[Clinical studies of familial hereditary factor VII deficiency (author's transl)]

The discovery of a severe factor VII deficiency with increased bleeding tendency resulted in investigations of 22 members of the family. In the propositus and in two of his siblings a severe hypoproconvertinemia was demonstrated, a partial deficiency was found in ten persons. Studies of the family confirmed that this disorder is transmitted by an autosomal gene with intermediate penetrance. The mutated gene produces a severe deficiency in the homozygote and partial deficiency in the heterozygote. The parents of the homozygote patients were consanguineous. Hemorrhagic diathesis was noted only in patients with a severe factor VII deficiency. Causes for the variability of the clinical manifestations are discussed.

Purification and properties of the membrane-bound acetylcholinesterase from adult rat brain

The membrane-bound acetylcholinesterase (acetylcholine acetylhydrolase, EC 3.1.1.7) from adult rat brain has been purified to homogeneity using sequential affinity chromatography on Con A-Sepharose and on dimethyl-aminoethylbenzoic acid-Sepharose 4B followed by DEAE-cellulose chromatography. The yield of the purified enzyme (specific activity: 3068 U/mg protein) is higher than 50%. Polyacrylamide gel electrophoresis in the presence of Triton X-100 gives only one band with acetylcholinesterase activity. With the exception of electrofocusing and pore gradient electrophoresis, where a multiple band pattern was detected (which seems to be artefactual), the enzyme appears to be homogeneous. Gel filtration and sucrose density gradient centrifugation in the presence of Triton X-100 give only one symmetrical peak, with a calculated molecular weight of 328 000. Since polyacrylamide gel electrophoresis in the presence of sodium dodecyl sulfate (SDS) and mercaptoethanol gives only one band with a molecular weight of 74 500, a tetrameric structure can be postulated for the membrane-bound acetylcholinesterase from rat brain.

[Effect of the antirheumatic drug Sulindac on thrombocyte function (author's transl)]

The effect of a treatment with the antirheumatic drug Sulindac (from 200 to 400 mg/day over 4 weeks) on thrombocyte function (bleeding time, platelet retention, platelet aggregation induced with suitable concentrations of ADP, epinephrine, collagen and Ristocetin) on thrombocyte count and thromboplastin time was investigated in 20 patients. In 10 healthy volunteers collagen-induced platelet aggregation was measured after oral application of 200 mg Sulindac. Analysis of the data obtained by the tests revealed no unwanted or harmful effects of Sulindac on platelet functions, platelet count and prothrombin time. No significant difference between the data before and during treatment was found. No medical drop out was registrated.

Comparison of myocardial oxygen consumption indices in man

Hemodynamic indices of myocardial oxygen consumption (MVO2) were examined in 13 patients with coronary heart disease. The specific aim of this study was to investigate whether clinical results agree with experimental findings in animals. During hemodynamic and respiratory steady-state conditions at rest, the MVO2 (7.6-14.2 ml/min/100 g) was measured directly by myocardial blood flow (argon method) and arterio-coronary venous oxygen content difference. MVO2 was compared with five indirect indices of MVO2. A complex additive parameter consisting of five components of MVO2 had the highest correlation with MVO2 (r = 0.97), as was also demonstrated in a recent experimental study at maximum changes in hemodynamics and MVO2. More easily measurable predictors of MVO2 such as tension-time index (r = 0.923), product of mean systolic aortic pressure and square root of heart rate (r = 0.928), pressure rate product (r = 0.915), and triple product (r = 0.941) were less closely correlated with MVO2. The lower correlations of the readily obtainable indices of MVO2 are probably related to their failure to incorporate factors such as contractility and ventricular dimensions, which are known to exert an important influence on MVO2. The excellent correlation of the hemodynamic additive parameter with MVO2 supports the theoretical concept and the implications of the experimental study. The accurate prediction of MVO2 is based on adequate measurement of MVO2 for the velocity of tension development and maintenance of tension during systolic ejection period, both of which are integrated in the additive index.

[Coumarin therapy during antirheumatism therapy with sulindac]

Possible interactions between the new non-steroidal antirheumatic drug Sulindac and a coumarin derivative have been investigated. 20 subjects, who required anticoagulation therapy for a variety of medical conditions, were treated for 4 consecutive weeks with Sulindac at varying dosages (200-400 mg per day). Prothrombin time, Thrombotest and bleeding time were not significantly affected by the concurrent administration of Sulindac. It can be concluded that there is no clinically important interaction between phenprocoumon and the doses of sulindac that are considered effective in rheumatic disorders. There were some moderate side effects, only one drop out was registered because of gastro-intestinal bleeding (melaena).

The effect of Org GC 94 on thrombocyte function, blood coagulation and the fibrinolytic system in man

The effect of a 14 day treatment with Org GC 94 in rising dosage to a maximum of 45 mg/day on thrombocyte function, blood coagulation and the fibrinolytic system was investigated in 16 healthy volunteers in a double-blind comparative trial with placebo. At the same time the influence on some liver function tests and on the general condition of the subjects was followed. Analysis of the data obtained in tests pertaining to platelet function, blood coagulation, fibrinolysis and liver function did not indicate unwanted or harmful effects of Org GC 94. No significant difference in effect between Org GC 94 and placebo was detectable. The general physical condition including appetite and body weight was not affected by Org GC 94. A mild, transient sedative effect of the maximum dose of Org GC 94 is likely and some influence upon concentration (decrease) and mood (indifference or elevation) in some subjects cannot be excluded.

[A method for the evaluation of nitroblue tetrazolium reduction in human platelets (author's transl)]

A long term incubation in NBT-solution leads not only to NBT-reduction by polymorphnuclear leukocytes and monocytes, but also in washed human platelets. The reaction is enhanced by ADP and to a smaller and very variable extent also by Thrombin and Ristocetin. It is inhibited by incubation in plasma environment as well by DBcAMP and PGE1. After a detailed demonstration of the applied method, some possible biochemical mechanisms of the NBT-reduction in human platelets are discussed.

[Cardiotoxicity of mianserin, an antidepressant (author's transl)]

The effect of mianserin on cardiac function was investigated on 60 adults with known heart disease, the drug previously having been shown not to influence the action of phenprocoumon. After satisfactory anticoagulation had been established, all patients were given additionally two different dosage regimens of mianserin or a placebo in a double-blind trial lasting three weeks. The dose was gradually increased to a maximal daily level of 30 mg or 60 mg, respectively, on the sixth day. Heart rate, blood pressure and electrocardiogram were obtained before and after mianserin had been added. There was no statistically significant difference between the three trial groups with respect to the three measured variables.

Phenprocoumon requirement, whole blood coagulation time, bleeding time and plasma gamma-GT in patients receiving mianserin

A possible interaction between the tetracyclic antidepressant mianserin and a coumarin derivative has been investigated. Sixty-three subjects, 61 of whom required anticoagulant therapy for a variety of medical conditions, were treated for 5 consecutive weeks with phenprocoumon, in a dose adjusted to reduce the prothrombin time to 15%-25%. After an initial control period of one week, subjects were randomly treated under double-blind conditions with mianserin 3 X 10 mg daily or 3 X 20 mg daily, or with a matching placebo. The dose of mianserin was gradually increased to reach the maximum by the 6th day. Three subjects dropped out and 60 completed the trial. The dose of phenprocoumon and the prothrombin, bleeding, and coagulation times were not significantly affected by administration of mianserin. It can be concluded that there is no clinically important interaction between phenprocoumon and doses of mianserin effective in depression. Sedation was more frequent in patients taking mianserin than in those given placebo.

[The effect of oral contraceptives on levels of thyroid hormone, blood coagulation and ceruloplasmin (author's transl)]

The effect of various hormonal contraceptives on the thyroid hormone level, plasmatic and thrombocytic coagulation, cholesterol and ceruloplasmin levels and the activity of gamma-glutamyl transpeptidase was investigaged by the changes produced by long term cyclic estrogen-gestagen therapy on the metabolism of the organism. The free thyroxine index and the total cholesterol were within the normal range. The thyroxine binding index at 44% was above the normal level and the mean value was significantly raised. The ceruloplasmin concentration in the serum was also significantly increased. Pointers to a general hypercoagulability could not be ascertained with a statistical significance.

[Continuity of life situation and "successful" aging (author's transl)]

The determinants of "successful" aging have been a main concern in social gerontological research. The Continuity Hypothesis suggests that there is a relationship between an older person's life satisfaction and the similarity of his social life situation in middle adulthood and in old age. The old person is the more likely to score low in life satisfaction the less similar his old age situation to his life situation in middle adulthood. This hypothesis has been tested in summer 1973 in Cologne with a sample of 406 people aged 65 and over. Findings indicate that continuity of life situation may be an important variable accounting for life satisfaction in old age. Moreover, it could be shown that the various negatively experienced life changes since adulthoood formed a complex of interacting variables, thereby increasing the negative effect on the old person's life satisfaction. Health proved to be one of the most important variables. The continuity hypothesis as stated here represents a modified version of activity theory.

Lupus cardiomyopathy: cardiac mechanics, hemodynamics, and coronary blood flow in uncomplicated systemic lupus erythematosus

Right and left heart pressures, left ventricular volumes, indices of contractility, myocardial wall stiffness, and coronary blood flow were determined in five young women with systemic lupus erythematosus (SLE) during diagnostic right and left heart catheterization. Examinations revealed (1) increases of right and left ventricular enddiastolic pressures; (2) decreases of cardiac output, stroke volume, ejection fraction, contractility indices, diastolic left ventricular volume inflow; (3) decreases of pharmacologically induced coronary vasodilation in SLE. The results demonstrate impaired pump function, reduced contractility, increased myocardial wall stiffness, and decreased coronary vascular reserve in SLE. It is concluded that lupus cardiomyopathy associated with an impairment of left ventricular function may be apparent in young women with SLE who have no clinical signs of cardiac dysfunction.

[Problems concerning the enucleation of both eyes in cases of incurable retinoblastoma (author's transl)]

Despite considerable advances in the treatment of retinoblastoma tumor growths cannot be arrested in a proportion of cases. The consent fro the removal of both eyes constitutes a burdensome decision on the part of the child's parents, so that it is quite frequently refused. A short movie illustrating the behaviour of a 6-year-old boy, who had undergone bilateral enucleation because of retinoblastoma should aid the parents having to face a similar situation.

[Cardiomyopathy in uncomplicated systemic lupus erythematosus (author's transl)]

Haemodynamic functions, myocardial contractility, and coronary blood flow were measured in five young women with systemic lupus erythematosus. There had been no signs of cardiac involvement. Left and right heart catherterisation excluded abnormal pressure gradients and valvar regurgitation. But left ventricular end-diastolic pressures were considerably raised while cardiac output, stroke volume, ejection fraction, and left ventricular compliance were decreased. Isovolumic indices of myocardial contractility were altered, corresponding to a decreased contractile state of the myocardium. Coronary blood flow was moderately increased at rest, but pharmacologically induced coronary vascular reserve was markedly reduced. It is concluded that in young women with this disease there may be, in the absence of clinical signs of cardiac involvement, haemodynamic abnormalities which must be ascribed to the consequences of a lupus cardiomyopathy.

Studies on plasma free-fatty-acid metabolism and triglyceride synthesis of brown adipose tissue in vivo during cold-induced thermogenesis of the newborn rabbit

Parameters of plasma free fatty acid metabolism (pool size, half time, disappearance rate, turnover time and absolute turnover rate), the influx of plasma free fatty acids into the glycerides of brown adipose tissue and the pathway of triglyceride synthesis in brown adipose tissue (glycerol-1-phosphate versus monoglyceride pathway) were examined after intravenous injection of [1-14C]palmitate in newborn rabbits. In the thermoneutral environment of 35 degrees C the turnover rate of plasma free fatty acids was 10.20 mumol/min per 100 g body weight and its flux into the glycerides of brown adipose tissue 0.367 mumol/min per 100 g body weight. Cold exposure at an ambient temperature of 20 degrees C caused a decrease to 5.84 mumol/min and 0.207 mumol/min per 100 g body weight, respectively. Both under basal conditions at an ambient temperature of 35 degrees C and under cold-induced thermogenesis at an ambient temperature of 20 degrees C triglyceride synthesis in brown adipose tissue ran through the glycerol 1-phosphate pathway.

In vivo metabolism of 14C-labeled palmitic acid in serum and in brown and white adipose tissues of well-fed and starved newborn rabbits. I. Tracer kinetic analysis of free fatty acid metabolism in serum

After i.v. injection of 20.10⁶ cpm/100 g body weight ¹⁴C-1-palmitic acid at a thermoneutral environment (Ta 35 °C) the primary FFA pool was in 7 days old well fed rabbits (Group I) 9,57 µmole and in rabbits of the same age but previously starved for 48 h at 20 °C (group II) 3.17 and in those starved 72 h at 35 °C (group II) 1.89. There was no significant difference in disappearance rate (λ) half time (t_0.5) and turnover time (t_t) indicating that the rate at which the label disappeared from the forerunner FFA pool was more dependent on the Ta maintained during the tracer kinetic experiment, than on the duration and the thermal conditions of the previous starvation. The absolute turnover rate of serum FFA (ms) was 9.38 µmole FFA/min in group I and 3.44 and 2.67 in group II and group III, respectively; pointing out that the transfer of FFA from the forerunner pool into the fatty acid compartments of various organs and tissues was significantly reduced by starvation.

In vivo metabolism of 14C-labeled palmitic acid in serum and in brown and white adipose tissue of well-fed and starved newborn rabbits. II. Tracer kinetic analysis of the incorporation rate of serum free fatty acids into the main lipid fractions of brown and white adipose tissues

Starvation at an ambient temperature (T_a) of 35 °C for 72 h or at T_a 20 °C for 48 h affected differently the free fatty acid (FFA), phospholipid and glyceride pools as well as the total flux of fatty acid (msf) between the intracellular and extracellular lipid compartments of brown (BAT) and white adipose tissues (WAT). Tracer kinetic studies with 20.10⁶ cpm/100 g body weight ¹⁴C-1-palmitic acid injected at T_a 35 °C showed that BAT takes up a consistently higher proportion of the initial serum FFA pool (ms) than WAT in both fed (group I) and fasting newborn rabbits (group II at T_a 20 °C; group III at T_a 35 °C. BAT of animals starved in the cold prior to the tracer’s injection (group II) shared a considerably larger fraction of ms than that of fed littermates (group I). Fasting in a thermoneutral environment (T_a 35 °C) consistently resulted in a very low absolute (msf) and relative (percentual msf) flow rates of FFA into BAT. In starving rabbits msF and percentual msF in WAT were consistently lower than in well-fed animals and were even more markedly reduced in animals previously starved in the cold (Ta 20 °C) than in a thermoneutral environment (T_a 35 °C).