[Possible influence of knee scores]

This study evaluated 96 knee joints with osteoarthritis (degree I according to Resnick). The patients were examined by three examiners with the following score systems: Larson, Lysholm, Marshall, Orthopädische Arbeitsgemeinschaft Knie (OAK), Hospital for Special Surgery (HSS), Visual Analog Scale (VAS), Tegner activity level, and the International Knee Documentation Committee (IKDC) scoring system. The portion of subjective criteria varied in the different scores between 22 and 95 %. Nevertheless, the agreement between criteria showed high correlations among the different examiners. Depending on the scoring system used and the examiners, different values were achieved. The results were significant at the 5 % level for the numerical results (Friedmantest) and for the total results (Bowkertest). The Lysholm score showed results that were extremely dependent on the different examiners, and the evaluation was very strict. The HSS scoring system was not as strict. The Marshall and the OAK scoring system presented few differences. The Larson score results compared with the OAK, and the Marshall score results showed comparable results in the evaluation by the different examiners. The Visual Analog Scale presented difficulties when used by the patients. The results showed a tendency to the middle values, the patients did not use the whole spread. Apart from this, the correlation between these VAS values and the results of the other scoring systems were high. Since it was only used one time, the Tegner activity level could not efficiently show the limitation caused by knee-joint damage. At the level of 1-4 the Lysholm scoring system and the VSA scale resulted in high values.

The "hybrid" approach for revascularisation: direct myocardial revascularisation and coronary angioplasty

We report the cases of two patients where catheter-based laser direct myocardial revascularisation has been coupled with conventional coronary angioplasty at the same sitting using the Biosense left ventricular electromechanically guided laser procedure. In both the cases, the non-revascularizable ischaemic target zone was identified using left ventricular electromechanical mapping signals, and Ho: YAG laser channels were placed at the designated target lesion following successful coronary stenting. The results did not show any procedural complications. This preliminary report suggests the feasibility and safety of this "hybrid" percutaneous approach for myocardial revascularisation.

Suppression of ongoing experimental myasthenia by oral treatment with an acetylcholine receptor recombinant fragment

Myasthenia gravis (MG) is an autoimmune disorder in which the nicotinic acetylcholine receptor (AChR) is the major autoantigen. In an attempt to develop an antigen-specific therapy for MG, we administered a nonmyasthenogenic recombinant fragment of AChR orally to rats. This fragment, corresponding to the extracellular domain of the human AChR alpha-subunit (Halpha1-205), protected rats from subsequently induced experimental autoimmune myasthenia gravis (EAMG) and suppressed ongoing EAMG when treatment was initiated during either the acute or chronic phases of disease. Prevention and suppression of EAMG were accompanied by a significant decrease in AChR-specific humoral and cellular responses. The underlying mechanism for the Halpha1-205-induced oral tolerance seems to be active suppression, mediated by a shift from a T-helper 1 (Th1) to a Th2/Th3 response. This shift was assessed by changes in the cytokine profile, a deviation of anti-AChR IgG isotypes from IgG2 to IgG1, and a suppressed AChR-specific delayed-type hypersensitivity response. Our results in experimental myasthenia suggest that oral administration of AChR-specific recombinant fragments may be considered for antigen-specific immunotherapy of myasthenia gravis.

Phylogeographical autocorrelation of phenotypic evolution in honey bees (Apis mellifera L.)

The analysis of phenotypic divergence among local populations within a species has been traditionally performed in a spatial context, although advances in genetic analysis using mtDNA have permitted a simultaneous evaluation of geographical and historical patterns of variation, so-called phylogeographical analysis. In this paper, we combine these two dimensions of variation (geographical space and phylogenetic history) to evaluate patterns of phenotypic evolution in honey bees (Apis mellifera L.). Data on 39 phenotypic traits, derived from 417 colonies grouped into 14 subspecies, were analysed using autocorrelation methods. Mantel tests indicated that the relationship between phenotypic divergence, estimated by Euclidean distances among subspecies' morphological centroids, was significant both when compared to geographical distance (r=0.371; P < 0.01) and to genetic distance (estimated as sequence divergence (%) in a mtDNA region encompassing part of the NADH dehydrogenase subunit 2 and isoleucine transfer RNA (r=0.329; P < 0.01)). For the analysis of each trait, the effects of the geographical co-ordinates (latitude and longitude of subspecies geographical range) and of the phylogenetic patterns (defined by eigenvectors of the genetic distance matrix) on phenotypic variation were simultaneously analysed using an extension of a recently developed model, called Phylogenetic Eigenvector Regression (PVR). In general terms, the partial regression slopes indicated that the variation in the characters traditionally associated with adaptive processes, such as body and wing size, were better explained by geographical position. However, characters usually thought to be neutral, such as wing venation angle, were more associated with phylogeny. This is expected because PVR can be interpreted as a partition model, in which adaptive variation tends to be independent of phylogeny (and, in this case, associated with geography). In addition, the first principal component derived from the expected values of the model for each trait, which can be interpreted as the phenotypic variation predicted by phylogeny, is more structured in a north-south cline than are the original data, supporting an adaptive interpretation. The phylogeographical autocorrelation analyses performed in this study show that different traits are more related to one of the two dimensions of variation (geography and phylogeny), and these patterns can furnish insights into the nature of phenotypic evolution in these organisms.

Evaluation of the acute and chronic safety of the biosense injection catheter system in porcine hearts

Direct myocardial injection of therapeutic agents has been explored as a new method for myocardial revascularization. The integration of a 3D electromechanical mapping catheter with a retractable injection needle should allow for intramyocardial injection to identified sites, obviating the need for open heart surgery. This study assessed the procedural safety and performance characteristics of a novel guided catheter-based transendocardial injection system. The electromagnetic guidance system was coupled with a retrievable 27G needle for left ventricular endocardial injection. Using this system, we injected, transendocardially, methylene-blue (MB) dye tracer at a volume of 0.1 or 0.2 ml per injection in eight normal pigs. Animals were sacrificed acutely, at 1, 3, and 7 days (two animal in each time). Three animals served as controls. The injections were followed by coronary angiography and echocardiogram to assess possible ventricular or coronary perforation and wall motion abnormalities. CK-MB levels were measured up to 24 hr following the procedure. The animals were sacrificed at the assigned time for gross and histopathology evaluation. A total of 101 injections were made in all regions of the heart except the apex and the mitral valve. No animal died as a result of the mapping or injection procedures. Vital signs did not change relative to baseline after the mapping and injection procedures. CK-MB values did not increase over time and there was no evidence of sustained arrhythmia or hemodynamic compromise. There was no evidence of left ventricular or coronary perforation, global or regional wall motion abnormalities, or hemopericardium. On histologic evaluation, the estimated volume of tissue staining was greater than the volume of the injected MB dye due to dispersion of the injectate in the interstitial and intracellular fluid compartments. It is concluded that using this magnetic guidance catheter-based navigational system, it is feasible and safe to perform the transendocardial injection procedure. Thus, if it is determined that direct intramyocardial injection of drugs is a valid therapeutic strategy, this approach offers a clear advantage over surgically based transepicardial injection procedures. Cathet. Cardiovasc. Intervent. 48:447-453, 1999.

[Effect of knee joint flexion and femur rotation on retropatellar contact of the human knee joint]

The aim of the present study was to evaluate retropatellar contact characteristics at different angles of flexion of the knee joint. To this end, 6 cadaveric legs were examined using pressure sensitive film (Fuji Prescale type "super low") at angles of flexion of 45 degrees, 60 degrees, 90 degrees and 120 degrees both in neutral rotation and 10 degrees internal and external rotation of the femur in the same knee joints. A force of 140 N was applied to both the vastus medialis and lateralis, and a comparison made with a medially and a laterally dominating muscle force. The contact areas decreased with increasing angles of flexion. The medially dominating muscle traction increased the contact area. Comparison between internal and external rotation revealed a decrease in contact area on internal rotation. The pressure measurements were comparable in all loading situations. Comparison between neutral and medial traction revealed significant differences in contact area, pressure and force. The influence of femoral rotation showed no significant difference. A comparison of the different angles of flexion revealed only few significant differences. To prevent the development of retropatellar arthrosis, maximum contact areas are necessary. The study has shown an advantage for medially dominating muscle traction, and external rotation of the femur.

The renal effect of low-dose dopamine in high-risk patients undergoing coronary angiography

OBJECTIVES

The purpose of the study was to examine the potential renal protective effect of low-dose dopamine in high-risk patients undergoing coronary angiography.

BACKGROUND

Contrast nephropathy is prevalent in patients with chronic renal failure (CRF) and/or diabetes mellitus (DM). Decreased renal blood flow due to vasoconstriction was suggested as a contributory mechanism. Low-dose dopamine has a dilatory effect on the renal vasculature.

METHODS

Sixty-six patients with mild or moderate CRF and/or DM undergoing coronary angiography were prospectively double-blindedly randomized, to either 120 ml/day of 0.9% saline plus dopamine 2 microg/kg/min (Dopamine group) or saline alone (Control group) for 48 h.

RESULTS

Thirty-three Dopamine-treated (30 diabetics and 6 with CRF) and 33 Control (28 diabetics and 5 with CRF) patients were compared. Plasma creatinine (Cr) level increased in the Control group from 100.6+/-5.2 before to 112.3+/-8.0 micromol/liter within five days after angiography (p = 0.003), and in the Dopamine group from 100.3+/-5.4 before to 117.5+/-8.8 micromol/liter after angiography (p = 0.0001), respectively. There was no significant difference in the change of Cr level (deltaCr) between the two groups. However, in a subgroup of patients with peripheral vascular disease (PVD), deltaCr was -2.4+/-2.3 in the Control group and 30.0+/-12.0 micromol/liter in the Dopamine group (p = 0.01). No significant difference occurred in deltaCr between Control and Dopamine in subgroups of patients with preangiographic CRF or DM.

CONCLUSIONS

Contrast material caused a small but significant increase in Cr blood level in high-risk patients. There is no advantage of dopamine over adequate hydration in patients with mild to moderate renal failure or DM undergoing coronary angiography. Dopamine should be avoided in patients with PVD exposed to contrast medium.

Cardiac troponin I levels and clinical outcomes in patients with acute coronary syndromes: the potential role of early percutaneous revascularization

OBJECTIVES

To establish the role of early catheter-based coronary intervention among patients sustaining acute coronary syndromes (ACS) stratified according to admission plasma troponin I (Tn-I) levels.

BACKGROUND

The impact of early revascularization strategy on the clinical outcomes in patients with ACS stratified by plasma Tn-I levels has not been established.

METHODS

In-hospital complications and long-term outcomes were assessed in 1,321 consecutive patients with non-ST elevation ACS undergoing early (within 72 h) catheter-based coronary interventions. Patients were grouped according to admission Tn-I levels. Group I (n = 1,099) had no elevated plasma Tn-I (<0.15 ng/ml), Group II (n = 95) had Tn-I level between 0.15 to 0.45 ng/ml and Group III (n = 127) had Tn-I >0.45 ng/ml. In-hospital composite cardiac events (death, Q-wave MI, urgent in-hospital revascularization) and 8 months clinical outcomes (death, MI, repeat revascularization or any cardiac event) were compared between the three groups.

RESULTS

The rate of in-hospital composite cardiac events was 6.1% among patients with Tn-I >0.45 ng/ml, 1.0% in patients with Tn-I between 0.15-0.45 ng/ml and 3.1% in patients without elevated admission Tn-I (p = 0.09 between groups). There was no difference in hospital mortality (p = 0.25). At eight months of follow-up, there was no difference in out-of-hospital death (3.5%, 3.8% and 1.8%, p = 0.17, respectively), MI (2.6%, 3.8% and 2.9%, p = 0.94) or target lesion revascularization (9.0%, 8.3% and 11.5%, p = 0.47), and cardiac event-free survival was also similar between groups (p = 0.66). By multivariate analysis, Tn-I >0.45 ng/ml was independently associated with in-hospital composite cardiac events [odds ratio (OR) = 2.4, p = 0.04] but not with out-of-hospital clinical events up to eight months.

CONCLUSIONS

In patients with ACS, early (within 72 h) catheter-based coronary intervention may attenuate the adverse prognostic impact of admission Tn-I elevation during eight months of follow-up despite a trend towards increased in-hospital composite cardiac events.

Central venous catheter mechanical irritation of the right atrial free Wall:A cause for thrombus formation

Thromboembolism is a major complication of long-term central venous catheter, usually associated with catheter or venous occlusion. Intracavitary right atrial thrombosis is currently considered to result from line-tip thrombosis extension. We report three adult patients in whom repeated mechanical trauma to the right atrial wall was probably the main mechanism. Transesophageal echocardiography revealed back and forth movement of the central catheter into a thrombus attached to the right atrial wall, thus suggesting a mechanism of catheter-associated thrombus formation, not previously visualized or suggested. Catheter removal and anticoagulation administration were undertaken with an uneventful clinical course and almost complete disappearance of the thrombi on transesophageal echocardiography follow-up.

Adenylyl cyclase interaction with the D2 dopamine receptor family; differential coupling to Gi, Gz, and Gs

1. The D2-type dopamine receptors are thought to inhibit adenylyl cyclase (AC), via coupling to pertussis toxin (PTX)-sensitive G proteins of the Gi family. We examined whether and to what extent the various D2 receptors (D2S, D2L, D3S, D3L, and D4) couple to the PTX-insensitive G protein Gz, to produce inhibition of AC activity. 2. COS-7 cells were transiently transfected with the individual murine dopamine receptors alone, as well as together with the alpha subunit of Gz. PTX treatment was employed to inactivate endogenous alpha i, and coupling to Gi and Gz was estimated by measuring the inhibition of cAMP accumulation induced by quinpirole, in forskolin-stimulated cells. 3. D2S or D2L receptors can couple to the same extent to Gi and to Gz. The D4 dopamine receptor couples preferably to Gz, resulting in about 60% quinpirole-induced inhibition of cAMP accumulation. The D3S and D3L receptor isoforms couple slightly to Gz and result in 15 and 30% inhibition of cAMP accumulation, respectively. 4. We have demonstrated for the first time that the two D3 receptor isoforms, and not any of the other D2 receptor subtypes, also couple to Gs in both COS-7 and CHO transfected cells, in the presence of PTX. 5. Thus, the differential coupling of the D2 dopamine receptor subtypes to various G proteins may add another aspect to the diversity of dopamine receptor function.

Biosynthesis of menthofuran in Mentha x piperita: stereoselective and mechanistic studies

Mentha x piperita shoot tips and first leaf pair were fed with aqueous solutions of [(2)H(2)]- and [(2)H(2)]/[(18)O]-labeled pulegone. The essential oil was analyzed by solid phase microextraction and enantioselective multidimensional gas chromatography/mass spectrometry. After feeding experiments with labeled pulegone racemate, both labeled (S)-menthofuran and (R)-menthofuran were detectable simultaneously together with genuine (R)-menthofuran. It could be shown that both labeled pulegone enantiomers are converted by Mentha x piperita to the corresponding labeled menthofuran enantiomers, favoring the labeled analogue of the nongenuine (S)-pulegone. The oxygen in menthofuran is introduced by enzymatic oxidation of pulegone, as concluded from feeding experiments with mixed labeled [(2)H(2)]/[(18)O]pulegone.

Functional anatomy of the kinesin molecule in vivo

We have developed an assay that allows the functional efficiency of mutant kinesins to be probed in vivo. We show here that the growth rate of the filamentous fungus Neurospora crassa can be used as a sensitive reporter for the ability of mutant kinesins to suppress the phenotype of the kinesin null mutant of Neurospora. Truncation mutants, internal deletion mutants and chimeras, in which homologous domains were exchanged between different fungal kinesins, were generated and transformed into the kinesin-deficient strain. None of the mutations affect motor velocity in vitro, but even minor alterations in the tail domain severely compromise kinesin's performance in vivo. The analysis of these mutants has identified subdomains in the stalk and tail likely to be involved in cargo binding and/or regulation of motor activity. The phenotypes of several mutants strongly suggest that kinesin requires a folded conformation to achieve full functionality in vivo. Folding critically depends on two flexible domains in the stalk that allow an interaction of the tail with the neck/hinge region near the catalytic motor domain. The assay has proven to be a valuable tool in the analysis of kinesin function in vivo and should help to characterize the sites involved in intra- and intermolecular interactions.

Structure elucidation, enantioselective analysis, and biogenesis of nerol oxide in Pelargonium species

A novel enantioselective synthesis of nerol oxide (3, 6-dihydro-4-methyl-2-(2-methyl-1-propenyl)-2H-pyran) was used for the determination of the absolute configuration at C-2. The order of elution of the enantiomers on octakis-(2, 3-di-O-butyryl-6-O-tert-butyldimethylsilyl)-gamma-cyclodextrin in OV 1701-vi as the chiral stationary phase in enantioselective GC was determined as (2R) before (2S). Enantioselective multidimensional GC/MS (enantio-MDGC/MS) was used for the determination of the enantiomeric ratios of nerol oxide in different geranium oils. As a result, in all investigated oils nerol oxide occurs as a racemate. The biogenesis of nerol oxide in Pelargonium species was investigated by feeding experiments using deuterium-labeled neryl glucoside as the precursor. The Pelargonium plants were able to convert the fed precursor into racemic nerol oxide, which has to be considered as a "natural racemate".

Biogenetic studies in Mentha x piperita. 1. deuterium-labeled monoterpene ketones: synthesis and stereoselective analysis

Pulegone, menthone, and isomenthone isotopomers are synthesized as regioselectively deuterated d(5)- and d(8)-stereoisomers. Deuterium-labeled menthone and isomenthone enantiomers are analyzed using enantioselective multidimensional gas chromatography/mass spectrometry. The deuterated stereoisomers of menthone and isomenthone are separated from the unlabeled menthone and isomenthone on a glass capillary column, coated with 50% octakis(2, 3-di-O-butyryl-6-O-tert- butyldimethylsilyl)-gamma-cyclodextrin in OV 1701vi as the chiral stationary phase. These deuterium-labeled monoterpene ketones are proved to be highly valuable substrates in biosynthetic studies of terpenoid compounds.

Biogenetic studies in Mentha x piperita. 2. Stereoselectivity in the bioconversion of pulegone into menthone and isomenthone

Mentha x piperita shoot tips and first leaf pairs were fed with aqueous solutions of different deuterium-labeled pulegone and various enantiomeric distributions. The essential oil was extracted by solid-phase microextraction and analyzed using enantioselective multidimensional gas chromatography/mass spectrometry. The genuine p-menthan-3-ones (-)-menthone and (+)-isomenthone as well as their labeled analogues were analyzed simultaneously. Both enantiomers of labeled pulegone were converted into the corresponding labeled p-menthan-3-ones by Mentha x piperita, indicating an unspecific reduction process. The generation of 4S- and 4R-configured p-menthan-3-ones differed in their stereoselectivities. Labeled (S)-pulegone was reduced by Mentha x piperita more rapidly rather than (R)-pulegone. From a comparison of labeled pulegone enantiomers the bioconversion preferrably led to 4S-configured diastereomers.

Primary biomechanical influence of different sterilization methods on a freeze-dried bone-ligament transplant

The transmission of bacteria and viruses in ligament transplants should be prevented by sterilization. In this study, the influence of two different methods on the mechanical properties of a freeze-dried medial collateral ligament was analyzed in sheep. Group I (n = 10) was treated with irradiation (26 kGy) and group II (n = 10) with ethyleneoxide. The mechanical properties changed in respect of the maximal load: group I (-29.9%; P < 0.05), group II (-7.7%), elongation: group I (-6.6%), group II (-0.3%), stress: group I (-20.1%), group II (-6.8%), strain: group I (-0.64%), group II (-0.3%), stiffness: group I (-10.2%), group II (-10.5%), energy: group I (-31.4%), group II (-6.9%) and elastic modulus: group I (-1.3%), group II (-5.0%). The irradiation dose significantly reduced the maximal load, whereas ethyleneoxide sterilization resulted only in minor changes. Because of the potential cancerogenity of ethyleneoxide, a close monitoring of aeration times and its residuals are very essential. Further studies with lower irradiation doses of between 15 and 26 kGy seem to be justified.

Antigen-specific modulation of experimental myasthenia gravis: nasal tolerization with recombinant fragments of the human acetylcholine receptor alpha-subunit

Myasthenia gravis (MG) and experimental autoimmune myasthenia gravis (EAMG) are antibody-mediated autoimmune diseases in which the nicotinic acetylcholine receptor (AcChoR) is the major autoantigen. The immune response in these diseases is heterogeneous and is directed to a wide variety of T and B cell epitopes of AcChoR. Candidate molecules for specific immunotherapy of MG should, therefore, have a broad specificity. We used recombinant fragments of the human AcChoR, encompassing the extracellular domain of the alpha-subunit, or shorter fragments derived from it, in experiments to modulate EAMG. We have demonstrated that intranasal administration of these recombinant fragments, which represent a major portion of epitopes involved in MG, prevents the induction of EAMG in rats and immunosuppresses an ongoing disease, as assessed by clinical symptoms, weight loss, and muscle AcChoR content. These effects on EAMG were accompanied by a marked reduction in the proliferative T-cell response and IL-2 production in response to AcChoR, in reduced anti-self AcChoR antibody titers and in an isotype switch of AcChoR-specific antibodies, from IgG2 to IgG1. We conclude that nasal tolerance induced by appropriate recombinant fragments of human AcChoR is effective in suppressing EAMG and might possibly be considered as a therapeutic modality for MG.

[Effect of patient age on use of the knee joint score]

AIM OF THE STUDY

Clinical studies are done with the help of scores though different factors of influence lower comparability. The underlying study examines the influence of patient age as this always presents a certain span.

METHOD

96 degree I damaged knee joints were examined by 3 examiners using the Larson-, Lysholm-, Marshall-, HSS- and OAK-score. Furthermore ratings by a VAS and the Tegner activity score were done. With the Friedman test, the rank correlation coefficient by Spearman and the contingency chart by Bowker it was tested if the examiners and the scores rate equally. To find out the influence of the age three age groups were made up.

RESULTS

The examiners judged significantly different excluding the Marshall and the OAK scores. In between two examiners no significant difference could be found between the young and the middle-aged patient group. Between two other examiners no significant difference was found only for the Lysholm and the HSS score in the young group and only for the Lysholm score in the middle-aged group. In the group of the senior patients no significant difference for the scores by Lysholm, Marshall and OAK were found. In the comparison of the second examiner pair no significant differences could be proven by the scores by Larson, the OAK and the HSS. All other comparisons were significantly different. In the comparison of all five scores significant differences were seen between the Larson score and the HSS and the Lysholm and the HSS. The Lysholm score proved to be the strictest, the HSS to be the leanest.

CONCLUSION

Especially for the senior patients in dependency of the examiner and the chosen score significant differences were found concluding that the relevance of results lessens for future times as the score results drop with patient age anyway. The age span in one study should have a maximum of 10-20 years to reduce the influence of age on the final result.

Dissection of silencer elements in first intron controlling the human renin gene

OBJECTIVE

A silencer within the renin first intron (intron A) was identified using Calu-6 cells, a pulmonary carcinoma cell line which produced renin. In the present study, a dissection of the first intron was performed to determine precisely the cis-regulatory elements involved in the silencer transcriptional effects.

MATERIALS AND METHODS

Intron A was completely sequenced to characterize potential binding sites for known transcription factors. Partial portions of intron A were subcloned upstream the 892 bp of the renin promoter and transfected in different models of renin-producing cells: primary culture of human chorionic cells, human Calu-6 cells and mouse As4.1 cells.

RESULTS

There is significant DNA homology (67%) between the 3' and 5' ends of the human and rat renin first intron. Several transcription factor binding sites identified in human first intron, but not in rat intron, do not contribute to the reported silencer activity. Transfections of renin/ luciferase constructs containing partial portions of first intron inserted upstream of the 892 bp in both renin-producing cells do not allow the precise characterization of cis-elements involved in the silencer effect.

CONCLUSIONS

The silencer located renin intron A is cell specific. The integrity of the human first intron seems necessary for its repressor activity on renin proximal promoter in renin-producing cells.

Influence of RecA on in vivo virulence and Shiga toxin 2 production in Escherichia coli pathogens

The enterohemorrhagic Escherichia coli (EHEC) O157:H7 strains 933 and 86-24 as well as the uropathogenic E. coli (UPEC) strain 536 were compared with their isogenic rec A mutants and rec A trans -complemented strains in intravenous lethality and lung toxicity assays in mice. While the wild-type EHEC strains were fully virulent, the virulence of the rec A mutants was strongly reduced. Complementation of the EHEC rec A mutants with the cloned E. coli recA gene restored their virulence capacity. The stx2EHEC mutant TUV86-2 as well as its isogenic rec A mutant were completely avirulent in both assays. In contrast, RecA had no influence on the virulence of UPEC strain 536. We conclude that the lethality observed with EHEC is presumably mainly due to Shiga toxin, which is severely down-regulated in the rec A mutants as a result of lacking spontaneous phage induction. Therefore, the EHEC rec A+strains 933 and 86-24 were compared for their Shiga toxin 2 (Stx2) production with the respective rec A-counterparts. The rec A mutants of the EHEC strains were significantly reduced in toxin synthesis and were devoid of Stx2 specific phage production. Complementation of the EHEC rec A mutants with the cloned rec A gene enabled the rec A mutants to restore toxin and phage production. These results suggest that the higher level of Stx2 synthesis in the EHEC strains is the result of a higher level of spontaneous Stx2 specific phage induction, which is controlled by RecA.

Electromechanical characterization of acute experimental myocardial infarction

OBJECTIVE

A new cardiac mapping system combines harmless magnetic field energy and tip-deflecting catheters (equipped with location sensors) to obtain real-time 3-dimensional electromechanical maps of the left ventricle endocardial surface without using x-ray fluoroscopy. This experimental study assessed electromechanical changes during acute coronary occlusion and reperfusion in a canine model.

METHODS

Group 1 (n = 10) underwent coronary occlusion for 45 minutes followed by reperfusion (n = 6) and group 2 (n = 11) underwent coronary occlusion for 90 minutes. Endocardial peak-to-peak voltage amplitudes and local endocardial shortening values were measured in ischemic and non-ischemic zones at baseline, following coronary occlusion and reperfusion.

RESULTS

In ischemic zones, local shortening was significantly reduced during coronary occlusion compared to baseline (Group 1: 4.7 +/- 2.0% at 45 minutes vs. 15.5 +/- 3.4%, p < 0.001, 6.2 +/- 2.1% at 90 minutes vs. 15.5 +/- 3.4%, p < 0.001; Group 2: 5.0 +/- 2.9% at 90 minutes vs. 13.9 +/- 3.3%, p = 0.007). Coronary occlusion caused a significant reduction in voltage potentials in the ischemic area (unipolar voltage at 45 minutes: 32.2 +/- 7.3 mV vs. 36.2 +/- 8.5 mV at baseline, p = 0.03; unipolar voltage at 90 minutes: 30.5 +/- 11.3 mV vs. 38.3 +/- 14.2 mV, p = 0.003; bipolar voltage at 45 minutes: 7.6 +/- 5.5 mV vs. 10.1 +/- 6.0 mV, p < 0.04; bipolar voltage at 90 minutes: 7.6 +/- 4.4 mV vs. 9.8 +/- 6.2 mV, p < 0.02). Voltage amplitudes were no longer reduced during reperfusion (unipolar voltage: 34.3 +/- 10.5 mV vs. 36.2 +/- 8.5 mV, p = 0.26; bipolar voltage: 9.1 +/- 4.5 mV vs. 10.1 +/- 6.0 mV at baseline, p = 0.37), or in non-ischemic regions during either coronary occlusion or reperfusion.

CONCLUSIONS

Electromechanical mapping study provides unique insights into acute myocardial infarction and stunning by detection and localization of early electromechanical changes during coronary occlusion and/or reperfusion.

Do functional deficits result from radial head resection?

The treatment of comminuted fractures of the radial head with primary or secondary head resection is controversial. To assess the outcome of patients after radial head resection, a retrospective study with clinical and radiologic follow-up including isokinetic testing was performed. Between 1981 and 1992, 151 patients underwent radial head resection for comminuted fractures. Fifty-nine patients were operated on during the first 2 weeks after injury (primary treatment), 47 patients were operated on between 3 weeks and 6 months after injury (early secondary), and 45 patients were operated on more than 6 months after injury (late secondary). Follow-up examinations of 108 patients were conducted at an average of 6 years after operation. In 64% of the patients only the radial head was fractured. In 26% of the patients the fracture was combined with a dislocation of the elbow. Results on the clinical and isokinetic tests were better for patients treated with primary resection than for patients treated with secondary resection. Of the patients treated with primary resection, 45% were subject to no restrictions in daily life and 64% had no limits at work.

Electromechanical characterization of myocardial hibernation in a pig model

BACKGROUND

This study attempted to assess in-vivo electromechanical changes following gradual coronary artery occlusion in a pig ameroid constrictor model using a novel three-dimensional left ventricular mapping system.

METHODS AND RESULTS

We measured unipolar and bipolar voltage potentials and local endocardial shortening in the ischemic lateral and non-ischemic anterior zones in animals at rest (n = 9) 5 weeks after the implantation of ameroid constrictors around the left circumflex artery. Echocardiography was used to assess regional contractility (percentage myocardial thickening), and an echo-contrast perfusion study was performed using acoustic densitometry methods. The ischemic lateral zone showed reduced myocardial perfusion at rest (peak intensity; 3.4 +/- 1.7 versus 20.7 +/- 14.8, P = 0.005), impaired mechanical function (percentage wall thickening 22 +/- 19% versus 40 +/- 11%, P = 0.03; local endocardial shortening 2.9 +/- 5.5% versus 11.7 +/- 2.1%, P = 0.002), and preserved electrical activity (unipolar voltage 12.4 +/- 4.7 versus 14.4 +/- 1.9 mV, P = 0.25; bipolar voltage 4.1 +/- 1.1 versus 3.8 +/- 1.5 mV, P = 0.62), compared with the anterior region.

CONCLUSIONS

Gradual coronary artery occlusion resulting in regional reduced perfusion and function at rest (i.e. hibernating myocardium) is characterized by preserved electrical activity. An electromechanical left ventricular mapping procedure such as the one described here may be of diagnostic value for identifying the hibernating myocardium.

[Value of alignment osteotomy of the proximal tibia in the endoprosthesis period]

AIM OF THE STUDY

To evaluate the value of high tibial osteotomy in times of growing numbers of endoprostheses we compared our personal with other results of this method as well as of the unilateral sledge prosthesis.

MATERIAL AND METHODS

Between 1972 and 1993 the high tibial osteotomy as described by Coventry was performed in 105 patients. 98 patients could be examined clinically-radiologically and evaluated with a questionnaire. The indication for surgery was given in patients with unilateral arthrosis without affection of the retropatellar joint and without significant ligamentous instability. The varus deviation was in no case more than 10 degrees. The average follow-up for the clinical-radiologic examination was 9.4 years.

RESULTS

77 patients (78.6%) were satisfied with the outcome of the surgery. Here it was seen that neither age nor pain or instability had an influence on this judgement. The walking distance on the other hand had a significant influence. Stair climbing and range of motion were significantly important as well. 23 patients gave the judgement "excellent", 31 "good", 36 "satisfactory" and 8 patients were "not satisfied". A significant influence of patient age on the judgement could not be proven. The division in the Japanese Score showed "good" results in 14%, "moderate" in 81% and "poor" in 5%. 13 knee joints (13.3%) were absolutely pain-free and in 67 cases (68.4%) there were a definite pain reduction. A significant correlation between the preoperative axis deviation and pain could not be found. An average flexion of 97.5 degree and an extension deficit of 3.3 degree on average was seen. A significant difference of range of motion dependent on age groups could not be found. In 42 knees (42.9%) the lateral ligaments were clinically stable, in 35 cases (35.7%) there was a first degree lateral stress gap and in 21 cases (21.4%) there was a second degree lateral instability. A significant correlation between the instability and age or pain could not be proven. 13 revision surgeries including 9 endoprosthesis implantations were performed.

CLINICAL RELEVANCE

The study showed a high level of satisfaction with an exact surgical indication. When seeing the growing number of implanted uni- or tricompartmental endoprostheses the procedure of tibial osteotomy can be suggested for patients with unilateral arthrosis without retropatellar arthrosis, with an axis deviation less than 15 degrees, with unaffected cartilage of the contralateral compartment and without ligamentous insufficiency independent of patient age.