Geographic distribution and origin of CFTR mutations in Germany

The geographic distribution and origin of CFTR mutations in Germany was evaluated in 658 three-generation families with cystic fibrosis (CF). Fifty different mutations were detected on 1305 parental CF chromosomes from 22 European countries and overseas. The major mutation. delta F508 was identified on 71.5% of all CF chromosomes, followed by R553X (1.8%), N1303K (1.3%), G542X (1.1%), G551D (0.8%) and R347P (0.8%). According to the grandparents' birthplace, 74% of CF chromosomes had their origin in Germany; the delta F508 percentage was 77%, 75%, 70% and 62% in northern, southern, western and eastern Germany, respectively. Ten or more mutant alleles in the investigated CF gene pool originated from Austria, the Czech Republic, Poland, Russia, Turkey and the Ukraine. This widespread geographic origin of CFTR mutations in today's Germany reflects the many demographic changes and migrations in Central Europe during the 20th century.

Effective Leucocyte Depletion of Platelet Concentrates by Filtration without Flow Reduction

Bei Langzeitsubstitutionen mitThrombozytenkonzentraten ist eine effektive Redu-zierung der Leukozytenkonzentration unerläβlich. Bisher war die Reduktion der Fluβrate während der Filtration notwendig, was mit einem erheblichen Zeitaufwand verbunden ist. Wir untersuchten die Effektivität der Leukozytendepletion durch Filtration von Thrombozytenkonzentraten ohne Fluβreduktion mittels Sepacell PL 5 II BT1. Verwendet wurden Random-Thrombozytenkonzentrate (5 Einzelpräparate gepoolt) bzw.Thrombozytapheresekonzentrate (Fresenius AS 104). Die Filtrations-zeit betrug in Abhängigkeit vom Volumen (Apheresekonzentrat 220 ml, Random-Poolpräparat 400 ml) 3–4 min. Obwohl die Volumen-Recovery für beide Präparate gleich hoch war (92 bzw. 94%), lag die Thrombozytenausbeute im Apheresekonzentrat mit 82% unter der des Poolpräparates (87%). Die Entfernung der Tropf-kammer im Filtersystem führte zu einer signifikant höheren Thrombozytenausbeute (92%). Der Restleukozytengehalt (Nageotte-Zählkammer) lag für alle Präparate unter der CILL-Dosis (critical immunogenic leucocyte load) von 1 × 10⁶ (0,6 × 10⁵,0,2 × 10⁶ bzw. 0,3 ×10⁶). Die Untersuchungen haben gezeigt, daβ eine Fluβreduktion bei der Filtration von Thrombozyten nicht notwendig ist. Auf die im Filtersystem integrierte Tropfkammer kann verzichtet werden, wodurch der Thrombozytenverlust deutlich reduziert wird.

Acute jejunal ileus in intestinal lymphangiectasia

A 26-year-old patient presented with epigastric pain of sudden onset and severe puffy swelling of both legs and forearms. An irregularly shaped nodular filling defect on selective jejunal films, severe hypoproteinemia, low IgG concentration, and lymphopenia were suggestive of primary intestinal lymphangiectasia with protein-losing enteropathy, and the patient was placed on a low-fat diet with medium-chain triglycerides. This initially improved his condition, but some weeks later he developed obstructive ileus of the small intestine. On laparotomy yellowish to whitish deposits were found to be present in some segments of the small intestine and a fist-sized mass 100 cm distal to the duodenojejunal flexure was resected without complications. Histologically, the submucosal lymphatics were dilated, and the jejunal wall showed extensive pseudocystic, intramural submucosal lymph edema with secondary bleeding and tight stenosis of the jejunal lumen. During the 14-month follow-up time after discharge the patient has been asymptomatic and working, on no treatment other than a low-fat diet with medium-chain triglycerides.

The spectrum of CFTR mutations in south-west German cystic fibrosis patients

The cystic fibrosis transmembrane conductance regulator (CFTR) gene of 110 cystic fibrosis (CF) patients from the south-west of Germany was screened for 12 different mutations. This analysis resulted in an identification of 79% of all CF mutations and a complete genotype in 66% of the families. The most common mutation found was delta F508 (67%). Another 5 mutations accounted for a further 12.5% (4% G542X; 3% R553X; 3% N1303K; 2% 1717-1 G-->A; 0.5% G551D) whereas 6 mutations (R117H, A455E, delta I507, S549I, S549N, and R1162X) were not found. Fifty-four (49%) patients were delta F508 homozygotes and 18 (16.5%) were compound heterozygotes for delta F508 and one of the rarer mutations. These frequencies differ slightly from those found in the north of Germany and considerably from those reported from the south of Europe, which seems to be consistent with a north to south decline of the relative abundance of delta F508. Two patients, age 6 and 25 years, were compound heterozygotes for G542X and N1303K. The clinical features of the 6 year old were characterised by severe gastrointestinal and as yet only mild pulmonary complications whereas the 25 year old manifested severe pulmonary and gastrointestinal symptoms indicating that the N1303K mutation of the C-terminal CFTR nucleotide binding fold significantly impairs protein function in both the pancreas and the lungs.

[Amnestic episodes]

Amnesic episodes, by no means infrequent occurrences, are likely to trigger off anxiety in the patient and to evade adequate diagnostic interpretation. They consist of an isolated disturbance of short-term memory, manifesting itself as a permanent memory gap. The clinical features may vary from a conspicuous behaviour with stereotype repetition of questions to a completely inconspicuous picture with flawless execution of even highly differentiated behaviour patterns. The vegetative state may either be completely undisturbed or vary from mild impairment with nausea and vertigo to marked vegetative disorder. We are advocating a classification in 3 groups: a) "Genuine" amnesic states as symptoms of impaired blood flow in the basilar system in the absence of other etiological clues. b) "Symptomatic" amnesic episodes with tangible pathogenic factors, such as injury of the head and cervical spine, epilepsy, intoxication with various agents. The "genuine" amnesic states can also be regarded as transitory ischemic attacks of the basilar system. They show the following criteria: preponderance in females beyond middle age, duration of several hours, relatively high frequency of vascular risk factors and degenerative changes in the cervical spine, often triggered off by stress on the cervical spine, low tendency towards recurrence, general clinical benignity. In consequence, we stress the importance of etiological clarification before the onset of therapy. After the diagnosis of "genuine" amnesic state has been established, treatment has to be in accordance with the principles of basilar stroke therapy with subsequent vascular prophylaxis. Nevertheless, because of possible therapeutic or forensic consequences, the "symptomatic" states have to be kept in mind.

Frequency of herpes simplex virus-specific murine cytotoxic T lymphocyte precursors in mitogen- and antigen-driven primary in vitro T cell responses

The aim of this study was to assess and to compare the frequencies and specificities of herpes simplex virus (HSV)-specific cytotoxic T lymphocyte precursors (CTL-p) in mitogen (concanavalin A)-activated splenic T cells, as well as in antigen-activated splenic T cells of normal nonimmunized mice. In the mitogen-driven system one of 130 T cell blasts developed clonal progenies able to lyse specifically HSV-infected syngeneic targets. In the antigen-driven system HSV-specific CTL-p could be detected in normal lymphocytes provided the stimulator cells used were enriched for dendritic cells and pulsed with high concentrations of heat-inactivated HSV. Depending on the mouse strain used, the frequencies of HSV-specific CTL-p ranged from 1/500 to 1/10,000 in normal mice. Upon antigen priming within local lymph node cells, an increase of frequencies from 1/500 to 1/170 was observed in CBA/Ca mice.

Frequency of herpes simplex virus-specific murine cytotoxic T lymphocyte precursors in mitogen- and antigen-driven primary in vitro T cell responses

The aim of this study was to assess and to compare the frequencies and specificities of herpes simplex virus (HSV)-specific cytotoxic T lymphocyte precursors (CTL-p) in mitogen (concanavalin A)-activated splenic T cells, as well as in antigen-activated splenic T cells of normal nonimmunized mice. In the mitogen-driven system one of 130 T cell blasts developed clonal progenies able to lyse specifically HSV-infected syngeneic targets. In the antigen-driven system HSV-specific CTL-p could be detected in normal lymphocytes provided the stimulator cells used were enriched for dendritic cells and pulsed with high concentrations of heat-inactivated HSV. Depending on the mouse strain used, the frequencies of HSV-specific CTL-p ranged from 1/500 to 1/10,000 in normal mice. Upon antigen priming within local lymph node cells, an increase of frequencies from 1/500 to 1/170 was observed in CBA/Ca mice.

[Presentation of a survey scale for neuro-rehabilitation--with a general discussion of current rehabilitation scales]

Presented is a newly developed rehabilitation survey scale for the field of neuro-rehabilitation, in which levels of functioning relative to ten specific and four global functions are documented at set intervalls by means of a five-grade rating scale. Additionally, numerous symptoms or associated phenomena are recorded ungraded. Used in the clinical setting, this scale affords a quick overview of the rehabilitation profile, with relatively little time and effort being required. Scientific evaluation may uncover information on the impact the disorders of specific functions have on global functions, which is relevant primarily in the social context. Also, the scale may be applied in the framework of larger-scale comparative studies. Dealt with in an extensive discussion, our newly presented scale may be accorded a number of advantages over currently used scales, which warrant its introduction. It is the outcome of many years of developmental work and pertaining reliability verifications.

Dopamine stimulated glycosylation of brain proteins in vitro is inhibited only partially by dopamine receptor antagonists

Dopaminergic agonists which act on adenylate cyclase-linked dopamine receptor sites (D1-type) (dopamine, apomorphine and ADTN) induced a dose-dependent increase in the incorporation of L-fucose and D-mannose into glycoproteins of hippocampal, striatal and cortical slices of rat and mouse brain, whilst in rat liver slices dopamine failed to elicit such alterations in protein glycosylation. Testing in slices of rat hippocampus dopaminergic agonists with selective affinity to D2-receptors (bromocriptine, ergometrine) no changes in sugar incorporation into glycoproteins of rat hippocampus were observed. Dopamine stimulated L-fucose incorporation into rat hippocampal glycoproteins was inhibited to a different degree, but almost incompletely by dopamine receptor antagonists like haloperidol, D-butaclamol, promazine and alpha-flupenthixol, whilst chloropromazine and the selective D2-receptor antagonist sulpiride were without any effects. Also serotonin receptor antagonists (cinanserine) and beta-adrenergic receptor blockers (pindolol, alprenolol, practolol) failed to interfere with this dopamine action. But D,L-propranolol enhanced dopamine stimulated glycosylation of rat hippocampal proteins in an additive synergistic manner. This effect appeared to be not related to the antagonistic action of propranolol on beta-adrenergic receptor sites. From our results it is concluded that interactions with dopamine receptor sites (D1-type) is only one part of the mechanism triggering dopamine stimulated glycosylation of brain proteins in vitro.

Abdominal wall hernias as a complication of peritoneal dialysis

Home peritoneal dialysis has recently become an important addition to the therapy of chronic renal failure. Abdominal wall hernias have become more apparent as complications of this mode of dialysis, with isolated instances of incarcerations and one fatality. Results of our review of 276 patients receiving peritoneal dialysis revealed seven with hernias, an incidence of 2.5 per cent. Six patients with hernias were receiving c.a.p.d.; one patient was receiving c.c.p.d., and none was receiving i.p.d., for incidences of 17, 5 and zero per cent, respectively. All hernias found at presentation occurred within two to 20 months after peritoneal catheter placement. Most were ventral or umbilical, and all were repaired electively without serious complications. All patients with hernias had associated problems with leaks, peritonitis or predialysis hernias. In two of four patients with predialysis hernias, herniorrhaphy without catheter removal resulted in two recurrences. Abdominal wall hernias are a more frequent complication of c.a.p.d. and c.c.p.d., modalities which require large volumes of peritoneal dialysate during ambulatory hours. Review of the literature reveals that wound tensile strength and healing are decreased in those patients having renal disease with uremia, anemia and malnutrition. However, these factors do not increase the over-all incidence of hernias. Patients should be screened for hernias, and hernias should be repaired prior to catheter placement. Hernias presenting during dialysis are best treated by herniorrhaphy and hemodialysis postoperatively or low volume peritoneal dialysis to optimize the metabolic state.

[Results of treatment with the anti-depressive agent lofepramine in neurological practice]

The effectiveness and tolerance of Lofepramine was investigated in a neurological practice on 100 patients with predominantly slight and moderately severe depressive states. The treatment could be carried out according to the trial plan on 78 patients and the success of the therapy could be evaluated. 67 patients showed definite improvement (85.9%) and tolerance was good to very good in 96.2% of the cases. Although a tranquilizaer was also administered to 62 patients, the success of therapy was definitely accounted for by the antidepressant. This applies particularly to the symptoms of fear, tiredness and impairment of work capacity as well as "depressive mood", hypochondria, somatization and states of agitation. No serious side effects were observed in any patient. Insufficient success in therapy was observed most often when the minimal dose of 35 mg per day was administered, while convincing results were obtained by a dosage of 70 to 140 mg of Lofepramine daily. A large number of patients who were initially treated with higher doses of Lofepramine profited from a subsequent long-term therapy lasting several months during which 17.5 to 35 mg of Lofepramine were administered daily.