[Food borne outbreak of a Salmonella enteritidis epidemic in a large pharmaceutical industry]

In summer 1991 an outbreak of a Salmonella enteritidis epidemic involving about 600 cases of gastroenteritis occurred at one of the leading pharmaceutical companies in southwestern Germany. The main source was a cold fruit soup, in addition Salmonella were isolated from meat strips and a curd cheese which were used for a salad dressing. A total of 2300 contaminated food portions were served resulting in an attack rate of about 25%. The possible origin could have been an asymptomatic Salmonella-positive member of the kitchen personnel who was the only one who was involved with the preparation of all the incriminated foods. A further spread of the epidemic and especially the possible contamination of pharmaceuticals was avoided by the timely and adequate reaction of the company's occupational medical service. This case exemplifies how classical crisis management, "increased initiative on one's own for prevention of infections in all areas of food processing" (Steuer) and finally the cooperation of the company with different institutions of the public health authorities contribute to the control of such a catastrophic scenario.

[Concurrent and predictive correlations between emotions and cardiovascular and metabolic parameters in patients with myocardial infarct]

Amongst 86 patients with myocardial infarction, during their stay in a rehabilitation clinic, emotions (Gottschalk-Gleser speech content analysis), assessed at the beginning of the treatment, and cardiovascular (systolic and diastolic blood pressure, heart rate and reactivity during physical stress, performance) and metabolic parameters (triglycerides, HDL- and LDL-cholesterin, cholesterin/HDL, uric acid) assessed at the beginning (concurrent) and end (predictive) of the treatment, are examined. The emotion-factors "dejection" (anger in, shame and death anxiety) and "aggression" (anger out-open, anger out-hidden and ambivalent aggression) show the following association with the biological factors in stepwise regression analysis, taking into account age, body-mass-index, smoking and drugs: dejection is concurrent associated with lower systolic and diastolic blood pressure and lower HDL-cholesterin and predictive with lower uric acid, lower HDL-cholesterin and higher cholesterin/HDL. Aggression corresponds predictive with higher pulse rate and higher reactivity during physical stress, lower HDL-cholesterin and higher cholesterin/HDL.

Veratridine activates a silent sodium channel in rat isolated aorta

To investigate the existence of silent Na+ channels, isolated rat aorta was treated with veratridine (0.1 mM) and the resulting Ca2+ uptake was determined. After 30-min incubation the total tissue uptake of Ca2+ and Ca2+ uptake increased from 2.325 +/- 0.017 to 2.614 +/- 0.080 nmol/mg wet weight (ww) and from 162.6 +/- 9.7 to 218.1 +/- 13.0 pmol/mg ww, respectively. The veratridine-induced Ca2+ uptake was blocked by tetrodotoxin (1 microM; to 17 +/- 5%) but not altered by amiloride (10 microM-1 mM). Activation of Na+/Ca2+ exchange by Na+ removal increased Ca2+ uptake from 74.2 +/- 4.5 to 97.3 +/- 5.3 pmol/mg ww, which was suppressed by amiloride (10 microM-1 mM). Nifedipine (10 nM) and verapamil (0.1 microM) at concentrations at which depolarization-induced Ca2+ uptake was diminished did not attenuate veratridine-induced Ca2+ uptake. Phenytoin at 0.1 mM reduced the Ca2+ uptake induced by veratridine or by depolarization. R 56865 (0.1 microM) and R 59494 (1 microM), novel anti-ischemic compounds inhibiting slowly inactivating Na+ channels, suppressed the veratridine-induced but not the depolarization-induced Ca2+ uptake. Guanidinium uptake was increased by veratridine (0.1 mM) from 371.2 +/- 7.2 to 574.8 +/- 45.9 pmol/mg ww. These results suggest that the rat aorta possesses a Na+ channel which is electrically silent under normal conditions but could be activated by veratridine.

Fatty acids in the portal vein of the rat regulate hepatic insulin clearance

The effects of FFA on hepatic insulin clearance were studied in the in situ perfused rat liver. Clearance decreased with increasing body weight (age) of the rats. When FFA were added to the perfusate a 40% reduction of hepatic removal of insulin was found over the normal, physiological range (less than 1,000 mumol/liter), less pronounced in heavier rats. When perfusion was started with high concentrations of FFA, inhibition was rapidly reversible, a phenomenon again blunted in heavier rats. In contrast to FFA, different glucose concentrations in the perfusate did not affect the hepatic insulin uptake in the presence of FFA within physiological concentrations. Thus, hepatic clearance of insulin is proportional to rat weight (age) and portal FFA concentrations. Other studies have recently shown that fatty acids inhibit insulin binding, degradation, and function in isolated rat hepatocytes, and that hepatic clearance is inversely dependent on hepatic triglyceride concentrations, both inhibitions reversible by prevention of fatty acid oxidation. It is suggested that the diminished hepatic clearance of insulin in heavier (older) rats is at least partly due to their relative obesity and increased hepatic triglyceride contents. This effect as well as that of portal FFA is probably mediated via fatty acid oxidation in the liver. This mechanism may have implications for the regulation of hepatic metabolism, and peripheral insulin concentrations.

Veratridine-induced intoxication in the isolated left atrium of the rat: effects of some anti-ischemic compounds

Veratridine-induced Na+ and Ca2+ uptake was used as a simulation of ischemia-induced Na+ and Ca2+ uptake. Therefore, electrically driven (1 Hz) isolated left atria of the rat were intoxicated with veratridine and the 45Ca2+ uptake was determined. Veratridine (10(-4) mol/l) increased the 45Ca2+ uptake from 575 +/- 13 to 2320 +/- 86 dpm/mg ww (n = 20). The total tissue content of 45Ca was elevated from 4328 +/- 132 to 5136 +/- 303 dpm/mg ww (n = 13). The veratridine-induced 45Ca2+ uptake was completely suppressed by tetrodotoxin (10(-7) and 10(-6) mol/l), whereas amiloride (6.10(-6) mol/l) and phentolamine (10(-6) and 10(-5) mol/l) exhibited no effect on the veratridine-induced 45Ca2+ uptake. Nifedipine (10(-7) and 10(-6) mol/l) was ineffective on veratridine-induced 45Ca2+ uptake. Verapamil (10(-5) mol/l) suppressed the veratridine-induced 45Ca2+ uptake, but the 45Ca2+ uptake in the absence of veratridine was also suppressed by verapamil (10(-6) and 10(-5) mol/l). The novel anti-ischemic compounds R 56865 (10(-8)-10(-5) mol/l) and R 59494 (10(-8)-10(-5) mol/l) totally abolished veratridine-induced 45Ca2+ uptake. It is speculated that Ca2+ enters the cell via a Na+ channel which changes its selectivity upon veratridine treatment. Consequently, R 56865 and R 59494 could display their protective effect by either inhibiting the modified Na+ channel or preventing the transition of the normal Na+ channel to its altered state.(ABSTRACT TRUNCATED AT 250 WORDS)

45Ca2+ movements induced by Ca2+ chloride in isolated rat aorta under K(+)-free conditions

Increasing the extracellular Ca2+ concentration induced a dihydropyridine-insensitive contraction in the isolated rat aorta bathed in K(+)-free solution. To obtain further insight into the mechanism of this contraction 45Ca2+ uptake measurements were carried out with isolated rat aorta. Increasing the extracellular Ca2+ concentration from 0.63 to 5.0 mM enhanced the 45Ca2+ uptake from 186 +/- 3 to 359 +/- 12 dpm/mg ww (n = 8). Under K(+)-free conditions increasing the extracellular Ca2+ concentration from 0.63 to 5.0 mM enhanced the 45Ca2+ uptake from 184 +/- 4 to 541 +/- 6 dpm/mg ww (n = 12) and elicited an increase in tension of 10.0 +/- 0.4 mN (n = 9). The Ca2(+)-induced 45Ca2+ uptake was not affected by the Ca2% channel antagonists, nifedipine (L-type), flunarizine (L- and T-type) and omega-conotoxin (N-type). Amiloride, a blocker of the Na+/Ca2+ exchange, indomethacin, a blocker of prostaglandin synthesis, the local anaesthetic, lidocaine, and the Ca2+ overload blocker. R 56865, had no effect on Ca2(+)-induced 45Ca2+ uptake. Additionally, R 56865 did not affect the Ca2(+)-induced contractile response. The inorganic Ca2+ entry blocker, lanthanum, reduced both the non-stimulated and stimulated 45Ca2+ uptake and inhibited the Ca2(+)-induced contractile response. We would like to suggest that the 45Ca2+ uptake induced by Ca2+ under K(+)-free conditions enters the cell via the leakage Ca2+ channel, because lanthanum was an effective antagonist and a significant contribution of any other Ca2+ pathway could not be demonstrated.

Adjuvant therapy of colorectal cancer: an overview

The substantial recurrence rate of colorectal cancer following potentially curative resection has fuelled the search for effective adjuvant therapy. Previous trials using 5-fluorouracil (5-FU) as a single agent or in combination chemotherapy regimens have not demonstrated meaningful benefits, an impression reflected in the results of a meta-analysis encompassing large patient numbers. Newer developments utilizing intraportal chemotherapy and the combination of 5-FU and levamisole have resulted in lower recurrence rates and improved survival in patients with colon cancer. In advanced disease, the biochemical modulation of 5-FU by Leucovorin has been shown to prolong survival in some studies. Combined chemotherapy and radiotherapy or chemotherapy alone have showed promising results in rectal cancer. These developments have now been incorporated into ongoing trials.

Multichannel biomagnetic system for study of electrical activity in the brain and heart

The authors designed a multichannel system for noninvasive measurement of the extremely weak magnetic fields generated by the brain and the heart. It uses a flat array of 37 superconducting magnetic field-sensing coils connected to sophisticated superconducting quantum interference devices. To prevent interference from external electromagnetic fields, the system is operated inside a shielded room. Complete sets of coherent data, even from spontaneous events, can be recorded. System performance was evaluated with phantom measurements and evoked-response studies. A spatial resolution of a few millimeters and a temporal resolution of a millisecond were obtained. First results in patients with partial epilepsy and investigations of the cardiac conductive pathway indicate that biomagnetism is now ready for a systematic clinical evaluation. Interpretation of measurements was facilitated by highlighting biomagnetically localized electrical activity in three-dimensional digital magnetic resonance images.

[Sex-specific changes in body composition during weight reduction]

The aim of this study was to ascertain whether overweight men and women of comparable age, body surface area and weight would display any differences in weight loss or changes in body composition while receiving identical calorie intakes. 15 men and 15 women of mean age 46.7 (26-57) years with obesity (body mass index 29-36 kg/m2) were given a reducing diet containing 700 kcal/d for 4 weeks. The two groups were identical in age, body weight and height. The change in body composition was studied by means of ultrasound and nitrogen balance. The women had thicker layers of subcutaneous fat (241 +/- 8 mm) over all parts of the body than the men (137 +/- 10 mm) (summated measurements at 14 points). Among the men body weight fell from 93.1 +/- 2.1 to 83.8 +/- 2.0 kg, but the women declined only from 92.9 +/- 2.0 to 84.7 +/- 1.9 kg. Although men achieved a greater weight loss (13%; P less than 0.001) the decrease in their subcutaneous fat layer was 33% less (to 117 +/- 9 mm) than in the women (211 +/- 8 mm). Cumulative nitrogen balance among the men was 4.7 times more negative than in women (-104 +/- 14 g versus -22 +/- 11 g); this points to accentuated muscle breakdown. More fat was mobilized in the women than in the men, chiefly from the regions of the limbs and hips.

[Focus of criticism--inpatient rehabilitation]

Inpatient rehabilitation has become an integral part of our health system. Whereas this development strikes a mood of optimism, it also raises several problems. These are mainly in respect of the selection of patients, the duration of the rehabilitation measure, the integration of family members and relatives, and the aftercare period. We are still without an adequate concept of rehabilitation and we lack a delineation between prevention, cure treatment and acute treatment methods. This lack of a clear approach makes systematic rehabilitation research absolutely mandatory.

Treatment of coronary heart disease by diet and exercise: fasting and diurnal lipoproteins

The effects of a combined exercise and low-fat dietary regimen were studied in 11 patients with angiographically documented coronary heart disease (cholesterol 233 mg/dl, triglycerides 158 mg/dl) and 13 comparable patients (cholesterol 224 mg/dl, triglycerides 174 mg/dl) on usual care. During one year, fasting serum lipoproteins were lowered to "ideal" levels in the intervention group (cholesterol 191 mg/dl, triglycerides 100 mg/dl, LDL-cholesterol 121 mg/dl). There was no change of triglycerides and cholesterol on usual care while LDL-cholesterol rose significantly. Neither regimen had any effect on HDL-cholesterol. Diurnal triglycerides as a presumptive measure of IDL in the intervention group were diminished by 39%. The study demonstrates the feasibility of a diet and exercise regimen to normalize mildly elevated plasma lipid levels and thus to possibly affect the course of coronary heart disease without drugs.

Low-fat diet and regular, supervised physical exercise in patients with symptomatic coronary artery disease: reduction of stress-induced myocardial ischemia

The effects of physical exercise and normalization of serum lipoproteins on stress-induced myocardial ischemia were studied in 18 patients with coronary artery disease, stable angina pectoris, and mild hypercholesterolemia (total serum cholesterol 242 +/- 32 mg/dl). These patients underwent a combined regimen of low-fat/low-cholesterol diet and regular, supervised physical exercise at high intensity for 12 months. At 1 year serum lipoproteins has been lowered to ideal levels (serum cholesterol 202 +/- 31 mg/dl, low-density lipoproteins 130 +/- 30 mg/dl, very low-density lipoproteins 22 +/- 15 mg/dl, serum triglycerides 105 [69 to 304] mg/dl) and physical work capacity was improved by 21% (p less than .01). No significant effect was noted on high-density lipoproteins, probably as a result of the low-fat/high-carbohydrate diet. Stress-induced myocardial ischemia, as assessed by thallium-201 scintigraphy, was decreased by 54% (p less than .05) despite higher myocardial oxygen consumption. Eighteen patients matched for age and severity of coronary artery disease served as a control group and "usual medical care" was rendered by their private physicians. No significant changes with respect to serum lipoproteins, physical work capacity, maximal rate-pressure product, or stress-induced myocardial ischemia were observed in this group. These data indicate that regular physical exercise at high intensity, lowered body weight, and normalization of serum lipoproteins may alleviate compromised myocardial perfusion during stress.

Is taurine a marker for retinitis pigmentosa?

In view of contrary reports in the literature on anomalies of taurine concentration in the blood of retinitis pigmentosa patients, taurine clearance has been determined in 19 patients and 17 controls. No significant difference has been found between the average values of the two populations. The taurine content in cataractous crystalline lenses of retinitis pigmentosa patients has been found higher than the taurine content in lenses with senile cataract, but the same behaviour was also shown by five selected proteogenic amino acids. The results are discussed together with related literature data to conclude that taurine can be involved at least in some subtypes of retinitis pigmentosa, but cannot be considered as a marker for the disease.

Metabolic effects and body fat mass changes in obese subjects on a very-low-calorie diet with and without intensive physical training

During 4 weeks, 40 obese subjects (body mass index 30-45 W/H2) were treated with a 300-kcal mixed diet alone or in combination with exercise training on a bicycle ergometer in a metabolic ward. Exercise had a minor effect on body weight, reflected by an additional fat loss of 1.7 kg (expected loss: 4.0 kg). Hyperinsulinemia was improved by diet and normalized by diet combined with exercise; a similar effect was observed regarding C-peptide levels. Plasma concentrations of epinephrine and norepinephrine decreased in both groups. At maximal work, norepinephrine levels were higher in the group with exercise. Free fatty acids and free glycerol increased at rest as well as during exercise in subjects on both regimens, the difference being more pronounced in the exercise group. Enhanced oxidation of fat was substantiated by lower respiratory quotients during endurance exercise. Working capacity increased and blood pressure decreased considerably as a consequence of physical training. It is concluded that exercise training in addition to a hypocaloric diet lowers body weight and body fat, although to a lower degree than expected. During and following bouts of exercise, fat mobilization and oxidation is enhanced, but these effects are probably counteracted at rest. On the other hand, the diet-induced deterioration of physical performance is overcompensated.

[Combination therapy of obesity with a reducing diet and physical training. Cardiovascular and metabolic effects]

Twenty obese patients were either given a caloric restricted diet (300 kcal/d) over 4 weeks alone or underwent an additional ergometer exercise programme for up to 2 hours daily. Combination therapy resulted in an improvement of physical performance by 26% despite weight loss of 11 kg. Blood pressure could be reduced both at rest and on exercise. Blood pressure regulation and heart rate under orthostatic conditions remained unchanged for both therapeutical approaches. The effect on carbohydrate and lipid metabolism was also more favorable in patients on combination therapy than in those given a reduction diet alone. Combination of reduction diet and physical exercise is therefore superior to caloric restriction alone with regard to cardiovascular and metabolic considerations.

[Pseudohypertriglyceridemia in glycerokinase deficiency]

Falsely high serum triglyceride concentrations (410-850 mg/dl) were measured in four members of a family of five from Franconia in Germany. The cause was hyperglyceridaemia on the basis of glycerol kinase deficiency. None had any symptoms and no other metabolic anomaly was demonstrated. The possibility of glycerol kinase deficiency should be considered in any case of elevated serum triglyceride concentration but with clear serum, normal lipid electrophoresis and lack of response to lipid-lowering measures.

Training-induced changes in serum lipids, fat tolerance, and adipose tissue metabolism in patients with hypertriglyceridemia

Ten males (mean age 44 years) with primary hypertriglyceridemia were trained for 4 months 3 times/week for 1-h sessions. Eleven patients with similar physical characteristics and hypertriglyceridemia served as controls. Serum was assayed for TG and cholesterol (CH) and the various lipoprotein fractions, apoprotein A-I, glucose, insulin, and C-peptide. The removal of TG from the circulation was estimated by the Intralipid test. An open fat biopsy was taken and the incorporation and esterification of [14C]palmitate and glycerol release were measured in vitro. Following endurance physical training, serum TG and VLDL-TG decreased by 25 and 27%, respectively. No changes were observed in total CH and CH in the lipoprotein fractions or in apoprotein A-I. Fat tolerance increased slightly (+8%) whereas the incorporation of labelled palmitate into adipose tissue was reduced by 16%. The diminished incorporation was concomitant with a reduction in the esterification of fatty acids to TG (-29%). Enhanced removal of TG may contribute to the lowering of serum TG. The skeletal muscle is probably responsible for this adaptation, whereas the uptake of TG into adipose tissue is diminished.