Longstanding Nonunion of Metatarsal Fractures in an Adult Patient with Autosomal Dominant Osteopetrosis: A Case Report

CASE

Osteopetrosis is a genetic condition that impairs bone turnover as the result of defects in osteoclast function and abnormal ossification of bone. Autosomal dominant osteopetrosis is often mild; however, the impaired fracture healing, increased density, and hardness of osteopetrotic bone present technical challenges for surgeons leading to complications with both nonoperative and operative treatment modalities. In this case report, we describe a patient treated empirically with ultrasonic bone stimulation for nonunion of fractures of multiple metatarsals after a failure of conventional therapy.

CONCLUSION

Ultrasonic bone stimulation may have a role in optimizing nonoperative management of osteopetrosis-related fractures in adults.

The times they are a-changin': The evolution of prostate cancer screening practices and beliefs among primary care physicians in Victoria, British Columbia

INTRODUCTION

Prostate cancer screening practices remain controversial among primary care practitioners (PCPs). Inconsistent guidelines and publication of large prostate cancer screening trials have failed to provide definitive guidance. This study investigates the evolution of prostate cancer screening practices and beliefs over 12 years, in Victoria, British Columbia.

METHODS

Questionnaires were delivered to 119 randomly selected PCPs in 2019. Descriptive analysis together with exploratory graphs and Pearson Chi-squared test for independence was calculated. The 2008 data was compared by determining if their value fell within the 2019 data's 95% confidence interval.

RESULTS

Response rate was 69.8% (83/119); 30.1% of PCPs reported regularly screening asymptomatic men with prostate-specific antigen (PSA) testing and 37.3% reported regularly performing digital rectal exam (DRE). The combination of PSA and DRE was the most used (48.2 %) screening modality. Most (73.5%) reported that guidelines influence their screening practices, with the most popular choice being those published by The Canadian Task Force on Preventive Health Care (CTF) (32.5%).

CONCLUSIONS

The results demonstrate a movement away from prostate cancer screening among PCPs when compared to 2008. PCPs believe that DRE and PSA are less valuable as screening tools and that there is insufficient evidence to support their use. The most used initial screening modality was the combination of PSA/DRE, however, we found a decrease in their use between the two study periods. Clinical guidelines continue to influence PCPs screening practices, but the shift of more PCPs following the CTF guidelines since 2008 has likely led to the reciprocal decrease in prostate cancer screening.

The Impact of the Change Trial on Physical Health in People With Schizophrenia

Life expectancy in patients with schizophrenia is reduced by 20 years for men and 15 years for women compared to the general population. About 60% of the excess mortality is due to physical illnesses, with cardiovascular disease being dominant. The aim of this trial was to improve the cardiovascular risk profile.

Methods

The CHANGE trial was an investigator-initiated, randomised, parallel-group, superiority, multi-centre trial with blinded outcome assessment. Patients diagnosed with schizophrenia spectrum disorders and increased waist circumference according (>88 cm for women, >102 cm for men), were recruited and centrally randomised 1:1:1 to 12-months of lifestyle coaching plus care coordination versus care coordination alone versus treatment as usual. The primary outcome was 10-year risk of cardiovascular disease assessed post-treatment and standardised to age 60, secondary outcomes included cardiorespiratory fitness and physical activity. Clinical.Trials.gov NCT01585493.

Findings

A total of 428 participants were randomly assigned to the CHANGE intervention (n = 138); care coordination (n = 142); or treatment as usual (n = 148). At 12 months, the mean 10 years risk of cardiovascular disease was 8.4% (SD 6.7) in the CHANGE group, 8.5% (SD 7.5) in the care coordination group and 8.0% (SD 6.5) in the treatment as usual group (P = 0.41). We found no intervention effects for any secondary or explorative outcomes, including weight, cardiorespiratory fitness, physical activity, diet or smoking.

Interpretation

The CHANGE trial did not support individual lifestyle coaching or care coordination as superior compared with treatment as usual in reducing the cardiovascular risk in patients with schizophrenia and increased waist circumference.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

[Practical application of phonoarthrography in the diagnosis of knee joint disease (author's transl)]

198 Phonoarthrographic examinations of the knee joint are reported on. An analysis was then carried out on the noise in knee joints with clinically and operatively demonstrated gonarthritis, chondromalacia of the patella, meniscus lesion and complex ligament injuries of the knee joint. Our results show that statistically, due to the division of the noise peaks into frequency groups, the four examined conditions could be separately identified. A practical use is possible now, in diagnosis as well as in examining the progress in knee joint disease. The representation of pathological-anatomical changes by phonoarthrograhy allows the effectiveness of therapeutical measures to be checked. This simple painless examination method provides an additional aid to diagnosis.

GB virus C coinfection and vertical transmission in HIV-infected mothers before the introduction of antiretroviral prophylaxis

OBJECTIVES

To investigate the prevalence of GB virus C (GBV-C) viraemia and GBV-C antibodies in a cohort of HIV-infected mothers and their infants between 1987 and 1994.

METHODS

GBV-C viraemia and antibodies were determined by polymerase chain reaction (PCR) and enzyme-linked immunosorbent assay (ELISA) in 52 HIV-infected mothers and their 53 infants, who were born before antiretroviral prophylaxis for reduction of HIV transmission was introduced at the end of 1994. Ten of these children acquired HIV.

RESULTS

Mothers of three children had GBV-C viraemia and mothers of another 14 children carried antibodies against GBV-C. No mother had GBV-C antibodies and GBV-C viraemia simultaneously. GBV-C viraemia was detected in only one infant. This child was delivered by the vaginal route to a mother with GBV-C viraemia, and was not HIV-infected. No vertical transmission of GBV-C occurred from mothers with GBV-C antibodies. However, four of 10 children who were infected with HIV had a mother with past or ongoing GBV-C infection.

CONCLUSION

Our findings suggest that the risk of vertical transmission of GBV-C is not elevated in HIV-infected mothers. Furthermore, although the number of HIV-1-infected children was low, we saw no evidence that the presence of ongoing or past GBV-C infection influenced the probability of vertical HIV transmission.

Kinetics of HIV-1 RNA and resistance-associated mutations after cessation of antiretroviral combination therapy

OBJECTIVE

To study the kinetics of HIV-1 RNA and drug-induced mutations after cessation of antiretroviral therapy (ART).

DESIGN AND METHODS

Successive plasma samples from 26 patients were tested for HIV-1 RNA by PCR and for mutations associated with drug resistance by sequencing of the pol gene.

RESULTS

After cessation of ART the phase of undetectable virus (< 50 copies/ml), ranging from 6 to more than 29 days, was followed by a rapid viral increase, which slowed down before a plateau corresponding to pre-treatment levels or higher was reached in most cases (14/19 patients). In one patient virus was still undetectable at 4 weeks. Also, a significantly larger number of primary protease inhibitor (PI)-associated mutations reverted to wild-type, as compared with secondary PI-, and primary reverse transcriptase inhibitor (RTI)-associated mutations. During the rapid viral increase no mutations disappeared, which instead happened during the slower viral increase preceding the viral plateau level.

CONCLUSION

After discontinuation of ART large individual variations were found for the time period until HIV-1 became detectable in plasma, possibly due to differences in the HIV-1 specific immunity. The more rapid loss of primary PI mutations suggests that they might cause a more impaired viral fitness than primary RTI mutations. However, the persistence of drug mutations during the initial viral load increase indicates that mutated strains may still replicate efficiently.

Initiation of therapy during primary HIV type 1 infection results in a continuous decay of proviral DNA and a highly restricted viral evolution

A latent pool of HIV-1 is established early in memory CD4+ T lymphocytes and persists during antiretroviral therapy. Also, viral replication may continue in subjects despite undetectable viremia. However, it remains unclear whether this residual replication results in any significant sequence evolution. We were therefore interested in studying the viral evolution and HIV-1 DNA dynamics in subjects with primary infection receiving or not receiving early potent antiretroviral therapy. In 16 subjects, HIV-1 DNA load was monitored from 1 to 23 days, up to 1253 days, after onset of symptoms. Extensive sequential cloning and sequence analysis of the V3 region was performed in four subjects. In the treated subjects a continuous decline in the proviral load was found, corresponding to a half-life of about 6 months. As expected in newly infected individuals the founder virus populations showed high intrasubject sequence similarity. Also, a limited increase in the viral divergence was detected during the first 6 months in three treated subjects. Thereafter, no significant sequence changes were found despite analysis of a large number of clones. Our data thus suggest that early and successful therapy in compliant subjects with primary HIV-1 infection results in a highly restricted viral evolution and a decline in the proviral load close to the decay rate of human memory T lymphocytes.

Proviral HIV-1 dynamics and evolution in patients receiving efficient long-term antiretroviral combination therapy

OBJECTIVES

Different experimental approaches have shown that, despite plasma viral loads under the threshold of detection, HIV-1 frequently continues to replicate in patients receiving potent antiretroviral therapy. However, whether this low-grade viral replication is sufficient for the generation of new major quasispecies has not been studied. Thus, in order to evaluate the extent of variation in the major proviral HIV-1 population, we monitored proviral DNA sequences in such patients over a time period of up to 30 months.

METHODS

DNA was extracted from peripheral blood mononuclear cells (PBMC) and the V3 region was amplified by nested polymerase chain reaction (PCR) and directly sequenced. Additionally, both HIV-1 RNA and DNA levels and CD4+ T-lymphocyte counts were monitored.

RESULTS

Analysing the V3 gene sequences of 17 patients, we observed a sequence evolution in nine patients. Interestingly, the majority of these changes (77%) occurred in the first interval following the initiation of therapy and despite signs of ongoing replication the proviral DNA levels continued to decrease in all patients.

CONCLUSIONS

Our data suggest that, although available data report that HIV-1 continues to replicate in patients with undetectable viraemia, the extent of viral replication in many of these patients is not sufficient to result in changes in the major viral population.

Short-term effect of amantadine sulphate on motor performance and reaction time in patients with idiopathic Parkinson's disease

In thirty patients with idiopathic Parkinson's disease (PD) we examined in a prospectively designed study the effect on motor performance and cognitive functions of amantadine sulphate, applied intravenously over a period of 14 days. Prior to the introduction of amantadine and post infusionem the motor function was measured by the Unified Parkinson Disease Rating Scale (UPDRS) and the Motor Performance Test Series (MPS); the simple and the choice reaction time were assessed using the Vienna Reaction Unit (VRU). The primary endpoint of efficacy was the change in the UPDRS part III (motor examination) after 14 days of amantadine sulphate administration compared with baseline. Secondary end-points were changes in the variables of-the MPS and VRU at the end of administration interval compared with baseline. Overall, after 14 days of intravenous amantadine administration (200mg/ day), a significant improvement was obtained in motor performance with respect to the semiquantitative motor scores of the UPDRS (p = 0.002) and the quantitative motor variables in the pertinent subtests of the MPS, reflecting precision and speed of arm-hand movement as well as manual and finger dexterity, for the right (p < 0.01) and the left hand (p < 0.05). However, all patients being viewed collectively, it was observed that there was a widely differing time delay of efficient motor response to amantadine from 4 to 9 days between individuals, whilst the quality of motor response remained stable for the follow-up period. Although simple reaction time showed no significant improvement, choice reaction time shortened significantly in less affected PD patients staging Hoehn and Yahr I to III (p < 0.05). We conclude that apart from efficacy on motor performance, amantadine sulphate - applied intravenously - has a positive effect on cognitive functions, particularly in less affected PD patients.

Variability and immunogenicity of human immunodeficiency virus type 1 p24 gene quasispecies

Despite the conserved nature of the human immunodeficiency virus type 1 (HIV-1) gag gene, multiple quasispecies of the p24 gene coexist in HIV-1-infected patients. We cloned and sequenced 31 p24 genes from four HIV-1-infected patients. The intrapatient homology between the p24 genes ranged from 97.1 to 99.1%, whereas the interpatient homology ranged from 91.5 to 93.8%, suggesting a host-specific evolution. Synonymous and nonsynonymous nucleotide changes were evenly distributed in the p24 gene, with 27 and 28%, respectively, located within host human leukocyte antigen class I recognition sites. This would suggest only a minor influence from the host cytotoxic T-cell response on the evolution of the p24 gene. The importance of minor variations within p24 was analyzed by designing DNA-based immunogens from two distinct p24 quasispecies genes simultaneously derived from one patient. In plasmid-immunized H-2(b), H-2(d), and H-2(k) haplotype mice, a clear influence from the host major histocompatibility complex was noted on the immune responses, fully consistent with those noted when a recombinant p24 protein is used as the immunogen. The two p24 DNA immunogens did not differ in their immunogenicity, indicating that the limited genetic variability (<1%) had little influence on the immune responses.

Nonintrusive optical measurements of aircraft engine exhaust emissions and comparison with standard intrusive techniques

Nonintrusive systems for the measurement on test rigs of aeroengine exhaust emissions required for engine certification (CO, NO(x), total unburned hydrocarbon, and smoke), together with CO(2) and temperature have been developed. These results have been compared with current certified intrusive measurements on an engine test. A spectroscopic database and data-analysis software has been developed to enable Fourier-transform Infrared measurement of concentrations of molecular species. CO(2), CO, and NO data showed agreement with intrusive techniques of approximately ?30%. A narrow-band spectroscopic device was used to measure CO(2) (with deviations of less than ?10% from the intrusive measurement), whereas laser-induced incandescence was used to measure particles. Future improvements to allow for the commercial use of the nonintrusive systems have been identified and the methods are applicable to any measurement of combustion emissions.

Variations in HIV-1 pol gene associated with reduced sensitivity to antiretroviral drugs in treatment-naive patients

OBJECTIVE

Various drugs against the HIV-1 enzymes reverse transcriptase (RT) and protease have been introduced in the last few years: protease inhibitors, nucleoside RT inhibitors (NRTI) and non-NRTI (NNRTI). Several sequence variations associated with reduced drug sensitivity have been described in the HIV-1 pol gene.

DESIGN

To analyse the occurrence of mutations associated with drug resistance in treatment-naive individuals.

METHODS

RNA was extracted from sera of treatment-naive individuals, who were first diagnosed to be HIV-1 infected between August 1996 and February 1998. The pol region was amplified by RT-PCR and directly sequenced. Data on mutations associated with resistance to antiretroviral drugs were obtained from literature.

RESULTS

Fifty protease genes and 53 RT genes from 57 individuals were sequenced. In the RT we analysed 20 amino-acid positions associated with resistance to NRTI and NNRTI. In total, 1054 amino acids at critical positions were analysed and three (0.3%) mutations known to contribute to RTI resistance were detected. In the protease, 16 amino-acid positions associated with resistance to protease inhibitors were analysed. By analysing a total of 768 amino acids at key positions in the protease, 50 (7%) mutations were detected that were associated with reduced drug sensitivity. Thirty-one (61%) patients showed between one and six mutations at the analysed protease amino-acid positions. In eight out of 16 analysed amino-acid positions, up to 44% of all patients carried mutations associated with resistance to protease inhibitors.

CONCLUSIONS

Very few pre-existing mutations to RTI were found, suggesting that the transmission of RT-resistant strains is still uncommon. However, about two-thirds of the patients had one or more mutations associated with resistance to protease inhibitors. In addition, at some amino-acid positions up to almost half of the patients carried variations claimed to contribute to protease inhibitor resistance. Most of these mutations are likely to reflect the natural polymorphism of the protease. Their impact on the long-term effect of antiretroviral treatment should be evaluated in future studies.

Coexisting members of HIV-1 p17 gene quasispecies represent proteins with distinct antigenicity and immunogenicity

BACKGROUND

Despite the comparatively conserved nature of the HIV-1 gag gene, countless quasispecies of the p17 gene coexist in HIV-1-infected patients. It is not known if the minor genetic differences in quasispecies will affect immune recognition.

OBJECTIVE

To characterize the antigenicity and immunogenicity of three different members of HIV-1 p17 quasispecies.

METHODS

Three members of HIV-1 p17 gene quasispecies, one from patient A (clone 9; qsA9) and two from patient E (clones 5 and 8; qsE5 and qsE8), were expressed and purified from Escherichia coli. The antigenicity of the p17 proteins was analysed using sera from HIV-1-infected individuals, and the immunogenicity was evaluated using sera and lymphocytes from primed mice of three different haplotypes.

RESULTS

The antigenicity of the qsE5 and qsE8 p17 recombinant proteins were distinct when tested for reactivity with human p17 antibodies. The qsE5 and qsE8 p17 were equally immunogenic in H-2d mice, but not in H-2b and H-2k mice. In H-2b mice the qsE8 protein induced higher levels of anti-p17 IgG2a, IgG2b and IgG3 than the qsE5 protein. Corroborating the IgG subclass pattern, H-2b-restricted qsE5-specific T cells produced higher in vitro levels of interferon-gamma, but not of interleukin (IL)-4, IL-5 and IL-6, than qsE8-specific T cells, suggesting a more pronounced T-helper (TH)1-like response.

CONCLUSIONS

The p17 gene quasispecies coexisting in the same patient at the same time may represent antigenically and immunogenically distinct proteins despite sequence homologies of above 90%. Subsequently, subtle differences between two p17 protein quasispecies are enough to prime different TH1/TH2 subsets. These findings will have implications for therapeutic HIV-1 immunizations.

The Far Infrared Spectrum of HOCl: Line Positions and Intensities

The far infrared spectrum of HOCl has been recorded at high resolution between 20 and 360 cm-1 by means of Fourier transform spectroscopy, and it was possible to observe pure rotation lines involving rotational levels with high Ka quantum numbers (up to Ka = 9). These lines combined with microwave and tunable far infrared data available in the literature were least squares fitted using a Watson-type Hamiltonian. The fitting leads to precise sets of rotational and centrifugal distortion constants for the ground states of both isotopomers HO35Cl and HO37Cl. Also relative line intensities were measured and their fitting allowed the determination of rotational corrections to the b-component of the permanent transition moment. Finally, to get Hamiltonian constants consistent with the newly determined ground state constants for the (100), (010), (001) vibrational states, available data concerning the nu1, nu2, and nu3 bands were refitted. Three interesting points are to be stressed. For the (001) state, we were able to complete the existing data with rotation lines observed in our spectra up to rather high Ka values (Ka = 7). For HO35Cl, we were able to show that some (010) and (100) levels are perturbed by levels of the (002) and (030) states, respectively, through Coriolis-type interactions. This allows the determination of the band centers of these two dark states. Copyright 1998 Academic Press.

Human immunodeficiency virus type 1 disease progression, CCR5 genotype, and specific immune responses

The correlation among the presence of a 32-bp deletion in the CC-chemokine receptor 5 (CCR5) gene, disease progression, and human immunodeficiency virus type 1 (HIV-1)-specific immune responses was analyzed for a cohort of 79 Caucasian HIV-1-infected patients. The CCR5 genotype (CCR5/CCR5 = wild type/wild type or delta32CCR5/CCR5 = 32-bp deletion/wild type) in peripheral blood mononuclear cells was determined by PCR, followed by sequencing of both wild-type and delta32CCR5 gene fragments. HIV-1-specific humoral responses to gp41 and V3MN peptides were determined by enzyme immunoassays. The prevalence of the delta32CCR5 allele was lower among 37 patients with rapid progression (progression to AIDS or to a CD4 cell count of <200 x 10(6)/liter in less than 9 years; P < 0.01) compared to that for 42 patients with slow progression (no AIDS and CD4 cell count of >200 x 10(6)/liter after at least 9 years from infection) or to that for 25 non-HIV-1-infected Swedish blood donors (P < 0.05). No differences were observed in the wild-type CCR5 sequences between the different groups of patients. For three analyzed patients, the 32-bp delta32CCR5 gene deletions were identical. The antibody titers against gp41 and a V3MN peptide in patients with the delta32CCR5/CCR5 genotype were not significantly different from those in pair-matched CCR5/CCR5 controls. However, in 13 analyzed patients, a stronger serum neutralizing activity was associated with the delta32CCR5/CCR5 genotype. Thus, a CCR5/CCR5 genotype correlates with a shortened AIDS-free HIV-1 infection period and possibly with a worse neutralizing activity, without an evident influence on the antibody response to two major antigenic regions of HIV-1 envelope.

Nonsynonymous mutations within the human immunodeficiency virus type 1 p17 gene are clustered to sequences binding to the host human leukocyte antigen class I molecules

We have analyzed the relation between intrapatient variabilities of the p17 gene and the location of known host p17 cytotoxic T lymphocyte (CTL) epitopes in five patients infected with human immunodeficiency virus type 1 (HIV-1). All patients were typed with respect to the human leukocyte antigen (HLA) class I type. One to seven previously fine-mapped p17 CTL epitopes corresponded to the HLA class I restriction elements of each patient. An average of 28+/-16% of the p17 gene of each patient encoded CTL epitopes corresponding to the HLA restriction elements of the host. Twenty full-length p17 gene clones were sequenced from each patient. The intrapatient homology between the p17 sequences ranged from 96.4 to 98.9%. The interpatient homology between the consensus sequences of each patient ranged from 83.1 to 91.6%. A total of 246 nucleotide differences within the 100 p17 clones was noted. Fifteen (16%) of 96 synonymous substitutions were found within host CTL epitopes, whereas 72 (48%) of 150 nonsynonymous nucleotide changes were found within CTL epitopes corresponding to the HLA restriction elements of the host (p < 0.0001; Fisher's exact test). Subsequently, variable residues indicating the evolution of at least two major p17 species (i.e., >20% of the clones) were determined to be more common at positions contained within these CTL epitopes (p < 0.01). The present data suggest that the evolution of the p17 gene is influenced by contact areas with the host HLA class I molecules.

The Rotational Spectrum and Anharmonic Force Field of Chlorine Dioxide, OClO

The rotational spectra of O35ClO and O37ClO in their (000), (100), (010), (001), and (020) states have been reinvestigated in selected regions between 130 and 526 GHz. About 800 newly measured lines spanning the quantum numbers 2 </= N </= 65 and 0 </= Ka </= 17 have been analyzed together with data from two previous microwave and millimeter wave studies. In particular, the spectroscopic constants in the ground vibrational states have been improved enabeling precise predictions of line positions into the submillimeter region. The newly derived ground state rotational and quartic centrifugal distortion constants, their vibrational changes, and the sextic centrifugal distortion constants were used together with data from infrared studies in a calculation of the quartic force field. Copyright 1997 Academic Press. Copyright 1997Academic Press

Determination of line strengths by Fourier-transform spectroscopy

A rigorous test of the photometric accuracy of commercial high-resolution Fourier transform spectrometers has been made by measuring line strengths in the pure rotational spectrum of carbon monoxide. Measurements have been made with a Bruker IPS 120 HR spectrometer (transitions: J″ = 7 . . . 23) and a Bomen DA3.002 spectrometer (J″ = 27 . . . 35). A least-squares fit of individual data sets and the combined data gave permanent electric dipole moments in the range 0.1091-0.1101 D and quadratic Herman-Wallis factors in the range -0.188 to -0.229 × 10(-3), in good agreement with literature values within the overall uncertainty. Sources of systematic errors in the Fourier-transform spectrometer and in the algorithms used to reduce the data are discussed in detail. The experimental results show that such errors affected the retrieved line strengths by less than 1%.

[Results of cementless acetabular revision surgery]

The great number of hip revision arthroplasties and the cementless fixation of arthroplasties has led to more and cementless hip revision operations with bone transplantation. This retrospective study shows the results of a clinical and radiological follow-up of 34 patients with an average age of 71 years and 4 months at their hip revision arthroplasty. The subjective and clinical result in the Harris-Hip-Score 3 years and 9 months (1 year 4 months-6 years 3 months) after surgery shows 67% of the patients content with the result of the revision arthroplasty. The Harris-Hip-Score shows an average of 41.1 points preoperatively and 73.2 points at the follow-up examination. The loosening-rate was 11.8%, all arthroplasties which seemed loosened radiologically had also a bad result clinically. No correlation could be shown between the age of the patients and the clinical results as well as between an additional stem revision (15 patients) and the clinical result in the Harris-Hip-Score. All revision operations were done with bone transplantation and demonstrate, that the concept of cementless fixation of acetabular component gives satisfactory results.

[Increasing the reliability of anamnestic data by increasing the length of the interview]

In accordance with the theory of mental tests in this study it was tried to improve the reliability of diagnostic interview data by enhancing the number of items concerning the same biographical topic (= homogeneous items). Reliability was defined as stability of the statements in repeated interviews. The reliabilities of three interview items concerning different topics were calculated. The interviews were carried out under two different conditions: Under the experimental condition (30 subjects) the item, of which the stability was calculated, was the last in a series of ten homogeneous items, under the control conditions (30 subjects) the item was the last in a series of ten heterogeneous items. Under the experimental condition the reliabilities of two items, concerning the diseases of children and concerning the school record, were significantly improved. Not improved was the reliability of the appraisal of parent's educational methods. The reliabilities of the interview data not seemed to depend on the age of the subjects.

[Investigations in animal experiments into the influence of the beta-1-selective blocking agent metoprolol on the cardiovascular and metabolic side effects of the tocolytic fenoterol]

The influence of the highly selective beta-1-adrenergic blocker Metoprolol on cardiovascular and metabolic side effects of the beta-mimetic Fenoterol, used for labour inhibition, was investigated in anesthetized mongrel dogs. In a dosage of 1.5 microgram/kg BW/min Metoprolol antagonized the positive inotropic and chronotropic cardiac effects of Fenoterol (0.06 microgram/kg BW/min) thus compensating the impaired energetic balance of the myocardium. As expected, there was no influence on the beta-mimetic mediated metabolic alterations. Taking into account its pharmacologic actions, the additional application of Metoprolol in labour inhibition with beta-mimetics seems to be advantageous. On account of the proven results a reduction of the more or less considerable missensations and a cardioprotective effect may be expected.

[Intracranial pressure - variations in brain-injured patients caused by PEEP-ventilation and lifted position of the upper part of the body (author's transl)]

Studies about ICP-variations of brain-injured patients under artificial ventilation seem to become important, since most of those patients, especially those with various additional injuries, do not breathe spontaneously. After having ventilated 10 patients with endexpiratory pressure from 0 to 10 cm H2O, significant ICP-rises could be monitored. A significant linear ICP-decrease could be induced by lifting the upper part of the body in corresponding linear rates. If applied in clinical work, the combination of these two methods we studied, seems to mean some sort of compensation of any ICP-changes during artificial ventilation. Therefore the indication for peep ventilation of brain-injured patients can be put less limited by ventilation-caused ICP-rises.

[Method for measuring physiological changes under fenoterol and verapamil. An experimental study on the origin of pulmonary oedema under tocolysis. I (author's transl)]

Fluidshifts in the lung seem to play an important role in labour inhibition with fenoterol and verapamil. Therefore the experimental procedure for an investigation of these drugs is discussed in detail. The Thermo-Dye-Technic is used for quantitating pulmonary extravascular water. Moreover methods for monitoring pulmonary and systemic hemodynamics, bloodgases and acid-base-balance, metabolic parameters and the realization of the experiment are described.

The mechanical, enzymatic and morphological changes in acute pulmonary insufficiency following the production of a haematoma in rabbits

The production of a haematoma in the hindleg of rabbits represents a simplification of post-traumatic models. The lungs, one of the target organs, show similar micromorphological alterations to those described in traumatised human beings. The lungs of rabbits, bearing a hindleg haematoma for 24 hr, showed a significantly increased incidence of micromorphological lung alterations compared to the control group. Moreover, measurement revealed a significantly decreased lung compliance within the haematoma groups. It was demonstrated that whether the haematoma was subcutaneous or intramuscular, similar alterations were seen in lung histology, and in lung compliance values. Studies on the activity of superoxide dismutase in lung tissue homogenates demonstrated a significant decrease in those rabbits having had a haematoma intramuscularly for 24 hr.

[The combination of etomidate and fentanyl as a short acting and introduction anaesthesia in the dog in experimental medicine (author's transl)]

The effects of a combination of etomidate (1.0 mg/kg bw) and fetanyl (0.005 mg/kh bw) on haematology, blood gases, acid-base balance and haemodynamics were investigated in 8 mongrel dogs. The only significant change in haematology was leucopenia. Blood gas values and acid-base balance initially showed a depression of respiration and a tendency to slight metabolic acid dosis. Decreased heart rate caused diminution of cardiac output, while systemic and pulmonary resistance as well as stroke volume were not altered significantly.