In vitro activity of the new quinoline derivative ciprofloxacin alone and in combination against various Mycobacterium-, Salmonella- and Escherichia coli strains

The antibacterial effect of 1-cyclopropyl-6-fluoro-1,4-dihydro-4-oxo-7-piperazine-1-ylquinoline++ + 3-carboxylic acid (ciprofloxacin, Bay o 9867) has been tested using different test systems and various strains, especially of Escherichia coli, Mycobacterium and Salmonella. Ciprofloxacin shows low MIC's against most of the tested strains. The high in vitro and in vivo activity against Salmonella is most promising for cure of salmonellosis.

[Esophageal carcinoma: transthoracic esophagectomy with regional lymphadenectomy and reconstruction with deferred priority]

In a retrospective analysis the risks were assessed of transthoracic oesophagectomy with mediastinectomy and regional lymphadenectomy followed 48-72 hours later by an abdomino-cervical operation with supra-pancreatic lymphadenectomy, retrosternal gastric interposition and cervical oesophageal stump anastomosis. Results in this group of 37 patients were compared with those in a group of 42 patients who had undergone a transmediastinal oesophagectomy (without thoracotomy) and immediate reconstruction. The 30-day death rate was 8.1% in the former (group I) and 7.1% in the latter (group II), total hospital death rate 10.8% and 11.9%, respectively. The complication rate was similar in the two groups, as was the recorded operative stress. The results indicate that the risk of an oncologically indicated oesophagectomy with regional lymphadenectomy is no greater than that of a palliative transmediastinal oesophagectomy.

[Clinical and prognostic relevance of the Kiel classification of non-Hodgkin lymphomas]

The Kiel classification provides a new subdivision of non-Hodgkin lymphomas into distinct entities showing different clinical and prognostic properties. In comparison with earlier classifications this system defines additional types of lymphoma (e.g. CC lymphoma, LP immunocytoma) (for abbreviations see text) which are to be considered separate entities also from a clinical point of view. By data derived from a multicenter prospective observation study (1,127 patients recruited from 1975 to 1980, follow-up until 1985) a precise definition of the clinical features of each lymphoma entity (e.g. frequency, age and sex distribution, patterns of initial involvement and spread of disease) was possible. In addition, the effect of radio- and/or chemotherapeutic measures was evaluated. Strictly localized disease (stage I/IE according to the Ann Arbor classification) occurred in 1.5 to 8% of patients with NHL of low-grade malignancy (comprising 69.4% of cases studied) and in 8 to 17% of patients with high-grade malignant NHL (comprising 30.2% of cases studied). Loco-regional irradiation alone was able to induce complete remission in 86 to 89% (CB and IB lymphomas) and in 100% (LP immunocytoma, CB-CC and CC lymphomas), respectively, of stage I/IE patients. Only CC and IB lymphomas showed a relevant risk of relapse (40% and 50%, respectively). Total lymphoid irradiation as able to induce stable complete remissions in about 50% of patients with stage III of CB-CC lymphoma. Probabilities of survival of patients with initial stages III and IV treated by several types of chemotherapy reflect different prognostic features of individual lymphoma entities.(ABSTRACT TRUNCATED AT 250 WORDS)

Biological parameters in Japanese quail genetically selected for resistance or sensitivity to an acute hypoxic survival

Various biological parameters were measured in two strains of Japanese quail selected for their resistance (Ls+) or susceptibility (Ls-) to an acute normobaric hypoxic challenge. Adults of these two strains showed very little or no significant differences concerning body weights, carbon dioxide emission, photoperiodic (L----D and D----L) respiratory reactions, cloacal temperatures, heart rates and ECG QRSII amplitudes, red blood cell data, hemoglobin electrophoresis, and plasma corticosterone (before and after an hypoxic challenge). Enzymatic capacities of phosphofructo-and pyruvate kinases, of glucose-6-phosphatase, lactico- and malate-dehydrogenases, measured in brains and hearts, showed but few statistically significant differences. Changing societal contacts did not suppress the differences of acute hypoxic survival between the two strains. Several statistically significant differences which concern reproduction and eggs, and especially egg laying and egg water vapor conductance were noted between the two strains.

Aclarubicin (aclacinomycin A) in the treatment of relapsing acute leukaemias

Forty patients with relapsing acute leukaemias were treated with aclacinomycin A (aclarubicin, ACM), 25 mg/m2 i.v. daily for 7 days. Twenty-nine patients with acute myeloid (AML) and five with acute lymphoblastic (ALL) leukaemia were evaluable. The overall response rate was 29.5%. Eight complete (CR) and one partial (PR) remissions were achieved in AML (31%). A high CR rate was induced in patients treated at first relapse without prior reinduction (6/12 patients). A small proportion of leukaemias resistant to daunorubicin or doxorubicin responded to ACM (3/17 patients). Median remission duration was 5.5 months (range: 2-9 months). The most common toxic effects were nausea, vomiting, stomatitis and diarrhoea. Acute cardiotoxic effects were documented in three patients. Congestive cardiomyopathy was not observed despite prior treatment with anthracyclines. We conclude that the present dose scheduling of ACM is effective in the treatment of relapsing AML and that it should be introduced in combined chemotherapy in phase III trials to compare its activity to that of daunorubicin or doxorubicin.

High-performance liquid chromatographic and enzyme-inhibition assays of methotrexate concentrations in serum from patients receiving high-dose therapy: tight binding of some methotrexate to a protein that could be dihydrofolate reductase

In the serum of patients receiving high-dose methotrexate (MTX), concentrations of the drug were monitored using both high-performance liquid chromatographic (HPLC) and enzyme-inhibition assays. In samples obtained greater than or equal to 24 hours after drug application, the HPLC assay measured higher MTX concentrations than the enzyme-inhibition assay. In 72-hour samples, the increase was usually greater than 200%. This difference was not observed in serum spiked with MTX. While the HPLC assay needs sample cleanup, ie, protein precipitation, the enzyme-inhibition assay routinely employs native serum. When MTX was measured in the supernatant with the enzyme inhibition assay, the results equaled those obtained with the HPLC procedure. In patient serum, MTX eluted from a Sephadex G-75 column in two fractions. One had the same retention volume as free MTX and could be assayed directly. The other had a retention volume like dihydrofolate reductase. In this fraction, MTX could only be determined after denaturing proteins. Only small amounts of tightly bound MTX were found in the serum of patients on intermediate-dose therapy (500-600 mg/m2). The observation that after high-dose MTX therapy part of the MTX in patient serum is strongly bound to a protein which could be DHFR raises the question as to the source and fate of this complex. Furthermore, the present finding has clinical relevance to the extent that the accepted limits for risk of MTX toxicity are based on methods using native serum. However, any procedure employing protein precipitation for sample cleanup may grossly overestimate active MTX serum concentrations, especially in the 72-hour serum samples.

[Fiberoptic bronchoscopy in intensive care medicine--functional efficacy and methodological side effects]

A prospective study was performed to determine the side effects of fiberoptic bronchoscopy on cardiopulmonary function, the influence of bronchial lavage on cardiopulmonary function, and the functional efficacy of fiberoptic bronchoscopy in obstructive atelectasis due to retained secretions. In 17 patients endotracheal intubation was immediately followed by a significant (P less than 0.01) rise in arterial, pulmonary artery and pulmonary capillary wedge pressure, heart rate, and cardiac output. There were no statistically significant differences in arterial blood gases and intrapulmonary right-to-left shunt. Two patients showed circulatory changes indicative of a heart insufficiency on the left side. A significant increase (P less than 0.001) in intrapulmonary right-to-left shunt from 12% to 17.5%, a significant decline in arterial oxygen tension of 15 mm Hg, and a significant increase of cardiac output from 6.4 to 7.71/min following saline solution lavage (20 ml in each bronchus) were observed in nine patients. The results indicate that bronchial lavage is the essential mechanism for the decline in arterial oxygen tension induced by fiberoptic bronchoscopy. In patients with unstable cardiopulmonary status, the cardiovascular response during bronchoscopy may be hazardous and the bronchoscopist should be aware of the pathophysiologic side effects involved. Fifteen therapeutic bronchoscopies were performed in five critically ill patients with obstructive atelectasis, due to retained secretions. Following the procedure, Qs/Qt declined from 23.9% to 15%, cardiac output from 9.3 to 7.31/min, and arterial Po2 increased from 58.9 to 70.9 mm Hg. The differences were statistically significant (P less than 0.0001). The therapeutic value of fiberoptic bronchoscopy in the treatment of obstructive atelectasis is demonstrated by the significant improvement in cardiopulmonary status.

Assemblies of linear arrays of particles in the apical plasma membrane of mitochondria-rich cells in the gill epithelium of the Atlantic hagfish (Myxine glutinosa)

In the gill epithelium of the Atlantic hagfish Myxine glutinosa a mitochondria-rich cell type is described which ultrastructurally resembles the chloride cells in other fish species. Freeze-fracture replicas reveal different supramolecular structures in the luminal plasma membrane and in the intracellular amplification (tubular system) of the basolateral plasma membrane of these mitochondria-rich cells. In the luminal plasma membrane ordered assemblies of particles and fibril-like elements are regularly found. On the P face, the assemblies are composed of up to 20 linear arrays of particles which are preferentially located in the microvillar membrane on which they show a helicoidal orientation. The arrays are formed by globular (diameter 8-9 nm) and rod-shaped (length 16-20 nm) particles, which occasionally are so tightly end-to-end attached that they generate fibril-like structures. The distances between adjacent arrays within an assembly measure 10-15 nm. On the E face complementary patterns of linear grooves are present. These assemblies have not previously been demonstrated in the freeze-fractured plasma membrane of branchial chloride cells. In the membrane of the tubular system, emerging from the basolateral plasma membrane of the mitochondria-rich cells, infrequently repeating rows of 7-8 nm particles are present in addition to randomly distributed globular particles (diameter 7-8 nm). Complementary patterns of grooves are present on the E face. These intramembranous structures resemble the repetitive elements which have been previously described in the tubular system of branchial chloride cells in euryhaline teleosts and the subunits of which are considered to be the sites of ion pumps.

Cellular hyperplasia and hypertrophy, capillary proliferation and myoglobin concentration in the heart of newborn and adult rats at high altitude

Newborn rats and their mothers were subjected to a simulated altitude of 5000 m for 4-5 weeks. Weight, capillary density (CD), fiber cross-sectional area (AF) and capillary-to-fiber ratio (C/F) of right (RV) and left (LV) ventricles and myocardial myoglobin (Mb) concentration were measured weekly in the newborns and at the end of the high altitude sojourn in the adults. Results were compared to sea level controls. In the adults, adaptive changes were only observed in the right ventricle. In newborns both, RV and LV, exhibited significant alterations. After 2 weeks at 5000 m the ventricular weight increase was 223% (RV) and 40% (LV) in the newborns and 96% in the adults' RV. Whereas only fiber hypertrophy was detectable in the RV of the dams, cardiac weight increase of the acclimatized neonates resulted from both, hypertrophy and hyperplasia of the myocytes. Appropriate capillary proliferation kept CD constant. Cardiac Mb concentration did not change. We conclude, that capillary neoformation primarily counteracts the increase of the O2 diffusion distance due to fiber hypertrophy and/or hyperplasia.

The significance of the number of centroblasts in centroblastic/centrocytic lymphomas. A long term study in a large group of patients

A group of 385 centroblastic/centrocytic lymphomas with long follow-up periods was subdivided on the basis of the relative number of centroblasts in the initial biopsies. Only minor differences in overall survival were found although a different survival pattern was observed between the groups. The transition into a high-grade malignant secondary centroblastic lymphoma correlated, at a statistically significant level, with the relative number of centroblasts in the initial biopsy.

[Quality control of the self-measurement of blood sugar in unselected type I diabetics. The importance of patient training]

Unselected type I diabetics were hospitalized for group training and treatment programme during which blood-sugar was self-monitored with the Haemo-Glukotest 20-800; quality of self-monitoring improved appropriately. The patients had taken part in either the standard training programme (67 patients) or in the "intensive" training programme (101 patients). At the beginning of the training week, after the first theoretical and practical instructions, the quality of blood-sugar self-monitoring was equally poor among patients of both programmes. At the end of the "standard" training week, self-monitoring results were still unsatisfactory, though slightly better than at the onset. Because of these poor results, the training programme was intensified. Optimal quality of self-monitoring was then achieved at the end of the training period. In 69 others, also unselected, type I diabetics the quality of self-monitoring was determined 14 months after their participation in the training programme. Using the Haemo-Glukotest 20-800 (57 patients), self-monitoring gave excellent results; using a blood-glucose measuring instrument (12 patients) it was slightly worse. Assuming intensive training, even unselected type I diabetics can obtain accurate blood-sugar measurements using test-strips.

[Clinical aspects and therapy of anaplastic T-zone lymphoma]

Between 1 January 1975 and 30 June 1983 four anaplastic T-cell lymphomas (1.1%) were observed among 368 non-Hodgkin lymphomas. The median age was 61.5 years (range 33 and 76 years). Males and females were equally affected. At the time of diagnosis stage IIIM- was seen in three cases and stage IVM+ in one case. In three of the four patients a marked B-symptomatology was noted. The median Karnofsky index was below 50%. Due to cardiac failure two patients were treated with combined cyclophosphamide, vincristine, procarbazine and prednisone and a lasting complete remission was achieved in both cases. The two other patients were treated with combined bleomycin, adriamycin, cyclophosphamide, vincristine and prednisone due to rapid progression. Lasting complete remissions were seen in the same manner. The median survival time is 42+ months, the Karnofsky index 100%.

Oxygen and carbon dioxide transport in the blood of the muskrat (Ondatra zibethica)

We have investigated the oxygen and carbon dioxide transport properties of a small diving mammal, the muskrat (Ondatra zibethica), where the hemoglobin primary structure has been established by Duffy et al. (1978). While whole blood oxygen capacity, the Haldane effect and the buffer capacity are not different compared to non-diving mammals of similar size, the Bohr effect and the oxygen affinity are increased. The oxygen half saturation pressure (P50) was 26.1 mm Hg (3.5 kPa) at pH 7.4, and the Bohr effect -0.66 (related to plasma pH) and -1.07 related to cell pH. The high affinity of muskrat blood is caused by a comparatively small effect of 2,3 DPG and CO2 on muskrat hemoglobin, that is accentuated through a relatively low concentration of 2,3-DPG in the muskrat red cell. The increased Bohr effect is caused primarily through the pronounced pH dependence of oxygen-linked binding of 2,3-DPG. The weak interaction of muskrat hemoglobin with 2,3-DPG is not caused by substitutions at the binding site.

Clinical and prognostic relevance of the Kiel classification of non-Hodgkin lymphomas results of a prospective multicenter study by the Kiel Lymphoma Study Group

Clinical and prognostic relevance of the Kiel classification of non-Hodgkin lymphomas (NHL) was investigated in 1127 patients entering a prospective multicenter observation study. Survival of the 782 (69.4 per cent) patients with low-grade malignant NHL (lymphocytic lymphomas, predominantly B-CLL, LP immunocytoma, centrocytic lymphoma, centroblastic-centrocytic lymphoma) exceeded that of the 341 patients (30.2 per cent) with high-grade malignant NHL (centroblastic, immunoblastic, lymphoblastic lymphomas). Prognosis was best in centroblastic-centrocytic lymphoma and in B-CLL and least favorable in immunoblastic and lymphoblastic lymphomas. Survival of LP immunocytoma and centrocytic lymphoma patients was intermediate after 2 to 2.5 years of follow-up. Corresponding to histopathology, pattern of survival curves of low-grade malignant NHL (slow decline, no plateauing) differed from that of high-grade malignant NHL (rapid decline, subsequent plateauing). Prognosis of B-CLL was superior to that of LP immunocytoma. Stages I and II were more frequent in centroblastic-centrocytic lymphoma (21 per cent) than in LP immunocytoma (2.5 per cent) and centrocytic lymphoma (11 per cent). Ability of radiotherapy to induce stable complete remissions in stage III of centroblastic-centrocytic lymphoma indicates prolonged restriction of lymphoma to the lymphatic system. In immunoblastic and centroblastic lymphomas, stages I and II were diagnosed in 34 and 38 per cent of cases, respectively, but only in stage I/IE of centroblastic lymphoma prolonged remissions were achieved by radiotherapy. In advanced high-grade malignant NHL marked improvement of prognosis was solely possible by induction of complete remissions whereas in corresponding low-grade malignant lymphomas also partial remissions were prognostically relevant.

Freeze-fracture study of the turtle lung. 2. Rod-shaped particles in the plasma membrane of a mitochondria-rich pneumocyte in Pseudemys (Chrysemys) scripta

In thin sections of the lung of the fresh-water turtle Pseudemys (Chrysemys) scripta some pneumocytes can be distinguished from the remaining pulmonary epithelial cells by a larger amount of mitochondria. In these cells the typical features of type-I and type-II cells are absent. Freeze-fracture replicas reveal rod-shaped particles in the apical plasma membrane of a small population of pneumocytes, which by cytological criteria seem to be identical with the mitochondria-rich cells observed in thin sections. It is assumed that these cells represent a distinct type of pneumocytes in the turtle lung and that they are a member of the group of mitochondria-rich cells present in some ion-transporting epithelia. The function of these cells in this location remains to be determined.

Histological, epidemiological and clinical aspects of centroblastic-centrocytic lymphomas subdivided according to the "working formulation"

A group of 424 lymphomas diagnosed as centroblastic-centrocytic lymphomas at the Lymph Node Registry in Kiel was subdivided into small (S), mixed (M) and large (L) cell groups, according to the "working formulation" proposed in a National Cancer Institute sponsored study. Histological epidemiological and clinical parameters were studied. It was found that in group S a follicular growth pattern was most frequent and in group L a follicular and diffuse growth, while group M took an intermediate position. No statistically significant differences were found in respect to epidemiological factors or overall survival. However, in the first 6 years after the diagnosis the survival in group S was better than in group M, but thereafter a reversal occurred. Group L appeared to have the worst survival throughout. Growth pattern and sclerosis were found to be of limited influence on survival within the cytological groups.

Parathyroid function in different stages of vitamin D deficiency rickets

Direct measurements of parathyroid activity are available in only small numbers of children with vitamin D deficiency rickets (VDR). Therefore serum immunoreactive parathyroid hormone (iPTH) and the urinary cyclic adenosine-3',5'-monophosphate excretion (UcAMP) were measured together with other important indices of calcium metabolism in 24 patients (aged 2-42 months) with VDR before vitamin D treatment. iPTH and UcAMP were significantly elevated in comparison to age-matched controls. In patients there was a highly significant positive correlation between iPTH and UcAMP and a negative relationship between both indices of parathyroid activity to serum phosphate and urine calcium, respectively, indicating that the simple measurement of serum phosphate and/or urine cAMP and Ca provides a reliable tool for the assessment of secondary hyperparathyroidism in VDR. In two patients classified as being in the early stage of VDR the parathyroid activity was not elevated despite hypocalcemia indicating relative hypoparathyroidism. Twelve patients with VDR were followed during vitamin D therapy: Within the first 2 weeks of treatment UcAMP slightly increased and thereafter decreased in most patients, but was still elevated in three patients even after 7 weeks, whereas iPTH became normal within 3 weeks of treatment. This favors the concept that vitamin D deficiency diminishes the activation of renal adenylate cyclase by PTH which is overcome by the highly increased PTH secretion in the advanced stages of rickets. The basal and calcium-stimulated serum calcitonin (CT) levels, determined in some of the patients, were normal, ruling out a significant disturbance of CT secretion in VDR.

Freeze-fracture study of the turtle lung. 1. Intercellular junctions in the air-blood barrier of Pseudemys scripta

The air-blood barrier in the lung of the turtle Pseudemys scripta was studied by means of freeze-fracture replicas in an attempt to give a detailed account on the structural organization of the intercellular junctions. Between the pneumocytes, zonulae occludentes containing 4-19 strands in the apico-basal direction are present; they are considered to be physiologically very tight. In the endothelium, fasciae occludentes, i.e., discontinuous occluding junctions can be found, composed of up to 4 strands. These junctions are regarded to be very leaky. The findings are discussed in relation to recent physiological results, suggesting that in comparison with 'dry' mammalian lungs, the turtle lung is a rather wet lung based on its much larger transcapillary fluid filtration into the interstitium. In addition, small maculae communicantes are demonstrated between the pneumocytes; they possibly serve for metabolic coupling.

[Computerized tomography and traumatology of the musculoskeletal system]

Value and indication of computerized tomography in diagnostic procedures after trauma of the musculoskeletal system is shown analyzing the case material with CT in traumatized patients. In general CT is not to take place of conventional X-ray methods. We feel CT is indicated in evaluation of: intraarticular fragments, congruity of joints, lesions of the cruciate ligaments and osteocartilagineous fractures, if conventional X-ray procedures prove insufficient.