[Primary reconstruction of the mandible with a pedicled muscle and bone transplant--the pectoralis major and rib flap]

The one-step reconstruction of the mandibular after tumor resection with a pedicle flap is reported. We used an osteomyocutaneous flap of teh pectoralis-mayor-muscle with a periosteal vascularized segment of the 5th rip. Our results in 8 cases are demonstrated. Technique and indications are introduced and discussed.

[Specific parent training in alalia. 1: Introduction and presentation of the seminar concept]

Developmental aphasia is the most severe form of speech retardation and needs therapeutic intervention. The young age of these children (< 3 years) makes therapy difficult. A specified speech therapy is not possible at this age. Intensive stimulation of verbal communication by the parents is necessary. Therefore we developed a specialized training program for parents. This preparation is very useful for later therapy and should prevent disturbance of interaction between parents and child. We will present our concept.

[Specific parent training in alalia. 2: Study of experiences of parents in the seminar]

Specified training for parents of children with developmental aphasia has been offered for several years. We want to guide the parents to a controlled stimulation of speech at home. We asked the former participants about their experiences with this training program. We also studied the realization of the program by parents in everyday life before their children started therapy. The experiences were mainly considered positive, realizing the program did not present difficulties.

[Symmetry of the human midface]

A new measuring instrument called "zygometer" is introduced. This device provides a simple technique for measuring the position of the zygomatic bone and arch allowing for lateral comparison. Standard measurements of the midface were collected from 250 uninjured test subjects. In 80% of the cases a symmetry of up to 2 mm was determined. The research results are presented and discussed with reference to clinical application.

Independent practice associations: risk contracting, financial controls and processes

The decision to enter into risk contracting with a health plan should be carefully considered. With today's pressure to control health care costs, an IPA's financial position can change rapidly. Even small numbers of enrollees can precipitate losses of hundreds of thousands of dollars over a few months if utilization and costs are not carefully projected and monitored. Prudent contracting to limit the IPA's downside risk in a new contract's early years is the most effective tool for preserving financial stability. However, the IPA must also develop sophisticated claims processing and financial reporting systems to ensure consistent payment practices and enable management to identify problem areas rapidly. Contracts with physician providers must allow the IPA flexibility in implementing administrative withholds and in renegotiating rates with short lead times.

Force-frequency-relation in human atrial and ventricular myocardium

In human heart failure, an increase in frequency of stimulation is followed by a reduced force of contraction in vivo and in vitro. The present study aimed to investigate whether a different origin of the myocardial sample or pretreatment with the cardioprotective agent 2,3-butanedione-monoxime (BDM) influences the force-frequency-relationship in electrically driven muscle strips taken from failing and nonfailing human myocardium. With as well as without pretreatment with BDM, the altered force-frequency-relationship in failing compared to nonfailing human ventricular myocardium can be observed. The effectiveness and the potency to increase force of contraction following an increase in frequency of stimulation was significantly higher in atrial than in ventricular myocardium in nonfailing and failing tissue. The different observations in atrial and ventricular myocardium provide evidence for functionally relevant differences in the electromechanical coupling between the human atrial and ventricular myocardium.

Cloning, sequencing, and heterologous expression of a cellulase-encoding cDNA (cbh1) from Penicillium janthinellum

From a Penicillium janthinellum cDNA library, two clones with 1.8- and 1.9-kb inserts were isolated by hybridization to a Trichoderma reesei cellulase-encoding gene probe (egl1). Both cDNAs have identical 5' ends and coding sequences, but different polyadenylation start points in their 3' untranslated regions. In the nucleotide (nt) sequence, one open reading frame of 537 amino acids was detected which shows 56% homology with endoglucanase I of T. reesei and 70% homology with cellobiohydrolase I of T. reesei, Phanerochaete chrysosporium, and Humicola grisea. Expression of the 1.9-kb cDNA in the Escherichia coli T7 system led to the detection of a 57-kDa protein, in agreement with the theoretical value. Fusion to the promoter of the yeast phosphoglycerokinase-encoding gene led to efficient expression and partial secretion of the cDNA-encoded cellulase with cellobiohydrolase I activity in Saccharomyces cerevisiae.

[Comparative studies of the ototoxicity of cisplatin and carboplatin]

The application of the potent anticancer drug cisplatin is limited by major side effects such as its ototoxicity and its nephrotoxicity. Since carboplatin has been introduced into clinical use, a platinum derivative with less pronounced ototoxicity and nephrotoxicity is available. The aim of this study was to quantify the ototoxicity of carboplatin comparing it to cisplatin using the wellknown guinea-pig model. Using morphological and functional methods it could be shown that the ototoxic damage was by far higher in a group which had received a total dose of 12 kg cisplatin/kg than in a group which had received a dosage of 90 mg carboplat/kg. Our investigations show that the ototoxic potential of cisplatin in the guinea-pig is more than 9 times higher than that of carboplatin.

Identification and imaging of OH (nu'' = O) and O(2) (nu'' = 6 or 7) in an automobile spark-ignition engine using a tunable KrF excimer laser

Planar laser-induced predissociative fluorescence is applied to image state-specific densities of OH and hot O(2) inside an internal-combustion car engine. Improved instrumentation is described. It includes better imaging optics and a spectrometer that permits desired molecular quantum states to be selected and identified in real time. The OH (nu'' = 0) images are cleanly separated from the isooctane fuel and they display a thin superequilibrium region at the flame front. In contrast, vibrationally excited O(2) (nu'' = 6 or nu'' = 7) is uniformly distributed behind the front. Uneven and broken flame fronts are commonly observed.

Increase of the extracellular magnesium concentration reduces cardiac glycoside toxicity in the human myocardium

We studied the influence of magnesium on contractility and on force-frequency-relationship as well as on the positive inotropic and toxic effects of ouabain (OUA) on electrically driven human right auricular trabeculae. Radioligand binding experiments were performed with myocardial tissue from nonfailing and from terminally failing patients. Magnesium produced a concentration-dependent negative inotropic effect (P < .05). In contrast, OUA (0.03-0.1 mumol/l) concentration-dependently increased isometric force of contraction. The maximal positive inotropic effect of OUA (5.9 +/- 0.9 mN; 1 mmol/l of magnesium) was unchanged after increasing magnesium from 1 to 2 mmol/l (5.8 +/- 0.9 mN). OUA was as effective as Ca++ (15 mmol/l; 6.7 +/- 0.5 mN). OUA (0.05 and 0.03 mumol/l) exerted toxic effects after 2 hr and 0.08 or 0.1 mumol/l of OUA after 30 min, respectively. Time until toxic effects occurred after OUA (0.1 mumol/l) was significantly longer with 2 mmol/l of magnesium compared to 1 mmol/l of magnesium. In right auricular trabeculae, the force of contraction increased with increasing frequency (0.5-1 .5 Hz) of stimulation. The force-frequency-relationship becomes negative after elevation of extracellular Ca++ (2.4 mmol/l of Ca++) (2 Hz: 92 +/- 5.5% basal). Magnesium restored the force-frequency-relationship in the presence of enhanced Ca++ concentration (2.4 mmol/l of Ca++; 2 mmol/l of Mg++; 2 Hz: 145 +/- 16.9% basal). The receptor-density and affinity measured by [3H]OUA binding was not different in nonfailing and failing myocardium. Magnesium increased concentration-dependently the affinity of [3H]OUA to its receptor.(ABSTRACT TRUNCATED AT 250 WORDS)

[Thiophene as a structural element of physiologically active substances. 20. Thiophene analogs of the leukotriene D4 antagonist Ro 23-3544]

The synthesis of 6-Acetyl-7-[[5-(5-acetyl-4-hydroxy-3-propyl-2-thienyl- oxy)pentyl]oxy]-3,4-dihydro-2H-1-benzopyran-2-carboxylic acid (1), a thiophene analogue of the leukotriene antagonist Ro 23-3544, is described. Compound 1 shows almost no effect on leukotriene D4 induced broncho-constriction on anesthesized guinea pigs.

Driving forces and pathways for H+ and K+ transport in insect midgut goblet cells

In the midgut of larval lepidopteran insects, goblet cells are believed to secrete K+; the proposed mechanism involves an electrogenic K+/nH+ (n &gt; 1) antiporter coupled to primary active transport of H+ by a vacuolar-type ATPase. Goblet cells have a prominent apical cavity isolated from the gut lumen by a valve-like structure. Using H(+)- and K(+)-selective microelectrodes, we showed that electrochemical gradients of H+ and K+ across the apical membrane and valve are consistent with active secretion of both ions into the cavity and that the transapical H+ electrochemical gradient, but not the transapical pH gradient, is competent to drive K+ secretion by a K+/nH+ antiporter. We used 10 mmol l-1 tetramethylammonium ion (TMA+) as a marker for the ability of small cations to pass from the gut lumen through the valve to the goblet cavity, exploiting the high TMA+ sensitivity of 'K(+)-sensitive' microelectrodes. These studies showed that more than half of the cavities were inaccessible to TMA+. For those cavities that were accessible to TMA+, both entry and exit rates were too slow to be consistent with direct entry through the valves. One or more mixing compartments appear to lie between the lumen bathing solution and the goblet cavity. The lateral intercellular spaces and goblet cell cytoplasm are the most likely compartments. The results are not consistent with free diffusion of ions in a macroscopic valve passage; mechanisms that would allow K+ secreted into the goblet cavity to exit to the gut lumen, while preventing H+ from exiting, remain unclear.

Two signals are involved in polyclonal B cell stimulation by T helper type 2 cells: a role for LFA-1 molecules and interleukin 4

T helper cell type 2 (Th2) cells when triggered by antibodies to CD3 acquire the capacity to stimulate the polyclonal proliferation of syngeneic, resting B cells. Here, we tested the ability of various monoclonal antibodies (mAb) to block the B cell proliferation-inducing potential of such activated Th2 cells. We demonstrate that anti-interleukin 4, as well as anti-LFA-1 antibodies interfere with the T-B cell interaction. In kinetic studies, anti-LFA-1 was found to be operative during the first half and anti-interleukin 4 during the second half of the 48-h culture period. This defines at least two different steps in B cell triggering by Th2 cells. In addition, the data imply that the T-B cell interaction involves an additional structure, namely an activation molecule, on the T cell surface.

The Insect Goblet Cell: A Problem in Functional Cytoarchitecture

The midgut of some insects actively transports K+ from blood to lumen. The transporting cells extrude K+ into an apical goblet cavity, from which it diffuses into the gut lumen via a small valve. The reasons why such a complicated cytoarchitecture envelops an ion transport process are explored.

[Bone-anchored epitheses and audioprostheses: 4 years' experience with the Branemark system in Germany]

Osseointegration describes direct contact between titanium and vital bone. The Branemark System uses this principle for bone anchorage of hearing aids and craniofacial prostheses. The experience made in the ENT Department of the University Hospital in Homburg/Germany with this procedure in the last 4 years is described. During this period, 40 patients have been operated and 119 titanium fixtures have been implanted. 30 patients got bone anchored prostheses (ear, nose or orbit) and 25 patients received bone anchored hearing aids. The large group of 15 patients with congenital ear malformation presented both indications. 100 out of 119 implants i.e. 84% caused no major problems. The most frequent complications were granulations (10 implants i.e., 8.4%). More severe problems as non-integration of three pillars or rejection of one pillar were rare. Our experience for 4 years in an important number of patients was very positive in the majority of cases and allows us to consider the bone anchorage of hearing aids and craniofacial prostheses as a major advance in craniofacial rehabilitation and audiology.