Early indicators for the risk of atherogenesis. A field test of a new methodology on kindergarten children in Düsseldorf

Parameters related to the risk of atherogenesis in adults were investigated in kindergarten children living in an industrial city. Height, weight and blood pressure were measured and capillary blood obtained. This study is a field test of methods for the analysis of 11 metabolic variables in capillary serum [glucose (GLUC), uric acid (UA), total, free and esterified cholesterol (TC, C, CE), triacylglycerols (TG), phosphatidylethanolamine (PE), phosphatidylcholine (PC); beta-, pre-beta- and alpha-lipoproteins (LPs)]. For lipid and LP analysis, new micro- and ultramicroprocedures were used, which have proved to be adequate for large-scale studies outside the clinic, including young children. Among 497 German children, a reference group, an overweight group and a socially underprivileged group were distinguished. In the reference group, several sub-groups with parameters lying in the tails of the concentration distributions were considered separately, thus providing specific metabolic patterns for these groups and, also, for any individual child. The children in the overweight group exhibited significantly reduced TC and beta-LP levels. In socially underprivileged children with anthropometric data within the normal range, a reduction of several blood constituents was seen: GLUC, TG, TC, PC, pre-beta- and alpha-LP; the PC: PE ratio was diminished. The beta: alpha-LP ratio in these children was moderately increased. This effect was more pronounced in growth-retarded children, who also showed negative correlation of TG: alpha-LP.

Selective incorporation of fluorescein-labeled steroids in the vaginal epithelium of women of childbearing age

The incorporation of fluorescein-labeled estradiol and desoxycorticosterone in human vaginal epithelial cells during the menstrual cycle was studied. The uptake of these steroids changes during the menstrual cycle and can be related to data on nuclear binding sites in the human endometrium during the menstrual cycle. Further studies must be done to prove the effectiveness of this method as a test for the hormone sensitivity of tissue or cells, especially the sensitivity of neoplastic tissue to hormonal therapy.

Progress in limb salvage by reconstructive arterial surgery combined with new or improved adjunctive procedures

In the past nine years, 1196 patients whose lower extremity was threatened because of infrainguinal arteriosclerosis have been treated at Montefiore Hospital. In the last six years, limb salvage was attempted in 679 or 90% of 755 patients. Femoropopliteal (318), small vessel (204) and axillopopliteal (29) bypasses were used along with transluminal angioplasty (128) and aggressive local operations to obtain a healed foot. Immediate (one month) limb salvage was achieved in 583 or 86% of the 679 patients in whom revascularization was possible. The 30-day mortality rate was 3%. The cumulative life table (LT) survival rate of all the patients undergoing reconstructive arterial operations was 48% at five years. The cumulative LT limb salvage rate after all reconstructive arterial operations was 66% at five years. The cumulative LT patency rate of femoropopliteal bypasses was not influenced by angiographic outflow characteristics of the popliteal artery but was increased 15% by appropriate reoperations to 67% at five years. Cumulative LT patency and limb salvage rates of small vessel and axillopopliteal bypasses were more than 50% at two years. Of patients undergoing arterial reconstruction, 88% of those who died within five years did so without losing their limbs. Of all the patients in whom limb salvage was attempted, 68% lived more than one year with a viable, useable extremity, and 54% lived over two years with an intact limb. We believe this aggressive approach to limb salvage is justified, and can be undertaken with a low cost in mortality, knee loss and morbidity.

[Antiphlogistic and analgesic effect of diclofenac sodium after maxillofacial interventions in a double-blind trial]

Diclofenac sodium (Voltaren) was tested over a period of six months in a double-blind experiment for its antiphlogistic and analgesic effect. A retained or impacted lower third molar was removed from each of the 138 patients studied. The postoperative course was evaluated in terms of the criteria of pain, trismus, swelling, and side effects; and the results were recorded. The swelling was objectified by photographic documentation and planimetric measurements. Our studies indicated that diclofenac sodium can also be recommended for the medicamentous prophylaxis of swelling and pain resulting from dental procedures.

Expanded polytetrafluoroethylene grafts in reconstructive arterial surgery. Preliminary report of the first 110 consecutive cases for limb salvage

One hundred ten arterial reconstructions, including several new and extended bypasses, were performed with polytetrafluoroethylene (PTFE) grafts and were observed for three to 16 months. Patency rates were 100% with 15 bypasses to the femoral artery, 95% with 66 bypasses to the popliteal artery, and 76% with 29 bypasses to the arteries of the leg and foot. These encouraging preliminary results justify continued use and evaluation of PTFE as an arterial prosthesis.

Renal involvement in Behçet's syndrome

A retrospective study of 77 cases of Behçet's syndrome showed that, of the 33 patients in whom urinalysis was done (including three with systemic amyloidosis reported earlier), 17 had pathological results. A prospective study of 51 of these patients uncovered eight additional subjects with urinary abnormalities, bringing the total to 25. The urinary abnormality was, as a rule, discrete, consisting of proteinuria and/or microhematuria. These occurred in some patients persistently, in some intermittently, in some alternatingly, and in some simultaneously. The initial finding was proteinuria in 10 patients, hematuria in 11, and both in 4. Over the years, eight showed only hematuria, seven only proteinuria and ten, both. The urinary sediment contained neither leukocytes nor casts. Pyelographies were unrevealing when performed and rectal biopsies uncovered no new instance of amyloidosis. These data suggest that a benign renal lesion occurs in Behçet's syndrome, whose pathological substrate, though not yet defined, is not amyloid deposition.

[Growth hormone determination in a combined adenohypophyseal stimulation test (author's transl)]

The authors sought the simplest but still reliable method for evaluation of the functional reserve of the anterior lobe of the pituitary gland. The proposed test is stimulation of those various functions by injection of insulin, gonadotropin releasing hormone (LH-RH = GnRH) and thyrotropin releasing hormone (TRH). The test fulfils the clinical requirements. Furthermore it forms a valuable first step for the classification of more scientific problems.