[Antigranulocyte scintigraphy of septic loosening of hip endoprosthesis: effect of different methods of analysis]

AIM

Diagnosis of infection with help of antigranulocyte scintigraphy near body stem is difficult because of contemporary visualisation of bone marrow. Therefore, we investigated, whether it is possible to improve the accuracy in diagnosing septic loosening of hip endoprosthesis by changing the analyzing methods.

METHODS

In 28 patients, the results of a visual interpretation of late scan, a visual interpretation and a quantitative interpretation of time-activity-course were compared. These results were verified by histology respectively microbiology.

RESULTS

Histological and microbiological verification found 14 septic loosening and 14 aseptic loosening of the hip prothesis. Therefore, sensitivity, specificity, negative and positive predictive value for the visual interpretation of late scan were 0.86, 0.57, 0.80 and 0.67. For visual and quantitative interpretation of time-activity-course we found 0.86, 0.79, 0.85 and 0.80 respectively 1, 0.93, 1, 0.93. For interobserver agreement we found kappa coefficients of 0.28 +/- 0.2 for visual interpretation of late scan, 0.48 +/- 0.17 for visual interpretation and 1.0 +/- 0 for quantitative interpretation of time-activity-course.

CONCLUSION

In all investigated values quantitative interpretation of time-activity-course was superior to the other analyzing methods. Therefore, antigranulocyte scintigraphy for septic loosening of hip endoprosthesis should be interpreted quantitatively.

Current practice of radioiodine treatment in the management of differentiated thyroid cancer in Germany

This prospective, observational study of a cohort of thyroid cancer patients in Germany focusses on the "real-world" practice in the management of thyroid cancer patients. This report includes data from 2376 patients with primary differentiated thyroid carcinoma first diagnosed in the year 1996. The study reveals considerable differences in actual practice concerning surgery and radioiodine treatment. The results indicate that consensus is lacking with respect to the multimodality treatment approach for differentiated thyroid carcinoma. Our analysis represents the most current and comprehensive national assessment of presenting patient characteristics, diagnostic tests, treatment and complications for thyroid cancer.

A scaffoldin of the Bacteroides cellulosolvens cellulosome that contains 11 type II cohesins

A cellulosomal scaffoldin gene, termed cipBc, was identified and sequenced from the mesophilic cellulolytic anaerobe Bacteroides cellulosolvens. The gene encodes a 2,292-residue polypeptide (excluding the signal sequence) with a calculated molecular weight of 242,437. CipBc contains an N-terminal signal peptide, 11 type II cohesin domains, an internal family III cellulose-binding domain (CBD), and a C-terminal dockerin domain. Its CBD belongs to family IIIb, like that of CipV from Acetivibrio cellulolyticus but unlike the family IIIa CBDs of other clostridial scaffoldins. In contrast to all other scaffoldins thus far described, CipBc lacks a hydrophilic domain or domain X of unknown function. The singularity of CipBc, however, lies in its numerous type II cohesin domains, all of which are very similar in sequence. One of the latter cohesin domains was expressed, and the expressed protein interacted selectively with cellulosomal enzymes, one of which was identified as a family 48 glycosyl hydrolase on the basis of partial sequence alignment. By definition, the dockerins, carried by the cellulosomal enzymes of this species, would be considered to be type II. This is the first example of authentic type II cohesins that are confirmed components of a cellulosomal scaffoldin subunit rather than a cell surface anchoring component. The results attest to the emerging diversity of cellulosomes and their component sequences in nature.

Comparison of HIG scintigraphy and bloodpool scintigraphy using HDP in arthritic joint disease

AIM

Because of a similar tracer accumulation, we assumed to get the same information about synovitis in arthritic joint disease with HIG scintigraphy and bloodpool scintigraphy using HDP. Therefore, we compared retrospectively 23 patients.

METHODS

In HIG scintigraphy, synovitis was diagnosed according to increasing activity from early to late image. In bloodpool scintigraphy according to an increased activity in comparison to the surrounding tissues.

RESULTS

In 694 joints comparison of both scintigraphic modalities was possible, resulting in a 2 x 2 kappa coefficient of 0.93 or 0.97 by using late-phase bone scintigraphy as an anatomical marker. For intra- and interobserver agreement, 2 x 2 kappa coefficients of 0.93 and 0.88 in HIG scintigraphy, respectively 0.96 and 0.90 in blood-pool scintigraphy were calculated.

CONCLUSION

This study shows an excellent agreement in the visualization of synovitis by HIG and bloodpool scintigraphy. Because of its higher objectivity and lower cost, investigation of synovitis should be performed by bloodpool scintigraphy.

A novel cellulosomal scaffoldin from Acetivibrio cellulolyticus that contains a family 9 glycosyl hydrolase

A novel cellulosomal scaffoldin gene, termed cipV, was identified and sequenced from the mesophilic cellulolytic anaerobe Acetivibrio cellulolyticus. Initial identification of the protein was based on a combination of properties, including its high molecular weight, cellulose-binding activity, glycoprotein nature, and immuno-cross-reactivity with the cellulosomal scaffoldin of Clostridium thermocellum. The cipV gene is 5,748 bp in length and encodes a 1,915-residue polypeptide with a calculated molecular weight of 199,496. CipV contains an N-terminal signal peptide, seven type I cohesin domains, an internal family III cellulose-binding domain (CBD), and an X2 module of unknown function in tandem with a type II dockerin domain at the C terminus. Surprisingly, CipV also possesses at its N terminus a catalytic module that belongs to the family 9 glycosyl hydrolases. Sequence analysis indicated the following. (i) The repeating cohesin domains are very similar to each other, ranging between 70 and 90% identity, and they also have about 30 to 40% homology with each of the other known type I scaffoldin cohesins. (ii) The internal CBD belongs to family III but differs from other known scaffoldin CBDs by the omission of a 9-residue stretch that constitutes a characteristic loop previously associated with the scaffoldins. (iii) The C-terminal type II dockerin domain is only the second such domain to have been discovered; its predicted "recognition codes" differ from those proposed for the other known dockerins. The putative calcium-binding loop includes an unusual insert, lacking in all the known type I and type II dockerins. (iv) The X2 module has about 60% sequence homology with that of C. thermocellum and appears at the same position in the scaffoldin. (v) Unlike the other known family 9 catalytic modules of bacterial origin, the CipV catalytic module is not accompanied by a flanking helper module, e.g., an adjacent family IIIc CBD or an immunoglobulin-like domain. Comparative sequence analysis of the CipV functional modules with those of the previously sequenced scaffoldins provides new insight into the structural arrangement and phylogeny of this intriguing family of microbial proteins. The modular organization of CipV is reminiscent of that of the CipA scaffoldin from C. thermocellum as opposed to the known scaffoldins from the mesophilic clostridia. The phylogenetic relationship of the different functional modules appears to indicate that the evolution of the scaffoldins reflects a collection of independent events and mechanisms whereby individual modules and other constituents are incorporated into the scaffoldin gene from different microbial sources.

Anatomical study of the blood supply in the human shoulder region

The blood supply of the shoulder muscles, ligaments and joint capsule was investigated by injection of silicone rubber into the arteria subclavia of postmortem cases. We show that the a. suprascapularis forms important anatomoses with other arteries in the region and is of greater importance for the blood supply of the rotator cuff as hitherto believed. We also describe the a. subcoracoidea as a so far unknown branch of the a. axillaris.

[Activity leakage and radiation exposure in radiation synovectomy of the knee: influence of different therapeutic modalities]

In rheumatic diseases, radiation synovectomy is a reliable method. Meanwhile, radiation synovectomy is an outpatient therapy. In addition, combination with arthroscopic synovectomy is an increasing therapeutic modality. In comparison to the hitherto inpatient modality, a greater lymphatic emigration of the radionuclide and, therefore, a higher radiation exposure is possible. In 35 patients we found radionuclide emigration in 17 cases by whole body scintigraphy, resulting in a 50%-percentile with 68.27%-confidence interval of 1.8 (0.45-4.78)% of the injected yttrium-90-activity. Comparison of 3 groups with the above mentioned therapy modalities resulted in no statistical difference (p>0.05). Because of the found radionuclide emigration, a radiation dose of 0. 1 (0.05-0,18) mSv in women and 0.2 (0.1-0.38) mSv in men was calculated. For lymph nodes, liver, spleen and whole body radiation doses of 619 (154-1644) mSv, 62 (15-165) mSv, 62 (15-165) mSv and 37 (9-99) mSv were calculated. Gonadal radiation dose can be neglected and the morbidity rate for tumors because of the whole body radiation dose is low with a value of 0.4 per thousand. Therefore, radiation synovectomy can be used unlimited by patients age and independent of the therapeutic modality.

The value of renal scintigraphy during controlled diuresis in children with hydronephrosis

Dynamic renal scintigraphy (DRS) during controlled diuresis is the method of choice to diagnose the functional relevance of urinary tract obstruction in children with sonographically demonstrated hydronephrosis. However, there are no commonly accepted scintigraphic criteria for surgical intervention. On the basis of our findings, we propose four stages of washout (WO) of tracer following diuresis: in stage I, WO>50%, neither further diagnosis nor intervention is necessary; in stage II, 50%>/=WO>/=12%, repetition of DRS is advised within 3-4 months; and in stage III, 12%>WO>/=5%, DRS should be repeated within 1-2 months. Only in stage IV, WO<5%, should surgery be done immediately. This procedure reduces surgical interventions by 50% without increasing the risk of residual renal damage.

The role of assembly in insulin's biosynthesis

Insulin is synthesised as a single-chain precursor, preproinsulin, that contains an N-terminal signal sequence and a connecting peptide linking the A and B chains of the insulin molecule. Nascent proinsulin is directed into the regulated secretory pathway, converted to insulin and stored as microcrystals. These processes exploit assembly to the zinc-containing hexamer. Structural, chemical and genetic studies, and experiments with transgenic animals and transfected cells are providing new details about the molecular events in insulin's biosynthesis.

[Radioiodine therapy of small, solitary autonomous adenomas]

AIM

In most cases of unifocal autonomous adenomas the indication of radioiodine therapy has so far been given only if the volume of the adenomas is > 8 ml, or if the Tc-Uptake is > 2% in combination with suppressed TSH incretion. We have investigated the question how far the indication of radioiodine therapy should be extended to other cases.

METHODS

Between March 1993 and April 1994 we treated 11 patients who did not fulfil these criteria but suffered from thyreogenic complaints.

RESULTS

After the radioiodine therapy, all the 11 patients improved evidently.

CONCLUSION

We suggest extending the indication of radioiodine therapy in order also to treat small unifocal adenomas.

Acute pulmonary embolism: value of transthoracic and transesophageal echocardiography in comparison with helical CT

OBJECTIVE

The goal of this study was to prospectively compare the accuracy of transthoracic and transesophageal B-mode and Doppler echocardiography with helical CT for detecting acute pulmonary embolism.

SUBJECTS AND METHODS

Thirty-five consecutive patients underwent transthoracic and transesophageal echocardiography and contrast-enhanced helical CT. Echocardiographic examinations were analyzed for indirect criteria, including increased main pulmonary artery diameter, tricuspid regurgitation, and dilatation of the right ventricular cavity, as well as for direct thrombus visualization. Sensitivity, specificity, and negative and positive predictive values were calculated.

RESULTS

Pulmonary embolism was revealed by helical CT in 22 of 35 patients; in 11 of these 22 cases, central pulmonary embolism was seen. Transthoracic and transesophageal B-mode echocardiography failed to reveal pulmonary embolism in nine patients, two of whom had central pulmonary embolism. The sensitivity and specificity of the combination of both echocardiographic investigations were 59% and 77% respectively (82% and 92% for central pulmonary embolism). In three patients, pulmonary embolism was diagnosed by direct clot detection with transesophageal echocardiography. In two patients, only the indirect parameters indicated pulmonary embolism. Overall indirect echocardiographic parameters were characterized by a low sensitivity that ranged from 50% for tricuspid regurgitation to 21% for main pulmonary artery diameter.

CONCLUSION

In comparison with helical CT, transthoracic and transesophageal echocardiography had limited accuracy for detecting pulmonary embolism.

Buflomedil hydrochloride attenuates tourniquet-induced microvascular reperfusion injury in striated muscle

With the use of intravital fluorescence microscopy and the dorsal skinfold chamber model we studied the effect of buflomedil hydrochloride on microvascular reperfusion injury after 4 h of tourniquet-induced ischemia in hamster striated muscle. Animals (n = 15) received 3 mg/kg buflomedil (i.v. bolus) 5 min before onset of reperfusion, and 3 mg/kg buflomedil (continuous i.v. infusion) during the first 20 min of reperfusion. Animals (n = 13) receiving equivalent volumes of saline served as controls. Tourniquet-induced ischemia resulted in (a) a marked decrease of functional capillary density and (b) accumulation and adherence of leukocytes in postcapillary venules after 30 min and 2 h of reperfusion. This was associated with an increased microvascular permeability (leakage of macromolecules), reflecting the alteration of endothelial cell integrity. Treatment with buflomedil significantly reduced both post-ischemic capillary perfusion failure and leukocyte adherence in venules. Concomitantly, the increase of microvascular permeability in postcapillary venules was almost prevented, indicating the beneficial effect of buflomedil on the manifestation of microvascular reperfusion injury following tourniquet ischemia in striated muscle.

Anaerobic pericarditis: case report and review

Purulent pericarditis is uncommon and is rarely caused by anaerobic bacteria. We describe a 58-year-old man with purulent pericarditis secondary to infection with Bacteroides fragilis; the most likely source for the B. fragilis infection was subsequently found to be a ruptured appendix. His pericarditis eventually resolved after drainage of purulent fluid and treatment with antibiotics directed against B. fragilis. We also review 29 cases of anaerobic pericarditis previously reported in the English-language literature (we excluded those cases due to actinomyces). In 17 cases only anaerobic bacteria were isolated, while in 13 anaerobes were isolated with a mixture of facultative and/or aerobic bacteria. The cases were secondary to a contiguous focus of infection or occurred via hematogenous seeding. Treatment of both anaerobic pericarditis and purulent pericarditis due to aerobic bacteria entails adequate drainage and appropriate antibiotic therapy, and in all cases there should be a search for the source of the organism infecting the pericardium.

Microvascular ischemia-reperfusion injury in striated muscle: significance of "no reflow"

"No reflow" has been implicated as prominent phenomenon in microvascular injury associated with ischemia-reperfusion (I/R). The objectives of this study were 1) to elucidate the significance of no reflow in microvascular I/R injury of striated muscle and 2) to determine whether reactive oxygen metabolites play a role in the development of postischemic no reflow. By use of the hamster dorsal skinfold preparation and intravital microscopy, microvascular perfusion of capillaries and postcapillary venules of striated muscle was quantitatively assessed before and 30 min, 2 h, and 24 h after 4 h of tourniquet-induced ischemia. I/R was characterized by a significant reduction (P < 0.01) in functional capillary density to 35% of baseline values during initial reperfusion, with incomplete recovery after 24 h (n = 9). In addition, capillary perfusion was found to be extremely heterogeneous, and wall shear rate in postcapillary venules was significantly decreased (P < 0.01). Treatment with either superoxide dismutase (SOD; n = 9) or allopurinol (n = 9) resulted in maintenance of capillary density of 60% of baseline (P < 0.05). Furthermore, I/R-induced capillary perfusion inhomogeneities and decrease of wall shear rate in venules were attenuated significantly (P < 0.01) by SOD and allopurinol. Thus part of capillary perfusion disturbances during I/R in striated muscle may be caused by increased postcapillary vascular resistance, probably mediated by reactive oxygen metabolites. However, the fact that in SOD- and allopurinol-treated animals 40% of the capillaries were still found to be nonperfused indicates that mechanisms other than oxygen radicals play an important role in the development of postischemic no reflow.

Microvascular ischemia-reperfusion injury in striated muscle: significance of "reflow paradox"

Ischemia-reperfusion (I/R)-induced microvascular injury is characterized by capillary "no-reflow" and reflow-associated events, termed "reflow paradox," including leukocyte-endothelium interaction and increase in microvascular permeability. The major objectives of this study were 1) to elucidate the significance of reflow paradox after 4 h of tourniquet-induced ischemia in striated muscle and 2) to determine the role of reactive oxygen metabolites in the pathogenesis of reflow paradox-dependent microcirculatory alterations. By use of in vivo fluorescence microscopy in a striated muscle preparation of hamsters, leukocyte-endothelium interaction in postcapillary venules and macromolecular extravasation from capillaries and venules were quantified before ischemia and after 30 min, 2 h, and 24 h of reperfusion. I/R elicited marked enhancement (P < 0.01) of leukocyte rolling during initial reperfusion and a 20-fold increase of leukocyte adherence (P < 0.01) lasting for the entire postischemic reperfusion period (n = 7). These phenomena were accompanied by significant leakage (P < 0.01) of macromolecules from capillaries and in particular from postcapillary venules (n = 9). Both superoxide dismutase (SOD, 20 mg/kg body wt, n = 7) and allopurinol (50 mg/kg body wt, n = 7) were effective in attenuating I/R-induced leukocyte rolling and adherence. In addition, microvascular leakage was significantly reduced by allopurinol (n = 9) and completely abolished by SOD (n = 9) (P < 0.01). These results support the concept that reactive oxygen metabolites contribute to I/R-induced reflow paradox, resulting in leukocyte accumulation, adherence, and increase in microvascular permeability.

Evaluation of humoral responsiveness in children

The evaluation of postvaccine antibody responses can provide a reasonably convenient and useful adjunct to the evaluation of possible humoral immune dysfunction syndromes. In patients whose clinical history is suspicious for an antibody deficiency syndrome, such studies can document normal antibody responsiveness. On the other hand the wide age-dependent variation in antibody responses makes careful interpretation necessary in concluding that a patient falls outside the "normal" pattern of antibody responsiveness. Finding a patient well below the mean values for age for multiple vaccines in concert with an appropriate clinical history would strongly suggest an abnormality of immune regulation. At this time the finding of abnormal antibody responses does not always imply that intervention with immunoglobulin therapy is indicated or that it would lead to improvement in clinical symptoms. It might help justify prophylactic antibiotic programs, however, similar to those used for recurrent otitis media. Interpretation of antibody responses in children younger than 2 years of age is probably hazardous since many patients may have relative retardation in their normal development of polysaccharide antibody responsiveness. Such patients usually develop a normal response as they grow older and do not need long term therapy. Until new technologies for measuring immune competence are developed, the above-mentioned measures of humoral immunity, when combined with clinical judgment, should be adequate to guide clinical decision-making in most cases.

Depression in the elderly. Characteristics and clinical management

Major depression and clinically significant depressive symptoms occur commonly in the community-dwelling, medically ill, and institutionalized elderly. Both major depression and depressive symptoms need thorough evaluation and treatment because of the significant morbidity and mortality associated with these syndromes. Depression may be difficult to diagnose, especially in the medically ill elderly, because of the masking of depressive symptoms by somatic complaints or the presumption that symptoms are attributable to concurrent medical illness. Therefore, the clinician must be alert to the possibility of depression in the elderly patient. Although no specific diagnostic test is available, rating scales can be useful in screening for depression in the elderly patient. It is necessary to rule out medical illness or medications as contributing factors to depression. Psychotherapy and psychopharmacology, alone or in combination, are effective treatments for most elderly patients with depression. ECT is a safe and effective treatment for major depression in this population. Depression in the elderly is potentially a chronic and relapsing illness with significant associated medical and social morbidity. Because of their frequent contact with the elderly, nurses play a particularly important role in the diagnosis and treatment of depression. They need to recognize typical and atypical symptoms of depression and must be familiar with the potential side effects of antidepressant treatment. Close monitoring for these potential side effects can minimize disability. By working as a team with physicians, psychologists, and others, nurses have a necessary role in the care of the elderly depressed patient.

[Etiology, diagnosis and therapy of tarsal tunnel syndrome--results of a retrospective study]

Tarsal tunnel syndrome is a rare entrapment neuropathy of the posterior tibial nerve. The compression of the nerve behind the medial ankle should be distinguished from that of the more distal compression syndrome of the plantar nerves, because of different anatomic conditions and pathogenesis. The patient's history is of special diagnostic value. The most impressive clinical finding is tenderness of the nerve. Neurological deficits must be searched for. Decompression by cutting the flexor retinaculum and neurolysis is advised. 77% of the 30 patients having undergone this operation were satisfied with the results.

[Indoor hockey: injuries and prevention]

Frequency and mechanisms of injuries in women's indoor-hockey are evaluated in a retrospective study of 89 players. Each athlete sustains 1.1 injury per season on the average. The goalkeeper's risk is about three times as high as that of the outfield players. The risk during match exceeds the risk during practice by a factor of 20. The most common site of injury is the lower limb (55%), 39% are related to the upper limb, 5% to head and trunk. Half of the lesions are caused by ball and stick, they involve especially hands and fingers. The facts allow to draw conclusions concerning preventive measures. The players must be protected by better equipment, special exercises and further development of the rules.

Anaphylaxis and desensitization to the murine monoclonal antibody used for renal graft rejection

The murine monoclonal antibody muromonab CD3 is currently used to reverse acute renal graft rejection. We report a case of systemic anaphylaxis during a muromonab CD3 infusion despite pretreatment with systemic antihistamines and corticosteroids. Rapid intravenous desensitization was performed the following day without untoward reactions and daily muromonab CD3 infusions were successful in reversing renal graft rejection. A second rapid desensitization to CD3 was performed 1 month later without any complications. Serum muromonab CD3-specific IgG and IgE antibodies were detected in serum samples obtained after the anaphylactic reaction. The anaphylactic reaction to muromonoab CD3 monoclonal antibody could have been due to allergen-specific antibodies noted in postreaction serum or a cross-reactive antibody to mouse antigens or both. More importantly, this case illustrates that rapid desensitization can be performed successfully without serious complications; therefore, systemic anaphylaxis can develop in susceptible atopic individuals receiving muromonab CD3 monoclonal antibody for renal graft rejection.

[Surgical therapy and results in rupture of the rotator cuff]

Follow up evaluations of 57 patients with surgically treated rotator cuff tears are presented and valued with regard to the literature. A short anterior exposure and cuff anchorage to the humerus is the method of choice. Anterior acromioplasty should not be a routine. Attention should be paid to adhesions of the sub-coracoidal space, they should be separated if necessary. Patients being of older age, with a short history and a long time interval between operation and final evaluation do have the best results.

[Clear cell chondrosarcoma--clinico-pathological report of an additional case]

On account of the rarity and its histologic features, the clear-cell chondrosarcoma is a particular entity. Up to the present, 98 cases have been reported in the literature. In the present report one case located in the proximal femur will be discussed. Approximately 60% of these tumors are situated in the mentioned region. Including one referred case, which will not be described in detail, 100 cases have been recognized. Clear-cell chondrosarcoma is radiographically indistinguishable from benign lesions or chondroblastoma. Therefore the histologic examination is crucial for the diagnosis. The histologic characteristics preclude the diagnosis of chondroblastoma. Clear-cell chondrosarcoma is characterized by regions of chondroid matrix and areas of closely packed, glycogen-rich large tumor cells with distinct boundaries. The centrally located nuclei are large with marked polymorphism, surrounded by abundant clear PAS positive cytoplasm. The chondroid matrix is lacking. Osteoid formation and multinucleated giant cells are present in clear-cell areas. In spite of the low malignancy there is still a metastatic potential. Therefore the type of surgical treatment is very important. En bloc excision with wide margins is the treatment of choice. The knowledge about this tumor is crucial for adequate surgical therapy.

[Chronic impingement syndrome of the shoulder]

The most common manifestation of periarthritis of the shoulder is the chronic impingement syndrome, which represents an "entrapment situation". When the arm is raised, the supraspinatus tendon that forms part of the rotator cuff, comes into contact with the coracoacromial arch. The complains can often be improved by conservative treatment. If, however, the problem persists--in about 10 to 20% of the cases--surgical decompression of the coracoacromial arch by resecting the coracoacromial ligament and the subacromial bursa is indicated. This limited intervention carries only a low risk and, as studies have shown, has such a high rate of success that, in the individual case, the indication for surgery can be established earlier than has so far been assumed.

[Topography of the upper biceps tendon segment]

26 shoulders are studied by polariscopic and histologic examination. It can be confirmed that the origin of the long biceps tendon is not only at the supraglenoid tubercle, but also y-shaped in the glenoid labrum. This finding can be explained by phylogenetic means. Further details are found during the course of the tendon through the bicipital groove. A mesotenonium is seen regularly. This is fixed either to the roof or the ground of the sulcus by a band of connective tissue. It is shown also, that the roof of the groove is not a ligament (ligamentum transversum humeri) but consists of collagen fibers continuing from the subscapularis and capsular attachment at the lesser tubercle.

Audiotaped versus written administration of the Situational Competency Test

The Situational Competency Test (SCT) is an audiotaped, verbal role-play measure of coping responses to eight drinking and eight non-drinking situations. The present investigation evaluated the comparability of response scores to audiotaped versus written administrations of the SCT in two samples of alcohol clients. The written administration of the SCT yielded significantly shorter durations of response in both clinical samples, but there were no other significant differences between the administration methods on the other scoring dimensions. Correlations of the audiotaped and written summary scores revealed no consistently significant or meaningful associations. Given the differences in duration, the generally poor correlations between summary scores, and the loss of the latency measure in the written format, we recommend retention of the audiotaped administration for use in research.

Arterial supply of the human long biceps tendon

The present study deals with the question whether an insufficient vascular supply of certain areas can be made responsible for ruptures in the biceps tendon. The macroscopic and microscopic examination shows that the blood supply of the tendon in the part most prone to ruptures, that is in the bicipital groove, is guaranteed even in older individuals. It is at least much better than in the intra-articular portion where ruptures are seldom observed. This means that mechanical components such as friction are dominant. The vascular factors seem to play a minor part.

A comparison of two ambulatory blood pressure monitors, the Del Mar Avionics Pressurometer IV and the Spacelabs 90202

The purpose of this study was to evaluate the accuracy of two noninvasive ambulatory blood pressure (BP) monitors, the new Del Mar Avionics Pressurometer IV (PIV) and the second generation Spacelabs 90202. Two sets of comparisons were made between two trained observers and the monitors on 17 normotensive and 28 hypertensive subjects. The result of the first comparison showed that the average difference between observers and the PIV was 1.2/-2.2 mm Hg for systolic and diastolic BP. Comparisons of both monitors to the observers showed differences of 0.9/1.0 mm Hg for the PIV and 0.3/0.8 mm Hg for the 90202 (systolic/diastolic). Correlations between the average observer reading and the monitors over both sets of comparisons ranged from 0.90 (diastolic 90202 vs observer) to 0.98 (systolic PIV vs observer). The percentage of readings within 5 mm Hg between observer and monitor over all comparisons ranged from a low of 68% (90202, systolic and diastolic) to a high of 83% (PIV, diastolic). In general, both devices are satisfactory and reliable machines for ambulatory BP monitoring, but each has a slightly different bias compared to auscultatory readings.

Papillary circulation dynamics in glaucoma

The ability of glaucomatous eyes to adjust to a sudden increase in intraocular pressure was investigated in nine certain glaucoma cases and in ten normal subjects. The "dynamic provoked circulatory response" (DPCR) was determined by continuously measuring the brightness of the papilla before (baseline), during, and after an abrupt artificial elevation in intraocular pressure. Following the onset of intraocular pressure elevation, the period during which the baseline brightness of the papilla persisted (latency time) was significantly (P less than 0.001) shorter in glaucomatous eyes (0.64 +/- 0.25 s) than in normal eyes (2.39 +/- 0.68 s). This led to the suggestion that the extent to which an eye can adjust to abruptly higher intraocular pressure is measurably reduced in glaucoma. That this effect can be quantified indicates a potentially useful method for detection and follow-up of glaucoma.

Collagen fiber arrangement of the human shoulder joint capsule--an anatomical study

The polariscopic examination of isolated shoulder joint capsules shows that the entire capsule does not have a homogeneous collagen structure. Most of the capsule is characterized by regular collagen fibers which cross at an obtuse angle in the area of the musculus supraspinatus and at an acute angle in the area of the m. infraspinatus. The density of the collagen network increases from the medial to the lateral part. Deviating from this basic pattern of the joint capsule, there is a different collagen texture in the area between the m. supraspinatus and the m. subscapularis. This texture has dissociated, rarefied and irregular collagen fibers. This means that the area--in comparison with the remainder of the capsule--is characterized not only by missing reinforcing ligaments but also by a deviating pattern of the collagen fibers. This different collagen structure is already existent in the fetus.

Bioconstruction of the extrahepatic biliary duct system in minipigs. Comparing normal condition with experimental obstruction

The extrahepatic biliary duct system is subject to a particular bioconstruction to secure its bile transport function. The dominant structure of the bile duct wall is a network of collagen fibres harboring muscle-fibre bundles. The collagen fibres are virtually inelastic, volumes can be changed only by rearranging the network. The ducts show different spatial arrangements of the fibres causing different extents of dilatation during obstruction. Extreme dilatation might cause a rupture of the network, and deficient postoperative retonisation could be the result.

Should gastric carcinoid tumors associated with pernicious anemia be treated aggressively?

Two patients with pernicious anemia developed gastric carcinoid, one 20 years and the other 1 year after diagnosis of pernicious anemia. One of the patients underwent successful resection of the tumor, while the second, with diffuse gastric carcinoid, was managed conservatively. She is well and asymptomatic 32 months after the diagnosis. We discuss the dilemma in management of gastric carcinoid associated with pernicious anemia.