Traumatic rupture of the thoracic aorta in childhood with special reference to the therapeutic strategy

Acute traumatic tear of the thoracic aorta is extremely rare in childhood. Based upon our own experience with two children, the essential diagnostic and therapeutic measures are discussed with special reference to timing of surgery. Aortic disruption must be suspected in a child who sustains severe blunt chest injury and develops an abnormally wide mediastinum. Definite diagnosis is established by aortography or computed tomography. The appropriate therapeutic approach is determined by the clinical symptomatology and particularly by the severity of concomitant lesions. In the absence of a significant hemothorax and if no difference in pulse amplitude between upper and lower extremities is evident, the risk of free aortic rupture with intrathoracic exsanguination is presumed to be rather low if the patient reaches the hospital alive. In that situation, the continuity of the injured aorta is maintained by the adventitia and surrounding mediastinal structures. Therefore, these patients may derive the best benefit from an initially conservative management including pharmacological intervention to reduce the risk of free aortic rupture. This concept is particularly indicated if aortic disruption is associated with severe concomitant injury such as intraabdominal or intracranial lesions. Such injuries preclude safe aortic repair immediately after establishment of diagnosis. Delay of aortic repair until recovery from associated major injury allows heparinization and the use of a pump oxygenator, which is regarded as the most effective method to prevent spinal cord ischemia and to reduce the risk of paraplegia.

Monoclonal antibodies to human chorionic gonadotropin (HCG) and their use in two-site binding enzyme immunoassays

A panel of mouse monoclonal antibodies (MABs) was produced against human chorionic gonadotropin (HCG) and its isolated beta-subunit (beta-HCG). According to their binding specificities the antibodies could be divided into HCG-specific and cross-reactive MABs. The HCG-specific antibodies reacted with antigenic sites on holo-HCG or holo-HCG and beta-HCG, or exclusively with the non-associated beta-HCG chain. The cross-reactive antibodies reacted with either HCG and luteinizing hormone (LH) or with HCG, LH, follicle-stimulating hormone (FSH) and thyroid-stimulating hormone (TSH). According to the binding specificities of the MABs and their reciprocal inhibition detected in two-site binding enzyme immunoassays (EIA), altogether 13 epitopes (including the 3 hidden epitopes detectable only on free non-associated beta-HCG) were distinguished by the antibodies described here. Antibody combinations resulting in most effective and specific HCG- or beta-HCG-determination were used as clinical assays and proved their reliability and correctness for monitoring patients with HCG- and/or beta-HCG-producing tumors before and after therapy.

Persistent müllerian duct syndrome: a case report

The persistent Müllerian duct syndrome is a rare disorder of sexual development. We report on a 4 month-old male who presented with a left-sided inguinal hernia and undescended testes. During the repair of the hernia 2 testes, 1 fallopian tube and an uterus were observed. The clinically suspected diagnosis of hernia uteri syndrome was confirmed by laboratory investigations. At the age of 18 months laparotomy was performed and the 2 fused gonades were descended into the right scrotum.

Increased levels of serum intercellular adhesion molecule 1 in HIV infection are related to immune activation

Cytopathic mechanisms in human immunodeficiency virus type 1 (HIV-1) infection involve syncytia formation, and it appears likely that increased expression of intracellular adhesion molecule 1 (ICAM-1) is involved in these cell adhesion phenomena. In this study, we determined serum concentrations of soluble ICAM-1 (sICAM-1) in 27 patients with HIV-1 infection and a control group. In addition, we compared sICAM-1 values to CD4+ T-cell counts, serum beta 2-microglobulin (beta 2M) and serum neopterin levels. HIV-1-infected patients had significantly higher sICAM-1, beta 2M and neopterin levels than controls. The subgroup of patients with Walter-Reed stages 3-6 had only slightly higher sICAM-1 concentrations in serum than Walter-Reed stages 1-2. The sICAM-1 concentrations in HIV-1-seropositive patients correlated with beta 2M levels but neither with neopterin nor with CD4+ T-cell counts. Increased sICAM-1 may result from immune activation, which enhances the expression of ICAM-1 in patients with HIV-1 infection.

Bispecific IgA/IgM antibodies and their use in enzyme immunoassay

Two hybrid hybridomas secreting polymeric bispecific antibodies to human chorionic gonadotropin and calf intestinal alkaline phosphatase were produced by fusion of IgA- and IgM-secreting mouse hybridomas. Both hybrid antibodies were purified from ascitic fluid by size exclusion chromatography. An IgM-like fraction was shown to exhibit bispecific activity. Bispecificity was completely lost following mild reduction and alkylation. Both bispecific antibodies were used to develop a sensitive enzyme immunoassay for hCG.

Surgical significance of the duplex kidney with bifid ureter

Between 1974 and 1990 in 16 children (5 boys and 11 girls) with a duplex kidney and bifid ureter surgery was indicated. The mean age of the 15 already operated patients was 7 years (0.3-12 years). 14 had uretero-ureteric reflux, 1 had a stenosis of the ureteric bifurcation, and 1 had a lower pole pelvi-ureteric junction obstruction. An interpyelic anastomosis was performed in 14 and a ureteroneocystostomy "en bloc" in 1. The follow-up was 3-10 years with a mean of 5 years. All 15 patients had normal uroradiological findings, and out of the 9 patients with longer follow-up (more than 3 years) 7 had a significantly diminished infection rate.

Preliminary experiences with the Orbis-Sigma-System as a ventriculo-peritoneal shunt

In the last 3 years an Orbis-Sigma system has been implanted in 40 hydrocephalic children (as a primary shunt in 28 and following another shunt system in 12). Its usefulness was tested by regular clinical examinations, head circumference measurement, ultrasonography or CT and the causes and frequency of shunt revisions. The preliminary results of a mean follow-up time of 1.4 years are discussed.

Low-dose oral natural human interferon-alpha in 29 patients with HIV-1 infection: a double-blind, randomized, placebo-controlled trial

OBJECTIVE

To evaluate clinical efficacy and toxicity of low-dose oral natural human interferon-alpha (nHuIFN alpha) on CD4+ lymphocyte counts and clinical symptoms in patients with HIV-1 infection.

DESIGN

Double-blind, randomized, placebo-controlled trial with crossover.

SETTING

Private practice specializing in the treatment of patients with AIDS.

PATIENTS, PARTICIPANTS

Only patients with HIV-1 infection and CD4+ lymphocyte counts between 200 and 500 x 10(6)/l were included for study. Thirty out of thirty-one patients at study entry completed treatment with placebo, and 29 completed nHuIFN alpha treatment. Mean patient age was 36 years (range, 25-58 years). The 30 patients included 26 men, of whom 22 were homosexual, and four women; five were drug users and none were currently on zidovudine therapy, although three had been previously.

INTERVENTIONS

Patients were randomly assigned to cohorts of 10 to receive either 200 IU nHuIFN alpha once daily orally absorbed or placebo with crossover after 6 weeks.

MAIN OUTCOME MEASURES

Every 2 weeks, a detailed history, physical examination, and laboratory tests, including CD4+ and CD8+ lymphocyte counts, were conducted.

RESULTS

There was only a slight, transient increase in mean CD4+ lymphocyte counts after 4 weeks of treatment with nHuIFN alpha, compared with a slight decline when placebo was administered. This effect reached statistical significance in a subgroup of patients only and was not sustained after 6 weeks. There were no significant changes in weight and clinical symptoms. All patients remained HIV-1-antibody-positive. Treatment-related adverse reactions were not observed.

CONCLUSIONS

Our double-blind, randomized, placebo-controlled clinical trial did not confirm a previous report of efficiency of oral nHuIFN alpha. Although non-toxic, our data do not justify the widespread use of low-dose oral nHuIFN alpha in HIV-infected patients outside controlled clinical trials.

Pharmacokinetics of the antidepressant levoprotiline after intravenous and peroral administration in healthy volunteers

To investigate the pharmacokinetics and the disposition of levoprotiline after i.v. and p.o. administration and to assess the absolute bioavailability, 12 healthy volunteers (11 women, 1 man) were given a 10 min i.v. infusion of 15 mg and a p.o. dose of 75 mg in a two-way crossover study. Blood and urine samples were collected after each dose. Unchanged levoprotiline and the sum of unchanged and glucuronidated levoprotiline (= total levoprotiline) were determined by a specific gas chromatographic-mass spectro-metric method. Intravenous levoprotiline was rapidly and extensively distributed into extravascular sites of the body; the steady-state volume of distribution was 18.81 kg-1. The elimination of levoprotiline from blood was independent of the dosing route, the half-life being 18.8 h. Only 1.8 and 0.6 per cent of the i.v. and p.o. dose, respectively, were excreted unchanged in the urine, whereas 57 per cent of each dose were renally excreted as total levoprotiline. The absolute bioavailability of p.o. levoprotiline was 40 per cent. About 60 per cent of the dose was subject to a first-pass effect in the liver. The systemic blood clearance of levoprotiline, determined after i.v. dosing, was 885 ml min-1, the renal blood clearance after i.v. and p.o. dosing was only 16.0 and 14.2 ml min-1, respectively. Presystemic and systemic clearance of levoprotiline occurred predominantly by direct glucuronidation.

Intracranial lipomas

Intracranial lipomas are very rare tumors, mostly being localized in the midline and often asymptomatic. We report on three children with intracranial lipomas (one with extension to the cervical spinal cord) diagnosed by CT and/or MR. All three had different symptoms and neurological signs. We summarize the case reports in the literature since the CT-era.

Cerebrospinal fluid pressure in 10-day-old rats with congenital hydrocephalus

Rats from the H-Tx strain develop hydrocephalus through a developmental obstruction of the cerebral aqueduct. The progressive ventriculomegally is accompanied by thinning of the cerebral cortex which is already present 10 days after birth. However, a previous study found that the CSF pressure was not significantly raised until 21 days after birth. New experiments have now been performed over a 90 min. period using control and hydrocephalic 10-day-old rats under light pentobarbitone anaesthesia, in order to study the level, time-course and morphology of the resting intraventricular pressure. The mean pressure and its fluctuations were calculated for each minute. Control rats had a mean pressure of 19.3 +/- 1.23 (SEM) mm H2O (n = 9, range: 13.6-24.7) and in hydrocephalic rats, pressure was significantly higher at 23.5 +/- 1.13 mm H2O (n = 9, range: 18.1-28.3). There was no consistent trend with time and no significant difference between groups in pressure fluctuations, but at least two of the hydrocephalic rats showed episodic waves similar to "B"-waves in humans.

Determination of the antidepressant levoprotiline and its N-desmethyl metabolite in biological fluids by gas chromatography/mass spectrometry

A specific and sensitive gas chromatographic/mass spectrometric method was developed and validated for the determination of the antidepressant levoprotiline in blood, plasma and urine and the simultaneous determination of levoprotiline and its desmethyl metabolite in urine. Deuterium-labelled analogues were used as internal standards. The compounds were isolated from the biological fluids by liquid-liquid extraction under basic conditions. Following derivatization with perfluoropropionic anhydride, the samples were analysed by capillary column gas chromatography/electron impact mass spectrometry with selected ion monitoring. The analysis of spiked samples demonstrated the high accuracy and precision of the method. Blood concentrations of levoprotiline down to 0.7 nmol l-1 (1 ml used for analysis) could be quantified with a coefficient of variation of 10% or less. The method is suitable for use in pharmacokinetic and bioavailability studies of levoprotiline in humans.

Enzyme sensor-FIA-system for on-line monitoring of glucose, lactate and glutamine in animal cell cultures

Enzyme sensors for glucose, lactate and glutamine were connected via flow-injection analysis (FIA) devices to two different bioprocesses. They were used for on-line process control of perfused bioreactor systems containing mammalian cell lines producing a monoclonal antibody and recombinant interleukin-2. The biosensor system gives direct access to important process data which can be used as control parameters for long term cell cultivation systems.

Results of extended craniectomy including supraorbital advancement in premature coronal and frontal craniosynostosis

Between 1982-1989 an extended craniectomy including supraorbital advancement was performed in 27 infants. Age ranged from 2.5 to 10 months (median 4.5 months). Six had a premature synostosis of the frontal suture, 11 a monolateral synostosis of the coronal suture and 10 a bilateral coronal synostosis. Eighty per cent had an excellent or good result. The amount of remodelling, as measured by the orbital roof angle, showed a tendency to normalisation of the anterior fossa in the lateral projection 3-4.5 months following surgery. In some of the infants the neurological signs and psychomotor development were ameliorated by the operation. But, in monolateral cases of coronal synostoses a squint of various types was observed more frequently.

Do electronic fetal heart rate monitors improve delivery outcomes?

Since the development of electronic fetal heart rate monitors, there has been considerable debate over observable benefits of their use. Early uncontrolled observational studies and retrospective case studies suggested that fetal distress detected by monitoring could help lower both intrapartum and neonatal death rates, serving a utility among high risk deliveries. However, these studies were conducted at a time when neonatal intensive care units and advancing technologies were also beginning to markedly influence perinatal mortality. Randomized clinical trials of the past 10 years have compared electronic monitoring to routine periodic auscultation and have consistently failed to demonstrate a statistically significant difference in either the perinatal mortality rate or the outcome of high risk pregnancies. A few of these studies, however, did report a lower incidence of neurological complications within the monitored deliveries. The latest research, though, has failed to substantiate any long-term neurological benefits from electronic monitoring.

The disposition of [14C]-labelled benazepril HCl in normal adult volunteers after single and repeated oral dose

1. The disposition of [14C]-labelled benazepril HCl, an ACE-inhibitor, was studied in four normal adult volunteers after a single oral dose of 20 mg and after repeated doses of 20 mg once daily for 5 days. Radioactivity was measured in plasma, urine and faeces. The prodrug ester benazepril and the pharmacologically active metabolite benazeprilat were determined quantitatively in plasma and urine by a g.c.-m.s. method. The pattern of metabolites in urine was analysed semiquantitatively by h.p.l.c.-radiometry. 2. After a single oral dose at least 37% was absorbed, as indicated by urinary recovery. The peak plasma concentration of benazepril (0.58 +/- 0.13 nmol/g (SD] was observed at 0.5h after dose, indicating rapid absorption. Peak concentrations of radioactivity (1.88 +/- 0.48 nmol/g) and of active benazeprilat (0.84 +/- 0.25 nmol/g) were observed at 1 h after dose, demonstrating rapid bioactivation. 3. The area under the plasma curve (AUC0-96 h) of total radioactivity amounted to 9.7 +/- 1.1 (nmol/g)h, 5% of which was accounted for by benazepril and about 50% by benazeprilat. 4. Over 9 days 96.8 +/- 0.5% of the dose was excreted in urine and faeces. Urinary excretion accounted for 37.0 +/- 6.0% of the dose, 80% of which was recovered in the first 8 h after dosing. 5. In urine, only 0.4% of the dose (1% of the radioactivity) was excreted as unchanged benazepril, indicating that the compound was extensively metabolized. Benazeprilat accounted for 17% of the dose (about half of the radioactivity; 0-96 h). Glucuronide conjugates of benazepril and benazeprilat constituting approximately 11% and 22% of the radioactivity (about 4% and 8% of the dose; 0-48 h) were tentatively identified. 6. Repeated oral treatment with benazepril HCl did not influence the pharmacologically relevant kinetics and disposition parameters.

The influence of hepatic cirrhosis on the pharmacokinetics of benazepril hydrochloride

The influence of hepatic disease on the pharmacokinetics of the new ACE inhibitor, benazepril hydrochloride, was evaluated in 12 male patients suffering from liver cirrhosis. The patients received a single oral 20 mg dose. The plasma concentrations and urinary excretion of unchanged benazepril and its active metabolite benazeprilat were determined. Compared with a historical control group of healthy volunteers treated with the same benazepril. HC1 dose, the plasma concentrations of benazepril were doubled in the cirrhotic patients. However, the time to reach maximum concentration (0.5 h) was not affected. The plasma kinetics and the urinary excretion of the metabolite benazeprilat were not significantly altered: Area under the curve and maximum concentration as well as time to maximum concentration (1.5 h) were comparable with those in the healthy subjects. There was also no significant difference between the two populations for the total urinary excretion and the renal clearance of benazeprilat. Both benazepril and benazeprilat were highly bound to serum proteins (96 and 94 per cent, respectively). In conclusion, the rate and the amount of bioactivation of the inactive prodrug benazepril to the active benazeprilat were virtually unaffected by hepatic cirrhosis. Thus, there seems to be no need for dosage adjustment of benazepril hydrochloride in patients suffering from cirrhosis of the liver.

Fetal ventriculomegaly due to isolated brain malformations

Management of 32 consecutive cases of fetal hydrocephalus diagnosed prenatally during a five years period is presented. Thirteen cases (40%) being patients with ventriculomegaly due to isolated brain malformation are the topic of this paper. In this group, management was conservative and consisted of termination of pregnancy by elective cesarean section after prenatal fetal assessment. Agenesis of corpus callosum (6 cases) and Dandy-Walker malformation (7 cases) were the most common observed forms. Antenatal sonography improved intrauterine follow-up. Skillful perinatal management and support facilities after birth have been found a reliable approach to conservative management of fetal hydrocephalus by lacking of satisfactory techniques for in utero permanent cerebrospinal fluid shunting.

Pharmacokinetics and pharmacodynamics of the ace inhibitor benazepril hydrochloride in the elderly

The pharmacokinetics and pharmacodynamics of a single oral dose benazepril.HCl 10 mg have been studied in 15 healthy volunteers aged 65 to 80 y. The kinetics of unchanged benazepril and its active metabolite benazeprilat did not differ significantly in males and females, so the combined kinetic data from all 15 elderly subjects were compared with a historical control group of 19-32 year-old healthy men treated in the same way. The disposition of benazepril was not affected by age. The time to maximum plasma concentration, tmax (0.5 h) and elimination half-life (0.6 h) in the elderly were the same as in young subjects. The kinetics of benazeprilat was slightly changed in the elderly; although its tmax (1.5 h) was not affected, Cmax and the AUC were 20-40% greater. The elimination half-life of benazeprilat during the first 24 h after dosing in the elderly was increased by about 20% to 3.2 h. The renal plasma clearance of benazeprilat (18.1 ml.min-1) was about 20% smaller than in the young subjects. An average of 18.5% of the dose was recovered as benazeprilat in the 24 h urine from the elderly subjects, which was similar to the recovery in the young subjects. Both benazepril and benazeprilat were highly bound to serum proteins (96 and 95%, respectively). Mean systolic and diastolic blood pressures in the elderly were reduced by a maximum of 37/16 mm Hg at 6 h, in association with a small rise in pulse rate. Treatment was generally well tolerated.(ABSTRACT TRUNCATED AT 250 WORDS)

Amino Acid Transport across the Tonoplast of Vacuoles Isolated from Barley Mesophyll Protoplasts : Uptake of Alanine, Leucine, and Glutamine

Mesophyll protoplasts from leaves of well-fertilized barley (Hordeum vulgare L.) plants contained amino acids at concentrations as high as 120 millimoles per liter. With the exception of glutamic acid, which is predominantly localized in the cytoplasm, a major part of all other amino acids was contained inside the large central vacuole. Alanine, leucine, and glutamine are the dominant vacuolar amino acids in barley. Their transport into isolated vacuoles was studied using (14)C-labeled amino acids. Uptake was slow in the absence of ATP. A three- to sixfold stimulation of uptake was observed after addition of ATP or adenylyl imidodiphosphate an ATP analogue not being hydrolyzed by ATPases. Other nucleotides were ineffective in increasing the rate of uptake. ATP-Stimulated amino acid transport was not dependent on the transtonoplast pH or membrane potential. p-Chloromercuriphenylsulfonic acid and n-ethyl maleimide increased transport independently of ATP. Neutral amino acids such as valine or leucine effectively decreased the rate of alanine transport. Glutamine and glycine were less effective or not effective as competitive inhibitors of alanine transport. The results indicate the existence of a uniport translocator specific for neutral or basic amino acids that is under control of metabolic effectors.

Phosphate transport across biomembranes and cytosolic phosphate homeostasis in barley leaves

Barley (Hordeum vulgare L.) plants were grown hydroponically with or without inorganic phosphate (Pi) in the medium. Leaves were analyzed for the intercellular and the intracellular distribution of Pi. Most of the leaf Pi was contained in mesophyll cells; Pi concentrations were low in the xylem sap, the apoplast and in the cells of the epidermis. The vacuolar concentration of Pi in mesophyll cells depended on Pi availability in the nutrient medium. After infiltrating the intercellular space of leaves with solutions containing Pi, Pi was taken up by the mesophyll at rates higher than 2.5 μmol· (g fresh weight)(-1) · h(-1). Isolated mesophyll protoplasts did not possess a comparable capacity to take up Pi from the medium. Phosphate uptake by mesophyll protoplasts showed a biphasic dependence on Pi concentration. Uptake of Pi by Pi-deficient cells was faster than uptake by cells which had Pi stored in their vacuoles, although cytoplasmic Pi concentrations were comparable. Phosphate transport into isolated mesophyll vacuoles was dependent on their Pi content; it was stimulated by ATP. In contrast to the vacuolar Pi concentration, and despite different kinetic characteristics of the uptake systems for pi of the plasmalemma and the tonoplast, the cytoplasmic pi concentration was regulated in mesophyll cells within narrow limits under very different conditions of Pi availability in the nutrient medium, whereas vacuolar Pi concentrations varied within wide limits.

Exposure in vivo vs social skills training for social phobia: long-term outcome and differential effects

This study examined the long-term effectiveness of specific exposure in vivo (individual IE or group GE) and of office-based social skills training (group SST) in two groups of patients with social inhibition (primary social skills deficits or primary social phobia). Seventy-eight outpatients were divided into these two subgroups according to clinical assessment. Twenty-seven patients received SST which consisted of 25 twice a week 90-min group sessions: 32 patients received GE and 17 IE. Exposure in vivo consisted of 4 weekly (8-hr in the group condition included 2 hr discussion; 3 hr in the individual condition included 1 hr discussion) sessions. Self-rating-assessments were carried out at pre- and post-treatment, at 3 months- and 2.5 yr follow-up. The general results indicate that all three treatment modes led to clinically and statistically-significant improvements in the main problem area (social anxiety, skills deficits), in other neurotic complaints (depression, obsessions, psychosomatic complaints) and in attribution-style. Patients with the diagnosis of primary phobia seemed to get the same profit from either treatment and showed slightly better gains (in all treatment modalities) than patients with skills deficits at long-term follow-up. Within the subgroup with skills deficits there was a tendency for superior outcome of group exposure. These results and recommendations for future research are discussed.

Endocrinological disorders in shunted hydrocephalus

Endocrinological findings were identified in 60% of 90 shunted patients with an isolated hydrocephalus, namely dwarfism in one third and abnormal proportions, obesity, sexual precocity and various combinations in 9-15%. Different causes of these findings were observed. But none of the cases had a malfunction of the shunt at the time of this study.