Detection of the adrenal glands by endoscopic or transabdominal ultrasound

BACKGROUND AND STUDY AIMS

The value of transabdominal and endoscopic ultrasound (EUS) in detecting normal adrenal glands is not yet established. The aim of our study was to evaluate whether these techniques can be routinely used to visualize the adrenal glands in patients without suspected adrenal pathology.

PATIENTS AND METHODS

Transabdominal ultrasound was validated by examination of 10 corpses and was performed in 80 healthy volunteers (3.5 and 5 MHz). EUS of the left adrenal gland was performed in 154 consecutive patients referred for various other reasons. In 20 patients we attempted to visualize the right adrenal gland as well.

RESULTS

Both adrenal glands were correctly identified in all of the 10 corpses once they were opened. In healthy volunteers, the right adrenal gland was visualized by transabdominal ultrasound in 79/80 patients (99 %) and the left adrenal gland in 55/80 patients (69 %). EUS allowed detection of the left adrenal gland in 151/154 patients (98%). In three patients EUS failed because of grossly distorted anatomy. In 6/20 patients we were also able to detect the right adrenal gland by EUS, which was obvious in two cases because of incidentalomas.

CONCLUSION

Visualization of the right adrenal gland is almost always possible by transabdominal ultrasound, while its detection by EUS is successful only in some cases. The left gland is more difficult to detect by transabdominal ultrasound, while it can nearly always be seen using EUS. Therefore, a combined transabdominal and endoscopic ultrasonographic approach is useful for visualization of the adrenal glands and may enable diagnosis of even small adrenal masses.

[Platelet count in the cat]

The technique of collecting blood samples is primarily responsible for the appearance of platelet-agglomeration in cats. Blood obtained by the conventional way ("one syringe technology", drips of blood) caused in 52% of the cases an activation of the large and therefore active thrombocytes however. Rejection of the first 2-5 ml blood for the platelet count ("two syringe technology") reduced the rate of platelet-agglomeration significantly. No big differences in platelet-agglomeration were found with regard to the place used for collecting blood (V. cephalica antebrachii/V. jugularis). Platelet-agglutination was observed with Li-Heparin, K-EDTA, Na-Citrat or ACD anticoagulated blood samples. Citrat (Na-Citrat, ACD) seemed to have a stabilizing effect on feline thrombocytes as has been described for human thrombocytes. The platelet count in cats should be performed within 30 minutes.

A single and multiple dose bioavailability study with carbamazepine 400 mg retard tablets with reference to enzyme autoinduction and circadian time differences

Both single and multiple dose bioequivalence studies are required to assess the quality of modified release formulations of drugs. In bioequivalence studies of drugs with enzyme autoinducing properties such as carbamazepine (CBZ), the standard multiple dose study design must be modified to guarantee equivalence of drug elimination. This problem was considered with regard to carbamazepine 400 retard AWD (test) whose bioavailability relative to a listed reference (Tegretal 400 retard) was studied in 2 randomized, open, crossover studies both with 18 healthy volunteers of Caucasian origin (20-36 years, 61.5-92 kg, 172-195 cm). The single dose study was done with 400 mg CBZ. Serum concentration time profiles of CBZ and its active metabolite CBZ-10,11-epoxide were determined until 144 h after administration. The multiple dose study was performed with 400 mg CBZ b.i.d. for 15 days (first 2 days: 200 mg b.i.d.) followed by a 7-day study with the alternative investigational product. 24-hour serum concentration time profiles of CBZ and its metabolite were measured on days 15 and 22 of the study. The quantitative drug analysis was done with an HPLC method the quality of which fulfilled the requirements of bioequivalence studies. Test was considered bioequivalent to reference with regard to the extent of absorption, if the 90% confidence intervals of the AUC0-infinity ratio (single dose) and AUC0-24h ratio (multiple dose) were within the range of 0.80-1.25, and with regard to rate of absorption if the 90% confidence intervals of the Cmax/AUC ratio (single dose) or AUCF0-24h ratio were within 0.70-1.43. The point estimators (90% confidence limits) of the AUC ratio (test/reference) of CBZ were 0.979 (0.94, 1.02) for the single and 1.01 (0.947, 1.076) for the multiple dose comparison. The point estimator (90% confidence limits) of the Cmax/AUC ratio was 0.989 (0.959, 1.020) and of the AUCF0-24h ratio 1.066 (0.937, 1.212). There were no circadian time differences in any pharmacokinetic parameter.

IN CONCLUSION

Carbamazepine 400 retard AWD tablets were bioequivalent to reference with regard to extent and rate of absorption after both single and multiple dose administration.

[Psychosocial characteristics and attitudes of clients of day care centers and contact and counseling facilities]

Within the last 20 years, many day-care centers (Tagesstätten = TSn) and drop-in centers (Psychosoziale Kontakt- und Beratungsstellen = KBSn) have been set up in Germany. Although these institutions are widespread, there are hardly any empirical studies on the characteristics of their users or on their effects. In this study, 100 patients in TSn and KBSn in Berlin were examined. Social characteristics, psychopathology and attitudes of the patients were investigated. Almost all patients had been in psychiatric hospitals before. The current psychopathology varied greatly and was moderate on average. Two-thirds of the patients were pensioners, most of them living alone with just a few or no friends. Contact with other people and structured day activities were most often mentioned as positive aspects by the patients. The most frequent negative aspect was annoyance by fellow users. Patients in TSn were significantly younger and had higher scores on BPRS subscale anergia. In other variables, there was little difference between patients in the two institutions. The results suggest that both institutions--as intended--care for chronic mentally ill patients with poor social integration. For these patients they provide some compensations for a insufficient social network. Limitations and consequences of the findings are briefly discussed.

Emergency room visits despite the availability of primary care: a study of high risk inner city infants

Very low birth weight preterm infants randomized to receive comprehensive primary care in an ongoing clinical trial were prospectively evaluated to determine the cause of frequent emergency room use despite the availability of a primary healthcare provider and specific social services. Mothers were interviewed to assess knowledge of available resources, when to seek medical attention, and the perception of problems that limit access to health care. The healthcare provider was not called before 49% of the emergency room visits and mothers often did not recall what infant signs needed medical attention. Seventy-nine percent of emergency room visits were delayed more than 10 hours; and 15 of 62 (24%) emergency room visits resulted in admittance to the hospital. We conclude that in high-risk populations, the mere availability of primary care does not assure that it will be used. New strategies to help parents know when and how to use services are needed to increase the delivery of primary care.

Ewing's sarcoma of the femur. Prognosis in 69 patients treated by the CESS group

We reviewed the treatment outcome of 69 patients with Ewing's sarcoma of the femur. The patients received chemotherapy according to the CESS 81 (n 14), CESS 86 (n 43), and CESS 91P (n 12) protocols. The 10-year relapse-free survival rates were 36%, 65%, and 65% (p = 0.01). 68 patients received local treatment. The primary tumor was treated by surgery without radiotherapy in 28 patients; 1 developed a local recurrence and 7 metastases. 10 patients received radiotherapy alone; 4 developed metastases and 4 local recurrences and metastases. 30 cases had a combination of surgery and radiotherapy; 7 developed metastases and 1 a local recurrence and metastasis. The survival of patients after radiotherapy alone was worse than that of patients after surgery with/without radiotherapy (p = 0.005). Pathological fractures (n 16) did not influence the prognosis.

Surgical complications after preoperative irradiation of Ewing's sarcoma

The influence of preoperative irradiation on surgical complications in 42 patients with Ewing's sarcoma was analysed. After preoperative irradiation and chemotherapy, 35 of 40 patients showed a good histological response and 25 of 40 patients had no viable tumour cells in the resected specimen. Local relapse alone did not develop, local relapse and metastasis developed in 2 patients and metastasis alone in 15 patients. Surgical complications appeared in 12 of 42 patients: 9 of 19 central tumours (19 pelvic lesions), 1 of 13 proximal and 2 of 10 distal tumours. Surgical complications after preoperative irradiation are distributed as follows: delayed wound healing 8, hematoma 2, thrombosis 2, skin infection 1, and abscess 1. On the other hand, complications appeared in 2 of 28 patients without preoperative irradiation: none in 9 patients having central tumours including 2 pelvic lesions, 1 in 12 patients with proximal tumours, and 1 in 7 patients with distal tumours. The multivariate regression test showed that the tumour site (central) is an influencing factor in the appearance of surgical complications. In central tumours, the surgical complication rate increases after preoperative irradiation; however, it is affected by the increase of the ratio of patients with pelvic tumours.

The impact of intraoperative brachytherapy on surgery of Ewing's sarcoma

Surgery of Ewing's sarcoma sometimes results in an inadequate surgical margin. The influence of intraoperative brachytherapy on local control of the tumor, operation time, blood loss, and surgical complications was evaluated, comparing the results of 20 patients who received brachytherapy to a series of 42 patients receiving surgery without brachytherapy. The dose of intraoperative brachytherapy ranged between 9 Gy and 21 Gy. The average operation time was longer in 20 cases with brachytherapy (7.9 h) than in 42 cases without brachytherapy (4.3 h) (P < 0.0001). The average blood loss in the groups with (3531 ml) and without brachytherapy (3515 ml) was comparable (P = 0.3840). The surgical complication rate in patients receiving brachytherapy was also similar to that of untreated patients (30% versus 31%, P = 0.7690). Local relapse developed in 1 of 20 patients who received brachytherapy and 1 of 42 patients without brachytherapy. On the basis of this analysis, it can be concluded that this procedure is safe and does not increase of the acute complication rate. The latest results of local controls are awaited.

Results of early surgery in poor-grade aneurysm patients

METHODS

During a 4-year-period (1991-1994) a total of 85 poor-grade [Hunt and Hess (H&H) IV and V] patients were treated for aneurysmal subarachnoid hemorrhage. Patients who were admitted in poor grades but improved after initial treatment were excluded from this study.

RESULTS

Overall mortality was 46% (N = 39). In particular, 29% (18 out of 63) of surgically treated patients had died as opposed to 95% (21 out of 22) of conservatively treated patients. Early surgery provided favourable (Glasgow-Outcome-Scores (GOS) 4-5) results in 52% of H&H grade IV patients but only in 22% of grade V patients. In particular, approximately one fourth of grade IV patients had a good outcome and 30% were only moderately disabled. Intracranial pressure (ICP) below 20 mmHg proved to be a favourable prognostic sign.

CONCLUSIONS

It is concluded that, in consideration of the management mortality encountered with delayed surgery, H&H grade IV patients benefit from early surgical treatment while the prognosis of grade V patients still remains unfavourable.

Significance of surgical margin on the prognosis of patients with Ewing's sarcoma. A report from the Cooperative Ewing's Sarcoma Study

BACKGROUND

There is little information regarding an adequate surgical margin for local control of Ewing's sarcoma.

METHODS

Two hundred and forty-four patients (PTS) with Ewing's sarcoma who were registered in the Cooperative Ewing's Sarcoma Studies underwent surgical treatment. Ninety-four PTS underwent definitive surgery (surgery alone), 131 PTS received postoperative irradiation, and 19 PTS received preoperative irradiation. The surgical margins were distributed as follows: radical, 29 PTS; wide, 148 PTS; marginal, 39 PTS; and intralesional, 28 PTS. The impact of the surgical margin on the treatment outcome of PTS was analyzed statistically.

RESULTS

The local or combined (local recurrence and systemic metastasis) relapse rate after surgery with or without irradiation was significantly lower compared with that after definitive irradiation (irradiation alone) (7% vs. 31%, P < 0.0001). The local or combined relapse rate after complete resection (radical or wide margin) with or without irradiation was less compared with that after incomplete resection (marginal or intralesional margin) with or without irradiation (5% vs. 12% P = 0.0455). The local or combined relapse rate did not greatly decreased after irradiation after incomplete surgery (from 14% to 12%). In both groups of good (viable tumor cells < 10%) and poor (viable cells > or = 10%) histologic response, the difference in systemic or combined relapse rate between patients undergoing complete and incomplete surgery was not significant. The 10-year overall survival of the PTS for each of the margins was distributed as follows: radical, 58%; wide, 65%; marginal, 61%; and intralesional, 71% (P = not significant).

CONCLUSIONS

Surgery in patients with Ewing's sarcoma adds to the safety of local control. Under the current treatment regimen with intensive chemotherapy and irradiation, complete resection of the tumor appears capable of decreasing the risk of local recurrence.

[Surgery versus radiotherapy in Ewing's sarcoma with good prognosis. Analysis of the CESS-86 data]

PURPOSE

The evaluation of radiotherapy and surgery as exclusive local treatment in comparably selected subgroups of patients with Ewing's sarcoma on the basis of the CESS 86-data.

PATIENTS AND METHODS

In the German multicenter Ewing's sarcoma study CESS 86, treatment consisted of four 9-week-courses of VACA- or VAIA-chemotherapy plus local therapy. VACA (vincristine, actinomycin D, cyclophosphamide, adriamycin) was given in low-risk extremity tumors with a tumor volume below 100 cm3. High-risk patients with central lesions or a tumor volume > 100 cm3 received VAIA (ifosfamide instead of cyclophosphamide). Local therapy started after one complete chemotherapy course in week 10. Based on an individual decision in each patient, local therapy was either radical surgery or resection plus postoperative irradiation with 45 Gy or definitive radiotherapy with 60 Gy. Because of poor results with radiotherapy in a preceding study, it was intended to restrict irradiation to patients with small lesions.

RESULTS

Hundred and seventy-seven protocol patients were recruited from January 1986 through June 1991 and 176 received local therapy: 39 underwent radical surgery, 44 received definitive radiotherapy and 93 were treated with resection and postoperative irradiation. The median tumor volume was higher in patients with radiotherapy as compared to combined local treatment or radical surgery, 156 cm3 versus 140 cm3 versus 102 cm3. The overall 5-year survival after radiotherapy and surgery was nearly identical, 63% versus 67% for the whole group 75% versus 65% in tumors < 100 cm3 volume and 65% versus 67% in tumors with 100 cm3 to 600 cm3 volume, respectively.

CONCLUSIONS

With regard to tumor volume, the most important single prognostic factor in Ewing's sarcoma, irradiated patients were poorer selected than surgically treated patients despite the fact that a selection of good-risk patients for radiotherapy was intended. The nearly identical survival figures after surgery and radiotherapy suggest that radiotherapy is as effective as surgery if selection of patients is comparable.

Structure-activity relationship of cytoplasmic 5'-nucleotidase substrate sites

Various 5'-nucleotidases (EC 3.1.3.5) exist in vertebrate tissues. The sequence and cDNA cloning of the membrane-bound ecto-5'-nucleotidase (e-N) and one of the cytosolic isoenzymes, IMP-preferring (c-N-II), but not the cytosolic AMP-preferring form (c-N-I), have been reported. While c-N-II has a broad tissue distribution, c-N-I is found only in vertebrate heart. The published data on substrate specificity involve mainly the naturally occurring nucleoside monophosphates, without a systematic structure-activity relationship study. In the present study we have used a series of AMP and IMP analogues to examine the structure-activity relationship for c-N-I and c-N-II in detail. The rank order of activity of the test compounds differed substantially between c-N-I and c-N-II. c-N-I and c-N-II varied with respect to the following interactions with substrate: (1) hydrogen-bond formation with the substituent in the 6-position of the purine ring (a donor-type with c-N-I and an acceptor-type with c-N-II); and (2) hydrophobic attraction of the 6-position unsubstituted purine ring (more pronounced with c-N-I than with c-N-II). No better substrate than 5'-AMP was found for c-N-I. We propose that c-N-I functions as an AMP-binding protein in the myocardial cell with an important role during ischaemic ATP breakdown when AMP accumulates rapidly.

Relative bioavailability of different valproic acid formulations

Relative bioavailability of valproic acid after oral administration of 2 Convulsofin (test) tablets each containing 300 mg calcium valproate (263.4 mg valproic acid) was studied versus 2 references (2 dragees each of 300 mg calcium valproate, ref.A, 600 mg sodium valproate in liquid form (258.7 mg valproic acid), ref.B). The controlled, randomized, clinical trial was performed in 16 healthy volunteers (12 males, 4 females, body weight 58-100 kg, Broca index 0.85-1.15) according to a 3-period changeover design with 7 days wash-out between 2 periods. Valproic acid was measured in serum with a GC method. Pharmacokinetic evaluation was done by compartment free methods. Test was considered bioequivalent with ref.A or ref.B with reference to extent of absorption if the 90% confidence interval of their AUC ratio was within the range of 0.80-1.25, and with respect to rate of absorption if the 90% confidence intervals of Cmax/AUC ratios were within 0.70-1.43. The point estimators (90% confidence limits) of the AUC ratios of test/ref.A and test/ref.B were 0.952 (0.882-1.028) and 1.063 (0.989-1.141), respectively. The point estimators (90% confidence limits) of Cmax/AUC ratios were 1.005 (0.923-1.094, test/ref.A) and 0.915 (0.845-0.991, test/ref.B). The following Cmax ratios were calculated: 0.957 (0.866-1.057, test/ref.A) and 0.972 (0.886-1.067, test/ref.B). No serious and unexpected adverse events were observed during the clinical trial. Test was bioequivalent with the 2 reference formulations ref.A and ref.B with respect to extent and rate of absorption. However, according to the secondary criterion tmax test tablets were more rapidly bioavailable than ref.A dragees (tmax-difference: -2.6 (-4.8 to -0.3 h) but more slowly (tmax-difference:+0.8 (-1.3 to +2.9 h) than ref.B juice.

Ewing's sarcoma of the ribs. A report from the cooperative Ewing's sarcoma study

31 patients with primary Ewing's sarcoma of the ribs were treated according to the protocols of CESS 81, CESS 86P and CESS 86. The results of treatment were reviewed and analysed. 24 patients presented with localised disease and 7 with regional disease. 20 of 24 localised cases and 6 of 7 regional cases underwent tumour resection. All but 2 localised cases received irradiation. The cumulative relapse-free survival (RFS) rate of 31 patients was 61% at 12.8 years. Patients with poor prognosis had tumour of the upper ribs (P = 0.0338), the posterior component of the ribs (P = 0.0597), or regional disease (P = 0.0001). Tumour size, existence of pleural effusion, type of the surgical margin and response to chemotherapy were not significant prognostic factors. Most of the localised cases could be controlled by combined treatment, but in regional cases prognosis remained poor.

[The magnetic resonance tomography of Ewing's sarcomas: the morphology and tumor extension]

PURPOSE

The morphology and delineation of Ewing sarcoma in magnetic resonance imaging was investigated.

METHODS AND MATERIALS

Magnetic resonance images (spin-echo techniques; T1-w pre/post gadolinium, T2-w) of 59 patients as part of a multicenter study were evaluated retrospectively. Qualitative image analysis was performed: signal intensity (point of reference extraosseous: muscle, intraosseous: bone marrow), enhancement patterns, lesion delineation and differentiation between tumor and oedema.

RESULTS

Signal intensity: T1-w: extraosseous: 75% isointense, intraosseous: 92% hypointense; T2-w extraosseous: 100% hyperintense, intraosseous: 93% hyperintense. Enhancement pattern: 97% both extra- and intraosseous. Best delineation intraosseous in T1-w (53% good, 36% very good), extraosseous in gadolinium enhanced T1-w (46% good, 37% very good) and T2-w (55% good, 33% very good). Differentiation between tumour and oedema was intraosseous not possible, extraosseous in T2-w in 61%.

CONCLUSION

Morphology of Ewing sarcoma in magnetic resonance imaging is rather uniform. The lesion is intra- and extraosseous sharply delineated, though tumour and oedema can be rarely differentiated.

Acquired von Willebrand disease in malignant peripheral neuroectodermal tumor (PNET)

In week 12 of the EICESS 92 protocol a 12-year-old boy with pelvic PNET developed acquired von Willebrand disease: bleeding time was prolonged (> 15 min) and von Willebrand factor antigen (54%) and ristocetin cofactor activity (50) were reduced. Platelet aggregations with thrombin and collagen and the number of major platelet glycoproteins/per platelet did not differ from the controls. After Haemate P (Behring Werke, Marburg, Germany) bleeding time normalized and surgery could be performed without occurrence of bleeding episodes. Three weeks after surgery bleeding time, ristocetin cofactor activity, and von Willebrand factor antigen increased to normal paediatric values. Without occurrence of further bleeding episodes the patient received another 10 courses of polychemotherapy (EICESS 92).

Reference tables for the intrasubject coefficient of variation in bioequivalence studies

Bioequivalence studies are usually performed as crossover studies and, therefore, information on the intrasubject coefficient of variation is needed for sample size planning. However, this information is usually not accessible in publications on bioequivalence studies, and only the pooled inter- and intrasubject coefficient of variation for either test or reference formulation is reported. It is the purpose of the present communication to provide reference values of the intrasubject coefficient of variation for various previously investigated drugs. The presentation includes pertinent pharmacokinetic characteristics for immediate- and extended-release formulations in single- and multiple-dose crossover studies.

[Prognosis in Ewing sarcoma patients with initial pathological fractures of the primary tumor site]

In this retrospective analysis, data of 52 patients with Ewing's sarcoma or PNET with a pathological fracture in the area of the primary tumor were evaluated. All patients were treated according to the trials CESS 81, CESS 86 P, CESS 86, CESS 91 P and EICESS 92 of the German Society of Pediatric Oncology and Haematology (GPOH). At the date of evaluation (15. September 1994) all patients had completed treatment and had been under observation for at least one year following diagnosis. The median follow-up time was 28 months. 22 patients were female, 30 male. The median age was 12 years. 75% of primary tumors had a volume of > or = 100 ml. 30 patients presented with fractures in proximal, 12 in central and 10 in distal parts of the skeleton. 10 patients had primary metastases. The histological definition was Ewing's sarcoma (including atypical Ewing's sarcoma) in 43 patients, PNET in 8 and small-cell osteosarcoma in 1 patient. For local therapy the patients underwent surgery, definitive radiotherapy or a combination of both. The percentage of primary metastases in the group of the patients with pathological fractures is comparable to the whole reference group. The present analysis focuses on those patients with pathological fractures who had no metastases at diagnosis. The relapse-free survival of patients with a pathological fracture and no primary metastases is 58%, the overall survival 65%. These rates are similar to those of the reference group of protocol patients without pathological fractures at diagnosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Intraoperative clotting factor dilution and activated hemostasis in children with Ewing's sarcoma or osteosarcoma: a prospective longitudinal study

BACKGROUND

The study was designed to evaluate prospectively intraoperative changes in coagulation and fibrinolysis in young patients with Ewing's sarcoma (n = 12) or osteosarcoma (n = 12) who underwent major surgery, and to relate them to hematocrit (HCT) readings.

MATERIALS AND METHODS

Blood samples (von Willebrand factor, fibrinogen, antithrombin III, protein C, plasminogen, t-PA ag, PAI 1 activity, F1+2, D-dimer, PAP) were obtained immediately prior to starting anesthesia, two and four hours later, immediately after surgery and on the first postoperative day. Intra- and postoperative hemostatic parameters were adjusted to preoperative HCT readings.

RESULTS

Major surgery induced dilution coagulopathy due to blood product transfusion to support the patient's vascular volume. Postoperatively, VWF (0.01) and fibrinogen (0.007) were found to be significantly enhanced, whereas antithrombin III levels were significantly (0.007) decreased. D-dimer formation showed a clear, significant (0.0019) rise two hours after skin incision and remained elevated through the first postoperative day. F1+2 and PAP showed only minor deviations. T-PA (0.012) and PAI 1 (0.001) rose during the operation and normalized on the first postoperative day. Within 36 hours of the initial operation, six of the 24 patients (25%) returned to surgery to stop severe hemorrhage.

CONCLUSIONS

These findings indicate that hemostatic parameters may be useful when monitoring surgery- and transfusion-induced hemostatic imbalance. Furthermore, the significant differences between the HCT-uncorrected concentration of the various plasma proteins clearly demonstrated the need to use HCT correction factors which may influence the necessity for and/or the frequency of substitution therapy with protein concentrates.

[Subjective evaluation criteria in psychiatric care--methods of assessment for research and general practice]

Evaluation of psychiatric care is an important task in research and in routine conditions. It requires definition of criteria. Subjective criteria are, for different reasons, of increasing interest. Subjective quality of life, subjective needs for help and support and patients' assessment of psychiatric treatment are regarded as particularly relevant criteria. We present and briefly discuss instruments for assessment of these criteria, that are new at least in the German language. Results of a first cross-sectional study in a community care setting are reported. Regarding quality of life healthy groups were examined too. The findings suggest that the instruments are usefully applicable and that they may produce plausible results.

Comparative bioavailability of metronidazole formulations (Vagimid) after oral and vaginal administration

Bioavailability of Vagimid 500 tablets (film coated, 500 mg metronidazole) and absorption of metronidazole into the systemic circulation after vaginal administration of Vagimid vaginal tablets (100 mg metronidazole) relative to respective listed references were studied in 16 female healthy volunteers (age 21-37 years, weight 45-67 kg, height 158-179 cm). Metronidazole and its main hydroxylated metabolite were measured using an HPLC-method with detection limits of 0.025 and 0.25 micrograms/ml (for vaginal and oral studies), respectively. Extent of absorption was assessed by AUC0-infinity (bioequivalence range 0.80-1.25), rate of absorption by Cmax/AUC0-infinity (bioequivalence range 0.70-1.43). Geometric means and 90%-confidence intervals of the ratios of these primary characteristics were calculated using a multiplicative model. Vagimid 500 tablets were bioequivalent to the reference formulation with regard to extent and rate of absorption of metronidazole because of AUC0-infinity = 0.995 (0.84-1.18) and Cmax/AUC0-infinity = 1.11 (0.94-1.30). The absorption of metronidazole into the systemic circulation after vaginal administration of Vagimid vaginal tablets caused maximal serum concentrations between 433 and 1,156 ng/ml after 8-20 h which are bactericidal only for the most susceptible anaerobic germs and which are most likely only of marginal importance for drug safety.

Nitric oxide mediates microvascular permeability in the isolated perfused rat mesentery?

The permeability influencing effect of nitric oxide was studied by means of an isolated perfused mesentery preparation in combination with a intravital/fluorescence microscopic set up. As a fluorescent marker served FITC-dextran mol wt 70,000 daltons. Tissue treatment was performed by application of NO-donors like SNP or GTN. Additionally the effects of bradykinin, L-nitroarginine or the combination of both were tested in regard to a permeability modulation. The results point out that NO-donors did not enhance microvascular permeability, whereas the permeability increasing effect of bradykinin is mediated by an NO-independent pathway.

Effects of acidosis and alkalosis on mechanical properties of hypertrophied rat heart fiber bundles

Effects of alkalosis (pH 7.4) or acidosis (pH 6.8) on the intrinsic mechanical properties of control and pressure-overloaded rat hearts were studied in Triton X-100-treated left ventricular fiber bundles. In control bundles, Ca sensitivity [pCa required for one-half maximal response (pCa50)] was 5.520 +/- 0.012 at pH 7.1. Alkalosis increased it by 0.357 +/- 0.018 pCa unit, whereas acidosis decreased it by 0.365 +/- 0.014 pCa unit with no change in Hill coefficient. Maximal tension was decreased by acidic pH and increased by alkaline pH. Stiffness was measured by the response to quick length changes. Acidosis decreased maximal stiffness but increased the stiffness-to-force ratio, whereas alkalosis increased maximal stiffness but had no effect on stiffness-to-force ratio, suggesting that acidosis decreased the force generated per cross bridge. Alkalosis increased the time constant of tension recovery following a quick stretch from 10.6 +/- 0.66 to 17.45 +/- 1.83 ms, suggesting a decreased cross-bridge cycling rate. Pressure overload induced by thoracic aortic stenosis for 4-6 wk led to a 200% cardiac hypertrophy associated with a shift from fast to slow ventricular myosin. pCa50 of hypertrophied bundles was not different from control (5.541 +/- 0.012). Ca sensitivity was increased by 0.383 +/- 0.008 in alkaline medium and decreased by 0.325 +/- 0.009 in acidic medium. Stiffness-to-force ratio was decreased in acidic pH, and the time constant of tension recovery was increased from 31.0 +/- 0.4 to 34.9 +/- 0.25 ms by alkalosis. In hypertrophied bundles, maximal tension was decreased by acidic pH but not changed by alkalosis. These results show that in the small pH range of our study 1) pH changes have symmetrical effects on Ca sensitivity in both control and hypertrophied bundles, 2) a decrease or an increase in H+ concentration does not have symmetrical effects on the mechanics of the cross bridges, and 3) changes in the phenotype of contractile proteins induced by aortic stenosis do not influence Ca sensitivity, only moderately influence the response to pH changes, and mainly affect the cross-bridge cycling rate.

[Initial findings using dynamic magnetic resonance tomography in the diagnosis of inflammatory diseases of the sacroiliac joint]

Up to now 42 patients with clinically suspected diagnosis of sacroiliitis (including 19 patients with confirmed spondylitis ankylosans) and 12 healthy volunteers were examined via magnetic resonance tomography. In oblique sections parallel to the plane of the sacrum the signal intensity patterns from normal and pathological tissues of the sacroiliac articulations were evaluated by plain T1-weighted spin-echo sequences and T2*-weighted FLASH sequences. In addition we used a dynamic FLASH measurement following intravenous application of gadolinium-DTPA for quantitative calculation of signal-time courses. This method has proved to be capable of definitely differentiating normal findings of sacroiliac articulations from inflammatory changes (p = 0.0001) and also enables quantification of the inflammatory activity.

Mechanical properties of rat cardiac skinned fibers are altered by chronic growth hormone hypersecretion

Chronic growth hormone (GH) hypersecretion in rats leads to increased isometric force without affecting the unloaded shortening velocity of isolated cardiac papillary muscles, despite a marked isomyosin shift toward V3. To determine if alterations occurred at the level of the contractile proteins in rats bearing a GH-secreting tumor (GH rats), we examined the mechanical properties of skinned fibers to eliminate the early steps of the excitation-contraction coupling mechanism. We found that maximal active tension and stiffness at saturating calcium concentrations (pCa 4.5) were markedly higher in GH rats than in control rats (tension, 52.9 +/- 5.2 versus 38.1 +/- 4.6 mN.mm-2, p < 0.05; stiffness, 1,105 +/- 120 versus 685 +/- 88 mN.mm-2.microns-1, p < 0.01), whereas values at low calcium concentrations (pCa 9) were unchanged. In addition, the calcium sensitivity of the contractile proteins was slightly but significantly higher in GH rats than in control rats (delta pCa 0.04, p < 0.001). The crossbridge cycling rate, reflected by the response to quick length changes, was lower in GH rats than in control rats (62.0 +/- 2.6 versus 77.4 +/- 6.6 sec-1, p < 0.05), in good agreement with a decrease in the proportion of alpha-myosin heavy chains in the corresponding papillary muscles (45.5 +/- 2.0% versus 94.6 +/- 2.4%, p < 0.001). The changes in myosin heavy chain protein phenotype were paralleled by similar changes of the corresponding mRNAs, indicating that the latter occurred mainly at a pretranslational level. These results demonstrate that during chronic GH hypersecretion in rats, alterations at the myofibrillar level contribute to the increase in myocardial contractility observed in intact muscle.

[Clinical pharmacokinetics of lidocaine after intraoral nerve block]

Aim of this study was to show the time course of plasma concentrations of 2% lignocaine with adrenalin at a concentration of 1:100,000. Four retinated third molars were removed in one session in 23 patients. For local anaesthesia in each patient we used 10 ml of Xylocaine 2% (Astra), which is commonly used in dentistry. The plasma-concentration was measured for the first 30 minutes after injection of the local anaesthetic using high pressure liquid chromatography (HPLC). Our results suggest that partially intravascular injection could not be avoided although careful aspiration was carried out before injecting. Neither subjective nor objective adverse central nervous effects were seen in our patients. Nevertheless we consider a peripheral intravenous cannula and ECG-monitoring strongly recommended in all major operations under local anaesthesia.

Pediatric bone marrow transplants: psychological aspects

On a pediatric bone marrow transplant unit, hematologist-oncologists, nurses, social workers, psychiatrists, psychologists, and others on the team deal with children and adolescents whose cancers are either treatable by marrow transplantation or are ultimately fatal. Contrary to original assumptions, many children and families cope well, especially in relatively uncomplicated cases with good outcome. Treatment may include direct psychotherapeutic intervention with the child and family, as well as use of psychopharmacologic agents such as antidepressants or anxiolytics for frank psychiatric disorders. Psychotherapists often have to function adjunctively with other staff members in their interactions with the patient and the family. A stress disorder model appears to best explain child, parent and family reactions to bone marrow transplantation. Given the medical severity and complexity of the conditions treated, and the approximately equal rates of overall success and failure, a supportive consultative approach is usually most helpful for child patients, parents and staff throughout the procedure. A retrospective study of the children treated over seven years in a tertiary pediatric hospital bone marrow transplant unit is presented. The level of child, parent, and family psychopathology was usually mild to moderate, but there were clear differences between patients. Mothers were more supportive than fathers under this extreme type of stress. Prospective longitudinal studies of children and families are needed to establish causal chains and optimal therapeutic interventions.

[Doppler echocardiographic diagnosis of pulmonary hypertension in children with mucoviscidosis]

Today Doppler echocardiography is a reliable noninvasive method in the diagnostic of pulmonary hypertension. We investigated 52 patients (age 1 to 19 years) with pulsed- or continuous-wave Doppler. Systolic pulmonary artery pressure (SPAP) was calculated about the equation of Akiba using acceleration time, corrected by heart rate. SPAP estimated in this way was less than 20 mmHg in 14% of the patients. 20-39 mmHg in 29%, 40-59 mmHg in 31% and about 60 mmHg in 26%. No correlation was found between age and SPAP and only low correlation between score of Shwachman (r = 0.37) or score of Norman-Crispin and SPAP. Between body fat, calculated from the thickness of skin folds, and SPAP was found a good correlation (r = -0.73, p = 0.01).

The craniodigital syndrome of Scott: report of a second family

We report on a boy with a characteristic combination of facial anomalies, syndactylies of fingers and toes, and mental retardation. Scott et al. (Journal of Pediatrics 78:658-663, 1971) observed 3 brothers with almost identical manifestations. The mother of these patients had bilateral syndactyly of toes 2 and 3. This led the authors to suggest X-linked inheritance. The mother of our patient also has cutaneous syndactyly between the second and third toes, strengthening the hypothesis of X-linked inheritance.

[Chemical and thermal compatibility of all-ceramic systems]

The chemical and thermal compatibility of the all-ceramic systems Vitadur-N, Hi-Ceram and In-Ceram as well as the combinations of Dicor with Vitadur-N, Dicor with NBK 1000 and Dicor with Vivodent, respectively, were investigated by means of electronmicroscopy and microprobe measurements at the interface of each compound, and thermomechanical analyses of the components were performed. The results show good contact at the interface of all combinations investigated. No evidence was found for diffusion at the interface except in the In-Ceram system, were a migration of K+ from Vitadur-N dentine into the glassy phase of In-Ceram occurs. The thermomechanical analyses showed a good thermal compatibility of all compounds investigated.

Flow cytometric analysis of G1- and G2/M-phase subpopulations in mammalian cell nuclei using side scatter and DNA content measurements

Several subcompartments of the cell cycle in addition to the G1-, S-, and G2-phases usually observed were identified by simultaneous flow cytometric measurements of ethidium bromide fluorescence and side scatter intensity of cell nuclei. Metaphase cells and very early G1-phase cells (G1A) with low side scatter intensities were discriminated from interphase cells with high side scatter intensities. The reason for the various side scatter intensities was found to be the different structure of metaphase cells and early G1-phase cells due to chromatin condensation as shown by sorting of the respective cell nuclei. The G1A-phase could further be subdivided into two compartments with very low side scatter (G1A1) and intermediate side scatter (G1A2) intensities. Using partially synchronized cells the duration of these subcompartments of the G1-phase could be estimated. The durations of G1A1- and G1A2-phases were found to be about 10 min and 20 min, respectively, compared to the total duration of the G1-phase of about 3 h. Additional flow cytometric measurements of side scatter intensities of cell nuclei provide therefore further information on subcompartments of the G1- and G2/M-phases.

Localization of a putative cell adhesion molecule (gp110) in Wistar and Fischer rat tissues

A plasma membrane glycoprotein (gp110) involved in cellular adhesion was studied in Wistar and Fischer rats. For quantitative analysis of the gp110 molecule a sandwich-ELISA was used. High quantities of gp110 were found especially in the liver, small intestine, submandibular gland and lung. The distribution and localization of the gp110 were investigated by immunohistochemistry utilizing soluble complexes of alkaline phosphatase and monoclonal anti-alkaline phosphatase antibodies. Immunoreactivity was present in plasma membranes of vascular endothelial cells of some organs. Furthermore, immunostaining also occurred in plasma membranes of lymphocytes, exocrine gland cells, excretory duct cells, hepatocytes, epithelial cells of the small intestine, kidney and vesicular gland and in the cytoplasm of renal connecting and collecting duct cells. The localization of gp110 in the luminal domain of the plasma membrane at many sites suggests that this glycoprotein is also involved in processes distinct from cell adhesion.

[Diagnosis of mucoviscidosis by examination of sweat: value of conductometry]

Two methods for the determination of sodium in the sweat after stimulation by pilocarpine-iontophoresis were compared in 227 patients, among them 27 with a known cystic fibrosis. These two methods were 1. the standardized method by flame fotometry (State Pharmacopoeia of the German Democratic Republic) and 2. the determination of the sweat conductance by the new apparatus "CF-Conductognost". Both methods showed a good correlation. We recommend the conductometry for the decentralized screening because it saves time and gives results immediately. But in all patients with a questionable or pathologic value of conductance the sweat test should be repeated with the standardized method. This concerns only about 10 per cent of all patients.

Primary cardiac tumors--clinical experiences and late results in 48 patients

Between 1971 and 1987 48 patients (35 female and 13 male) underwent operations at the Department of Cardiovascular Surgery, Justus-Liebig-University Giessen, for primary cardiac tumors. The age of the patients ranged from 21 to 71 years. Clinical symptoms were congestive heart failure, cardiac murmurs and findings similar to mitral stenosis, chest pain, arrhythmias, arterial embolism, myocardial infarction and pericarditis. 39 of the tumors were benign and 9 were malignant. Diagnosis was confirmed by echocardiography and/or cineangiocardiography. The left atrium was most commonly involved, followed by the right atrium. Surgery was performed in all cases using cardiopulmonary bypass. Benign tumors were totally removed, including attachment to the atrial septum or the free wall. In one case the tumor resection was carried out by autotransplantation of the heart. During the perioperative period we lost one of the 39 patients with benign tumors due to low cardiac output. Observing a mean follow up period of 48 months, no recurrence of tumors was noted and all patients are doing well now. The malignant neoplasms could not be removed completely, and in 4 cases only a reduction of the tumor mass was possible. Three of the 9 patients died during the postoperative period. Only one patient survived longer than 48 months. Whereas surgical therapy of malignant cardiac tumors is still a matter of discussion based upon these discouraging results, benign or semimalignant cardiac neoplasms have a very favourable prognosis when the surgical intervention can be performed prior to the occurrence of severe complications, such as congestive heart failure and arterial embolism.(ABSTRACT TRUNCATED AT 250 WORDS)

Rapid purification of dipeptidyl peptidase IV from rat liver plasma membrane

Dipeptidyl peptidase IV (EC 3.4.14.5) was solubilized from rat liver plasma membranes with sulphobetaine 14 and purified by successive affinity chromatography on Con A-Sepharose, wheat germ lectin-Sepharose and arginine-Sepharose columns. The specific activity of the final preparation was 49.4 mumol Gly-Pro p-nitroanilide/min per mg protein, representing a 1098-fold purification of the homogenate. SDS-polyacrylamide gel electrophoresis of the arginine-Sepharose eluate showed a single protein band with a molecular weight of 105,000. The isoelectric point was determined to be 3.9 under non-denaturing conditions with sulphobetaine 14. The preparation was free of post-proline cleaving enzyme. The content of aminopeptidase M was 0.2% of the total protein.

Doppler-sonographic examination of the arterial flow in the carotid and supratrochlear arteries during carotid angiography

In 55 patients, the blood flow in the carotid and supratrochlear arteries was examined by Doppler sonography during cerebral angiography. In general, a threefold response was observed: an initial phase of turbulence during the injection was followed by a phase of depressed and then of increased arterial flow. The second phase of reduced perfusion which probably is caused by the increased viscosity of the mixture of contrast medium and blood, is more pronounced in the internal carotid artery, whereas the third phase of accelerated flow is more marked in the external carotid artery. In patients with an occlusion of the internal carotid artery, the cerebral blood supply often depends on the collateral pathway via the ophthalmic artery. In these cases, the reduction of the blood flow is specially marked and long-lasting, as we could show. This may contribute to a higher angiographic risk of those cases with an important ophthalmic collateral flow.