[Sepsis score in surgical intensive care medicine]

In a prospective study (400 patients, intensive care stay > 18 h) the following data were documented daily: Clinical sepsis, a modified sepsis score, Apache II-score, number of organ failure, Elastase-concentrations and injury severity score (ISS > or = 20 = polytrauma). On admission day a prognostic assessment for early diagnosis of septic complications during intensive care could be demonstrated by a combination of the modified sepsis score and the number of organ failures and the presence of polytrauma. All other parameters did not have any predictive value.

Immunoglobulin subclass concentration in preterm infants treated prophylactically with different intravenous immunoglobins

The most immature infants have critically low concentrations of all immunoglobulin G (IgG) subclasses, associated with a higher risk for pyogenic, respiratory, and meningeal infection. Selective IgG subclass deficiency is an established indication for intravenous immunoglobulin (IVIG) substitution. However, considering that therapeutic efficacy of IVIG is dependent on its pharmacokinetics, we studied peak and trough IgG subclass serum levels during the neonatal period (28 days) in a group of 34 healthy preterm babies (30.2 +/- 2 weeks gestational age (GA) and 1065 +/- 210 g birthweight (BW) treated prophylactically with three daily standard doses of two different IVIG preparations: Sandoglobulin (SG) (0.5 g/kg/day) and Pentaglobin (PG) (5 mL/kg/day). IgG subclass levels were assayed by radioimmundiffusion (RID) before treatment (day 1) and at days 3, 5, 7, 14, and 28 of life. Statistical analysis was performed by paired t test. In the first week of life only (days 3, 5, 7), for both IVIG preparations, subclass levels were higher than pretreatment values: IgG1, 4.6 +/- 1.7 versus 5.6 +/- 1.6 g/L; IgG2, 1.6 +/- 0.8 versus 2.1 +/- 0.6 g/L; IgG3, 0.2 +/- 0.7 versus 0.3 +/- 0.1 g/L; IgG4, 0.3 +/- 0.1 versus 0.9 +/- 0.1 g/L (p < 0.05). During this time (7 days) IgG2 levels were higher in the SG group and IgG4 was higher in the PG group (p < 0.05). This study shows pretreatment IgG subclass levels 14 days after treatment and different patterns, depending on the used preparation. We conclude that prospective clinical trials should include the study of target serum levels and timing of IVIG administration not only for IgG but also for IgG subclasses.

[The hematological laboratory of clinical practice]

The spectrum of analyses of a hematological laboratory comprises the counts of erythrocytes, leukocytes and platelets, the determinations of the hemoglobin concentration and of the hematocrit, the calculation of the red cell indices and the microscopic examination of the blood film. The determination of white blood cells, platelets, hematocrit and MCV as well as staining of the blood film should be performed within two hours after blood sampling. The hemoglobin concentration, red-cell count and MCH value remain constant for five days, provided that the blood samples is stored at 4 degrees C. The recognition of morphologically 'minor' pathological findings is important in view of the possible clinical significance that they might have. In the case of thrombotic-thrombocytopenic purpura, for instance, it is very important that the fragmentocytes are recognized and recorded. The grading of pathological findings by use of +, ++, is based on strict limits of ranges. Quality control and quality assurance are integral parts of the daily laboratory performance; moreover, the importance of external quality control in morphological hematology is stressed as being a challenge to the hematological laboratory technologist.

[Demonstration of intrathecal antibody formation against Borrelia burgdorferi in Lyme neuroborreliosis]

Neurologic complications are common in Lyme borreliosis. In adults in particular, detection of intrathecally formed antibodies to B. burgdorferi is a decisive diagnostic criterion. As in neurosyphilis diagnosis, the specific antibody titer against B. burgdorferi in the CSF is compared with the serum titer by calculating the specific antibody indices, taking into account the disturbed blood/CSF barrier. Deriving from these specific indices, we adapt by dilution the serum IgG level to that in the CSF of the same day, thus allowing for passive diffusion of antibody through the blood/CSF barrier. Determination of the specific antibody titer by indirect immunofluorescence demonstrates intrathecal synthesis of specific antibodies against B. burgdorferi if the CSF titer is higher than in the diluted serum tested in parallel. The individual methods are presented in a group of patients.

Serial IgG and IgM serum levels after infusion of different Ig-preparations (IgG or IgM-enriched) in preterm infants

Intravenous administration of Immunoglobulin (IVIG) has been used for prevention or treatment of neonatal sepsis. However, therapeutic efficacy of IVIG is dependent on pharmacokinetic factors. There have been no comparative studies in neonates between licensed IgG and IgM enriched preparations. The aim of this study was to investigate serial IgG and IgM serum levels during the neonatal period in two groups of non-septic, preterm infants treated prophylactically with IVIG. Twenty-two very low birth weight (VLBW) patients (1001-1500g) (gestational age 31.8 +/- 2.0 weeks and 1265 +/- 245g birth weight) and 12 extremely low birth weight (ELBW) patients (< 1000g) (gestational age 28.6 +/- 2.5 weeks and 910-85g birth weight) received at random three standard doses of Sandoglobulin (SG) (0.5 g/kg/day) or IgM enriched Pentaglobin (PG) (5 ml/kg/day). IgG and IgM concentrations were assayed by rate nephelometry before treatment and at day 3, 5, 7, 14 and 28 of life. At any time IgG levels were higher in the SG-VLBW group (p < 0.01), no difference being observed in the ELBW group (p > 0.5). IgM levels were higher at day 3 and 5 in the PG-VLBW group and until day 7 in the ELBW group (p < 0.01). This study indicates a wide range of IgG and IgM kinetics in the healthy premature and suggests frequent monitoring of immunoglobulin serum levels during efficacy studies.

Laminin and aminoterminal propeptide of type III procollagen in seminal plasma from fertile and vasectomized men

The components of the extracellular matrix, laminin and aminoterminal propeptide of type III procollagen (PIIINP) were determined in seminal plasma of 50 patients with vasectomy and of 50 age-matched fertile patients. The concentration of laminin was highly significantly (P < 0.001) elevated in the fertile group as compared to the vasectomy group, whereas the concentrations of PIIINP were not significantly different between these two groups. Only weak correlations were observed between the concentrations of laminin and PIIINP. It is suggested that part of the laminin found in seminal plasma is derived from the ductus deferens, while the source of PIIINP is probably located at an upper part of the urogenital tract.

Fetal haemoglobin levels in adult type 1 (insulin-dependent) diabetic patients

Glycated haemoglobin levels (HbA1 and HbA1c) are established parameters of long-term glycaemic control in diabetic patients. Depending on the method used, fetal haemoglobin interferes with the assays for glycated haemoglobin. If present in high amounts, fetal haemoglobin may lead to overestimation of glycated haemoglobin levels, and therefore, of average blood glucose concentration in diabetic patients. Glycated (HbA1c) and fetal haemoglobin levels were measured by high pressure liquid chromatography in 60 (30 female) adult Type 1 (insulin-dependent) diabetic patients of Swiss descent, and were compared with levels obtained from 60 normal, non-diabetic control subjects matched for age and sex. Fetal haemoglobin levels were significantly higher in the diabetic patients (0.6 +/- 0.1%, mean +/- SEM; range: 0-3.6%) than in the control subjects (0.4 +/- 0.1%, p < 0.001). Elevated fetal haemoglobin levels (> or = 0.6%) were found in 23 of 60 diabetic patients (38%) compared to 9 of 60 control subjects (15%; chi 2 = 8.35, p < 0.01). In addition, fetal haemoglobin levels in diabetic patients are weakly correlated with glycated haemoglobin (HbA1c) (r = 0.38, p < 0.01). Fetal haemoglobin results were confirmed with the alkali denaturation procedure, and by immunocytochemistry using a polyclonal rabbit anti-fetal haemoglobin antibody. A significant proportion of adult patients with Type 1 diabetes has elevated fetal haemoglobin levels. In certain patients this may lead to a substantial over-estimation of glycated haemoglobin levels, and consequently of estimated, average blood glucose levels. The reason for this increased prevalence of elevated fetal haemoglobin remains unclear, but it may be associated with poor glycaemic control.

[Dry chemistry in the clinical laboratory: how reliable is it?]

The performance of dry chemistry analysis systems was evaluated using the results obtained from proficiency testing 1991 of practitioner's laboratories. 59% of the participants use dry chemistry (Ektachem DT 60 Kodak, Reflotron Boehringer, Cobas Ready Roche). The evaluation reveals the following: The declared values of the control sera for the dry chemistry systems agree well with those of the conventional wet chemistry, excepting enzyme assays. The precision of the dry chemistry parameters is substantially higher than that of the wet chemistry. The overall performance of the dry chemistry analysis systems was found to be superior as compared to the wet chemistry performance. A prerequisite for dry chemistry proficiency testing are control sera of human origin.

[Non-enzymatic marking of gene probes using digoxigenin for the diagnosis of sickle cell mutation and beta thalassemia]

A method is described in which allele-specific oligonucleotides (ASO) are labeled non-enzymatically with digoxigenin (DIG). The ASOs were synthesized in a DNA synthesizer. A primary C6-alkylamine was incorporated at the 5'end of the ASO. The derivative was coupled to digoxigenin-3-0-methylcarbonyl-epsilon-aminocaproic acid-N-hydroxy-succinimide ester. The DIG-ASO probes were isolated from the crude preparation and hybridized with amplified genomic DNA. The annealed probes were detected with an ELISA test. The DIG-ASO probes were successfully used for the identification of sickle cell disease genotypes and the most common beta-thalassemia mutations.

[Acquired hemoglobin H disease in the early stage of erythroleukemia]

At the onset of erythroleukemia, the patient, a 74-year-old Swiss male, was also found to have microcytic-hypochromic anemia (Hb: 82 g/l, MCV: 69 fl, MCH: 21 pg). Further laboratory examinations revealed reduced hemoglobin stability, a hemoglobin H fraction of 3.0% on cellulose acetate-electrophoresis, and an abundance of hemoglobin H inclusion bodies in red cells. These findings, as well as the Swiss origin of the patient and his age at the onset of the disease, were consistent with acquired hemoglobin H disease. In addition to genetic hemoglobin H disease, acquired hemoglobin H disease was reported to be associated with myelodysplastic and myeloproliferative syndrome, or erythroleukemia and acute myelogenous leukemia. The literature contains fewer than 50 cases. It is suggested that the molecular basis of this rare disease involves a gene in trans to the alpha-globin genes reducing the expression of all four alpha-globin genes to approximately 10% of normal activity.

[Platelet satellitosis]

Platelet satellitism (PS) is a rare phenomenon described sporadically in the literature. It involves adhesion of thrombocytes sensitized by antibodies to leucocytes and is observed in vitro in EDTA anticoagulated blood. The authors' contribution to the problem is the observation of special thrombocyte aggregates surrounding neutrophils resembling comet tails, as well as the fact that the authors observed the formation of aggregates surrounding also lymphocytes and eosinophil cells.

[Congenital methemoglobinemia with cytochrome-b5-reductase deficiency: 4th Swiss family]

In a female newborn presenting with pronounced cyanosis in the absence of cardiopulmonary disease, the cyanosis was due to methemoglobinemia of 33% at birth and 17% at 24 hours (upper limit 0.5%) which was found to be secondary to deficiency of red blood cell cytochrome b5 reductase (EC 1.6.2.2.). Only residual activity of this enzyme was measurable, thus indicating homozygosity. Both parents were found to be heterozygous for this inherited disease. Of the six sisters and brothers of the newborn's father, five were investigated and all found to be heterozygous for the defective allele. Measurement of cytochrome b5 reductase showed both soluble and membrane bound fractions to be affected equally in the red cells of the baby's heterozygous parents.

Unusually high concentrations of Zn alpha 2-glycoprotein and the lack of alpha 2HS-glycoprotein in human ejaculates

Ejaculates of 132 nonvasectomized and 129 vasectomized men were assayed for their Zn alpha 2- and alpha 2HS-glycoprotein contents by radial immunodiffusion. The respective mean concentrations of Zn alpha 2-glycoprotein were 319 and 309 mg/L, respectively, but these fluids were devoid of alpha 2HS-glycoprotein. In comparison, the concentration of these two proteins in serum of normal men were 62 and 617 mg/L for Zn alpha 2- and alpha 2HS-glycoprotein, respectively. Because albumin in the ejaculates is 100-fold less concentrated than in serum, the fivefold increase in the concentration of Zn alpha 2-glycoprotein of the ejaculates represents about a 500-fold enrichment of this protein in the ejaculates over the concentration expected by comparison with albumin.

Unusually high concentrations of Zn alpha 2-glycoprotein and the lack of alpha 2HS-glycoprotein in human ejaculates

Ejaculates of 132 nonvasectomized and 129 vasectomized men were assayed for their Zn alpha 2- and alpha 2HS-glycoprotein contents by radial immunodiffusion. The respective mean concentrations of Zn alpha 2-glycoprotein were 319 and 309 mg/L, respectively, but these fluids were devoid of alpha 2HS-glycoprotein. In comparison, the concentration of these two proteins in serum of normal men were 62 and 617 mg/L for Zn alpha 2- and alpha 2HS-glycoprotein, respectively. Because albumin in the ejaculates is 100-fold less concentrated than in serum, the fivefold increase in the concentration of Zn alpha 2-glycoprotein of the ejaculates represents about a 500-fold enrichment of this protein in the ejaculates over the concentration expected by comparison with albumin.

Automated blood count analysis by trimodal size distribution of leukocytes with the SYSMEX E-5000

The automated haematology analyser, SYSMEX E-5000, measures and computes quantitative haematological parameters, and determines the size distribution of blood cells and platelets. After partial lysis, the analyser classifies the leukocytes into 3 populations: small cells (lymphocytes), intermediate sized cells (basophils, eosinophils, monocytes) and large cells (neutrophils, including band cells). One thousand blood samples from inpatients and outpatients were analysed automatically in the SYSMEX as well as being submitted to microscopic blood smear differentiation, and the results were compared. The trimodal size distribution of the automated analysis revealed 1.8% false normal results. Ten cases of eosinophilia of between 6.6 and 12.5% remained undetected by the automated method, which also failed to detect 7 cases of left shift with normal leukocyte count, as well as a single sample containing 2% of myelocytes. Both diagnostic sensitivity and diagnostic specificity were high, i.e. 97.1% and 81.8%, respectively. The predictive values were also high for both pathological and normal results. Since certain changes in blood cell morphology are not detected by the SYSMEX, certain clinical indications still call for a microscopic blood smear examination. With due regard to these limitations, the apparatus yields reliable results and economizes considerably the routine laboratory work load. In the present study, 31% of the microscopic blood cell differential counts were saved by using the SYSMEX E-5000.

[Method and clinical significance of cerebrospinal fluid spectrophotometry]

The results of the spectrophotometric analysis of 932 cerebrospinal fluid specimens are presented. The specimens were obtained from 95 patients with subarachnoid and intracerebral hemorrhages, 75 patients with traumatic head injuries, 40 patients with infectious diseases of the central nervous system, 302 patients with cerebrovascular accidents and 302 patients suffering from a variety of diseases such as multiple sclerosis, herniated intervertebral discs and vasomotor headache. Normal cerebrospinal fluid is colourless and shows a spectrophotometric absorption characterized by a flat curve with decreasing absorption from 350 to 650 nm. In disease states Oxy-Hemoglobin, Met-Hemoglobin and Bilirubin can be identified in cerebrospinal fluid. These pigments, when present in cerebrospinal fluid, change the spectrophotometric curve due to their specific absorption spectra. According to the quantitative relationship between the pigments and their chronological order of appearance in the cerebrospinal fluid, typical spectrophotometric patterns have been delineated. The spectrophotometric absorption curve of a hemorrhage due to rupture differs from that of a diapedetic hemorrhage. Moreover, tap bleeding results in an absorption curve which can be differentiated early from that of a subarachnoid hemorrhage. Finally, artifacts due to desinfectants can easily be identified. It is concluded that the spectrophotometric analysis of cerebrospinal fluid gives helpful information in subarachnoidal-hemorrhage, subdural and intracerebral hematoma, in contusions of the brain, carcinomatosis of the leptomeninx, spinal tumor and meningoencephalitis of unknown origin.

One-step sandwich enzyme immunoassay for insulin using monoclonal antibodies

An enzyme-linked immunosorbent assay for the measurement of insulin in human serum has been developed. The test is based on the sandwich technique with two monoclonal antibodies directed against two different epitopes of insulin using coated plastic tubes as the solid phase and horse radish peroxidase as the label. The immunoreactions are completed in one step within 2 h. The horse radish peroxidase activity bound to the tube wall is measured photometrically after an additional 1-h incubation with the substrate. The standards used cover the range from 0 to 260 mU insulin/L. Employing the Enzymun-Test System ES 22 modular batch analyzer, the detection limit was found to be 3.7 mU insulin/L. Coefficients of variation (CV's) between 1.4-7.8% for intraassay precision and 5.6-10% for interassay precision were obtained over the concentration range of 17-107 mU Insulin/L. The correlation between the procedure described here (y) and a commercially available double antibody radioimmunoassay (x) is expressed by the following equation: y = 1.07x + 1.14 mU insulin/L.

Complete amino acid sequence of human plasma Zn-alpha 2-glycoprotein and its homology to histocompatibility antigens

In the present study the complete amino acid sequence of human plasma Zn-alpha 2-glycoprotein was determined. This protein whose biological function is unknown consists of a single polypeptide chain of 276 amino acid residues including 8 tryptophan residues and has a pyroglutamyl residue at the amino terminus. The location of the two disulfide bonds in the polypeptide chain was also established. The three glycans, whose structure was elucidated with the aid of 500 MHz 1H NMR spectroscopy, were sialylated N-biantennas. The molecular weight calculated from the polypeptide and carbohydrate structure is 38,478, which is close to the reported value of approximately equal to 41,000 based on physicochemical measurements. The predicted secondary structure appeared to be comprised of 23% alpha-helix, 27% beta-sheet, and 22% beta-turns. The three N-glycans were found to be located in beta-turn regions. An unexpected finding was made by computer analysis of the sequence data; this revealed that Zn-alpha 2-glycoprotein is closely related to antigens of the major histocompatibility complex in amino acid sequence and in domain structure. There was an unusually high degree of sequence homology with the alpha chains of class I histocompatibility antigens. Moreover, this plasma protein was shown to be a member of the immunoglobulin gene superfamily. Zn-alpha 2-glycoprotein appears to be a truncated secretory major histocompatibility complex-related molecule, and it may have a role in the expression of the immune response.

Human serum alpha 2HS-glycoprotein modulates in vitro bone resorption

We previously isolated a family of bone-resorbing proteins from human cancer ascites fluid and established that the three purified bone-resorbing proteins were chemically and immunochemically related to each other and to alpha-2HS glycoprotein (alpha 2HS). After this finding we purified the normal human serum counterpart of these ascites proteins and studied its effects on bone resorption. The bone-resorbing properties of normal human serum alpha 2HS were examined in vitro over a wide dose range. This normal human serum glycoprotein had a biphasic effect on 45Ca2+ release from bone. More specifically, this protein stimulated bone resorption at the lower concentrations tested, with a maximum effect [treated over control ratio of 2.5 +/- 0.30 (+/- SE); P less than 0.01] at 40 micrograms/mL. In contrast, at doses above 40 micrograms/mL, a sharp decline in calcium mobilization occurred, with a return to baseline occurring above 80 micrograms/mL. These results suggest that serum alpha 2HS may participate in the regulation of bone metabolism in vivo.

Behavior of beta 2-microglobulin in patients with chronic renal failure undergoing hemodialysis, hemodiafiltration and continuous ambulatory peritoneal dialysis (CAPD)

beta 2-microglobulin (beta 2-m) is the major component of a new form of amyloid deposit found in carpal tunnel syndrome and dialysis arthropathy of long-term hemodialysis patients. In 52 patients on maintenance hemodialysis, serum beta 2-m concentration was elevated to 37.9 +/- 1.4 (normal 1.2 +/- 0.6) mg/l. It was correlated with the time on hemodialysis (r = 0.43, p less than 0.01) and was inversely correlated with residual renal function (r = 0.87, p less than 0.001). In 20 patients on CAPD, beta 2-m likewise was increased to 31.6 +/- 2.3 mg/l; daily elimination by dialysate was only 34 mg (normal 150 mg). Hemodialysis with a cuprophane membrane caused a rise in serum beta 2-m, whereas hemodiafiltration with a polysulfone membrane performed in 5 patients over 2 1/2 months was accompanied by a decrease in serum beta 2-m from 39.5 +/- 0.7 to 29.7 +/- 1.0 mg/l predialysis (19.1 +/- 1.1 postdialysis). On the other hand, beta 2-m elimination reached only approximately 100 mg per day in spite of markedly elevated serum levels. It is concluded that serum beta 2-m is massively elevated in long-term hemodialysis and CAPD patients; contrary to routine hemodialysis with cuprophane membranes, newer more permeable membranes will permit some elimination of beta 2-m. However, based on quantitative considerations it seems difficult to obtain beta 2-m concentrations in the high normal or moderately elevated range with present day techniques.

Can automated haematology analysers discriminate thalassaemia from iron deficiency?

The use of automated analysers in population screening for beta-thalassaemia has been a matter of controversy. The new fully automated haematology analyser Sysmex E-5000 (Toa Medical Electronics Co. Ltd) facilitates the discrimination of heterozygous thalassaemia from iron deficiency anaemia. In addition to haemoglobin, mean corpuscular haemoglobin and mean corpuscular volume, the red cell size-distribution width is measured. In patients with hypochromic microcytic red cells, the Sysmex data have been evaluated and compared with the indices described by England and Fraser [Lancet i, pp. 449-452, 1973], Mentzer [Lancet i, p. 882, 1973] and by Shine and Lal [Lancet i, pp. 692-694, 1977]. For the detection of beta-thalassaemia trait, the size-distribution width is superior to the previously described indices. The sensitivity is 79%, the specificity 95% and the predictive value for a positive test 94%.

[Phagocytosis of blood cells in pleural effusions]

Macrophages can be found in pleural effusions in varying number according to etiology and duration of the underlying pleural disease. These phagocytes are able to ingest different particles and cells: morphologically intact white and red blood cells or degradation products (such as, for instance, specific granules of granulocytes) are detectable in up to 10% of pleural macrophages. Little is known about the significance and mechanisms of cytophagocytosis of blood cells by macrophages in pleural effusions. To learn more about it we studied the phenomenon of endocytosis in 105 patients with pleural effusions of various etiologies. Cytophagocytosis can be observed in all pleural effusions independently of underlying pleural processes. The nature of ingested cells in macrophages corresponds to free blood cells in effusions and a similar ratio can be shown. The results indicate that white and red blood cells which enter the pleural space may be eliminated by macrophages by a similar mechanism to the well known cytohemolysis of blood cells in the reticulo-endothelium of the body.

The complete amino acid sequence of the A-chain of human plasma alpha 2HS-glycoprotein

Normal human plasma alpha 2HS-glycoprotein has earlier been shown to be comprised of two polypeptide chains. Recently, the amino acid and carbohydrate sequences of the short chain were elucidated (Gejyo, F., Chang, J.-L., Bürgi, W., Schmid, K., Offner, G. D., Troxler, R.F., van Halbeck, H., Dorland, L., Gerwig, G. J., and Vliegenthart, J.F.G. (1983) J. Biol. Chem. 258, 4966-4971). In the present study, the amino acid sequence of the long chain of this protein, designated A-chain, was determined and found to consist of 282 amino acid residues. Twenty-four amino acid doublets were found; the most abundant of these are Pro-Pro and Ala-Ala which each occur five times. Of particular interest is the presence of three Gly-X-Pro and one Gly-Pro-X sequences that are characteristic of the repeating sequences of collagens. Chou-Fasman evaluation of the secondary structure suggested that the A-chain contains 29% alpha-helix, 24% beta-pleated sheet, and 26% reverse turns and, thus, approximately 80% of the polypeptide chain may display ordered structure. Four glycosylation sites were identified. The two N-glycosidic oligosaccharides were found in the center region (residues 138 and 158), whereas the two O-glycosidic heterosaccharides, both linked to threonine (residues 238 and 252), occur within the carboxyl-terminal region. The N-glycans are linked to Asn residues in beta-turns, while the O-glycans are located in short random segments. Comparison of the sequence of the amino- and carboxyl-terminal 30 residues with protein sequences in a data bank demonstrated that the A-chain is not significantly related to any known proteins. However, the proline-rich carboxyl-terminal region of the A-chain displays some sequence similarity to collagens and the collagen-like domains of complement subcomponent C1q.

[Chronic fatal vitamin A poisoning with hemolytic anemia]

A case of chronic, lethal vitamin A intoxication is reported, the diagnosis of which was not established intra vitam. The patient presented with chronic mixed prehepatic and hepatic icterus and hypersplenism with hemolytic anemia. On post mortem histological examination, abundant deposits of neutral lipids in the reticuloendothelial cells of liver, spleen and bone marrow were found. Chemical analysis of the lipids extracted from these organs revealed esterified fatty acids. Triglycerides could be ruled out since the triglyceride content of the patient's liver was significantly lower than that of a normal control. By means of thinlayer chromatographic analysis it was possible to identify retinol, i.e. retinylester (vitamin A) in the deposits. Vitamin A was determined photometrically and found to be very elevated in the liver and, to a lesser degree, in the spleen of the patient. These findings lead to a definite diagnosis of chronic hypervitaminosis A. Unique features of the case presented are both hemolytic anemia and the lethal outcome of the chronic hypervitaminosis A.

[Pregnancy in a representative Swiss population (study of pregnancy and newborn infants in Aarau). 3. Diseases and drugs in pregnancy]

As part of an overall study, a cohort of 996 Swiss mothers was interviewed upon admission to the labour ward regarding illnesses, disorders and the use of drugs during pregnancy. The data are presented and compared with analogous data on the entire female population of the same age group in Switzerland, and with epidemiologic reviews of pregnancy events from other countries. Somatic illness, particularly the common cold, were reported by 55%, and complaints of a more psychosomatic character by 47%. Illness related to pregnancy was found in more than 40% of the women. Only 16% reported no illnesses or complaints during the course of pregnancy. On the other hand, 33% of the mothers had taken no medication during pregnancy. Compared with studies from other countries the use of medication in this group of women was lower, particularly self-medication for minor complaints. The women reported an average intake of 1.6 drugs. In the offspring of these mothers only a few minor somatic effects were demonstrable. The Brazelton behavioral assessment did, however, reveal some significant correlations.

[The course of pregnancy in a representative Swiss sample (Aarau Pregnancy and Newborn Infant Study). II. Stimulants in pregnancy]

Within the framework of a study on the course of pregnancy, a cohort of 996 Swiss mothers was interviewed upon admission for delivery at Aarau Maternity Hospital regarding nicotine, alcohol, caffeine and narcotics consumption. The data are presented and compared with analogous data on the entire female population of the same age group in Switzerland and with epidemiologic reviews of pregnancy events from other countries. The relationship between these data and effects on the newborn is also discussed. This group of mothers aged 20-40 years had, even prior to pregnancy, below-average alcohol and nicotine consumption. During pregnancy nicotine use in the last trimester, though reduced, was still admitted by 18% of the gravidae despite the fact that about 3/4 of the mothers were well informed about detrimental effects on the offspring. Nicotine use by the mother had several somatic effects on the newborn, in contrast to consumption of caffeine and small amounts of alcohol. The behavioral assessment was altered by previous use of nicotine and caffeine.

[Benefits of routine automatic blood picture differentiation]

The benefits of automated blood smear differential cell counting as a supplementary laboratory examination have been studied. The investigations focussed on patients of whom hematology requisitions were limited to total leukocyte count and hemoglobin determination. The specimens were derived from patients of departments of surgery and obstetrics and gynecology. For specimen collection the vacutainer system was used. The blood smears were prepared in a Coulter Electronics slide spinner, stained with a Hematek II slide stainer and analyzed in the Coulter Electronics Diff 3-50 cell classifier. A total of 1700 blood smears were examined. Following processing of each sample, the classification of each cell was inspected. Corrections were performed, if necessary, and the number of classification changes performed for each smear was registered. Using the in-house normal ranges, 34.5% were pathological smears. Since this group included a large number of borderline cases, new discrimination limits for clinically relevant pathological findings were set empirically. According to these wider ranges, the fraction of pathological slides amounted to 15.2%. Among these, immature granulocytes, eosinophilia and lymphopenia were the most frequent pathological findings. Microscopic control proved in 57.6% of the total number of smears. This complemental procedure was not found to be time-consuming.

[Automatic blood smear differentiation using the Coulter Electronics Diff 3-50 system]

The Coulter Electronics Diff 3-50 consists of a slide spinner, a slide stainer and a cell classifier. The cell analyzer is composed of an optical system with a microscope, microprocessor, video camera and printer. The system used in this laboratory is supplemented by a video monitor. The Diff 3-50 analyzes blood cells according to the classical criteria used in hematology. It classifies 11 types of nucleated blood cells and it processes an average of 45 blood smears per hour. It features a visual control of each cell classified with a built-in mechanism for change of classification by the operator if necessary. Moreover, the system estimates leukocyte and platelet count and generates a quantitative estimate of platelet number. Blood smears of 507 blood samples from patients admitted to the hospital were included in the present study. They were analyzed twice, first by the Diff 3-50, and secondly by visual checking of the automatic classification of each cell. The results of the two procedures were then compared. The findings indicate an overall false negative error of 1.4% and an overall false positive error of 4.3%. Major differences were found, though not consistently, only when the classification by the Diff 3-50 of the band neutrophils was compared with the visual classification performed by the operator. Lymphocytes and monocytes correlated well when both procedures were compared. Blasts present in 5 blood smears were recognized by the classifier. The Diff 3-50 identified immature granulocytes in 47 out of 48 cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Characterization of the B-chain of human plasma alpha 2HS-glycoprotein. The complete amino acid sequence and primary structure of its heteroglycan

alpha 2HS-Glycoprotein, a normal human plasma protein, was recently shown to consist of two polypeptide chains. In the present study, we have separated these two chains from one another and have elucidated the complete primary structure of the B-chain. Employing automated Edman degradation, the polypeptide moiety of this chain was shown to consist of 27 amino acid residues with an unequal distribution of the neutral and charged amino acid residues. The first 20 residues are uncharged, whereas the carboxyl-terminal heptapeptide contains all charged residues. Utilizing 500-MHz 1H-NMR spectroscopy, the carbohydrate unit proved to be a trisaccharide consisting of sialic acid, galactose, and N-acetylgalactosamine O-glycosidically linked to serine (residue 6). The structure of the B-chain was found to be as follows. (formula; see text) Thus, the molecular weight of the B-chain is 3386. Evaluation of the polypeptide chain by the procedure of Chou and Fasman (Chou, P.Y., and Fasman, G.D. (1979) Adv. Enzymol. 47, 45-148) predicts that the B-chain has two beta-turns. Thereby, the carbohydrate unit which is linked to the Ser residue located in the first beta-turn appears to be directed away from the protein. The second beta-turn probably includes the Cys residue which links the B- to the A-chain. In agreement with the CD analysis, the B-chain lacks beta-conformation but possesses a short alpha-helical region.

[Plasmapheresis treatment in multiple myeloma with kidney insufficiency]

Two patients with multiple myeloma and renal insufficiency are described. In both cases free lambda-chains were demonstrated in blood and urine. Plasmapheresis induced a marked reduction of lambda-chains in both patients. In one patient, a 63 year old man, oliguria ceased but renal function remained impaired and required treatment with longterm hemodialysis. The patient died after 6 1/2 months from sudden circulatory failure. In the second patient, a 68 year old woman, renal function was recovered sufficiently to enable hemodialysis to be stopped. Plasmapheresis may efficiently lower the paraprotein concentration in plasma and bring about improvement of renal function, at least in certain cases. However, treatment should be started before the terminal oliguric stage of renal insufficiency has been reached.

[Elimination of fluoride in urine during fluoridation of salt and drinking water]

From 552 ambulatory gynecological patients in different parts of Switzerland the urinary excretion of fluorine was measured. The patients were classified into 4 groups according to origin: (1) 84 women were from the Canton Basel-Stadt. In this city water has been fluoridated since 1962; (2) 139 women from Canton Glarus. In this area a pilot study was under way using table and baker's salt, to both of which 250 mg F/kg had been added; (3) 128 women from Canton Aargau who were using a low dose fluoridated salt (90 mg F/kg); (4) 201 patients from Cantons Aargau and Tessin respectively who were consuming neither fluoridated water or salt acted as controls. Quantitation of ionized fluorine in urine was performed by means of the fluoride ion sensitive electrode in afternoon urine samples, thus eliminating the influence of sex difference and diurnal rhythm in fluorine excretion. The molar urinary fluorine concentration was related to the corresponding urinary creatinine concentration and expressed as mumol F per mmol creatinine. The fluoridation of salt or water was considered ideal when the excretion factor amounted to 6.29 mumol X mmol-1. The most important finding was that the Glarus females excrete higher levels of fluorine than the patients from Basel, though the difference was no significant. The fluoridation of salt with 90 mg F/kg is followed by an increase of the excretion factor from 2.58 to 3.65 mumol X mmol-1. It could also be demonstrated that in Canton Glarus, where salt with higher fluorine content is used, the excretion coefficient remains below the level believed to be toxic in the long run. It is concluded that salt fluoridation with 250 gm F/kg is safe. Furthermore, the excretion of fluorine in the control group seems to confirm that fluorine is a trace element of ubiquitous occurrence even excreted in urine of individuals who deliberately avoid fluorine as an additive to table salt or water.

[Results of using the reflomat for determining glucose concentration, and the influence of glycolysis inhibitors on Reflotest-glucose (author's transl)]

There was a close correlation between the hexokinase-glucose-6-phosphate-dehydrogenase method and reflomat/Reflotest-glucose on capillary blood samples without addition of glycolysis-inhibitors. The relative deviations were less than 10% over the entire range. In systematic studies set up to determine the influence of sodium fluoride and sodium monoiodo-acetate on the reflomat/Reflotest glucose system it was demonstrated that sodium monoiodo-acetate can be used when determining glucose with reflomat/Reflotest glucose, while sodium fluoride produced false values with this system.

[A simple and quick method for measuring low blood-glucose concentrations (author's transl)]

A new method of measuring glucose concentrations (Reflotest-Hypoglycemie) was tested on 141 serum samples and 119 capillary blood samples and compared with the hexokinase-glucose-6-phosphate dehydrogenase method. The Reflotest (reflectance meter) compared well with the reference test. Comparison of results with three sera measured by the method in six different laboratories indicated the accuracy of the test. Endogenous bilirubin, uric acid, and haematocrit values did not influence the result. The test is therefore suitable for quantitative measurements.

Myoinositol--a uremic neurotoxin?

In 28 patients predialysis plasma myoinositol was significantly elevated to 10.8 +/- 2.5 versus 0.75 +/- 0.15 mg/100 ml in normals (mean +/- 1 SD), and was weakly correlated with plasma creatinine concentrations (r = 0.42, p less than 0.05). Dialysis decreased plasma myoinositol concentrations to 3.5 +/- 1.1 mg/100 ml. In 16 patients studied more extensively plasma myoinositol was similarly elevated to 10.6 +/- 3.4 mg/100 ml, and spinal fluid myoinositol was increased to 9.4 +/- 2.3 mg/100 ml (versus 2.7 +/- 0.7 in normals, p less than 0.001). Nerve conduction velocities were reduced in 15 and EEG tracings were abnormal in 12 of the 16 patients. However, neither spinal fluid nor plasma myoinositol showed any correlation with nerve conduction velocities or EEG changes (r = 0.05-0.20, NS) Myoinositol is one of the substances retained in renal insufficiency but no indication was found that it is a toxin causing uremic neurological disturbances.

[Hemolysis-inducing substances in gastric secretion, incidence-rate of lysolecithin]

Samples of gastric contents from 152 patients with pyloric reflex were taken during gastroscopy after an overnight fast and examined for hemolytic activity. Hemolysis was induced by 97 specimens (64%). The hemolysis test was positive in 45% of patients with a histologically normal gastric mucosa, in 76% of patients suffering from chronic atrophic gastritis with intestinal metaplasia, in 83% with gastric erosions and in 67% with gastric ulcer. No lysolecithin was found in 9 of the 97 positive specimens. The other aspirates contained widely differing values up to 320 mg/100 ml. The average quantities of lysolecithin in gastric contents varied in the different patient groups from 20 to 60 mg/100 ml. These values are much higher than the mean value of 0.9 mg/100 ml quantified in patients without pyloric reflex during an earlier investigation. It is now widely accepted that pyloric reflex promotes gastritis. Furthermore, it has been shown on several occasions that bile constituents exert a damaging effect on the gastric mucosa barrier. The same is true of lysolecithin, which promotes (for example) acute cholecystitis under experimental conditions. These findings, together with the results of our investigation, seem to afford evidence that lysolecithins may exert a pathogenic influence in the development of different gastric lesions.

[Isolation, identification and quantitative determination of lysolecithin in the human gastric juice]

Lysolecithin was isolated and identified from the gastric contents of 5 patients with gastric ulcer and erosive and atrophic gastritis. The methods used involved methanolic extration, column chromatography on silica gel and sephadex gel filtration, followed by preparative thin layer chromatography. Identification of lysolecithin was verified in one sample by thin layer chromatography and elementary analysis. A method for quantitation of lysolecithin in human gastric fluid for routine clinical analysis is described, based on the procedure used for identification of this phospholipid. Further, a hemolysis test is proposed for screening gastric contents for lysolecithin concentrations above approximately 10 mg/100 ml. With the quantitative method, an average concentration of 66.1 mg of lysolecithin in 100 ml gastric content was found in the group of 5 patients. The screening test was positive in all 5 samples, but was negative with native gastric juice in 25 persons serving as controls. When the gastric fluid of the controls was concentrated, however, 9 samples gave a positive hemolytic reaction. From these 9 specimens, the lysolecithin concentration was found to average 0.9 mg/100 ml. These findings afford evidence that lysolecithin may be involved as a factor in the pathogenesis of gastric ulceration.

Highly elevated content of free myo-inositol in the cerebrospinal fluid of neonates

Free myo-inositol in cerebrospinal fluid was determined in 60 babies aged from newborn to 12 months. In the neonates, a high inositol concentration was found (18-81 mg/100 ml). With increasing age, the values gradually decreased. The finding is discussed in relation to the maturation processes in central nervous tissue.