[Differentiation of osteogenetic cells: systems and regulators].

Bone formation comprises a complex but ordered sequence of events, beginning with the proliferation of chondrogenic and osteogenic precursor cells followed by their subsequent differentiation, ultimately leading to extracellular matrix maturation and mineralisation. Several models have been established which recreate discrete elements of this network. Factors induce ectopic bone formation, when implanted into muscle pouches, have been characterized as members of the TGF-beta-superfamily. Detailed information about the course of OB-differentiation has been obtained from an in vitro model system. The process of mineralisation was found to consist of three distinct time periods: a proliferative phase, a period of extracellular matrix maturation and mineralisation. The development of each states depends on each other. This model is not as complex as the whole organ and cannot of course lead to any conclusion about the kinetic differentiation path of a cell in its normal spatial environment. Different organ culture systems are described and through the application of sensitive methods the differentiation can be studied in the normal spatial environment. The cascade of events in the differentiation process must be strictly regulated. Hormones and growth factors in many cases show a bone-forming and/or bone-resorbing action. The effects of the classical calcium regulating hormones Vitamin D and PTH on OB-differentiation are reviewed. A large number of growth factors have been shown to effect OB. Growth factors, that have been isolated from the bone matrix are of particular interest to bone formation.


[Imaging procedures in diagnosis of bone tumor].

The historical development of the various imaging procedures for diagnosis, differential diagnosis and for the effect of chemotherapy of malignant bone lesions are discussed. The present status of imaging including MRT has been defined.


[KMFTR (Kotz Modular Femur Tibia Reconstruction System) modular tumor endoprosthesis system for the lower extremity].

206 patients with tumorendoprosteses of the KMFTR-type at the lower extremity were operated at the Institute Rizolli Bologna and at the University Clinic of Vienna. The minimum follow up was 2 years (mean 3.2, max. 8 years). In order to bridge the defect caused by tumor resection the proximal femur was replaced in 42 cases, the distal femur in 119 cases and in 6 patients a total femur prosthesis was used. The proximal tibia was replaced in 35 cases and in 4 cases a total knee prosthesis was implanted. Clinical evaluation according to Enneking revealed 71.6% excellent and good results. In 83.4% the radiological score was higher then 20. We saw deep infections in 8.2% (17 patients), breakage of the prosthesis in 6.8% and aseptic loosening in 5.8%. 3 patients had to be amputated due to infection. In the remaining cases of infection in 66% of the patients healing was observed. All cases of aseptic loosening or breakage could be revised successfully by an exchange of the prostheses and therefore salvage of the leg was achieved.


[Chemotherapy of osteosarcoma].

Intensified adjuvant chemotherapy increased the 4-year metastasis-free survival probability from 50% (COSS-77) to roughly 80% (COSS-86). Preoperative chemotherapy was found without recognizable hazard and promoting conservative surgery. Following resection the local failure rate ist significantly higher than after demolitive procedures, including rotation plasty (10.5% vs. 2.5%). Local failures bare a very poor prognosis (19/23 DOD). The acute therapy related mortality is less than 3%. Late toxicities like ototoxicity and cardiotoxicity are intriguing and deserve increased attention. The management of the osteosarcoma patient is a complex and difficult interdisciplinary task which is best performed in centers experienced in the treatment of malignant musculo-skeletal tumors.


[Isolated systolic hypertension in persons older than 60].

Isolated systolic hypertension (ISH) is generally defined as a systolic pressure of 160 mmHg or more, with a diastolic pressure cut-off point below 95 mmHg in some studies and 90 mmHg in others. Its prevalence and incidence vary from 3 to 30% depending on the definition applied, methodology of measurement, as well as the population and the age and sex of the patients. Mechanisms that could lead to the development of isolated systolic hypertension are discussed, especially the role of atherosclerosis and sodium intake. Comparing results from different countries, the Intersalt study showed that the age related rise in systolic pressure was positively related to the mean sodium excretion in that country. A post-hoc analysis of data from 4 Belgian groups could not show such a correlation within our country. The risks of systolic hypertension on mortality and morbidity in the elderly are considered. The need for further studies to quantify the risk and to establish the effect of treatment is emphasized. Three such studies in patients above the age of 60 years with ISH were started. The studies are double-blind, placebo-controlled trials and the main purpose is to examine the influence of treatment on morbidity, mortality, and general well-being. In the American SHEP study the patients of the actively treated group received a diuretic and possibly a beta-blocker or reserpine. The results indicate a significant reduction in non fatal stroke, heart failure and myocardial infarction without a significant reduction in fatal stroke, fatal myocardial infarction, cardiovascular or all cause mortality. Studies in other continents are still in progress, such as the Syst-Chin in China and the Syst-Eur trial in Europe. They may indicate whether the results obtained in the U.S.A. can be extrapolated to other continents and whether the use of other drugs without metabolic disturbances, such as calcium entry blockers and angiotensin converting enzyme inhibitors, produce a similar reduction in events. Additional studies are needed to establish the effect of reducing salt intake in younger age groups on the prevalence of ISH and of the related morbidity and mortality.


[Mobility of patients with coxarthrosis].

The common methods of evaluating walking capacity of patients with osteoarthritis of the hip reported in literature are all inaccurate and are based on symptoms. It has been proved, that these informations are to uncertain and therefore have to be replaced by objective criterias. A method of assessment was developed which can easily be applied in clinical routine without great apparative means. With a pedometer and a stopwatch the time can be measured which the patient needs to pass a distance of 30 meters as quick as possible (MAX 30). Similarly the maximal walking distance (MAX DIST) is evaluated as well as the average walking distance (MEDIAN). It could be shown, that walking capacity is not dependent on the amount of degenerative changes, duration of hip disease and hip motion. Walking capacity is negatively influenced by pain, muscle atrophy and lack of training. Patients with osteoarthritis of the hip are able to walk on average 3 km without interruption, thereby they develop a speed of 4 km/h on average. So they are not much slower than healthy subjects. The two must important aims of conservative treatment of hip disease must be alleviation of pain and improvement of muscular strength. Main indication criterium for hip replacement is walking capacity, not the radiological assessed amount of degenerative changes.


[Metal-metal total prosthesis of the hip joint: back to the future].

Late loosening in total-hip-replacement is explained by a foreign body reaction of the connective tissue along the bone-implant interface due to polyethylene debris. In contrast, metal-metal-prostheses, implanted in the sixties, may still today work perfectly without any signs of osteolysis along the bone-cement interface, proving, that metal-metal-pairing is superior to prostheses with polyethylene cups and that cement-anchorage may also be adequate for fixation. A new metal-metal-total hip-joint is presented, that has been implanted from 1988-1990 62 times.


[Results 2 to 5 years after implantation of the cement-free "APS" total knee prosthesis. A retrospective study of the first 160 cases].

One hundred-and-forty-seven out of 160 cementless APS total knees replacements have been clinically and radiologically evaluated with a mean follow-up period of 38 (24-60) months. Primary diagnosis has been osteoarthrosis in two thirds and rheumatoid arthritis in one. Reoperations have been performed in 4.9% due to aseptic loosening of the tibial tray, and in 3.7% due to patellar problems (aspetic loosening in 1.2% and luxation in 2.5%). There have been three late infections of the joint leading to arthrodesis in two or exchange operation in one case. The radiologic course of the remaining 126 implants showed excellent or good osseous integration of the implants in more than 80%. We were able to show that rheumatoid arthritis as well as malimplantation of the prosthesis can decrease the rate of osseous integration.


[Water quality].

The quality of water is more and more important in the polluted world of today. The nephrologist is with his patients a great consumer of water; water for dialysis should be of the highest quality as each maintenance dialysis patient uses up to 150 liters 3 times per week for years, in direct contact with his blood through a very thin dialysis membrane. Water may be polluted at the collection-, treatment- or distribution centers or locally at the place of consumption. Aluminum, chloramine, pesticides, copper, herbicides and many other substances as well as bacteria, may be found in water. For these reasons the nephrologist uses a series of devices to clean or purify the water before use in his dialysis unit: softeners, de-ionisators, reverse-osmosis, charcoal filters, ultraviolet irradiation, a.o. A correct water circuit is important as well, as dead spaces could cause bacterial contamination. The ultra pure water has to be mixed before use in the dialyzer, with a concentrated electrolyte solution. The author discusses all these different aspects of water treatment in the particular situation of hemodialysis.


Influence of supplementation with N-3 fatty acids on different coronary risk factors in men--a placebo controlled study.

Recent epidemiological studies have shown some beneficial health effects of the long chain (n-3) polyunsaturated fatty acids found in fatty fish. Although the results of these studies are often ambiguous and inconclusive, they have prompted many intervention trials to study the effects of n-3 fatty acids (FA) on the cardiovascular risk profile. However screening of the literature revealed that many of the beneficial effects of fish (oil) were obtained in intervention studies which had several serious shortcomings in their design. Therefore we started a placebo controlled randomised trial with increasing doses of n-3FA (respectively 0; 1.12; 2.24 and 3.37 g n-3 FA/day) and in order to have a maximum compliance this study was done in healthy monks. Fifty eight subjects took the fish oil capsules during 12 months and were thereafter followed for another 6 months. We couldn't detect any effect of n-3 FA supplementation on total cholesterol, HDL cholesterol, LDL cholesterol, apo A1, Lp(a), HbA1C, glucose, fibrinogen, factor VIII, antithrombin III, plasminogen activator inhibitor, tissue plasminogen activator and von Willebrand factor concentration, on bleeding time or on systolic or diastolic blood pressure. A pronounced significant dose dependent decrease of triglyceride levels was seen, while a slight but statistical significant decrease of apo B levels was observed in the highest fish oil dose. As the importance of triglycerides in the pathogenesis of atherosclerosis is still under discussion, the clinical relevance of these finding is not clear at the moment. It seems therefore improbable that the anti-atherosclerotic action of n-3 FA is due to an effect on the lipid, apoprotein, coagulation or fibrinolysis parameters as measured in our study. Hence further research must be focused on other parameters (prostaglandins) which can be influenced by n-3 FA and which probably play an equally important role in the atherosclerotic process.


[Functional Independence Measure as a predictor of expected rehabilitation outcome in patients with total endoprosthesis replacement and after apoplectic infarct].

Functional Independence Measure (FIM) is a method for uniformly recording functional status in rehabilitation patients. It has been under development in the USA since 1985. In this study, the prognostic value of function tests by FIM on admission to the rehabilitation clinic was investigated in two groups (45 patients in all). Thirty-three patients were admitted for rehabilitation following apoplectic shock, the remaining 12 following treatment of fractures of the femoral neck by total hip replacement. A highly significant correlation was found between the total FIM score on admission and the patient's status on discharge. Of the individual functions studied, the activities "dressing and undressing" and "walking/riding in wheelchair" were found have the highest predictive value.


[Psychological adjustment to invasive surgical and medicamentous tumor treatment of osteosarcoma patients with rotation-plasty].

Ten patients with osteosarcomas and rotation plasties made themselves available for a psychological survey. The time elapsed after their operations was between two and ten years, giving an average of six years. All patients were free of tumours at the time of the follow-up examination. Both in personal interviews and in psychological tests, it was possible to observe a very positive development of these patients' attitudes. Contributory factors in this context were discussions with the doctors administering treatment, the cheerful atmosphere of the hospital and the nursing staff, the physicotherapists and ergotherapists, and the excellent social support which all those interviewed also received from their relatives. Continuous positive motivation, a favourable social dialogue and patients' ability to control their own lives would appear to be the key factors in helping patients to come to terms with their illness.


[A modern textbook is 100 years old. Albert Hoffa and the "Textbook of Orthopedic Surgery"].

The appearance of Albert Hoffa's "Textbook book of orthopaedics" in 1891 saw the young special discipline enter a new phase of professionalisation in the German-speaking countries. Hoffa defined in this work the scope and methodology of orthopaedics in a sense that is still valid today. By including operative and conservative forms of treatment, he created the foundation for a continued scientific development of the subject. Only with the appearance of Hoffa's work did orthopaedics gain acceptance as a special area by many physicians. The far-reaching influence and significance of the textbook for orthopaedics is portrayed with the aid of historic sources.


Modulation of the Ca(2+)-sensitivity in phasic and tonic smooth muscle.

This work describes the relationship between the cytoplasmic free calcium concentration ([Ca2+]i) measured by the fluorescent Ca(2+)-indicator fura-2, the phosphorylation of the myosin light chain and the force development in the phasic longitudinal smooth muscle layer of guinea-pig ileum and the tonic rabbit pulmonary artery. The close temporal relationship between the rise in cytoplasmic Ca2+ and the initiation of force development as well as the rather good correlation between cytoplasmic Ca2+ and force maintenance leaves little doubt about cytoplasmic Ca2+ being the primary regulator of force. However the present experimental evidence indicate that [Ca2+]i and force are not invariably tightly coupled in smooth muscle. A dissociation between the time course of [Ca2+]i and force was found in the tonic rabbit pulmonary artery but not in the phasic ileum of the guinea-pig. In contrast, there was a pronounced decline in the Ca(2+)-sensitivity of the contractile apparatus (desensitization to Ca2+) in the guinea-pig ileum during prolonged depolarization, an observation not found in the pulmonary artery. Such desensitization could reflect the activation of highly active myosin light chain phosphatase(s) and the different Ca(2+)-sensitivities of tonic and phasic smooth muscles can, at least in part, be due to differences in myosin light chain kinase/phosphatase activity ratios. The sensitivity of the regulatory/contractile apparatus to Ca2+ was increased by agonists in intact and in permeabilized preparations. Furthermore a different sensitizing potentiation between different agonists was observed. The mechanism of the "sensitization" of the contractile response to Ca2+ could act through the activation of the phosphorylation of a protein phosphatase inhibitor, thereby inhibiting the myosin light chain phosphatase. The experiments therefore show that different levels of tension may be present at the same [Ca2+]i and indicate that the Ca(2+)-sensitivity can be modulated in smooth muscle.


[The neonatal form of Bartter's syndrome: current findings in etiology and physiopathology].

I. Time has come to distinguish "Bartter syndrome" from "Bartter disease". The latter is an autosomal recessive renal tubulopathy which manifests itself mostly during infancy and childhood. II. Bartter disease is caused neither by a primary renal potassium loss nor by a primary renal hyperprostaglandinism. All evidence is in favor of a defect in the chloride pump located at the thick ascending limb of Henle's loop. III. The most severe expression of Bartter disease is its neonatal form which is characterized by polyhydramnios, premature delivery and a life threatening sodium chloride loss during the early weeks of life. It takes several weeks before sodium wasting turns into renal potassium wasting. IV. Polyhydramnios not associated with echographically detectable fetal malformation is highly suggestive of Bartter disease. Prenatal diagnosis is based on the combination of fetal polyuria and elevated chloride in the amniotic fluid. V. In this setting the administration of indomethacin is useless and even dangerous from the 32nd week of gestation on. Similarly, indomethacin should not be given to the newborn Bartter patient for the first weeks and months of life. Treatment at that stage consist mainly of the administration of large amounts of fluid and sodium chloride. VI. Indomethacin can be used as soon as children with Bartter disease stop growing normally and preferably after the age of 18 months when kidney maturation is established. The daily dose should not exceed 2.5 mg/kg body weight. VII. Hypercalciuria is part of (the neonatal form of) Bartter disease and it is so severe that nephrocalcinosis seems to be the rule. This hypercalciuria is the direct consequence of the chloride reabsorption defect in Henle's loop. Research is needed to find an adequate solution to this problem.


[Nucleolus organizer regions in pathomorphologic tumor diagnosis].

Morphology and biological behaviour of tumours are closely related to each other and are the main objects of diagnostic tumour pathology. Anaplasia, for example, a well-known cytomorphological criterion of malignancy, is however only an indirect sign of impaired cellular growth control mechanisms. Nowadays, it is a goal of cancer research to investigate these regulatory processes in order to elucidate new diagnostic criteria of malignancy. Silver staining of nucleolar organizer regions (AgNORs) basically meets this new concept. NORs (rDNA) encode for ribosomal RNA and are thus of central importance for the protein synthesis of a cell. Silver stains NOR associated proteins and indicates activated rDNA. Therefore, AgNOR staining covers the proliferative potential of a given cell or a tumour respectively. A prerequisite of reliable application of the AgNOR method to diagnostic tumour pathology is standardization of the technique, which should be based upon scientific results obtained by basic research. Accordingly, in interphasic cells AgNORs are primarily substructures of nucleoli corresponding to the fibrillar centers at the ultrastructural level. This has been shown to be an important criterion to determine the quality of the silver staining reaction. Most artifacts result from inadequate tissue preservation (fixation), unspecific argyrophilic structures and the staining procedure itself. They should either be excluded or--when ever possible--controlled by a proper staining technique, i.e. adjustment to the stainability of every individual specimen. In this respect, digital image analysis proved to be a useful tool. The mean size of AgNORs in small lymphocytes of the same tissue sample is an equivalent of the argyrophilia of a given histological and cytological specimen (internal staining standard). By use of such a standardized staining technique a high diagnostic accuracy is achieved. The proliferative potential of a cell or a tumour can be determined by number, size, staining intensity and distribution of the silver stained dots. In histological tissue sections the quotient of the mean number of AgNORs/cell and the mean area of one AgNOR dot/cell has been shown to be a very sensitive diagnostic parameter. In cytological specimens determination of the total silver stained area per cell is superior to counting of AgNORs simply by eye. Normal and malignant tissue can reliably be discriminated by these morphometric values. In addition, the malignancy potential of the different preneoplastic lesions, e.g. of the urinary bladder, can precisely be described. Flat urothelial lesions with moderate cytological atypia (D2) exhibit AgNOR values in the range of well differentiated papillary carcinomas.(ABSTRACT TRUNCATED AT 400 WORDS)


Identification of bent DNA and ARS fragments in the genome of Choristoneura fumiferana nuclear polyhedrosis virus.

We identified four CfMNPV DNA fragments with autonomously replicating sequences (ARS) functional in Saccharomyces cerevisiae. A 0.9-kb fragment which, mapped to 54.5 to 55.3 map units within EcoRI HI of the CfMNPV genome, showed the strongest ARS activity of the four. Sequence analysis of this 0.9-kb DNA segment revealed an A+T-rich region separated from a G+C-rich region by 320 bp. Although no sequence matched exactly the ARS core-consensus sequence, 13 near-matches differing by only one or two nucleotides from the core-consensus sequence, were identified. Ten near-matches were clustered within a 105-bp A+T-rich region, and were arranged as inverted repeats. A section of bent DNA structure was predicted within this region. The bent DNA, which showed temperature-dependent retardation during polyacrylamide gel electrophoresis, was unique as its sequence was arranged as a symmetrical 'tilde' (approximately) structure. The second (1.0 kb) and third (1.6 kb) ARS-bearing fragments mapped within EcoRI-E and -B fragments which contain homologous repeat sequences. The fourth (1.5 kb) fragment had the weakest ARS activity and mapped to the EcoRI-D or -B regions of the genome.


Transfer of maternal antibodies results in inhibition of specific immune responses in the offspring.

A potentially detrimental consequence of maternally transferred antibodies was demonstrated in a mouse model for rabies virus, where pups from rabies virus-immune dams showed a decrease in the generation of specific B- and T-cell responses to immunization with rabies virus antigen, resulting in vaccine failures. The degree and duration of the vaccine failures was inversely correlated with the amounts of maternally transferred antibodies, and exceeded the time when maternal antibodies provided reliable protection against a viral challenge. The low responsiveness to vaccination, measured by serum antibody titers and by lymphokine release upon in vitro restimulation of in vivo-primed lymphocytes, was specific for the target virus of the maternal antibodies and was also observed in pups from Sendai virus-immune dams upon vaccination with the homologous virus. In addition, an inhibition of the specific immune responses was demonstrated upon passive immunization of newborn mice with monoclonal antibodies to rabies virus. Although the mechanism(s) that causes the observed inhibition in the offspring of immune dams or in pups that were inoculated with antibodies postnatally is currently unknown, data presented in this manuscript indicate that the observed effect on B- and T-cell responses might not be solely caused by removal of the antigenic load due to residual maternal antibodies.


Characterization of rabies virus glycoprotein expressed by recombinant baculovirus.

A cDNA of the glycoprotein (G protein) gene of rabies virus Nishigahara strain was cloned and inserted into a baculovirus genome under the control of the polyhedrin promoter. Infection of Spodoptera frugiperda cells with this recombinant virus produced a large quantity of new protein instead of the parental polyhedrin protein. By immunofluorescent and immunoblotting analyses, the recombinant protein was antigenically similar to the authentic G protein. Its molecular mass estimated by sodium dodecyl sulfate polyacrylamide gel electrophoresis, however, was slightly smaller than that of the authentic one, and this observation was suggested to be due to the difference in glycosylation level between the two G proteins. The recombinant G protein expressed on the cell surface of the insect cells showed a fusion activity at low pH. The fusion activity was inhibited by antiserum against either whole virions or G protein of rabies virus.


Increased influenza A virus sialidase activity with N-acetyl-9-O-acetylneuraminic acid-containing substrates resulting from influenza C virus O-acetylesterase action.

Influenza virus type C (Johannesburg/1/66) was used as a source for the enzyme O-acetylesterase (EC 3.1.1.53) with several natural sialoglycoconjugates as substrates. The resulting products were immediately employed as substrates using influenza virus type A [(Singapore/6/86) (H1N1) or Shanghai/11/87 (H3N2)] as a source for sialidase (neuraminidase, EC 3.2.1.18). A significant increase in the percentage of sialic acid released was found when the O-acetyl group was cleaved by O-acetylesterase activity from certain substrates (bovine submandibular gland mucin, rat serum glycoproteins, human saliva glycoproteins, mouse erythrocyte stroma, chick embryonic brain gangliosides and bovine brain gangliosides). A common feature of all these substrates is that they contain N-acetyl-9-O-acetylneuraminic acid residues. By contrast, no significant increase in the release of sialic acid was detected when certain other substrates could not be de-O-acetylated by the action of influenza C esterase, either because they lacked O-acetylsialic acid (human glycophorin A, alpha 1-acid glycoprotein from human serum, fetuin and porcine submandibular gland mucin) or because the 4-O-acetyl group was scarcely cleaved by the viral O-acetylesterase (equine submandibular gland mucin). The biological significance of these facts is discussed, relative to the infective capacity of influenza C virus.


Analysis of relatedness of subgroup A respiratory syncytial viruses isolated worldwide.

Respiratory syncytial virus strains (subgroup A) isolated from around the world during the period 1988-1991 were analysed to determine their relatedness. Analysis was by restriction mapping and nucleotide sequencing following amplification of selected regions of the virus genome by polymerase chain reaction (PCR). Twenty-three viruses of subgroup A isolated from cities in temperate regions of the Northern and Southern hemispheres and the tropics during the period 1988-1991 fell into distinct groupings closely related to four of the six lineages defined in analysis of recurrent epidemics within the same city (Birmingham, UK) during the same period. These observations confirm that multiple lineages of RS virus co-circulate locally, and show that very similar viruses are present simultaneously in widely separated countries.


The attenuation phenotype conferred by the M gene of the influenza A/Ann Arbor/6/60 cold-adapted virus (H2N2) on the A/Korea/82 (H3N2) reassortant virus results from a gene constellation effect.

A single gene reassortant (SGR) virus that derived its M gene from the attenuated influenza A/Ann Arbor/6/60 cold-adapted (CA) donor virus and the remaining genes from the A/Korea/82 (H3N2) wild type (WT) virus (designated A/Korea/82 CA M-SGR) was previously shown to be attenuated in mice, hamsters, ferrets, and humans. The attenuation (ATT) phenotype of this SGR virus could result directly from an altered function of the mutant M gene product of the A/Ann Arbor/6/60 CA virus, which differs from the M gene of the A/Ann Arbor/6/60 WT virus at only one amino acid or, indirectly from a gene constellation effect in which ATT results from an inefficient interaction between the products of the M gene of the A/Ann Arbor/6/60 virus and other genes of the A/Korea/82 virus. Several lines of evidence from the present study are consistent with our interpretation that the ATT phenotype of the A/Korea/82 CA M-SGR results from a gene constellation effect. First, the A/Korea/82 CA M-SGR and an A/Korea/82 SGR containing the A/Ann Arbor/6/60 WT M gene were each restricted in replication in the upper and lower respiratory tract of mice compared with the A/Korea/82 WT virus. Second, an A/Udorn/72 CA M-SGR containing the M gene from the A/Ann Arbor/6/60 CA donor virus in a background of other genes derived from the A/Udorn/72 (H3N2) WT virus was not attenuated in the respiratory tract of mice. These data suggest that the change in the amino acid sequence of the M gene product from the A/Ann Arbor/6/60 WT to CA virus is not responsible for the ATT phenotype of the A/Korea/82 CA M-SGR. In addition, evidence of the genetic instability of the A/Korea/82 CA M-SGR is presented, specifically, an extragenic mutation that results in loss of the ATT phenotype. The implications of these findings for the ATT phenotype of the live attenuated reassortant viruses derived from the A/Ann Arbor/6/60 CA donor virus are discussed.


Expression and properties of the V protein in acute measles virus and subacute sclerosing panencephalitis virus strains.

Measles virus (MV) inserts one guanosine (G) residue at a specific site in a subpopulation of the mRNA transcribed from the phosphoprotein (P) gene to produce V mRNA. Using an antiserum against the unique carboxyl-terminal region of the predicted V protein, we found that a phosphorylated V protein was expressed in two acute MV strains (Edmonston and Nagahata) and three SSPE virus strains (Biken, Yamagata, and Niigata). The V protein of Biken strain SSPE virus was electrophoretically and antigenically indistinguishable from the V protein of Nagahata strain acute MV, the likely progenitor of the Biken strain. The V protein of these two viruses was not present in the intracellular viral nucleocapsids, but was found only in the cytosolic free protein pool. Pulse-chase experiments failed to show transport of the V protein to the plasma membrane. The V protein was also absent in the extracellular virions. The P protein synthesized from the cloned gene associated with the MV nucleocapsids in vitro, but the V protein had no affinity to the MV nucleocapsids. These results suggest that expression and properties of the V protein are conserved in chronic MV infection.


Baculovirus expression of the glycoprotein gene of Lassa virus and characterization of the recombinant protein.

A recombinant baculovirus was constructed that expresses the glycoprotein gene of Lassa virus (Josiah strain) under the transcriptional control of the polyhedrin promoter. The expressed protein (B-LSGPC) comigrated with the authentic viral glycoprotein as observed by sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE), was reactive with monoclonal antibodies (MAbs) in Western blots, and was glycosylated. Although the recombinant protein was not processed into the mature glycoproteins, G1 and G2, it demonstrated reactivity with all known epitopes as measured by indirect immunofluorescence (IFA), and it was immunogenic, eliciting antisera in rabbits that recognized whole virus in IFAs. Regarding future applications to diagnostic assays, the recombinant glycoprotein proved to be an effective substitute for Lassa virus-infected mammalian cells in IFAs and it was able to distinguish sera from several human cases of Lassa fever, against a panel of known negative sera of African origin, in an enzyme immunoassay (EIA).


[Occurrence of beta-phenylethylamine and its derivatives in cocoa and cocoa products].

2-Phenylethylamine was extracted from cocoa nibs and chocolates and analysed by coupled gas chromatography-mass spectroscopy. The amine concentration increases in fermentation of cocoa and decreased during roasting and alkalization. Its concentration in chocolates is dependent on non-fat cocoa contents. Previously unreported aldimines were found in cocoa powders, which arise from the condensation of phenylethylamine and aldehydes. The main component of these products is N-phenylmethyl-N-phenylmethylene amine (CAS 3240-95-7).


[Determination of polydextrose in food using ion exchange chromatography and pulsed amperometric detection].

A method to determine the synthetic carbohydrate polydextrose, which is used as a bulking agent for the preparation of calorie-reduced foodstuffs, is described. The sample clean-up involves the extraction of polydextrose with water and enzymatic degradation of interfering polysaccharides, such as starch and inulin. The chromatographic system consists of a high-performance anion-exchange column that separates carbohydrates up to molecular weights of 15,000 and pulsed amperometric detection. For unbaked goods recoveries ranged from 94 to 106%, for baked goods recovery rates of 100 to 115% were measured.


Power calculation for cohort studies with improved estimation of expected numbers of deaths.

This paper focuses on improving the accuracy of sample size calculations for cohort studies by careful calculation of the expected number of deaths in the population, taking into account either prior information or realistic assumptions about variables which may affect the mortality or incidence. Sometimes small changes in the assumptions can dramatically alter the expected numbers and may necessitate modifications in the design of the study. Possible modification include extension of the follow-up time, and recognition that the real strength of the study may lie in the potential for pooling several similar studies. The problem will be discussed with reference to two examples of occupational cohort studies where differing prior information was available.


[The synchronization of behavior and individual distances in groups of wild boars (Sus scrofa L.)].

Some ways of synchronization are identified in the wild pig behaviour, which are parallel body orientation, group getting together and away, individual approaching and moving away, sound signals. Parallel synchronization is characteristic for various compact groups, males and females exposing some differences in the synchronization duration and distances. The synchronization is mainly a property of individuals united by common motivation and interests. Each family union, each offspring group have their own peculiarities of synchronization depending on their structure. Synchronization duration and distances vary by season, while within- and between-group distances are different in ages and sexes. Two ways of appearance of special distances are recognized. The synchronization works as a trigger system regulation spatial distribution of individuals and various social functions.


Case-control studies in pediatric epidemiology: parent surrogates and potential pitfalls of inaccurate and selective recall.

The case-control study is quite popular as a study design for exploring associations between risk factors and disease in pediatric epidemiology. Since data concerning exposures to the child are often collected through interviews with parents or other surrogates, researchers should be aware of the opportunities for bias due to inaccurate or incomplete recall. Methods which exist for the control of this problem are presented. These include: the selection of control groups with childhood conditions of similar etiologic uncertainty as the disease being studied; collecting exposure data from both parents; collection of data from children where possible; diligent interviewer training; reviewing clinical records; and use of validity scales. Strengths and weaknesses of these strategies are discussed.


[Quality of data provided by VESKA medical statistics: the case of the fractured proximal femur].

Within the framework of a retrospective study of the incidence of hip fractures in the canton of Vaud (Switzerland), all cases of hip fracture occurring among the resident population in 1986 and treated in the hospitals of the canton were identified from among five different information sources. Relevant data were then extracted from the medical records. At least two sources of information were used to identify cases in each hospital, among them the statistics of the Swiss Hospital Association (VESKA). These statistics were available for 9 of the 18 hospitals in the canton that participated in the study. The number of cases identified from the VESKA statistics was compared to the total number of cases for each hospital. For the 9 hospitals the number of cases in the VESKA statistics was 407, whereas, after having excluded diagnoses that were actually "status after fracture" and double entries, the total for these hospitals was 392, that is 4% less than the VESKA statistics indicate. It is concluded that the VESKA statistics provide a good approximation of the actual number of cases treated in these hospitals, with a tendency to overestimate this number. In order to use these statistics for calculating incidence figures, however, it is imperative that a greater proportion of all hospitals (50% presently in the canton, 35% nationwide) participate in these statistics.


[Learning from America?--Managed Health Care, experiences in health cost containment exemplified by Medicaid in Massachusetts, USA].

Managed Health Care is characterized by a number of different control mechanisms aiming at cost containment in health care delivery. The means and consequences of its application are discussed using the approach of the state of Massachusetts to improve care delivery for Medicaid eligibility as an example and unsolved problems are specified.


Leisure time physical activity in Scotland: trends 1987-1991 and the effect of question wording.

In this article data collected between 1987 and 1991 is analyzed to identify changes in the proportion of sedentary individuals in Edinburgh and Glasgow. In the primary question, which asked the respondents about physical activity for exercise such as walking, running and swimming, a wording change deleting the prompt to specific activities is taken into consideration. The data were collected by telephone on 13,586 respondents. A considerable decrease in the proportion of sedentary individuals in both cities was observed between 1987 and 1991. This decrease could not be related to changes in specific sporting activities. The change to an unprompted question led to a 14% lower estimate of physical activity. This was almost fully explained by a change in the estimate of the proportion of walkers. Older respondents in particular were affected by the question change.


Detrimental effect of alcohol intoxication on severity of injuries in male traffic accident victims: a cross-sectional study.

A cross-sectional emergency room study was performed among traffic accident victims aged 16 to 75 years in order to investigate the prevalence of alcohol intoxication (blood alcohol concentration (BAC greater than or equal to 0.8 g/kg) and its potential detrimental effect on injury severity. A BAC greater than or equal to 0.8 g/kg was present in 29% of the male patients. Intoxicated patients had a similar propensity to require inpatient hospital care (65 versus 60%) but had significantly longer hospital stays than the non-intoxicated patients (36 versus 20 days; p less than 0.05), observations which may be explained by the higher prevalence of serious injuries (head and internal injuries) among the intoxicated cohort. This study supports and emphasizes the detrimental effect of alcohol intoxication on the severity of injuries in traffic accident victims, and reinforces the need for further legal and public health measures in preventing alcohol-related traffic accidents.


[Prevalence of smoking in hospital personnel and future teachers].

We have surveyed the prevalence of smoking habits and the opinions about it's regulation among 192 students in two different schools (a teachers' and a nursing school) and among 320 employees of the University Hospital of Geneva. Smoking prevalence varies depending on the profession and sex, and remains high considering the level of education of the surveyed population. Among the future school teachers 23% are smokers. In the hospital, the smoking prevalence is 25% in the health professionals and 32% in the administrative and technical staff. As many as 46% of the future nurses are smoking. Obviously much still needs to be done in order to decrease the number of smokers among the health professionals. The majority of the employees questioned, both smokers and non-smokers, were in favor of regulating smoking in the workplace. 91% of the hospital staff, and 86% of the smokers among them, favored a smoke free hospital policy. Restriction of tobacco use in the workplace should be implemented particularly when it is the wish of a majority of employees.


[Disabilities and impairment in activities of daily living as possible risk factors in dementia: prospective study in Basel 1986].

Because of the increasing number of old people in our society more and more dementia cases will be expected. The etiology of dementia is far from being clear. To get some idea about risk factors 4200 participants (on average 60 years old) of the Prospective Basel Study were asked by letter questions about their health and their way of life. One of the hypotheses to be tested is whether or not disabilities or impairments of activities of daily living could be risk factors for dementia. At present only the results of the basic survey can be discussed. Impairments of hearing, of mobility, of cutting toe-nails and of general physical activity were the conditions which were most frequently named. These results of people being mainly healthy with regard to dementia, will make it possible in the future--in contrast to the cross-sectional studies mentioned in the literature--to test the risk of physical disabilities and impairments of activities of daily living for dementia without being confounded by impairments due to dementia.


Knowledge of and attitudes towards family planning and early detection of breast and cervical cancer in two female populations in Greece.

This paper presents the results of surveys of contraceptive use, the frequency of induced abortions, the use of the Papanicolaou smear test and knowledge about the practice of breast self-examination in two female populations, characterized by a different socioeconomic level. There exist similar trends, as well as some remarkable differences between the two populations. Both of these populations included a high proportion of women who had undergone at least one abortion. Withdrawal and condom use were the most common contraceptive methods. About one third of women of the two populations had had a smear Pap-test carried out during the last year. 53.8% of the women in the population I and a 44.8% of the population II stated that they know how to practice breast self-examination.


A descriptive analysis of articles in the journal of Social and Preventive Medicine (Soz Präventivmed): 1980-1990.

This study provides a descriptive image of the work published in Soz Präventivmed between 1980 and 1990, and analyses certain trends. All articles of this period were categorized and recorded in a data base for: language of publication, city of location and affiliation of first author, sponsor (funding body), citation in Medline, regions and population concerned, type of article and subject matter. Over the decade, we note a reduction in the number of articles with a corresponding increase in their page length, and a progressive increase in the number of articles in English when compared with the two principal languages, German (1/2) and French (1/3). A majority of authors have university affiliations. Studies with original results comprise on average 44.6% of all publications, a tendency which gradually decreases over time. The proportion of epidemiological studies, a majority of which are descriptive studies, has increased progressively since 1980. Among the twelve categories of subject matter chosen as indicators some, such as health services research and research on elderly persons, appear more frequently during the first half of the decade, and others, such as heart disease, cancer epidemiology and AIDS, appear during the second half.


Measuring discrepancies between knowledge, preoccupation and fear of aids in populations.

A simple tool to quantify discrepancies between knowledge, preoccupation and fear regarding hiv and aids is presented. This tool is based on standard questions available in health surveys. Some results using recent Swiss data are presented, and the method is discussed.


[Restrictions to smoking at the workplace and smoking habits: a literature review].

Based on a critical review of the literature, we assess the consequences of restrictive smoking policies at the worksite on smoking habits of active smokers. The majority of the fourteen studies reported to date (eleven studies from the United States, one study from Canada, one from Australia and one from the FRG) suggest that restrictive smoking policies might have a major impact on reduction of cigarette smoking and eventual smoking cessation of active smokers. However, most of the studies suffer from serious methodologic limitations, and more stringent scientific investigations should be carried out. Nevertheless, implementation of restrictive smoking policies at the worksite appears to be a reasonable measure of nonsmoker protection, even before definitive evaluation of the impact on smoking behavior of active smokers. Such implementation should take place without discrimination of smokers in the context of comprehensive worksite prevention programs and should be accompanied by thorough scientific evaluation.


[Rheumatism epidemiology in Europe].

The article describes the present and potential of the epidemiology of the rheumatic diseases in Europe, considering especially rheumatoid arthritis (rA) and fibromyalgia (FMA). This is preceded by a short review of the history of European rheuma-epidemiology within the past 40 years. In rA European rheumatologists and epidemiologists have made important contributions to a differentiated nosology, longterm follow up studies and prognostication, conceptualization and measurement of outcomes and the analysis of a possibly decreasing incidence and severity of the disease. In an own study we were able to use the 1987 revision of the ARA-criteria and to test their stability over time. Among 11,534 German residents of Hannover, aged 25-74 we identified 58 with clinically proven rA or undifferentiated arthritis (uA), resulting in an estimated true prevalence of 0.83% (prevalence according) to Rome-criteria 0.53%, ARA-criteria 1987 0.33%). 39/58 could be reexamined after an average of 29 months. Only 9 of 25 ARA-1987-positive rAs maintained their nosological status. The actual care of the total group seemed widely inadequate. The Concept of FMA has been developed in Canada (H. Smythe) and in Germany/Switzerland (W. Müller) at about the same time, in Europe under the notion of "generalized tendomyopathie". Whereas the credit for developing and defining FMA-criteria goes entirely to rheumatologists from North America, it is an European privilege to provide first epidemiological data. After Jacobsson's work in Malmö/Sweden we studied in Southern Germany 541 German residents of Bad Säckingen, aged 25-74. We eventually identified 10 subjects with a history of widespread pain, 17+ out of 34 tender points and 2 or less out of 10 control points, giving a minimal FMA-prevalence of 1.9% and an estimated true prevalence of 3.0% (95%-Ci 1.6-4.4%). We identified however several nosologic as well as nosographic difficulties, that question the concept of FMA as an exclusively rheumatological disorder within the spectrum of "soft tissue" rheumatism.


[Performance appraisal of internal health services].

In the present context of scarce resources, satisfying at best essential needs in the area of health care leads gradually towards a new conception of the management of health services and towards the development of information tools designed to evaluate performance. This paper presents a general framework for that purpose; it can be adapted to more specific and contextual problems. The authors review the difficulties involved in the measure of performance, the basic data required by the methods as well as some indicators that can be derived from their application, all exemplified in a case study.


[Case report: anorexia nervosa in a 10-year-old boy].

A 10-year-old boy was admitted to the Children's Hospital with a 7-month history of disturbed eating behavior and a recent rapid weight loss: During the 24-day hospital stay the boy displayed a characteristic anorectic eating pattern, hyperactivity, anxiety, depression and compulsive behavior. Discharge followed a 4-kg weight gain. During the subsequent 12 months of outpatient care weight gain and eating behavior normalized. The boy's premorbid personality was described as compulsive and difficult. Although his intelligence was above average the boy had spelling problems and inadequate verbal skills. A change to a college-preparatory school and contact with a family with a vegetarian way of life probably precipitated the acute illness.


[Correlation between inpatient and ambulatory psychotherapy exemplified by a case of secondary encopresis in preadolescence].

By comparing the in-patient and out-patient psychotherapeutic treatment of a patient with encopresis in early adolescence the authors develop a psychoanalytical understanding of the psychotherapeutic effects which the different settings have on the patient and his parents. In the authors' opinion both forms of therapy supplement each other and promote the patient's development during the course of treatment.


[Need for control and anxiety of losing it--reflections on the treatment of anorexia nervosa].

In connection with the symptoms of anorexia nervosa, which are usually based on a fear of losing control over food intake, we describe a therapeutic approach with the following important aims: To reduce patient's fear of loss of control, to free parents from controlling the food intake of their daughter and to establish a framework that provides a good climate for effective family-oriented or individual psychotherapy or both. In patients with anorexia that began early, we recommend starting with family therapy. This can be followed by individual psychotherapy, which is in fact often requested by the patients themselves.


[Nicotine-induced ambulatory stimulant effect and its reverse tolerance].

Nicotine-induced ambulatory stimulant effect and its reverse tolerance produced by daily administration of nicotine in rats were investigated. Nicotine (0.5 and 1.0 mg/kg, sc) increased the ambulatory activity, which was enhanced by the daily administration of nicotine. Although total ambulatory activity and drinking behavior during 20 h (from 13:00 to 9:00) following daily administration of nicotine (1.0 mg/kg, sc) for 7 successive days decreased, these behaviors returned to the control levels after the nicotine-treatment period. Moreover the periods (tau s) of the ambulatory activity and drinking were not changed by daily injections of nicotine (1.0 mg/kg, sc) for 6 successive days. The enhancement of the ambulatory stimulant effect produced by daily injections of nicotine (0.5 mg/kg) was antagonized by mecamylamine (0.2 mg/kg) and haloperidol (0.05, 0.1 and 0.2 mg/kg), which were subcutaneously administered at 20 min before injections of nicotine. These results suggest that the enhancement of nicotine-induced ambulatory stimulant effect by the daily administration of nicotine is concerned with central dopaminergic stimulation through the nicotinic acetylcholine receptor in the rat brain.


[A simple method using a maze task for estimating working memory in mice].

Mice were housed in a cage with a T-maze for 7-9 h a day. A watering place was equipped at one end of the maze. At the other end of the maze, the right and left arms each have two exits, one of which leads to the home cage where food is placed, and the other of which leads to the watering place via a bypass. The exit leading to the home cage in either the right or left was alternately closed every two hours. One-way swinging doors were inserted at the entrance to each arm and between each bypass and the watering place. The mice housed in this apparatus acquired the alternation task at 5 s delay on the 6th day. As the delay became longer (5-150 s), correct response rate showed gradual decrease. Scopolamine (0.1-0.4 mg/kg) did not decrease correct response rate at 5 s delay, but did at longer delay (30 s and 60 s). These results suggest that this method is useful in estimating working memory of mice.


5-HT3 receptor antagonists block cocaine- and methamphetamine-induced place preference.

The effects of 5-HT3 receptor antagonists, MDL72222 and ICS205-930, on cocaine- and methamphetamine-induced place preference were examined. Cocaine (0.5-4.0 mg/kg, ip) and methamphetamine (0.25-2.0 mg/kg, ip) induced a dose-dependent place preference. The cocaine (4 mg/kg)-induced place preference was blocked by both MDL72222 and ICS205-930 (0.1 mg/kg, ip). On the other hand, the dose (0.1 mg/kg) of 5-HT3 antagonists did not block the methamphetamine (2 mg/kg)-induced place preference, although a higher dose (1.0 mg/kg) of 5-HT3 receptor antagonists did block it. The difference in sensitivity may reflect a difference in attack point in dopaminergic system of these two psychostimulants. Our findings suggest that the rewarding effects of cocaine and methamphetamine may be indirectly regulated by 5-HT3 receptor; cocaine being more sensitive to 5-HT3 receptor antagonists than methamphetamine.


[Behavioral assessment of antidepressants (1)--The forced swimming test: a review of its theory and practical application].

Forced swimming test is now widely used as a screening method for antidepressant drugs since it was proposed by Porsolt in 1977. In this article, we at first reviewed its theoretical background and then pointed out various factors which could possibly affect the results. These include the apparatus used for the test (quality and size of cylinder), experimental animals (breeding condition, body weight, age and strain), method of drug administration and evaluation of animal's behavior (criteria for counting the immobility time and those for excluding variety of orienting or escape behaviors, such as jumping, climbing, diving, circling and extended sniffing behaviors). Finally, potential pitfalls and difficulty of the test were discussed based on our own experiences. We concluded that the various factors discussed in this article should be carefully controlled for the pertinent application of the forced swimming test.


[Effects of nicotine on circadian rhythm of ambulatory activity and drinking in rats].

Effects of the intake of nicotine solution and/or forced administration of nicotine at a fixed time-of-day on circadian rhythm of ambulatory activity and drinking in rats were observed under various conditions. Rats showed nocturnal pattern under the light-dark cycle (L: D = 12:12, light period 6:00-18:00), and the patterns scarcely altered while the rats were given 150 micrograms/ml of nicotine solution. When a restricted feeding only for 1 h per day (10:00-11:00) was loaded to the rats, the ambulatory activity and drinking appeared in the light period, especially around the feeding time. While rats were given 15-150 micrograms/ml of nicotine solution under the restricted feeding condition, they demonstrated a marked phase-shift in the circadian rhythm in the concentration-dependent manner. Rats showed free-running rhythms with tau value of longer than 24 h under the constant red dim light condition (CRDL), and such rhythm was scarcely modified by the intake of nicotine solution of 50-150 micrograms/ml. However, when nicotine (1.5 mg/kg po), but not tap water, was administered at 10:00 every day under the CRDL condition, it also produced phase-shift which was similar to that induced by the nicotine ingestion under the redose of nicotine is administered or taken at a fixed time-of-day.


[The threshold lowering effects of chronic treatment with haloperidol on beta-carboline derivative-induced tonic convulsion].

To clarify a relationship between dopamine neuron and purine, GABA or benzodiazepine system, we have studied the changes in the threshold of tonic convulsion induced by each antagonist after chronic treatment with haloperidol in mice. Mice were given haloperidol (1 mg/kg, sc) once a day for 19 d and challenged with caffeine (an adenosine receptor antagonist), beta-DMCM (beta-carboline derivative: as a benzodiazepine receptor antagonist), picrotoxin (a Cl- channel blocker) or bicuculline (a GABAa receptor antagonist) 30 min, 24 h and 48 h after the last injection of haloperidol. Only the threshold of beta-DMCM-induced tonic convulsion was lowered and it was reversed 7 d after the last injection. The beta-DMCM-induced convulsions on 2 d withdrawal were reversed by diazepam (2.5 mg/kg, ip; a benzodiazepine receptor agonist), Ro15-1788 (5.0 mg/kg, ip; as like a benzodiazepine receptor partial agonist), muscimol (2.0 mg/kg, ip; a GABAa receptor agonist) or apomorphine (0.25 and 2.0 mg/kg, ip; a dopamine receptor agonist). These results suggest that the lowering effect of chronic haloperidol on seizure threshold may be involved in the development of tolerance to haloperidol. It may implicate in direct interactions between benzodiazepine and dopamine or GABA systems but may not between dopamine and GABA neurons in development of lowering seizure threshold following chronic haloperidol treatment.


[Postsynaptic mechanism of long-term potentiation].

Long-term potentiation (LTP) is an experimental model for memory and learning in higher animals. It is a well-known fact that intracellular rise in Ca2+ is an essential requirement for generation of LTP. Little is known about the synaptic modulation triggered by the intracellular Ca2+ rise, though the involvement of protein kinase C, Ca2+/calmodulin-dependent protein kinase II (CaM KII), and/or calpain are indicated experimentally. For the purpose of making the synaptic change clearer we tried to characterize the substrates for the protein kinases associated with isolated postsynaptic density (PSD)-enriched fractions. Four major groups of substrates for the CaM KII (250 k M(r), 200 k M(r), 180 k M(r), and 140 k M(r)) and one for kinase C (17 k M(r)) were identified. The 250 k M(r) substrate resembled P400 protein, IP3 receptor, in structure. The 17 k M(r) substrate was different from myelin basic protein which was electrophoresed nearly at the same distance. We made an antibody against the 140 k M(r) substrates to obtain biological and physicochemical properties of the protein. We also made an antibody specific to the Thr286-autophosphorylated and autonomous form of CaM KII. The latter antibody is an extremely useful reagent to understand the biological functions of the CaM KII, especially the role of autophosphorylation of the kinase in modulation of the synaptic function such as in LTP.


[The pathogenesis of Alzheimer's disease demonstrated by immunocytochemistry with anti-beta-protein antibody].

Alzheimer's disease is the most common cause of dementia in the elderly. The characteristic neuropathologic findings in this disease are neurofibrillary tangles, senile plaques, and often amyloid infiltration of cerebrovascular walls. These lesions are commonly found in the neocortex and hippocampus, and their clinical significance has been highlighted by quantitative studies showing a significant correlation between the numbers of neurofibrillary tangles and senile plaques and the clinical severity of dementia. In 1984, Glenner and Wong isolated a novel protein (termed "beta-protein") from cerebrovascular amyloid of individuals with Alzheimer's disease and adult Down's syndrome. In the following year, Masters et al, using amino acid sequence data, demonstrated that beta-protein is also a component of senile plaque amyloid fibrils. Subsequently, this chemical data was supported by light microscopic and electron microscopic immunohistochemical studies showing that cerebrovascular and senile plaque amyloid deposits are reactive to synthetic beta-protein peptide antibodies. In addition, some recent histochemical and immunocytochemical studies have revealed important new information on the pathogenesis of the senile plaque: senile plaques may undergo sequential structural changes. On the basis of the investigation on a series of Down's syndrome cases, an extensive appearance of beta-protein deposits is an early pathologic change in Alzheimer's disease, and the formation of neurofibrillary changes, including tangles, develops at an advanced stage. The availability of beta-protein amino acid sequence data led to the identification of a full-length cDNA clone coding a possible precursor of amyloid beta-protein. However, the origin or function of this beta-protein precursor still remains uncertain. Further studies are required to know the exact pathogenesis of Alzheimer's disease.


[Discriminative stimulus properties of D-amphetamine: a neuropharmacological review].

It has been reported that laboratory animals can discriminate the presence of the psychomotor stimulant, D-amphetamine, from a non-drug or another drug condition. Under test conditions, doses lower than the training dose typically result in proportional decreases in D-amphetamine-appropriate responding, that is, dose-response curve is obtained. When drugs other than the training drug (D-amphetamine) are tested, they produced drug-appropriate responding to the extent that they resemble D-amphetamine (generalization or substitution test). And some antagonists (e.g., chlorpromazine) attenuate the stimulus effects of training drug. In the present review, the attempt to characterize the neuropharmacological characteristics of the discriminative stimulus properties of D-amphetamine is presented. The neural processes due to the transduction of D-amphetamine into stimulus properties may primarily involve central dopaminergic nervous system. Furthermore, drugs that share the discriminative stimulus properties in laboratory animals often produce similar subjective effects in human.


[Autoradiography for drug metabolism and pharmacokinetics study].

Since Ullberg presented a macroautoradiograph showing the distribution of 35S-benzylpenicillin in rats by use of a commercial X-ray film in 1954, anything besides X-ray film has never been used for macroautoradiography. In the minireview a new type of radiation sensor, "Imaging Plate" (IP), is introduced as a useful sensor as a sensor that is more useful than previous ones. The IP is a photo-stimulable phosphor that can trap and store the radiation energy quantitatively. About 100 times higher sensitivity than any of ordinary X-ray films and very precise quantitativeness are demonstrated by many results reported recently. Simple procedures are herein presented with a few demonstrative examples of macro- and microautoradiography.


[Regulation of (-)-sulpiride-induced increase in evoked dopamine release from striatal slices in rat].

The effects of dopamine (DA) agonist and antagonists on (-)-sulpiride-induced increase in electrically evoked DA release from striatal slices of rats were investigated. (-)-Sulpiride at concentrations of 10 nM to 1 microM in the superfusate caused a dose-dependent increase in electrically evoked DA release from the slices. (+)-Sulpiride had little effect on the evoked DA release up to 1 microM. Apomorphine inhibited the electrically evoked DA release which was antagonized by sulpiride. SCH 23390 and forskolin had no effect on the sulpiride-induced enhancement of evoked DA release. Pretreatment with the irreversible DA receptor antagonist, N-ethoxy-carbonyl-2-ethoxy-1,2-dihydroquinoline (EEDQ), caused a significant increase in evoked DA release and prevented the sulpiride-induced increase in evoked DA release. These results indicate that the sulpiride-induced increase in evoked DA release is due to an antagonism of the activation of DA autoreceptors by endogenously released DA.


[Soft tissue sarcoma in adulthood].

Soft tissue sarcomas (STS) represent a heterogenous group of malignant tumors arising in mesenchymal tissue and in the autonomal and peripheral nervous systems. Only 1% of all malignancies in adults are STS. Most of them are localized at the extremities, but they also occur in the abdomen and the thorax as well as at the abdominal and chest wall. They are usually surrounded by a pseudocapsule which contains tumor cells and they can exhibit a discontinuous growth pattern. Macroscopically undetectable branches might grow along given anatomical structures. Thus the whole sarcoma-related anatomic compartment should be judged as tumor-contaminated. The high rate of local failure is often caused by insufficiently extended primary resections. Lymph node metastases are rare. The main prognostic factors are histological grading, tumor size and surgical radicality. Diagnosis of STS is often made at a rather late state of tumor progression often too late for curative therapy. Early histological diagnosis is thus of great importance. The operation aims at the removal of the whole tumor bearing anatomic compartment. Even wide excisions of the sarcoma surrounded by 3 cm of tumor free tissue will lead to at least 60% local recurrencies. Excisions along the pseudocapsule (enucleation) will most likely leave parts of the tumor behind. Insufficient surgical radicality cannot be compensated for by adjuvant therapies. The resection should be carried out without compromises.


[AA-amyloidosis in inflammatory rheumatic diseases. A report of clinical experiences].

A review of the literature on rheumatic diseases with secondary amyloidosis and our diagnostic and therapeutic experiences in 33 own cases were reported. The place of subcutaneous fat biopsy in the diagnosis of secondary amyloidosis was shown included our own results and the corresponding literature. We saw amyloidosis type AA mostly in patients with high disease activity and progressive stage. There is no sure relationship to the duration of the disease. The renal involvement is clinical most significantly and also most frequently. The renal amyloidosis type AA can be influenced therapeutically however only in normal or unimportant restricted renal function. The therapeutic success is not depended on the choice of the long acting antirheumatic drug. The results were discussed in respect with the current literature.


[Data of two years of the comparative study methotrexate/aurothiomalate in 102 patients].

102 patients (pat.) with active erosive rheumatoid arthritis (RA) with a median disease duration of only 14 months without malalignment or deformities entered a randomized study to compare the effects of 15 mg methotrexate (MTX) and 50 mg gold sodium thiomalate (GST) administered intramuscularly once a week. The study was double blind during the first year and open during the second year. Clinical and laboratory evaluations were made every three months. X-rays of hands, wrists and forefeet in standard a.p.-projection were taken at month 0, 6, 12 and 24. 32 joints were evaluated according to Larsen. 17/52 (MTX) and 21/50 (GST) patients were withdrawn for several reasons. Withdrawals for toxicity were significantly more frequent in the GST group. 35 patients in the MTX group and 26 patients in the GST group were evaluated for efficacy. All clinical parameters, ESR and CRP improved by more than 50% in both groups without significant intergroup difference. The greatest improvement was seen already after six months. An > 50% improvement occurred in 57% of pat. in both groups. The Larsen score (sum of the Larsen grades of 32 joints) deteriorated significantly in both groups during the first six months (MTX = 3.0, GST = +4.3), it remained stable thereafter in the MTX group and decreased in the gold group. The number of erosive joints increased significantly in both groups during the first six months. This increase was slowed down after six months in the MTX group, in the gold group a decrease was seen indicating a healing of erosions. All differences between the groups were not significant, however. While tolerability was better with MTX, both drugs were similarly effective in the treatment of RA and slowed down radiologic progression.


[The incidence of wound healing disorders in heart surgery].

In a five-year retrospective study we investigated the wound infection rate after median sternotomy in 2805 adult patients on whom elective surgery had been performed with extracorporeal circulation. On the basis of 14,700 apparently relevant data from 101 patients with wound healing disturbances at the sternotomy site, both the significance of predisposing risk profiles and the prevalence of nosocomial pathogens were evaluated. The control group was formed by 100 patients selected at random. The results were checked for statistical significance using the X2 test for alternative characters; the significance level was set at alpha = 5%. The infection rate observed in our group was 3.6%, which was assigned to 5 internally defined degrees of severity. Cases of healing by second intention were caused to 93% by coagulase-negative staphylococci and staphylococcus aureus. Factors leading to a decrease in oxygenation of the wound area (low-output syndrome, rethoracotomy), diabetes, obesity and the duration of wound drainage were accompanied by a significantly more frequent occurrence of wound healing disturbances. On the other hand, perfusion-technical parameters, operation duration, revascularisation techniques (IMA/ACVB), pulmonary conditioned hypoxemias and the end-of-year desinfection usual in our clinic had no influence on wound healing. Seasonal fluctuation of the epidermal microclimate appear to be responsible for the prevalence and virulence of the pathogen strains in the clinic environment. The preventive measures used in cardiosurgical clinics do not yet represent a fully developed prophylaxis against exposure to nosocomial pathogens.


[L-tryptophan-associated chronic eosinophilia-myalgia syndrome treated with cyclosporin].

After 2 weeks of ingestion of 130 g L-Tryptophan a 52 year old female develops an Eosinophilia Myalgia Syndrome with acute onset of deep venous thrombosis of forearm and possible initial cardiac manifestation featuring intermittent sinustachykardia. This is followed by a severe chronic disease (follow-up 15 months) with diffuse scleroderma and sensomotoric polyneuropathia. The deep muscle biopsy-specimen shows mononuclear infiltration of fascia and interstitial myositis with rare eosinophils. A blood eosinophilia (900/ul) occurs only in the initial acute onset of the illness. Plasma level of Kynurenine is significantly high (4000 pmol/ml), collagenneosynthesis is activated (Procollagen type III peptid 0.927 U/ml). No significant clinical improvement was seen with Acathioprine (100 mg/d) and Prednisolon (40-60 mg/d), after treatment with Ciclosporin scleroderma regresses completely, polyneuropathy is persisting.


[Arthrography of the iliosacral joint].

We anatomically dissected four pelvic bones without damaging any ligaments, and tried to find a dorsal approach to arthrograph the sacroiliac joint. The joint could not be punctured through its proximal two-thirds: on the one hand, because of its overall angulated orientation, on the other hand, because of the significant overhang of the spina iliaca posterior superior, medially, and the impossibility to make further needle corrections through the very strong ligaments. The only possible approach was situated one finger's width medially to the spina iliaca posterior inferior, with the needle directed laterally at an angle of 20 degrees to the horizontal. Only 0.1-0.2 ml of contrast fluid could be injected. The arthrographic information was reduced to only determining the form of the joint; the state of the cartilage and integrity of the capsule could not be assessed. The best image exposure had to be determined individually and for each case under fluoroscopy, with, unfortunately, a certain level of irradiation. In vivo, the puncture of the lower third of the joint is impossible; the concept of "intraarticular injection of the sacroiliac joint" must be abandoned, as this joint can hardly be punctured dorsally.


[Treatment of type II B open fracture--therapeutic regimen and results].

A consecutive series of 119 type III B compound fractures in 103 patients was treated at the University of Louisville from May 1983 to May 1989. All patients had timely irrigation of their wounds, serial wound debridements, external skeletal stabilization and parenteral systemic antibiotics (penicillin, cefazolin, tobramycin). 96 open fractures were managed with the supplemental local use of tobramycin-PMMA-beads. There were 13.5% wound infections and 10.1% osteomyelitis observed. The additional local antibiotic therapy was of significant (p less than 0.001, p less than 0.025) benefit to lower both infectious complications. The amputation rate was overall 5%, 9.7% for the lower leg. Four patients died due to multiple trauma.


[Closing the resection surface in left pancreatic resection with the surgical stapler].

In the present paper a technique is demonstrated wherein the closure of the pancreatic remnant following left pancreatectomy with absorbable staples was performed. The good results with minimal complications recommend this method.


[3H-thymidine incorporation into chondrocytes of arthritic cartilage].

An autoradiographic investigation was done to characterize cell proliferation in osteoarthrotic cartilage with regard to the formation of clusters. Altogether, 3H-thymidine labelled chondrocytes were rarely observed--a labelling index of 0.5/1000 was calculated. One isolated 3H-thymidine labelled mitosis was found. Labelled cells were often encountered in chondrocyte clusters leading to the assumption that an increased proliferation of chondrocytes is the mechanism of cluster formation.


[Perioperative treatment in elective colorectal resection in Germany].

The perioperative treatment of patients with elective colorectal resections in 1086 german hospitals was analysed. In 40% of all hospitals preoperative parenteral nutrition was administered. Following resection iv-fluids were administered in every hospital (6.2% hypo-, 72.4% normo-, 18.7% hypercaloric). Systemic chemoprophylaxis with iv-antibiotics was given in 95.4% of all hospitals. Preoperative bowel preparation included orthograde lavage in 86.1% of the hospitals and oral non-resorbable antibiotics were given in 22.5%. 40.1% of all surgeons performed intraoperative testing of colorectal anastomoses and abdominal drains were used on a regular basis in more than 83% of the hospitals. The principles in perioperative treatment of patients with elective colorectal resections are almost identical all over Germany. Minor differences in perioperative treatment occurred in association with localisation, class of hospital, size of surgical department and annual amount of resections. Also differences between clinical practice and results of recent scientific studies can be observed.


[Preoperative intestinal lavage with a polyethyleneglycol-containing solution. A prospective randomized study in comparison with Ringer's lactate solution].

Aim of that study was to prove, whether a solution containing polyethyleneglycol (PEG) is more useful in comparison to the normal method using Ringer's-lactate solution for preoperative bowel preparation. From January 1990 up to February 1991 we compared in a prospective randomized simple blind study on 110 patients the whole gut solution (Hewitt) to a bowel preparation with PEG (Oralav). The patients, that were prepared in the common way (Ringer's-lactate, control group; n = 54) were approximately given the double amount of liquid (9663 ml) as those in the other group (target group; n = 54: 4777 ml). We found no significant differences concerning the electrolytes. Hemoglobin (-1.1 g/dl) and hematocrit (-3.5%) were significantly lower in the control group. Both groups showed a similar frequency of nausea (control group 25% vs target group 34%). Vomiting was mainly found in the control group (20.8% vs 1.9%). Both groups showed comparably good results in bowel cleansing. Between the two groups we found no differences in specific bowel bacterial flora. Characteristic and number of postoperative complications were similar low (5.7 vs 3.8%). Due to a better compliance by oral application, the lower given amounts of liquid and the equal cleansing effect we prefer the use of the PEG containing solution (Oralav).


[Angioarchitecture of the ileum and colon in Crohn disease].

Vascular changes in resected bowels of Crohn's disease were examined angiographically, microangiographically, micro-preparatorily and histologically. The proper angioarchitecture of the small and the large bowel is being destroyed in the course of the ongoing inflammatory process. Dilated capillaries, destruction of the primary angioarchitecture and its replacement by an irregular, partially bizarre pattern of scar vessels with bundling of the unchanged Vasa recta as varying vessel diameters caused by obliterating secondary fibroses can be seen in advanced Crohn's disease. The angioarchitecture of the pseudo-polyps in Crohn's disease is characterized by an increased number of vessels, bizarrely bended vessels and a radial pattern of veins. All these vascular changes in Crohn's disease are to be seen as secondary changes due to the inflammatory reaction.


[Puncture catheterization of central veins--experiences from a primary care clinic].

We introduced in the years 1984-1989 317 central venous catheters. Our results and conclusions for using those catheters in smaller hospitals are described. 4 physicians inserted under standardized conditions 317 central venous catheters in the intensive care unit using the transmuscular way for puncturing the V. jugularis interna and the infraclavicular way for puncturing the V. subclavia. Puncturing the V. basilica complications were not registered. By the V. subclavia route a Pneumothorax rate of 1.7% and an arterial puncture rate of 4.1% were found compared with a 4% arterial puncture rate using the V. jugularis interna. We couldn't find the V. subclavia in 3.4% and the V. jugularis interna in 8%. The complication rate decreased with increasing experience of the physicians. The positions of the catheters in the venous system were not appropriate in 46.9% of the cases after puncture of the V. basilica and in 1.3% after puncture of V. subclavia. Wrong catheter positions were not found after puncturing the V. jugularis interna. Complications as thrombophlebitis were observed in 6.5% after puncturing the V. basilica and 1.1% of the cases after V. subclavia puncture. Central venous catheters can be safely used also in smaller hospitals if applied by a standardized method. A limited team of physicians can get enough experiences also in a slight number of patients, so that complication rates as low as in international statistics were found.


[The compartment syndrome with special reference to vascular surgery aspects. A patient sample of the Cologne University Clinic 1981 to 1991].

The compartment syndrome, a well known complication in traumatized patients, is not taken enough notice of in the literature of vascular surgery despite it's obviously important pathophysiological context. Considering arterial occlusive disease the ischemia as well as the reperfusion can increase the compartmental volume respectively the tissue pressure. The subfascial pressure measurement should not lead to a false certainty, since no critical pressure values exist that can serve as a general criterion for diagnosis and treatment. The "thought about it" may be the first step to a clinical diagnosis and subsequent therapy. Decompression of all four compartments at the lower leg by the technique of Matsen represents the therapy of choice for the compartment syndrome of the lower leg.


[Serum gastrin level in patients with colorectal adenoma or carcinoma].

During the last years interest has focused on the trophic effect of gastrin in colorectal carcinomas. Some reports indicated an increased serum level of gastrin in patients with colorectal adenomas or carcinomas. In a prospective study in 261 patients submitted to colonoscopy fasting serum gastrin concentrations were determined. 91 patients served as control, 89 patients had one or more adenomas, 55 patients suffered from a colorectal carcinoma, 17 had a benign, postoperative stenosis of the colon, and 9 had a chronic inflammatory bowel disease. All patients fulfilled the following criteria: No regular drug intake, no previous gastric or small bowel operation, no known ulcer disease, no abnormalities in serum calcium, creatinine, triglycerides, cholesterol and blood urea. Mean gastrin level was 86.63 +/- 23.8 pg/ml in the control, 84.57 +/- 25.1 pg/ml in the adenoma group and 84.6 +/- 24.4 pg/ml in the carcinoma group. No difference of serum gastrin levels were observed regarding sex, age, tumor stage and localisation.


[Results of surgical therapy of choledocholithiasis--a retrospective study].

A multimodal therapeutic concept of choledocholithiasis with endoscopic and surgical procedures is presented. Between January 1986 and December 1990 106 patients with choledocholithiasis were operated. These patients are retrospectively analyzed. The success rate is 95.3%, the morbidity 18.7% and the mortality 0. These results are compared with the published data of the surgical or endoscopic therapy of the choledocholithiasis.


[The arterial blood supply of extrahepatic bile ducts of the donor liver].

The discussion of the etiopathogenesis of biliary complications after orthotopic liver transplantation have always encountered the problem of the status of a limited or interrupted blood supply of the ductus hepatocholedochus in the liver graft. For the description of the arterial vascular anatomy of the common bile duct 40 liver specimen were postmortem explanted and injection replica were made using corrosion technique. The arterial structures were systematically analysed and classified on the basis of their origin, distribution, calibre and combination. As a result, two types of arterial blood supply were defined and conclusions drawn for the surgical dissection during hepatectomy of the graft.


[Gunshot and stab injuries of the abdomen].

From 1973 to 1991 a total of 422 patients underwent surgery because of an abdominal trauma. 12 patients had gunshot wounds and 46 patients stab wounds. In a retrospective study the diagnostic and therapeutic procedure and the indication for surgery are analysed. After gunshot wounds of the abdomen we always performed a laparotomy. In 11 od 12 cases we found serious intra-abdominal injuries. Only in one case the laparotomy was "unnecessary", because of a tangential wound without penetrating of the abdominal wall. After stab wounds the diagnostic and therapeutic management was more selective. Indications for mandatory laparotomy after stab wounds were a manifest hemorrhagic shock, evisceration and a still left weapon in the abdomen (n = 22). The first clinical examination was completed by ultrasound or peritoneal lavage. Pathological findings like free intraperitoneal fluid or a positive lavage also were indications for laparotomy (n = 9). The other patients were observed closely, including repeated physical examination. The indication for surgery then based on the development of clinical signs. The time between first examination and laparotomy was never more than 12 hours. 39 patients (84.7%) had injuries of intraabdominal organs. 5 patients (10.8%) had a negative laparotomy. The mortality rate was 3.4%, but there was no death as a result of the selective approach.


[Use of the dynamic condylar screw in fractures of the coxal end of the femur--are there advantages in gerontologic traumatology?].

Till now instable fractures of the upper end of the femur were treated by using the 95 degrees fixed angle blade in gerontotraumatology, too. As an alternative treatment within 16 month we used the dynamic condylar screw (DCS) in 87 cases of patients elder than 65 years. The results were compared to 81 patients, who had been treated by implantation of 95 degrees fixed angle blades. As to gerontotraumatology it was interesting, that there were no DCS-specific complications, which demanded operative revision. Advantages of the DCS are easy insertion, firm fixation, increased strength and resistance to stress failure, short times of operation and hospitalisation. The most important disadvantage--as to gerontotraumatology--however is the not existing primarily load capacity.


[External torsion fractures of the tibia combined with ankle joint fractures].

The aim of this retrospective study is to emphasize on combined fractures of the tibia with lesions of the ankle joint. The report bases on 820 fractures of the lower leg. 123 cases showed external rotation fractures of the tibia, which were combined with lesions of the ankle joint in 88 cases. 25 patients were operated on the ankle joint. Because of the combination of external rotation fractures with lesions of the ankle joint, which accounted to 65% of the posterior tibial margin, to 17% of the lateral malleolus and to 3% of the syndesmosis, it is important to investigate the ankle joint radiologically and clinically.


[Uterine abnormality and fallopian tube damage--surgical correction in one session?].

From 1983 to 1990 15 metroplasties were carried out at the Department of Obstetrics and Gynecology Greifswald. 11 of these operations were combined with a microsurgical tubal operation. For the diagnostics of uterus malformation and tubal damage as many methods as possible (hysterosalpingography, laparoscopy with chromotubation, hysteroscopy and sonography) should be used. A postoperative life birth rate of 62.5% shows that an operative correction of uterus malformation and tubal damage in one session is justified. Metroplasty is also indicated at primary tubal sterility with simultaneous uterus malformation. A caesarean section is not primarily indicated after metroplasty.


The grand multipara--an obstetric problem?

At the Medical Central Department of Obstetrics and Gynecology in Sibenik over 1970-1991 period there were 26,116 deliveries (multiple births excluded), of which 254 (0.97%) occurred in grand multiparas (five and more deliveries). The authors have found that the number of grand multiparas decreased by 38.3% (P < 0.001) over the past eleven years. Control subjects were 7920 multiparas (two to four deliveries, 20-34 years of age, from the same period). In 84.3% of the cases grand multiparas were delivered of their fifth or sixth infant, and 68.5% were > or = 35 years of age. Spontaneous abortion occurred in 16.9%, and 14.2% had no antenatal visit. EPH gestosis (8.3%), glucose intolerance (9.9%), preterm delivery (8.3%) and meconium-stained amniotic fluid (15.0%) were more common in the grand multiparas, whereas cervical cerclage (5.4%) and 7-to-12-hour duration of labour (12.8%) were more common in the control group. No significant differences were found in weight gain, prolonged pregnancy, caesarean delivery, assisted breech and vacuum extraction between two groups. There was also no difference in the incidence of neonatal morbidity and congenital abnormalities between the grand multiparas and controls. Late fetal and early neonatal deaths in the grand multiparous and control group occurred in 1.18% and 1.57, respectively, resulting in a 2.75% overall perinatal death rate for both groups (P > 0.05). No case of maternal death or uterine rupture occurred in either group. The authors conclude that pregnancy and delivery in grand multiparas are at higher risk due to poorer antenatal care and advancing maternal age.(ABSTRACT TRUNCATED AT 250 WORDS)


[Experiences in dealing with tubal sterilization].

The political changes in the GDR and the unity of Germany give the women the possibility of deciding for tubal sterilization as a method of contraception that was restrictively used in the GDR. This investigation analysis the psychosocial and medical factors influencing the women in their decision for sterilization. 103 women were interviewed with a questionnaire before they underwent tubal sterilization in a great medical center in Sachsen-Anhalt. The findings known in the literature regarding the satisfied after sterilization were discussed. However the sterilization is an intervention that should be thought over carefully.


[Lupus anticoagulant and antiphospholipid antibody values in a family with systemic lupus erythematosus].

The Lupus Anticoagulant (LA) is an immunoglobulin directed towards the phospholipid portion of the prothrombin activator complex. This immunoglobulin because first identified in the plasma of patients with Systemic Lupus Erythematodes, was named as Lupus Anticoagulant. Although initially described in patients with SLE, it was subsequently observed in other diseases and also in patients without any manifest disease. SLE or similar diseases are present in 35% of LA (+) patients. The LA prevalence in SLE patients has been found as 34% whereas ACA prevalence was found as 44%. While searching for the presence of LA and the levels of APA in cases having unexplained recurrent fetal losses, a family (a mother and 3 daughters) was discovered, whose each member has been diagnosed as SLE at different times and with different symptoms. Data suggesting the presence of LA and high APA levels were determined in all the members of the family and also it was realised that cause who had recurrent fetal losses had the highest APA levels. In addition to immunoassay methods to detect APA, examination of coagulation tests in patients with unexplained thrombosis and/or fetal losses, would be of great help.


Acute periappendicitis after an elective section.

The diagnosis periappendicitis is well known. The causes to periappendicitis are manifold. In the literature, we have not yet found a case, where periappendicitis developed because amnion fluid passed to the peritoneum during an elective section. We present a case, where a patient, 5 days after an elective section, developed the symptoms of appendicitis. The pathologic diagnosis is periappendicitis, presumably developed because of the amnion fluid.


[Factor XIII deficiency: blood coagulation defect in pregnancy].

Rare haemorrhagic disorders cause a lot of diagnostic and therapeutic problems to the obstetrician. By means of a pregnancy course and a birth process a report is given on the physiological drop of the factor XIII serum concentration and its difficult clinical interpretation. This paper presents pathophysiology, symptoms, complications and treatment of factor XIII deficiency in pregnancy.


[C-1 esterase inhibitor deficiency as an obstetric problem: a case report].

The present paper reports a case of C-1-esterase-inhibitor-deficiency in pregnancy. After preoperative i.v. application of 500 E-1-esterase the section caesarean was performed. Problems of this disease, relevant for obstetrics have been described. An interdisciplinary cooperation between obstetrics, anaesthetics and dermatologists is important.


[Functional aspects of healing in microsurgical tubal anastomosis--experimental studies of the rabbit fallopian tube].

Ovarian function and fertility was studied in 46 female New Zealand White rabbits after isthmic-isthmic reanastomosis of the oviduct. Postoperative ovarian function was slightly suppressed and returned to normal after two month. No significant differences were found between the control side and the side of anastomosis. Fertility was reduced directly after surgery on the side of anastomosis as well as on the control side. On the side of reanastomosis a continuous increase of tubal function occurred up to two month after surgery. At this time tubal function was reduced to 30%, the nidation index was about 0.6. Tubal function of the untreated oviduct was nearly normal (nidation index 0.8) two weeks after surgery.


[Ultrasound assessment of the endometrium in early detection of endometrial cancer in high risk patients].

In 300 postmenopausal adipose and complaint-free patients but with one risk factor for the development of endometrial carcinoma one prospective study transabdominal and transvaginal ultrasonographic examinations by 3.75-MHZ abdominal and 5-MHZ vaginal sound was carried out. In all cases with endometrial thickness of 10 mm and also with endometrial thickness of 5-10 mm and irregular endometrial boundary fractional curettage was done. The rate of abnormal findings was 8% of which in 18 patients the findings were histologically confirmed (3 endometrial cancer, 5 hyperplasia, 8 polyp and 2 submucosal myomas). The sensitivity of ultrasonography was found to be 75%. Patients with normal findings were controlled in 6 months, none of these patients showed pathological symptoms.


[Organ preserving endosurgery in pyosalpingitis].

Pyosalpinges are a difficult therapeutic problem in a complicated pelvic inflammatory disease. To avoid a diffuse peritonitis, often a laparotomy with salpingectomy is performed. 20 women of reproductive age with a uni- or bilateral pyosalpinx were incorporated in a prospective study to investigate the possibilities of a combined endosurgical/antibiotical treatment. After endoscopic confirmation, the patients were taken into study. During diagnostic laparoscopy, a salpingotomy with rinsing of the tubes and a drainage of the Douglas pouch took place. After one week of antibiotic treatment, a second-look laparoscopy was performed in all patients; no recurrence was documented. The combination of endosurgery and chemotherapy showed to be a safe and efficient therapy of tubal abscesses in women of reproductive age.


[Duplicity of Gartner duct cysts--a single case report].

A 44 year old patient has pains over a long period of years. Only surgical removal of residuals of Gartner-duct-system both para-vaginal and sub-urethral could make her painless.


Surgery, dopamine agonist therapy of combined treatment--results in prolactinoma patients after a 12 month follow-up.

In a non-randomized retrospective study n = 36 prolactinoma patients (n = 7 micro- and n = 29 macroadenomas) were evaluated before (E0), 4 (E1) and 52 weeks (E2) after applying 3 different treatment modalities: A dopamine agonist (DA) therapy (n = 14), B surgery as initial procedure (n = 12) and oral DA therapy, C DA preinjection, subsequent surgery (n = 10) and oral DA medication. T0 outline the effect of the 3 regimens upon serum prolactin (PRL) and tumour size reduction, clinical signs and symptoms, anterior/posterior pituitary lobe function and MRI/CT findings were evaluated in each patient at E0, E1 and E2. In group A, PRL normalization was achieved in n = 10 patients (71%), although the frequency of an empty sella was only one out of 12 macroprolactinoma patients (less than 10%). Patients of group C showed the lowest PRLE2 levels (32 +/- 11 ng/ml, normalization rate 60%), although not statistically significant when compared with the other groups (A: 41 +/- 28 ng/ml, B: 114 +/- 33 ng/ml, normalization rate 31%). According to MRI studies in groups B and C total removal was achieved in 33% and 50% of macroprolactinomas, respectively. The most favourable ratio of the leading pre/posttreatment signs and symptoms was observed in patients of group C. It was concluded that no superiority of either treatment regimen exists for prolactinoma patients. Each mode of therapy has its own benefits which may be applied to the different biological behaviour of a prolactinoma in the respective patient.


[Delayed onset of postoperative deterioration in clivus chordoma and clivus meningioma].

The starting-point of the presented retrospective, clinical study is the observation, that in some cases a delayed postoperative neurological deterioration develops after removal of great, extraparenchymal, infratentorial brain tumors. Therefore, we evaluated the postoperative clinical course of 50 clivuschordomas and clivusmeningiomas of the Neurosurgical University Clinic in Mainz (Germany). The results obtained show, that 1 of 3 patients develops a delayed, postoperative deterioration. Important factors, which cause that deterioration, are the age of patients and the size of tumors. Mostly, we found a perifocal edema concomitant to the delayed deterioration within the decompressed brain tissue. We call that phenomenon "decompression edema" as a "hypothesis a posteriori", which has to be proven experimentally.