[A protracted course in Cardiobacterium hominis endocarditis]

A 69-year-old man without previous cardiac disease was found over the last 9 months to have a markedly elevated erythrocyte sedimentation rate (ESR: 120 mm/1. h), haemolytic anaemia (haemoglobin 8.2 g/dl, lactate dehydrogenase 304 U/l), markedly reduced exercise tolerance, backache and weight loss of 5 kg. Radiological, biochemical and endoscopic examinations failed to provide a diagnosis. Nine blood cultures grew, at normal body temperature, Cardiobacterium hominis, a rare Gram-negative organism which can cause endocarditis. Echocardiography revealed endocarditis of the aortic valve with regurgitation. Despite protracted and high-dosage antibiotics (4 times daily 10 million U penicillin G for 6 days, followed by four times 5 million U penicillin G for 6 days, followed by four times 5 million U daily for five weeks, and three times daily 60 mg gentamycin for 10 days), as well as treatment of extensive chronic parodontitis, anaemia, haemolysis and increased ESR have now persisted for over a year, with negative blood cultures. Immune-complex phenomena are thought to be the reason for the persistence of signs of infection.

Calcitonin gene-related peptide (CGRP) causes redistribution of blood flow in humans

In normal human subjects (n = 6), blood flow in the common carotid artery, assessed with an ultrasonic duplex-scanning unit, was increased up to 152% of basal levels by 60-min infusions of human calcitonin gene-related peptide I (alpha CGRP) 80 pmol.kg-1.h-1, but it was not affected by 20 pmol.kg-1.h-1 CGRP or 88 pmol.kg-1.h-1 human calcitonin. In the superior mesenteric artery, on the other hand, blood flow was reduced by 80 pmol.kg-1.h-1 CGRP to 58% of the basal level, but not by 20 pmol.kg-1.h-1 CGRP or with 88 pmol.kg-1.h-1 calcitonin. Blood flow in the abdominal aorta remained largely unchanged under the same conditions. Skin blood flow, assessed by a laser Doppler unit, was increased up to 682% of the basal level by 80 pmol.kg-1.h-1 CGRP, but not by 20 pmol.kg-1.h-1 CGRP or calcitonin. Thus CGRP increased regional blood flow to the brain and the skin at the expense of the gastrointestinal tract.

M-mode echovenography: a new technique for the evaluation of venous wall and valve motion

The M-mode technique which is widely used in echocardiography allows continuous recording of spontaneous venous wall movements. Compliance of the vein can be quantified. The diameter of the normal vein changes with respiration, while only minor changes are induced by cardiac function. Distensibility and compressibility of the common femoral vein (CFV) were documented. During Valsalva manoeuvre the mean diameter of the CFV increased from 1.05(SD 0.18) cm to 1.52(0.25) cm (p less than 0.01) in the recumbent position and from 1.50(0.20) cm to 1.63(0.17) cm (NS) in the upright position. A patent vein can be completely compressed by the scan head, a thrombosed vein is incompressible. The valve of the normal subclavian vein describes a characteristic M-shaped tracing. The waveform is modulated by cardiac and respiratory function. The study of venous wall movement and venous valve motion provides new insights into venous physiology.

Abscisic acid and water transport in sunflowers

The role of abscisic acid (ABA) in the transport of water and ions from the root to the shoot of sunflower plants (Helianthus annuus) was investigated by application of ABA either to the root medium or to the apical bud. The exudation at the hypocotyl stump of decapitated seedlings was measured with and without hydrostatic pressure (0-0.3 MPa) applied to the root. All ABA concentrations tested (10(-10)-10(-4) mol·l(-1)) promoted exudation. Maximal amounts of exudate (200% of control) were obtained with ABA at 10(-6)·mol·l(-1) and an externally applied pressure of 0.1 MPa. The effect was rapid and long-lasting, and involved promotion of ion release to the xylem (during the first hours) as well as an increase in hydraulic conductivity. Abscisic acid applied to the apical bud had effects similar to those of the rootapplied hormone. Increased rates of exudation were also obtained after osmotic stress was applied to the root; this treatment increased the endogenous level of ABA in the root as well as in the shoot. Water potentials of the hypocotyls of intact plants increased when the roots were treated with ABA at 5°C, whereas stomatal resistances were lowered. The results are consistent with the view that ABA controls the water status of the plant not only by regulating stomatal transpiration, but also by regulating the hydraulic conductivity of the root.

Analysis of flow motion by the laser Doppler technique in patients with peripheral arterial occlusive disease

Laser Doppler flux was measured at the forefoot in 12 healthy subjects and in 36 patients with different degrees of ischemia due to peripheral arterial occlusive disease. Two characteristic patterns of flow motion waves were observed: Large waves with a mean amplitude of 0.77 +/- 0.4 arbitrary units and a mean frequency of 3.03 +/- 1.0 c/min (0.051 +/- 0.02 Hz) and small waves with a mean amplitude of 0.21 +/- 0.1 arbitrary units and a mean frequency of 21.7 +/- 4.2 c/min (0.362 +/- 0.07 Hz). The prevalence of large waves tended to decrease with more advanced ischemia, whereas small waves occurred almost exclusively in ischemia and most frequently in severe cases. Large flow motion waves were enhanced during reactive hyperemia after arterial occlusion or appeared after peak flux had been reached. Time to peak flux or to vasomotion were reliable parameters for characterizing skin ischemia. The previously undescribed small flow motion waves might represent a compensatory mechanism involved in pathophysiology of ischemia.

[Duplex sonography in the diagnosis of peripheral arterial circulation disorders]

From January 1984 to June 1986, 621 duplex scans of the arteries of the lower extremities were performed. 54.8% of the examinations were performed for clinical reasons. In 45.2% the indication was strictly scientific. Clinical and non-invasive examinations including pulse-volume recordings and Doppler pressure measurements preceded duplex-scanning. The analysis shows that duplex scanning may replace arteriography in patients with localized stenosis and short occlusions where catheter therapy is possible. Patients with insignificant stenosis or long occlusion may be selected for conservative treatment without arteriography.

Laser-Doppler probes for the evaluation of arterial ischemia

Rhythmic variations of microvascular flux have been studied at the forefoot of patients with arterial occlusive disease by laser-Doppler flowmetry. Two patterns of flow motion with characteristic amplitudes and frequencies could be observed. The prevalence of small waves with a mean amplitude of 0.21 +/- 0.1 AU and a frequency of 21.7 +/- 4.2 c/min increased with the degree of ischemia. Big flow motion waves with a mean amplitude of 0.77 +/- 0.4 AU and a frequency of 3.0 +/- 1.0 c/min were found in both controls and patients with different degrees of ischemia. The small waves may represent a compensatory mechanism in skin ischemia.

Desensitization to growth hormone-releasing factor (GRF) is associated with down-regulation of GRF-binding sites

The time course, concentration dependence, and mechanism of rat anterior pituitary desensitization to GRF were studied. Chronic stimulation of cultures of rat anterior pituitary cells with rat GRF (rGRF) resulted in desensitization to a subsequent challenge with the peptide. Despite a slight enhancement of GH synthesis, prolonged exposure to GRF caused substantial depletion of cellular GH pools. As a result, acute secretory responses were markedly blunted. Depletion was accompanied by a time-dependent decrease in sensitivity to rGRF; GRF EC50 values for GH release of 0.5 nM rGRF-pretreated cells were 24.8 +/- 6 (+/- SEM) pM after 2 h, 46.2 +/- 2.4 pM after 4 h, and 154.7 +/- 31 pM after 8 h compared to 9.2 +/- 0.6 pM for control cells. The process of desensitization was complete within 8 h, as cells pretreated for 24 h exhibited sensitivity to rGRF comparable to that of cells pretreated for 8 h. Desensitization was associated with a time-dependent decrease in rat anterior pituitary cell GRF-binding capacity; a 48% loss of binding sites was evident after a 2-h pretreatment with 0.5 nM rGRF, with a maximum loss occurring after 8 h. The dose of rGRF required to produce an attenuation of responsiveness did not completely correlate with the dose requirement for down-regulation of binding sites. The decrease in GRF-binding sites was not associated with any alteration of apparent Kd values, which were 0.36 (0.18-0.72) nM in control and 0.1 (0.01-0.82) nM after 8 h of exposure to 0.5 nM rGRF. Both the reduction in GRF-binding capacity and decreased sensitivity to GRF were reversible after 24 h, although cellular GH pools were not restored to control levels. These results suggest that rat anterior pituitary cells become desensitized to rGRF after chronic stimulation with a maximal concentration of the peptide. One mechanism for this decrease in apparent sensitivity to rGRF may be the pronounced reduction or down-regulation of GRF-binding sites.

[The purification and characterization of Cordemcura]

3-Amino-5-(4-pyridinyl)-1,2-dihydro-pyrid-2-one (1) is an amphoteric compound and forms one crystalline sodium salt and two hydrochlorides. Physicochemical properties UV, NMR and MS are described. TLC has been used mainly and is the most sensitive method for estimation of 1-byproducts. Coloured byproducts, generated by hypochlorite or air oxidation during synthesis and handling in solution, are monitored by vis-spectra, diminished by sulfite addition and removed by alkaline precipitation. The purification procedure is able to produce 1 with only 0.1% of precursors or byproducts.

Down-regulation of growth hormone releasing factor receptors following continuous infusion of growth hormone releasing factor in vivo

The in vivo chronic infusion of growth hormone releasing factor (GRF) results in a loss of the pituitary growth hormone (GH) response to GRF as well as in a substantial depletion of pituitary GH content. To evaluate if the loss in response is due to the down-regulation of GRF receptors the specific GRF binding capacity of pituitary homogenates prepared from rats infused with saline or GRF (1 or 15 micrograms/h for 24 h) was determined. The pituitary binding capacity of animals infused with GRF was significantly reduced as compared to animals infused with saline.

Binding sites for calcitonin gene-related peptide in distinct areas of rat brain

Calcitonin gene-related peptide (CGRP) binding sites were localized in rat brain and spinal cord by an in vitro labeling light microscopic technique using [125I]rCGRP as radioligand. Specific rCGRP binding with a dissociation constant (Kd) of 0.53 nM to membrane preparations from rat brain cortex was characterized. The presence and the selective distribution of specific high affinity CGRP binding sites in the central nervous system suggest a role for this recently predicted peptide as a neurotransmitter.

Growth hormone-releasing factor binding sites in rat anterior pituitary membrane homogenates: modulation by glucocorticoids

Specific high affinity binding sites for growth hormone releasing factor (GRF) were described in rat anterior pituitary homogenates with use of the analog [His1-mono-125I-Tyr10,Nle27]-hGRF(1-32)-NH2 as radioligand. Computerized analysis of competition experiments indicated one class of specific high affinity binding sites with a dissociation constant of 0.19 nM. The relative binding affinities of rGRF, hGRF(1-40) and various analogs correlated well with their in vitro biological potencies. Further, the number binding sites was drastically decreased after adrenalectomy; chronic dexamethasone treatment of these animals restored GRF binding capacity to control without changing binding affinity. These results may in part explain the enhanced responsiveness of the somatotroph after dexamethasone treatment.

Receptor for calcitonin gene-related peptide: binding to exocrine pancreas mediates biological actions

In the present study we demonstrate by immunohistochemical techniques that calcitonin gene-related peptide (CGRP) is present in nerve terminals in the islets of Langerhans. Furthermore, binding studies with 125I-CGRP indicate that dispersed acini from guinea pig pancreas contain a single class of high-affinity binding sites for CGRP with an apparent dissociation constant of 18 nM. Vasoactive intestinal peptide (VIP), rat growth hormone-releasing factor (rGRF), cholecystokinin octapeptide (CCK-OP), and bombesin do not interact with these receptors. Interaction of CGRP with these receptors leads to release of amylase from the acinar cells. Amylase release is half maximal at 0.3 nM CGRP and maximal at 3 nM CGRP. Maximal amylase release with CGRP is one-third of that observed with VIP. CGRP-induced amylase release is dependent on theophylline in the incubation medium. CGRP potentiates the amylase release stimulated by bombesin and CCK-OP but has no effect on amylase release stimulated by VIP, rGRF, and natural glucagon. CGRP stimulates a 25% increase in basal cellular cAMP. These results indicate that guinea pig pancreatic acinar cells contain a novel receptor for CGRP and that interaction of CGRP with this receptor leads to digestive enzyme secretion through a cAMP-mediated pathway. The presence of CGRP in the islets of Langerhans suggests a pathway for CGRP to reach the exocrine pancreas through an insuloacinar portal system.

Growth hormone-releasing factor stimulates pancreatic enzyme secretion

Growth hormone-releasing factors (GRF's) from two human pancreatic tumors (hpGRF's) that caused acromegaly and from the rat hypothalamus ( rhGRF ) were recently isolated and characterized. Although these peptides are potent growth hormone secretagogues, they have not until now been described to have actions outside the pituitary. These GRF's were shown to stimulate digestive enzyme secretion from an exocrine pancreatic preparation in vitro, rhGRF being more than 100 times as potent as hpGRF. Adenosine 3',5'-monophosphate mediates this action of the GRF's.

Somatostatinoma syndrome. Clinical, morphological and metabolic features and therapeutic aspects

A case of somatostatinoma syndrome in a 30-year-old woman is presented. Basal levels of growth hormone and of pancreatic and gastric hormones were reduced and the response of growth hormone, insulin and C-peptide to stimuli such as arginine, glucose, glibenclamide and calcium was virtually abolished. Similarly, gastric acid secretion, pancreatic exocrine function and intestinal absorption were significantly reduced. On the other hand, basal and stimulated levels of adrenocorticotropic hormone (ACTH), luteinizing hormone (LH), follicle-stimulating hormone (FSH) and thyroid-stimulating hormone (TSH) were within the normal range. Plasma somatostatin-like immunoreactivity was increased to 600-2,000 pg/ml (normal: 88-140 pg/ml). Immunocytochemical studies demonstrated the presence of somatostatin immunoreactive material in the primary tumour in the head of the pancreas and in the liver metastases. In spite of two courses of chemotherapy with streptozotocin and 5-fluorouracil the patient died due to liver failure 5 months after the first admission to hospital.

[Fluorescence microscopy study of fluorescein in the posterior segment of the eye following local application of drugs]

After local application of gentamicin, dexamethasone and tropicamide to rat eyes, no effect on the permeability or the caliber of retinal vessels was observed, nor any diffusion of fluorescein from the choriocapillaris to the outer retinal layers. The qualitative assessment of fluorescence microscopic preparations (and photographic reproductions of them) is relatively unreliable and has led to confusion in the literature. The results presented here, which to some extent contradict earlier findings published in 1971, are discussed. The authors expect to obtain more accurate results from the quantitative method which they are now using.

[Hydrops fetalis caused by isoimmunization against Kell factor (author's transl)]

The article reports on a case of hydrops fetalis caused by Kell antibodies, antibody formation having been triggered by pregnancy. Since the relative frequency of Kell (and rhesus sub-group) intolerance is increasing due to the successes achieved by anti-D-immunoglobulin prophylaxis, the question arises, on account of the possibly severe course of the disease, whether the Kell factor should be taken into consideration in all blood transfusions in girls during their childhood and in women of childbearing age.

[Intravenous and oral galactose loading of rats suffering from galactosamine hepatitis and ANIT-cholestasis; comparison of the kinetics in vivo and the galactose metabolism in the liver in vitro (author's transl)]

Different groups of rats suffering from galactosamine hepatitis or ANIT-cholestasis received 200 mg galactose either by 5 minutes intravenous infusion or via a gastric tube. Blood galactose concentrations were measured for a time period of 1.5 hrs. after intravenous administration and the galactose elimination capacity (GEC) was calculated. After oral administration the galactose blood concentrations were determined for a period of 3.5 hrs. and the oral galactose clearance was estimated. After termination of both types of galactose loading the activity of the galactokinase (EC 2.7.1.6.) was determined in total liver homogenate and compared either to the GEC or to the oral galactose clearance in vivo. Galactokinase activity in the liver increased in the group of animals with experimental cholestasis and was significantly reduced in the galactosamine treated group. In vivo these changes could be estimated much better by the GEC than by determination of the oral galactose clearance.

Low molecular weight RNAs as components of nuclear ribonucleoprotein particles containing heterogeneous nuclear RNA

70-130 S polyparticles as well as 38 S monoparticles were isolated from rat liver nuclei and analyzed in respect to their RNA components by microgel polyacrylamide electrophoresis in formamide. In addition to the high molecular weight polydisperse hnRNA of polyparticles several low molecular weight RNAs (snRNA) were detected. There are at least six distinct snRNA species in polyparticles. Except for one species, which is missing, 38 S monoparticles showed a similar snRNA pattern. From densitometer tracings of microgels the snRNAs were estimated to represent about 11% of the total polyparticle RNA. The number of nucleotides for the various snRNAs were determined from a plot of relative electrophoretic mobility versus log number of nucleotides. The possibility that the snRNAs are degradation products of the hnRNA was excluded on the basis of the following findings. (1) The snRNA pattern was similar in mono- and polyparticles. (2) Whereas the hnRNA of polyparticles incubated at 37 degrees C was extensively degraded, the snRNA did not show a corresponding increase. (3) After a 30 min pulse with [3H]orotate the hn RNA was readily labeled; none of the snRNAs, however, incorporated radioactivity. The snRNAs were still found after treatment of polyparticles with 2 M NaCl excluding contamination by nucleoplasm.

The effect of sodium chloride on the structure of ribonucleoprotein particles from rat liver nuclei

38S (monoparticles) and greater than 50--200S ribonucleoprotein particles (polyparticles) from rat liver nuclei were treated with increasing concentrations of sodium chloride. Treatment of 38S or greater than 50--200S particles, with 0.14, 0.25, 0.5, 1.0, and 2.0M NaCl resulted in a decrease of protein to RNA ratios from 8 to 3.1 for 38S particles and from 4.0 to 1.5 for greater than 20--200S particles. Correspondingly the densities in CsCl increased. Whereas the maximum of the sedimentation profile of polyparticles decreased from 90S to 50S after treatment with increasing NaCl concentrations, a discontinuous change was found in the case of monoparticles. It was shown by sodium dodecyl sulfate-polyacrylamide gel electrophoresis that the proteins which were dissociated by NaCl were in the molecular weight range of 30--45 000. Four of the 5 small molecular weight RNAs in the range of 4.5 to 8S remained tightly associated even after treatment of polyparticles with 2.0M NaCl. When 38S or 70--200S nRNP particles were exposed to increasing concentrations of NaCl (0.25, 0.5, 1.0, 2.0M), the molar ellipticity at 264 nm increased progressively to about 40%. Upon NaCl treatment of polyparticles and successive removal of the dissociated proteins by centrifugation the increase in the positive CD band at 264 nm was only 15%.

[Effects of alcohol in the embryo, fetus, and newborn infant (author's transl)]

At delivery the newborn infant of a drunken mother had a bloodalcohol concentration of about 2.0%. The elimination rate was calculated to be 0.08%/h. The infant exhibited obvious features of an embryofetal alcohol syndrome. Several cases from literature are cited with ethanol given for therapeutic purpose in obstetrics and bloodalcohol concentration exceeding to 1%-2%. This means that values up to 2% in newborn infants without any other pathological findings should not solely be accepted as cause of death in forensic cases.

[Erythrocyte concentrate instead of whole blood: perspectives for blood banks and clinical therapy]

In 1974 some 117 000 units of blood were collected by the German Red Cross Blood Center in Ulm. Some 65 000 units were distributed to hospitals, mainly as whole blood. The surplus blood units (44%) were used for the preparation of plasma products. On 1 October 1974 glass bottles were replaced by plastic blood bags. The same date was chosen for the introduction of buffycoatfree red cell concentrates. It proved possible to replace whole blood almost entirely (92% of all blood units) by red cell concentrates within a few days after the deadline. The factors which prompted the clinicians to follow this new policy are described, and the clinical and economic implications are discussed.