[Incidence of stab injuries of the heart in the clinic and forensic autopsy practice. Experiences with 6 surgical procedures]

During a period when 6 patients were operated following a cardiac stab wound 4 patients survived the procedure. In 45 persons forensic autopsies were performed. The analysis of both groups elucidate that successful treatment is possible if pericardial tamponade inhibits free bleeding into the cavity of the thorax. But this situation must be treated very quickly avoiding cardiac arrest due to cardial blockage. In contrast to the autopsies in the clinical group no atrial wounds or incisions of coronary arteries were observed.

[Computed tomographic findings in extrinsic allergic alveolitis. Comparison with conventional x-ray findings]

Seventeen patients with extrinsic allergic alveolitis or bird-fancier's lung were examined by standard radiological techniques and classified after Hapke's classification. In addition, the patients were examined by CT. The CT patterns have been analysed and compared with standard radiological findings. The methodological advantages of CT are discussed. Radiological investigation is of limited value in the diagnosis of extrinsic allergic alveolitis. Conventional radiography remains the standard of initial x-ray examination. In early cases, however, CT may be a valuable addition within the diagnostic strategy of a diagnostic imaging department.

Involvement of actin-containing microfilaments in HSV-induced cytopathology and the influence of inhibitors of glycosylation

Two and a half hours after infection with a high dose of different strains of HSV-1 which induce rounding of cells, breakdown of actin containing microfilaments can be observed. At the periphery of the cell, actin containing knob-like protuberances were visible. Later on, actin seems to be located exclusively on the surface of cells. Observations were done by immunofluorescence microscopy, scanning electron-microscopy and immunoperoxidase staining of ultrathin sections. The envelope of HSV appears to be stained by anti-actin. Strain IES produces rounding of cells at a high dose of infection before fusion proceeds at 37 degrees C. Similar alterations were not observed with the fusing strains MP and HFEM. Incubation of infected cells at 39 degrees C revealed strain dependent differences of the fusion activity. At 41 degrees C no "fusion from within" of cells but only rounding was detectable. Application of tunicamycin resulted in complete inhibition of fusion by all strains. The fusion activity of some strains of HSV-1 (ANG, HFEM, and MP) was not inhibited by addition of 2-deoxy-D-glucose and 2-fluoro-deoxy-D-glucose. A variant from strain MP could be isolated, which is sensitive to the effects of 2-deoxy-D-glucose. Inhibitors of processing of glycoproteins did not affect fusion of cells.

Evaluation of lymphocytes' influence in luminol-dependent chemiluminescence emission of mouse spleen cells

The focus of this study was to elucidate the influence of lymphocytes on phagocytic cell-dependent chemiluminescence (CL). CL was induced by in vitro addition of mitogens, particulate substances and Keyhole Limpet Hemocyanin (KLH)-antigen. CL was measured in spleen cells of immunologically naive mice and in mice immunized with KLH. Mice immunized with KLH and Freund's adjuvant incomplete (FA) showed a lower CL-response than mice injected with FA only. No influence on CL-activity by lymphocytes derived from immunologically naive mice could be found. Adoptive transfer of T cells from KLH-sensitized donor mice did not influence CL-activity elicited with Zymosan in spleen cells derived from KLH-unsensitized recipient mice. Preincubation of spleen cells with supernatants of T cell cultures or with T cell growth factor (TCGF) stimulated with KLH or Con A could not trigger CL-reactivity. Therefore, the lower CL-response of spleen cells derived from KLH-sensitized mice appears to be not a consequence of a suppressive cellular or lymphokine effect, but is due to direct influence of KLH on accessory cells themselves.

Phosphocreatine content and intracellular pH of calf muscle measured by phosphorus NMR spectroscopy in occlusive arterial disease of the legs

Energy metabolism of calf muscle was assessed non-invasively by phosphorus (31P) NMR spectroscopy in eleven patients with symptomatic arterial occlusion and in seven matched controls. Phosphocreatine (PCr) content and pH values decreased during non-ischaemic foot exercise to lower values in severely afflicted patients but in all patients, as a group, they were not significantly decreased compared to controls. In contrast, recovery from ischaemic exercise (arterial occlusion by a tourniquet) demonstrated significant differences between patients and controls. Intracellular pH and PCr recovered more slowly in patients than in controls; PCr recovery proceeded exponentially with a recovery half-time of 203 +/- 74 s in patients compared to 36.7 +/- 5.5 s in controls (P less than 0.02). Phosphocreatine (PCr) recovery after ischaemic exercise correlated significantly with the degree of arterial stenoses as assessed by Doppler ultrasound (r = 0.739, P = 0.019) and by angiography (r = 0.885, P = 0.005), suggesting that the degree of large vessel stenoses limits the postischaemic increase in mitochondrial oxidative phosphorylation. Reactive blood flow after ischaemia failed to correlate with PCr recovery or with the degree of arterial stenoses. Phosphorus (31P) NMR spectroscopy provides, therefore, quantitative parameters of muscle energy metabolism in patients with peripheral arterial occlusions.

Extremity bone tumors: evaluation by P-31 MR spectroscopy

High-resolution P-31 MR spectra were obtained in four patients with bone tumors of their distal extremities. In one case the tumor, a Ewing sarcoma of the tibia, was investigated during clinical remission after radiation therapy and chemotherapy. The other three cases - one low-grade chondrosarcoma of the tibial head, one malignant fibrous histiocytoma of the tibia, and one chondroblastoma of the medial femoral condyle - showed clinically active tumor growth, with corresponding increased metabolism as demonstrated by bone scintigraphy. The spectra of the three active tumors indicated a comparably high adenosine triphosphate content, similar to previously published spectra from animal tumors or human tumors implanted into animals. There were also high resonances of inorganic phosphate and low resonances of phosphocreatine; there were definite peaks in the phosphodiester and phosphomonoester regions, indicating the existence of these metabolites in the tumors. Slight but definite changes in the metabolite content were observed in one tumor after chemotherapy. The spectra of the unaffected leg did not show any well-resolved P-31 signals, which is typical for healthy bone. These are the first P-31 MR spectra of human bone tumors measured in patients to our knowledge.

Evidence for a Na-K-ATPase-inhibitor in erythrocytes of patients with essential hypertension

ATPase activities were determined in haemolysed and dialysed erythrocytes and in haemoglobin-free membranes of twenty patients with essential hypertension and twenty normotensive controls. Ouabain-sensitive ATPase (Na-K-ATPase) activity of haemolysate but not that of membranes was decreased in hypertensives whereas ouabain-insensitive ATPase (Mg-ATPase + some residual Ca-ATPase) activity was increased in both enzyme preparations when measurements were preformed in the absence of Ca2+-chelating substances. In haemolysed erythrocytes ouabain-sensitivity as a percentage of total ATPase activity was a good discriminator between both groups and may be a possible marker for essential hypertension. The decreased activity of Na-K-ATPase in haemolysate is apparently due to a non dialysable inhibitor of Na-K-ATPase which is either tightly bound to the erythrocyte membrane or dissolved in the cytoplasm. Following haemolysis with subsequent centrifugation the Na-K-ATPase inhibitor is removed, at least in part, and thus differences in Na-K-ATPase activity demonstrable in haemolysed and dialysed erythrocytes are no longer apparent in haemoglobin-free membranes.

Myocardial bioptic findings in correlation with TL-201 imaging and hemodynamic parameters in patients with latent cardiomyopathies suspected of having myocarditis

Sixty-eight patients (24 males, 44 females, mean age 37.2 years) belonging to NYHA classes I and II were investigated. All patients had a nondilated ventricle as well as hemodynamic criteria of "latent cardiomyopathy." In 78% of the patients, a high susceptibility to infection, frequent angina, or possible myocarditis were found. In 75.5%, the mean pulmonary artery pressure was abnormal. T1-201 scintigraphy revealed perfusion defects in 78%. Dyskinesia or hypokinesia were found in 52%. The left ventricular ejection fraction was normal in 74%. On biopsy, pathologic findings were detected in 60.9% of patients with a high frequency of hypertrophy and fibrosis (50%). In two patients, lymphocytic infiltrates were found. Immunohistologically, deposits of complement, IgG, IgM, and gammaglobulin, mainly in the sarcolemma, could be identified in 19.1% of cases. The myocardium was normal in 39.1%; insufficient material was found in 5.9% of patients. Morphologic, scintigraphic, and hemodynamic findings could not be correlated but the combination of two pathologic parameters permitted diagnosis. Biopsy was the most effective diagnostic method in myocarditis.

[Fractures of the lumbar spine and the lower thoracic spine--surgical technic and results]

Improved healing results are achieved by surgical treatment of fractures of the lumbar spine and of the thoracic transition, if the indication is correct, i.e. in case of splintered fracture with severe instability or neurologic troubles, but also in case of luxations occurring rarely in the region of the lumbar spine. The anterior fusion of fractions with bone defects in the region of the vertebral body is more logical with regard to the biomechanical aspect.

T cells with FC receptors in myeloma; suppression of growth and secretion of MOPC-315 by T alpha cells

We have previously demonstrated that 1) BALB/c mice and patients with IgA myeloma developed a marked expansion of T cells with surface IgA-Fc receptors (T alpha cells), 2) the FcR alpha were induced by direct interaction of soluble myeloma IgA with T cells, and 3) the T alpha cells induced in IgA myeloma were Lyt-1-2+, IgA isotype-specific suppressor cells in normal immune responses. These findings established that the host with IgA myeloma responds to the large amounts of Ig produced by the tumor by activating an otherwise normal IgA isotype-specific suppressor circuit. In the present studies, we extend our previous observations and show that T alpha cells can suppress both the growth and secretion of MOPC-315 myeloma tumor cells. Thus, the isotype-specific immunoregulatory circuit activated in myeloma is capable of suppressing tumor cells as well as normal cells.

Fusion from without induced by herpes simplex virus type 1

Strains ANG and ANG path of herpes simplex virus type 1 (HSV1) produced fusion from without (FFWO) of cells in culture. FFWO required 45 min to become complete. In contrast, fusion from within (FFWI) was not detected until 3-4 h after infection, depending on the cell type. FFWO was temperature dependent: at 0 degrees no fusion could be observed, but increase of temperature increased the degree of fusion. The pH optimum for FFWO was 7.8-8.5. The FFWO activity of the virus was found to be slightly more heat stable at 46 degrees than was infectivity. FFWO was produced in Vero, CV-1 and BSC1 cells, but not in BHK clone 13 or in primary or secondary rabbit kidney cells. FFWO was linked to the presence of virus particles and perhaps to other sedimentable, infected-cell material but not to soluble factors. Actinomycin D, cycloheximide, and UV irradiation did not block this activity, indicating no direct activity of the HSV1 genome for FFWO.

T cells with FC receptors in myeloma; suppression of growth and secretion of MOPC-315 by T alpha cells

We have previously demonstrated that 1) BALB/c mice and patients with IgA myeloma developed a marked expansion of T cells with surface IgA-Fc receptors (T alpha cells), 2) the FcR alpha were induced by direct interaction of soluble myeloma IgA with T cells, and 3) the T alpha cells induced in IgA myeloma were Lyt-1-2+, IgA isotype-specific suppressor cells in normal immune responses. These findings established that the host with IgA myeloma responds to the large amounts of Ig produced by the tumor by activating an otherwise normal IgA isotype-specific suppressor circuit. In the present studies, we extend our previous observations and show that T alpha cells can suppress both the growth and secretion of MOPC-315 myeloma tumor cells. Thus, the isotype-specific immunoregulatory circuit activated in myeloma is capable of suppressing tumor cells as well as normal cells.

Depression of chemiluminescence response in mouse spleen cells by infective and inactivated influenza virus

The effect on respiratory burst of murine splenic cells after exposure to influenza viruses was studied by luminol-dependent chemiluminescence (CL). Infectious influenza A and B viruses considerably depressed the zymosan-induced CL response of the cells. Commercially available trivalent influenza virus vaccines also depressed CL activity. The whole-virus vaccine induced the greatest inhibition of the CL response, followed by the subunit and the split-virus vaccines. Virus-induced depression of CL was observed in the unseparated and in the granulocyte-enriched populations but no apparent effect was found in the lymphocyte-enriched populations. Prior sensitization of mice with representative, inactivated prototype strains of human influenza A and B viruses depressed the moderate CL induced by infectious influenza viruses. These results indicate that both infectious and inactivated influenza viruses impair the generation of the respiratory burst.

[Scintigraphic diagnosis of bile leakage]

Specificity and sensitivity of cholescintigraphy for diagnosis of bile leakage were evaluated in a prospective study in 91 patients with partial liver resection and in 64 patients with liver transplantation. Sensitivity was found to be 0.93, specificity in the evaluable scintigrams 1.0. If all non-evaluable scintigrams are considered to be wrong, specificity was 0.83. Cholescintigraphy is a non-invasive method without irritation of the patient with a high specificity and sufficient sensitivity for demonstration or exclusion of a leak. These leaks may arise not only postoperatively but also after biopsies, trauma or spontaneously. In cases of clinical suspicion cholescintigraphy should be used as primary investigational tool.

[Myelolipoma of the adrenal gland]

Myelolipoma is a benign, rare and hormone-inactive tumour of the adrenal gland. Only symptomatic or large myelolipomas have to be removed. CT enables diagnosis with a high degree of safety and accuracy.

[Differential nuclear medicine diagnosis of intrahepatic space-occupying diseases]

The use of ultrasonography has led to an increase of symptom-free carriers of intrahepatic masses. Whereas follicular nodular hyperplasia and haemangioma does not require further treatment, all other tumours should be resected. In a prospective study involving 81 patients with intrahepatic masses the value of nuclear medical methods for such a differentiation was assessed. In 21 out of 23 patients with follicular nodular hyperplasia and in 17 out of 18 cases of haemangioma a correct classification was achieved. In addition, all 3 adenomas and 36 out of 37 malignant tumours could be attributed correctly. Sequential and blood pool scanning of the liver as non-invasive methods thus permit differential diagnosis of intrahepatic masses with sufficient accuracy.