[Sensitivity and specificity of masked field campimetry]

Patients with circumscribed visual field defects are able to perceive the scotomata immediately while looking at randomly distributed black and white squares (12' x 12') flickering on a VDU with a high frequency (approximately 30 Hz), resulting in a stimulus field comparable to the white-noise field on a TV screen without reception. In 368 eyes of 368 patients with varying lesions of the visual pathway the results of white-noise field campimetry were compared with those of conventional threshold-related, slightly suprathreshold automated grid perimetry. Rate of detection (sensitivity) was 84.2% in conventional perimetry and 80.7% in white-noise field campimetry, respectively. The results are not significantly different (p > 0.1; McNemar test). Examinations in 198 eyes of 198 persons without any indication of a visual pathway defect allowed a definition of the normal range of white-noise field campimetry to be made. The specificity of this new method was 82.3%. The outcome of this most extensive study on sensitivity and specificity of noise field campimetry is compared with other publications. The results presented emphasize the capabilities of this new method as a screening test. They encourage the initiation of a field study using the noise field stimulus broadcasted to home TV sets.

[A new miniaturized flicker test for detection of florid retrobulbar neuritis]

A new transportable miniaturized flicker test equipped with green LEDs is contrasted with the conventional Tübingen flicker test, based on brightness perception of intermittent white light. The results are compared with those of former studies. In this study we examined 45 eyes suffering from florid optic neuritis. Another group of 114 eyes were either normal (except minimal ametropia) or suffered from a non-inflammatory or non-refractive impairment of central visual function. In all groups only one eye of each subject was examined. Using the criteria of Trauzettel-Klosinski, the new miniaturized "green" flicker test for the detection of a florid optic neuritis showed a specificity of only 50.9% (83.3%) and a sensitivity of 91.1% (64.4%). (The corresponding results of the conventional Tübingen flicker test are shown in parentheses.) Alternatively, analyzing the data with the help of a logistic regression, the "green" flicker test turned out to have a specificity of 92.9% (93.8%) and a sensitivity of 60.5% (44.2%). For further examinations using the flicker test it is useful to consider the duration and reproducibility of each brightness match by repeating the test several times.

[Pholedrine for determining the site of Horner syndrome]

BACKGROUND

Pharmacologic testing by indirect acting sympathomimetics like hydroxyamphetamine may determine the site of the lesion in Horner's syndrome. Pholedrine is chemically similar to hydroxyamphetamine. Therefore we examined if it shows the same effects in normal subjects and in patients with Horner's syndrome.

METHODS

Pupil diameter was measured by means of standardized photography before and after single and with different intervals repeated administration of pholedrine eye drops in normal subjects. In 18 patients with Horner's syndrome and known hydroxyamphetamine test results, a pholedrine test was carried out analogous to the hydroxyamphetamine test.

RESULTS

Pholedrine dilates the normal pupil by 2.2 mm (mean). It acts at the longest 8-10 hours with maximal effect between 20 and 90 minutes. After this period its effect decreases rapidly. It acts independently from age and from baseline pupil diameter. Given repeatedly the second administration reaches the same mydriatic effect as the first only if the interval between both applications is 72 hours or more. This is because it needs some time to refill the noradrenaline stores in the sympathetic neuron innervating the dilator muscle of the pupil. In Horner's syndrome pholedrine dilates the involved pupil only minimally in case of a postganglionic lesion, and in case of a preganglionic lesion it dilates the pupil even slightly more than the normal fellow pupil. It shows the same effect as hydroxyamphetamine. There are only few side effects.

CONCLUSION

Pholedrine is a substitute for hydroxyamphetamine to localize the site of the lesion in patients with Horner's syndrome.

Influence of suction cup oculopression on corneal astigmatism

In 11 (right) eyes of 11 ocularly healthy subjects an artificial stepwise intraocular pressure (IOP) elevation was applied by suction cup oculopression. The initial negative pressure in the suction cup was 80 mmHg; it was raised in steps of 40 mmHg. The median of the corneal astigmatism, measured with a Zeiss ophthalmometer, was 0.50 D before oculopression (the values of the 10th and 90th percentiles were 0.30 and 1.10 D, respectively). Corneal astigmatism increased to 2.00 (0.00-5.10) D, 2.25 (1.00-5.55) D, 2.63 (0.63-7.00) D, 3.38 (1.88-6.88) D, 3.38 (2.83-7.25) D, and 4.38 (2.85-5.63) D with 80, 120, 160, 200, 240, and 280 mmHg oculopression, respectively. The astigmatism dropped to 0.75 (0.00-2.30) D immediately after removal of the suction cup. Thus, suction cup oculopression not only influenced IOP but also ocular refraction. This is of particular importance since visual evoked potential (VEP) amplitude is to a high degree dependent on refractive changes. This fact has to be considered if changes in VEP amplitude during suction cup oculopression are used as a tolerance test in glaucoma diagnosis.

[Meningioma of the optic nerve sheath with extensive intraocular growth]

PATIENT

We report on an elderly female patient with a diagnosis of an optic nerve sheath meningioma 11 years after onset of ophthalmological symptoms. 8 years after diagnosis and consecutive tumour-resection near the orbital apex the eye had to be enucleated because of a painful secondary glaucoma. Prior to enucleation computed tomography had revealed extra- and intraocular tumour.

MORPHOLOGY

Morphological investigations showed a neoplasia which had entered the eye via the optic nerve head. Besides severe secondary changes there was a diffuse tumour spread within the choroid and a "mushroom-like" growth towards the vitreous cavity. No differences between extra- and intraocular meningioma were found light- and electronmicroscopically.

GTP binding and hydrolysis by the signal recognition particle during initiation of protein translocation

The signal recognition particle (SRP) consists of one RNA and six protein subunits. The N-terminal domain of the 54K subunit contains a putative GTP-binding site, whereas the C-terminal domain binds signal sequences and SRP RNA. Binding of SRP to the signal sequence as it emerges from the ribosome creates a cytosolic targeting complex containing the nascent polypeptide chain, the translating ribosome, and SRP. This complex is directed to the endoplasmic reticulum membrane as a result of its interaction with the SRP receptor, a membrane protein composed of two subunits, SR alpha and SR beta, each of which also contains a GTP-binding domain. In the presence of GTP, SRP receptor binding to SRP causes the latter to dissociate from both the signal sequence and the ribosome. GTP is then hydrolysed so that SRP can be released from the SRP receptor and returned to the cytosol. Here we show that the 54K subunit (M(r) 54,000) of SRP (SRP54) is a GTP-binding protein stabilized in a nucleotide-free state by signal sequences, and that the SRP receptor both increases the affinity of SRP54 for GTP and activates its GTPase. We propose that nucleotide-mediated conformational changes in SRP54 regulate the release of signal sequences and the docking of ribosomes at the endoplasmic reticulum.

[Age dependence of pupillary near reflex]

BACKGROUND

This study was performed to gain age correlated normal values for the pupillary near reflex.

METHODS

Accommodation and pupillary near reaction were measured by means of simultaneous infrared video retinoscopy and pupillography in 64 healthy volunteers aged between 5 and 55 years. Measurements were done at a reduced, near mesopic, light condition with accommodation to 10, 14, 20 and 33 cm.

RESULTS

The pupillary near response varied highly with age: persons younger than 20 years of age showed a significantly smaller pupillary near response as compared to those older than 20 years. In most of the children younger than 10 years the pupil near response was very small (less than 10% constriction) at accommodation distances longer than 10 cm. There was a significant difference between the age groups younger and older than 20 but no statistically significant differences within these age groups.

CONCLUSION

A change of the pupillary near reaction takes place around the age of 20. We conclude that this change does not only reflect the aging of the cristalline lens but is due to an age related change of the supranuclear control.

Uncommon chiasmal lesions: demyelinating disease, vasculitis, and cobalamin deficiency

We report on eight patients who presented for evaluation of unexplained visual loss. They all showed a typical chiasmal visual field defect (bitemporal hemianopia, junction scotoma). In all patients, high-resolution computer-assisted tomographic (CT) scans of the sellar region were normal, and neither the medical history nor additional ophthalmological findings pointed to any explanation for the underlying disease. Six patients seemed to have suffered from chiasmal optic neuritis. Magnetic resonance imaging (MRI) scans could elucidate the diagnosis in five cases: white-matter lesions typical of multiple sclerosis (MS) were found and, additionally, in four cases an enlargement of the chiasm or barrier defect was revealed in post-gadolinium MRI. In one patient, MRI was normal. He recovered completely after megadose steroid therapy. One patient developed motoric symptoms of MS during the following year, another patient had mild sensory symptoms and recurrence of severe optic neuritis. An MR-proven chiasmal lesion due to a leukocytoclastic immunovasculitis combined with small subcortical white-matter lesions was diagnosed in another patient. The field defects disappeared spontaneously. In a 28-year-old woman a low vitamin B12 level was found in routine blood samples. Parenteral vitamin B12 substitution led to an almost complete recovery of the visual field defects. Chiasmal optic neuritis may occur isolated or during the course of MS. Megadose steroids may be of value if contraindications have been ruled out. A chiasmal visual field defect caused by vitamin B12 deficiency is very uncommon. A similar case was reported in 1961.

[Differential diagnostic strategies in uncertain vision disorders]

The differential diagnosis of visual disturbances of unclear origin can cause major problems in ophthalmology, especially if there are no functional defects or if functional defects cannot be explained by morphological findings after an extensive regular ophthalmological investigation. The aim of this paper is to present strategies that allow subtle visual disturbances to be related to certain groups of functional defects. Especially simple investigations are emphasized that lead quickly to a well-founded possible diagnosis that helps both the ophthalmologist and patient save time and cost-consuming deviations. The key investigations are: (1) a symptom-oriented case history; (2) exclusion of refractive problems by pin-hole test, retinoscopy and ophthalmometry; (3) the swinging flashlight test; (4) ophthalmoscopy of the macula and optic disc; (5) visual field. A flow chart is presented that explains the strategy of additional special investigations based on the results of the key findings in order to approach quickly the cause of a visual disturbance. Some of the more common causes of visual disturbances of unclear origin are discussed, including some major therapeutic principles.

Inter-individual variability in the dynamics of natural accommodation in humans: relation to age and refractive errors

1. To study the relationship between accommodation under natural viewing conditions, age and refractive errors, we have measured time courses of accommodation in thirty-nine human subjects aged 5-49 years using a newly developed technique. The technique is based on infrared photoretinoscopy and involves fully automated on-line image processing of digitized video images of the eyes with a sampling rate of 5.3 Hz. 2. The distance between the subject and the video camera was about 1.3 m. Head movements of the subject required little restriction because the eyes were automatically tracked in the video image by the computer program. All subjects were tested under binocular viewing conditions. 3. Both refraction of the right eye and pupil diameter were measured with a precision of 0.2-0.4 dioptres (D) and 0.1 mm, respectively, and were plotted on-line. The data were subsequently automatically analysed. 4. Automated infrared photoretinoscopy proved to be very convenient and easy to handle in both children and adults. 5. The maximal speed of accommodation for a target at a distance of 5 D declined in the subjects with age (from up to 21.7 D s-1 for accommodation and 32.7 D s-1 for subsequent accommodation to a distant target ('near to far accommodation') in children down to 2-18 D s-1 in adults). There was a striking inter-individual variability in the maximum possible speed of accommodation and near to far accommodation. 6. Speed of accommodation and of near to far accommodation was correlated for each subject. However, in most of the subjects, the process of near to far accommodation was faster than accommodation (P < 0.005, if averaged over all subjects). This correlation was independent of age. 7. The accommodation-induced pupillary constriction (pupillary near response) was absent in children for a 4 D target; even at 10 D, there was no reliable pupillary response. The pupillary near response increased to about 1.6 mm D-1 of accommodation at the age of 47. Since a pupillary near response could still be elicited in presbyopic subjects unable to accommodate, the ratio of pupillary constriction per dioptre of accommodation approached infinity. 8. The magnitude of the pupillary near response was highly variable even among subjects of the same age but was typical for each subject. There was a correlation (P < 0.01) to refractive error: corrected myopes had weaker pupillary near responses than emmetropes or hyperopes.(ABSTRACT TRUNCATED AT 400 WORDS)

[Prospective follow-up of neuropsychological deficits after cervicocephalic acceleration trauma]

30 patients with acute cervico-cephalic syndrome following whiplash injury (neck and head pain, vegetative symptoms and subjective complaints of impaired mental functions) without neurological deficits were investigated in a prospective follow-up of 3 months with neuropsychological examination in the acute phase (x = 5.7 days) and again 6 and 12 weeks after the accident. Attention, concentration, cognition and verbal and visual memory functions were quantified by neuropsychological tests, and changes over the observation period were analysed. In the acute phase all neuropsychological functions were below the individual's normal level. Deficits in attention and concentration recovered within the first 6 weeks. Further recovery within the following 6 weeks were observed in visual memory, imagination and analytic capacity. The capability of verbal memory and abstraction, cognitive selectivity and information processing speed was impaired for a longer time and first recovered after 12 weeks. In conclusion, intraindividual neuropsychological deficits following whiplash injury can be quantified and monitored to show the time course of recovery. Thus in clinical and forensic practice the diagnosis of a pseudoneurasthenic or even "neurotic" syndrome in acute whiplash injury should be made with caution.

[White-noise field campimetry before and after artificial increase of intraocular pressure. Possible applications in diagnosis and evaluation of glaucoma]

A total of 173 eyes (visual field defect stages O-V) of 99 glaucoma patients were investigated by means of conventional threshold-oriented suprathreshold automated test point perimetry using the Tübingen Automatic Perimeter (TAP) and by means of white-noise-field campimetry (flickering random dot pattern) using the Tübingen Electronic Campimeter (TEC). Most eyes were affected by primary open-angle glaucoma (119) or low tension glaucoma (35). The concordance between the two methods was good in 65 eyes (37.6%). Sufficient in 32 (18.5%) eyes, poor in 32 cases (18.5%) and inadequate in 44 eyes (25.4%). Among the last group of 44 eyes, 32 perceived a scotoma in the noise field (NF) but did not show any pathologic defect in conventional automated test point perimetry: the opposite constellation was found in only 12 eyes. In most cases, scotoma in the NF showed a change in both brightness and motion (noise) perception. No clear relationship between the type of glaucoma and a certain constellation of the aforementioned NF specifications could be found. Complete lack of noise perception in the scotoma occurred more frequently in advanced glaucoma (stage > or = IV). In 110 eyes of 63 of the glaucoma patients, white-noise-field campimetry was carried out during artificial IOP elevation achieved by suction-cup oculopression: during steplike increases of the negative pressure in the suction-cup up to maximum of 375 mmHg the following stages could be seen (the percentage of eyes that perceived each phenomena over the negative pressure range is shown in brackets): change in NF perception compared with initial findings (96.4%); impairment of central noise-field perception (78.2%); concentric constriction of NF (61.8%); complete breakdown of noise (field) perception (42.7%). A further, quantitative classification of these eyes was possible by evaluation of the negative pressure in the suction-cup that led to any one of these NF phenomena. The results demonstrate the usefulness of white-noise-field campimetry as a very fast screening method for detecting glaucomatous visual field defects. It can also be performed as a pressure tolerance test and thus be used to classify glaucomatous risk stages.

Tonic pupil, areflexia, and segmental anhidrosis: two additional cases of Ross syndrome and review of the literature

Two patients are described with the triad of tonic pupil, hyporeflexia and segmental anhidrosis (Ross syndrome). Only 18 cases of this syndrome have been reported in the literature so far. While tonic pupil and reduced sweating can be attributed to the affection of postganglionic cholinergic parasympathetic and sympathetic fibres projecting to the iris and sweat glands, respectively, the pathogenesis of diminished or lost tendon jerks remains obscure. To identify the characteristic clinical features, the previous cases of Ross syndrome are reviewed. Recent evidence of subclinical disturbances of sweating in most patients with Adie's syndrome, i.e. tonic pupil and areflexia, casts doubt on the nosological concept of Ross syndrome as a distinct clinical entity.

[Narrowing of the palpebral fissure as the first symptom of extensive osteoma with orbital involvement]

Unilateral narrowing of palpebral fissure and moderately impaired visual acuity induced a 14 years old woman to consult an ophthalmologist. Neuroradiological examination revealed a large osteoma starting from the ethmoid cells and invading both the orbit and the cranial cavity. This case illustrates that proptosis may be absent even in cases of extensive and compact orbital tumors. Therefore, exophthalmos is a common but not an indispensable sign of an orbital tumor. In Gardner's syndrome osteomas are associated with soft tissue tumors, intestinal polyposis and colonic adenomatosis that ultimately progresses to colorectal cancer. This association is frequent enough that a colon examination should be suggested to all patients with osteoma.

[Bilateral optic neuropathy with papilledema]

The findings in nine patients are presented who suffered from acute bilateral visual loss occurring within less than one week, and all showed optic disc edema. CT scans revealed no abnormalities and the CSF-pressure measured in 6 patients was normal. Four of the patients (22 to 53 years old) recovered completely under orally given prednisolone (about 100 mg/day). The recent history of three patients suggested that the optic neuropathy was associated with an infection. This parainfectious process may be identical to the bilateral optic neuritis described in children. Four older patients (55 to 63 years) did not respond to steroid therapy. Their vision did not significantly improve. They showed attenuated retinal arteries; therefore it can be assumed that ischemia plays a role in the pathogenesis of this second type of optic neuropathy. In none of the cases a toxic optic neuropathy could be confirmed. One patient who experienced a visual loss down to finger counting after throat-surgery without marked blood loss recovered partially after steroid treatment.

[Ross syndrome: Adie syndrome with disorders of sweat and body temperature regulation]

In 1958 Ross described a triade consisting of tonic pupils, hyporeflexia and sudomotor denervation. Etiology and pathogenesis are unknown. 14 cases of Ross' syndrome have been mentioned in the literature up to now. Three additional cases are demonstrated.

An E. coli ribonucleoprotein containing 4.5S RNA resembles mammalian signal recognition particle

The signal recognition particle (SRP) plays a central role in directing the export of nascent proteins from the cytoplasm of mammalian cells. An SRP-dependent translocation machinery in bacteria has not been demonstrated in previous genetic and biochemical studies. Sequence comparisons, however, have identified (i) a gene in Escherichia coli (ffh) whose product is homologous to the 54-kilodalton subunit (SRP54) of SRP, and (ii) an RNA encoded by the ffs gene (4.5S RNA) that shares a conserved domain with the 7SL RNA of SRP. An antiserum to Ffh precipitated 4.5S RNA from E. coli extracts, implying that the two molecules reside in a complex. The 4.5S RNA can also bind to SRP54 and can replace 7SL RNA in an enzymatic assay. The product of a dominant mutation in the ffs gene (4.5S RNAdl1) is also coprecipitated by the antiserum to Ffh protein and is lethal when expressed from an inducible promoter. After induction of 4.5S RNAdl1, the earliest observed phenotype was a permanent induction of the heat shock response, suggesting that there was an accumulation of aberrant proteins in the cytoplasm. Late after induction, translocation of beta-lactamase was impaired; this may be an indirect effect of heat shock, however, because translocation of ribose binding protein or of the porin, OmpA, was unaffected. An unusual separation of the inner and outer membranes, suggestive of a defect in cell envelope, was also observed. Protein synthesis did not cease until very late, an indication that 4.5S RNA probably does not have a direct role in this process.

Cavernous angiomas of the anterior visual pathways

Three patients with cavernomas of the optic nerve, chiasm, or optic tract are presented. All suffered progressive visual loss due to local hemorrhage and the space-occupying effects of the vascular malformation. Computed tomography scans revealed small lesions with mild contrast enhancement in the suprasellar and parasellar cisterns, whereas angiography was unremarkable. Magnetic resonance imaging was helpful in our cases both for diagnosis and for planning surgical approach, showing typical signs of cavernomas as confirmed by subsequent surgery and histological examination. The clinical and intraoperative findings are presented.

[Age dependence of kidney function]

Although kidney function is immature in infants and decreases with increasing age in adults, when assessing the kidney clearance, it is not common to make an adjustment for age. On the other hand, correction for the standard body surface is generally accepted. Previous studies have yielded contradictory results, probably due to the small numbers of patients studied. To obtain the statistically significant relationship between age and kidney clearance, we compiled more than 1000 studies. These studies were divided into three groups: (1) children under 2 years of age (n = 71); (2) children and adolescents from 2 to 15 years (n = 64 male/58 female); (3) adults (n = 474 male/424 female; age: 16-80 years). Total clearance determinations were only considered if there were no differences between the two kidneys and if there was no obstruction of micturition or other pathological findings. Surprisingly, the statistical analysis showed no differences in clearance values between sexes. The maximal clearance values were found in the groups with children about 8 years old and the greatest scatter of values was seen in children under 2 years of age (a discrepancy between maturation age and calendar age). The complete set of data was based on the presumption that continuous function consisting of three trunks describes the course of normal kidney clearance in relation to patient age. If one determines an arbitrary reference value (e.g., 25 years), correction factors can easily be derived from the function described in order to compare individual clearance with a normal value.(ABSTRACT TRUNCATED AT 250 WORDS)

Chronic borrelia encephalomyeloradiculitis with severe mental disturbance: immunosuppressive versus antibiotic therapy

A 57-year-old male was repeatedly admitted to hospital because of complex neurological symptoms, including radicular pain, disturbance of micturition, seizures, and severely impaired mental state. The diagnosis was encephalomyeloradiculitis possibly of viral origin, and treatment with immunosuppressants was initiated. An alternating course with a tendency towards improvement ensued. Two and a half years after the occurrence of the initial symptoms, identification of specific antibodies in the blood and CSF led to the diagnosis of borreliosis with CNS involvement. High-dose therapy with penicillin rapidly reduced the symptoms, beginning with those of radicular pain and followed by an improvement of the mental state. Attention is directed to the wide spectrum of clinical symptoms of chronic borreliosis with CNS involvement. Previous reports that immunosuppression may result in some improvement but with a tendency towards relapse are confirmed. Our encouraging treatment results support those of other reports that penicillin therapy may lead to improvement even at late chronic stages in patients with severe CNS deficits.

The involvement of the major surface glycoprotein (gp63) of Leishmania promastigotes in attachment to macrophages

The interaction between the macrophage and the parasite plays a central role in the continued success of Leishmania infection. The promastigote surface ligand, and its complementary macrophage membrane receptor, involved in attachment and phagocytosis are likely to exert considerable influence over the outcome of a new infection. In this study, we report experiments pertaining to one such parasite membrane protein. Initial examination of promastigote surface proteins by radiolabeling and two-dimensional-polyacrylamide gel electrophoresis revealed an abundant polypeptide with an apparent m.w. of 63,000. Lectin-binding studies indicated that it was a glycoprotein containing mannose, N-acetyl glucosamine, and N-acetyl galactosamine residues. Monospecific antiserum raised against this glycoprotein, gp63, decorated the entire promastigote plasmalemma. Univalent antibody fragments from this antiserum blocked the interaction between promastigotes and macrophages by inhibiting attachment. Anti-gp63-inhibition reduced parasite/macrophage binding to 30 to 35% of the control binding level. Additional evidence of the involvement of gp63 in attachment to macrophages was provided by studies that made use of gp63-containing proteoliposomes. These vesicles were avidly phagocytosed by macrophages. Uptake of the gp63-containing liposomes was suppressed by greater than 90% by both anti-gp63 F(ab) fragments and the oligosaccharide mannan, indicating that their phagocytosis was receptor dependent. These results demonstrate that the abundant glycoprotein gp63 plays an important role in attachment of promastigotes to macrophages, and attachment via this parasite ligand is sufficient to trigger phagocytosis.

The involvement of the major surface glycoprotein (gp63) of Leishmania promastigotes in attachment to macrophages

The interaction between the macrophage and the parasite plays a central role in the continued success of Leishmania infection. The promastigote surface ligand, and its complementary macrophage membrane receptor, involved in attachment and phagocytosis are likely to exert considerable influence over the outcome of a new infection. In this study, we report experiments pertaining to one such parasite membrane protein. Initial examination of promastigote surface proteins by radiolabeling and two-dimensional-polyacrylamide gel electrophoresis revealed an abundant polypeptide with an apparent m.w. of 63,000. Lectin-binding studies indicated that it was a glycoprotein containing mannose, N-acetyl glucosamine, and N-acetyl galactosamine residues. Monospecific antiserum raised against this glycoprotein, gp63, decorated the entire promastigote plasmalemma. Univalent antibody fragments from this antiserum blocked the interaction between promastigotes and macrophages by inhibiting attachment. Anti-gp63-inhibition reduced parasite/macrophage binding to 30 to 35% of the control binding level. Additional evidence of the involvement of gp63 in attachment to macrophages was provided by studies that made use of gp63-containing proteoliposomes. These vesicles were avidly phagocytosed by macrophages. Uptake of the gp63-containing liposomes was suppressed by greater than 90% by both anti-gp63 F(ab) fragments and the oligosaccharide mannan, indicating that their phagocytosis was receptor dependent. These results demonstrate that the abundant glycoprotein gp63 plays an important role in attachment of promastigotes to macrophages, and attachment via this parasite ligand is sufficient to trigger phagocytosis.

Palliative therapy of tumor-induced pleural effusions with 90Yttrium-silicate

In 20 patients with rapidly recurring malignant pleural effusion, 90Yttrium-silicate was intrapleurally instilled after the puncture. In all patients this treatment resulted in marked reduction, or even interruption, of exudate formation. Eleven patients died with an average survival of 166 days. Nine patients are still alive and have been followed up for a mean of 140 days without the pleural effusion recurring. Side effects were not observed, either subjectively or in relation to hematological and other laboratory findings.

[Localization diagnosis and differential diagnosis of postoperative intraperitoneal abscesses using 99m technetium-stannum-colloid-marked granulocytes]

Occult intraperitoneal abscesses are difficult to locate and dispose of. Therefore, a method of examination is needed that is specific, can be used at any time, is not expensive, and yields early results within 2-3 h. This seems possible with a new methods of examination. 99mTc-Sn colloid was used to label autologous polymorphonuclear leukocytes which, when reinjected, emigrate to the site of the suspected abscess. Standard scintigraphy localizes the labeled inflammatory cells. In 32 surgical patients, 34 scans were performed with good results (controlled by greyscale ultrasound); 17 (53.1%) scans represented intraperitoneal abscesses; 3 (9.4%) scans demonstrated true positive extra-abdominal inflammations.

[Quantitative radiocardiography in the differential diagnosis and follow-up of cardiac disease (author's transl)]

Gated blood pool studies have been performed in about 400 patients, evaluating the regional motility and, by Fourier analysis, the following functional parameters: ejection fraction, peak ejection rate and its time, peak filling rate and its time. Wih the calibration procedure used during the first passage, we measured also the endsystolic and endiastolic volume of the left ventricle and the cardiac outpout. The changes of the different parameters caused by various diseases of the heart are discussed. It can be shown tha the measured values allow important conclusions to be made concerning the differential diagnosis. The examinations before and after surgery facilitate evaluation of therapeutic results.

Quantitative Radiokardiographie zur Differentialdiagnose und Verlaufskontrolle von Herzkrankheiten

Bei über 400 Patienten wurde eine quantitative Herzbinnenraumszintigraphie durchgeführt und hierbei die regionale Motilität und mittels Fourieranalyse die folgenden Funktionsparameter ermittelt: Ejektionsfraktion, maximale Ejek-tionsrate und deren Zeitpunkt, maximale Füllungsrate und deren Zeitpunkt. Zusätzlich ergeben sich durch das bei der ersten Passage verwendete Kalibrierungsverfahren die Ventrikelvolumina und das Herzminutenvolumen. Die Veränderungen der verschiedenen Funktionswerte bei unterschiedlichen Herzerkrankungen werden im einzelnen diskutiert. Hierbei zeigt sich, daß sich aus den Meßwerten wesentliche differentialdiagnostische Hinweise ergeben. Die Untersuchungen vor und nach chirurgischen Eingriffen erlauben eine weitgehende Beurteilung des Therapieerfolges.

The application of radioactive labeled leucocytes for the proof of inflammations

The methods we have tested are reliable for the labeling of granulocytes and monocytes as well as with colloidal substances and with soluble 99mTc-phytate. Supravital colorations and electronmicroscopic pictures do not show any damage of the cells caused by the labeling procedures. In the clinical application after the reinjection of the labeled granulocytes and monocytes, inflammations in the abdomen and in the bone could be proved and localized exactly. A final evaluation of the described methods and its differentiation from other diagnostic possibilities will only be possible after further investigations.

[Current possibilities of preoperative diagnosis in planned partial kidney resections]

Sequential and functional scintigraphy utilizing the regions of interest technique has a definite place in preoperative diagnostic renal evaluation prior to partial nephrectomy. Whereas scintigraphy offers information regarding parenchymal function and eventual therapy, renal angiography enables one to visualize the vascular tree, which is technically important for the urologist during surgery. The fate of the diseased parenchymal portion should not only be determined from the subjective intraoperative findings, but rather from more exact methods which measure function and morphology.

Stimulus overselectivity: a common feature in autism and mental retardation

Groups of children with different IQ levels were trained to discriminate between stimulus cards containing two or more pictures. In subsequent testing the pictures were presented singly in order to determine how many pictures the child had responded to during discrimination training. The data showed that the lower the IQ, the fewer pictures the child responded to. We speculated that intellectually retarded functioning may be related to problems in overselective attention; the lower a person's IQ level, the less of the environment becomes functional in controlling his behavior.

EEG changes during spontaneous and controlled menstrual cycles and their correlation with psychological performance

1. EEG (occipito-central, anterior and posterior temporo-central), blood concentration of hormones (oestradiol, progesterone, prolactin, folliculo-stimulating (FSH) and luteinizing (LH) hormones) and psychometric tests (reaction time, concentration, simple calculations, visual orientation and simple motor performance tasks) were recorded from 16 young women during a spontaneous menstrual cycle (s.c.w. group) and from 16 women taking combined oral contraceptives (o.c.w. group). All data were collected every second day except Sundays. 2. The EEGs underwent power spectrum analysis. Power and weighted mean frequency were determined for different frequency bands (theta, alpha and beta). The most constant finding in the s.c.w. group was a slight increase of mean alpha frequency during the luteal phase until menstruation (mean of occipital alpha acceleration = +0.3c/sec). The average time course of this acceleration fitted the time course of progesterone increase, but no direct correlation could be established. No such acceleration of alpha frequency could be found in the o.c.w. group, but the mean frequency in this group was about 0.5c/secslower than that of the s.c.w. group. In addition, minor cyclic changes of EEG paramenters in the s.c.w. group were observed in the occipital and temporal theta activity, the temporal alpha activity, but none in the beta range. 3. Reaction times to simple tasks, simple arithmetic, etc. were slightly but significantly decreased in the s.c.w. group during the luteal phase with a minimum on the day before or during menstruation. No such changes were observed in the o.c.w. group, which performed, in all tasks, slightly slower and slightly less correctly than the s.c.w. group. 4. The individual relative accelerations of alpha frequency and shortening of reaction times were positively correlated with each other.