Der Einsatz von Methylphenidat im Kindesalter: Analyse des Verordnungsverhaltens auf der Basis von Routinedaten der gesetzlichen Krankenkassen zu Arzneimittelverordungen

In Germany only few data is available on the use of stimulants in the treatment of Attention Deficit/Hyperactivity Disorder. For the first time a full survey of health insurance data was carried out on methylphenidate prescriptions from 2000 to 2001 in an East German District. 783 patients of the total cohort received at least one prescription for methylphenidate. In our sample, the treatment prevalence more than doubled in the observation period from 0.6 % to 1.4 % in children aged between 5 and 15 years, this age group representing the largest treatment group. Younger children, adolescents and adults were only rarely treated. The treatment was undertaken predominantly by paediatricians, general practitioners and neurologists/psychiatrists/child psychiatrists. Prescriptions were issued by one, or by not more than two doctors.

CONCLUSION

In Mecklenburg-Vorpommern the prevalence of stimulant treatment has clearly increased. Since diagnosis-related data is not available it is not possible to assess the indications for treatment. Further studies should serve to evaluate the correspondence between diagnosis and therapy in relation to stimulant medication.

Liver enzyme activity and histological changes in the liver of silver foxes (Vulpes vulpes fulva) experimentally infected with opisthorchiid liver flukes. A contribution to the pathogenesis of opisthorchiidosis

Blood samples from silver foxes experimentally infected with Opisthorchis felineus and Metorchis bilis, respectively, were examined for the activity of liver enzymes. The average activities of aspartate aminotransferase (AST), glutamate dehydrogenase (GLDH), alkaline phosphatase and alanine aminotransferase in uninfected control animals were 20, 1.8, 57 and 44 units/l, respectively. The liver enzymes in infected foxes reacted differently, depending on dose, species of flukes and individual peculiarities. The highest individual deviation of infected from control animals was registered in the case of GLDH, reaching increases of up to 200-fold. In contrast, AST showed the lowest deviation from control values (less than 10-fold). By the end of the study period, enzyme activities had declined. The prepatent periods for M. bilis and O. felineus in foxes were 2 weeks and 4 weeks, respectively. High egg per gram values were established at the beginning of the patent period. At necropsy, chronic inflammatory reactions were found in the bile ducts and in the wall of the gall bladder. The number of flukes at the end of the study was low.

Tight control of prehospital ventilation by capnography in major trauma victims

BACKGROUND

Tracheal intubation combined with controlled ventilation of the lungs is an important part of the prehospital management of major trauma victims, but gauging the adequacy of ventilation remains a major problem.

METHODS

Ninety-seven major trauma victims who underwent tracheal intubation in the field and controlled ventilation of the lungs during prehospital treatment by a Helicopter Emergency Medical Service were assigned randomly to one of two groups: (1) monitor group (n=57) and (2) monitor-blind group (n=40), according to whether the anaesthetist could or could not see an attached capnograph screen. In the monitor-blind group ventilation was set by using a tidal-volume of 10 ml kg(-1) estimated body weight and an age-appropriate ventilatory frequency. In the monitor group, ventilation was adjusted to achieve target end-tidal carbon dioxide values determined by the 'physiological state' of the trauma victim. Arterial blood gases were measured upon hospital admission while maintaining the ventilation initiated in the field and the Pa(CO(2)) value obtained was used as the determinant of the adequacy of prehospital ventilation.

RESULTS

The incidence of 'normoventilation' was significantly higher (63.2 vs 20%; P<0.0001) and the incidence of 'hypoventilation' upon hospital admission was significantly lower (5.3 vs 37.5%; P<0.0001) in the monitor group; patients with severe head and chest trauma and haemodynamically unstable patients and those with a high injury severity score were significantly more likely to be 'normoventilated' upon hospital admission in the monitor group than in the monitor-blind group.

CONCLUSIONS

The data support the routine use of prehospital capnographic monitoring using target end-tidal carbon dioxide values adapted to the physiological state of the patient in major trauma victims requiring tracheal intubation in the field.

Indirect ELISA for the detection of antibodies against Opisthorchis felineus (Rivolta, 1884) and Metorchis bilis (Braun, 1790) in foxes

Serological investigations focused on the detection of specific opisthorchiid liver fluke antibodies in silver foxes (Vulpes vulpes fulva). Animals were experimentally infected with Opisthorchis felineus (nos. 1 and 2) and Metorchis bilis (nos. 3-8) by feeding fish with a counted number of metacercariae. Four foxes remained as non-infected negative controls (nos. 9-12). For the indirect ELISA, an excretory-secretory antigen was produced by in vitro cultivation of O. felineus and M. bilis adults isolated from livers of experimentally infected hamsters. Immunoglobulin G (IgG) seroconversion against homologous antigen took place between weeks 2 and 6 postinfection (p.i.) and foxes remained seropositive up to the end of the trial at week 41 p.i. In contrast, IgG titres against heterologous antigen remained significantly lower and stayed near the cut-off. All infected animals excreted opisthorchiid eggs, starting between weeks 2 and 4 p.i. The number of liver flukes found at necropsy was relatively low, except in one fox that was sacrificed at the week 11 p.i. These results suggest that the ELISA is a suitable tool for the detection of specific O. felineus and M. bilis antibodies in the fox.

Optimised conditions for the production of hepatitis B virus from cell culture

In chronically infected patients, hepatitis B virus (HBV) particles reach numbers as large as >10(9) genome equivalents (GE)/ml of serum. However, expression of infectious HBV particles in cell culture only yields 10(5)-10(6) GE/ml, which is insufficient for many studies. HBV transcription and possibly replication is dependent on hepatocyte-specific differentiation. Thus, we tested several cell culture parameters that have been reported to enhance the expression of hepatocyte-specific markers, such as growth on different extracellular matrices, different cell culture media, low concentrations of fetal calf serum (FCS) and the addition of dimethyl sulfoxide (DMSO) to the medium. Lower concentrations of FCS, growth on collagen and inclusion of DMSO in the medium only moderately enhanced HBV production in vitro when applied individually. However, combinations of these parameters optimised cell culture conditions and reproducibly increased the release of HBV particles about 100-fold to titres >10(8) GE/ml of culture medium.

[Occurrence of parasites in indigenous birds of prey and owls]

In the present paper a general overview on parasites in birds of prey and owls is given. This part is followed by a study investigating the prevalences and species of parasites in free-ranging birds of prey and owls in Berlin and Brandenburg State, Germany. Over a one year period, 84 birds of prey and owls of the following species were examined for the presence of endo- and ectoparasites: Common Buzzard (Buteo buteo) (n = 32), Kestrel (Falco tinnunculus) (n = 20), Sparrowhawk (Accipiter nisus) (n = 9), Goshawk (Accipiter gentilis) (n = 8), Black Kite (Milvus migrans) (n = 4), Peregrine Falcon (Falco peregrinus) (n = 3), Marsh Harrier (Circus aeruginosus) (n = 1), White-tailed-Sea Eagle (Haliaeetus albicilla) (n = 1), Tawny Owl (Strix aluco) (n = 4), Long-eared Owl (Asio otus) (n = 1) and Barn Owl (Tyto alba) (n = 1). In 97.6% of the cases, ectoparasites (feather mites and hippoboscid flies) were found. Especially eyasses (93.3%) were positive for hippoboscid flies. Trichomonas was detected in 28.6% of all birds of prey and owls examined. A prevalence of 100% was established in the Sparrow Hawks as well as Peregrine Falcons. Leucozytozoon sp. and Hemoproteus sp. as blood parasites were found in 26.9% of the birds in total. Common Buzzards showed the highest prevalence (44.8%). 58.3% of birds examined were positive for endoparasites. Flukes were found in 16.7%, tapeworms in 14.3%, round-worms in 48.8% and acanthocephales in 2.4% of the cases. Interestingly, Tylodelphis clavata (in a Common Buzzard) and Hovorkonema variegatum (in a Goshawk) were found for the first time in raptors. The results of this study underline the importance of a parasitological examination in the process of raptor rehabilitation.

[Change in procedure and re-osteosynthesis of the femur. Definition and retrospective analysis]

The change of treatment modality in osteosynthesis is based on two principles. On one hand, one can exchange the implant as part of a two step procedure to reduce side effects of stabilizing fractures. On the other hand, a reosteosynthesis may be required for treatment of complications. A retrospective analysis was undertaken to differentiate the situation of indication, technique and results of patients with fractures of the femur. Indications for two step procedure of therapy at the femur are limited to fractures of polytraumatized patients and fractures with severe soft tissue damage. External fixator devices have been used for stabilization of long bone fractures with severe soft tissue damage using the two step procedure in the past decades; nowadays unreamed nailing is commonly preferred. Reosteosynthesis may be appropriate for the treatment of failing of osteosynthesis; they can also be used due to delayed union or nonunion of fractures, osseous deficiency or infection. In the case of failing osteosynthesis, the reasons for failing have to be studied thoroughly and a variety of subsequent procedures has to be taken into consideration for successful treatment.

[Helminth findings in indigenous raccoon dogs Nyctereutes procyonoides (Gray, 1843)]

Internal organs of 74 racoon dogs originating from the eastern districts of the Federal Land Brandenburg were subjected to a complete helminthological dissection. In addition, samples of diaphragma muscles from 46 further animals were examined for Trichinella larvae. Altogether 3 trematode- (Alaria alata, Isthmiophora melis, Metorchis bilis), 3 cestode- (Mesocestoides sp., Echinococcus multilocularis, Taenia polyacantha) and 7 nematode species (Capillaria aerophila, C. plica, Trichinella spiralis, Uncinaria stenocephala, Molineus patens, Crenosoma vulpis, Toxocara canis) could be identified. Thereby, the racoon dog has a comparable helminth spectrum as well known in red foxes. Differences in the frequency of the occurrence of helminths in both hosts can be explained by different food preferences.

Electrochemical nanostructuring with ultrashort voltage pulses

The application of nanosecond voltage pulses to electrodes provides three ways to conduct local electrochemistry on the micro- to nanometer scale. (1) The finite charging time of the double-layer capacity allows the machining of three-dimensional microstructures. (2) In an electrochemical scanning tunneling microscope, reactions are confined to the tunneling region, due to the depletion of the electrolyte in the tip--surface gap. (3) Ordering processes, following very fast electrochemical reactions, lead to unconventional island patterns on a surface.

[Liver fluke infection and sarcoptic mange in red foxes in Berlin]

396 red foxes originating from the city of Berlin were examined for opisthorchiid liver flukes and clinical sarcoptic mange between January 1997 and March 1998. Out of 232 (= 58.6%) foxes positive for opisthorchiid flukes 221 animals harboured Metorchis bilis and 70 were infected with Opisthorchis felineus. Pseudamphistomum truncatum was found only in 8 foxes. M. bilis occurred as mono-infection in 154 animals. M. bilis in combination with O. felineus was found in 61 cases. Pure Opisthorchis infection as well as other fluke combinations were found in a small number of animals only. 85 (= 21.5%) foxes showed clinical sarcoptic mange. Liver fluke positive foxes showed a higher mange prevalence than uninfected animals. However, significant associations between flukes and manage were only found when comparing uninfected foxes with those having the highest worm burden. The association of liver flukes and mange could be established for adult female foxes by a significant Odds Ratio of 4.3.

Chemistry of the oil gland secretion of Collohmannia gigantea (Acari: Oribatida)

The chemistry of the lemon-scented oil gland secretion of Collohmannia gigantea, a middle-derivative mixonomatan oribatid mite, was investigated by gas chromatography - mass spectrometry. Gas chromatographic profiles of whole body extracts of C. gigantea revealed two distinct chromatographic zones, the first containing a set of six volatile compounds, comprising the lemon-scented monoterpene aldehydes neral and geranial, the scented monoterpene ester neryl formate, a distinctly scented aromatic aldehyde (2-hydroxy-6-methyl-benzaldehyde = 2,6-HMBD), and the two non-scented hydrocarbons, tridecane and pentadecane. All six components appeared to be present in steady relative proportions in scenting mites only, indicating their unity within the scented secretion. In contrast, the components of the second chromatographic zone were less volatile and found in both, scenting and nonscenting mites. Chemically, they represent a set of fatty acids of already known cuticular origin. The secretion bouquet of the first chromatographic zone was linked with oil glands by histochemical means: large amounts of aldehydes were present only in oil gland reservoirs, not in any other region of the mite body. While chemical profiles of oil gland secretions of several dozen astigmatid mites are known, only one other oribatid oil gland composition, from a desmonomatan species, has been elucidated, being almost the same as that of C. gigantea. Moreover, all components of these two secretions are widely distributed amongst astigmatid mite species and may also be common in a restricted set of middle-derivative oribatids. These findings are consistent with the idea of astigmatid mite origin from a mixonomatan-desmonomatan group.

Duck hepatitis B virus expresses a regulatory HBx-like protein from a hidden open reading frame

Duck hepatitis B viruses (DHBV), unlike mammalian hepadnaviruses, are thought to lack X genes, which encode transcription-regulatory proteins believed to contribute to the development of hepatocellular carcinoma. A lack of association of chronic DHBV infection with hepatocellular carcinoma development supports this belief. Here, we demonstrate that DHBV genomes have a hidden open reading frame from which a transcription-regulatory protein, designated DHBx, is expressed both in vitro and in vivo. We show that DHBx enhances neither viral protein expression, intracellular DNA synthesis, nor virion production when assayed in the full-length genome context in LMH cells. However, similar to mammalian hepadnavirus X proteins, DHBx activates cellular and viral promoters via the Raf-mitogen-activated protein kinase signaling pathway and localizes primarily in the cytoplasm. The functional similarities as well as the weak sequence homologies of DHBx and the X proteins of mammalian hepadnaviruses strongly suggest a common ancestry of ortho- and avihepadnavirus X genes. In addition, our data disclose similar intracellular localization and transcription regulatory functions of the corresponding proteins, raise new questions as to their presumed role in hepatocarcinogenesis, and imply unique opportunities for deciphering of their still-enigmatic in vivo functions.

[Distribution of opisthorchiid liver flukes in red foxes (Vulpes vulpes) in western Brandenburg]

226 (= 43.9%) out of 515 red foxes originating from the western districts of the Federal State Brandenburg were positive for opisthorchiid flukes. Metorchis bilis, Opisthorchis felineus and Pseudamphistomum truncatum occurred in prevalences of 36.9, 8.9 and 0.2% respectively. Although low fluke burden were predominant the maximum number of each fluke species isolated was 419, 46, and 78 respectively. No clear relations were found between the liver fluke prevalence and the proportion of surface waters of the different administrative districts. However, most positive foxes originated from municipalities closely situated to rivers, canals, and lakes.

Electrochemical micromachining

The application of ultrashort voltage pulses between a tool electrode and a workpiece in an electrochemical environment allows the three-dimensional machining of conducting materials with submicrometer precision. The principle is based on the finite time constant for double-layer charging, which varies linearly with the local separation between the electrodes. During nanosecond pulses, the electrochemical reactions are confined to electrode regions in close proximity. This technique was used for local etching of copper and silicon as well as for local copper deposition.

[Self-impalement after thoracic stab wound. An unusual method of suicide in psychotic symptomatology]

A 35 year-old male was found dead within a vast collection of garbage in his parent's house with 13 stab wounds of the thorax. 6 years before death he had suffered from a severe cerebral trauma with intracranial hemorrhage, after which an organic psychosis had ensued. At autopsy besides the stab wounds measuring 1-3.5 cm in length and partly exhibiting a so-called "fish-tail" formation a piece of wood was detected, having penetrated the fourth intercostal space along the sternal border and lacerated the pericardium, right pulmonary hilum and the pleura parietalis at the paravertebral line between the eight and ninth rib. There the leading part of the tool had apparently broken and bent to the left in a nearly 90 degrees angle, thus penetrating the left pleural cavity with a slight laceration of the lower lobe of the lung. From the forensic pathologist's point of view this case of multiple stabbing and additional impalement was at least remarkable and at first sight might have raised a suspicion of homicide due to the extent of the rib penetrations and especially the intrusion of the wooden device, which had been pushed by substantial force into an already existing wound. The police presupposed a suicide based on the personal history and situation at the site, where no traces suggesting an activity of somebody else could be ascertained. Reconstruction of the case and resulting differential diagnostic considerations are to be discussed.

Malignant cell detection by fluorescence in situ hybridization (FISH) in effusions from patients with carcinoma

Cytological diagnosis of malignant cells in effusions is hampered by difficulties in the differentiation from reactive mesothelial cells. Because interphase cytogenetics by fluorescence in situ hybridization (FISH) might complement cytological evaluation, we determined the power of tumor cell detection using FISH and cytology in 201 effusions from patients with advanced cancer. Furthermore, 9 primary breast tumors were FISH-karyotyped, and chromosomal aberrations were compared with those of corresponding metastatic effusion cells. By using centromeric probes representing chromosomes 7, 8, 11, 12, 17, and 18, a rate of malignancy-associated aneusomy combined for the 6 chromosomes was detected in an overall of 44.8% of effusion specimens (range, 31.8% to 39.3% for the individual chromosome), comparable to cytology (43.3%). The combination of just 2 FISH probes (namely, representing chromosome pairs 8/11 and 8/17) was almost equally efficient in the identification of aneusomy. Approximately one fourth of the cytologically negative effusions were FISH positive and vice versa. From the initially FISH-negative effusions, 18.9% could be subsequently classified positive with dual-color FISH by visualization of intranuclear chromosomal complexity in rare aneuploid cells. Thus, "overall FISH analysis," including dual-color evaluation, identified tumor cells in significantly more effusions (55.2%, P = .001) than conventional cytology, implying greater sensitivity. Finally, our finding that numerical aberration patterns in primary breast tumors and corresponding metastatic effusions are comparable indicates that FISH examination of primary tumors will indicate the centromeric probe(s) best suited for an efficient search for metastasis in the individual case.

Oribatid mites (Acari, Oribatida) as intermediate hosts of tapeworms of the Family Anoplocephalidae (Cestoda) and the transmission of Moniezia expansa cysticercoids in South Africa

Six species of adult oribatid mites (Galumna racilis, Kilimabates pilosus, Kilimabates sp., Scheloribates fusifer, Muliercula ngoyensis and Zygoribatula undulata) and two immature stages belonging to the superfamilies Galumnoidea and Ceratozetoidea were isolated from a lawn (mixed Pennisetum and Cynodon spp.) at Onderstepoort Veterinary Institute, South Africa. The mites were subsequently used in an infection trial using Moniezia expansa eggs. Tapeworm cysticercoids were recovered in G. racilis, K. pilosus, Kilimabates sp., S. fusifer, M. ngoyensis and Z. undulata, as well as in immatures of Ceratozetoidea. The percentage of infected mites was 7,6, 6,3, 16,4, 66,7, 57,1, 60,0 and 46,7% respectively. Immatures of Galumnoidea did not become infected. The highest number of cysticercoids isolated from one individual was six from an adult S. fusifer.

Induction of apoptosis by the transactivating domains of the hepatitis B virus X gene leads to suppression of oncogenic transformation of primary rat embryo fibroblasts

Epidemiology shows a clear correlation between chronic infection with the hepatitis B virus (HBV) and development of hepatocellular carcinoma (HCC). The potential role of the transactivating hepatitis B virus X protein (HBx) in transformation by HBV is controversial. Here we report that HBx suppresses transformation of primary rat embryo fibroblasts (REFs). Cooperating oncogenes like c-Ha-ras and c-myc transform REF very efficiently but cotransfection with HBx suppressed transformation of REFs down to 5%. Similarly, transfection of HBx together with the cooperating oncogenes Ha-ras and SV40 LTAg or c-Ha-ras and mutant p53 reduced the number of foci to 13%. Comparable results were obtained with HBx in the context of the whole HBV. Suppression of focus formation in REF could be partly relieved by cotransfection of apoptosis inhibitors Bcl-2 or E1B. However, cotransfection of apoptosis inhibitors crmA and p35 did not influence the proapoptotic functions of HBx. Thus, HBx may specifically activate the Bcl-2 sensitive pathway leading to apoptosis. Experiments with 13 HBx linker scanning mutants revealed that the domains necessary for HBx dependent transactivation overlap with the domains needed for the apoptotic/growth arrest functions of HBx.

Stress-induced recrystallization of a protein crystal by electron irradiation

Ordering of a system of particles into its thermodynamically stable state usually proceeds by thermally activated mass transport of its constituents. Particularly at low temperature, the activation barrier often hinders equilibration--this is what prevents a glass from crystallizing and a pile of sand from flattening under gravity. But if the driving force for mass transport (that is, the excess energy of the system) is increased, the activation barrier can be overcome and structural changes are initiated. Here we report the reordering of radiation-damaged protein crystals under conditions where transport is initiated by stress rather than by thermal activation. After accumulating a certain density of radiation-induced defects during observation by transmission electron microscopy, the distorted crystal recrystallizes. The reordering is induced by stress caused by the defects at temperatures that are low enough to suppress diffusive mass transport. We propose that this defect-induced reordering might be a general phenomenon.

Passive smoke exposure in infants and children with respiratory tract diseases

1. The adverse effect of passive smoke exposure on the respiratory tract, particularly in infants and children, is not an issue of dispute. It was the objective of this study to analyse the extent and the intensity of passive smoke exposure in infants and children with respiratory tract diseases, and compare the information obtained with parents' subjective assessment. At the time of admission to the hospital, the parents of 295 infants and children (aged 1 month to 11 years) were questioned by the physician as to the smoking habits in the families' homes. An HPLC method was employed to determine simultaneously nicotine, cotinine and trans-3'-hydroxycotinine in the children's urine. 2. The sum of the nicotine metabolites turned out to be a sensitive marker in determining passive smoke exposure. Measurements revealed passive smoke exposure in 66% of the children, the frequency in younger children being significantly (P < 0.001) higher than in children over 5 years (84% vs 52%). The average concentration of nicotine metabolites in younger passive smokers was significantly (P < 0.001) higher when compared to the older ones (193 nmol/l vs 86 nmol/l). Forty-nine per cent of the parents assessed that their children had experienced passive smoke exposure, and another 10% emphasised that they only smoked in the absence of their child. In children with cystic fibrosis and bronchial asthma, the number of passive smokers as assessed by their parents were lower by 65% and 29% respectively when compared to the findings obtained from measurements. In children without respiratory diseases, the difference was as little as 18%. 3. Parents when questioned in conjunction with an illness of their children, tended to understate, or even withhold the truth about, passive smoke exposure. Therefore, reliable information on passive smoke exposure of patients can only be obtained through objective measurements.

Hyperdiploidy and apparent aneusomy in mesothelial cells from non-malignant effusions as detected by fluorescence in situ hybridization (FISH)

Interphase cytogenetics by fluorescence in situ hybridization (FISH) can be used to detect malignant cells characterized by chromosomal aneuploidy. However, apparent aneusomy in normal "control" tissues has to be considered when using FISH as diagnostic tool. In effusions as model tissue exposed to metastasis, the definition of cut-off levels for background aneusomy by FISH was aimed in this study. Using centromeric probes representing chromosomes 7, 8, 11, 12, 17 and 18, extensive chromosome copy number enumeration by single-color FISH analysis was performed in pleural and ascitic effusions derived from 15 patients with various, non-malignant diseases. In all effusions, cells with gain of hybridization signals for several or all chromosomes tested were found (in up to 1.94% of cells). A consistent finding was high grade hyperdiploidy (>4 centromeric signals). Mesothelial elements mainly contributed to hyperdiploidy in effusions, as demonstrated by a combined analysis of FISH and immunocytochemistry with staining for cytokeratin. Dual-color FISH analysis showed that hyperdiploidy was predominantly corresponding to polyploidization; however, there were always minor cell populations classified as aneuploid by dual-color FISH. In conclusion, stringent criteria have to be applied to distinguish malignancy-related aneuploidy from background aneusomy by FISH.

Liver fluke (Opisthorchiidae) findings in red foxes (Vulpes vulpes) in the eastern part of the Federal State Brandenburg, Germany--a contribution to the epidemiology of opisthorchiidosis

Parasitological examination of 677 livers from red foxes shot in connection with a rabies control programme were carried out in the eastern districts of the Federal State Brandenburg/Germany in 1996. Of the foxes, 32.5% were positive for opisthorchiid flukes. Metorchis bilis, the most frequently occurring fluke was found in 28.1% of foxes with numbers between 1 and 185. Opisthorchis felineus was found in 6.7% of fox livers. A maximum of 169 specimens was removed from one animal. Pseudamphistomum truncatum was present in only 2 foxes. The percentage of positive foxes in different districts varied between 15.8 and 43.3%. Significant differences in fluke prevalence were found between districts with a high share of surface water compared with a district with a low percentage of surface water. No sex-dependent differences in opisthorchiid prevalence were established.

Presence of a p53 gene deletion in patients with multiple myeloma predicts for short survival after conventional-dose chemotherapy

In multiple myeloma (MM), previous studies showed that mutations of the p53 gene are rare events in patients with newly diagnosed disease, but it is not known whether deletions of p53 are of any significance in MM. To address this question, we used interphase fluorescence in situ hybridization (FISH) with a DNA probe specific for the p53 locus at 17p13 and investigated bone marrow plasma cells from 72 patients with MM (59 patients = 81.9% before therapy). By FISH, deletions of p53, which were found to be predominantly monoallelic, were detected in 32.8% and 54.5% of patients with newly diagnosed and relapsed MM, respectively. Karyotypes from six of the patients with a p53 deletion by FISH showed a structural abnormality of 17p in only one of them. Additional FISH studies including a distal-17p probe (specific for the D17S34 locus) provided evidence for an interstitial deletion on 17p resulting in loss of p53 hybridization signals in myeloma cells. Among all 59 patients with newly diagnosed MM, presence of a p53 deletion was associated with stage III (P = .054), but not with other laboratory and clinical parameters. Patients with a p53 deletion had significantly shorter survival time compared with those without a deletion, both from the time of diagnosis (median 13.9 v 38.7 months; P < .0001) and from the time of initiation of induction treatment consisting of conventional dose chemotherapy (median 15.9 months v median not reached at 38 months; P < .0002). On stepwise multivariate regression analysis, presence of a p53 deletion was the most significant independent parameter predicting for shortened survival (P = .002). We conclude that a p53 gene deletion, which can be identified by interphase FISH in almost a third of patients with newly diagnosed MM, is a novel prognostic factor predicting for short survival of MM patients treated with conventional-dose chemotherapy.

High ethanol tolerance in young adults is associated with the low-activity variant of the promoter of the human serotonin transporter gene

Central serotonergic neurotransmission has been implicated in the aetiology of ethanol tolerance and dependence. Cellular expression of the serotonin transporter and serotonin reuptake is modulated via a polymorphic, repetitive element in the 5'-flanking regulatory region of the serotonin transporter gene (5-HTTLPR). We report the association of the low-activity, short variant of the 5-HTTLPR with high ethanol tolerance among young adults in a case-control association study (n = 713). The low-activity 5-HTTLPR showed a significantly increased allele frequency (chi2 = 7.30; df = 2; P = 0.007) and genotype frequency among young adults (< or =26 years) with high ethanol tolerance homozygous for the short allele (chi2 = 7.58; df = 1; P = 0.02). The estimated odds ratio for the homozygous short variant compared to the homozygous long variant was 2.82 (95% CI 1.30-6.11). This indicates that the low-activity 5-HTTLPR may be involved in the neuronal mechanisms responsible for ethanol tolerance and dependence.

Aneuploidy of chromosome 8 as detected by interphase fluorescence in situ hybridization is a recurrent finding in primary and metastatic breast cancer

Previous work from our laboratory demonstrated aneuploidy for several chromosomes by interphase fluorescence in situ hybridization (FISH) in a high proportion of breast cancer specimens. In the literature, only limited data are available concerning chromosome 8 anomalies in breast cancer. To determine chromosome 8 ploidy status in primary and metastatic specimens from 81 breast cancer patients, FISH analysis with a DNA probe recognizing chromosome 8 centromeres was performed. In all primary tumor specimens (n = 30), significant proportions of cells were aneuploid exhibiting gain of chromosome 8 copy numbers; in 75% of effusion specimens previously classified as malignant by cytology and/or FISH for various chromosomes (n = 40), cell populations aneuploid for chromosome 8 were detected; effusions previously classified non-malignant (n = 11) were diploid in 10 cases, whereas one specimen contained rare hyperdiploid cells. Among these cells complex chromosomal aneuploidy could be demonstrated by two-color FISH, suggesting malignancy. Trisomic and tetrasomic clones were predominant in the majority of samples, but a marked intratumor cytogenetic heterogeneity was observed in most cases. Primary tumors and corresponding positive axillary lymph nodes revealed similar distributions of chromosome 8 copy numbers, analogous to previous findings with other chromosomes. This implies that, by using suitable FISH probes after examination of the respective primary tumor, an efficient search for (micro)metastasis might be feasible.

Prospective, double-blind, placebo-controlled, multicentre study on the effect of high-dose, intravenous immunoglobulin in children and adolescents with severe bronchial asthma

OBJECTIVE

In order to study the effect of high-dose, intravenous immunoglobulin (i.v.IG) in severe childhood asthma, we investigated 31 children and adolescents (15 girls, 16 boys) aged 9-22 years (median age of 14 years) suffering from severe bronchial asthma.

METHODS

In a prospective, double-blind fashion, patients received either four doses of i.v.IG (1 g/kg body weight) or identical doses of intravenous human serum albumin. The first two doses were given on two consecutive days, followed by two further doses at 4 week intervals.

RESULTS

There was no statistical difference in the actively treated group when compared with the placebo group in symptom-score, bronchial hyperreactivity or peak-flow-variability. There was a trend for fewer total days of upper respiratory tract infections and also symptom-scores in the i.v.IG group but these did not reach statistical significance.

CONCLUSION

Our data indicate that treatment with i.v.IG in asthmatic children did not show a significant reduction in the incidence of upper respiratory tract infections, but the patients who did have upper respiratory infections in the i.v.IG-group appear to have less protracted infections. Severity and bronchial hyperreactivity do not seem to be affected by the treatment as performed in our study.

[Diagnosis and clinical results in elderly patients in an internal medicine intensive care unit]

OBJECTIVE

To ascertain prospectively whether age is an independent prognostic factor for patients in a medical intensive care unit (MICU).

PATIENTS AND METHODS

The data recorded prospectively for all patients admitted to a MICU between October 1994 and April 1996 were analysed with regard to demographic items, admission diagnosis. APACHE II score, days spent in the MICU and mortality rate. The data were arranged by age group and admission diagnosis (APACHE II score).

RESULTS

753 patients were admitted, 423 aged 65 or over (56.2%). Analysis of subgroups among the latter revealed a significant decrease in cardiovascular admission diagnoses with increasing age (65-74 years: 59%; 75-84: 55%; 85 or over: 32%), while the opposite trend pertained for pulmonary disease (65-74 years: 10%; 75-84%: 19%; 85 or over: 21%). There was a significant correlation for the total collective between mortality rate and severity of the disease on admission to the MICU (APACHE II score; P < 0.05). Those 65 years or older had a higher APACHE II score (17.4 vs 12.0; P < 0.05) and thus a higher mortality rate than the younger patients (25% vs > 12%; P < 0.01).

CONCLUSION

Many of the patients admitted to a MICU were aged over 65 years. The incidence of cardiovascular ailments on admission decreased with increasing age, while the opposite trend was true for pulmonary disease. There was no difference in mortality rate between different age groups given similar disease severity.

[Investigations on the endoparasitic fauna of domestic cats in eastern Brandenburg]

The internal organs of 155 cats originating from 3 different territories in the eastern part of Brandenburg state were examined for parasites between 1993 and 1995. Parasites were found in 85% of cats. Parasites with the highest prevalence were Toxocara mystax (45%), Hydatigera taeniaeformis (22%), Ancylostoma tubaeforme (17%) and Opisthorchis felineus (16%). Metorchis bilis, Mesocestoides spp., Taenia pisiformis, Capillaria plica, Capillaria sp., Ollulanus tricuspis, Aelurostrongylus abstrusus, Cystoisospora spp. and Sarcocystis spp. were diagnosed with a lower frequency. The occurrence of H. taeniaeforme, A. tubaeformis und O. felineus was depending on the origin of the cats.

Cardiorespiratory and renal responses to arterial chemoreceptor stimulation by hypoxia or almitrine in men

1. The cardiorespiratory and renal responses to 3 h of normobaric whole-body hypoxic hypoxia (FiO2 = 0.12) as well as to arterial chemoreceptor stimulation by the oral administration of 100 mg almitrine bismesylate during normoxia were measured in 12 normotensive young men undergoing water diuresis. A third series of responses obtained under comparable conditions in the same subjects served as time controls. 2. No significant changes could be detected over time in the parameters measured in control experiments. The subjects reacted to both whole-body hypoxic hypoxia and to pharmacological chemoreceptor stimulation with significant increases in heart rate, tidal volume, minute ventilation and filtration-fraction. Overall renal vascular resistance rose significantly in hypoxia; increases in renal vascular resistance in almitrine experiments were not significant. 3. Renal fractional lithium excretion decreased significantly in response to whole-body hypoxic hypoxia and increased slightly in response to almitrine. Fractional urine and sodium excretion showed negligible changes. 4. The data indicate that, in humans, both almitrine and whole-body hypoxic hypoxia affect not only alveolar ventilation but also renal haemodynamics. 5. The renal electrolyte excretion pattern suggests that under certain circumstances (e.g. dilated renal vascular bed) acute, but well-tolerated, whole-body hypoxic hypoxia can simultaneously stimulate renal proximal tubular sodium reabsorption and inhibit distal tubular sodium reabsorption. The renal tubular responses also indicate that almitrine may influence renal tubular lithium reabsorption by, thus far, unknown mechanisms.

A focus of opisthorchiidosis in Germany

Epidemiological investigations were carried out in a focus of opisthorchiidosis in Brandenburg state of Germany. 9 out of 23 cats harboured adult flukes in their livers. Beside Opisthorchis felineus, Metorchis bilis was found in 4 cats. Muscle samples of 227 cyprinid fish belonging to 6 species (Rutilus rutilus, Scardinius erythrophthalmus, Alburnus alburnus, Abramis brama, A. ballerus, Blicca bjoerkna) were examined for trematode metacercariae. 12 different types of cysts were found. O. felineus was present in all fish species. R. rutilus and A. alburnus showed a prevalence of Opisthorchis of more than 70%. Two out of 166 Bithynia leachi were positive for trematode developmental stages. Due to their young age the rediae could not be specified.

Cardiorespiratory and renal responses to arterial chemoreceptor stimulation in early hypertension

The peripheral arterial chemoreceptors (PAC) modify not only cardiorespiratory but also renal hemodynamic and excretory function. There is evidence that in hypertensive animals and humans the reflectoric actions of the PAC on ventilation and circulation differ from those of normotensive subjects. However, the influence of these receptors on kidney function of hypertensive subjects is poorly understood. Cardiorespiratory and renal responses to pharmacological stimulation of PAC by almitrine bismesylate during normoxia were measured in 16 normotensive (NT) and 13 age-matched borderline-hypertensive young men (BHT) undergoing water diuresis. Placebo experiments served as time controls in each subject. NT reacted to almitrine with significant rises in heart rate, minute ventilation, and filtration fraction. Renal vascular resistance tended to increase slightly. In BHT the drug caused a significant rise in heart rate and minute ventilation too, however, this reaction had a longer latency when compared to NT. In contrast to NT, filtration fraction, and renal vascular resistance decreased. Renal fractional sodium and lithium excretion did not show any clear response to almitrine in NT, but decreased in BHT. The results suggest that the weaker ventilatory response in BHT vs. NT might indicate a lower reactivity of their PAC to almitrine. The different reactions of the renal vascular bed to pharmacological chemoreceptor excitation in mild hypertensives might result from a different reactivity of the renal arterioles, whereas the enhanced proximal tubular sodium reabsorption could be due to an exaggerated increase in efferent renal nerve activity.

Evidence for lateral transfer and recombination in OspC variation in Lyme disease Borrelia

The ospC gene was amplified by the polymerase chain reaction from each of 76 Lyme disease Borrelia strains. Restriction fragment length polymorphism (RFLP) analysis demonstrated 33 distinct RFLP types; two additional RFLP types were identified from published ospC sequences. For each RFLP type, at least one ospC gene was sequenced and the degree of sequence relatedness examined by construction of an ospC gene tree. The genes were extremely diverse, with sequence identity ranging from 74.4% to 99.0%; the majority of changes are localized within the central portion of the molecule. A comparison of ospC sequences suggests that recombination occurs frequently between ospC alleles; this genetic exchange is proposed to be mediated by lateral transfer of ospC sequences. Evidence indicates that recombination occurs between ospC genes from the same Borrelia species (i.e. B. afzelii and B. garinii) as well as between different Borrelia species (i.e. B. afzelii and B. garinii, B. burgdorferi and genogroup DN127).

Use of mathematical models for predicting the metabolic effect of large-scale enzyme activity alterations. Application to enzyme deficiencies of red blood cells

There are numerous examples showing that the metabolism of cells can be severely impaired if the activity of only one of the participating enzymes undergoes large-scale alterations, resulting, for example, from spontaneous mutations (inherited or acquired enzymopathies), the administration of toxic drugs or self-inactivation of enzymes during cell aging. However, a quantitative relationship between the degree of enzyme deficiency and the extent of metabolic dysfunction is very difficult to establish by experimental means. An alternative is to tackle this problem by mathematical modelling. Our approach is based on a comprehensive mathematical model of the energy and redox metabolism for human erythrocytes. We calculate stationary states of the cell metabolism, varying the activity of each of the participating enzymes by several orders of magnitude. The metabolic states are then evaluated in terms of a performance function which relates the metabolic variables to the overall functional fitness of the cell. The performance function for the erythrocyte takes into account the homeostasis of three essential metabolic variables: the energetic state (ATP), the reductive capacity (reduced glutathione), and the osmotic state. Based on the behaviour of the performance function at varying enzyme activities, we estimate those ranges of enzyme activities, in which the metabolic alterations should be either tolerable, associated with non-chronic or chronic diseases, or lethal. For most enzymopathies, the experimental and clinical observations can be satisfactorily rationalized by the computational results. Moreover, a surprisingly high correlation is found between the range of the activity range where disease is predicted by the model and the observed number of diseased probands. Another objective of our study was to contribute to the theory of metabolic control. The well-elaborated concept of the metabolic control theory is restricted to (infinitely) small activity alterations. In order to quantify the metabolic effect of finite (large-scale) changes in the activity of an enzyme, we propose, as a control measure, the effective activity E alpha, defined as the relative activity of an enzyme (with respect to the activity in a reference state) required to bring about a change in the stationary value of a metabolic variable by the (finite) factor alpha. We demonstrate that none of the existing extrapolation methods using the conventional control coefficient is capable to provide reliable predictions of the effective activities for all enzymes of erythrocyte metabolism.