[Self-mutilation with a coumarin derivative]

The experiment of a self-injury by permanent intoxication with the coumarin derivative Warfarin is described. Various isolated haemostatic defects as differential-diagnostically demarcated causes for the leading symptom decrease of the value of the thromboplastin time which concern the effect of coumarin are mentioned. It is referred to the coagulation-analytic and chemical-toxic methods of proof of coumarins.

Multicentre randomized therapeutic trial for advanced centrocytic lymphoma: anthracycline does not improve the prognosis

Within a multicentre observation study on non-Hodgkin lymphomas (NHL) diagnosed according to the Kiel classification advanced stages III and IV of centrocytic (CC) lymphoma exhibited the worst prognosis among lymphomas of low-grade malignancy with a 5-year survival probability of less than 10 per cent. Treatment had been solely expectative and palliative with treatment results showing a prognostic superiority of patients achieving partial and complete remissions over non-responders. Therefore, a randomized multicentre study was initiated to compare the remission-inducing potential of the COP regimen (Bagley et al., 1972) with that of the more intensive adriamycin-containing CHOP regimen (McKelvey et al., 1976). From 91 newly diagnosed CC lymphomas 63 fulfilled randomization criteria with 37 patients assigned to the COP regimen and 26 patients to the CHOP regimen. Between the COP- and CHOP-treated patients no significant differences could be demonstrated with respect to initial clinical parameters, rate of complete (41 per cent versus 58 per cent) or partial remissions (43 per cent versus 31 per cent), median overall survival probability (32 versus 37 months), relapse-free survival (10 versus 7 months) and rates of relapse (73 per cent versus 67 per cent) and death (57 per cent versus 50 per cent). It can be concluded that CC lymphoma is a typical lymphoma of low-grade malignancy with its inability to reach stable remissions while the demonstration of identical survival probabilities for patients with complete and partial remissions constitutes a unique feature of this lymphoma entity. These observations prove advanced CC lymphoma to represent an incurable neoplastic disease under conventional therapeutic approaches.

Predominant localization of phosphoenolpyruvate carboxykinase mRNA in the periportal zone of rat liver parenchyma demonstrated by in situ hybridization

In rat liver parenchyma, expression of the phosphoenolpyruvate carboxykinase (PEPCK) gene was studied by Northern blot analysis with a biotinylated cRNA probe and the zonal localization of PEPCK mRNA was demonstrated by in situ hybridization with a radiolabelled cRNA probe. During the feeding period at night, overall PEPCK mRNA levels were low and PEPCK mRNA was detected only in small areas of the periportal zone. At the beginning of the light period (7 am) the overall PEPCK mRNA level began increasing and the periportal areas containing PEPCK mRNA broadened. The maximum of the total abundance and of the area with high levels of PEPCK mRNA was reached at noon. Fasting for 24-72 h did not cause further significant alterations in the level or localization of PEPCK mRNA. The present data are in line with previous findings of the predominant localization of PEPCK activity and enzyme protein in periportal hepatocytes. They suggest that the heterogeneous expression of the PEPCK gene in rat liver is regulated at the pretranslational level.

TPA-induced differentiation and adhesion of U937 cells: changes in ultrastructure, cytoskeletal organization and expression of cell surface antigens

Incubation of the human promonocytic cell line U937 with 12-O-tetradecanoylphorbol-13-acetate (TPA) for 72 h resulted in differentiation into immature macrophage-like cells and was accompanied by marked morphological and functional changes. U937 cells which normally grow in suspension and show a smooth surface, extended pseudopodia and became adherent to each other and to the surface of the culture vessel. Concomitant with the TPA-induced adherence U937 cells ceased to proliferate. Our results show that phorbol ester-treated U937 cells exhibited markedly increased levels of fibronectin and of the cytoskeletal proteins actin, myosin and vimentin including a reorganization of actin and vimentin filaments. The induction of both cellular adherence and growth inhibition were accompanied by a significantly reduced level of cells expressing transferrin receptors and changes in cell surface antigen expression. Here, the expression of the leukocytefunction antigens (LFA-1), including CD11 and CD18 was markedly enhanced during phorbol ester-induced differentiation. TPA-treatment, however, failed to enhance the small amount of U937 cells expressing the monocyte/macrophage-specific CD14 antigen or expressing MHC class-II antigens. A detailed analysis of the CD14 cluster by 7 differential antibodies resulted in an induction of TM1, UCHM1, MEM15, My4, and 3C10, whereas the epitopes recognized by TM2 and Mo2 remained unaltered. Neither indomethacin nor interferon-gamma were capable of inducing a marked expression of these antigen epitopes in TPA-treated cells. Although these data demonstrate that during phorbol ester-induced differentiation U937 cells acquire many properties typically associated with macrophages, the failure to express marked levels of macrophage-specific cell surface antigens suggests a transition of U937 cells from a promonocytic to an immature macrophage intermediate state rather than into mature macrophage-like cells.

Clonal gene rearrangement patterns correlate with immunophenotype and clinical parameters in patients with angioimmunoblastic lymphadenopathy

T cell receptor beta (TcR beta) chain gene rearrangements have been reported in cases of angioimmunoblastic lymphadenopathy (AILD) and provided evidence for the presence of clonal T cell proliferations in this disorder. Twenty-three cases of AILD and two cases of hyperimmune reaction (HR) were investigated. In the two HR cases, essentially the same histologic pattern was present as in AILD but lymph node follicles were hyperplastic. Both HR cases showed germline configuration for the TcR and immunoglobulin heavy chain (IgH) genes. All other patients diagnosed with AILD had clonal rearrangements for TcR gamma and beta chain genes. In addition, seven out of these cases had clonally rearranged their IgH genes. These two different rearrangement patterns (TcR with or without Ig gene rearrangement) correlated to immunohistochemical and clinical data. Cases with TcR but without Ig gene rearrangements (group I) exclusively showed CD4+ proliferating T cells, whereas those cases with TcR and Ig gene rearrangements had significantly elevated numbers of CD8+ proliferating cells (group II). Group II patients significantly more often presented with hemolytic anemia and went into transient remission spontaneously or under steroid treatment. Group I patients, however, had a higher response to chemotherapy and a longer survival time. These data show that, based on different rearrangement patterns, it is possible to divide AILD into two different groups with distinct immunophenotypic properties and differences in clinical parameters. Immunogenotyping in AILD thus will have prognostic and therapeutic implications.

Intercellular junctions in the gill epithelium of the Atlantic hagfish, Myxine glutinosa

The intramembrane organization of the occluding junctions in the gill epithelium of the Atlantic hagfish, Myxine glutinosa, was studied by means of freeze-fracture electron microscopy. Mitochondria-rich cells, characterized by assemblies of rod-shaped particles in the luminal plasma membrane and by an extensive intracellular amplification of the basolateral plasma membrane, are singly distributed between the pavement cells in the gill epithelium of this marine and stenohaline cyclostome. The occluding junctions between mitochondria-rich cells and pavement cells do not differ from those between adjacent pavement cells, concerning the number of superimposed strands (median 6, range 4-9) and their geometrical organization. These observations suggest that, in contrast to marine teleosts, the paracellular pathway plays a minor role in transepithelial ion movements in the hagfish gill epithelium. The findings are in agreement with the absence of hypoosmoregulatory mechanisms in hagfish, as have been evolved in various marine vertebrates. In addition, small communicating junctions are demonstrated between pavement cells; they possibly serve for a coordinated synthesis and secretion of mucus by the pavement cells.

[En-bloc resection of the esophagus in esophageal cancer]

En-bloc esophagectomy not only comprises the elimination of the esophagus but also the mediastinal lymphadenectomy and the resection of the azygos vein and thoracic duct. Additionally the suprapancreatic abdominal lymphadenectomy is included and in tumors located orally of the tracheal bifurcation also the cervical lymphadenectomy. The surgical technique can be estimated as fully developed and standardized. Possible complications are postoperative hemorrhage (3.3%), chylothorax (1.6%) and tracheal lesions (4.9%). The mortality rate ranges under 10% in experienced centers, in our own patients around 6.6%. With en-bloc esophagectomy an exact staging of esophageal cancer becomes possible. In a high percentage complete tumor elimination (R0-resection) can be achieved and it seems that herewith prognosis in early tumor stages (T1/2N0/1) can be improved.

[The value of lymphography of malignant testicular tumors]

Between 1965 and 1968, 6500 lymphograms were performed at the University of Göttingen. Amongst these, there were 412 patients with malignant testicular tumours. In 81 patients the results of lymphography could be checked histologically. There was agreement between the lymphographic and histological findings in 65 patients (80.3%), sensitivity of 98.1% (51 out of 52) and specificity of 48.3% (14 out of 29). In 50 patients CT was performed in addition. The findings agreed in 31 cases; in eight patients lymphangiography resulted in a false positive finding and CT was incorrect in 12 patients. In all patients with proven retroperitoneal metastases, one or the other method produced a correct diagnosis.

[Surgery of acute pancreatitis. A problem of retroperitoneal sepsis?]

Of 99 patients with acute pancreatitis 31 had to be operated upon. Surgical intervention was indicated if, in the presence of pancreatic necrosis demonstrated by computed tomography, clinical evidence of sepsis developed. The operation was performed on average ten days after the onset of symptoms. Evidence of bacterial contamination of the pancreatic necrosis was obtained in 26 patients. The operation consisted of left pancreatic resection with formation of a left compartment. Four of the 31 operated patients died (12.9%).

[Therapy of Hodgkin's lymphomas. Results of the German Hodgkin's Disease Study Group]

Between July 1983 and May 1987 143 untreated patients with Hodgkin's lymphoma in stages I-IIIA with risk factors qualified for the HD1 protocol, and 230 patients in stages IIIB/IV qualified for HD3. Patients in HD1 received a combined chemo-radiotherapy (2 x COPP + ABVD + 20 Gy EF vs. 40 Gy EF). Patients in HD3 received induction chemotherapy (3 x COPP + ABVD) and were randomized into consolidation by radiotherapy (20 Gy IF) vs. chemotherapy (1 x COPP + ABVD). In HD1, 73 of 89 evaluable patients (82%) achieved a complete remission. The survival of patients in stages I-IIIA with risk factors treated according to HD1 is as good as the survival of patients in stages I and II without risk factors. In HD3, 86 of 137 patients (63%) achieved complete remission after induction chemotherapy with 3 x COPP + ABVD. This is significantly better than the 31% complete remission rate observed in a pilot study with COPP alone (p less than 0.01). Including salvage therapy (radiotherapy in case of persisting nodal disease; chemotherapy with 4 x CEVD in case of persisting disseminated disease), a total of 76% complete remissions in stages IIIB/IVAB were achieved. An ESR greater than 80 mm/h was the most significant single risk factor in stages IIIB/IV for induction of CR and freedom from progression.

Glycogen synthesis via the indirect gluconeogenic pathway in the periportal and via the direct glucose utilizing pathway in the perivenous zone of perfused rat liver

The isolated liver from 24 h fasted rats was perfused in a non-recirculating manner in the ortho- and retrograde direction with erythrocyte-containing (20% v/v) media to provide adequate oxygenation of the liver. Glucose and/or gluconeogenic precursors were added as substrates. Glycogen formation was determined biochemically and demonstrated histochemically. With glucose as the sole exogenous substrate glycogen was deposited in the perivenous area, with gluconeogenic precursors it was formed in the periportal zone during ortho- and retrograde flow. When glucose and gluconeogenic compounds were offered together, glycogen was deposited in both zones. The results corroborate the model of metabolic zonation predicting that periportal glycogen is synthesized indirectly from gluconeogenic precursors while perivenous glycogen is formed directly from glucose.

Dependence of O2 transfer conductance of red blood cells on cellular dimensions

To estimate the significance of the dimensions of RBC on O2 transfer, the kinetics of O2 release from RBC into medium containing dithionite (40 mmol/l) was measured, by a stopped-flow technique, for nine different species with varying RBC size (man, llama, vicuna, alpaca, dromedary camel, pygmy goat, domestic hen, muscovy duck and turtle). The observed O2 transfer kinetics were found to be size-dependent, i.e. the O2 transfer conductance of the single RBC, gst, was lower, whereas the specific O2 transfer conductance of packed RBC, Gst, or of whole blood, theta st, was higher for smaller RBC. The ratio of surface area to effective diffusion path length which was found to be about one fourth of the mean cell thickness irrespective of cell size and cell shape, may be considered as the essential morphological factor determining O2 transfer efficiency of the single RBC.

Glycogen synthesis from pyruvate in the periportal and from glucose in the perivenous zone in perfused livers from fasted rats

The isolated liver of 24 h fasted rats was perfused in a non-recirculating manner in the orthograde or retrograde direction with media containing glucose and/or gluconeogenic precursors. Glycogen formation was determined biochemically and demonstrated histochemically. With glucose as the only exogenous substrate glycogen was formed exclusively in the perivenous area during both orthograde and retrograde perfusion. With gluconeogenic precursors as the exogenous substrates glycogen was deposited in the periportal zone during orthograde perfusion and in the intermediate zone during retrograde perfusion. Supply of glucose and gluconeogenic substrates initiated glycogen synthesis only in the upstream region, i.e. in the periportal zone during orthograde and in the perivenous zone during retrograde perfusion. This localization of glycogen synthesis was probably due to an unavoidable, insufficient oxygen supply of the respective downstream area. In general, the results confirm the hypothesis that periportal and perivenous glycogen was synthesized from different substrates.

[Intestinal liberation and resorption of monosaccharides from carbohydrates of different degrees of polymerization. I. Relation between intestinal hydrolysis of carbohydrates and resorption of monosaccharides]

The study was designed to compare the intestinal absorption of monosaccharides from carbohydrates of different chain length. Furthermore, a correlation between the efficiency of hydrolysis of the polymers and the efficiency of the intestinal absorption was expected to be established. Glucose, the disaccharides maltose and sucrose and the polysaccharides maltodextrin DE 20 , maltodextrin DE 5 and starch were employed as substrates. The whole small intestines of anaesthetized rats were perfused in situ for 60 min with 0.5% solutions of these substrates in an open perfusion system. Initially 3-minute fractions of the perfusion medium, later 10-minute fractions were collected. The parameters determined were: secretion of pancreatic alpha-amylase activity, substrate hydrolysis (by alpha-amylase and by disaccharidases of the brush border membrane), intestinal absorption of the monosaccharides. alpha-amylase activity was significantly higher when the perfusion was carried out with starch solution. The possibility is discussed that this high-polymer substrate might stimulate the pancreas to an elevated alpha-amylase secretion. The highest rate of hydrolysis (45 mumol glucose/min) was determined from maltose as a substrate. The cleavage of the high-polymer substrates was less intensive. The hydrolysis of starch was limited by the capacity of the alpha-amylase, that of the sucrose by low activity of the saccharose. Absorption of glucose was more effective from the maltose solution than from the glucose solution. To understand this phenomenon, an additional "hydrolases-related transport system" could be taken into consideration. Glucose absorption from maltodextrin DE 20 was less effective than might have been expected from the rate of hydrolysis. This fact might possibly be explained by an inhibitory effect of oligosaccharides of chain length 4-10, contained in relatively high amounts in maltodextrin DE 20.

[Intestinal liberation and resorption of monosaccharides from carbohydrates of different degrees of polymerization. II. Relations between monosaccharide resorption, blood glucose level and serum insulin concentration]

The small intestines of anaesthetized rats were perfused in situ for 60 min with 0.5% solutions of glucose, maltose, sucrose, maltodextrin DE 20, maltodextrin DE 5 or starch. Blood samples were repeatedly taken from the v. portae and the v. femoralis to estimate blood glucose and serum insulin levels as a function of perfusion time. The experiment was also performed to clarify whether a correlation exists between these parameters and the substrate uptake from the intestinal lumen (determined in the first part of the study). The highest glucose levels in v. portae and the highest portal-peripheral differences were found when glucose and maltose solutions were administered. Glucose levels in v. femoralis were almost independent of the substrate perfused. Perfusion with glucose caused a considerable insulin secretion starting immediately with the onset of perfusion. It was concluded that glucose might also stimulate insulin secretion on the intestinal level. Perfusion with maltose also effected a significant insulin output, the start of which was delayed however, compared with the effect of glucose.

[Treatment guidelines in intestinal burns]

Intestinal burns due to ingestion of acids or alkaline materials still put the physician in a difficult position because until now it is not possible to correlate the amount of ingested material to the extent of damage that can be expected. Furthermore, there are no objective criteria to determine the depth of the burn. Diagnosis is based on endoscopy. Mild, moderate and severe damage can be differentiated endoscopically. Mild and moderate burns are not operated upon primarily. Surgery is indicated with moderate burns whenever complications occur during intensive care treatment, and generally with severe corrosive burns. Operative management depends on intraoperative findings.

Intramembrane aspects of myotendinous and myomuscular junctions: a freeze-fracture study of the gill sac-muscle of the Atlantic hagfish, Myxine glutinosa

The intramembrane organization of the sarcolemma at the sites of myotendinous and myomuscular junctions was studied in the gill sac-muscle of the Atlantic hagfish, Myxine glutinosa, by using freeze-fracture replicas. At these sites rows of irregularly shaped particles (diameter approximately 6 nm) and short fibrils are present on the P face and a complementary pattern of grooves is present on the E face of the split plasma membrane. The center-to-center distance between adjacent rows of particles and grooves ranges from 12 to 20 nm. Rodlike projections being in register with the rows of particles and grooves, respectively, extend from the plasma membrane toward the extracellular space. These rodlike projections are also recognizable in thin sections, where they appear as spinelike projections (cross sections) or linear arrays (grazing sections) located in the lamina lucida of the basal lamina. The intramembrane particles are considered to be integral membrane proteins and to represent transmembrane links in a series of molecules by which intracellular actin filaments and extracellular collagen fibrils are connected across the plasma membrane. The rodlike projections are probably peripheral membrane proteins possibly connecting the plasma membrane with structural components of the basal lamina.

[Lymphography in malignant testicular tumors]

Experience and results are reported on the basis of more than 380 lymphographic investigations in patients with a malignant testicular tumor. In 61% of these patients, there was suspicion of a metastatic infiltration of the retroperitoneal lymph nodes. In 75 patients, histological checking of the lymphographic finding was possible on the basis of a retroperitoneal lymphadenectomy. Lymphography was shown to have a precision of 81%. Lymphography is obligatory as a complement to other techniques of investigation such as sonography and computer tomography in patients with malignant testicular tumor, since the greatest diagnostic information can be expected from combined application of all three methods.

Mitosis of the Hofbauer cell: possible implications for a fetal macrophage

Human chorionic villi from placentae collected during the first half of pregnancy were examined by light microscopy and transmission electron microscopy. In serial semithin sections mitoses of Hofbauer cells, as well as those of other cellular components of the villous stroma, were generally easily identified. In some cases, when the Hofbauer cells showed very few vacuoles, thin sections were helpful in differentiating this cell type from the fixed stromal cells. Hofbauer cells in mitotic division were not uncommon, but were irregularly distributed. Mitosis of the Hofbauer cells could be a mechanism involved in maintaining the permanent presence in the chorionic villi of cell subpopulations with different origins and functions. Another explanation for the mitotic division of these cells could be that they are a self-renewing population independent of fetal monocytes which appear later in gestation in chorionic villi. In addition, mitosis of the Hofbauer cells could allow a rapid increase in their numbers when required by the local microenvironment.

Oxygen transfer properties and dimensions of red blood cells in high-altitude camelids, dromedary camel and goat

To estimate the advantage of the small red blood cells (RBC) of high-altitude camelids for O2 transfer, the kinetics of O2 uptake into and release from the RBC obtained from llama, vicuña and alpaca were investigated at 37 degrees C with a stopped-flow technique. O2 transfer conductance of RBC (G) was estimated from the rate of O2 saturation change and the corresponding O2 pressure difference between medium and hemoglobin. For comparison, O2 kinetics for the RBC of a low-altitude camelid (dromedary camel) and the pygmy goat were determined and previously measured values for human RBC were used. O2 transfer of RBC was found to be strongly influenced by extracellular diffusion, except with O2 release into dithionite solutions of sufficiently high concentration (greater than 30 mM). The G values measured in these 'standard' conditions, Gst (in mmol X min-1 X Torr-1 X (ml RBC)-1) were: high-altitude camelids, 0.58 (averaged for llama, alpaca and vicuña since there were no significant interspecific differences); camel 0.42; goat, 0.42; man, 0.39. The differences can in part be attributed to expected effects of the size and shape of the RBC (volume, surface area, mean thickness), as well as to the intracellular O2 diffusivity which depends on the concentration of cellular hemoglobin. The high Gst of RBC of high-altitude camelids may be considered to enhance O2 transfer in lungs and tissues. But the O2 transfer conductance of blood, theta, equal to Gst multiplied by hematocrit (in mmol X min-1 X Torr-1 X (ml blood)-1), was only slightly higher as compared to other species: 0.20 (llama, alpaca, vicuña), 0.14 (camel), 0.18 (goat), 0.17 (man).

Orthogonal arrays of particles in the plasma membrane of pneumocytes

The presence of orthogonal arrays of particles (OAP) in pneumocytic membranes was studied using freeze-fracture replicas of lung tissue from turtles, frogs and various mammalian species, including man. OAP are typically present in the basal plasma membrane of pneumocytes in turtles and frogs, while they have only been detected in the plasma membrane of type I cells in human lungs among the mammalian species studied. The median of particles per OAP was 10 (range 4-40) in lower vertebrates and 8 (range 4-24) in man. The mean density of OAP per unit cell surface varied between 40 and 60/micron2. The frequent occurrence of OAP in pneumocytic membranes in the lungs of man, turtles, and frogs suggests that they are related to a specific, although undetermined pulmonary function which is restricted to the ciliated airway epithelium in those mammalian species lacking OAP in the alveolar epithelium.