[Incidence and significance of angina pectoris in aortic valve disease]

To determine the incidence and significance of angina pectoris in aortic valve disease, clinical, haemodynamic, and angiographic data concerning 111 consecutive patients aged 27-68 years (mean 52) were retrospectively analysed. 14.4% (group A) had significant, 85.6% (group B) had no coronary heart disease. There was a significant difference between the groups regarding the incidence of typical angina pectoris (62.5% vs 31.6%, p less than 0.01) and freedom from chest pain (12.5% vs 32.6%, p less than 0.05). No difference, however, could be found concerning the incidence of atypical chest pain (25% vs 35.8%). Of 12 patients aged over 50 years with coronary artery disease, no patient was free of angina pectoris. 83% had typical, 17% had atypical angina pectoris. Of 4 patients below 45 years with coronary artery disease, however, none had typical angina pectoris, 2 patients had atypical angina, and 2 patients had none. These results demonstrate that typical angina pectoris in patients with aortic valve disease is not a specific indicator of concomitant significant coronary artery disease. On the other hand, absence of chest pain does not predict absence of coronary artery disease, especially in younger patients. We therefore suggest that coronary angiography be carried out in all adult patients in whom aortic valve surgery is being considered.

Plasmapheresis in multiple sclerosis: prospective trial of pheresis and immunosuppression versus immunosuppression alone

A prospective trial of plasmapheresis and azathioprine or azathioprine alone was carrier out on 20 patients with chronic progressive MS. Seven of 10 patients in each group continued therapy for 12 months. When the groups were compared by disability ratings, the combination of plasmapheresis and azathioprine was no better than azathioprine alone. Transient subjective improvement occasionally followed plasmapheresis, but no objective improvement was documented.

Identification of an antigen associated with transforming genes of human and mouse mammary carcinomas

Sera from tumor-bearing mice immunoprecipitated a 86,000-dalton glycoprotein from extracts of NIH cells transformed by human mammary carcinoma DNA. This antigen was not immunoprecipitated from extracts of NIH 3T3 cells, spontaneously transformed NIH cells, NIH cells transformed by normal human DNA, NIH cells transformed by human bladder carcinoma DNA, or NIH cells transformed by Rous sarcoma virus DNA. In addition, sera from mice bearing tumors induced by NIH cells transformed by either normal human DNA or human bladder carcinoma DNA did not immunoprecipitate this antigen from extracts of NIH cells transformed by human mammary carcinoma DNA. However, this antigen was immunoprecipitated by sera from mice bearing tumors induced by NIH cells transformed by mouse mammary carcinoma DNAs and from mice bearing primary mammary carcinomas. These results indicate that this glycoprotein represents an antigen that is specifically associated with expression of the transmissible transforming genes of human and mouse mammary carcinomas.

Changes in physiological, EEG and psychological parameters in women during the spontaneous menstrual cycle and following oral contraceptives

In a controlled cross-over design study performed with 14 female subjects, serum hormone levels, the EEG and a number of performance tests were recorded during spontaneous and oral contraceptive-controlled menstrual cycles. The mean alpha-frequency showed cyclic changes, i.e. slower alpha-waves during the follicular phase and faster alpha-waves during the luteal phase. Smaller cycle stage-dependent differences in the power of the theta- and beta-bands also were noted. An increase in several performance task scores was noted during the periovulatory period, whereas lowest performance scores were recorded during the late luteal and early menstrual phases. No such effects were observed in the same subjects while they were taking oral contraceptives. These results demonstrate that the gross electrical activity of the brain changes in a parallel with changed hormone levels. The changes in performance tests coincide with increasing or decreasing alpha activities in the EEG. The common underlying mechanism may be an activation of central nervous system monoaminergic pathways which are known to be involved in steroid feedback.

Peak centred power spectra: a successful attempt to calculate efficient parameters in the alpha range of EEG

This paper presents a parametrization method for the alpha range of EEG Fourier spectra which obviates the limitations of conventional frequency partition and is concerned with the location of the individual peak frequency. The superiority of this procedure in comparison with the conventional method could be shown through the performance of a cross validation.

Adrenocortical tumor in a patient with congenital adrenal hyperplasia due to 21-hydroxylase deficiency

An adrenal cortical tissue tumor developed in a patient with poorly controlled salt-losing congenital adrenal hyperplasia. A 16-year-old girl became progressively virilized from 13 to 16 years of age. Base line serum progesterone, 17-hydroxyprogesterone, and testosterone levels were high and there was a diurnal pattern of the hormones. Initially elevated urinary 17-ketosteroid and serum steroid levels were decreased by high dose dexamethasone therapy, and at laparotomy an adenoma was found in the cortex of the hyperplastic left adrenal gland. It is inferred that persistent adrenocorticotrophic hormone stimulation may result in neoplastic transformation of hyperplastic adrenal cortical tissue in patients with congenital adrenal hyperplasia.

[Combined plastic bridging of a post-traumatic osseous defect of the tibia in the sense of compound osteosynthesis in elderly patients (author's transl)]

The article presents a woman (now 82 years of age) in whom adjustment osteotomy had been performed in order to cope with her proximal fracture of the tibia which had healed in varus position after conservative therapy. After absorption of the bone wedge and loosening of the osteosynthesis material, the defect was filled with bone cement with embedded screws and plates. Three years later, the patient returned for treatment with completely loosened Palacos seal which had perforated distally through the skin and rather broadly. Besides pseudarthrosis, there was also a marked arthrosis of the knee joint. The patient was re-operated, bridging the defect by means of Fracto nets and a bolted Placos seal into which a Sheehan's knee was inserted.

Induction of plasminogen activator synthesis by antibodies

We have purified the immunoglobulins (IgG) from rabbit antisera raised against two cell lines--LLC-PK1 derived from pig kidney and from Kirsten sarcoma virus-transformed BALB/3T3--and have studied the effects of IgG on cultures of the respective target cells. The following observations were made with both cell types: (a) The addition of purified IgG produced a rapid change in morphology within 2 h. This consisted of cell rounding, agglutination, and detachment from the surface of the dish. (b) Beginning approximately 2 h after IgG addition there was a progressive rise in plasminogen activator production for 24--36 h. (c) Both the morphological change and the induction of plasminogen activator (PA) synthesis were reversible and required the continued presence of IgG for their maintenance. The increase in PA production, but not morphological change, depended on genetic transcription and translation, being inhibited by actinomycin and/or cycloheximide. (d). These effects of IgG were specific: they were not observed with preimmune or indifferent IgG and occurred only after interaction between an IgG preparation from antisera and the cells used to generate the particular antiserum. The divalent IgG fragments F(ab')2 retained fully the activities of the native IgG molecules from which they were derived.

The effects of targeting improvements in urine glucose on metabolic control in children with insulin dependent diabetes

A treatment program designed to increase the percentage of negative urine tests was implemented using a multiple-baseline across groups design in a sample of 19 families of children with insulin dependent diabetes. The treatment involved instruction in insulin adjustment, decrease in intake of simple sugars and saturated fats, and increase in exercise, along with teaching the parents to support improvements in children's self-regulatory behaviors using a point economy and praise. New procedures designed to measure and reinforce adherence to the urine testing regimen were developed. Results showed significant increases in percentage of negative urines consistent with implementation of treatment across the three treatment groups, which were maintained over the follow-up period. Metabolic measures of control, including glycosylated hemoglobin and serum glucose did not show improvements even though the relationship between the percentage of negative urine tests and glycosylated hemoglobin was very high during treatment.

Electrophysiological and psychological changes induced by steroid hormones in men and women

The effects of hormonal changes during the menstrual cycle and of oral contraceptives on the EEG, heart-rate and a number of performance tasks were investigated in 16 female subjects (Ss). Powerspectral analysis in the EEG revealed significantly increased alpha-frequencies and heart-rates during the luteal phase of the menstrual cycle whereas the mean theta-frequency and power decreased. A number of psychological test variables, such as reaction time to a tone, to a flickering light and to a colour-tone sequence and the time to solve simple arithmetic problems was shorter at the periovulatory time. Another minimum was reached during the perimenstrual phase. The flicker-fusion-frequency was higher during these two periods. No such effects could be observed when the same Ss were treated with oral contraceptives. It is concluded that the phenomena observed during the luteal phase of the cycle may be the expression of a slight general arousal effect, possibly medicated by progesterone via the noradrenergic system. In a subsequent double blind study 30 male Ss were treated with an gestagenic compound (D-Norgestrel, 2.5 mg/die), an estrogenic compound (estradiolvalerate, 5 mg/die), an androgenic substance (Mesterolone, 100 mg/die) or with placebo. Only treatment with the progestational compound revealed significant changes in the EEG and the performance tests. These changes were qualitatively similar to those observed during the luteal phase of the female Ss. Under both conditions, i.e. the luteal phase and D-Norgestrel treatment, the body-temperature was significantly increased. Hence, the question whether gestagens exert their effects directly on CNS structures which modulate EEG appearance and behavior or indirectly via increased body-temperature cannot be answered convincingly.

Measurement and modification of the accuracy of determinations of urine glucose concentration

Studies were designed to assess the accuracy of urine glucose testing in a sample of juvenile diabetic subjects, and to determine the effects of a visual discrimination training procedure on the accuracy. In the first study, each of 81 juvenile-diabetic children was presented three prepared glucose solutions and asked to determine the glucose concentration using the 2-Drop Clinitest method. Results showed errors in 54.3% of the judgments, with greatest difficulty occurring with 1-g/dl concentrations. The majority of errors were false negatives. Study II involved similar testing accuracy on a sample of 10 nurses and 2 research technicians, before and after a visual discrimination training procedure. Results showed that the subjects were incorrect on 39% of the trials initially, with a reduction in the error rate to less than 19% after training.

Storage of audiometric data - online - with a small computer

For online storage of audiometric measuring data we use an audiometer with serial operating output, a computer (DEC PDP 11/03), and a graphic terminal (DEC VT 55). The data can be controlled at any given time on the display and read like an audiogram. To transmit the data it is mainly only necessary to activate one button on the audiometer in addition. Pure tone and speech audiograms appear on the display in separate diagrams; in addition, beneath the pure tone threshold the results of the suprathreshold tests and the impedance measurements are indicated. For additional observations three lines are left available. If desired, a computer-supported masking aid can be used; independent of this, cross-heard values and applied masking noise intensities are stored. Paper documentations can achieve success as a hardcopy or as a four-coloured plotter print. Statistical groupings are possible without further processing.