Thrombophile Hämostasestörung in der Schwangerschaft

Frauen, die Trägerinnen angeborener und/oder erworbener thrombophiler Risikofaktoren sind, haben ein erhöhtes Risiko für schwangerschaftsassoziierte vaskuläre Komplikationen wie venöse Thromboembolien, Abort, Präeklampsie und intrauterine Wachstumsretardierung. Diese Komplikationen gehen mit hoher maternaler und fetaler Morbidität und Mortalität einher. Eine antikoagulatorische Therapie in der Schwangerschaft ist zur risikoadaptierten Prävention und Behandlung venöser thromboembolischer Komplikationen sowie zur Prävention von Aborten bei Frauen mit Antiphospholipidsyndrom indiziert. Angesichts der Studien, die eine Assoziation zwischen hereditärer Thrombophilie und schwangerschaftsassoziierten Komplikationen zeigen, erfolgt zunehmend auch der Einsatz von Heparin zur Prävention schwangerschaftsbedingter vaskulärer Komplikationen. Die Therapieempfehlungen bei Frauen mit thrombophilen Risikofaktoren und Abortneigung, Präeklampsie und intrauteriner Wachstumsretardierung werden kontrovers diskutiert, da keine großen randomisierten Placebo-kontrollierten Therapiestudien verfügbar sind. Trotz dieser Limitationen und fehlendem internationalen Konsens haben positive Studienergebnisse die klinische Praxis und auch die Erwartungshaltung der Patientinnen zugunsten einer Heparinprophylaxe beeinflusst. Für die abschließende Wertung sind randomisierte Placebo-kontrollierte Studien nötig.

Venöse Thrombose in der Schwangerschaft

Thromboembolien sind nach wie vor führende Ursache für die mütterliche Letalität in Schwangerschaft und Wochenbett. Eine rationale und risikoadaptierte Heparin-Prophylaxe setzt 1. die Identifizierung von Frauen mit erhöhtem Thromboserisiko und 2. die genaue Quantifizierung dieses Risikos voraus.

Ohne Thrombose in der Vorgeschichte ist ein heterozygoter Faktor V Leiden oder eine heterozygote G20210A-Mutation im Prothrombin-Gen lediglich mit einem Thromboserisiko in der Schwangerschaft von ca. 1 : 400 assoziiert. Aufgrund dieses niedrigen absoluten Risikos für eine Venenthrombose ist eine Heparin-Prophylaxe in der Schwangerschaft deshalb nicht generell zu empfehlen. Bei kombiniertem Vorliegen der beiden genetischen Risikofaktoren in heterozygoter Konstellation steigt das Thromboserisiko überproportional auf ca. 1 : 25 an. Frauen mit vorausgegangener Thrombose in einer vorübergehenden definierten Risikosituation (Operation oder Trauma) ohne Nachweis eines genetischen Risikofaktors dürften ein niedriges Thromboserisiko in der Schwangerschaft haben. Die Datenlage hierzu ist jedoch widersprüchlich. Im Gegensatz dazu ist das Thromboserisiko bei Frauen mit vorausgegangenem thromboembolischen Ereignis und Nachweis hereditärer Risikomarker oder einer positiven Familienanamnese einer Thrombose deutlich erhöht (>10%). Eine Heparin-Prophylaxe anteund postpartal erscheint deshalb indiziert. Trotz des Fortschritts in der Risikostratifizierung schwangerschaftsassoziierter Thrombosen sind die genaue Beurteilung des absoluten Thromboserisikos und ein optimales Therapieregime noch in der Diskussion.

[Childhood abuse experiences and chronic low back pain. Direct and mediated effects of childhood abuse in different pain dimensions of nonspecific chronic low back pain]

BACKGROUND

Physical, sexual and emotional abuse in childhood and adolescence is considered to play a role in the etiology and generalization of chronic pain in adulthood. However, it remains unclear whether abuse is specifically associated with different dimensions of nonspecific chronic low back pain (CLBP) and if these associations are mediated by psychological symptoms.

MATERIAL AND METHODS

A total of 103 patients with validated CLBP were assessed by pain drawing, the multidimensional pain questionnaire and the pain experience scale. The childhood trauma questionnaire was used to retrospectively screen for physical, sexual and emotional abuse in childhood and adolescence. Patients were also screened for symptoms of depression, anxiety and dissociation in order to look for possible mediators.

RESULTS

Patients with CLBP who reported childhood abuse showed higher pain intensity, higher spatial extent of pain, higher affective and sensory pain sensation and more pain disability compared to CLBP patients who had not experienced abuse. However, multivariate analyses revealed that only the spatial extent of pain was directly associated with childhood abuse. Furthermore, a significant association between childhood abuse and sensory pain sensation was found to be mediated by symptoms of anxiety and dissociation.

CONCLUSION

The influence of childhood abuse on CLBP is different for specific pain dimensions; therefore, CLBP should be faced as a complex construct that comprises different dimensions. Childhood abuse is suggested as a risk factor for spreading pain in CLBP persons; therefore, CLBP patients reporting additional pain locations might benefit from diagnostic and therapeutic interventions specific for childhood abuse experiences.

[Thrombophilia in pregnancy: venous thromboembolism, fetal loss, preeclampsia, intrauterine growth restriction]

Women with acquired and hereditary thrombophilia are at increased risk of developing venous thromboembolism and other associated gestational vascular complications like fetal loss, preeclampsia, intrauterine growth restriction, and placental abruption during pregnancy. These complications are a major cause of maternal and fetal morbidity and mortality. In view of the data showing an association between thrombophilia and these adverse pregnancy outcomes, clinicians are increasingly using antithrombotic therapy in women at risk of these complications. Aside from recurrent pregnancy loss in antiphospholipid syndrome and prevention of venous thromboembolism, there is limited evidence on the benefit of antithrombotic interventions to guide therapy. The data in favour of antithrombotic therapy in women with hereditable thrombophilia and vascular placental complications consist predominantly of small uncontrolled trials or observational studies. Randomized, placebo-controlled trials are lacking as most patients do not accept placebo. Further randomised controlled trials are urgently required to explore this therapeutic option.

Phytoassessment of acid mine drainage: Lemna gibba bioassay and diatom community structure

An integrated multilevel phytoassessment of an acid mine drainage (AMD, pH range 3.3-6.8) in southern Portugal was performed. A 7-day phytotoxicity bioassay with the duckweed Lemna gibba (chlorosis, necrosis, growth) was carried out, both in the laboratory and in situ, combined with an analysis of the resident epilithic diatom community. The toxicity test was performed with water from the AMD gradient, an unpolluted river control and acidified control water, in order to discriminate potential pH-effects from combined pH- and metal-effects. Diatom communities discriminated well among the sites (alkalophilic species versus halobiontic, acidobiontic and acidophilic species), showing inter-site differences to be larger than intra-site seasonal variations. In L. gibba exposed to AMD, necrosis and growth inhibition were higher in situ compared to the laboratory experiments. L. gibba was more sensitive to AMD than to acidified water. Already after 4 days, growth rate inhibition in L. gibba proved to be a reliable indicator of AMD-stress. Ecotoxicological thresholds obtained with L. gibba corresponded with those obtained previously with animals of intermediate tolerance to AMD. The results were summarised in a multimetric index.

Hematopoietic cell transplantation (HCT) after low-dose, total body irradiation-based regimen increased leukemia-free survival (LFS) in elderly patients with cytogenetic high-risk AML compared to chemotherapy (OSHO 97 study)

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Background: Even after reaching initial CR, most AML patients > 60 years relapse within 2 years of diagnosis. Cytogenetic high risk AML (abn 3q26, abn 11q23, -5/5q-, -7/7q- and complex) has an even worse prognosis. Attempts to improve survival by intensifying consolidation chemotherapy have so far failed. We investigated the role of allogeneic HCT in comparison to chemotherapy among patients with high risk cytogenetics entered into the OSHO AML 97 protocol. Methods: Initial treatment consisted of a course of induction therapy (AraC 2 g/m2 iv on day 1,3,5,7 + mitoxantrone 10 mg/m2 iv day 1 –3, repeated once in case of PR) followed by one consolidation course (AraC 240 mg/m2 iv day 1 –5 + mitoxantrone 10 mg/m2 iv day 1 –2). Patients in CR1 after the consolidation I were either treated with an additional consolidation therapy or with an allogeneic HCT from related (n=2) or unrelated (n=10) donors. Transplant patients were conditioned with fludarabine and TBI 200 cGy and immunosuppressed with cyclosporine and mycofenolate mofetil. Results: A total of 347 patients are evaluable. Of 105 (33%) patients with high-risk cytogenetics, 53 (50%) went into remission after one or two cycles of induction chemotherapy. Of these 53 patients, 42 received consolidation I and 35 patients were available for either consolidation II (n=23) or HCT (n=12). Median age of the patients receiving chemotherapy was 64 (range 61–77) years and that of the transplant patients was 64 (range 61–68) years. LFS at 4 years was 42 ± 14% after HCT and 15 ± 8% after chemotherapy. Major differences in relapse incidences were seen between the two groups, with the lowest RI at 4 years after HCT (36 ± 15%) followed by chemotherapy (85±8%, p<0.04). Treatment related mortality at 4 years was 35±17% and 0±0% for patients receiving HCT and chemotherapy, respectively (p<0.05). Conclusions: From these results, we conclude that consolidation with allogeneic HCT after minimal conditioning is superior to chemotherapy even in older patients with high risk cytogenetics. While differences in TRM were seen between the treatment arms, a lower relapse incidence after related and unrelated HCT contributed to the improved LFS.

No significant financial relationships to disclose.

[Pregnancy-associated venous thromboembolic disease: prediction, prevention, and therapy]

Thromboembolic disease remains a leading cause of maternal mortality during pregnancy and the puerperium. Rational and risk-adapted administration of heparin prophylaxis depends on 1. the identification of those women who have an increased risk of thrombosis and 2. the accurate quantification of this risk. In women without prior thrombosis, the presence of a heterozygous factor V Leiden or heterozygous G20210A mutation in the prothrombin gene is associated with a pregnancy-associated thrombotic risk of approximately 1 in 400. Thus, in pregnant carriers of either one of these mutations the risk of venous thromboembolism is low. Therefore, no heparin prophylaxis is recommended. A combination of the two genetic risk factors can increase the risk to a modest level of 1 in 25. In women with a single episode of prior thrombosis associated with a transient risk factor, e.g. surgery or trauma, and no additional genetic risk factor, the probability of a pregnancy-associated thrombosis appears also to be low. However, data are sparse and conflicting. In contrast, in women with a prior idiopathic venous thrombosis who carry an additional hereditary risk factor or who have a positive family history of thrombosis, a high risk (>10%) can be expected supporting the indication for active antepartum and postpartum heparin prophylaxis. Despite the remarkable progress in risk stratification, the absolute magnitude of risk and the optimal management in many cases is an issue of ongoing debate.

Effects of acid mine drainage and acidity on the activity of Choroterpes picteti (Ephemeroptera: Leptophlebiidae)

Survival and behavior of the mayfly Choroterpes picteti (Leptophlebiidae) exposed to acid mine drainage (AMD: pH 3.3-6.4) and a reservoir polluted with arsenic (pH 6.8) from Sao Domingos mine (Portugal) were studied in laboratory and in situ bioassays (48 h) with the Multispecies Freshwater Biomonitor, and compared with water from a reference river and acidified reference water (acid only). Metal body-burdens showed a negative pH dependency for Mn and As, a positive one for Pb, and for Zn, Cu, Co, and Cd a decrease at pH < 4.4. Generally, survival decreased with decreasing pH. The 48-h LC(50) (pH) for AMD and for acid only were similar (pH 4.8-4.9); however, the LT(20) (h) at pH 3.3 revealed AMD to be less toxic than acid only. C. picteti show diurnal rhythm with increased locomotor activity in the night. The circadian rhythm was weakened by acid exposure, but less so by AMD exposure. Compared to reference river water, ventilation was stimulated at pH < 6.0 in acid only and in reservoir water. Locomotion was stimulated at pH 5 in acid only and reservoir; however, it was reduced in all other treatments, when compared to reference river water. Under acid-only exposure, both locomotion and ventilation were significantly higher compared to AMD exposure at the corresponding pH values. The laboratory results were field validated.

The G20210A prothrombin-gene mutation and the plasminogen activator inhibitor (PAI-1) 5G/5G genotype are associated with early onset of severe preeclampsia

Hereditary risk determinants of venous thrombosis have been reported to be associated with severe preeclampsia. So far there are no data to support whether these risk determinants are related to the time of onset of severe preeclampsia. We used a case-control design, studying 97 women with severe preeclampsia in previous pregnancies and 277 normal women, to assess hereditary risk factors of venous thrombosis as risk determinants for severe preeclampsia. A case-only design comprising solely the 97 women with a history of preeclampsia was used to evaluate these risk factors as risk determinants for early onset of severe preeclampsia. Using the case-control design, there was no significant risk association of the hereditary risk factors with severe preeclampsia [factor V Leiden, odds ratio (OR) 0.9, 95% confidence interval (CI) 0.4, 2.2; prothrombin mutation, OR 1.9, 95% CI 0.5, 7.0; methylentetrahydrofolate reductase 677TT genotype, OR 0.8, 95% CI 0.4, 1.8; plasminogen activator inhibitor (PAI-1) 4G/4G genotype, OR 1.2, 95% CI 0.7, 2.1; PAI-1 5G/5G genotype, OR 1.0, 95% CI 0.5, 1.8]. However, the onset of severe preeclampsia was significantly earlier in women with the G20210A prothrombin gene mutation (24.5 weeks vs. 30.1 weeks, P = 0.046) and in women with the PAI-1 5G/5G genotype (25.7 weeks vs. 30.8 weeks, P = 0.024). Hereditary risk factors for venous thrombosis do not predispose for severe preeclampsia. However, women who are carriers of the G20210A prothrombin gene mutation and the PAI-1 5G/5G genotype are at risk for early onset of severe preeclampsia. It appears that these risk factors do not induce the pathomechanism but accelerate the course of preeclampsia.

Macroinvertebrate response to acid mine drainage: community metrics and on-line behavioural toxicity bioassay

The hypothesis is tested that toxicity of acid mine drainage can be detected by a selection of existing macroinvertebrate community and bioindicator metrices supplemented by toxicity tests with the local mosquitofish Gambusia holbrooki Girard and the shrimp Atyaephyra desmaresti Millet. The behavioural responses of A. desmaresti to acid mine drainage were recorded in the Multispecies Freshwater Biomonitor, based on behaviour and survival as parameters. Bioassessment methods were based on community diversity, structure, function, and bioindicators and supplemented by chemical analysis (temperature, pH, metals). The Biological Monitoring Working Party adapted for the Iberian Peninsula, the number of predators (Coleoptera, Hemiptera) and the number of Ephemeroptera and Trichoptera taxa differentiated the sites well. The on-line toxicity test revealed pH-dependent acute toxicity of the acid mine drainage for the shrimp (LC(50)-48 h: pH-AMD=5.8) and a pH- dependent decrease in locomotory activity with the lowest-observed-response-times (LORTs) within 5 h of exposure. Shrimp were more sensitive to acid mine drainage than fish (LC(50)-48 h: pH-AMD=4.9). A new multimetric index combining toxicity testing and bioassessment methods is proposed.

Immunocytological confirmation of bone marrow metastases in a dog with cholangiocarcinoma

The case history of a four-year-old, male Bernese mountain dog is presented. Carcinoma cells were detected in the liver by ultrasound-guided fine-needle aspiration. Bone marrow aspirated from the iliac crest and the left femur showed a distinct infiltration by carcinoma cells. Immunocytological examination of the liver and bone marrow metastases showed a negative staining result for large spectrum cytokeratin (CK) KL1, a strong positive result for CK7 and a focal weak positive result for CK20. The dog was euthanased due to the grave prognosis. Histopathological examination revealed metastatic cholangiocarcinoma. The authors conclude that cytological and immunocytological examination of bone marrow aspirates should be used more frequently for the detection of distant metastases of carcinomas in small animal medicine.

Seroreactivity against MAGE-A and LAGE-1 proteins in melanoma patients

BACKGROUND

Cancer-testis antigens exemplify a growing number of tumour antigens which are expressed in a variety of malignancies, but not in normal tissues other than germ cells, primarily those of the testis.

OBJECTIVES

To investigate the humoral response to known cancer-testis antigens in melanoma patients.

METHODS

We used phage clones coding for seven different melanoma antigens MAGE-A or LAGE-1A proteins. These clones were isolated using the newly developed DNA hybridization analysis of recombinantly expressed cDNA libraries (HYREX) approach. HYREX combines the advantage of a nonradioactive library screening method with the possibility of subsequently analysing the serological response to the recombinant proteins. We isolated clones coding for MAGE-A1, -A3, -A4b, -A6, -A9 and -A12, as well as LAGE-1A. Additionally, we correlated gene expression and seroreactivity.

RESULTS

Between 13% and 27% of sera (n = 15) were reactive against individual tumour antigens. We found the presence of specific antibodies was, with only two exceptions, generally correlated with mRNA expression of the antigen within cell lines derived from the same patient. While cross-reactivity of patients' IgG might play a role in these cases, antibodies from patients' sera were able to distinguish even the closely related MAGE-A3 and -A6. In general, the mRNA expression frequency was higher than the detected IgG responses.

CONCLUSIONS

Antibody recognition of specific tumour antigens by patients' sera may be used for evaluating the possible immunogenicity of new antigens; serological tests could be used for tumour monitoring purposes.

[Chronic-idiopathic enteropathy in cats--a case control study]

Aim of this study is to clinically, microbiologically and histopathologically characterize inflammatory bowel disease (IBD) in the cat. Nine cats with chronic persistent or intermitent vomitus and diarrhea were examined between 1998 and 2001. All cats had a thuorough diagnostic workup performed. Full thickness biopsies from stomach, duodenum, jejunum, ileum and colon were surgically obtained for histopathological examination. Duodenal juice was obtained by direct aspiration for microbiologic qualitative and semiquantitative examination. Seven cats euthanized for other medical reasons were used as controls. Six cats had a lymphoplasmacytic IBD and three an eosinophilic IBD. Four cats with IBD had additional diseases diagnosed. Three cats with IBD had elevated bacterial counts. Retrospectively no correlation could be found between clinical symptoms and histopathological results. Serum TLI was not able to differentiate chronic pancreatitis and IBD. Serum folic acid and cobalamin did not correlate with the distribution of lesions in the gastrointestinal tract. Finally, no correlation was found between bacterial counts in the proximal duodenum and IBD.

Chironomidae (Diptera, Nematocera) fauna in three small streams of Skania, Sweden

Two unpolluted streams and one chemically and thermally polluted stream in Skania, Sweden, were investigated in summer 1995 for their temporary chironomid fauna and the occurrence of buccal deformities. The unpolluted streams 'Ovedsan' and 'Skäralidbäcken' each contained, respectively, 13 and 16 taxa, with a dominance of Microtendipes pedellus group and Micropsectra spp., respectively. Most taxa were found in the pebbles and the submerged vegetation. Deformities were insignificant. The degraded stream Ybbarpsan in Perstorp contained 5 taxa, dominated by Procladius choreus. This species had 14% deformed larvae, interpreted as an effect of the chemical pollution. Shannon H and equitability J reflected the differences in chironomid community structure between the two unpolluted and the polluted sites. The Belgian Biotic Index scored maximally '10' in Skäralid, however only '6' in Oved and '5' in Perstorp. The combination of rapid assessment of macrobenthos and description of communities of Chironomidae, with mention of deformed larvae, adds a bonus of information about the temporary state of a stream.

Successful thrombolysis of st. Jude medical aortic prosthesis with tissue-type plasminogen activator in a pregnant woman: a case report

Mechanical valve thrombosis is a life-threatening event. Pregnancy is associated with a hypercoagulable state that further emphasizes the importance of adequate anticoagulation. This is associated with a therapeutic dilemma. Continued anticoagulation with warfarin throughout the first trimester can result in fetopathic effects, while replacement of warfarin by heparin between 6 and 12 weeks of gestation does not completely prevent the risk of valve thrombosis. There are a small number of reported cases of pregnant women with prosthetic heart valve thrombosis under low molecular weight heparin and consecutive lytic therapy. The authors report a 33-year-old pregnant woman with a St. Jude Medical aortic prosthesis, anticoagulated with a therapeutic dosage of low molecular weight heparin from 6 weeks of gestation, who developed prosthetic heart valve thrombosis at 17 weeks of gestation. A thrombolysis with recombinant tissue-type plasminogen activator (50 mg for 2 hours) was performed. Under thrombolysis, ST-segment elevation in leads II, III, aVF, V5, and V6 developed electrocardiographically with a maximal creatine kinase (CK) of 349 U/L (CK-MB isoenzyme of 48 U/L). Echocardiography revealed normal function of the St. Jude Medical aortic prosthesis 2 hours after thrombolysis and normal wall motions. Short-course thrombolytic therapy appears to be an effective alternative to surgical intervention for the treatment of thrombotic dysfunction of valve prostheses in pregnancy.

Pseudohypoparathyroidism and Graves'disease: a rare combination of two endocrinological diseases

We report a 26-year-old woman presented at the day of admission in the I.C.U. with increased perspiration, plethora and distinct tetany of both legs. Particularly unusual was an exophthalmus on both sides, a rectal temperature of 38.3 degrees Celsius and a blood pressure of high level (180/110 mmHg). Laboratory findings were a low serum calcium concentration of 2.86 mval/l, a hyperphosphataemia (5.0 mg/dl), free thyroxine of 31.7 pmol/l, TSH basal of < 0.01 U/ml and positive MAK and TRAK. Serum parathormone concentration was excessively high: 766 ng/l (12-72). Ultrasound of the thyroid gland revealed a normal size with a volume of 10.4 ml; the echosonic state was not typical for Graves' disease. The initial treatment consisted of high dose thiamazole and hydrocortisone intravenous, calciumcarbonate and propranolol per os. After acute situation the treatment continued with thyreostatics, calcitriol and calciumcarbonate. The symptoms at the day of admission (tetany) disappeared within 2 days; only local paraesthesia of fingers persisted longer. Normalization of thyroid parameters was reached after 11 days; the serum calcium concentration persisted on an increasing but still lower level than standard (3.8 mval/l). During substitution parathormone decreased to 443 ng/l. What is unusual about this case is the combined appearance of autoimmunethyreoiditis (Graves' disease) and pseudohypoparathyroidism.

Short-term responses of Oryzias latipes (Pisces: Adrianichthyidae) and Macrobrachium nipponense (Crustacea: Palaemonidae) to municipal and pharmaceutical waste water in Beijing, China: survival, behaviour, biochemical biomarkers

Whole effluent toxicity was assessed for the fish Oryzias latipes and the prawn Macrobrachium nipponense for 18 h in a dilution series (0-66%) of the inflow and effluent of a municipal waste water treatment plant as well as waste water from a teramycin producing pharmaceutical industry, before, during and after a pilot laboratory purification process. The waste waters caused acute toxicity as measured by inhibition of light emission in the luminiscent bacterium Vibrio qingaiensis sp. nov. (Q67). EROD and aryl hydrocarbon hydroxylase activity in in vitro carp liver-cells showed a dose-dependent toxic response to the municipal waste water. Behavioural responses and time-to-death of fish and prawn, recorded online with the "Multispecies Freshwater Biomonitor" proved to be concentration- and time-dependent sensitive toxicity indicators in both types of waste water. Behaviour changed stepwise from normal activity to (increased or decreased) activity to more time spent on ventilation and finally to increased morbidity at higher concentration and time of exposure. The municipal waste water treatment plant managed to reduce toxicity to bacteria (Q67), prawn and fish. The pharmaceutical waste water treatment process still has to be improved, in order to reduce toxicity for fish and prawn.

Comparison of the sensitivity of different diagnostic tests for pancreatitis in cats

The objective of this study was to compare the sensitivity of different diagnostic tests for pancreatitis in cats. Twenty-one cats with confirmed pancreatitis were evaluated at the Small Animal Clinic of the School of Veterinary Medicine in Hannover, Germany, between September 1997 and January 1999. Clinical signs of affected cats were nonspecific, with 95% of the cats showing anorexia and 86% lethargy. Also, hematologic and biochemical abnormalities of affected cats were nonspecific. Serum feline trypsin-like immunoreactivity (fTLI) in these 21 cats with pancreatitis was 127.5 +/- 109.5 microg/L (mean +/- SD; range, 24-500 microg/L). Fourteen of the 21 cats with pancreatitis had complicating conditions. Their serum fTLI was 153.9 +/- 124.3 microg/L (mean +/- SD; range, 29 500 microg/L). In this study, abdominal ultrasound showed a sensitivity for pancreatitis of 24%, and abdominal computed tomography had a sensitivity of 20%. Serum fTLI had a sensitivity between 86% when a cut-off value of 49 microg/L was used (upper limit of the control range) and 33% when a cut-off value of 100 microg/L was used. We conclude that in this group of cats with pancreatitis, measurement of serum fTLI was the most sensitive diagnostic test of those evaluated. Abdominal ultrasound, however, may be a valuable diagnostic tool in some cats with pancreatitis.

Fermentation of 4-aminobutyrate by Clostridium aminobutyricum: cloning of two genes involved in the formation and dehydration of 4-hydroxybutyryl-CoA

Clostridium aminobutyricum ferments 4-aminobutyrate via succinic semialdehyde, 4-hydroxybutyrate, 4-hydroxybutyryl-CoA and crotonyl-CoA to acetate and butyrate. The genes coding for the enzymes that catalyse the interconversion of these intermediates are arranged in the order abfD (4-hydroxybutyryl-CoA dehydratase), abfT (4-hydroxybutyrate CoA-transferase), and abfH (NAD-dependent 4-hydroxybutyrate dehydrogenase). The genes abfD and abfT were cloned, sequenced and expressed as active enzymes in Escherichia coli. Hence the insertion of the [4Fe-4S]clusters and FAD into the dehydratase required no additional specific protein from C. aminobutyricum. The amino acid sequences of the dehydratase and the CoA-transferase revealed close relationships to proteins deduced from the genomes of Clostridium difficile, Porphyromonas gingivalis and Archaeoglobus fulgidus. In addition the N-terminal part of the dehydratase is related to those of a family of FAD-containing mono-oxygenases from bacteria. The putative assignment in the databank of Cat2 (OrfZ) from Clostridium kluyveri as 4-hydroxybutyrate CoA-transferase, which is thought to be involved in the reductive pathway from succinate to butyrate, was confirmed by sequence comparison with AbfT (57% identity). Furthermore, an acetyl-CoA:4-hydroxybutyrate CoA-transferase activity could be detected in cell-free extracts of C. kluyveri. In contrast to glutaconate CoA-transferase from Acidaminococcus fermentans, mutation studies suggested that the glutamate residue of the motive EXG, which is conserved in many homologues of AbfT, does not form a CoA-ester during catalysis.

Prothrombin and factor V mutations in women with a history of thrombosis during pregnancy and the puerperium

BACKGROUND

Venous thromboembolism is a leading cause of morbidity and mortality during pregnancy and the puerperium. However, the role of mutations in the prothrombin and factor V genes and other thrombophilic abnormalities as risk factors for thromboembolism in women during pregnancy and the pueperium is not known.

METHODS

In a study of 119 women with a history of venous thromboembolism during pregnancy and the puerperium and 233 age-matched normal women, we measured the activity of antithrombin, protein C, protein S, and lupus anticoagulant. We also performed genetic analyses to detect the G1691A mutation in the factor V gene (factor V Leiden), the G20210A mutation in the prothrombin gene, and the C677T mutation in the methylenetetrahydrofolate reductase gene. Blood samples were obtained at least three months post partum or after the cessation of lactation.

RESULTS

Among the women with a history of venous thromboembolism, the prevalence of factor V Leiden was 43.7 percent, as compared with 7.7 percent among the normal women (relative risk of venous thromboembolism, 9.3; 95 percent confidence interval, 5.1 to 16.9); that of the G20210A prothrombin-gene mutation, 16.9 percent as compared with 1.3 percent (relative risk, 15.2; 95 percent confidence interval, 4.2 to 52.6); and that of both factor V Leiden and the G20210A prothrombin-gene mutation 9.3 percent as compared with 0 (estimated odds ratio, 107). Assuming an overall risk of 1 in 1500 pregnancies, the risk of thrombosis among carriers of factor V Leiden was 0.2 percent, among carriers of the G20210A prothrombin-gene mutation, 0.5 percent, and among carriers of both defects, 4.6 percent, as calculated in a multivariate analysis.

CONCLUSIONS

The G20210A prothrombin-gene mutation and factor V Leiden individually are associated with an increased risk of venous thromboembolism during pregnancy and the puerperium, and the risk among women with both mutations is disproportionately higher than that among women with only one mutation.

Whole Effluent Toxicity Testing with Oncorhynchus mykiss (Walbaum 1792): Survival and Behavioral Responses to a Dilution Series of a Mining Effluent in South Africa

Survival, behavioral early warning responses to, and behavioral effects of a complex effluent from Richards Bay Minerals in Natal, South Africa, were studied using rainbow trout Oncorhynchus mykiss (Walbaum 1792) as a biosensor. Three replicates of eight juvenile fish were exposed to a dilution series of the effluent (0, 5, 10, 20, 50, 75, 100%) and the behavioral pattern (ventilation, locomotion) was measured online with quadropole impedance conversion. Survival decreased with increasing effluent concentration. Before death, O. mykiss coloration darkened, demonstrating skewed bodies subsequently after death. Decreased activity and increased ventilation combined with increased ventilation frequency were found within the first 2 h of exposure at >/=96-h LC50 value of 10% effluent concentration indicating early warning responses. During 4 days of exposure, activity decreased and ventilation increased further at concentrations around the 96-h LC50 value indicating toxic effects.

[Necrotizing vasculitis of the cerebral and spinal leptomeninges in a Bernese mountain dog]

A case of necrotizing vasculitis involving the central nervous system in a seven month old Bernese mountain dog is reported. The clinical signs include apathy, fever and increased head and cervical pain. The cerebrospinal fluid was unusual viscous and bloody. In the EEG high activity and spikes were found. A hydrocephalus internus was confirmed by CT scan. On histopathological examination a necrotizing vasculitis on the medulla oblongata and spinal cord leptomeninges with perivascular granulomatous inflammation were detected. The neuropathological lesions are consistent with those reported for the rare disease of necrotizing vasculitis in the central nervous system of Bernese mountain dogs, beagles and boxers. The cause is unknown.

Behavioural early warning responses to polluted water : Performance ofGammarus pulex L. (Crustacea) andHydropsyche angustipennis (Curtis) (Insecta) to a complex industrial effluent

Behavioural early warning responses to polluted surface water from an industrial effluent have been measured in two freshwater macroinvertebrate species using the four electrode impedance conversion technique. Specimens ofGammarus pulex (L.) andHydropsycho angustipennis (Curtis) were caught from reference streams and exposed to water from above and below the factory and to reference water for about 1 h with different kinds of behaviour being registered on-line every 10 min, such as time spent on locomotion, number of "high swimming peaks", number of activity phases, cleaning, time spent on ventilation, ventilation frequency and netspinning. Additionally, G.pulex was exposedin situ above and 100 m, 500 m and 1000 m below the factory for 24 h.G.pulex reacted to water pollution within 1 h with less time spent on locomotion, fewer "high swimming peaks" and lower number of activity phases (p < 0.01). The same results were found after thein situ exposure (p < 0.05) and the pollution gradient mirrored survival and behavioural performance of the organisms.H. angustipennis reacted to water pollution within 1 h with decreased time spent on ventilation (p < 0.001), no change in locomotion and netspinning during daytime. During the night, exposure to water pollution resulted in increased locomotion (p < 0.0001).Simultaneous multispecies on-line biomonitoring of industrial effluents is recommended for reliable risk assessment.

Monitoring behavioural responses to metals in gammarus pulex (L.) (Crustacea) with impedance conversion

An impedance conversion technique was used to study the behaviour of Gammarus pulex (L.) exposed to acutely toxic concentrations of Pb (0.01, 0.05, 0.1 and 0.5 mg Pb 1(-1)) and to field concentrations of Cu (≤ 0.05 mg Cu 1(-1)). Initial stress responses were studied during short-term exposure (1 h), and sublethal toxic effects were monitored during 7 (Pb) and 35 days (Cu), respectively. Exposure to Pb caused 30 % mortality and resulted in a bioconcentration factor (BCF) of 2700 at 0.5 mg Pb l(-1) after 168 h. Exposure to Cu polluted stream water caused no mortality within 35 days, and uptake was low (BCF 5.8). Gammarus pulex reacted with initial stress responses to metal exposure within 30 min (Cu) or 1 h (Pb). The reactions consisted of increased ventilation and decreased locomotion.Sublethal concentrations of Pb and Cu caused toxic effects on the behaviour of G. pulex after several days of exposure, consisting of increased ventilation and decreased locomotion.Impedance conversion is an appropriate method for detecting stress responses to metals and can be used in "early warning" biomonitoring systems as well as for acute and chronic behavioural toxicity testing.

Monitoring behavioural responses to metals inGammarus pulex (L.) (Crustacea) with impedance conversion

An impedance conversion technique was used to study the behaviour ofGammarus pulex (L.) exposed to acutely toxic concentrations of Pb (0.01, 0.05, 0.1 and 0.5 mg Pb l(-1)) and to field concentrations of Cu ( ≤ 0.05 mg Cu l(-1)). Initial stress responses were studied during short-term exposure (1 h) and sublethal toxic effects were monitored during 7 (Pb) and 35 days (Cu), respectively.Exposure to Pb caused 30 % mortality and resulted in a bioconcentration factor (BCF) of 2700 at 0.5 mg Pb l(-1) after 168 h. Exposure to Cu polluted stream water caused no mortality within 35 days and uptake was low (BCF 5.8).Gammarus pulex reacted with initial stress responses to metal exposure within 30 min. (Cu) or 1 h (Pb). The reactions consisted of increased ventilation and decreased locomotion.Sublethal concentrations of Pb and Cu caused toxic effects on the behaviour of G.pulex after several days of exposure, consisting of increased ventilation and decreased locomotion.Impedance conversion is an appropriate method for detecting stress responses to metals and can be used in "early warning" biomonitoring systems as well as for acute and chronic behavioural toxicity testing.

Effects of subacute doses of cadmium on pH-stressed Leptophlebia marginata (L.) and Baetis rhodani Pictet (Insecta: Ephemeroptera)

Cd uptake, emergence, survival and locomotory activity at two pH levels were studied in a 27-day experiment with Leptophlebia marginata and in a 19-day experiment with Baetis rhodani. Model ecosystems containing recirculating stream water, patches of sediment and leaves, simulated a natural stream. During the experiments, concentrations of Al, Cd, Fe and Zn increased in the water at pH 5, while conductivity decreased. Cd was taken up by both species at a rate which indicated linear uptake kinetics. No steady state of Cd in the animals was observed. The larvae of B. rhodani contained significantly more Cd than the adults (p<0.001). Uptake of Cd by Baetis rhodani was higher at pH 7 than at pH 5 (p<0.05). The survivial of L. marginata was not influenced by pH and Cd stress, but emergence was significantly reduced (p<0.05). The survival and the emergence of B. rhodani were reduced by low pH and also by Cd addition (p<0.01). At pH 7, Cd had no significant adverse effect on survival. Locomotory activity of Baetis rhodani was reduced by low pH and additionally by Cd stress.

Effects of glucose and glucose polymers on calcium absorption in healthy subjects

Glucose polymers have been shown to enhance intestinal calcium absorption in normal subjects as well as in patients with gastrointestinal disease. Glucose polymers are widely used as an energy source in enteral nutritional supplements and infant formulas. In this study, eight normal subjects underwent 47Ca absorption tests to compare the effect on calcium absorption of carbohydrate given orally as a simple carbohydrate (glucose) or a more complex carbohydrate (glucose polymers). Oral coadministration of glucose with calcium increased the efficiency of intestinal calcium absorption by 20% and coadministration of glucose with glucose polymers increased calcium absorption by 27%. This suggests that glucose, derived from glucose polymers by hydrolysis, may be responsible for the positive effect of polymers on calcium absorption. The potential positive effect of coadministration of carbohydrate on calcium bioavailability deserves considerations in the design of calcium supplementation strategies.

Hypercalcemia. A complication of advanced chronic liver disease

Hypercalcemia has not previously been recognized as a complication of advanced chronic liver disease without hepatoma. During a five-year period, 16 patients evaluated in the liver transplantation program at the University of Pittsburgh developed hypercalcemia. All had advanced chronic liver disease with mean total bilirubin concentration of 29.5 +/- 4.6 mg/dL (50.1 +/- 78.2 mumol/L) (mean +/- SEM) and prothrombin time 16.8 +/- 0.8s. The highest serum calcium level was 17.2 mg/dL (4.3 mmol/L). The mean serum calcium level was 11.7 +/- 0.3 mg/dL (2.93 +/- 0.075 mmol/L) with an ionized calcium level of 5.41 +/- 0.35 mg/dL (1.35 +/- 0.088 mmol/L) and a phosphorus level of 4.2 +/- 0.4 mg/dL (1.4 +/- 0.1 nmol/L). Mild to moderate renal insufficiency was present in 14 (87%) patients; the mean serum creatinine level was 2.8 +/- 0.4 mg/dL (247 +/- 35 mumol/L). In five (38%) patients parathyroid hormone was completely suppressed and in an additional five (38%) patients, it was in a range most compatible with nonhyperparathyroid hypercalcemia. The 25-hydroxyvitamin D or 1,25-dihydroxyvitamin D levels were normal or low in the 11 patients in whom determinations were made. Hypercalcemia that is not due to hyperparathyroidism or hypervitaminosis D is a potential complication of advanced chronic liver disease.

Adaptive responses of rat liver to the gestagen and anti-androgen cyproterone acetate and other inducers. II. Induction of growth

Treatment of female Wistar rats with cyproterone acetate (CPA) leads to considerable enlargement of the liver. The organ content of water, dry mass, protein, RNA, and DNA increased in parallel with the enlargement; only lipid accumulation showed a slight excess. The changes were maximal after treatment for 3 days and increased in a dose-dependent manner, the threshold dose being 5--10 mg CPA/kg DNA synthesis was strongly enhanced after a lag phase of 12--14 h; a maximal rate of synthesis was attained after 18--24 h. The number of parenchymal cells involved in DNA synthesis and mitosis were increased up to 20-fold. Sinusoidal cells participated only slightly in the growth process, and their number decreased relative to the number of parenchymal cells. These results indicate that CPA induces (presumably adaptive) liver growth essentially by parenchymal hyperplasia; of the model inducers used for comparison only pregenolone-16 alpha-carbonitrile (PCN) produced a similarly strong hyperplastic response while liver enlargement elicited by a alpha-hexachlorocyclohexane (alpha-HCH), phenobarbital (PB) and 3-methylcholanthrene (3-MC) was partly or exclusively due to hypertrophy. Liver growth was also observed in male rats treated with CPA, but was less pronounced in this sex. After discontinuation of treatment, liver enlargement and the increase of DNA regressed partially within 1--3 weeks; this regression seemed to be due to sequestration of old cells which were not involved in replication after CPA treatment. The relationship between induction of liver growth by CPA and hepatoma formation in rats is discussed.