[Preoperative autologous blood donation, effect of hydroxyethyl starch on the reticuloendothelial system and opsonins]

The effect of 6% low molecular weight (LMW) HES (MW 270,000) on reticuloendothelial function was studied in 9 male patients, median of age 50 years, who were scheduled for vascular surgery. An erythrocyte clearance test (Anti Rh) labeled with 99 mTc, evaluating primarily the splenic section of the RES, showed a considerable variation (37-87%) prior to hemodilution. 24 hours after replacement of 15 ml/kg body weight of blood, there was no significant change of the clearance rate, a follow up weeks later approached the base line values. Plasma opsonins like fibronectin, complement fraction 3, complement fraction 4 and immunoglobulin G showed a proportional decrease following hemodilution, and after 24 hours approached control levels. Changes at this time seemed to be independent from the course of the hematocrit. It is concluded that LMW HES does not adversely influence the spleen dependent phagocytic capacity of the RES system.

[Comparison of the Lithander (Kolt test) pediatric visual acuity test with the standardized Landolt ring test]

The visual acuity values obtained with the four test figures of Lithander's "Kolt-test" have been compared with Landolt ring acuity under standardized conditions which meet the requirements of DIN 58,220 and ISO/DIS 8596/7. For a given test figure size, the Kolt-test optotypes turned out to be somewhat easier legible than the Landolt ring. On average, visual acuity measured with the Kolt-test exceeded Landolt ring acuity by 0.08 log (angle of resolution) units. Thus, according to DIN and ISO criteria, the legibility of the Kolt-test is not equivalent to the standard Landolt ring. Equal acuity values could be obtained by increasing the observation distance proposed by the manufacturer of the Kolt-test by 19%. The legibility of the four optotypes differs on adult subjects: "circle" is more difficult, "cross" is easier legible than "square" and "triangle". Confusion of Kolt-test figures is basically restricted to two pairs of two optotypes ("cross" - "triangle", "square" - "circle").

[Acute pancreatitis--etiology, pathological anatomy and pathogenesis]

Acute pancreatitis is a disease characterized by abdominal pain, low-grade fever, abdominal tenderness and rigidity, and moderate elevation of the white blood cell count. A widely used revised classification of pancreatitis is that proposed in 1984 at Marseille. It only distinguishes between acute and chronic pancreatitis. In 61 cases were 40 men and 21 women. The mean age in the total series was 52.5 years. The etiology of the acute condition was alcoholism in 32.8% and biliary tract disease in 23%. In 9.8% the acute pancreatitis is associated with alimentary tract diseases (adipositas, hyperlipidemia). The severity of acute pancreatitis is pathological anatomy determined by three stages. In pathogenesis the process of digestion is caused by activated pancreatic enzyme with acinar cell injury. The acinar cell is normally protected from the action of its own enzymes by elaborate intracellular compartmentation of enzymes. Acute pancreatitis is triggered by pancreatic phospholipase A leading to necrosis of lipolytically active fat cells with release of membrane-toxic fatty acids with following destruction of adjacent tissue. Fat necrosis initiates an acute inflammatory reaction with immigration of granulocytes and liberation of kinins, which activate pancreatic enzyme. Pancreatic enzymes are similar to lysosomal enzymes with regard to substrate specificity. Activation will be also triggered by lysosomal enzymes of necrotic acinar cells.

Experimental studies on nephrotoxicity and pharmacokinetics of LY 146032 (daptomycin) in rats

The nephrotoxicity and pharmacokinetics of LY 146032 (daptomycin) were studied in an experimental rat model. Nephrotoxicity was assessed by measuring urinary loss of tubular cells and malate dehydrogenase. LY 146032 (10-250 mg/kg daily iv) led to a dose-dependent and reversible increase of cell elimination. The tubulo-toxic threshold dose is stated to be 10 mg/kg daily. Nephrotoxicity induced by LY 146032 can be reduced by coadministration of fosfomycin or D-glucaro-1.5-lactam, and enhanced by combination with tobramycin. LY 146032 accumulated in renal tissue during repeated administration. Electron microscopy revealed histopathological changes in the kidneys. Therefore the nephrotoxic potential of LY 146032 should be taken into consideration in clinical trials.

Contrecoup fractures of the anterior cranial fossae as a consequence of blunt force caused by a fall

Contrecoup fractures of the base of the skull are regarded as rare in the clinical literature. In our material (n = 171 falls on the same level and on or from stairs), the overall frequency of contrecoup fractures of the anterior cranial fossa in fatal cranio-cerebral trauma due to falls was 12%, as compared to 24% with occipital point of impact of the head. The relationships between the impact site on the head, form of fracture at the point of impact with involvement of the skull cap and/or the base of the skull, coup and contrecoup injuries of the brain, localization of contrecoup fractures in the anterior cranial fossa and the occurrence of monocle and spectacle haematomas display a major variability. Fractures occur in the form of simple fractures and as impression fractures (fracture fragments or fracture boundaries displaced to the inside). Clinical diagnosis is difficult because of the concealed position of the anterior skull base. Contrecoup fractures become of forensic medical significance when symptoms of a frontobasal injury occur for the first time after trauma which has occurred some time in the past and when the question arises as to the causal connection with the original trauma. In investigation of living persons, it may be difficult to decide whether haemorrhages in the region of the orbit and its vicinity result from a direct blunt force or derive from fractures of the base of the skull, especially contrecoup fractures.

Präoperative Eigenblutspende, der Einfluß von Hydroxyäthylstärke auf Retikuloendothelialsystem und Opsonine

Die Wirkung von 6%iger niedermolekularer Hydroxyäthylstärke (Molekulargewicht 270.000) auf das Retikuloendothelialsystem wurde an 9 männlichen Patienten, deren medianes Alter 50 Jahre betrug und die für gefäßchirurgische Eingriffe vorgesehen waren, untersucht. Der Erythrozyten-Clearancetest (Anti Rh) wobei 99 mTc zur Markierung verwendet wurde und welcher vor allem den Milzanteil des RES erfaßt, zeigte eine beträchtliche Streuung (37–87%) vor der Hämodilution. 24 Stunden nach dem Ersatz von 15 ml/kg Körpergewicht Blut konnte keine signifikante Änderung der Clearance nachgewiesen werden, eine weitere Überprüfung Wochen später zeigte eine Rückkehr des Testes zum Vorwert. Plasmaopsonine wie Fibronectin, Komplementfraktion 3, Komplementfraktion 4 und Immunoglobulin G zeigten einen der Hämodilution proportionalen Abfall und nach 24 Stunden eine Rückkehr auf annähernd den Ausgangswert. Zu diesem Zeitpunkt schien der Verlauf unabhängig vom Hämatokrit zu sein. Es wird aus den Untersuchungen gefolgert, daß niedermolekulare Hydroxyäthylstärke die milzabhängige phagozytierende Kapazität des Retikuloendothelialsystems nicht nachteilig beeinflußt.

Antinuclear antibodies in patients with chronic idiopathic autoimmune thrombocytopenia followed 2-30 years

We determined whether serological investigations can assist to distinguish between chronic idiopathic autoimmune thrombocytopenia (cAITP) and immune-mediated thrombocytopenia in patients at risk to develop systemic lupus erythematosus (SLE); 82 patients were seen in this institution for the evaluation of immune thrombocytopenia. In nine of these patients a diagnosis of SLE was made at presentation or shortly thereafter. In the remaining 73 patients with an established diagnosis of cAITP we obtained serum samples at a median disease duration of 7 years; 45 patients were investigated again 2 years later. cAITP patients suffered from their disease for up to 30 years (median 7 years, range 2-30 years) without developing clinical features of SLE. Elevated antinuclear antibodies were found in all patients with a diagnosis of SLE but also in seven patients with established cAITP. All patients who had thrombocytopenia in association with SLE had additional antibodies to anti-nDNA and/or antibodies to soluble cellular antigens. Neither in the initial, nor in the follow-up investigation, such antibodies were discernible in patients with cAITP. We conclude that patients with cAITP do not develop SLE and do not form antibodies to defined cellular antigens, even if suffering from the disease for many years. The ANA titer does not help to differentiate cAITP from thrombocytopenia of SLE. A differentiation, however, between the two diseases is possible by the combined screening for antinuclear antibodies, anti-nDNA, and antibodies to defined soluble cellular antigens.

[The synthesis of P-substituted DL-2-phenylglycine octylesters]

9 Titel compounds (p-RC6H4)CH(NH2.HCl)COO (CH2)7CH3 [R = F, Cl, HO, CH3O, CH3(CH2)3O, C6H5CH2O, CH3, (CH3)2CH and (CH3)2N.HCl] were obtained by esterification of p-substituted DL-2-phenylglycines with octanol either in the presence of dry hydrogen chloride (procedure A) or with thionyl chloride (procedure B). The advantages of the procedure B are the mild conditions, the more pure products, the possibility of esterification of diamino acids, and the stability of alkoxy groups as substituents. The synthesized octylesters are potential antiinflammatory and analgesic substances with spasmolytic activity.

Long-acting somatostatin analog controls acid and gastrin secretion in benign, not in malignant, Zollinger-Ellison syndrome

The long-acting somatostatin (SMS) analog, SMS 201-995 has beneficial effects on APUDomas. In two Zollinger-Ellison syndrome (ZES) patients we assessed basal acid output (BAO) and 24-h pH under SMS and compared them to controls. We also assessed total gastrin, gastrin 17, insulin, glucagon, C-peptide, and SMS by radioimmunoassay. In the benign gastrinoma, an acid-controlling action of SMS was shown, elevating the 24-h pH threshold over the pH range 1.5-5 of 55-10% compared with control. A parallel inhibition of the gastrins greater than 90% was apparent. We found no beneficial effect on gastric acid secretion and on tumor gastrin in the malignant gastrinoma despite a fourfold higher plasma SMS level. Non-tumor-related peptides were suppressed by approximately 50% and in contrast to gastrin they again reached pre-SMS levels before the next dose of the drug. We conclude that SMS is more effective in benign than in malignant gastrinomas, and may be exclusively so.

[Non-medicamentous prevention of calcium oxalate urinary calculi]

In a prospective study the efficacy and actual outcome of non-medicamentous preventive measures with metabolically unremarkable calcium-oxalate urolithiasis were investigated in 49 idiopathic calcium-oxalate stone formers. Overnight urine excretion was not increased. The mean concentration and excretion of essential parameters in terms of lithogenesis were hardly influenced. The obvious reduction of the pelvi-calyceal area in both lithogenous and non-lithogenous kidneys after one year of calculus prophylaxis was striking. By means of a discriminant function including morphological parameters and high-molecular urine components some developments may be verified in the discriminant space suggesting a good prophylactic result in many patients.

Platelet factor 4 and the response to plasma exchange in the treatment of thrombotic thrombocytopenic purpura

We report two patients with thrombotic thrombocytopenic purpura who were subjected to plasma exchange. In one case, the plasma levels of platelet factor 4, measured shortly after plasma exchange, increased significantly during plasma exchange. This was followed, however, by a failure to respond to therapy. Repeated plasmapheresis over 3 weeks gave no therapeutic benefit and reversible deep coma occurred. This patient recovered completely after treatment with vincristine. In the second patient, a decline in platelet factor 4 was observed after plasma exchange. This was accompanied by improvement of the patient's condition and a slow rise in platelet count. Plasma exchange was again carried out in this patient because of a recurrence of thrombotic thrombocytopenic purpura 3 years later; again decreased platelet factor 4 plasma levels were observed after plasma exchange and again a therapeutic response followed. Platelet factor 4, therefore, seems to be an effective and early index for the therapeutic benefit of plasma exchange in thrombotic thrombocytopenic purpura.

Influence of different factors on the formation of calcium oxalate stones. II. Discriminant analytical computations of morphological parameters of pelvic-calyceal systems and clinicochemical urine parameters of controls and calcium-oxalate stone formers

Until now almost exclusively clinicochemical urine parameters have been used to determine the risk of urinary stone formation. In part I of this study pelvic-calyceal systems of healthy persons and calcium oxalate stone formers are compared with regard to their morphology, whereas urine parameters will be briefly included in part II. Discriminant functions are given by means of which it is possible to calculate the risk and, e.g. to quantify a follow-up.

Demonstration of monoamine oxidase-A and -B in the human brainstem by a histochemical technique

The distribution of both monoamine oxidase subtypes, monoamine oxidase-A and -B, is demonstrated in brainstems from 16 humans by use of a histochemical technique. The results presented here, focus primarily upon the aminergic areas of the substantia nigra, the locus coeruleus and the raphe nuclei. While dopaminergic neurons of the substantia nigra revealed no staining for monoamine oxidase, noradrenergic neurons of the locus coeruleus stained positively with the monoamine oxidase-A substrate serotonin, and serotonergic neurons of the raphe nuclei were stained by the monoamine oxidase-B substrate beta-phenylethylamine. In addition, data are presented showing that glial cells stain predominantly for monoamine oxidase-B.

The microbiological efficacy of the combination of fosfomycin and vancomycin against clinically relevant staphylococci

Infections with multiresistant strains of Staphylococcus aureus and Staphylococcus epidermidis pose severe clinical problems. The drug of choice in such cases, vancomycin, is potentially ototoxic and nephrotoxic and this may give rise to additional problems in the patient. Fosfomycin has been shown to be nephroprotective when given with vancomycin and with other nephrotoxic drugs. We report the inhibitory and bactericidal activity of fosfomycin and vancomycin alone and in combination against 26 clinically relevant strains of S. aureus and 48 strains of S. epidermidis. In most instances these two drugs showed indifferent or additive effects, synergism or antagonism was only rarely observed. Assessment of the bactericidal action of the combination revealed similar effects. The combination of fosfomycin and vancomycin may, therefore, be beneficial in clinical situations where the nephrotoxic effect of vancomycin cannot be tolerated.

Influence of different factors on the formation of calcium oxalate stones. I. Discriminant analytical computations of morphological parameters of the pelvic-calyceal systems of calcium oxalate stone formers and controls

Until now almost exclusively clinicochemical urine parameters have been used to determine the risk of urinary stone formation. In part I of this study, pelvic-calyceal systems of healthy persons and calcium oxalate stone formers are compared with regard to their morphology, whereas urine parameters will be briefly included in part II. Discriminant functions are given by means of which it is possible to calculate the risk and, e.g. to quantify a follow-up.

The pitfalls of technetium Tc 99m/thallium 201 parathyroid scanning

Technetium Tc 99m/thallium 201 parathyroid scanning has been proved to be effective by multiple researchers. A review of 54 patients who underwent scanning and operations at an institution showed the scans to be accurate in 83%. There were 15% false-negative and 2% false-positive scans. The pitfalls of parathyroid scanning can be related to false-positives and false-negatives.