[Isolation and NMR spectroscopic characterization of sialic acid compounds and hemofiltrate of chronic uremia patients]

Eight sialyloligosaccharides have been isolated from the hemofiltrate of a patient with end stage renal disease using reverse osmosis, gel filtration, ion-exchange and high-performance liquid chromatography. The structures were predominantly elucidated by one- and two-dimensional 1H- and 13C-NMR spectroscopy: 1 NeuAc alpha 2-3Gal beta 1-4Glc; 2 NeuAc alpha 2-6Gal beta 1-4Glc; 3 NeuAc alpha 2-3Gal beta 1-4GlcNAc; 4 NeuAc-alpha 2-6Gal beta 1-4GlcNAc; 5 NeuAc alpha 2-3Gal beta 1-4-GlcNAc alpha 1-P; 6 NeuAc alpha 2-6Gal beta 1-4GlcNAc alpha 1-P; 7 NeuAc alpha 2-3Gal beta 1-3GalNAc alpha 1-P; 8 NeuAc alpha 2-8NeuAc. While compounds 1-7 are also components of normal human urine, di-N-acetyl-D-neuraminic acid (8) could be isolated for the first time from biological material. The origin and possible clinical relevance of these compounds have to be proved in further investigations.

Real-time ultrasound in Crohn's disease: characteristic features and clinical implications

Thirty-two children with Crohn's disease were evaluated by real-time ultrasonography. The typical pattern of Crohn's disease caused by bowel wall thickening is the "bull's eye phenomenon", the elongated tubular stiff bowel loop with narrowing of the lumen and the small bowel conglomerate tumor. In indefinable abdominal complaints sonography may lead to the correct diagnosis. The differential diagnosis of similar sonographic features and the limitations of ultrasound in gastrointestinal disease must be considered. In proven Crohn's disease the findings in follow-up match the clinical course and may delineate complications, such as ileus, abscess, hydronephrosis, gallstones or involvement of parenchymal organs, as seen in 15 patients. Thus ultrasound will restrict repeated x-ray studies and support patient management.

N-Acetylneuraminic acid storage disease

Increased amounts of free sialic acid were found in body fluids, leukocytes, cultured fibroblasts, and liver tissue of a four-year-old boy with mental retardation, ataxia, and clinical and radiologic findings of a mild mucopolysaccharidosis. A diagnosis of Salla disease was made though in contrast to earlier reports, recurrent upper respiratory infections and hepatosplenomegaly were present already in infancy, and skeletal abnormalities of dysostosis multiplex were found in early childhood. Free sialic acid in the urine was identified as N-acetylneuraminic acid by 1H-NMR spectroscopy. Sialidase activities were normal. Increased amounts of bound sialic acid were found in liver and cultured fibroblasts and were attributed to an intracellular inhibition of sialyloligosaccharide-degrading neuraminidase by excessive amounts of free neuraminic acid. The molecular basis of N-acetylneuraminic acid storage disease is unknown but may be related to a defective transport mechanism preventing neuraminic acid from leaving the lysosomal compartment.

Congenital renal arteriovenous malformation (aneurysmal type) in childhood

We report on a 9-year-old boy with a congenital renal arteriovenous fistula of the aneurysmal type, a form previously not observed in childhood. The clinical picture was unusual with severe arterial hypertension, excessive polyuria and decreased levels of serum sodium and chloride as main signs. Clinical and biochemical findings normalised after nephrectomy of the kidney involved.

Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome (AIDS). Diagnosis with bronchial brushings, biopsy, and bronchoalveolar lavage

Sixty-one diagnostic biopsies for Pneumocystis carinii pneumonia were performed on 40 homosexual male patients with acquired immunodeficiency syndrome (AIDS), using flexible fiberoptic bronchoscopy. Bronchial brushings and bronchoalveolar lavage were performed in conjunction with the biopsy in 58 and 29 bronchoscopies, respectively. Using a rapid methenamine silver stain, P carinii pneumonia was diagnosed in 27 (68 percent) of the patients. Twenty of these patients had a repeat biopsy one or more times for evaluation of therapy. Eighteen of the biopsies following two to three weeks of therapy were positive. There was an 84 percent correlation between findings on transbronchial brushing and biopsy (89 percent on initial biopsy before treatment) and an 86 percent correlation between bronchoalveolar lavage and biopsy. Additionally, transbronchial brushing permitted demonstration of Pneumocystis organisms in four follow-up bronchoscopies in which the biopsy was negative or inadequate. Rapid methenamine silver stain of transbronchial brushings permits diagnosis of P carinii pneumonia in patients with AIDS within one-half hour of bronchoscopy.

[Kawasaki syndrome with acute gallbladder hydrops--case report and review of the literature]

We describe a 2 3/4-year-old boy with Kawasaki disease associated with the rare complication of acute hydrops of the gallbladder. Because of the severe abdominal symptoms cholecystectomy was performed. A review of the literature shows that about half of the patients had been operated upon. Therefore conservative treatment may provide complete improvement. Ultrasonography is not only very helpful in the diagnosis but also in follow-up.

[Delta infection in HBsAg carriers]

Anti-delta as an indicator of chronic delta infection was found in 7/180 HBsAg carriers. This indicates a low incidence of delta infection in Germany. The following risk factors to acquire delta infection were established: Mediterranean origin (3 cases) and transfusion of blood products (4 hemophiliacs). All anti-delta positive individuals had a biopsy proven chronic active hepatitis and the serological pattern: HBsAg, anti-HBc and anti-HBe positive without indicators of Dane particle synthesis (negative tests for HBeAg and DNA polymerase activity).

[H-NMR spectroscopy. Specificity of microbial sialidases against complex substrates]

The specificities of one viral and five bacterial sialidases were investigated by 1H-NMR-spectroscopy with substrates or substrate mixtures containing two sialic acid residues of different linkage types. This technique allows - in contrast to the methods used before - the simultaneous determination of the rates of hydrolysis of both NeuAc linkages in a single experiment. The substrate specificities of the enzymes are discussed on the basis of the relation of the rate constants k/k'. The data obtained are more exact and more informative than those of separate experiments as reported previously. Among the enzymes investigated, i.e. sialidases of fowl plague virus (FPV = VKH), Clostridium perfringens (CP), Vibrio cholerae (VC), Bifidobacterium bifidum var. pennsylvanicum (BBif), Bifidobacterium lactentis (BLac), and Arthrobacter ureafaciens (AU), the activity of the viral sialidase VKH shows the highest, the activities of the Bifidobacterium sialidases the lowest dependence on the nature and on the linkage type of the different substrates. All sialidases preferentially cleave the NeuAc alpha 2-3-Gal linkage with the exception of the enzyme of Arthrobacter ureafaciens (AU) which shows a higher affinity to alpha 2-6 linkages. However, this does not apply to the side-arm-linked NeuAc alpha 2-6 structure in NeuAc alpha 2-3 Gal beta 1-3 (NeuAc alpha 2-6)-GlcNAc beta 1-3Gal beta 1-4Glc (Substrate B). This substrate in generally cleaved very slowly and is hardly affected by the viral enzyme. After the alpha 2-3 linkage, the alpha 2-8 bond in NeuAc alpha 2-8 NeuAc alpha 2-3 Gal beta 1-4Glc(Substrate A) is most susceptible for the sialidases VKH, CP and VC. An elongation of the carbohydrate chain (Substrate D) is accompanied by a reduction of the rate of cleavage for all enzymes. The experiments with alpha 1-acid glycoprotein, fetuin, and with the glycopeptides obtained by proteolytic degradation of the latter, revealed the same specificity towards the alpha 2-3 and the alpha 2-6 linkages as the oligosaccharides. Influenced by the chemical nature and the size of the substrate, NeuAc is released from the native alpha 1-acid glycoprotein more quickly than from the corresponding glycopeptide. All sialidases investigated so far are strictly exo-enzymes as could be demonstrated by the cleavage of NeuAc alpha 2-8 NeuAc alpha 2-3 Gal beta 1-4Glc (Substrate A).

[Effect of proteolytic enzymes, electrolytes and other factors on the crystallization of calcium oxalate in the urine]

On the basis of 18 discriminance-analytically balanced urine parameters of patients with recidive calcium-oxalate nephrolithiasis and control subjects without urological complaints, it is shown in this article that the concentration of proteolytic activity, of enzyme inhibitors, of acid mucopolysaccharides and inhibition indices do not give better separation between the control group and recidive calcium-oxalate lithiasis patients than the usually measured urine parameters.

Sonographic biometry of liver and spleen size in childhood

In 194 healthy children of all ages, sonographic measurements of the liver and spleen were performed on standardized section planes and normal values established. These measurement values showed an approximately linear increase in the course of development and correlated best with the body length. For a rapid orientational evaluation of the liver size, sonographic nomograms of the individual measurements were developed. The spleen size was determined by volume calculation. On the basis of an index of liver size, which was calculated from the individual measurements, a diagram for simultaneous determination of liver and spleen size could be developed. These nomograms permit objective morphometry of size changes in the two organs.

[Technic of percutaneous nephropyelostomy with a single-tube system]

The technique of percutaneous nephropyelostomy with specially prepared tubes is described. The advantages are secure positioning and good drainage. The splint allows diagnostic and therapeutic intervention. With certain indications the percutaneous renal fistula represents a great therapeutic advance.

[Transcutaneous nephropyelostomy--indications, complications and results]

The authors report on 34 successfully applied nephropyelostomies in 30 patients. The most frequent indication was obstruction of the uterus with retention of substances usually eliminated in the urine. The operation was carried out under local local anesthetic using a monitor. The rate of complication was very low. No deaths resulted. In the authors' opinion puncture nephrostomy is the best method of drainage in causes of obstruction with benign genesis. For carcinoma patients it must be individually decided whether this operation is indicated.

[1H-NMR spectroscopy--a potent method for the determination of substrate specificity of sialidases (author's transl)]

We describe here the application of 1H-NMR spectroscopy to determine the substrate specificity of sialidases using a 1:1 mixture of NeuAc alpha 2-3Gal beta 1-4Glc and NeuAc alpha 2-6Gal beta 1-4Glc, one viral and five bacterial sialidases. This method utilizes the separate signals in NMR spectra, characteristic for the different alpha ketosidically linked NeuAc residues and also for bound and free NeuAc. The signals generally most suitable for these purposes are those of H3a, H3e and NCOCH3. By observation and integration of these signals we can follow--qualitatively and quantitatively--which and how many NeuAc residues of the substrates are hydrolized. In contrast to the generally used colorimetric tests it is now possible to investigate with this method substrates containing two or more NeuAc residues and to determine the corresponding rate constants for hydrolysis of the differently bound NeuAc molecules. The six sialidases used show large differences in their specificity as compared with our "model substrate": The sialidase from fowl plague virus hydrolizes NeuAc alpha 2-3Gal beta 1-4Glc nearly 18 times and the enzyme from Clostridium perfringens four times, from Vibrio cholerae two times faster than NeuAc alpha 2-6Gal beta 1-4Glc. On the contrary, the sialidase from Arthrobacter ureafaciens hydrolizes the alpha 2-6 linkage six times faster than the alpha 2-3 linkage. The sialidases from Bifidobacterium show no obvious differences in their specificities relative to the linkage.

Partial trisomy 12q

A partial trisomy 12q243 leads to qter resulting from a maternal balanced translocation, 46,XX,t(9;12)(p243;q243) was detected in a male newborn with multiple congenital abnormalities. The maternal grandmother was also a carrier of the 9;12 translocation. Our patient exhibited a number of clinica features similar to two others reported, who were also trisomic for the distal part of 12q. Aberrations of chromosome 12 are very rare. There have been only two reports of partial trisomy 12q, both the result of a familial translocation. We describe a third unbalanced case.

Effects of awareness and motor involvement on autonomic conditioning in chronic schizophrenics

Chronic schizophrenics under neuroleptic medication were compared with normals, matched for age and education, in two conditioning experiments. Both experiments employed a differential paradigm with long conditional stimulus--unconditional stimulus (CS-UCS) intervals. Skin resistance (SR) and finger pulse or heart rate (HR) were recorded. In Experiment 1, half of the subjects were trained in categorizing the to-be conditional stimuli. In a further step, half of the subjects were informed about the CS-UCS contingency. The UCS was an electric shock. Information improved discrimination of SR responses only of normals, and discrimination training had no effect at all on autonomic responses. In Experiment 2, only electrodermal responders were included. Each subject was tested in two sessions, using a loud tone as UCS in one, and a reaction time signal in the other. Again, half of the subjects wee informed about the contingency. Information improved discrimination of SR responses of both diagnostic groups. Decelerations of HR following CS onset showed informed schizophrenics to discriminate better with the loud tone UCS than with the reaction time signal. General autonomic responsivity seems to determine not only discriminative conditioning of schizophrenic patients but also the reports of awareness and the effects of manipulations of awareness. However, when subjects are matched for electrodermal responsivity and are equivalent in terms of SR response conditioning, patients react to information about the contingency with enhanced HR deceleration to the CSs, possibly reflecting a heightened sensitivity of the cardiovascular system.

[The circumcaval ureter--etiology, diagnosis and therapy]

The circumcaval course of the ureter can no more be regarded as a urological rarity. Primarily a disturbance of the development of veins in the 6th to 8th fetal week is present. A division in 2 forms of the course of the retrocaval ureter is possible. In addition to the pathologic course the type 1 still shows a disease of the precaval segment. The two forms are demonstrated with the help of own observations. According to the opinion of the authors the two types must be differentiated before operation and must be removed by different operation techniques. Associated malformations must be taken into consideration.