A literature review and expert consensus statement on diagnostics in suspected metal implant allergy

BACKGROUND

Although rare, allergic reactions to metal implants represent a diagnostic challenge in view of missing guidelines.

OBJECTIVES

To develop an European expert consensus on characteristics of metal allergy reactions and the utility of various diagnostic tools in suspected metal implant allergy.

METHODS

A nominal group technique (NGT) was applied to develop consensus statements. Initially an online literature database was created on a secure server to enable a comprehensive information. Twenty-three statements were formulated on potential aspects of metal implant allergy with a focus on diagnostics and grouped into five domains. For the consensus development, the panel of 12 experts initially did refine and reformulate those statements that were ambiguous or had unclear wording. By face-to-face (9/12) or virtual participation (3/12), an anonymous online voting was performed.

RESULTS

Consensus (≥80% of agreement) was reached in 20/23 statements. The panel agreed that implant allergy despite being rare should be considered in case of persistent unexplained symptoms. It was, however, recommended to allow adequate time for resolution of symptoms associated with healing and integration of an implant. Obtaining questionnaire-aided standardized medical history and standardized scoring of patient outcomes was also considered an important step by all experts There was broad consensus regarding the utility/performance of patch testing with additional late reading. It was recognized that the lymphocyte transformation test (LTT) has to many limitations to be generally recommended. Prior to orthopaedic implant, allergy screening of patients without a history of potential allergy to implant components was not recommended.

CONCLUSIONS

Using an expert consensus process, statements concerning allergy diagnostics in suspected metal implant allergy were created. Areas of nonconsensus were identified, stressing uncertainty among the experts around topics such as preoperative testing in assumed allergy, histological correlate of periimplant allergy and in vitro testing, which underscores the need for further research.

The influence of edible coatings and natural antioxidants on fresh-cut potato quality, stability and oil uptake after deep fat frying

The effect of four edible hydrocolloid coatings (carboxymethyl cellulose, chitosan, pectin and gum arabic) on fresh-cut potato's colour, pH and moisture content during storage was studied. Possibility of coating enrichment with natural olive leaf extract and sodium ascorbate was also evaluated. Coatings scored as the best ones straight after coating or during storage for 7 days at 10 ± 1 °C, were used for deep fat frying of potato. Chitosan was shown to cause significant decrease in pH and browning of potato strips. Pectin was classified as good coating alone but in combination with olive leaf extract showed lower quality parameters of fresh-cut samples compared to control. Only carboxymethyl cellulose and gum arabic itself or enriched with olive leaf extract or sodium ascorbate were shown not to affect colour, pH and moisture during storage. Moreover, these coatings significantly reduced fat content in deep fat fried potato strips, without influence on L*, b*, whiteness index (WI), and ΔE.

Fatigue Prediction of Aluminum Alloys Considering Critical Plane Orientation under Complex Stress States

This publication is intended to present a new way of estimating the fatigue life of various construction materials. Carpinteri's proposal was modified by replacing the fatigue limits ratio with the value of the normal to shear stress ratio for a given number of cycles. In this study, the proposed criterion and calculation model was verified for the selected group of aluminium alloys. The purpose of the analysis of the experimental studies was to check the effectiveness of the proposed method of estimating fatigue life under the applied bending and torsional load conditions. The results of the fatigue calculations are presented in graphical form by means of diagrams showing the comparison of design and experimental strength. Before fatigue life was calculated, the critical plane orientation according to Carpinteri's model and the proposed model were determined. After analyzing the results of the comparison of design and experimental durability, it can be stated that the proposed fatigue life estimation algorithm gives satisfactory results for multiaxial cyclic loads.

Disturbances in primary dental enamel in Polish autistic children

Dental enamel is a structure that is formed as a result of the regular functioning of ameloblasts. The knowledge of the patterns of enamel secretion allows an analysis of their disruptions manifested in pronounced additional accentuated lines. These lines represent a physiological response to stress experienced during enamel development. The aim of this study was to assess the occurrence of accentuated lines in the tooth enamel of autistic boys. The width of the neonatal line and the periodicity of the striae of Retzius were also assessed. The study material consisted of longitudinal ground sections of 56 primary teeth (incisors and molars): 22 teeth from autistic children and 34 teeth from the control group. The Mann-Whitney U test indicates that the accentuated lines were found significantly more often in autistic children (Z = 3.03; p = 0.002). No differentiation in the rate of enamel formation and in the rate of regaining homeostasis after childbirth were found. The obtained results may indicate a higher sensitivity of autistic children to stress factors, manifested in more frequent disturbances in the functioning of ameloblasts or may be a reflection of differences in the occurrence of stress factors in the first years of life in both analyzed groups.

Steroidogenic potential of human fetal kidney at early gestational age

Steroidogenic potential of the human fetal kidney (hFK) at the end of first trimester is poorly investigated. Little is known about the ontogeny of steroidogenic enzymes and activities of steroidogenic pathways in the hFK at early pregnancy. Our aim was to explore steroidogenesis and the expression of steroidogenic enzymes in the hFK at gestational weeks (GW) 9-12. Steroids in the hFK were analyzed by gas chromatography/coupled to tandem mass spectrometry. The expression of steroidogenic enzymes in the hFK at GW 9-12 was investigated by qPCR, automated Western blotting and immunohistochemistry. We observed that the hFK produced substantial amount of steroids of the Δ⁵ and Δ⁴ pathways and several steroid precursors in the biosynthesis of DHT via the backdoor pathway but not DHT itself. The levels of steroids and expression of relevant steroidogenic enzymes (e.g., CYP17A1, HSD3B1, HSD3B2, CYP11B1 and AKR1C4) we significantly higher in the hFK at GW11-12 compared to GW9. We also found the expression of sex steroid receptors (e.g., AR, ERα and ERβ) in the hFK at GW9-12. No sex-dependent differences in the levels of all identified steroids and expression of steroidogenic enzymes in the hFK from male and female fetuses were found. Altogether, our data indicate that the hFK at early pregnancy is steroidogenic organ with potential to synthesize multiple steroids that may play an important role in the formation and development of this organ in humans.

Ontogenesis of human fetal testicular steroidogenesis at early gestational age

The onset of steroidogenesis in human fetal testes (HFT) during the first trimester is poorly investigated. One important unresolved question is the ontogeny of steroidogenic enzymes and formation of steroidogenic pathways in the HFT at early pregnancy. Our aim was to explore steroidogenesis, the expression of steroidogenic enzymes and their maturation in the HFT at gestational weeks (GW) 8-12. Steroids in the HFT were analyzed by gas chromatography/coupled to tandem mass spectrometry. The expression of steroidogenic enzymes in the HFT at GW8-12 was investigated by qPCR, automated Western blotting and immunohistochemistry. We demonstrated that the HFT at GW8-9 produced low level of testosterone via the Δ⁴ pathway and progesterone was the major steroid found in the testicular tissue. In contrast, more mature Leydig cells from the HFT at GW11-12 synthesized high levels of androgens via the Δ⁵ pathway. We also observed a significant upregulation of the expression of StAR, CYP11A1, CYP17A1 and its accessory proteins, P450 oxidoreductase (POR) and cytochrome b5 in the HFT at GW11-12 compared to GW8-9. Altogether, our data suggest that that human fetal Leydig cells differentiate rapidly at the end of the first trimester by acquiring capacity to express high levels of steroidogenic enzymes and switch from the Δ⁴ to the Δ⁵ pathways to synthesize high levels of androgens due to maturation of the CYP17-POR-b5 complex.

Spermatogonial quantity in human prepubertal testicular tissue collected for fertility preservation prior to potentially sterilizing therapy

STUDY QUESTION

Does chemotherapy exposure (with or without alkylating agents) or primary diagnosis affect spermatogonial quantity in human prepubertal testicular tissue?

SUMMARY ANSWER

Spermatogonial quantity is significantly reduced in testes of prepubertal boys treated with alkylating agent therapies or with hydroxyurea for sickle cell disease.

WHAT IS KNOWN ALREADY

Cryopreservation of spermatogonial stem cells, followed by transplantation into the testis after treatment, is a proposed clinical option for fertility restoration in children. The key clinical consideration behind this approach is a sufficient quantity of healthy cryopreserved spermatogonia. However, since most boys with malignancies start therapy with agents that are not potentially sterilizing, they will have already received some chemotherapy before testicular tissue cryopreservation is considered.

STUDY DESIGN, SIZE, DURATION

We examined histological sections of prepubertal testicular tissue to elucidate whether chemotherapy exposure or primary diagnosis affects spermatogonial quantity. Quantity of spermatogonia per transverse tubular cross-section (S/T) was assessed in relation to treatment characteristics and normative reference values in histological sections of paraffin embedded testicular tissue samples collected from 32 consecutive boy patients (aged 6.3 ± 3.8 [mean ± SD] years) between 2014 and 2017, as part of the NORDFERTIL study, and in 14 control samples (from boys aged 5.6 ± 5.0 [mean ± SD] years) from an internal biobank.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Prepubertal boys in Sweden, Finland and Iceland who were facing treatments associated with a very high risk of infertility, were offered the experimental procedure of testicular cryopreservation. Exclusion criteria were testicular volumes >10 ml and high bleeding or infection risk. There were 18 patients with a diagnosis of malignancy and 14 patients a non-malignant diagnosis. While 20 patients had the testicular biopsy performed 1-45 days after chemotherapy, 12 patients had not received any chemotherapy. In addition, 14 testicular tissue samples of patients with no reported testicular pathology, obtained from the internal biobank of the Department of Pathology at Karolinska University Hospital, were included as control samples in addition to reference values obtained from a recently published meta-analysis. The quantity of spermatogonia was assessed by both morphological and immunohistochemical analysis.

MAIN RESULTS AND THE ROLE OF CHANCE

The main finding was a significant reduction in spermatogonial cell counts in boys treated with alkylating agents or with hydroxyurea for sickle cell disease. The mean S/T values in boys exposed to alkylating agents (0.2 ± 0.3, n = 6) or in boys with sickle cell disease and exposed to hydroxyurea (0.3 ± 0.6, n = 6) were significantly lower (P = 0.003 and P = 0.008, respectively) than in a group exposed to non-alkylating agents or in biobank control samples (1.7 ± 1.0, n = 8 and 4.1 ± 4.6, n = 14, respectively). The mean S/T values of the testicular tissue samples included in the biobank control group and the patient group exposed to non-alkylating agents were within recently published normative reference values.

LIMITATIONS, REASONS FOR CAUTION

Normal testicular tissue samples included in this study were obtained from the internal biobank of Karolinska University Hospital. Samples were considered normal and included in the study if no testicular pathology was reported in the analysed samples. However, detailed information regarding previous medical treatments and testicular volumes of patients included in this biobank were not available.

WIDER IMPLICATIONS OF THE FINDINGS

This study summarizes, for the first time, spermatogonial quantity in a prepubertal patient cohort just before and after potentially sterilizing treatments. Boys facing cancer and cytotoxic therapies are regarded as the major group who will benefit from novel fertility preservation techniques. There are no previous reports correlating spermatogonial quantity to cumulative exposure to alkylating agents and anthracyclines (non-alkylating agents) and no information about the timing of cytotoxic exposures among this particular patient cohort. For prepubertal boys in whom fertility preservation is indicated, testicular tissue should be obtained before initiation of chemotherapy with alkylating agents, whilst for those with sickle cell disease and treated with hydroxyurea, this approach to fertility preservation may not be feasible.

STUDY FUNDING/COMPETING INTEREST(S)

This study was supported by grants from The Swedish Childhood Cancer Foundation (PR2016-0124; TJ2016-0093; PR2015-0073, TJ2015-0046) (J.-B.S. and K.J.), the Jane and Dan Olssons Foundation (2016-33) (J.-B.S.), the Finnish Cancer Society (K.J.), the Foundation for Paediatric Research (J.-B.S.), Kronprinsessan Lovisas Förening För Barnasjukvård/ Stiftelsen Axel Tielmans Minnesfond, Samariten Foundation (J.-B.S.), the Väre Foundation for Paediatric Cancer Research (K.J.) and the Swedish Research Council (2012-6352) (O.S.). R.T.M. was supported by a Wellcome Trust Fellowship (09822). J.P.A.-L. and M.K. were supported by the ITN Marie Curie program 'Growsperm' (EU-FP7-PEOPLE-2013-ITN 603568). The authors declare no conflicts of interest.

TRIAL REGISTRATION NUMBER

N/A.

Degradation Processes of Pesticides Used in Potato Cultivations

Potato is one of the most important crops, after maize, rice and wheat. Its global production is about 300 million tons per year and is constantly increasing. It grows in temperate climate and is used as a source of starch, food, and in breeding industry.Potato cultivation requires application of numerous agro-technical products, including pesticides, since it can be affected by insects, weeds, fungi, and viruses. In the European Union the most frequently used pesticides in potato cultivations check are: thiamethoxam, lambda-cyhalothrin and deltamethrin (insecticides), rimsulfuron (herbicide) and metalaxyl (fungicide).Application of pesticides improves crop efficiency, however, as pesticides are not totally selective, it affects also non-target organisms. Moreover, the agrochemicals may accumulate in crops and, as a consequence, negatively influence the quality of food products and consumer health. Additional risks of plant protection products are related to their derivatives, that are created both in the environment (soil, water) and in plant organisms, since many of these compounds may exhibit toxic effects.This article is devoted to the degradation processes of pesticides used in potato crop protection. Attention is also paid to the toxicity of both parent compounds and their degradation products for living organisms, including humans. Information about the level of pesticide contamination in the environment (water, soil) and accumulation level in edible plants complement the current knowledge about the risks associated with widespread use of thiamethoxam, lambda-cyhalothrin and deltamethrin, rimsulfuron and metalaxyl in potato cultivation.

Prenatal factors associated with the neonatal line thickness in human deciduous incisors

The neonatal line (NNL) is used to distinguish developmental events observed in enamel which occurred before and after birth. However, there are few studies reporting relationship between the characteristics of the NNL and factors affecting prenatal conditions. The aim of the study was to determine prenatal factors that may influence the NNL thickness in human deciduous teeth. The material consisted of longitudinal ground sections of 60 modern human deciduous incisors obtained from full-term healthy children with reported birth histories and prenatal factors. All teeth were sectioned in the labio-lingual plane using diamond blade (Buechler IsoMet 1000). Final specimens were observed using scanning electron microscopy at magnifications 320×. For each tooth, linear measurements of the NNL thickness were taken on its labial surface at the three levels from the cemento-enamel junction. The difference in the neonatal line thickness between tooth types and between males and females was statistically significant. A multiple regression analyses confirmed influence of two variables on the NNL thickness standardised on tooth type and the children's sex (z-score values). These variables are the taking of an antispasmodic medicine by the mother during pregnancy and the season of the child's birth. These two variables together explain nearly 17% of the variability of the NNL. Children of mothers taking a spasmolytic medicine during pregnancy were characterised by a thinner NNL compared with children whose mothers did not take such medication. Children born in summer and spring had a thinner NNL than children born in winter. These results indicate that the prenatal environment significantly contributes to the thickness of the NNL influencing the pace of reaching the post-delivery homeostasis by the newborn's organism.

Synthetic peptides which inhibit the interaction between C1q and immunoglobulin and prolong xenograft survival

BACKGROUND

Acute vascular xenograft rejection (AVXR), also termed delayed xenograft rejection (DXR), occurs when hyperacute rejection (HAR) is prevented by strategies directed at xenoreactive natural antibodies and/or complement activation. We have hypothesized that AVXR/DXR is initiated in part by early components of the complement cascade, notably C1q. We have developed synthetic peptides (termed CBP2 and WY) that interfere with the interaction between C1q and antibody.

METHODS

CBP2 and the WY-conjugates were used as inhibitors of immunoglobulin aggregate binding to solid phase C1q. Inhibition of complement activation by the peptides of the classical system was determined using lysis assays with sensitized sheep red blood cells or porcine aortic endothelial cells as targets and of the alternate complement pathway using guinea pig red blood cells as targets. Two transplant models were used to study the effects of administering peptides to recipients: rat heart transplant to presensitized mouse, and guinea heart transplant to PVG C6-deficient rats.

RESULTS

CBP2 and WY-conjugates inhibited immunoglobulin aggregate binding to C1q. The peptides also inhibited human complement-mediated lysis of sensitized sheep red blood cells and porcine aortic endothelial cells in a dose-dependent manner and the WY-conjugates prevented activation of the alternate complement pathway as shown by inhibition of guinea pig red blood cells lysis with human serum. In addition, the use of the peptides and conjugates resulted in significant prolongation of xenograft survival.

CONCLUSIONS

The CBP2 and WY peptides exhibit the functional activity of inhibition of complement activation. These peptides also prolong xenograft survival and thus provide reagents for the study of the importance of C1q and other complement components in transplant rejection mechanisms.

Renal xenografts from triple-transgenic pigs are not hyperacutely rejected but cause coagulopathy in non-immunosuppressed baboons

BACKGROUND

The genetic modification of pigs is a powerful strategy that may ultimately enable successful xenotransplantation of porcine organs into humans.

METHODS

Transgenic pigs were produced by microinjection of gene constructs for human complement regulatory proteins CD55 and CD59 and the enzyme alpha1,2-fucosyltransferase (H-transferase, HT), which reduces expression of the major xenoepitope galactose-alpha1,3-galactose (alphaGal). Kidneys from CD55/HT and CD55/CD59/HT transgenic pigs were transplanted into nephrectomised, nonimmunosuppressed adult baboons.

RESULTS

In several lines of transgenic pigs, CD55 and CD59 were expressed strongly in all tissues examined, whereas HT expression was relatively weak and did not significantly reduce alphaGal. Control nontransgenic kidneys (n=4) grafted into baboons were hyperacutely rejected within 1 hr. In contrast, kidneys from CD55/HT pigs (n=2) were rejected after 30 hr, although kidneys from CD55/CD59/HT pigs (n=6) maintained function for up to 5 days. In the latter grafts, infiltration by macrophages, T cells, and B cells was observed at days 3 and 5 posttransplantation. The recipients developed thrombocytopenia and abnormalities in coagulation, manifested in increased clotting times and an elevation in the plasma level of the fibrin degradation product D-dimer, within 2 days of transplantation. Treatment with low molecular weight heparin prevented profound thrombocytopenia but not the other aspects of coagulopathy.

CONCLUSIONS

Strong expression of CD55 and CD59 completely protected porcine kidneys from hyperacute rejection and allowed a detailed analysis of xenograft rejection in the absence of immunosuppression. Coagulopathy appears to be a common feature of pig-to-baboon renal transplantation and represents yet another major barrier to its clinical application.

[Pseudoallergic reactions. Intolerance to natural and synthetic food constituents masquerading as food allergy]

Adverse hypersensitivity reactions to natural foods and certain drugs and food additives are mediated by immunological (allergy) or non-immunological mechanisms. Some clinical and physiological similarities have been noted between these allergic and non-allergic reactions. This observation has led to the concept of "pseudoallergic reactions-PAR". PAR can be triggered in various ways such as: interactions with the central or peripherical nervous system, non-specific release of mediators, enzyme inhibition due to hereditary or pharmacologically induced enzyme deficiencies and pharmacological properties of some natural food constituents such as biogenic amines. The prevalence of adverse reactions to food additives has been calculated to be about 0.1%. PAR to food additives occurs frequently in patients suffering from urticaria, asthma and may be accompanied by history of aspirin or NSAI pseudoallergic reactions. The same additives (azo dyes, sulphites, benzoates) are used in various drug formulations and may be responsible for eliciting PAR. In Poland, labelling of food additives, following the "E number system", has been mandatory since 1993. Unfortunately, this satisfactory trend has not yet been applied to drug additives. The diagnosis of PAR to food additives is based on the anamnesis with analysis of the patient's drug and dietary intake. Skin tests and "in vitro" tests are only sporadically informative. In each individual patient, a specific challenge with additives is desirable. Food additives may be tested according to the schedule based on DBPCFC principle. Individually performed exclusion regimes are the principal methods of prevention.

Pseudoallergic skin reactions to opiate sequences of bovine casein in healthy children

Skin tests with opioid peptides naturally occurring in cow's milk: beta-casomorphin-7 and alpha-casein (90-95), were performed in 25 healthy children. Wheal and flare reactions, similiar to histamine and codeine were observed in all children. The area of these reactions was concentration dependent. Pretreatment with H1 antagonist--cetirizine significantly inhibited the skin response to both peptides. Beta-casomorphin-7 and alpha-casein (90-95) are noncytotoxic histamine releasers in humans.

Combined treatment with antibiotic, heparin and streptokinase--a new approach to the therapy of bacterial osteomyelitis

Combined treatment by continuous intravenous infusion of a selected antibiotic and heparin and/or streptokinase was elaborated as a method of causal, systemic treatment of bacterial osteomyelitis. The aim of the combined treatment was to overcome infection and disturbances in the coagulation and fibrinolysis system which lead to impairment of the bone blood supply and its subsequent necrosis as the main factor in the aetiopathology of osteomyelitis. Between 1969 and 1991, combined treatment was introduced in 63 patients with acute onset disease or with chronic osteomyelitis. Osteomyelitis was located in the mandible in 38 patients and in the long bones in 14 patients. Prior to combined treatment, moderate bone surgery was performed in 21 patients, while 31 patients were excluded from surgery. Combined treatment with an antibiotic and heparin (A+H) was performed in 43 patients, and the other 6 patients had infusion of an antibiotic, streptokinase and heparin (A+S+H). The authors' method of combined treatment offers a new approach and an alternative to routinely-ordered antibiotic therapy and radical surgery, which allow frequent recurrences of the disease, a long-lasting course and severe complications.

Familial medial telangiectatic nevus: variant of nevus flammeus--port-wine stain

Six families in which a few members, in three generations, were affected with medial telangiectatic nevus (salmon patch, stork bite, angel's kiss) on the forehead, glabella, upper eyelids, upper lip, nose, and nuchal and occipital areas are presented. This is a mild variant of lateral telangiectatic nevus (nevus flammeus, port-wine stain) that disappears in about 50 percent of patients during the first years of life. In one family, lateral telangiectatic nevus (nevus flammeus, port-wine stain) and superficial (strawberry) hemangioma coexisted with medial telangiectatic nevus. This paper discusses the familial incidence of medial telangiectatic nevus and a new modality of treatment. Moreover, the paper presents a classification of vascular malformations and proposes a new terminology.

A naturally occurring opioid peptide from cow's milk, beta-casomorphine-7, is a direct histamine releaser in man

beta-Casomorphine-7, a naturally occurring product of cow's milk with opiate-like activity, was studied for possible direct histamine liberation activities in humans. It was found to cause concentration-dependent in vitro histamine release from peripheral leukocytes of healthy adult volunteers. Intradermal injection of beta-casomorphine-7 induced a wheal and flare reaction in the skin similar to histamine or codeine. Oral pretreatment with the H1 antagonist terfenadine significantly inhibited the skin responses to beta-casomorphine-7. The intradermal injection of an opiate receptor antagonist, naloxone, inhibited in vitro histamine release and skin reactions only in a 100-fold excess over beta-casomorphine-7. These findings suggest that beta-casomorphine-7 can be regarded as a noncytotoxic, direct histamine releaser in humans. The clinical relevance of these findings deserves further studies.

Antibodies against toxic shock syndrome toxin no. 1 (TSST-1) in Poland

A total of 174 sera from healthy Polish individuals of different age groups were tested for TSST-1 antibody by the micro-ELISA method. Over 90% of sera contained the antibody with titres equal to above 1:10(2), even in children and adolescents. The data suggest that the majority of the Polish population acquires TSST-1-antibody during early childhood, whereas a small portion of the population seems to remain anti-TSST-1-negative.

Foreign bodies in the orbit. Review of 20 cases

The interdisciplinary problem of foreign bodies in the orbit is presented on the basis of personal experience in the treatment of 20 patients. These foreign bodies often cause severe injuries to the organ of sight and even threaten life. Early removal of a foreign body is technically easy, prevents infection and facilitates anatomical reconstruction of the damaged structures. Only in exceptional cases may removal be avoided. Of the 20 patients treated, only 9 were early admissions to our Department where the foreign body was removed and primary surgery performed. The others were admitted after some delay, which made correct treatment more difficult. Data on the injuries found in 20 patients, surgical technique, follow up and results are presented. Total recovery was obtained in 7 patients, improvement in vision in 2, enucleation of the globe was necessary in 5, and in 2 loss of vision was a sequel to a lesion of the optic nerve. Depending on the indications, reconstructive plastic surgery and prosthetic rehabilitation gave good aesthetic results. The necessity for interdisciplinary collaboration in the diagnosis and treatment of patients with foreign bodies in the orbit is emphasized.

[Eight years follow-up of lithium prophylaxis in patients of psychiatric-neurological practice (author's transl)]

A follow-up of patients under lithium-prophylaxis in a psychiatric neurological practice over a period of eight years is presented. It allowed for the evaluation of the therapeutic results of 54 of a total of 65 patients with affective psychoses. 32 patients remained free from any further episodes of illness (average duration of treatment 3.8 years). In another 14 patients (average duration of treatment 2.9 years) further episodes occurred but with obviously milder symptomatics. 8 patients (average duration of treatment 4.5 years) had to be considered as non-responders. This result largely consists with reports by other authors. Failures were mainly due to non compliance or diagnostic errors. The small number of patients stopping the prophylaxis without approval of the therapist (5 out of 65 patients) may be attributed to a rigid preselection of patients and to the fact that the conditions for a good patient compliance are more favourable in the practice with its tight and continuous doctor - patient relationship than in a typical out-patient department. Intoxications or other lithium-induced complications did not occur. Generally side effects could be well controlled and/or were tolerated by the patients. Discontinuance of therapy due to side effects was necessary in 3 cases.

The immunologic response to tobacco antigens in smokers. IV. Effect of heparin, aspirin, promethazine and prednisone

The effects of heparin, aspirin, promethazine and prednisone on late skin reactions, provoked by tobacco extracts were studied in four groups of 17 patients with coronary artery disease. In all patients, intracutaneous tests were made with four different tobacco preparations, both on the first day of their hospitalisation and after 14 days of therapy. It was found that strongly positive late skin reactions with tobacco extracts were decreased or suppressed in patients taking heparin and in patients taking prednisone, but not in those who were treated with promethazine or with aspirin. This seems to confirm the hypothesis that these reactions are really provoked by a local type III allergy to tobacco antigens.

Anti-staphylococcal gamma hemolysin antibodies in rabbits with staphylococcal osteomyelitis

Titers of antibodies against staphylococcal gamma hemolysin were estimated in 23 rabbits with experimental staphylococcal osteomyelitis and in 32 control animals. In all but three infected animals from 2- to 64-fold increases of the antibody titers were detected. Most of the control animals showed no changes in anti-gamma toxin antibody titers, but in two animals some increase was noted. The possible significance of these differences is discussed.

Nasotracheal general anaesthesia in maxillofacial surgery

Following a survey comprising of 172 patients subjected to nasotracheal general anaesthesia accounting for 37, 1% of all cases of anaesthesia the authors stress the particular usefulness of this method of anaesthesia in maxillofacial surgery. Nasotracheal anaesthesia is the most suitable method of general anesthesia in oral operations and it can almost completely eliminate tracheostomy which is a procedure frequently associated with both early and late complications. No early complications were observed in patients undergoing nasotracheal anaesthesia. Certain improvements of the technique of intubation and conduction of anaesthesia are described.