Liver and lung transplantation in cystic fibrosis: an adult cystic fibrosis centre's experience

Liver disease develops in one-third of patients with cystic fibrosis (CF). It is rare for liver disease to have its onset after 20 years of age. Lung disease, however, is usually more severe in adulthood. A retrospective analysis was performed on nine patients. Three patients required lung transplantation approximately a decade after liver transplant, and another underwent combined liver and lung transplants. Four additional patients with liver transplants are awaiting assessment for lung transplants. One patient is awaiting combined liver and lung transplants. With increased survival in CF, several patients may require more than single organ transplantation.

Factors associated with uptake of treatment for recent hepatitis C virus infection in a predominantly injecting drug user cohort: The ATAHC Study

Despite that the majority of hepatitis C virus (HCV) infection occurs among injection drug users (IDUs), little is known about HCV treatment uptake in this group, particularly during recent infection. We evaluated uptake of treatment for recent HCV infection, including associated factors, within a population predominantly made up of IDUs. The Australian Trial in Acute Hepatitis C was a study of the natural history and treatment of recent HCV infection. All participants with detectable HCV RNA at screening were offered HCV treatment, assessed for eligibility and those initiating treatment were identified. Logistic regression analyses were used to identify predictors of HCV treatment uptake. Between June 2004 and February 2008, 163 were enrolled, with 146 positive for HCV RNA at enrolment. The mean age was 35 years, 77% (n=113) participants had ever injected illicit drugs and 23% (n=34) reported having ever received methadone or buprenorphine treatment. The uptake of HCV treatment was 76% (111 of 146) among those who were eligible on the basis of positive HCV RNA. Estimated duration of HCV infection (OR=1.03 per week, 95% CI=1.00-1.06, P=0.035) and log(10) HCV RNA (OR=1.92 per log(10) increase, 95% CI=1.36-2.73, P<0.001) were independently associated with treatment uptake whereas injection drug use was not. This study demonstrates that a high uptake of HCV treatment can be achieved among participants with recently acquired HCV infection. Decisions about whether to initiate treatment for recently acquired HCV were mainly driven by clinical factors, rather than factors related to sociodemographics or injecting behaviors.

Laparoscopic surgery on upper urinary tract in children younger than 1 year: technical aspects and functional outcome

PURPOSE

Minimally invasive procedures are increasingly important in pediatric urology. However, experience is still limited with minimally invasive operations on the upper urinary tract in infants. We analyzed 3 minimally invasive procedures (pyeloplasty, heminephroureterectomy and nephrectomy) in children younger than 1 year.

MATERIALS AND METHODS

We analyzed 67 children (mean +/- SD age 5.1 +/- 2.9 months) undergoing minimally invasive pyeloplasty in 26 patients (group 1), heminephroureterectomy in 18 (group 2) or nephrectomy in 23 (group 3) with regard to technical aspects, surgical outcome and complications. Preoperative and postoperative ultrasound and mercaptoacetyltriglycine renal scan were statistically evaluated in groups 1 and 2.

RESULTS

Mean +/- SD patient weight was 6.4 +/- 1.8 kg and mean +/- SD operative time was 113.2 +/- 41.6 minutes. Conversion to open surgery was necessary in 1 pyeloplasty. One complication (missed intraoperative bowel perforation) occurred. No blood transfusion was required in any child. After pyeloplasty there were improved tracer clearances (mercaptoacetyltriglycine scan) and improved morphologies of the pyelon (ultrasound) in all patients. In groups 1 and 2 there was no statistical difference between preoperative and postoperative partial function of the affected kidney. Mean +/- SD followup was 32.5 +/- 19.8 months.

CONCLUSIONS

Minimally invasive procedures on the upper urinary tract in children younger than 1 year are technically challenging, and require expertise of the surgeon and the entire team. Given these assumptions, such procedures can be safely performed with excellent functional outcomes.

Characteristics and treatment outcomes among HIV-infected individuals in the Australian Trial in Acute Hepatitis C

BACKGROUND

The Australian Trial in Acute Hepatitis C (ATAHC) is a National Institutes of Health-funded prospective cohort study of the natural history and efficacy of treatment in individuals with recently acquired hepatitis C. Enrollment is open to both human immunodeficiency virus (HIV)-infected and -uninfected individuals. The aim of this article was to evaluate characteristics and virological outcomes among HIV-infected individuals enrolled in ATAHC.

METHODS

Eligibility criteria included the first positive result of testing for anti-hepatitis C virus (HCV) antibody within 6 months and either clinical hepatitis diagnosed within the past 12 months or documented anti-HCV seroconversion within the past 24 months.

RESULTS

Of the initial 103 patients enrolled, 27 (26%) were HIV infected. HIV-infected patients were more likely to be older, to have HCV genotype 1 infection and high levels of HCV RNA at baseline than were HCV-monoinfected patients. Sexual acquisition accounted for the majority (56%) of HCV infections among HIV-infected patients, compared with only 8% of HCV-monoinfected patients. The median duration from estimated HCV infection to treatment was 30 weeks. Treatment with 24 weeks of pegylated interferon and ribavirin resulted in rates of undetectability of HCV RNA of 95%, 90%, and 80% at weeks 12, 24, and 48, respectively. Undetectability at week 4 was achieved in 44% of patients and yielded positive and negative predictive values for sustained virological response of 100% and 33%, respectively.

CONCLUSIONS

Significant differences were demonstrated between HIV-infected and HIV-uninfected individuals enrolled in ATAHC. Treatment responses among HIV-infected individuals with both acute and early chronic infection are encouraging and support regular HCV screening of high-risk individuals and early treatment for recently acquired HCV infection.

[Spinal deformities and their mechanopathology in oarsmen (author's transl)]

Motional analysis of the spinal segments with an x-ray amplifyer and studies of mechanical stress in the spine at oarsmen show, that during the phase of driving through with the oars immersed, the direction of the resulting load in the spine is approximately vertical to the next vertebral body. While referring to the vertebral bodies the direction of the resulting load does not change essentially, the size of the load differs conspicuously during active motion. In rowing the quantity of stress in the spine is limited by the torque of the counterforce, the erector trunci. Using an exact and correct rowing technique the quality of stress is compatible with the physiologically axial stresspattern of the vertebral body and the intervertebral disque. The frequency of peakstress in active rowing may possible lead to early and augmented degenerative changes in the vertebral bodies. In 45 Austrian top oarsmen the spine was examined clinically and radiologically, 68% showed signs of a previous Scheuermann's disease, while degenerative changes of vertebral bodies were found in 48%. Comparing spinal damages in different sports used in the training of the examined oarsmen, only in bicycling a similar pathomechanical effect on the spine could be observed.

Fat loss depends on energy deficit only, independently of the method for weight loss

BACKGROUND

This study was designed to compare the effects of 2 different but isocaloric fat reduction programs with the same amount of energy deficit - diet alone or diet combined with aerobic training - on body composition, lipid profile and cardiorespiratory fitness in non- or moderately obese women.

METHODS

Twenty non- or moderately obese (BMI 24.32 +/- 3.11) females (27.3 +/- 6.6 years) were tested at the beginning and after an 8-week period of a mild hypocaloric diet for the following parameters: (1) body mass and body fat; (2) total cholesterol, HDL-C, LDL-C and triglycerides; (3) lactate (millimol/liter) during submaximal exertion (100 W); (4) heart rate during submaximal exertion (100 W), and (5) maximum exercise performance (watt). Subjects were randomly divided into either a diet alone (D, -2,095 +/- 659 kJ/day) or a diet (-1,420 +/- 1,084 kJ/day) plus exercise (DE, three 60-min sessions per week at 60% of VO(2)max or -5,866 kJ/week) group.

RESULTS

Body mass and body fat decreased significantly in D (-1.95 +/- 1.13 kg or -1.47 +/- 0.87%; p < 0.05) and DE (-2.23 +/- 1.28 kg or -1.59 +/- 0.87%; p < 0.05), but there was no significant difference observed between the groups. Statistical analysis revealed no significant changes of total cholesterol, HDL-C, LDL-C, triglycerides and heart rate during submaximal exertion (100 W). Lactic acid accumulation during submaximal exertion (100 W) decreased significantly (-0.8 +/- 1.4 mmol/l, p < 0.05) in DE and increased significantly (+0.4 +/- 0.5 mmol/l, p < 0.05) in D. Maximum exercise performance improved significantly (+12.2 +/- 8.8 W, p < 0.05) in DE and did not change significantly in D.

CONCLUSIONS

This study showed that independently of the method for weight loss, the negative energy balance alone is responsible for weight reduction.

The Effects of Systematic Resistance Training in the Elderly

The aim of the study was to examine the effects of a maximal resistance training following the principles of the most effective resistance training known from sport adapted to elderly people. Twenty-four subjects were randomly assigned into a training group (10 females and 4 males, age; 76.2 +/- 3.2 years) that underwent a training program and a control group (6 females and 4 males, age; 76.6 +/- 2.7 years) that did not participate in the training program. Before and after the training period, both groups were identically examined (blood and urine sample, spiroergometric testing, morphological measurements). The training group underwent a 12-week training program. Eight different exercises for the largest muscle groups of the largest joints were defined as one training circle. Training took place twice a week and commenced with two training circles per week (one circle per training session). After every four weeks, one training circle per week was added until four training circles per week were reached. Before, after every four weeks (changes in training amount) and after the training period, the maximum strength was measured. Data was analysed by the independent T-test and the analysis of variance, in case of significance, the dependent T-test and the Scheffé-test were used. In the resistance training group, the fat-free body mass was increased by approximately 2.9 +/- 0.5 kg, with no significant difference between females and males. Ergometrical fitness was increased by approximately 15 %, while the maximum oxygen uptake was increased by approximately 12 %. Maximum strength was increased between 26 % (bench pull) and 38 % (leg press). Resistance training that consisted of two training sessions per week was found to be at least as efficient as resistance training that included three training sessions per week, provided that the number of sets performed were equal. Seventy-five-year-old females were found to have a significantly higher body fat content than males of the same age (37 % versus 26 %, respectively). However, the decrease in body fat mass due to resistance training was found to be equal in both females and males (- 4 +/- 0.8 kg). Furthermore, there was almost no difference in muscle strength between the sexes for this age group (for example; leg press: females 86 kg versus males 82 kg).

Continuous glucose monitoring in diabetic long distance runners

Marathon running is growing in popularity, and many diabetic patients are participating in various marathon races all over the world each year. This study aimed to investigate the prevalence and extent of glycemic excursions (hypo- and hyperglycemic) during a marathon run in patients with well-controlled diabetes mellitus using a continuous glucose monitoring system (CGMS). Five subjects with type 1 and one patient with type 2 diabetes mellitus were monitored with the Medtronic MiniMed CGMS during the 2002 Vienna City Marathon (n = 3) or the "Fernwärme run" (n = 3) long distance runs of 42.19/15.8 km. All six patients finished their course. The CGSM system was well tolerated in all patients over an average duration of 34 +/- 4.0 hours and it did not limit the patients' activities. The mean running time for the Vienna city marathon was 257 +/- 8 min (247 to 274 min) and for the Fernwärme run 134 +/- 118 min (113 to 150 min). A total of 1470 blood glucose measurements (mean 245 readings per subject) were performed. During and after the marathons frequent hypo- and hyperglycemic episodes with and without clinical symptoms were measured. Our data confirm that the CGMS may help to identify asymptomatic hypoglycemia or hyperglycemia during and after a long distance run. The system may also be helpful to improve our understanding about the individual changes of glucose during and after a marathon and may protect hypoglycemic or hyperglycemic periods in future races.

Strength and endurance training lead to different post exercise glucose profiles in diabetic participants using a continuous subcutaneous glucose monitoring system

BACKGROUND

Although both strength training (ST) and endurance training (ET) seem to be beneficial in type 2 diabetes mellitus (T2D), little is known about post-exercise glucose profiles. The objective of the study was to report changes in blood glucose (BG) values after a 4-month ET and ST programme now that a device for continuous glucose monitoring has become available.

MATERIALS AND METHODS

Fifteen participants, comprising four men age 56.5 +/- 0.9 years and 11 women age 57.4 +/- 0.9 years with T2D, were monitored with the MiniMed (Northridge, CA, USA) continuous glucose monitoring system (CGMS) for 48 h before and after 4 months of ET or ST. The ST consisted of three sets at the beginning, increasing to six sets per week at the end of the training period, including all major muscle groups and ET performed with an intensity of maximal oxygen uptake of 60% and a volume beginning at 15 min and advancing to a maximum of 30 min three times a week.

RESULTS

A total of 17,549 single BG measurements pretraining (619.7 +/- 39.8) and post-training (550.3 +/- 30.1) were recorded, correlating to an average of 585 +/- 25.3 potential measurements per participant at the beginning and at the end of the study. The change in BG-value between the beginning (132 mg dL(-1)) and the end (118 mg dL(-1)) for all participants was significant (P = 0.028). The improvement in BG-value for the ST programme was significant (P = 0.02) but for the ET no significant change was measured (P = 0.48). Glycaemic control improved in the ST group and the mean BG was reduced by 15.6% (Cl 3-25%).

CONCLUSION

In conclusion, the CGMS may be a useful tool in monitoring improvements in glycaemic control after different exercise programmes. Additionally, the CGMS may help to identify asymptomatic hypoglycaemia or hyperglycaemia after training programmes.

Typhoid Fever in Travelers: Who Should Be Targeted for Prevention?

To clarify indications for typhoid vaccination, we reviewed laboratory-confirmed cases of typhoid fever reported to the United States Centers for Disease Control and Prevention between 1994 and 1999. To estimate the risk of adverse events associated with typhoid vaccination, we reviewed reports to the Vaccine Adverse Event Reporting System for the same period. Acute Salmonella enterica serotype Typhi infection was reported for 1393 patients. Of these patients, recent travel was reported by 1027 (74%), only 36 (4%) of whom reported having received a vaccination. Six countries accounted for 76% of travel-associated cases (India [30%], Pakistan [13%], Mexico [12%], Bangladesh [8%], The Philippines [8%], and Haiti [5%]). For 626 travelers who traveled to a single country, the length of stay was <or=1 week for 31 (5%), <or=2 weeks for 100 (16%), <or=3 weeks for 169 (27%), <or=4 weeks for 232 (37%), <or=5 weeks for 338 (54%), and <or=6 weeks for 376 (60%). Reports of serious adverse events due to typhoid vaccination were very rare. Vaccination should be considered even for persons planning short-term travel to high-risk areas.

Antiaggregatory activity of hypoglycaemic sulphonylureas

AIMS/HYPOTHESIS

Vascular complications observed in diabetes are often related to altered platelet functions. The most widely used hypoglycaemic drugs for treating Type II (non-insulin-dependent) diabetes mellitus are sulphonylurea derivatives. The purposes of this study were to evaluate the inhibitory effects of hypoglycaemic agents on platelet aggregation, to measure their lipophilicity and identify their structural parameters which assess their antiaggregatory activity.

METHODS

An antiaggregatory test in vitro was carried out for 13 sulphonylurea derivatives. Aggregation of platelets, incubated with the agents at concentrations varying from 7.5 to 480 micromol/l, was induced by 10 micromol/l ADP. Drug lipophilicity parameter, log k(w), was measured by gradient HPLC and the agents were subjected to molecular modelling.

RESULTS

The most pronounced inhibition of platelet aggregation was by glimepiride, gliclazide, gliquidone, glibenclamide and compound 2A. The IC(25) values were 15.9, 18.6, 20.4, 28.5 and 34.7 micromol/l, respectively. Quantitative structure-activity relationships indicate that antiaggregatory activity is mainly affected by electronic and not by lipophilic properties of the agents.

CONCLUSION/INTERPRETATION

Glimepiride appeared to be a more potent ADP-induced platelet aggregation inhibitor in vitro than gliclazide. Antiaggregatory activity was shown for gliquidone and confirmed for glibenclamide. The QSAR analysis supports the hypothesis of a free radical mechanism of action of sulphonylurea derivatives previously suggested for gliclazide.

Transient renal insufficiency by bilateral renal cysts and posterior urethral valves

Renal insufficiency developed in a newborn with huge bilateral renal cysts and posterior urethral valves. Definitive therapy consisted of laser coagulation of the valves and transient percutaneous drainage of the cysts.

Enhancing vaccine safety surveillance: a capture-recapture analysis of intussusception after rotavirus vaccination

The Vaccine Adverse Event Reporting System (VAERS) is the passive reporting system for postmarketing surveillance of vaccine safety in the United States. The proportion of cases of an adverse event after vaccination that are reported to VAERS (i.e., VAERS reporting completeness) is mostly unknown. Therefore, the risk of such an event cannot be derived from VAERS only. To study whether its reporting sensitivity and risks could be estimated, VAERS was linked to data from a case-control and a retrospective cohort study in a capture-recapture analysis of intussusception after rotavirus vaccination (RV). Cases of intussusception after RV were selected from the common time frame (December 1998 through June 1999) and the common geographic area (19 states) of the three sources. Matching occurred on birth date, gender, state, date of vaccination, and date of diagnosis. Thirty-five matches were identified among a total of 84 cases. The estimated VAERS reporting completeness was 47%. The relative risks of intussusception in the periods 3-7 and 8-14 days after RV (relative risk = 22.7 and 4.4, respectively) were comparable with those reported in the two studies. Linkage of VAERS to complimentary data sources may permit more timely postmarketing assessment of vaccine safety.

Separation of strength and selectivity of mobile phase by spectral mapping technique

The retention behaviour of seven monotetrazolium and nine ditetrazolium salts was studied in seven different mobile phases on alumina and impregnated alumina stationary phases. The strength and selectivity of the components of mobile phases were separately calculated by the spectral mapping technique. It was established that tetrahydrofuran (THF) has the highest solvent strength while the differences among ethanol, 1-propanol, 2-propanol and dioxane were relatively low. The selectivity of THF was also considerably different from those of other solvents. Hydrophobicity and electronic parameters were equally involved in the retention strength and selectivity of tetrazolium salts, indicating the mixed character of their interaction with the alumina stationary phase.

Intravenous magnesium sulfate for bronchial hyperreactivity: a randomized, controlled, double-blind study

BACKGROUND

Magnesium has been shown to be helpful in the treatment of acute exacerbations of asthma. Conflicting data exist concerning the effect of magnesium on bronchial hyperreactivity.

METHODS

We performed a randomized, double-blind, placebo-controlled study to investigate the effect of intravenous magnesium sulfate on bronchial reactivity to metacholine in 30 subjects with bronchial hyperreactivity. Two days after baseline metacholine provocation, 20 subjects received 0.3 mmol/kg/h of intravenous magnesium sulfate and 10 subjects received normal saline solution. Metacholine provocation was repeated 30 minutes after the initiation of the magnesium or placebo infusion.

RESULTS

The difference of the postinterventional minus the baseline provocative dose of metacholine required to decrease the forced expiratory volume in 1 second by 20% (PC20) was significantly higher in the magnesium group compared with the placebo group (0.48 +/- 0.46 mg/mL versus 0.05 +/- 0.73 mg/mL, P = .028). In the magnesium group, the PC(20) significantly increased (from 0.83 +/- 0.54 mg/mL to 1.31 +/- 0.66 mg/mL, P = .0001), whereas there was no change in the placebo group (0.86 +/- 0.52 mg/mL to 0.91 +/- 0.54 mg/mL, P = .83).

CONCLUSIONS

In the magnesium group, 30% of the subjects reached a normal PC(20) compared with 10% in the placebo group. We conclude that intravenous magnesium sulfate significantly improved bronchial hyperreactivity and may serve as an adjunct to standard treatment.

Intussusception among recipients of rotavirus vaccine: reports to the vaccine adverse event reporting system

BACKGROUND

Rotavirus vaccine was licensed on August 31, 1998, and subsequently recommended for routine use among infants. To assess rare adverse events, postlicensure surveillance was conducted.

OBJECTIVE

To describe the cases of intussusception among rotavirus vaccine recipients reported to the Vaccine Adverse Event Reporting System from October 1998 through December 1999.

SETTING AND PARTICIPANTS

Infants vaccinated with rotavirus vaccine in the United States.

OUTCOME MEASURES

Intussusception confirmed by radiology, surgery, or autopsy report with medical record documentation or confirmed by a primary health care provider.

RESULTS

There were 98 confirmed cases of intussusception after vaccination with rotavirus vaccine reported to the Vaccine Adverse Event Reporting System; 60 of these developed intussusception within 1 week after vaccination. Based on calculations using vaccine distribution data and intussusception incidence rates from 2 separate databases, an estimated 7 to 16 cases would have been expected to occur in the week after vaccination by chance alone.

CONCLUSION

Using a passive surveillance system for vaccine adverse events, we observed at least a fourfold increase over the expected number of intussusception cases occurring within 1 week of receipt of rotavirus vaccine. Other studies were initiated to further define the relationship between rotavirus vaccine and intussusception. In light of these and other data, the rotavirus vaccine manufacturer voluntarily removed its product from the market, and the recommendation for routine use of rotavirus vaccine among US infants has been withdrawn.

Alcohol and the pancreas

This article represents the proceedings of a workshop at the 2000 ISBRA Meeting in Yokohama, Japan. The presentations were (1) Phenotypic alteration of myofibroblast during ethanol-induced pancreatic injury: its relation to bFGF, by Masahiko Nakamura, Kanji Tsuchimoto, and Hiromasa Ishii; (2) Activation of pancreatic stellate cells in pancreatic fibrosis, by Paul S. Haber, Gregory W. Keogh, Minoti V. Apte, Corey S. Moran, Nancy L. Stewart, Darrell H.G. Crawford, Romano C. Pirola, Geoffrey W. McCaughan, Grant A. Ramm, and Jeremy S. Wilson; (3) Pancreatic blood flow and pancreatic enzyme secretion on acute ethanol infusion in anesthetized RAT, by H. Nishino, M. Kohno, R. Aizawa, and N. Tajima; (4) Genotype difference of alcohol-metabolizing enzymes in relation to chronic alcoholic pancreatitis between the alcoholic in the National Institute on Alcoholism and patients in other general hospitals in Japan, by K. Maruyama, H. Takahashi, S. Matsushita, K. Okuyama, A. Yokoyama, Y. Nakamura, K. Shirakura, and H. Ishii; and (5) Alcohol consumption and incidence of type 2 diabetes, by Katherine M. Conigrave, B. Frank Hu, Carlos A. Camargo Jr, Meir J. Stampfer, Walter C. Willett, and Eric B. Rimm.

Computer simulation for the simultaneous optimization of any two variables and any chromatographic procedure

Computer software that allows the simulation of any chromatographic separation as a function of simultaneous changes in any one or two variables that can affect sample separation order (selectivity) is described. For one example, an application is described for the simultaneous variation of the mobile phase pH and gradient time in reversed-phase liquid chromatography. The accuracy of such predictions is examined for a sample mixture of 17 substituted benzoic acids and anilines, and requirements for an acceptable predictive accuracy are summarized. In a second example, the separation of three peptides by capillary electrophoresis is optimized.

Retention of barbituric acid derivatives on immobilized artificial membrane stationary phase and its correlation with biological activity

A series of 30 barbituric acid derivatives were subjected to high-performance liquid chromatography (HPLC) on the 'immobilized artificial membrane' (IAM) column with acetonitrile buffer mobile phase. The retention parameter log k(IAM) was related to the logarithms of partition coefficients determined in octanol-water partition system, log P, to a thin-layer chromatographic (TLC) parameter from partition TLC, R(m0), to an adsorption HPLC retention parameter, log k(0), and to a solubility parameter, delta. It was demonstrated that log k(IAM) correlated significantly to the other parameters of barbiturates determined in partition systems but not to delta. However, log k(IAM) appeared to be a distinctive descriptor of hydrophobicity of barbiturates as compared to the standard log P parameters. The parameter log k(IAM) was shown to correlate with bioactivity data of the agents studied.

Reversed-phase liquid chromatographic separation of complex samples by optimizing temperature and gradient time III. Improving the accuracy of computer simulation

Previous studies have shown that four experimental runs, where both temperature T and gradient time tG are varied, can be used for the reliable prediction of separation as a function of these two variables (two-dimensional optimization). Computer simulation (e.g., DryLab) can then be used to predict "optimized" conditions for maximum sample resolution using either isocratic or gradient elution. Samples that contain a large number of components (e.g., n>15-20) present a greater challenge. Resolution for these more complex samples is often quite sensitive to small changes in T or tG in turn requiring greater accuracy in predictions that result from computer simulation. In the present study of several samples, we have examined computer simulation errors that can arise from inexact expressions for retention time as a function of T, tG or isocratic %B. Resulting conclusions are applicable to both complex and simpler samples, in either one- or two-dimensional optimization. Means to anticipate and minimize the impact of these predictive errors are examined.

The Guillain-Barré syndrome and the 1992-1993 and 1993-1994 influenza vaccines

BACKGROUND

The number of reports of influenza-vaccine-associated Guillain-Barré syndrome to the national Vaccine Adverse Event Reporting System increased from 37 in 1992-1993 to 74 in 1993-1994, arousing concern about a possible increase in vaccine-associated risk.

METHODS

Patients given a diagnosis of the Guillain-Barré syndrome in the 1992-1993 and 1993-1994 influenza-vaccination seasons were identified in the hospital-discharge data bases of four states. Vaccination histories were obtained by telephone interviews during 1995-1996 and were confirmed by the vaccine providers. Disease with an onset within six weeks after vaccination was defined as vaccine-associated. Vaccine coverage in the population was measured through a random-digit-dialing telephone survey.

RESULTS

We interviewed 180 of 273 adults with the Guillain-Barré syndrome; 15 declined to participate, and the remaining 78 could not be contacted. The vaccine providers confirmed influenza vaccination in the six weeks before the onset of Guillain-Barré syndrome for 19 patients. The relative risk of the Guillain-Barré syndrome associated with vaccination, adjusted for age, sex, and vaccine season, was 1.7 (95 percent confidence interval, 1.0 to 2.8; P=0.04). The adjusted relative risks were 2.0 for the 1992-1993 season (95 percent confidence interval, 1.0 to 4.3) and 1.5 for the 1993-1994 season (95 percent confidence interval, 0.8 to 2.9). In 9 of the 19 vaccine-associated cases, the onset was in the second week after vaccination, all between day 9 and day 12.

CONCLUSIONS

There was no increase in the risk of vaccine-associated Guillain-Barré syndrome from 1992-1993 to 1993-1994. For the two seasons combined, the adjusted relative risk of 1.7 suggests slightly more than one additional case of Guillain-Barré syndrome per million persons vaccinated against influenza.

Mechanism of separation on cholesterol-silica stationary phase for high-performance liquid chromatography as revealed by analysis of quantitative structure-retention relationships

The retention characteristics of a newly synthesized stationary phase were determined for reversed-phase high-performance liquid chromatography obtained by chemical immobilization of cholesterol on spherical silica gel. For a designed series of analytes the retention factors, log k, were determined at several compositions of the methanol-water mobile phase. Logarithms of retention factor corresponding to a hypothetical pure water eluent, log k(w), were calculated by extrapolation of the linear relationships of individual log k data versus volume percent of methanol. The series of 24 test analytes were characterized structurally by means of the logarithms of n-octanol-water partition coefficients, log P, by a set of the linear solvation energy relationship (LSER)-based descriptors of the polarity and bulkiness of the analytes and by structural descriptors of analyte size and polarity acquired by molecular modelling. Quantitative structure retention relationships (QSRR) were derived by multiple regression analysis using the three groups of structural descriptors of analytes and the log k(w) data determined on the new stationary phase. For the sake of comparison the corresponding QSRR equations were also derived for retention parameters determined on a standard octadecylsilica and on the so-called immobilized artificial membrane (IAM) stationary phase. The QSRR analysis clearly proved distinctive retention properties of the new cholesterol-silica stationary phase. It has been concluded that the new phase may possess valuable analytical specificity. Its application for modelling penetration of xenobiotics through biological membranes appears rather unlikely.

Aerobic endurance training program improves exercise performance in lung transplant recipients

STUDY OBJECTIVE

To determine whether an aerobic endurance training program (AET) in comparison to normal daily activities improves exercise capacity in lung transplant recipients.

PATIENTS AND STUDY DESIGN

Nine lung transplant recipients (12+/-6 months after transplant) were examined. All patients underwent incremental bicycle ergometry with the work rate increased in increments of 20 W every 3 min. Identical exercise tests were performed after 11+/-5 weeks of normal daily activities and then after a 6-week AET. The weekly aerobic training time increased from 60 min at the beginning to 120 min during the last week. Training intensity ranged from 30 to 60% of the maximum heart rate reserve.

RESULTS

Normal daily activities had no effect on exercise performance. The AET induced a significant decrease in resting minute ventilation from 14+/-5 to 11+/-3 L/min. At an identical, submaximal level of exercise, a significant decrease in minute ventilation from 47+/-14 L/min to 39+/-13 L/min and heart rate from 144+/-12 to 133+/-17 beats/min, before and after the AET, was noted. The increase in peak oxygen uptake after AET was statistically significant (1.13+/-0.32 to 1.26+/-0.27 L/min).

CONCLUSIONS

These data demonstrate that normal daily activities do not affect exercise performance in lung transplant recipients > or = 6 months after lung transplantation. An AET improves submaximal and peak exercise performance significantly.

The effect of ethanol on pancreatic enzymes--a dietary artefact?

The effects of ethanol on pancreatic digestive and lysosomal enzymes may be relevant to the pathogenesis of alcoholic pancreatitis since pancreatic enzymes are thought to play an important role in the development of pancreatic injury. Previous studies, using the Lieber-DeCarli pair-feeding model of ethanol administration, have demonstrated that ethanol significantly increases the content and gene expression of pancreatic enzymes. However, these findings have been questioned because, in the Lieber-DeCarli model, ethanol-fed rats have a lower carbohydrate intake than their pair-fed controls, making it difficult to ascribe any observed changes to ethanol alone. This study was designed to distinguish between the effects of ethanol and those of reduced dietary carbohydrate on pancreatic enzymes, using a quartet-feeding model of ethanol administration. Rats were fed liquid diets containing low (11%) and high (47%) amounts of carbohydrate, with and without ethanol, for four weeks. The effects of ethanol on pancreatic content and messenger RNA levels for digestive enzymes (trypsinogen, chymotrypsinogen and lipase) and a lysosomal enzyme (cathepsin B) were assessed. Ethanol feeding resulted in a significant increase in glandular content with a corresponding increase in mRNA levels for all four enzymes studied. By contrast, a reduction in dietary carbohydrate intake alone did not alter pancreatic content or gene expression for the above enzymes. These results indicate that (i) ethanol significantly increases the capacity of the acinar cells to synthesise digestive enzymes and the lysosomal enzyme cathepsin B, and (ii) these changes are due to ethanol itself and are not due to variations in dietary carbohydrate intake.

Effects of physical training on heart rate variability in diabetic patients with various degrees of cardiovascular autonomic neuropathy

OBJECTIVE

To investigate the effects of regularly performed endurance training on heart rate variability in diabetic patients with different degrees of cardiovascular autonomic neuropathy (CAN).

METHODS

Bicycle ergometer training (12 weeks, 2 x 30 min/week, with 65% of maximal performance) was performed by 22 insulin-requiring diabetic patients (age 49.5 +/- 8.7 years; diabetes duration 18.6 +/- 10.6 years; BMI 25.1 +/- 3.4 kg/m2): i.e., by 8 subjects with no CAN, 8 with early CAN and by 6 patients with definite/severe CAN. A standard battery of cardiovascular reflex tests was used for grading of CAN, a short-term spectral analysis of heart rate variability for follow-up monitoring of training-induced effects.

RESULTS

While the training-free interval induced no changes in spectral indices, the 12-week training period increased the cumulative spectral power of the total frequency band (P = 0.04) but to a different extent (P = 0.039) in different degrees of neuropathy. In patients with no CAN the spectral power in the high-frequency (HF) band (0.15-0.50 Hz) increased from 6.2 +/- 0.3 to 6.6 +/- 0.4 In [ms2]; P = 0.016, and in the low-frequency (LF) band (0.06-0.13 Hz) from 7.1 +/- 0.1 to 7.6 +/- 0.3 in [ms2]; P = 0.08 which resulted in an increase of total spectral power (0.06-0.50 Hz) from 7.5 +/- 0.1 to 8.0 +/- 0.3 in [ms2] (P = 0.05). Patients with the early form of CAN showed an increase of spectral power in HF (5.1 +/- 0.2 to 5.8 +/- 0.1 in [ms2], P = 0.05) and LF bands (5.6 +/- 0.1 to 6.3 +/- 0.1 in [ms2], P = 0.008), resulting in an increase of total power from 6.1 +/- 0.1 to 6.6 +/- 0.1 in [ms2] (P = 0.04), whereas those with definite/severe CAN showed no changes after the training period. Training improved fitness in the whole patient cohort. The increased autonomic tone as assessed by spectral indices disappeared after a training withdrawal period of 6 weeks.

CONCLUSIONS

In diabetic patients with no or early CAN, regularly performed endurance training increased heart rate variability due to improved sympathetic and parasympathetic supply, whereas in subjects with definite/severe CAN no effect on heart rate variability could be demonstrated after this kind of training.

Pulmonary dysfunction in type 1 diabetes in relation to metabolic long-term control and to incipient diabetic nephropathy

The available data on pulmonary function in type 1 diabetes are still conflicting. Recently, restrictive alterations of pulmonary function were demonstrated in type 1 diabetic patients with end-stage renal failure (diabetic nephropathy), whereas patients with kidney failure from other causes had normal pulmonary function test results. In this study, the prevalence and nature of pulmonary dysfunction in type 1 diabetes and the relationship of pulmonary function tests to incipient diabetic nephropathy and metabolic long-term control were analyzed. Pulmonary function tests were performed in long-standing type 1 diabetic patients (n = 39) with normal serum creatinine levels (< 1.3 mg/dl) and the results compared with those of healthy control (n = 44). The patients were divided into those with a normal urinary albumin excretion rate (AER; n = 21, < 30 mg/day) and those with microalbuminuria (n = 18, AER 30-300 mg/day). We found a significant reduction of the following pulmonary function tests (performed by standardized spirometry and wholebody plethysmography) as compared with controls (C) in diabetic patients with microalbuminuria (M) and in diabetic patients with normoalbuminuria (N): total lung capacity (TLC; % predicted: M 89.6, p < 0.004; N 98.5, p = NS; C 101.1), vital capacity (VC; % predicted: M 83.7, p < 0.001; N 90.2, p < 0.03; C 97.3), forced expiratory volume in 1 s (FEV1; % predicted: M 81.2, p < 0.002; N 88.8, p < 0.02; C 93.8), and diffusing capacity of the lung for CO (DLCO; % predicted: M 83.4, p < 0.04; N 92.4, p = NS; C 95.6). We also found a slight increase of the airway resistance (kPa/l/s: M 0.22, p < 0.03; N 0.2, p = NS; C 0.18). The differences in TLC (% predicted) between diabetic patients with normo- and microalbuminuria were significant (p < 0.04). Further a close relation of pulmonary function tests to metabolic long-term control (mean values of repeated HbA1c measurements) was observed: TLC (% predicted: M r= -0.61, p < 0.007, N p = NS), VC (% predicted: M r = -0.57, p < 0.01; N r= -0.59, p < 0.005), and FEV1 (% predicted: M r = -0.50, p < 0.03; N r= -0.62, p < 0.003).

IN CONCLUSION

pulmonary dysfunction in long-standing type 1 diabetic patients is more pronounced in patients with increased AER. Typical features of restrictive pulmonary defects, namely a reduction of TLC (% predicted) plus DLCO (% predicted) were observed predominantly in patients with incipient diabetic nephropathy. The clear correlation of pulmonary function tests with HbA1c measurements stresses the importance of optimal metabolic long-term control in type 1 diabetes.

Systematic strength training as a model of therapeutic intervention. A controlled trial in postmenopausal women with osteopenia

Physical exercise is often recommended as a therapeutic tool to combat pre- and postmenopausal loss of bone density. However, the relationship between training dosage (intensity, duration, frequency) and the effect on bone density still is undergoing discussion. Furthermore, the exercise quantification programs are often described so inadequately that they are neither quantitatively nor qualitatively reproducible. The aim of this investigation was to determine whether a clearly defined training of muscle strength, under defined safety aspects, performed only twice weekly, can counteract bone density loss in women with postmenopausal osteopenia. Data from 16 women in the training group (age, 63.6 +/- 6.2 yr) and 15 women in the control group (age, 67.4 +/-9.7 yr), of comparable height and weight, were evaluated. Strength training was performed for 6 mo as continually adapted strength training, providing an intensity of about 70% of each test person's one repetition maximum. Bone mineral density of lumbar vertebrae 2 to 4 and the femoral neck was measured by dual-energy x-ray absorptiometry. Maximum performance in watts and parameters of hemodynamics were controlled with a bicycle ergometer test to maximal effort. In addition, metabolic data were assessed. In the lumbar spine and femoral neck, the training group showed no significant changes, whereas the control group demonstrated a significant loss of bone mineral density, especially in the femoral neck (P<0.05). The strength increase was highly significant in all exercised muscle groups, rising to about 70% above the pretraining status (P<0.001). Heart rate and blood pressure data indicated a slight economization, metabolism was not significantly influenced. Based on these findings, we conclude that continually adapted strength training is an effective, safe, reproducible, and adaptable method of therapeutic strength training, following only two exercise sessions per week.

Individual susceptibility to alcoholic pancreatitis: still an enigma

Evidence is increasing that individuals vary in their susceptibility to alcoholic pancreatitis. Numerous investigators have attempted to account for this individual susceptibility by studying associations between alcoholic pancreatitis and potential risk factors. Those studies, reviewed here, have focused on the amount, type, and pattern of alcohol consumption, genetic markers (such as blood groups, HLA phenotypes, alpha 1-antitrypsin, and alcohol dehydrogenase isoenzyme distribution), diet, hypertriglyceridemia, tobacco consumption, and pancreatic ischemia. Associations between pancreatitis and several of these factors have been reported, but many studies offer conflicting conclusions. A number of studies are difficult to interpret because of methodologic problems, particularly with regard to inadequate controls and small numbers of index subjects. At present, the evidence is insufficient for one to conclude that any of the above-mentioned factors are well-established risk factors for pancreatitis. As a result, individual susceptibility to alcoholic pancreatitis remains unexplained. Clarification of potential risk factors may ultimately lead to the ability to prevent this relatively common disorder, but additional, appropriately designed studies are required.

Relationship between hepatitis C virus subtypes and clinical features of liver disease seen in alcoholics

The influence of hepatitis C virus and its subtypes on the clinical course of liver disease in alcoholics was assessed. Hepatitis C virus infection was confirmed by a reverse transcription and polymerase chain reaction method for the hepatitis C virus NS-5 region in the sera of alcoholics with various stages of histologically proven liver disease. The frequency of hepatitis C virus was significantly higher in alcoholics with chronic hepatitis (73%) than in those with liver fibrosis (18%), alcoholic hepatitis (17%), and fatty liver (0%). Hepatitis C virus subtypes, namely K1 and K2, were determined by dot-blot hybridization analysis of the polymerase chain reaction products with specific probes, and their frequencies were 68% and 32%, respectively. The proportion of patients whose serum transaminase levels returned to normal following 4 weeks of abstinence in hospital was significantly lower in alcoholics with hepatitis C virus viremia (glutamic oxaloacetic transaminase: 53.8%; glutamic pyruvic transaminase: 42.3%) than in those without viremia (glutamic oxaloacetic transaminase: 86.2%, p < 0.01; glutamic pyruvic transaminase: 89.7%, p < 0.01). When alcoholics with the K1 and K2 subtypes of hepatitis C virus were compared, normalization of transaminase levels was less frequent in alcoholics with K1 (glutamic oxaloacetic transaminase: 42.8%; glutamic pyruvic transaminase: 28.6%) than in those with K2 (glutamic oxaloacetic transaminase: 88.9%, p < 0.05; glutamic pyruvic transaminase: 77.8%, P < 0.05). These data indicate that hepatitis C virus infection is associated with a reduced rate of recovery of serum transminase levels following abstinence in subjects with alcoholic liver disease, more so in the K1 subtype than in the K2 subtype.

Aerobic fitness and sympatho-adrenal response to short-term psycho-emotional stress under field conditions

A possible relationship between aerobic fitness (AF), measured by maximal cycle ergometry (CE) and sympatho-adrenal response to acute, short lasting psycho-emotional stress was investigated by monitoring heart rate (fc) and excretion of catecholamines. The activation of the sympatho-adrenal system was characterised by the noradrenaline: adrenaline ratio. A group of 11 healthy men [22.8 (SD 2.52) years] lived under identical environmental conditions; their mean maximal oxygen uptake (VO2max) was 47.1 (SD 3.9) ml.min-1.kg-1. After the physiological and psychological laboratory tests had been completed the fc of the subjects was monitored continuously during the "guerilla slide" and "parachute jump by night", two emotionally stressful military tasks. Maximal fc (fc, max) attained during these events was 84.5% and 83% of fc, max during CE (fc, max, CE), respectively. A significant relationship (r = -0.92, P < 0.0002) between fc, max reached during the stressful tasks and VO2max was found only for the guerilla slide, which was preceded by physical strain, sleep deprivation and energy deficit. One subject with some prior experience in parachuting showed the lowest fc response and the lowest sympatho-adrenal activation in both events, independent of the degree of AF. In conclusion, AF was found to influence the sympatho-adrenal and fc response to acute, short-lasting emotional stress when the stressful event was aggravated by preceding physical strain, the magnitude of the stress response depending largely on individual experience and effective mechanisms for coping with specific stimuli.

[Amphetamine doping in leisure-time mountain climbing at a medium altitude in the Alps]

Although doping in leisure sports may potentially be of relevance for medical emergency situations, it has attracted much less attention than doping in elite athletes. The aim of our study was to evaluate the prevalence of amphetamine consumption in medium altitude mountaineering. Urine samples were taken from 253 males after a successful ascent. Analysis for amphetamines proved positive for 7.1% of mountaineers climbing above 3300 m. On peaks between 2500 to 3300 meters above sea level, 2.7% of the mountaineers we examined had amphetamines residues in their urine. Below 2500 meters, no positive sample was detected. For tourists living outside of the Alpine range, we noticed a significantly higher proportion of positive analyses. We conclude that attempts to induce a higher performance level by pharmacological means are not overly uncommon in leisure mountaineering. Such a behaviour may be of medical relevance in emergency situations.

A rare complication of a central venous catheter system (Port-a-Cath). A case report of a catheter embolization after catheter fracture during power training

A 36 year old patient received an implantable central venous catheter system for a bone marrow transplantation. One year after the successful transplantation, embolization of the catheter was discovered by a routine x-ray three weeks after beginning of an exercise program with a spring expander including arm exercises. The catheter was removed without further complication via the vena femoralis. We assume that the cause for this incident was material fatigue due to pressure between clavicula and first rib possibly caused by strength training. We suggest as a consequence that patients with an implanted catheter system should before starting exercise consult a sports medicine specialist who would in turn cooperate with the specialist responsible for the catheter, so that an adequate and safe training program can be selected.

[Systematic strength training in the postmenopause: accompanying densitometric control with DXA]

Of all the forms of osteoporosis, the postmenopausal type is the most important in social medicine due to the potentially high fracture risk in aging. The positive effects of physical activity on bone density have been emphasized in several studies. In this study on 31 female volunteers (minimum age 50 years), who had been postmenopausal for at least 2 years, 16 underwent systematic strength building (training group). They were compared with a control group consisting of 15 female volunteers. The parameters of success were physical strength and bone mineral density (BMD) before and after training. BMD was measured by dual-energy X-ray absorptiometry. The subjects in the control group showed significant decrease in bone density after 6 months: between 6.7 and 22.3% of the values measured at the beginning. The loss was more evident in the proximal femur than in the lumbar spine. In contrast, the subjects in the training group only showed a marginal decrease in bone density in the proximal femur: 0.8 to 3.8% of the earlier values. In the lumbar spine there was even a slight increase (+0.3%) in bone density.

Influence of acupuncture on physical performance capacity and haemodynamic parameters

In a single blind study the question as to whether the needling of specific acupuncture points is able to produce an increase in physical performance capacity and better regulation of heart rate and blood pressure was examined. Thirty-six healthy young men were assigned at random to three groups, receiving either actual acupuncture, placebo acupuncture or no stimulation. Performance was determined by means of a spiro-ergometer test which was carried out at the beginning and at the end of five weeks of treatment consisting of one session per week. The subjects from the group which actually received acupuncture were able to increase maximum performance capacity significantly and also physical performance at the anaerobic threshold. This may be interpreted as a sign of functional improvement in haemodynamic and metabolic mechanisms. There was, on the whole, no noticeable effect produced by the placebo acupuncture. The control group, which received no stimulation, showed unfavourable changes in the values obtained compared with the results of the performance test at the commencement of the study.