation was June 31, 1991.