Lactic acidosis update for critical care clinicians.

Lactic acidosis is a broad-anion gap metabolic acidosis caused by lactic acid overproduction or underutilization. The quantitative dimensions of these two mechanisms commonly differ by 1 order of magnitude. Overproduction of lactic acid, also termed type A lactic acidosis, occurs when the body must regenerate ATP without oxygen (tissue hypoxia).

The pharmacologic profile of desloratadine: a review.

Desloratadine is a new agent for the treatment of diseases such as seasonal allergic rhinitis and chronic urticaria. The pharmacologic profile of desloratadine offers particular benefits in terms of histamine H1-receptor binding potency and H1 selectivity. Desloratadine has a half-life of 21-24 h, permitting once-daily dosing.

Clonal analysis in glioblastoma with epithelial differentiation.

Epithelial differentiation in glioblastomas (GBM) may be associated with circumscribed growth and focal keratin expression resembling carcinoma metastasis. Therefore these rare lesions can pose a diagnostic problem suggesting coincidental occurrence of two separate neoplasms. However molecular analysis should succeed in establishing a common origin of seemingly unrelated tumor samples.

Lymph-node dissection in breast cancer.

Background: Along with the ongoing modifications in treatment of primary breast cancer, the purpose and extent of lymph-node dissection has changed. The following is an overview of the current knowledge and practice of lymph-node dissection in breast cancer, with special regard to expected developments in the near future. Axillary dissection is described as a ten-step procedure, including dissection of level-I and -II and Rotter's nodes, without level-III nodes, providing at least ten lymph nodes for accurate staging information.

Characterisation of the newly identified human Ump1 homologue POMP and analysis of LMP7(beta 5i) incorporation into 20 S proteasomes.

Biogenesis of mammalian 20 S proteasomes occurs via precursor complexes containing alpha and unprocessed beta subunits. A human homologue of the yeast proteasome maturation factor Ump1 was identified in 2D gels of 16 S precursor preparations and designated as POMP (proteasome maturation protein). We show that POMP is detected only in precursor fractions and not in fractions containing mature 20 S proteasome.

Angiotensin II directly increases transforming growth factor beta1 and osteopontin and indirectly affects collagen mRNA expression in the human heart.

Objectives: Angiotensin II (Ang II) induces fibroblast proliferation and collagen synthesis in the myocardium, but its precise mechanisms of action in human hearts are still unknown. Therefore, we investigated whether Ang II directly affects the collagen mRNA content in the human myocardium and in isolated human cardiac fibroblasts or whether the growth factors TGFbeta-1 and osteopontin are involved in this process.

Methods And Results I: In a first set of experiments, the direct effect of Ang II on collagen I, TGFbeta-1 and osteopontin mRNA content in fresh samples of human atrial myocardium was determined by the use of a short stimulation period.

Saccadic suppression induces focal hypooxygenation in the occipital cortex.

This study investigated how a decrease in neuronal activity affects cerebral blood oxygenation employing a paradigm of acoustically triggered saccades in complete darkness. Known from behavioral evidence as saccadic suppression, electrophysiologically it has been shown in monkeys that during saccades an attenuation of activity occurs in visual cortex neurons (Duffy and Burchfiel, 1975). In study A, using blood oxygen level-dependent (BOLD) contrast functional magnetic resonance imaging (fMRI), the authors observed signal intensity decreases bilaterally at the occipital pole during the performance of saccades at 2 Hz.

Endothelium function in sepsis.

Endothelial cells can be the prime target for an infection and infected endothelial cells may serve as an initiating system for a systemic response as these cells are able to secrete many mediators known to be of paramount importance. Endothelial cell functions in turn are regulated by these circulating mediators. Cellular interactions with leukocytes revealed protective and destructive functions.

Comprehensive allelotype and genetic anaysis of 466 human nervous system tumors.

Brain tumors pose a particular challenge to molecular oncology. Many different tumor entities develop in the nervous system and some of them appear to follow distinct pathogenic routes. Molecular genetic alterations have increasingly been reported in nervous system neoplasms.

Management of spontaneous congenital chylothorax: oral medium-chain triglycerides versus total parenteral nutrition.

The aim of this article is to compare total parenteral nutrition (TPN) with oral medium-chain triglycerides-diets (MCT) in the management of spontaneous congenital chylothorax. We analyzed retrospectively the charts of 6 patients seen in our tertiary care center and of 11 comparable patients from the literature. All neonates were symptomatic at birth; 15 had bilateral chylothorax.

Disaster with a new type of band for gastric banding.

Background: Laparoscopic gastric banding has become an established therapy for morbid obesity. Typical complications are band dislocation, pouch dilatation and stomach slippage. A new type of adjustable silicone band with eyes for suture fixation was proposed to avoid these complications.

Urokinase activates calcium-dependent potassium channels in U937 cells via calcium release from intracellular stores.

The urokinase receptor (uPAR) is highly expressed in the human promyelocytic cell line U937 and contributes to transmembrane signalling. However, the signalling mechanisms are poorly understood. We used the patch-clamp technique to demonstrate that urokinase (uPA) binds to uPAR and thereby stimulates Ca(2+)-activated K+ channels in U937 cells.

Characterization of the pulse signal over the human head by near infrared spectroscopy.

In this study we examine and describe the changes in the hemoglobin oxygenation and the Cytochrome-C-Oxidase redox state that are caused by the pulsatile character of the blood flow in the human head. We used near-infrared spectroscopy (NIRS) in combination with simultaneously recorded ECG and Transcranial Doppler sonography of arteries and veins and show that there is a distinct time lag between heart activity, arterial blood flow, hemoglobin concentration as measured by NIRS and venous blood flow. NIRS has intensively been used to measure functional activation of the brain.

Anagrelide, a novel platelet lowering option in essential thrombocythaemia: treatment experience in 48 patients in Germany.

We report on our treatment experience in Germany with anagrelide, a novel platelet lowering agent, in 48 patients (27 females, 21 males) with essential thrombocythaemia. Their age was between 19 and 79 yr when anagrelide therapy was initiated. Sixteen patients were previously untreated, 15 pretreated with hydroxyurea and 17 had multiple pretreatments.

Locoregional recurrence of rectal cancer: biological and technical aspects of surgical failure.

The advantages of sphincter-saving treatment of rectal cancer are counterbalanced when local recurrences develop requiring abdominal-perineal excision of the rectum for salvage. Biological properties of the primary tumor contribute to this problem together with the surgeon's technique and overall oncological strategy. Adverse factors of the primary tumor are lymphatic, perineural, and venous invasion as well as mucinous type of adenocarcinoma and poor differentiation.

Local excision of rectal cancer through windowed specula: long-term results.

Transanal local excision of rectal cancer has been advocated as a curative option in patients with early rectal cancer and for patients unsuitable for radical surgery. We report our long-term experience with an easy-to-use and inexpensive technique based on windowed specula. From 1982 to 1994, 137 patients with rectal cancer were treated by local excision with curative intention.

Seromuscular spiral cuff perineal colostomy: an alternative to abdominal wall colostomy after abdominoperineal excision for rectal cancer.

Seromuscular spiral cuff perineal colostomy may be an alternative to abdominal wall colostomy after abdomino-perineal excision. We present our initial experience with the procedure in 13 patients operated upon between March 1993 and December 1997. Patients undergoing abdomino-perineal excision for rectal cancer, under 65 years of age, without severe concomitant disease, and strongly motivated to comply with an intensive postoperative physiotherapy were selected.

Development of pulmonary lipophilic antioxidants and peroxidizable lipids during lung maturation.

The objective of this article is to test whether the concentration of potentially oxidizable lipids (polyunsaturated fatty acids [PUFA], total and free cholesterol) and lipophilic antioxidants (plasmalogens, vitamin E) in the fetal lung correlate with lung maturation (P/S ratio). In amniotic fluid palmitic/stearic acid (P/S) ratio, concentrations of PUFA, total and free cholesterol, vitamin E, and plasmalogens were measured. Ratio of PUFA to stearic acid (PUFA/S ratio) was determined in lung effluent of 15 preterm infants with IRDS and compared with values from 15 term healthy infants.

Are biochemical parameters of lung maturation from gastric, tracheal, and pharyngeal aspirates comparable?

Phospholipid parameters -- lecithin/sphingomyelin (L/S) ratio and palmitic acid/stearic acid (P/S) ratio -- of gastric (GA), pharyngeal (PA), and tracheal aspirates (TA) have often been used for estimation of lung maturation. However, it was not known whether values from different sources can be alternatively used. The study was performed to test whether P/S and L/S ratios in GA, PA, and TA are comparable.

Antisense oligodesoxynucleotide strategies in renal and cardiovascular disease.

Antisense oligodesoxynucleotides (ODN) provide a novel strategy to inhibit RNA transcription and thereby the synthesis of the gene product. Because antisense ODN hybridize with the mRNA strand, they are highly specific. Their backbone structure has been modified to phosphorothioates or phosphoamidates so that they can better withstand degradation after delivery.

Nibrin, a novel DNA double-strand break repair protein, is mutated in Nijmegen breakage syndrome.

Nijmegen breakage syndrome (NBS) is an autosomal recessive chromosomal instability syndrome characterized by microcephaly, growth retardation, immunodeficiency, and cancer predisposition. Cells from NBS patients are hypersensitive to ionizing radiation with cytogenetic features indistinguishable from ataxia telangiectasia. We describe the positional cloning of a gene encoding a novel protein, nibrin.