Determination of Fumonisins B1 and B2 in Corn and Corn Flakes by Liquid Chromatography with Immunoaffinity Column Cleanup: Collaborative Study

A liquid chromatographic (LC) method for the determination of fumonisins B1 (FB1) and B2 (FB2) in corn and corn flakes was collaboratively studied by 23 laboratories, which analyzed 5 blind duplicate pairs of each matrix to establish the accuracy, repeatability, and reproducibility characteristics of the method. Fumonisin levels in the corn ranged from <0.05 (blank) to 1.41 μg/g for FB1 and from <0.05 to 0.56 μg/g for FB2, whereas in the corn flakes they ranged from <0.05 to 1.05 μg/g for FB1 and from <0.05 to 0.46 μg/g for FB2. The method involved double extraction with acetonitrile–methanol–water (25 + 25 + 50), cleanup through an immunoaffinity column, and LC determination of the fumonisins after derivatization with o-phthaldialdehyde. Relative standard deviations for the within-laboratory repeatability (RSDr) of the corn analyses ranged from 19 to 24% for FB1 and from 19 to 27% for FB2; for the corn flakes analyses, RSDr ranged from 9 to 21% for FB1 and from 8 to 22% for FB2. Relative standard deviations for the between-laboratories reproducibility (RSDR) of the corn analyses ranged from 22 to 28% for FB1 and from 22 to 30% for the FB2; for corn flakes analyses, RSDR ranged from 27 to 32% for FB1 and from 26 to 35% for FB2. Mean recoveries of FB1 and FB2 from corn spiked with FB1 at 0.80 μg/g and with FB2 at 0.40 μg/g were 76 and 72%, respectively; for corn flakes spiked at the same levels recoveries were 110 and 97% for FB1 and FB2, respectively. HORRAT ratios for the analyses of corn ranged from 1.44 to 1.53 for FB1 and from 0.96 to 1.48 for FB2, whereas for corn flakes they ranged from 1.60 to 1.82 for FB1 and from 1.39 to 1.68 for FB2.

[The influence of dexamethasone on pain after lumbar disc surgery. A double-blind study.]

Patients operated because of lumbar disc herniations (104 patients) were included in a randomized double-blind study analyzing the influence of dexamethasone versus placebo on postoperative drug requirements and the pain score on the visual analogue scale. High doses of dexamethasone had been administered: 40 mg i.v. on the night before the operation; 8 mg intraoperatively topical perineural application; 8 mg i.v. in the evening of the day of operation; 2x8 mg i.m. on days 1 and 2 postoperatively; 2x4 mg i.m. on days 3 and 4; 4 mg po on day 5 and 6 postoperatively. A significant decrease in the requirement for analgesics was found in the drug-treated group, particularly male patients, and also an impressive reduction in the lumbar pain score. In conclusion, there was good alleviation of sciatic pain in the dexamethasone-treated group of females during the 1st week after operation, but we found no evidence that the agent tested had an influence on the clinical outcome 1 month following the operation.

[Spontaneous spinal epidural hematoma: good outcome after delayed treatment]

Spinal epidural haematomas are rare and are often encountered after previous operations on spinal disease and in combination with anticoagulation therapy. Usually early diagnosis and surgical treatment are the most important factors for a good result and neurological recovery. In 4 cases of spinal epidural haematoma treated in our institution, we found that also after some delay of diagnosis and treatment, surgery is always worthwhile even after some days to achieve a better neurological function.

Exchange blood transfusion in severe falciparum malaria: retrospective evaluation of 61 patients treated with, compared to 63 patients treated without, exchange transfusion

The rationale for exchange blood transfusion (ET) in severe falciparum malaria is threefold: reduction of parasitaemia, reduction of presumptive 'toxic' factors, and improvement of the rheological quality of the blood. We evaluated the records of 61 patients treated with ET to describe the present status of malaria treatment in Germany, Austria and Switzerland and to assess the efficacy of ET. Clinical data of 61 patients treated with ET were compared to data of 63 patients treated in 2 hospitals where ETs were generally not performed. We found that exchange transfusion is applied according to the clinician's subjective impression rather than strict guidelines. Logistic regression analysis adjusting for the differences in clinical parameters between patients treated with or without ET did not identify treatment as a prognostic indicator (odds ratio for relative risk of death with ET: 1.3; 95% CI: 0.4-4.9). Exchange transfusion did not significantly improve the unfavourable prognosis in cases of severe falciparum malaria. However, failure to reach statistical significance may be due to the retrospective design of the study and therefore non-systematic approach.

Splenectomy for suspected malignant lymphoma in two patients with loiasis

Intrasplenic lesions can cause diagnostic difficulties because malignant diseases can be excluded only by histologic examination. We present the cases of two patients with splenic manifestations of loiasis. Both patients had visited central Africa. Several years later, intrasplenic lesions were found during routine examinations (for chest trauma and employment, respectively). Both patients underwent splenectomies because malignant lymphoma was suspected. In both cases, histologic examination of the spleen showed eosinophilic granulomata with multiple Loa loa microfilariae.

[Halofantrine in the treatment of imported malaria in nonimmune travelers]

The efficacy (criteria: cure rate, time to resolution of fever or absence of parasites) and safety (criteria: clinical side effects, altered laboratory parameters) of halofantrin were investigated in a multi-centre study of 96 non-immune patients (71 men, 25 women, mean age 34.3 [21-62] years) with malaria imported from regions of high resistance into Germany or Switzerland. The initial 63 patients received one-day treatment (three doses of 500 mg halofantrin), while the last 33 patients received an additional course of treatment one week later. Treatment was curative in all patients in the second group, but relapses occurred in five of the 41 patients (12.2%) with falciparum malaria who received one-day therapy. Fever resolved after a mean of 45 hours and parasites were absent after a mean of 66 hours. There were small increases in transaminase values (most probably because of the infection) in five patients, but all became normal again within a few days. Halofantrin is a safe drug and is suitable for both therapy and stand-by therapy of resistant Plasmodium infections. Treatment should be repeated after 7 days.

The efficacy of halofantrine in the treatment of acute malaria in nonimmune travelers

A multicenter prospective trial was performed to investigate the efficacy and the tolerability of halofantrine in nonimmune patients with malaria imported from areas with drug-resistant falciparum parasites (mainly Africa). Forty-five of the 74 subjects were treated with a one-day regimen (3 x 500 mg) of halofantrine, and the other 29 received the same regimen with an additional treatment on day 7. In the second group, a 100% efficacy rate was demonstrated, but in the group receiving the one-day regimen, four recrudescences were observed in patients with falciparum malaria. Only five mild adverse reactions were seen, which disappeared spontaneously after the end of the treatment. We conclude that halofantrine is highly effective in curing malaria in nonimmune subjects. The treatment scheme for such persons should include an additional treatment on day 7 for nonimmune individuals. This drug was well tolerated in our patients, indicating that halofantrine will be useful in the treatment of multidrug-resistant malaria in nonimmune persons.

Different changes of n-6 fatty acids in lipoproteins from hyperlipemic subjects after diets supplemented with n-3 fatty acids

After diets supplemented with canned mackerel or herring, in a cross-over design, containing different amounts of long-chain n-3 fatty acids (eicosapentaenoic acid, C20:5n-3-EPA, and docosahexaenoic acid, C22(6)n-3-DHA) an increase of both EPA and DHA was confirmed in triglycerides (TG), cholesterol esters (CE) and phospholipids (PL) of very low density (VLDL) and low density lipoproteins (LDL) as well as in high density lipoproteins (HDL) from hyperlipidemic subjects. An unexpected finding was the simultaneous increase of arachidonic acid (C20:4n-6-AA) in TG and CE and its constant portion in PL of lipoproteins, whereas linoleic acid (C18:2n-6-LA) appeared lower in CE and in PL of VLDL + LDL and HDL. In general, the changes were minor after a diet supplemented with canned herring providing a lower dose of n-3 fatty acids. The results indicate dose-related changes not only of n-3 fatty acids, but also of n-6 fatty acids in serum lipids after fish diets. This different behavior of LA and AA in serum lipids might be a new aspect in the interrelations and the dietary modulation of both families of polyunsaturated fatty acids (PUFA). The accumulation of AA in neutral lipids could be linked with an elevation of prostaglandin I2, which was found apart from an increased formation of prostaglandin I3 after diets supplemented with n-3 fatty acids. The concomitant increase of prostaglandins I2 and I3 spotlights widely ignored interrelations within the eicosanoid pathway, which become evident after diets enriched with long-chain n-3 fatty acids.

[Dengue fever with hemorrhagic manifestations after a stay in Thailand]

On returning from a 24-day long stay in Thailand a 30-year-old German woman fell ill with high fever and head and limb aches. Soon after a confluent petechial exanthem was noted, as well as conjunctival and gastrointestinal bleedings. Biochemical findings (fall in haemoglobin concentration and haematocrit, leucopenia and thrombocytopenia, rise in lactate dehydrogenase) and a rise in Dengue antibody titre to 1 : 320 (on the 13th day of illness) confirmed the diagnosis of Dengue fever with haemorrhagic manifestations. This mosquito-transmitted viral disease, while so far only rarely reported in tourists, should be considered in the differential diagnosis of fever of undetermined origin in travellers to the tropics.

Extreme decrease of linoleic acid in renal medulla from rats after a diet supplemented with cod liver oil

Spontaneously hypertensive (SHR) and normotensive rats were fed a diet supplemented with linseed oil or cod liver oil for 22 weeks. The most remarkable finding was an extreme fall of linoleic acid in lipids from renal medulla after cod liver oil supplementation. In free fatty acids (FFA) eicosatrienoic acid (C2): 3n-9) appeared increased as a sign of essential fatty acid (EFA) deficiency.

Evidence for a circaseptan and a circasemiseptan growth response to light/dark cycle shifts in nucleated and enucleated Acetabularia cells, respectively

Nucleated as well as enucleated Acetabularia mediterranea cells were subjected to 14 different patterns of shifts in a regimen of 12 hr of light alternating with 12 hr of darkness in four 30-day long experiments. With one exception, which might be due to a circannual modulation, these experiments showed that nucleated cells had maximal growth rates when a shift was performed every 7th or 15th day. In enucleated cells, maxima were observed on shift schedules that were about 3-4 days rather than about 7 days apart. The results indicate that in the unicellular green alga Acetabularia a rhythm of about 7 days (circaseptan) exists and that removal of the nucleus results in a circaseptan frequency multiplication.

[Fronto- and laterobasal injuries in childhood and adolescence]

Within a period of 5 years, the author treated, among 106 children and adolescents up to 15 years of age with craniocerebral injuries, 12 who had frontobasal and laterobasal lesions. These were extended comminuted fractures, impression fractures, linear fractures (fissures), ethmoidal fractures, as well as a petrosal bone fracture. Principal signs were rhinoliquorrhoea or otoliquorrhoea, traumatic disturbances of consciousness and intracranial air accumulations. Less frequently, traumatic shock, signs of CSF infection and concomitant eye injuries were seen. Surgical care (treatment of the dural defect and plastic occlusion by means of Lyodura, galea-periosteal flap or fascia lata) was mostly effected transfrontally, in two cases transethmoidally and in one case with combined technique. In two cases, primary frontal decomminution had to be followed by a transethmoidal second intervention to close a lesion of the dura in the region of the sphenoid sinus. Surgery was carried out as an immediate operation in case of open injuries and in massive liquorrhoea if the general condition of the patient was good. In all other cases, operation was delayed until the second week after injury.

Prognosis of severe head injuries in childhood and adolescence

In a retrospective, non-random study, the effect of supplementary medical treatment (Dexamethasone, barbiturates) was investigated upon the prognosis of severe head injuries. Of 107 children and adolescents up to 16 years of age, 51 were treated with Dexamethasone; 56 received only standard therapy. Evaluation of the results shows that Dexamethasone therapy in high doses clearly reduced mortality in cases of severe head injuries (from 33.3% to 13.6%) without causing any noteworthy neurological defects. Among the individual types of injury, the effect was most evident in cases of intracranial hematoma (drop in mortality from 36.8% to 11.8%). On the other hand, definitive effects of therapy could not be established in the most severely injured patients with extreme brain damage and those with milder forms of trauma without substantial cerebral edema. Barbiturates were given only when severe intracranial pressure could not be alleviated by other means. Remission was successful in a few cases but the total number is not yet sufficient for a conclusive evaluation. Further important factors for prognosis are: depth and length of the initial disturbance of consciousness, age, concomitant injuries as well as some peculiarities of childhood and adolescence (tendency to develop severe cerebral edemas, clustering of atypical intracranial hematomas).

[Possibilities and limitations of intensive therapy in severe craniocerebral injuries]

In a retrospective, non-randomised study, the author examined the influence of additional drug treatment on the prognosis of severe injuries of the skull and brain. The emphasis of this study was on treatment with dexamethasone and barbiturates. Of 489 injured persons, 260 were treated with dexamethasone and 229 by the conventional standard treatment method only. Evaluation of the results showed that the high-dosage dexamethasone therapy clearly reduced the mortality in severe injuries of the skull and brain (from 57.4% to 32.4%), although this partly resulted in an increase of defective conditions. On the other hand, no definite effect of treatment was noticeable in extremeLy severe cases with high-grade substantial brain damage and with the milder forms of trauma in which the traumatic brain oedema did not play a prominent role. Barbiturates were used only where it proved impossible to reduce the increased brain pressure by other means. Good remissions were seen in some patients, but the total number is insufficient for a final evaluation. Independent of the treatment, however, other factors (depth and duration of the initial disturbance of consciousness, age, concomitant injuries) exercise a significant influence on the prognosis of severe injuries of the skull and brain.

[Computerized tomographic findings in brain contusions (author's transl)]

Over a 1 1/2 year period computerized tomographical examinations were performed on 104 patients suffering from brain concussions. The evaluation of findings resulted in the following classification: Type 1: severe generalized brain oedema without visible contusional foci, Type IIa: typical contusion with solitary or multiple contusional foci, Type IIb: typical contusion with severe, locally pronounced oedema, Type IIIa: contusion with flat subdural contusional bleeding, Type IIIb: contusion with minor intracerebral contusional bleeding, Type IIIc: contusion with intraventricular bleeding. Space-occupying haemorrhages were excluded. The comparison of computerized tomographic findings with the clinical course justifies such a classification. There are significant correlation between CT findings and the clinical picture, especially with the degree of clouding of consciousness as well as with further prognosis.

[Course dynamics and early prognosis of traumatic intracranial hemorrhage. III. Intracerebral hematomas (author's transl)]

56 traumatic intracerebral haemorrhages were surgically treated within a period of 3 years. In most cases, they were dur to severe craniocerebral traumas, often (in 71,4% of the patients) combined with calvarial fractures. The average age was 44,7 years, and the sex distribution male : female = 4:1. The temporal and frontal regions were the preferential sites in approximately equal incidence. Depending sites in approximately equal incidence. Depending upon the rapidity of the clinical course, acute haematomas are different from the sub-acute ones (12-hours limit); both groups differ from each other especially with regard to the prognosis involved. Disturbances of consciousness were most prominent in the clinical patterns: they were either primary and consistent (41.1%) or secondary and continually increasing (53,6%); a free interval was only rarely observed. The findings obtained on angiography if the carotid artery are not haematoma-specific. Proof of the existence of a haematoma is most reliably established via computed tomography, which is also a safe method to identify severe accompanying damage and posttraumatic cerebral edemas. The indications for surgery can be restricted by means of computed tomography to major haemorrhages with space-occupying growths and clinical signs of cerebral pressure, as well as in patients where the clinical pattern deteriorates during conservative treatment. In all other cases, it is advisable to adopt a cautious conservative attitude coupled with CT controls. Early prognosis (mortality 62,5%) depended on the severity of the primary traumatic cerebral damage, the extent of disturbance of consciousness, rapidity of the clinical course localisation of haemorrhage, and age of the patient.

[Nerve grafting and other plastic procedures in traumatic injuries of the brachial plexus (author's transl)]

In 52 patients with traumatic injuries of the brachial plexus plastic procedures were carried out on the nerves in order to improve function: primary suture of the torn portion of the plexus (one case), external and internal neurolysis with division of the epineurium (four times), anastomosis of the secondary branches or the main arm nerves, with the intercostal nerves by insertion of sural transplants (47 times). Seventy per cent showed an improvement in protective sensation and in 48% a useful gain in motor function was achieved. The results are dependent on the age of the patient (better results in the younger patients), on the interval between injury and operation (failure when the injury was more than one year previously), and the anatomical site (good regeneration with axillary and musculo-cutaneous, partial success with the radial and median, and failure with ulnar nerves). Although complete recovery cannot be expected, we recommend that such a "plastic" nerve operation should be done before considering the radical step of a definitive arthrodesis or amputation.

[Course dynamics and early prognosis in traumatic intracranial hemorrhage. II. Subdural hematoma]

181 subdural haematomas were subjected to surgery within a period of 3 years. Basing on the dynamics of their course and on their prognosis, we can differentiate between acute (50.8%, interval up to 24 hours), sub-acute (10.5%, interval 2 to 10 days) and chronic types (38.7%, interval 11 days to 6 months). Acute subdural haematomas are due to severe traumas, mostly combined with skull fractures; in most cases, there is no free interval, and they are associated with severe disturbances of consciousness. Their prognosis is poor (mortality 7.2%) and less due to a space-occupying growth, namely the haematoma, than to the primarily traumatic cerebral lesion. Sub-acute subdural haematomas are often characterized by a free interval; the disturbances of consciousness are less severe, and their prognosis is much more favourable (mortality 26.3%). Chronic subdural haematomas are the sequels of milder traumas, but it is clinically impossible to distinguish them from pachymeningiosis haemorrhagica interna. They become manifest by mental changes, headache and neurological focal symptoms. If treated in time, their prognosis is favourable, the mortality being 10%. All types of subdural haematoma present a characteristic clinical pattern. Atypical courses are much rare than with the epidural haematomas. Preoperative classification with assessment of prognosis can be achieved via findings obtained by computed tomography and angiography of the carotid artery.

[Dynamics of the course and early prognosis of traumatic intracranial haemorrhages. I. Epidural haematomas (author's transl)]

79 epidural haematomas were surgically treated within a period of 3 years (66 acute and 13 sub-acute courses), half of the cases being due of traffic accidents. The average age was 31.6 years, and the sex distribution male : female = 4 : 1. The most frequent location of the haematoma was temporal (59.5%), followed by parietal (20.3%) as well as frontal and occipital (10.1% each). In only 20.3% of the cases, we found the classical three-stage course with free intervals, whereas primarily persistent and secondarily continuously increasing disturbances of consciousness (34.2% and 45.6% respectively) were more frequent. Dilatation of the pupils on the side of the focus was seen in barely one-half of the patients; in 88.6% of the patients, fracture of the skull was diagnosed on the haematoma side. Diagnosis of haematoma was confirmed either by computed tomography or by angiography of the carotid artery. Early prognosis (mortality = 21.5%) depended on the dynamics of the course of the haematoma (mortality in acute cases 25.8%, in sub-acute courses 0%), the extent of the primary traumatic cerebral damage (manifested by the severity of the disturbance of consciousness) and the rapidity of surgical intervention. The mortality was 45.5% in patients in whom the midbrain had already been affected, as demonstrated by relevant signs with extension spasms and comatose condition of consciousness, whereas the mortality was 75% if both pupils were wide and fixed.

[Cerebral missile injuries in civilian practice (author's transl)]

Over a 10 year period we have treated 63 cases of cerebral gunshot injuries, most of them attempted suicides. Following the presentation of ballistic data, and the classification and pathophysiology of the clinical symptoms, early and late complications are reported in detail and recommendations for therapy given. The mortality rate of all admitted patients in our material was 60.9%; a direct relation between the severity of primary brain damage (recognizable in the degree of initial unconsciousness) and the chance of survival was found.

[A study on the problem of thoracic discprolapse (author's transl)]

The article reports on twenty patients with thoracic prolapsed discs treated by surgery within a period of ten years. The incidence in relation to prolapses at all levels was 1.2%. The average age was 50.3 years and there was no definite sex predominance. The segments Th 10-11 and Th 11-12 were the preferred sites. The period of the disease varied from a few hours to nine years. Among the most frequent subjective complaints were radiating pain, paraparesis of the legs and disturbed micturition. A definitely traumatic cause of the disease was present in one case only. Besides exact neurological diagnosis it is imperative to effect myelography with positive contrast medium, revealing the typical circular or oval-shaped filling defects. In our patients, laminectomy was performed 17 times, and hemilaminectomy three times. Besides removal of the prolapse, the dentate ligament was always divided. In some cases we also performed rhizotomy. Operation improved 15 patients, whereas in two patients the condition got worse and three patients showed neither improvement nor deterioration.