[Treatment of extreme anemia with polymerized bovine hemoglobin : Case report and review of the literature]. / Therapie einer extremen Anämie mit vernetztem Rinderhämoglobin : Fallbericht mit Literaturüberblick.

This article reports the case of a 29-year-old female Jehovah's Witness with severe anemia after intrauterine fetal death in the 25th week of gestation, complicated by vaginal bleeding, acute renal failure and hemolysis. Due to her religious beliefs the patient categorically refused blood transfusions. Despite adhering to the recommendations for patient blood management, the hemoglobin (Hb) level gradually decreased to 1.9 g/dl on day 10, when she fainted and had to be sedated and invasively ventilated. Inhalative isoflurane was chosen for sedation because of its potential organ-protective effects and because it provides deep sedation with reduced oxygen requirements, while enabling rapid neurological examination during the sedation windows as well as regular and calm spontaneous breathing. Posthypoxic encephalopathy was demonstrated clinically and electroencephalographically by seizure activity during the sedation windows. Anticonvulsive treatment was started. At a hemoglobin of 1.8 g/dl, she received 2 units of polymerized bovine hemoglobin (Hemopure®, Hemoglogin Oxygen Therapeutics LLC, Souderton, PA, USA), repeated several times on subsequent days because of its short half-life. Considerable methemoglobinemia was noted. After subtracting methemoglobin, the hemoglobin rose by 0.4-0.8 g/dl after each 2 units, initially increasing the oxygen binding capacity of the blood by 33%. After a full neurological recovery and weaning from the ventilator but still on hemodialysis, the patient was transferred to another hospital after 38 days.If allogeneic blood transfusion is not an option, administration of polymerized bovine hemoglobin can temporarily increase the oxygen transport capacity as a last resort treatment. Reduction of oxygen requirements by deep inhaled sedation with isoflurane also seems beneficial and provides advantages.

Tuning intermolecular interactions in dioctyl-substituted polyfluorene via hydrostatic pressure.

Polyfluorenes (PFs) represent a unique class of poly-para-phenylene-based blue-emitting polymers with intriguing structure-property relationships. Slight variations in the choice of functionalizing side chains result in dramatic differences in the inter- and intrachain structures in PFs. Dioctyl-substituted PF (PF8) is characterized by different backbone conformations that depend upon the torsion angle between the monomers. We present photoluminescence (PL) and Raman scattering studies of bulk samples and thin films of dioctyl-substituted PF (PF8) under hydrostatic pressure. The bulk sample was further thermally annealed and studied as a function of pressure. The PL energies of the as-is and thermally annealed samples both red shift but at very different rates, and the difference between their pressure coefficients elucidates the role of the backbone torsional angle. This is further corroborated by density functional theoretical calculations of a fluorene oligomer, where the energy gap is calculated as a function of both the torsion angle as well as compression. The Raman peaks harden with increasing pressures; the intraring C-C stretch frequency at 1600 cm(-1) has a pressure coefficient of 7.2 cm(-1)/GPa and exhibits asymmetric line shapes at higher pressures, characteristic of a strong electron-phonon interaction.

[Influence of gender on the intubation conditions with rocuronium]. / Einfluss des Geschlechts auf die Intubationsbedingungen nach Rocuronium.

PURPOSE: There is increasing evidence for gender differences in the pharmacokinetics and pharmacodynamics of anaesthetic drugs and neuromuscular blocking agents, e.g. rocuronium (Roc). Females require 30% less Roc than males to achieve the same degree of neuromuscular block and onset times are shorter. However, whether this leads to an improvement of the intubation conditions in females is unclear. METHODS: After approval of the ethics committee 60 female and 60 male patients were each randomised into 2 groups to receive 0.6 mg/kg body weight Roc or 1.0 mg/kg succinylcholine (Sux; control group). Induction: thiopentone (5 mg/kg), fentanyl (3 microg/kg) then Roc (Roc groups) or Sux (Sux groups) and tracheal intubation after 60 s. Time to intubation, glottic exposure and intubating conditions were assessed. RESULTS: Men were significantly larger and heavier (p<0.001) than women, but the body mass index was comparable (ns). Number of attempts, time to intubation, and Cormack grades were comparable (ns). However, the rate of clinically acceptable intubation conditions was significantly higher in the female compared to the male Roc group: 80% vs 47%, p<0.05. The incidence of clinically acceptable intubation conditions in the female Roc and Sux groups were similar (80%). CONCLUSION: The intubation conditions after Roc were significantly better in women than in men. The differences were Roc-related and did not occur in the control groups.

Women report more pain on injection of a precurarization dose of rocuronium: a randomized, prospective, placebo-controlled trial.

BACKGROUND: The purpose of this study was to investigate whether gender influences the perception of pain on injection of rocuronium. METHODS: In this prospective, placebo-controlled trial 120 patients were randomized into four groups to receive rocuronium 0.03 mg kg(-1) (40 female and 40 male patients) or saline (20 female and 20 male patients). The incidence and severity of the injection pain after administration of the study drug was compared between female and male patients using a numerical rating scale (0-10). Signs of local irritation, i.e. erythema and thrombophlebitis, were assessed up to 48 h after surgery. RESULTS: In 26 (32.5%) of the 80 patients receiving rocuronium, pain on injection was observed. This occurred significantly more frequently in the female compared with male patients: 18 (45%) vs. eight (20%), respectively (P = 0.032). The severity was more pronounced in the women than in the men (P = 0.020). The incidence of the rocuronium-associated pain was significantly increased compared with the Saline groups (P < 0.001). After surgery no patient complained of any residual pain and no local signs were observed in any patient during the study period. CONCLUSIONS: Women experienced more pain on injection of rocuronium than men, moreover this is an additional evidence for gender-related differences in pain perception. When rocuronium is used as a precurarization agent, an analgesic pretreatment (e.g. opioids) should be considered, especially for female patients.

Microenvironmental differences and changes in bilayers of unilamellar vesicles probed by spectroscopic and kinetic parameters.

The UV/Vis absorption band maximum lambdamax of trans-4,4'-nitrophenylaminoazobenzene, the thermal isomerization rate constant kiso of its cis-isomer, the fluorescence intensity ratio of monomer and excimer, and the fluorescence lifetime of the excimer, respectively, of 1,3-di(1-pyrenyl)propane were determined as probes for polarity, water content, and viscosity, respectively, in unilamellar vesicles of di-n-alkyl-dimethylammonium bromides and 1,2-acyl-sn-glycero-3-phosphocholines. The dependence on vesicle size, the solvent (water or HEPES buffer/NaCl solution, each with H2O or D2O), and the temperature (20-60 degrees C) was studied. Apparent Arrhenius activation energies and kinetic solvent isotope effects (KSIE = kiso,H2O/kiso, D2O) were derived. Size and stability of the vesicles prepared by extrusion were controlled by dynamic light scattering. The probe properties clearly indicate the reversibly decreasing size of didodecyldimethylammonium bromide vesicles with increasing temperature but are insensitive against vesicles size variation in most other cases. In the temperature range of the main phase transition of the bilayers, changes of the microenvironment of the probes, and their changing position in the bilayer, respectively, are reflected by characteristic changes of their properties. Buffer/NaCl solution causes vanishing influence of the lipid chain but remaining difference between cationic and zwitterionic headgroups probed by means of kiso.

A natural rubber drainage tube with antithrombogenic lumen surface.

A drainage tube was made by radiation vulcanization of a high polymeric substance based on natural rubber elastomers. Pentosan polysulphate sodium bound to a carrier substance (synthetic type 4A or 13X zeolite) was incorporated in the drainage tube which was then tested for its anticoagulant properties during perfusion with Tris buffer solution, citrated plasma, and blood, resp. The amount of pentosan polysulphate sodium released from the tube walls during perfusion with human citrated plasma in an open circulatory system was sufficient to exert an anticoagulant effect on the streaming plasma. This effect was corroborated by prolonged thrombin times and by unclottability in case of recalcified plasma samples in thrombelastographic studies. The antithrombogenicity test according to Chandler in a closed circulatory system revealed thrombus formation times (TFT) of more than 24 h (control: TFT = 1-3 min in native blood).

Scarlet fever and types of erythrogenic toxins produced by the infecting streptococcal strains.

Group A streptococcal strains were isolated from the throats of 46 children suffering from scarlet fever. For detection of erythrogenic toxins (ETs), the culture supernatants were concentrated 100 times by ethanol precipitation and solubilisation in acetate buffer. ELISA was used to identify ETA and double immunodiffusion to identify ETB and ETC. The presence of the ETA gene was detected by a specific DNA probe. ETA (alone or in combination with ETB and/or ETC) was found in 51.9% of the strains, ETB (alone or in combination with ETA and/or ETC) in 76.9% and ETC (in combination with ETA and ETB) in 28.9%. Only 5.8% of strains did not produce any detectable ET. In SDS-PAGE, supernatants of ETB-producing strains showed a pronounced band in either the region of the proteinase zymogen or the active proteinase. There was no correlation between the type of erythrogenic toxin and the serological M or T type of the producing strain. The mitogenic potency of culture supernatants did not differ significantly irrespective of the toxin type(s) present. Culture supernatants of strains without a detectable amount of the known ETs were highly mitogenic, indicating the production of other streptococcal mitogens. A correlation with clinical symptoms was determined with regard to exanthema and fever. Strains producing two or three toxins caused a more intense exanthema. Patient temperature was higher (greater than or equal to 38 degrees C) when the infecting strain produced ETB. The toxin-producing patterns of the strains of this study were compared with those isolated during the last epidemic outbreak of scarlet fever in East Germany.

[Streptococcus-induced syndrome of toxic shock (streptococcal toxic shock syndrome)]. / Streptokokkenbedingtes Syndrom des toxischen Schocks (Streptococcal Toxic Shock Syndrome).

Report on the first case of streptococcal toxic shock syndrome in the GDR. The patient was a 54-year-old female. One week before admission to the hospital she cut her finger. The day before admission to the hospital she presented with a painful left shoulder. Demarcation followed, and Streptococcus pyogenes (group A streptococci) was isolated from this area. The temperature rose to more than 40 degrees C and she became confused, hypotensive and anuric. There was evidence for disseminated intravascular coagulation. She died 23 h after admission. Clinical course and laboratory parameters resembles staphylococcal toxic shock syndrome, except a diarrhoea. The streptococcal strain produced a large amount of erythrogenic toxin type B (more than 20 ng/ml), but not erythrogenic toxins A or C. Erythrogenic toxins of Streptococcus pyogenes seem to play the same role in the development of streptococcal toxic shock syndrome as the toxic shock syndrome 1 (TSST-1) in staphylococcal toxic shock syndrome.

[Treatment of chronic recurrent erysipelas with streptococcal vaccine]. / Die Behandlung des chronisch-rezidivierenden Erysipels mit Streptokokkenvakzine.

One hundred patients suffering from relapsing erysipelas were treated with streptococcal vaccine consisting of a phenol- und heat-inactivated mixture of 12 different types of streptococci. Simultaneously the entry point was cured and general disposition and local terrain factors were treated. In the majority of cases further relapses were avoided or their frequency reduced. The results of the treatment with streptococcal vaccine were compared with those of long-term benzathine-penicillin therapy in 47 patients. The vaccine has proved to be equivalent to the penicillin therapy and can be recommended as a real alternative to it for prevention of further infections and late sequelae, especially those of chronic lymphedema. The beneficial therapeutic effect of the vaccine is probably attributable to a non-specific immune stimulation. A partial cellular immune defect involving the protective M-antigen together with simultaneous partial abnormalities of immune reactivity is discussed as a cause of relapsing erysipelas.

Tissue cages for study of experimental streptococcal infection in rabbits. III. Influence of immunization with erythrogenic toxin type A (ET A) and its toxoid on subsequent infection with an ET A producing strain.

Purified erythrogenic toxin type A (ET A) and the corresponding toxoid, prepared by formalin treatment, were used for the immunization of rabbits (200 micrograms per rabbit). The impact of anti-erythrogenic toxin and toxoid immunity was investigated under the conditions of experimental infection with the ET A-producing Streptococcus pyogenes strain SF 130 (type 1). Whereas non of the immunized rabbits (n = 14) died after infection, 40% of nonimmunized animals did not survive (Table 1). The increase of the spleen weight after infection was significantly smaller in the immunized groups (Table 2). The immunized rabbits responded after infection with a significantly lower increase of fever which did not exceed 0.8 degree C (2 degrees C in infected non-immunized animals). Humoral antibodies to ET A were detected after immunization by means of ELISA. The challenge infection acted as a booster leading to a further increase of antibodies. The antibodies were found to be neutralizing the nonspecific mitogenicity of ET A in vitro in relation to the antibody titer. Cell-mediated immunity was tested in the lymphocyte transformation reaction with peripheral lymphocytes. The nonspecific mitogenicity of ET A, ET B, ET C and Con A was pronounced after immunization, whereas the nonimmunized rabbits responded to these antigens to a lower degree. The toxoid was found to be nonmitogenic. The altogether higher lymphocyte stimulation was also observed using spleen lymphocytes of immunized animals after infection.

Biological and biochemical activities of a toxoid of erythrogenic toxin type A.

A toxoid of erythrogenic toxin type A (ET A) was prepared by formaldehyde treatment. Already 15 min after exposure to formaldehyde in isoelectric focusing the ET A band at pH 5.2 shifted to a band at pH 4.5. In Ouchterlony double diffusion test ET A and its toxoid were found to be identical, in fused rocket immuno-electrophoresis a reaction of partial identity was seen. Formaldehyde treatment of ET A resulted in an apparent increase of electrophoretic mobility. In contrast to ET A, its toxoid is non-mitogenic, non-pyrogenic and has lost its ability to induce delayed type hypersensitivity. Binding of ET A toxoid to human peripheral lymphocytes is of the same magnitude as binding of gold-labelled ET A.

Studies on elastomeric materials with incorporated antithrombotics.

Antithrombotically effective drugs (heparin, pentosan polysulphate, streptokinase) were incorporated into elastomeric materials by means of zeolites as carrier. The incorporated antithrombotic agents can be delivered to the surrounding medium. These self-antithrombotic elastomers may be used as tubes to drain off body fluids (catheters, drains, etc.).

Purification and characterization of Streptococcus pyogenes erythrogenic toxin type A produced by a cloned gene in Streptococcus sanguis.

The gene of Streptococcus pyogenes erythrogenic toxin type A (speA) has been previously cloned in Streptococcus sanguis (Challis) and produces extracellular erythrogenic toxin type A (ET A). The ET A produced and secreted by this heterologous host was purified to homogeneity and shown to have properties identical to ET A produced by S. pyogenes strain NY-5; i.e., serological identity in immunodiffusion, migration in SDS-polyacrylamide gel electrophoresis, mitogenic activity, inhibition of mitogenic activity by specific antibody, and precipitation by an international scarlatina antitoxin preparation. The cloned speA gene specified an ET A which had a molecular weight identical to that of ET A from S. pyogenes previously reported from this laboratory. NH2-terminal sequence determination of the purified protein showed the first nine residues to be gln gln asp pro asp pro ser gln leu; this is consistent with predictions made from the nucleotide sequence of the speA gene according to Weeks and Ferretti and different from the sequence published by Johnson et al.

Streptococcal outbreaks and erythrogenic toxin type A.

Reference strains of Streptococcus pyogenes and strains from recent epidemics and sporadic cases of scarlet fever were examined for their ability to produce erythrogenic toxin type A (ET A) by ELISA and double immunodiffusion (Ouchterlony) using an anti-ET A antibody purified by affinity chromatography. Of the reference strains (most of them isolated before 1945) 16/51 produced more or less ET A (Table 1). ET A synthesis is strain-specific, but not type-specific. Well-known toxin producers like the strains NY-5; 594 or "Smith" produce up to 16.000 micrograms/l under optimal culture conditions. Type 3 strains isolated from scarlet fever patients during the outbreak 1972/73 seem to belong to one clone as evidenced by the uniform SDS-PAGE pattern: They were found to produce 5-200 micrograms/l (mean 68 micrograms/l) ET A only. Type 3 strains from sporadic cases, isolated 10 years later, produced 0-138 micrograms/l (mean 30 micrograms/l). Strains of the type 1 clone, causing the epidemic in 1982/83 produced only 0.75-10 micrograms/l (mean 8 micrograms/l) ET A (Table 3). Only a few strains of S. pyogenes isolated 1984 or later synthesized ET A but they were found more often to produce ET B (proteinase precursor) in batch cultures. S. pyogenes strains seem to have lost their ability to produce large amounts of ET A during the last decades. Because this toxin must be considered as a pathogenicity factor the decrease in toxin production may be one reason for the present mild form of scarlet fever.

Analysis of blink-induced vertical motion of contact lenses.

This report discusses blink-induced vertical motion of contact lenses as measured with a slit lamp. The motion seen this way represents the displacement of the lens from its position just before a blink to its position immediately after the blink. Motion amplitudes reported in the literature will be discussed in the context of a hypothesis which seeks to account for lens motion by taking into consideration the post-lens tear film characteristics, the diameter of the lens, and the geometry of the anterior segment of the eye.

Further studies of contact lens motion during blinking.

Contact lens motion is felt to be of increasing importance in connection with debris elimination, particularly in extended wear lenses. Thus an improved analysis is made of a simple model for investigating the initial motion of a hard contact lens over the eye during blinking. It is shown that the assumption of constant tear film thickness is a reasonable one. This greatly simplifies the analysis. Various vertical force vs. time variations are considered and lens velocity/time graphs and maximum lens displacement calculated. These are in good agreement with the results of experiment.

[Isolation and characterization of erythrogenic toxins. VIII. Purification of a biologically active protein of the molecular weight 10,000 (LMP-10k) from filtrates of Streptococcus pyogenes, strain NY-5. Relationship to erythrogenic toxin type A]. / Isolierung und Charakterisierung von erythrogenen Toxinen VIII. Die Reinigung eines biologisch aktiven Proteins vom Molekulargewicht 10 000 (LMP-10k) aus Kulturfiltraten des Streptococcus pyogenes, Stamm NY-5. Beziehung zum erythrogenen Toxin Typ A.

The "classical" method for purification of erythrogenic toxin type A results in two products: erythrogenic toxin type A and a low molecular weight protein, m.w. 10,000 (LMP-10k) with mitogenic activities. LMP-10k was purified from culture supernatants of S. pyogenes (group A) by CM-Sepharose CL-6B chromatography and Sephacryl S-200 and Sephadex G75 gel filtration to a high degree of purity with minimal amounts of residual erythrogenic toxin A. The isoelectric point of LMP-10k is the same as for erythrogenic toxin A: 5.2. The immunogenic activity is low, only one of two rabbits produced anti-LMP-10k-antibodies after a prolonged course of immunization. On the other hand it is possible to induce antierythrogenic toxin A-antibodies by immunization with LMP-10k preparations contaminated with small amounts of erythrogenic toxin A. Possibly the data given by some authors for the m.w. of erythrogenic toxin type A as 8 000 D are the results of a mix-up with co-purified LMP-10k.