Using cognitive strategies to enhance bladder control and comfort

Compromised urinary bladder syndrome (CUBS), a combination of frequency and incontinence, causes multiple discomforts for community-dwelling adults. A holistic intervention--audiotaped cognitive strategies--was designed to augment the effects of an educational program designed to treat CUBS. CUBS was operationalized with a voiding diary, and comfort related to bladder health was operationalized in a questionnaire. In this quasi-experimental design the outcomes were measured at four time points. Repeated measures multivariate analyses of variance and nonparametric analyses were conducted to assess differences between the two groups. Results indicated that the treatment group had more comfort and improved CUBS compared with the control group.

MEIG1 localizes to the nucleus and binds to meiotic chromosomes of spermatocytes as they initiate meiosis

Meiosis, the fundamental evolutionarily conserved differentiative process by which haploid gametes are produced, is a complex and tightly regulated nuclear process. The murine Meig1 gene was previously shown to have a germ cell-specific transcript which is abundantly expressed during meiosis, in both males and females, suggesting that it is involved in meiotic processes. Protein analysis revealed that MEIG1 appears in multiple phosphorylated forms, including two dimeric forms of M(r) 31,000 and 32,000, which exhibit a developmentally regulated switch in their relative abundance. The tyrosine-phosphorylated M(r) 31,000 form becomes the dominant form once the cells enter meiosis. In this study we show that the M(r) 31,000 dimeric form appears in the nuclear fraction of testicular protein extract, whereas the M(r) 32,000 dimeric form and the monomeric forms of MEIG1 remain cytoplasmic. The appearance in the nuclear fraction is developmentally regulated, coinciding with progression of the first spermatogenic wave through meiotic prophase I. Utilizing immunocytochemistry we show that nuclear localization is apparent in primary spermatocytes through their maturation into elongated spermatozoa, but not in either somatic cells or germ cells from early postnatal pups. We also show that MEIG1 associates specifically with meiotic chromosomes in vivo. These results indicate that in germ cells, the M(r) 31,000 dimeric form enters the nucleus during the first meiotic prophase and binds to the meiotic chromatin. Possible nuclear functions, as well as possible modes of nuclear localization, are discussed.

Treatment of pyruvate carboxylase deficiency with high doses of citrate and aspartate

A patient with severe pyruvate carboxylase deficiency presented at age 11 weeks with metabolic decompensation after routine immunization. She was comatose, had severe lactic acidemia (22 mM) and ketosis, low aspartate and glutamate, elevated citrulline and proline, and mild hyperammonemia. Head magnetic resonance imaging showed subdural hematomas and mild generalized brain atrophy. Biotin-unresponsive pyruvate carboxylase deficiency was diagnosed. To provide oxaloacetate, she was treated with high-dose citrate (7.5 mol/kg(-1)/day(-1)), aspartate (10 mmol/kg(-1)/day(-1)), and continuous drip feeding. Lactate and ketones diminished dramatically, and plasma amino acids normalized, except for arginine, which required supplementation. In the cerebrospinal fluid (CSF), glutamine remained low and lysine elevated, showing the treatment had not normalized brain chemistry. Metabolic decompensations, triggered by infections or fasting, diminished after the first year. They were characterized by severe lactic and ketoacidosis, hypernatremia, and a tendency to hypoglycemia. At age 3(1/2) years she has profound mental retardation, spasticity, and grand mal and myoclonic seizures only partially controlled by anticonvulsants. The new treatment regimen has helped maintain metabolic control, but the neurological outcome is still poor.

Vascular endothelial growth factor (VEGF) and its receptors in tumor-bearing dogs

The molecular biology of the angiogenic growth factor, vascular endothelial growth factor (VEGF), has been studied in the dog. All major isoforms of VEGF are present in the dog. The amino acid sequences are identical between human and dog in the loop regions that are responsible for receptor binding. Accordingly, the VEGF receptors of dogs and humans are very similar and permit functional exchange of the growth factor. Here we show that canine VEGF activates human endothelial cells to the same extent as human VEGF. Similarly, the two proteins display identical cell binding properties. The VEGF receptor 1 (Flt-1) shows the same alternative splicing in humans and dogs and is overexpressed in the majority of tumors in both species. VEGF occurs also in canine tumors in similar relative quantities as in human malignancies. Based on the literature and our study we suggest that the molecular biology and the function of the VEGF signaling system are virtually identical in humans and canines and in healthy as well as in disease conditions.

Component-resolved diagnosis (CRD) of type I allergy with recombinant grass and tree pollen allergens by skin testing

The diagnosis of Type I allergy is based on the measurement of allergen-specific IgE antibodies and on provocation with allergens, most frequently conducted by skin testing. Both forms of diagnosis are currently performed with allergen extracts that are difficult to standardize regarding their allergen contents, and which contain additional undefined nonallergenic components. We report the expression in Escherichia coli and purification of some of the most relevant timothy grass- and birch pollen allergens. Recombinant timothy grass- (rPhl p 1, rPhl p 2, rPhl p 5) and birch pollen (rBet v 1, rBet v 2) allergens were purified and used for the measurement of allergen-specific IgE and IgG subclass responses as well as for skin prick testing in 55 pollen allergic patients and 10 nonatopic individuals. Results obtained showed that the recombinant allergens allowed in vivo allergy diagnosis in 52 of 54 of the grass pollen and in 35 of 36 of the birch pollen allergic patients. Positive skin reactions were observed almost exclusively in patients containing detectable allergen-specific IgE antibodies but not in the nonatopic group; however, sensitivity to a given allergen as measured by skin reactivity was weakly correlated with the levels of allergen-specific IgE. Our results demonstrate that recombinant allergens can be used for component-resolved skin test diagnosis (CRD) of the patients' allergen sensitization profile, whereas allergen extracts at best allow to identify allergen-containing sources. CRD may thus represent the basis for novel forms of patient-tailored immunotherapy.

Some notes on the 'heroic self' and the meaning and importance of its reparation for the creative process and the creative personality

The author discusses a few points in a long clinical history from which he has derived the notion of 'heroic self', describing how it manifested through 'heroic' projective and introjective identifications. He also demonstrates the importance of repairing both the heroic self and the internal objects, and how essential it is for the analyst to differentiate between the heroic self and its megalomaniac psychopathic manifestations, and to recover the heroic self when it appears to be lost, as in the case of severe, quasi-melancholic, depression. By heroic self and heroic projective and introjective identifications, he means the creative person's specific need to associate himself with, to compete with and excel the heroes of his own cultural tradition. The creative person is able to do so via these projections and introjections, and the need is based on the creator's inner awareness of naturally possessing unusual, or even outstanding, gifts; in other words, the creative person has an awareness of being, or of the possibility of becoming, a creative hero. Brief reference is made throughout to other clinical material, and in the final section further support is given to the author's views on the heroic self with short quotations and examples from non-psychoanalytic sources that provide further interesting evidence of the existence and functioning of the heroic self. With particular reference to Segal's work in this field (1952, 1991), and her notion of 'meaningful form', the author tries to further develop its implications in the light of the heroic self and of the heroic projective and introjective identifications, as far as the creator and those who respond to and evaluate his or her work are concerned.

The GSI Cancer Therapy Project

At the Heavy Ion Research Institute GSI in Darmstadt an experimental cancer treatment program with a five years duration has been developed. A new method for cancer treatment with ions is applied, using rasterscan method in addition to an active pulse to pulse variation of ion beam properties, including the energy, intensity and focusing. An overview of this Cancer Therapy Project is presented, that covers both accelerator aspects to provide the required beam variations within a short time and the installations at the treatment place for rasterscan control. In addition to a description of the technical design (control-hard- and software) experimental results will be shown, containing the achieved beam properties and measurements of rasterscan performance.

Diltiazem retards the metabolism of oral prednisone with effects on T-cell markers

The area under the time-plasma concentration curve (AUC) was measured for prednisolone (the major active metabolite of prednisone) after ingestion of 15 mg of prednisone (phase 1) and again after 3 d of oral diltiazem (180 mg/d) followed by the same dose of oral prednisone (phase 2) in eight normal adult patients. Diltiazem increased the prednisolone AUC by 21% (range 3-38%), from 1297 +/- 157 ng/h/mL to 1560 +/- 169 ng/h/mL (p = 0.001). This effect was associated with a greater decrease from baseline in CD3+ lymphocyte number at 4 h after prednisone ingestion (596 +/- 175 vs. 516 +/- 140, p = 0.05), a larger percentage decrease of circulating CD3+ lymphocytes at 8 h (43 +/- 19% vs. 53 +/- 19%, p = 0.04), and a decrease in the number of CD3+ CD8+ T cells at 4 h post-prednisone ingestion (279 +/- 81 vs. 236 +/- 51, p = 0.04). Diltiazem retards prednisolone metabolism and when used chronically with prednisone could conceivably, in some patients, enhance its immunologic and other clinical effects. Potentiation of prednisone side-effects by diltiazem may be of special interest in pediatric patients, and possible diltiazem-prednisone interactions merit study in this population.

Protein status of infants with phenylketonuria undergoing nutrition management

OBJECTIVES

The objectives of this study were to determine if Phenex-1, amino-acid modified medical food with iron maintained normal indices of protein status in infants with phenylketonuria (PKU) and to investigate factors that influence plasma amino acid concentrations.

METHODS

A study was conducted for six months in 35 infants with classical PKU diagnosed in the neonatal period. Diet diaries and plasma amino acid concentrations were obtained monthly. Blood for analysis of plasma albumin, blood urea nitrogen (BUN), retinol binding protein (RBP) and transthyretin was obtained at one, three and six months of study.

RESULTS

Mean (+/-SEM) total daily intake of medical food and nutrients was 79+/-4 g; 17.3+/-0.6 g protein, 660+/-18 kcal, 255+/-10 mg phenylalanine (Phe), and 1423+/-56 mg tyrosine (Tyr). Mean concentrations of plasma amino acids, except cystine (during entire study), glycine (first month) and Phe were in the normal range. Mean concentrations of plasma Phe were in the treatment range (120 to 360 micromol/L). Plasma concentrations of arginine, methionine, Phe, tryptophan, Tyr, and valine were positively correlated with intakes at various months of study. Concentrations of aspartic and glutamic acids, Phe, and Tyr were positively correlated and 17 amino acids were negatively correlated with the interval between feeding and blood draw. At six months of study, concentration of plasma albumin was 4.1+/-0.1 g/dL, RBP was 3.74+/-0.2 mg/dL, transthyretin was 17.9+/-0.9 mg/dL, and urea nitrogen was 11.9+/-0.5 mg/dL.

CONCLUSION

During study, all mean plasma indices of protein status were in normal reference ranges. Phenex-1 supports normal mean plasma amino acid, albumin, RBP, transthyretin, and BUN concentrations when fed in adequate amounts.

IgG subclass reactivity to human cardiac myosin in cardiomyopathy patients is indicative of a Th1-like autoimmune disease

Studies performed in mice together with the demonstration of increased levels of heart-specific autoantibodies, cytokines and cytokine receptors in sera from cardiomyopathy (CMP) patients argued for a pathogenic role of autoimmune mechanisms in CMP. This study was designed to analyse the presence of IgG anti-heart antibodies in sera from patients suffering from hypertrophic and dilatative forms of CMP as well as from patients with ischaemic heart disease and healthy individuals. Patients' sera were analysed for IgG reactivity to Western-blotted extracts prepared from human epithelial and endothelial cells, heart and skeletal muscle specimens as well as from Streptococcus pyogenes. The IgG subclass (IgG1-4) reactivity to purified human cardiac myosin was analysed by ELISA. While sera from CMP patients and healthy individuals displayed comparable IgG reactivity to a variety of human proteins, cardiac myosin represented the prominent antigen detected strongly and preferentially by sera from CMP patients. Pronounced IgG anti-cardiac myosin reactivity was frequently found in sera from patients with dilatative CMP and reduced ventricular function. ELISA analyses revealed a prominent IgG2/IgG3 anti-cardiac myosin reactivity in CMP sera, indicating a preferential Th1-like immune response. Elevated anti-cytomegalovirus, anti-enterovirus IgG titres as well as IgG reactivity to nitrocellulose-blotted S. pyogenes proteins were also frequently observed in the group of CMP patients. If further work can support the hypothesis that autoreactivity to cardiac myosin represents a pathogenic factor in CMP, specific immunomodulation of this Th1- towards a Th2-like immune response may represent a promising therapeutic strategy for CMP.

Two alternatively spliced Meig1 messenger RNA species are differentially expressed in the somatic and in the germ-cell compartments of the testis

Previous studies regarding the transcriptional pattern of the murine Meig1 gene (formally designated meg1) suggested that its transcription is restricted to germ cells at the first meiotic prophase, in both primary spermatocytes and primary oocytes. However, protein analysis revealed that certain forms of the MEIG1 protein exist in testes of early postnatal pups at stages that have no germ cells in the testis, excluding very few primitive type A spermatogonia cells. This suggested that MEIG1 expression is not confined to germ cells. In this study, we show that testicular somatic cells do, indeed, express MEIG1. This is especially evident in Leydig cells, where this protein is highly abundant. We also demonstrate that alternatively spliced mRNAs of Meig1 are differentially transcribed in the germ cell and the somatic compartments of the testis. There is a very low level of somatic transcript, whether labile or transcriptionally regulated, in contrast to the abundant MEIG1 protein in the somatic cells. This implies that the somatic transcript is very efficiently translated and reconfirms that protein levels do not necessarily reflect transcript abundancy. Structural features of the Meig1 transcript that would be expected to inhibit translation are discussed in light of the efficient translation of this RNA species.

[Cervical pregnancy. A gynecologic-obstetric emergency situation]

The cervical pregnancy is defined as the implantation of the blastocyst into the cervical canal. The characteristic clinical sign is a severe asymptomatic uterine bleeding in early pregnancy or during curettage. Prior to 1978, correct preoperative diagnosis was rare and in almost all cases a hysterectomy was performed. Today, transvaginal sonography allows early diagnosis, and conservative treatment (two-time treatment: first treatment with systemic or intraamniotic methotrexate, secondly with curettage or ligature of the uterine arteries) improves the prospects of fertility.

Selective examination of plasma membrane-associated photosensitizers using total internal reflection fluorescence spectroscopy: correlation between photobleaching and photodynamic efficacy of protoporphyrin IX

Fluorescence spectra, fluorescence decay kinetics, photobleaching kinetics and photodynamic efficacy of protoporphyrin IX (PP) were investigated in endothelial cells in vitro after different incubation times. Fluorescence spectra and photobleaching kinetics were determined during total internal reflection (TIR) illumination or epi-illumination. Because penetration depth of the excitation light during TIR illumination was limited to about 100 nm, plasma membrane-associated PP was almost selectively examined. Spectra obtained by TIR fluorescence spectroscopy (FS) showed a very low background, whereas spectra obtained by epi-illumination exhibited considerable background by autofluorescence and scattered light. For photobleaching kinetics during TIR illumination after 1 h or 24 h incubation, a biexponential fluorescence decrease was observed with a rapidly and a slowly bleaching portion. After 1 h incubation, the rapidly bleaching portion was the predominant fraction, whereas after 24 h incubation comparable relative amounts of the rapidly and slowly bleaching portion were determined. The rapidly and slowly bleaching portion were assigned to PP monomers and aggregated species in close vicinity to the plasma membrane. Fluorescence decay measurements after epi-illumination support the decrease of PP monomers within the whole cell with increasing incubation time. In contrast to TIR illumination, photobleaching of PP during epi-illumination was characterized by slow monoexponential fluorescence decrease after 1 h or 24 h incubation. Photodynamic efficacy of PP using epi-illumination was found to depend strongly on incubation time. Considerable cell inactivation was determined for short incubation times (1 h or 3 h), whereas photodynamic efficacy was diminished for longer incubation times. Reduced photodynamic efficacy after long incubation times was assigned to the lower amount of photodynamically active monomers determined close to the plasma membrane as well as within the whole cell. In conclusion, TIRFS measurements are suggested to be an appropriate tool for the examination of the plasma membrane-associated photosensitizer fraction in living cells.

[Intracanalicular trabeculostomy--a new approach to glaucoma surgery]

BACKGROUND

A new "ab externo" technique for glaucoma trabecular surgery creating multiple perforations of the trabeculum to improve outflow facility was tested.

MATERIAL AND METHOD

In order to perform a draining canal to the anterior chamber, a quartz fiber (phi: 300 microns) with a side-firing tip, coupled to an Er:YAG laser (2.94 microns), was inserted into Schlemm's canal of an enucleated human eye.

RESULTS

Eight pulses of 8 mJ each were sufficient to perforate the trabecular meshwork. Histologic analysis showed a rippled canal with 50 microns average diameter and a surrounding necrosis zone of 15-35 microns.

CONCLUSIONS

The Er:YAG laser trabeculostomy, in conjunction with special fibers, shows promise as a new "ab externo" technique for minimally invasive therapy of open angle glaucoma.

Nonlinear Dynamics of Intracellular Methylene Blue During Light Activation of Cell Cultures

Methylene blue (MB+) is a well-known dye in medicine and has been discussed as an easily applicable drug for topical treatment in photodynamic therapy (PDT). Methylene blue can potentially be used as a redox indicator to detect the important redox reactions that are induced during PDT. The kinetics of this process was analyzed on a subcellular level with confocal laser scanning microscopy. BKEz-7 endothelial cells were incubated 4 h with 1 microM MB+. The fluorescence dynamics of MB+ during irradiation with 633 nm light was observed with subcellular resolution. Images were acquired at 0.5 s intervals (frame rate 1 image/0.5 s). Fluorescence was observed in the red channel of the laser scanning microscope. Synchronously, the phase-contrast image was visualized with the green channel. Morphological changes could therefore be correlated with the dynamics of MB+. In addition, the light-dose-dependent phototoxicity at 633 nm irradiation was determined by viable cell counting. After an induction period (phase I), fast fluorescent spikes could be observed in the whole cytoplasm, which decayed with a time constant of about 20 s (phase II), followed by a period of nearly constant fluorescence intensity (phase III) and exponential photobleaching (phase IV). Phase II exhibits highly nonlinear kinetics, which is hypothesized to correlate probably with a nonlinear quantal production of reactive oxygen species (ROS). Morphological cell changes were not observed during phase II. During phase III, a pycnotic cell nucleus developed. From the determination of viable cells we can conclude that a light dose applied within phase II was only sublethal in correlation with morphological observations. Overproduction of ROS leading finally to cell killing during phases III and IV is discussed.

[Dynamic interstitial laser application for therapy of secondary liver tumors. An animal experiment study]

Laser-induced interstitial thermotherapy (LITT) is a promising method of treating different types of tumors. To increase the effectiveness of LITT, a new thermo-controlled application system for minimal invasive intervention was designed. This laser system consists of a laser applicator 3 mm in diameter, insertion equipment and an Nd:YAG laser source. The power of the laser source is controlled dynamically by thermosensors in a water-cooling system of the laser applicator. In in vivo experiments in five pigs, within 10 min we found homogeneous coagulation regions in the liver that were of 3 cm and 5 cm in diameter. Via ultrasound we observed in real time the increasing coagulation zone that appeared as a hyperechogenic halo. However, due to perifocal edema, the real coagulation area was smaller than detected by ultrasound. Macroscopically and microscopically, the coagulation zones showed well-demarcated borders of the coagulation lesions, and the surrounding tissue appeared vital. The reparative reaction after irradiation was early fibrosis. In the course of 4 weeks, the surrounding scar capsule, containing fibrocytes, biliary ductules and collagen fibers enlarged. As a result, the coagulation necrosis became more and more fragmented between collagen fibers and was largely resorbed. The absence of complications in our animal experiments suggest that the technique of thermo-controlled laser light application is safe and useful in therapy for metastases that are not resectable.

[Modified radiation administration in Er:YAG laser ab externo sclerostomy]

BACKGROUND

Ab externo sclerostomy enables the restrained aqueous humour drain via a microgram wide corneoscleral canal into the subconjunctival space being an alternative surgical method in glaucoma therapy. The tissue ablative infrared laser radiation (2.94 microgram) was applied until now via a quartz fiber manually pushed forward in permanent tissue contact. Our aim was the development of a new applicator tip without manual feed in order to achieve a reduction in times for construction and maintenance of the former tip as well as in the risk of an infection and mechanical damage of intraocular structures.

MATERIAL AND METHOD

In pig eye experiments, the laser parameters were varied in histological and scanning electron microscopic evaluation (pulse energy: 10-60 mJ, repetition rate: 5-17.5 Hz, combinations of constant power: 200 mW). Their influence on the canal shape and the morphology of the internal ostium has been proven in special tests.

RESULTS

The new development of the applicator tip (core diameter: 550 microgram) enables a conical profile of the beam (diameter 500-150 microgram) within a distance of 2-3 mm, now without pushing the fiber forward ("fixed fiber"). Smooth canal surfaces, a small homogeneous necrosis zone (25 microgram) and only few tissue ruptures have been seen histologically and on SEM. The correlations of ablation rates/-speed as well as canal characteristics are more significant to energy densities than to repetition rates. First clinical application was technically successful.

CONCLUSIONS

The new applicator tip optimizes the method of Er: YAG-laser ab externo sclerostomy from the technical and surgical point of view.

Energy transfer spectroscopy for measuring mitochondrial metabolism in living cells

Microscopic energy transfer spectroscopy was established using mixed solutions of reduced nicotinamide adenine dinucleotide (NADH) and the mitochondrial marker rhodamine 123 (R123). This method was applied to probe mitochondrial malfunction of cultivated endothelial cells from calf aorta incubated with various inhibitors of specific enzyme complexes of the respiratory chain. Autofluorescence of the coenzyme NADH as well as energy transfer efficacy from excited NADH molecules (energy donor) to R123 (energy acceptor) were measured by time-gated fluorescence spectroscopy. Because intermolecular distances in the nanometer range are required for radiationless energy transfer, this method is suitable to probe selectively mitochondrial NADH. Autofluorescence of endothelial cells usually exhibited a weak increase after specific inhibition of enzyme complexes of the respiratory chain. In contrast, pronounced and statistically significant changes of energy transfer efficacy were observed after inhibition of the same enzyme complexes. Detection of NADH and R123 in different nanosecond time gates following the exciting laser pulses enhances the selectivity and improves quantification of fluorescence measurements. Therefore, time-gated energy transfer spectroscopy is suggested to be an appropriate tool for probing mitochondrial malfunction.

High-level expression and purification of the major birch pollen allergen, Bet v 1

Bet v 1, the single major allergen from birch pollen, shares IgE epitopes with all major tree pollen allergens from closely related species such as alder, hazel, hornbeam, beech, and European chestnut. Because of high sequence homologies among these allergens and the well-studied cross-reactivities on B cell epitopes, Bet v 1 is a representative model protein which can be used for in vitro studies. The cDNA coding for Bet v 1, the single major allergen from birch pollen, was cloned into the T7-based Escherichia coli expression system pMW 175/BL21(DE3) and synthesized as a nonfusion protein. In contrast to other E. coli systems (e.g., pKK233-2/JM105), this system produces high levels of readily extractable proteins corresponding to 5-10% of E. coli total protein, the percentage varying with culture conditions. The overall yield was 8-10 mg of purified recombinant protein per liter of culture medium. The recombinant allergen was purified by several steps, including ion-exchange and hydrophobic interaction chromatography. The purified recombinant allergen showed identical immunological properties with the respective natural counterpart. The use of recombinant allergens of high purity is expected to result in more accurate diagnostic procedures, but possibly also in a superior immunotherapy of Type I allergic diseases when compared with methods using crude allergen extracts containing various amounts of allergen concentrations.

Dynamic fluorescence changes during photodynamic therapy in vivo and in vitro of hydrophilic A1(III) phthalocyanine tetrasulphonate and lipophilic Zn(II) phthalocyanine administered in liposomes

The fluorescence emission of hydrophilic tetrasulphonated aluminium phthalocyanine (AlPcS4) and hydrophobic zinc phthalocyanine (ZnPc), bound to the membrane of liposomes, was investigated in vivo in an appropriate tumour model of the rat bladder and in RR 1022 epithelial cells of the rat. The sensitizers were administered systemically to the rats and photodynamic therapy (PDT) was performed 24 h later. During PDT treatment, the fluorescence was measured every 30 s. The fluorescence was excited with 633 nm light from an HeNe laser and the fluorescence spectra were detected with an optical multichannel analyser system. PDT was performed for both sensitizers using 672 nm light from an Ar+ dye laser. The fluorescence changes during PDT were significantly different for the two phthalocyanines. For AlPcS4, an initial fluorescence intensity increase, followed by subsequent photobleaching, was observed. In contrast, ZnPc fluorescence showed an exponential decrease and no increase at the start of treatment. Tumour necrosis 24 h after PDT was significant only for ZnPc. RR 1022 cells incubated for 24 h with AlPcS4 revealed a granular fluorescence pattern, whereas ZnPc was localized diffusely in the cytoplasm of the cells. In agreement with the in vivo measurements, subcellular relocalization and a fluorescence intensity increase were detected exclusively in the case of AlPcS4. Morphological changes at this time were significant only for ZnPc. The subcellular localization and fluorescence kinetics were obtained using a confocal laser scanning microscope.

Regeneration processes in rabbit endometrium: a photodynamic therapy model

The origin and process of regeneration in rabbit endometrium was evaluated following photodynamic epithelial destruction using topically applied aminolevulinic acid (ALA). Selective destruction of endometrial epithelium was performed using photodynamic therapy (PDT). ALA was diluted to 200 mg/ml dextran 70 shortly prior to administration. A volume of 1.2 ml was injected into the left uterus. Intrauterine illumination (wavelength 630 nm, light dose 40-80 J/cm2) was performed 3 h after drug administration. Tissue morphology was evaluated by light and scanning electron microscopy 1, 3, 7 and 28 days post-treatment (three animals at each time-point). Regeneration of the endometrium following epithelial ablation by PDT was fully activated after 24 h and was completed after 72 h. Endometrial surface generation occurred by proliferation, originating primarily in deeper regions of the glands. Findings from our morphological follow-up study support the origin of endometrial regeneration being mainly from undifferentiated stem cells and residual glandular epithelium.

[Concomitant injuries after upper ankle joint dislocations]

Functional treatment with the Air Stirrup Ankle Brace recommended by C. N. Stover in 1979 can reduce pathological inversion of the ankle joint. In our retrospective study of 109 patients treated by this kind of ankle brace we found 96 patients (88%) with excellent results. Only 13 patients (12%) reported moderate to good results. To detect and characterize their painful conditions of ankles we did a clinical, radiological and MRI-Investigation. In only 2 cases we found a moderate instability after clinical investigation, anterior stress roentgenogram and talar tilt. By using the MRI-investigation 1.0 Tesla with a 512 x 360 Matrix we could find 10 cases with osteochondral lesions of the ankle. In 7 cases there was separated ossicle in the fibulotalar joint, in 1 case we detected a fracture of the processus anterior tali, in another case we could see a posttraumatic lesion of the talus and calcaneus with bone bruise and at least one osteochondral fracture of the distal tibia. The capability of the MRI to detect particularly osteo-chondral lesions of the talus and the tibiofibular joint was shown in 10 of 13 cases. Therefore we recommend to do an MRI-investigation on all patients after ankle sprain if there are painful conditions within the ankle after conservative treatment.

Immunoglobulin E response to human proteins in atopic patients

The demonstration that human IgE recognizes both exogenous allergens and structurally related human proteins has led to the hypothesis that IgE autoreactivity may be a pathogenic factor in atopic diseases. To determine the frequency of occurrence as well as the disease specificity of this phenomenon, we tested sera from patients with atopic diseases and, for control purposes, from persons with immunologically mediated disorders for serum IgE reactivity with nitrocellulose-blotted human proteins. We found that 12 of 20 sera from atopic patients with pronounced skin lesions contained Western blot-detectable IgE antibodies. Patients suffering predominantly from allergic rhinoconjunctivitis as well as control individuals failed to display serum IgE autoreactivity, but occasionally exhibited elevated serum IgE levels. The molecular weights of the IgE-defined autoantigens ranged predominantly from 10 to 100 kDa. Whereas some of these were expressed in only certain cell types, others were detected in histogenetically different cells. Our results suggest that IgE autoimmunity occurs frequently in atopic dermatitis patients and may be of pathogenic relevance for the chronicity of skin manifestations typical of this disease.

Determination of the scattering coefficient and the anisotropy factor from laser Doppler spectra of liquids including blood

Laser Doppler measurements were performed on scattering liquids flowing through a highly scattering static medium to determine the scattering coefficient and the anisotropy factor of the liquids. Monte Carlo simulations of light propagation in the static and moving media were used to calculate the Doppler spectra for suspensions of polystyrene spheres in water, and these spectra were in excellent agreement with experimental results. A faster Monte Carlo code was developed so that nonlinear regressions to the measured laser Doppler spectra could be used to determine the anisotropy factor of other liquids. This approach was used to deduce the scattering properties of Intralipid and blood at λ = 820 nm. It was found that the anisotropy factor of blood is well described by Mie theory in contradiction to results reported in the literature that were obtained by goniometric measurement of the phase function.

Spatially resolved absolute diffuse reflectance measurements for noninvasive determination of the optical scattering and absorption coefficients of biological tissue

The absorption and transport scattering coefficients of biological tissues determine the radial dependence of the diffuse reflectance that is due to a point source. A system is described for making remote measurements of spatially resolved absolute diffuse reflectance and hence noninvasive, noncontact estimates of the tissue optical properties. The system incorporated a laser source and a CCD camera. Deflection of the incident beam into the camera allowed characterization of the source for absolute reflectance measurements. It is shown that an often used solution of the diffusion equation cannot be applied for these measurements. Instead, a neural network, trained on the results of Monte Carlo simulations, was used to estimate the absorption and scattering coefficients from the reflectance data. Tests on tissue-simulating phantoms with transport scattering coefficients between 0.5 and 2.0 mm(-1) and absorption coefficients between 0.002 and 0.1 mm(-1) showed the rms errors of this technique to be 2.6% for the transport scattering coefficient and 14% for the absorption coefficients. The optical properties of bovine muscle, adipose, and liver tissue, as well as chicken muscle (breast), were also measured ex vivo at 633 and 751 nm. For muscle tissue it was found that the Monte Carlo simulation did not agree with experimental measurements of reflectance at distances less than 2 mm from the incident beam.

[Ab externo sclerostomy with the Er:YAG laser: report of outcome after 2 years]

OBJECT

Results over a period of 24 months of performing the Er:YAG laser ab externo sclerostomy.

MATERIAL AND METHODS

The procedure was performed 81 times (chronic glaucoma with open angle (n = 55) and narrow angle (n = 15), 6 secondary glaucoma, 4 pigment glaucoma, 1 normal pressure glaucoma) in 74 eyes of 64 patients at the age of 70 +/- 10 years without any peribulbar anesthesia. The pulse energy was 11 mJ with a repetition rate of 7 Hz. Antimetabolites were not applicated. Success was defined as an IOP of less than 22 mm Hg or a decrease of at least 30%, with or without anti-glaucoma medication.

RESULTS

The mean IOP of all cases decreased from preoperatively 28 +/- 8.1 mm Hg (Success group: 26.7 +/- 7.3 mm Hg) to 15 +/- 8.4 mm Hg (Success group: 14.6 +/- 7.8 mm Hg) on the first postoperative day. The success rate was about 50% within the period of two weeks to six months and decreased to about 15% in the 24th month. Complications were iris incarceration/synechia (n = 33), hypotony (n = 36) with consequent choroidal detachment (n = 8), hyphema (n = 19) and more pronounced inflammation symptoms (n = 10). In most cases, the early postoperative outflow failure is caused by iris incarceration into the internal ostium. The scarring tendency of the episcleral tissue leads to closure of the external ostium after months. Resurgery was necessary in 26 cases.

CONCLUSIONS

Further efforts should be directed to maintain the intact corneoscleral morphology of the canal, created by an optimized method of the surgical technique. The application of antimetabolites in correct dosage or the implantation of modified silicon draining systems would be helpful.

Why do veins appear blue? A new look at an old question

We investigate why vessels that contain blood, which has a red or a dark red color, may look bluish in human tissue. A CCD camera was used to make images of diffusely reflected light at different wavelengths. Measurements of reflectance that are due to model blood vessels in scattering media and of human skin containing a prominent vein are presented. Monte Carlo simulations were used to calculate the spatially resolved diffuse reflectance for both situations. We show that the color of blood vessels is determined by the following factors: (i) the scattering and absorption characteristics of skin at different wavelengths, (ii) the oxygenation state of blood, which affects its absorption properties, (iii) the diameter and the depth of the vessels, and (iv) the visual perception process.

Are coping strategies related to disease outcome in early breast cancer?

A consecutive series of 107 women with early breast cancer were investigated for coping strategies and disease outcome 5 to 6 years after primary surgical treatment (mastectomy or lumpectomy). Coping was assessed several times during a 3-year investigation period by the Zurich and Freiburg Questionnaires of Coping with Illness (ZQCI, FQCI). Data analysis revealed no significant correlations between coping strategies and the target variable "death from breast cancer". However, significant relations were found between postsurgical tumour size (p < or = 0.01), positive histological node status (p < or = 0.01) and death from breast cancer. The results of a discriminant analysis also indicated that somatic parameters are more important for the course of breast cancer disease than psychological aspects of coping. The role of psychosocial variables for the outcome of cancer disease remains unclear and further studies in this field are necessary.

Erbium:YAG laser photoablation of human cornea

PURPOSE

To determine whether the healing response of the human cornea after photoablation with a midinfrared solid-state laser was more pronounced than after excimer laser keratectomies because of the increased thermal damage in adjacent tissue.

METHODS

We treated five blind human eyes with an erbium:YAG (Er:YAG) laser prototype and followed up the patients for nine months.

RESULTS

Regarding epithelial healing and corneal clarity, the patients had a healing response very similar to that of excimer laser. Further clinical and experimental studies are necessary to estimate healing and regression.

'Et in arcadia ego...?' Some notes on methodological issues in the use of psychoanalytic documents and archives

The author uses archival material, mainly the letters exchanged between Jones and Strachey in the fifties, when Jones was writing his biography of Freud and Strachey was working on the Standard Edition. He shows the complexity of the interaction between these two men; the more or less conscious ambivalences, motivations and resentments against the so-called Freudian establishment of that time. This per se can help us to understand how a 'certain image' of Freud was created in Great Britain during those years and the reasons for its authoritative persistence. Yet the paper touches on more general issues such as those of the fascination with psychoanalytic archives and the more or less accepted and admitted unconscious motivations of the interpreters of these documents too, not excluding myself. The conclusion reached is that even psychoanalytical documents do not rest in a peaceful Arcadia and that archives cannot be considered as the Arcadia of documents--at least not in the ways that Arcadia has always been considered and interpreted, misleadingly, even in two paintings by Poussin, which I refer to in my paper. These in reality remind us that in Arcadia there is death too. Even the memory that the documents should help us to conserve is ineluctably bound to loss, dissemination, mutilation and uncertainty, and therefore must also face the presence of death also.

An investigation of differences between three age groups in verbal and spatial task performance using the dual-task paradigm

A dual-task paradigm with concurrent verbal and spatial tasks was used to investigate differences across three age groups for lateralized effects, magnitude of tapping interference, and cognitive task output. In addition, rescaled scores comparing verbal with spatial measures within and across age groups were analyzed to examine asymmetric age differences for right versus left hemisphere abilities. Results of the present dual task finger tapping investigation of three age groups showed all groups left lateralized for verbal tasks and right lateralized for spatial tasks. However, the magnitude of interference in tapping was significantly greater in paced nonideational shadowing tasks and during paced purposeful spatial tasks. Outcomes of exploratory analyses suggest a complex interplay between aptitude and the corresponding lateralized effects and cognitive effort to perform the task.

Intracellular fluorescence behaviour of meso-tetra(4-sulphonatophenyl)porphyrin during photodynamic treatment at various growth phases of cultured cells

Meso-tetra(4-sulphonatophenyl)porphyrin (TPPS4) taken up by cells is mainly localized in lysosomes as previously shown by fluorescence microscopical and fluorescence spectroscopical investigations. In the present study the intracellular fluorescence behaviour and the intracellular amount of this dye at various growth periods of cells were examined. For cells irradiated in the growth phase a relocalization of TPPS4 from the lysosomes into the cytoplasm and finally into the nucleus was observed. In contrast, for cells irradiated in the stationary phase no redistribution could be detected and therefore no evidence for severe damage of the lysosomal membranes and subsequently for the release of lytical enzymes is given. In both cases lethal damage of the cells was achieved as examined using the trypan blue exclusion test. This indicates that damage of the lysosomes is less important in the photodynamic inactivation of cells sensitized by TPPS4.