[The value of differentiated transurethral resection in primary superficial bladder cancer]

In a prospective study the efficacy of transurethral resection (n = 60) and differentiated resection (n = 66) in primary superficial bladder cancers was evaluated for persistent tumors and recurrences. At the control examination after 8 weeks an persistent tumor was found in 18.3% of cases after simple resection and in 9.1% after differentiated resection. The frequency of recurrences after a follow-up period of 3 years was 40% after simple resection and 27% after differentiated resection. The necessity of a third resection for complete removal of the tumor was shown in 12.1% following differentiated resection. Understaging or undergrading was detected in 3% with this method.

Angiogenesis: modulation with opioids

1. The effect of beta-endorphin (beta-EP) and morphine sulfate (MS), in presence and absence of naloxone (NX), on chicken chorioallantoic membrane was studied as a function of blood vessel proliferation. 2. A 50% reduction in blood vessel proliferation occurred by 10 micrograms of beta-EP or by 5 micrograms of MS per egg compared to controls. 3. An individual dose, i.e. 5 micrograms of beta-EP, did not significantly inhibit blood vessel counts after initial 24 hr period of the drug application when given alone compared to inhibition occurring with combined use of NX. 4. NX (1 microgram) did not significantly reverse the angiostatic effects of MS (10 micrograms) or of beta-EP (5 micrograms). 5. The observed modulation of angiogenesis by opioids suggests involvement of beta-EP and MS in the proliferation of vascular endothelial cells. 6. This may be due to an effect of beta-EP and MS on cell-mediated immunity factors such as interferons, interleukins and prostaglandin E2.

Coping strategies and course of disease of breast cancer patients. Results of a 3-year longitudinal study

In a prospective 3-year longitudinal study investigating correlations between coping strategies and course of breast cancer a consecutive series of 107 patients were assessed for biological and psychosocial data. Data analysis indicated no significant correlations between coping strategies and course of cancer. On the other hand, biological parameters such as size of tumor and lymph node stage at time of surgery correlated significantly with the course of disease. It was concluded that the assessed indicators of coping are of little importance in regard to the course of the disease and less predictive compared with somatical parameters of breast cancer.

[Focal size and shock wave pressure: a comparison of three different physical shock wave generators]

Shock-wave delivery and focal size of three different generators-electrohydraulic, electromagnetic and piezoelectric--were compared. Pressure measurements were uniformly made by needle hydrophone (piezoelectric transducer). The smallest focus, 17 x 3 x 3 mm, was achieved with the piezoelectric system (50% isobars), while the focus with the electromagnetic generator was much larger (50 x 7 x 4 mm). With the electrohydraulic generator the focal size of the 60% isobars was 20 mm in the longitudinal axis. The highest pressure, 1512 bar, was achieved with the piezoelectric lithotriptor (mean shock-wave pressure in focus: electrohydraulic 1000 + 100, electromagnetic 1000 + 25, piezoelectric 1400 + 27 bar). The rapid positive pressure rise was followed by a slower pressure fall and a small negative wave. In the focal region the negative pressure wave was between 112 and 200 bar with the electrohydraulic system, 100-146 bar with the electromagnetic one, and 134 bar with the piezoelectric one. The significance of the negative wave is not clear; perhaps it contributes to the development of the cavitation effect and facilitates stone fragmentation.

Competition between photobleaching and fluorescence increase of photosensitizing porphyrins and tetrasulphonated chloroaluminiumphthalocyanine

The time-dependent fluorescence changes of photosensitizing porphyrins and tetrasulphonated chloroaluminiumphthalocyanine (A1C1SPc) were measured at different intracellular sites using video-enhanced microscopy and image processing. To obtain variations in intracellular fluorescence intensity, different radiant exposures of a Kr+ laser-pumped dye laser were delivered via a 600 microns plastic-clad silica fibre connected to the microscope. During irradiation, competition between photobleaching and fluorescence increase of the different dyes was observed. The porphyrins normally showed photobleaching, which was dependent on the sensitizer and its specific accumulation within the cell. Photobleaching was less pronounced for hydrophilic uroporphyrin than for more hydrophobic dyes. In contrast with an almost exponential decrease in porphyrin fluorescence with increasing light dose, the fluorescence intensity of A1C1SPc significantly increased at the beginning of irradiation, and could be correlated with intracellular deaggregation.

Light scattering by blood components after supplying glucose

Investigations were performed in order to find out whether the glucose concentration in liquids can be determined by means of light scattering. Both static light scattering and photon correlation spectroscopy (PCS) were used. Neither of them revealed a possibility of determination of glucose concentration in a pure glucose solution. But for glucose-protein-solutions a clear correlation between intensity of light scattering and glucose concentration was detected due to glycosylation of proteins. In blood serum it is solely possible to measure non-enzymatic reaction products between glucose and proteins and to determine the influence of Amadori products on protein structure. Therefore not even indirect conclusions on the present glucose concentration are possible.

The contact Nd:YAG laser: a new technique for conservation of the fallopian tube in unruptured ectopic pregnancy

Between August 1986 and April 1988, 22 women with unruptured tubal pregnancy were treated by laparoscopy in the Department of Gynaecology and Obstetrics at the University of Ulm. Linear salpingotomy was performed using the contact Nd:YAG laser technique. The laser beam was delivered by special sapphire probes attached to a standard optical fibre for incision and coagulation. Two different shapes of sapphire probes were used. The specific laser properties and the application of vasopressin enabled treatment without any other incision instruments or coagulation agents. In one patient subsequent laparoscopy became necessary due to persisting trophoblastic tissue. Sixteen women were assessed subsequently by second-look laparoscopy or hysterosalpingography for tubal patency and possible formation of adhesions. In 14 (88%) women the tubes were patent, and in two women adhesions were seen.

[Tube-preserving endoscopic surgical procedures in unruptured tubal pregnancy. What significance does laser use have?]

Between 1985 and 1989 115 non-ruptured tubal pregnancies were operated upon, using a pelviscope and preserving of the tube. For the purpose of prophylactic haemostasis 2,5 I.U. ornipressin (Por 8) were injected into the mesosalpinx. The tube was opened (linear salpingotomy) by using various instruments. This method was used in 49 patients by means of the thermocoagulator and hooked scissors; with the remaining 66 patients the following laser systems were employed: CO2-laser (n = 13); Nd: YAG-laser by the contact method (n = 22); argon-laser (n = 31). No intraoperative complications were noted. Postoperative rebleeding occurred in three patients requiring subsequent treatment, and pelviscopy had to be repeated in two patients, because of incompletely removed trophoblastic tissue. The tubal condition (patency; occurrence of adhesion) was checked in 53 (47%) of the patients by means of hysterosalpingography (n = 15) or second-look pelviscopy (n = 38). Tubal patency/peritubal adhesion were found after conventional surgery in 64%/55% of the controlled cases and after laser salpingotomy in 90%/11%, respectively. Summing up, we can say, that the various laser systems are suitable for operating non-ruptured pregnancies due to their accurate incision and simultaneously coagulating effect. Due to the lower postoperative tubal occlusion rate and lower tendency to adhesion, it appears, that the laser systems are superior to the conventional endoscopy instruments, although the rate of complications was highest after CO2-laser application.

The effect of laparoscopic treatment of polycystic ovarian disease by CO2-laser or Nd:YAG laser

The feasibility and efficacy of laparoscopic CO2 laser and Nd:YAG non-contact laser application for the treatment of polycystic ovarian disease (PCOD) were evaluated in 30 patients (19 patients treated with the CO2 laser, and 11 with the Nd:YAG laser). The criteria for inclusion of PCOD in our study were: amenorrhea or oligomenorrhea with chronic anovulation, failure to ovulate in response to clomide or human menopausal gonadotropin, elevated serum levels of luteinizing hormone (LH) or an elevated LH/follicle-stimulating hormone ratio, exaggerated LH response to gonadotrophin-releasing hormone (GnRH), elevated serum androgen levels, and ultrasonographic features of polycystic ovaries. Eight pregnancies after CO2 laser and three after Nd:YAG laser were achieved. Decline of serum androgen concentrations was noted in both groups, but was significantly higher in the Nd:YAG laser group (from 3.4 +/- 0.4 ng/ml to 2.2 +/- 0.2 ng/ml). Nine patients checked before and after laser treatment showed a decrease in the characteristically exaggerated pituitary response to exogenous GnRH injection. There were no consistent findings of the pattern in LH pulsatility studied in 5 patients after Nd:YAG laser treatment. Ovarian status was investigated in 11 patients by second-look laparoscopy or cesarian section. There were absolutely no adhesions after Nd:YAG laser coagulation. Filmy adhesions were seen in 3 patients in the CO2 laser group.

Clinical efficacy of amoxycillin/clavulanate in laparoscopically confirmed salpingitis

To test the efficacy and safety of amoxycillin/clavulanate (Augmentin), 102 hospital patients with laparoscopically confirmed acute salpingitis were treated with parenteral amoxycillin/clavulanate (1.2 g qid for three days) followed by oral amoxycillin/clavulanate (two tablets of 625 mg tid for a further six days). Bacteriological samples were obtained from the cervix uteri and the pouch of Douglas. One hundred patients were assessable for clinical outcome using several variables including pain scores. Amoxycillin/clavulanate alone was effective in 95 patients (95%). Three patients (3%) responded to amoxycillin/clavulanate with marked improvement but another antibiotic was subsequently added to their treatment regimen. Treatment failed in two patients. At follow-up two weeks after hospital discharge, three patients (3.8%) had relapsed or were re-infected. Adverse drug events included one case of drug fever, one case of rash and one case of severe diarrhoea. Treatment was stopped in all three cases. Gastrointestinal reactions, mainly mild diarrhoea, were seen in 31 patients. No clinically relevant changes in haematological or clinical chemical indices were attributable to the amoxycillin/clavulanate treatment. We conclude that amoxycillin/clavulanate is a clinically effective and safe treatment for acute salpingitis.

On narcissism. The Kleinian approach

This article describes the Kleinian approach to narcissism. During the last 70 years, Klein and her followers came to the conclusion that clinically and theoretically speaking, psychoanalysts are dealing only with more or less severe forms of secondary narcissism. Freud's concept of primary narcissism is considered obsolete. Narcissism, according to the Kleinian approach, is a pathologic defense against the pain caused by the first primitive object relationship: that to the mother breast as described by Klein. Greed, destructive emotions, and impulses that manifest themselves through envy, omnipotent denial of dependence, megalomanic idealization of the self, and confusion with the external object erotization of destructiveness play a fundamental part in narcissism. Of particular clinical importance, in contemporary Kleinian thinking and analytic technique, is the concept of narcissistic destructive organizations as described by Rosenfeld, Meltzer, and Segal.

[Causal attributions and coping with illness in patients with breast cancer]

The aim of the present study was to investigate whether breast cancer patients who attribute their disease to different causes differ in their ability to cope with the disease. A semistructured interview technique was used to question a total of 107 patients, six months after the operation, about the psychological stress involved in their disease and how they coped with it. In addition, two further questionnaires were used: the Freiburg questionnaire concerning adjustment to the disease (FKV) and another questionnaire to register the causes to which the patients attributed their disease (PUK). The results revealed that environmental pollution was the most frequent and important cause of disease mentioned by the patients. This mainly correlated with depressive adjustment to the disease. The same type of adjustment was also frequently seen in patients who attributed their disease to individual psychic problems. Daily stress mentioned as the cause of disease was additionally closely connected with the desire for social support. In accordance with the poor adjustment in connection with internal causes reported in the literature, it was further shown that attribution to psychic causes made psychic adjustment to the disease more difficult, at least within the first six months after the operation.

Characterization of Micropolyspora faeni antigens by human antibodies and immunoblot analysis

IgG, IgM and IgA antibody responses against Micropolyspora faeni (Mf) antigens were studied by means of immunoblotting experiments using 70 sera derived from three groups of farmers, namely patients with extrinsic allergic alveolitis (EAA) due to thermophilic actinomycetes (n = 25), patients without EAA but with hay exposure (n = 14), and patients suspected to have EAA (n = 31), and 27 sera from two groups of control persons (healthy laboratory workers, n = 13; healthy farmers, n = 14). Patients with EAA showed IgG, IgM and IgA antibody responses mainly against the antigens with molecular weights (MW) of 11, 12, 25, 35 and 60 kD ("major antigens"), and in addition, but less often, against six antigens with MW in the range of 15 to 62.5 kD ("minor antigens"). The other two groups of patients and also the exposed control persons showed very similar results; however, the antibody response in healthy farmers was substantially weaker in comparison to the three groups of patients and was almost limited to the major antigens with MW 11, 25 and 60 kD. Although patients with proven EAA had higher amounts of antibodies, there was no correlation between this antibody response and the onset of disease. The results indicate the necessity of including at least the major antigens with MW of 11, 25 and 60 kD in all extracts used for in vitro diagnosis of Mf-induced EAA.

Activation and release of enzymes and major basic protein from guinea pig eosinophil granulocytes induced by different inflammatory stimuli and other substances. A histochemical, biochemical, and electron microscopic study

In order to investigate the availability and release of enzymes from eosinophilic granulocytes in response to a variety of stimuli, guinea pig peritoneal eosinophils were obtained after repeated intraperitoneal injections of freeze-dried Trichinella spiralis larvae. The activities of the enzymes peroxidase, arylsulfatase B, beta-glucuronidase, aminopeptidase, histaminase, cytochrome c oxidase, acid phosphatase, adenosine triphosphatase and glucose 6-phosphatase, and the major basic protein (MBP) were studied histochemically and, in part, also biochemically. Eosinophils were incubated with the following substances: histamine, platelet activating factor, calcium ionophore, compound 48/80, leukotriene B4, prostaglandins E1, and E2, heparin, and eosinophil-chemotactic factors from neutrophils and lymphocytes. Eosinophils displayed a selective and stimulus-dependent enzyme and MBP reaction. Calcium ionophore and compound 48/80 provoked a release of cytotoxic major basic protein, partly associated with peroxidase release, while leukotriene B4 and eosinophil chemotactic factors caused histaminase and peroxidase release and activated leucinaminopeptidase. Heparin and calcium ionophore induced release of both MBP and histaminase. These data support the concept that eosinophils exhibit either inflammatory or cytotoxic, or antiinflammatory properties upon stimulation by various agents.

Intracellular distribution of photosensitizing porphyrins measured by video-enhanced fluorescence microscopy

The intracellular distribution of photosensitizing porphyrins with different amounts of aggregates was measured in a fluorescence microscope using video-intensified detection and image processing. Porphyrin fluorescence was localized in the plasma membrane, cytoplasm, nuclear membrane and nucleoli. The fluorescence intensity in the plasma membrane decreased with increasing aggregation of the photosensitizers. In addition, a redistribution of the porphyrin molecules from the plasma membrane to the nuclear membrane and adjacent intracellular sites was observed with increasing incubation time. Photobleaching of porphyrin fluorescence was most pronounced in the plasma membrane and least efficient within the nucleoli.

Anogenital warts of the condyloma acuminatum type in HIV-positive patients

Anogenital warts of the condyloma acuminatum type seem to occur quite often during HIV infection. These warts--according to our study--are not commonly caused by malignancy-associated human papilloma virus types, but by types 6 and 11 as seen in the nonimmune-compromised population. Widespread condylomata acuminata may appear in rather early stages of HIV infection and they may therefore represent early warning signs of HIV infection.

Electrophoretic mobility of corneocytes measured by laser Doppler spectroscopy

A new approach studying the characteristics of the stratum corneum is presented: the electrophoretic mobility of corneocytes by laser Doppler spectroscopy. The detergent scrub technique was used for harvesting corneocytes from three body regions (forehead, palm, and sole) of normal persons (n = 20) under casual conditions and after thorough defattening of the skin with 70% isopropyl alcohol or petrol. Similarly, cells from the forehead, shoulder, and palm were obtained from 22 acne patients treated with isotretinoin (13-cis retinoic acid) 0.5-0.7 mg/kg body weight (b.wt.)/day for 12-16 weeks, and in patients receiving arotinoid (Ro 15-0778) 192 mg (n = 5) or 500 mg (n = 5) per kg/b.wt./day for 6 weeks (forehead and shoulder). In another experiment, cell suspensions with a pH ranging from 5.0-7.3 were evaluated. Measurements were performed by dynamic laser light scattering. This laser application allows exact electrophoretic mobility measurements in a short time (3 min). When cells pass the laser beam, the scattered light is frequency-shifted due to the optical Doppler effect. These frequency shifts are analyzed by the heterodyne light beating technique. The analog signal of the photodetector is converted into a power spectrum by Fourier analysis. This power spectrum represents the spectrum of electrophoretic cell mobility distribution. Results showed different electrophoretic mobility values for corneocytes dependent on the topographic region: forehead 1.18 +/- 0.16, palm 1.10 +/- 0.14, and sole 0.83 +/- 0.10 (means +/- SEM) micron cm/Vs. Defattening with isopropyl alcohol decreased the mobility values to 0.90 +/- 0.09 (p less than or equal to 0.01), 0.95 +/- 0.10, and 0.77 +/- 0.10 micron cm/Vs respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

The Photosynthetic Apparatus of Ectothiorhodospira halochloris 3. Effect of Proteolytic Digestion on the Photoactivity

Photsynthetic membranes of Rhodopseudomonas virids and Ectothiorhodospira halochloris were treated with proteinase K. The photochemical activity (light minus dark difference spectra) were compared to the polypeptide composition (SDS-polyacrylamide gel analysis). In E. halo­chloris, difference bands appear at 806 (+), 838 (+) and 854 nm (-) . All three decrease in intensity upon incubation with proteinase K., but this decrease is much slower than the proteolysis of both the reaction center and antenna related polypeptides. Photochemical activity remains high as long as a small part of the RC and two lower molecular weight polypeptides M* (22.0 kDa) and B* (15.3 kDa) are present. The M subunit is the most stable polypeptide in the RC of Rp. viridis too, and the photochemical activity is related to the remainder of this and to the one newly formed polypeptide (15.3 kDa), but doesn’t show the typical absorption shift of the antenna (B 800/1020 → B 800/960). The results are discussed quantitatively and compared to those obtained from Bchl α containing organisms.

Size and shape of the multicatalytic proteinase from rat skeletal muscle

The multicatalytic proteinase from rat skeletal muscle, a non-lysosomal high molecular weight enzyme active at neutral to alkaline pH, has been examined in the electron microscope as well as by dynamic laser light scattering. Both methods reveal monodisperse particles. Electron micrographs show a cylinder-shaped complex with a diameter of 11 nm and a length of 16 nm in negatively stained, and a diameter of 9.6 nm and a length of 14.3 nm in freeze-dried, heavy metal replicated specimens. The molecule is composed of four rings or disks.

Clinical evaluation of semiautomatic blood pressure devices for self-recording

Sixteen semiautomatic blood pressure devices for self-recording were compared with a Hawksley random zero sphygmomanometer using three criteria for determination of accuracy: correlation analysis; mean differences; standard deviation of mean differences. Only one of the tested instruments showed excellent results, but three other devices had satisfactory accuracy of blood pressure recording. These devices could be recommended for self-recording by patients. Only minor differences were found between the devices as regards reliability and convenience in use.

The effect of different surface chemical groups on drug binding to liposomes

The binding of four secondary and tertiary amine drugs with local anesthetic activity (propranolol, tetracaine, lidocaine, procaine) to liposomes containing charged surface groups of different chemical composition has been investigated. Binding is determined by measurement of partition coefficients and of drug induced zeta potential changes of the liposomes. For propranolol 30% of the total amount of drug dissolved in phosphatidylcholine is located as protonated form in the liposome surface. Fifty percent of tetracaine and 13% of procaine contribute to the surface charges. Negative surface charges (phosphatidylserine) facilitate drug binding and drug protonization in the liposome surface. Positive surface charges (hexadecyltrimethylammonium) prevent the protonization of the drugs. Different chemical groups of single negatively charged phospholipids or of electrostatically neutral lipids have no significant effect on drug binding which proves that binding is not influenced by steric and bulky head group configurations. The drugs interact hydrophobically with the lipid phase in such a way that the drug amine protonizes in the presence of the negatively charged phosphate oxygen of the phospholipid. Hexadecanoic acid is located deeper within the liposome surface than other negatively charged phospholipids. Correspondingly the drug action is weaker and drug protonization is prevented.

Adriamycin alone or combined with vincristine in the treatment of advanced breast cancer

One hundred and nineteen women with advanced breast cancer treated previously by endocrine therapy but no prior chemotherapy were given adriamycin 70 mg/m2 i.v. on day 1 of a 3-weekly cycle for 8 courses, followed by a regimen of cyclophosphamide, methotrexate and 5-fluorouracil (CMF) until relapse. They were allocated randomly to receive either no treatment (group A) or vincristine 1.4 mg/m2 i.v. on days 1 and 8 during treatment with adriamycin (group AV). In 107 evaluable patients objective responses were seen in 30/53 patients (57%) in group A and in 28/54 patients (52%) in group AV. The projected dose of adriamycin received was 78% in group A and 75% in group AV; and 60% for vincristine in group AV. The subjective and haematological toxicity for adriamycin was similar in both groups, but 65% of patients treated with vincristine developed neurotoxicity. The median duration of objective regressions was the same for both groups (7 months), and the median time to failure was 5 months for group A and 6 months for group AV respectively. The median survival of the responders tended to be longer in group AV (17.5 months) than in group A (13 months), but this difference was not statistically significant (P = 0.112). It is concluded that there is no advantage therapeutically in combining vincristine and adriamycin in patients with advanced breast cancer.

Results of endocrine therapy do not predict response to chemotherapy in advanced breast cancer

One hundred and four patients with advanced breast cancer treated with adriamycin +/- vincristine had had prior endocrine therapy. Of 28 responders to prior endocrine therapy a response to subsequent chemotherapy occurred in 15 (54%); the response frequency in the 76 non-responders to endocrine therapy was 51% (39 patients). The median time to treatment failure was not significantly different between responders to prior endocrine treatment and non-responders (7 months vs 5 months; P = 0.136). Although the median survival from starting chemotherapy tended to be longer in the endocrine responders (18 months) than in the non-responders (12 months), there was no significant difference between the two groups (chi = 2.749; P = 0.097). In a subgroup of 31 non-responders to endocrine therapy who had had stable disease (greater than or equal to 6 months) the median time to treatment failure was 6 months and median survival 13 months. This lack of differences existed for each subgroup of endocrine therapy. Response to prior endocrine treatment was not shown to be a determinant of response to subsequent chemotherapy.

Human sperm motility--enhancement and inhibition measured by laser Doppler spectroscopy

Laser Doppler spectroscopy is an excellent instrument to measure motility parameters of human spermatozoa. Experiments have been performed by the aid of a now commercially available instrumental setup called LAZYMOT to study enhancement and inhibition as well as influences of different physical treatments on the motility of human spermatozoa. The motility enhancing influence of Kallikrein (up to 40% with 4 KU/ml) and prostaglandin E2 could be proven, thereby verifying some sort of mechanism of action within the Kallikrein-Kinin system. Furthermore tested substances in this context were bradykinin (no effect), caffeine (enhancement), salicylic acid (slight decrease), and other prostaglandins (no effect). The influence of washing, centrifugation, resuspension liquid, and temperature has been examined. It turned out that the lowest motility degradation is to be achieved by washing twice at a pH value of 7.4 at forces of 200 g for 10 min each time. The optimal temperature during this process and the measurements thereafter was found to be 36 degrees C. Unsaturated fatty acids like arachidonic acid have been found to be very strong motility inhibiting substances, which can totally block any movement of spermatozoa.

Drug-induced surface potential changes of lipid vesicles and the role of calcium

The effects of four different drugs with local anesthetic properties were investigated on the surface potential of phospholipid vesicles composed of electrostatically neutral lipids (phosphatidylcholine), negatively charged lipids (phosphatidylserine) and a mixture of acidic and neutral lipids (soy bean lipids). Propranolol, tetracaine, lidocaine and procaine decrease the negative surface potential of phosphatidylserine and soy bean liposomes and increase that of phosphatidylcholine liposomes. The drugs interact with the liposomes in such a way that the protonated amine groups point towards the polar head groups of the phospholipids and the rest of the molecule is probably incorporated into the hydrophobic core of the lipid bilayer. The same sequence in drug activity normally measured in biological tissues (propranolol greater than tetracaine greater than lidocaine greater than procaine) is found for the surface potential change of the phospholipids. Calcium prevents the binding of the drugs to phosphatidylserine, especially the binding of lidocaine and procaine. Because of its high affinity for negative surface charges, Ca2+ chelates with phosphatidylserine and blocks the incorporation of the drug molecule. Vice versa, when incorporated into the liposomal bilayer, the drug blocks the interaction of calcium. These antagonistic effects are only observed in liposomes made from acidic phospholipids and not in those made from pure electrostatically neutral lipids like phosphatidylcholine.

Effect of pH and different substrates on the electrokinetic properties of (Na+, K+)-ATPase vesicles

Some biophysical properties of a (Na+, K+)-ATPase preparation from guinea-pig kidney have been analysed. The recently developed technique of laser Doppler spectroscopy was applied to measure particle mobility under electrophoretic conditions. The following results were obtained: 1. magnesium ions at pH 7.3 decrease the mobility of the ATPase containing vesicles by binding to negatively charged surface groups. At pH 3.3 the competitive binding of protons causes a shift of the mobility vs. [Mg2+] curve to higher values of [Mg2+], 2. binding of ATP at pH 7.3 (Kd = 0.9 X 10(-4) M for (mM 1 NaCl, 0.2 KCl, 0.1 MgCl2, 0.1 Tris) was measured as an increase in particle mobility depending also on [Mg2+]. At pH 3.3 also unspecific ATP-binding occurred, 3. ITP and GTP had the same Kd value as ATP; ADP a slightly lower one (Kd = 1.2 X 10(-4) M). Tris-H3PO4 (Kd = 2.6 X 10(-4) M) was also able to increase particle mobility, but only at higher concentrations and not to the same extent as ATP; AMP induced only very small changes, 4. from the mobility-pH curve an isoelectric point of 4.1 is derived (buffer: 1 mM NaCl, 0.2 mM KCl, 0.1 mM MgCl2, 0.1 mM Tris). In the presence of 0.9 mM ATP the isoelectric point is shifted to 3.2. As the electrophoretic mobility is directly proportional to the net charge of the vesicles, the results may be interpreted as changes in surface charge density, originating from both a conformational change of the ATPase polypeptide and a decrease in vesicle size.

Contribution of prednisolone to the primary endocrine treatment of advanced breast cancer

Two hundred and four patients with progressive locally advanced or metastatic breast cancer not controllable by local therapy alone, and who had had no prior systemic therapy for advanced disease, were treated by primary endocrine therapy according to menopausal status. Premenopausal patients received ovarian irradiation (O) whilst postmenopausal patients received tamoxifen 10 mg b.d. (T). Patients were randomised to receive either no additional treatment or prednisolone 5 mg b.d. (P). In 180 evaluable patients, T + P induced significantly more responses than T alone (26/73 vs 9/72, P less than 0.01) and the addition of P to O in premenopausal patients also induced more responses than O alone (7/16 vs 4/19), but this difference was not significant and accrual of premenopausal patients continues. There was a trend for patients receiving T + P to have a longer survival than those receiving T alone (median 25 vs 16 months). These trends occurred in patients with tumours positive for oestrogen receptors and when receptor status was unknown; patients with receptor-negative tumours had a negligible response to endocrine treatment. P mitigated the occurrence of hypercalcaemia and tumour flare sometimes seen with T alone.

Patterns of disturbed myocardial perfusion in patients with coronary artery disease. Regional myocardial perfusion in angina pectoris

Fifty patients who presented with angina pectoris were studied to examine the disturbances of regional myocardial perfusion during stress. Each patient underwent 16-point precordial mapping of the ECG during an exercise test, and coronary and left ventricular angiography. Regional myocardial perfusion was assessed using an atrial pacing test and a short-lived radionuclide, krypton-81m. Eleven patients had negative exercise tests and uniform increases in myocardial activity of krypton-81m of 98 +/- 18.0% during pacing. Ten patients performed 30,000-43,000 J in positive exercise tests. These patients showed abnormal coronary anatomy and increases in myocardial activity of krypton-81m to remote and jeopardized myocardium at the onset of pacing. However, further pacing produced a decrease in activity in the affected segment of 68.0 +/- 9.0% accompanied by ST-segment depression and angina. Twelve patients achieved 26,000-32,000 J in positive exercise tests and had significant coronary artery disease. Atrial pacing produced increased activity of krypton-81m to remote myocardium. The jeopardized segment at first showed no change and then a decrease in regional activity of krypton-81m (89.0 +/- 17%) accompanied by ST-segment depression and chest pain. Seventeen patients achieved only 7000-22,000 J in positive exercise tests. These patients showed abnormal coronary anatomy and developed decreases in regional activity of krypton-81m to the affected segment of myocardium starting at the onset of atrial pacing and decreasing by 88 +/- 0 7.0% below control. We conclude that different patterns of disturbed myocardial distribution of krypton-81m are present during stress-induced ischemia in patients with coronary artery disease. There was a close temporal relationship between these disturbances and ST-segment depression.

Cell electrophoresis for diagnostic purposes. II. Critical evaluation of conventional cytopherometry

Determination of the electrophoretic mobility of test cells has been widely used in an attempt to detect so-called lymphokines in a laboratory test for cancer, but operational difficulties are inherent in conventional cytopherometers. This study therefore investigates the technical and operational aspects of cell electrophoresis, using the Zeiss cytopherometer; e.g. influence of electro-osmosis, focus uncertainty, movement due to convection and other sources of error. Implications and possible improvements in the test are discussed.

Cell electrophoresis for diagnostic purposes. I. Diagnostic value of the electrophoretic mobility test (EMT) for the detection of gynaecological malignancies

Lymphocytes from 278 gynaecological patients (100 controls and 178 patients with a malignant condition) have been investigated for their response to encephalitogenic factor, cancer basic protein, and KCl extract of adenocarcinoma of the body of the uterus as "antigens", using tanned sheep erythrocytes ETS as indicator particles in the electrophoretic mobility test (EMT). Electrophoretic mobility was measured with a Zeiss cytopherometer. The study was split into three test series producing in the cancer group 66% correct positive test results (34% false negatives) and in the control group 83% correct negative results (17% false positives). Consequently, with the instrumentation used, EMT is, at least in our hands, not sufficiently reliable for the diagnosis of cancer.

Modulation of NK and K cell activity by trypsin treatment of effector cells

The effect of trypsin-treated human peripheral blood lymphocytes on spontaneous cell-mediated cytotoxicity (SCMC) and antibody-dependent cellular cytotoxicity (ADCC) was investigated using benzylpenicilloyl (BPO)-coated HeLa cells as targets. For ADCC-experiments an anti-BPO-IgG was purified from rabbit hyperimmune sera by affinity and subsequent ion exchange chromatography and used in different concentrations. After treatment of lymphocytes with high enzyme concentrations (21,500 U/2 X 10(6) lymphocytes/ml) both SCMC (mediated by NK cells) and ADCC (mediated by K cells) were markedly reduced in 3 hours as well as 18 hours 51Cr-release assays. Since decrease of K cell activity in this kind of assay might be due to impairment of SCMC, the effect of trypsin treatment was reevaluated in an NK-free system using BPO-coated lymphocytes as target cells and lymphocytes from the same donor as effector cells. Once again, in this system the K-cell activity was significantly reduced. Chessboard titration resulted in either enhancement of depression of ADCC depending on the dose of enzyme and IgG concentrations. In addition it could be seen from these dose response studies with different IgG concentrations (10--10,000 ng/ml) and different proteolytic activities (170--21,500 U/2 X 10(6) lymphocytes/ml) that the use of high IgG concentrations and low proteolytic activities might simulate resistance of K cells to trypsin treatment. The data presented indicate that the IgG-mediated ADCC should no longer be designated as "trypsin-resistant".

Cadiovascular complications of homozygous familial hypercholesterolaemia

Seven patients with homozygous familial hypercholesterolaemia, two female and five male, aged 12 to 25 years, underwent clinical and angiographic assessment to define the associated cardiovascular abnormalities. Four patients had angina, two of whom also had syncope on exertion. All had an ejection systolic murmur but no ejection click and a loud aortic second sound. All but one had a systolic gradient between the left ventricle and aorta, ranging from 20 to 80 mmHg at the time of presentation. Angiography showed a characteristic narrowing of the aortic root in all and five of the seven patients had coronary ostial stenosis. One patient died after an aortocoronary bypass and aortic valvotomy and two others underwent aortocoronary bypass and aortic valve replacement, one of whom also died after operation. The survivor and three other patients are now undergoing regular plasma exchange and remain well. The seventh patient died suddenly before the latter form of treatment could be started. These findings confirm that premature, severe atheroma of the aortic valve and root is a characteristic feature of homozygous familial hypercholesterolaemia and carries a high mortality.