Efficacy of moxidectin, nemadectin and ivermectin against an ivermectin-resistant strain of Haemonchus contortus in sheep. The efficacies of ivermectin, nemadectin and moxidectin were evaluated when administered orally to lambs infected with either a susceptible laboratory strain of Haemonchus contortus or a strain reported to be resistant to ivermectin. Groups of 24 Dorset cross Cheviot cross Suffolk lambs were infected with either the susceptible or resistant strain of H contortus and allocated to treatment groups according to their faecal egg counts 27 days after infection. One day later the lambs were dosed orally with one of the three anthelmintics at 0.2 mg/kg bodyweight, and they were killed and surviving worms were recovered 13 or 14 days after treatment. Against the ivermectin resistant strain, ivermectin did not significantly reduce the egg count or the numbers of adult H contortus; however, both nemadectin and moxidectin reduced the nematode egg counts and the numbers of H contortus by 99 and 100 per cent, respectively. Against the susceptible strain, all the anthelmintics reduced the egg counts by 100 per cent as early as four days after treatment and reduced the numbers of susceptible H contortus by 100 per cent. No adverse reactions to any of the drugs were observed.


Factors affecting the leukotoxin activity of Fusobacterium necrophorum. The effect of cultural conditions on the production of leukotoxin by biotypes A and B of F. necrophorum was investigated. Biotypes A and B were grown in prereduced, anaerobically sterilized, brain-heart infusion (BHI) broth. The average leukotoxin titer of culture supernatant was 18 times higher from biotype A strains than from biotype B strains. Leukotoxin activity peaked during the late-log and early-stationary phases of growth, then declined precipitously in both biotypes. F. necrophorum biotype A was grown in different media (BHI, liver infusion, and Eugon broths), at various pH (6.6, 7.3, 7.7, and 8.2), incubation temperatures (30, 35, 39, and 43 degrees C), redox potentials (-352 to +375 mV), and iron concentrations (less than 0.2, 4.2, 42.1, and 361.4 microM). Anaerobic BHI broth with pH from 6.6 to 7.7 at 39 degrees C incubation temperature supported maximal F. necrophorum growth and leukotoxin production. The optimum redox potential for F. necrophorum growth was in the range of -230 to -280 mV. However, the presence of titanium III citrate or dithiothreitol (7.78 mM) in the medium decreased (P less than 0.05) the leukotoxicity of F. necrophorum. Low iron concentration (less than 0.2 microM) decreased (P less than 0.05) growth rate but not leukotoxin activity of F. necrophorum, whereas high iron concentration inhibited the leukotoxin activity.


Efficacy of a trivalent Haemophilus paragallinarum vaccine compared to bivalent vaccines. The efficacy of a trivalent oil-adjuvant Coryza vaccine containing serotypes A, B and C of Haemophilus paragallinarum has been compared with that of a bivalent oil-adjuvant Coryza vaccine containing serotypes A and C and that of a commercially available, bivalent A1(OH)3-potentiated vaccine, containing types A and C. The trivalent vaccine, given at 10 and 17 weeks of age, provided the best protection. Even at 55 weeks after booster vaccination, chickens were still significantly protected, following severe challenge with either of the three serotypes of Haemophilus paragallinarum. Both bivalent vaccines did not protect against type B challenge. Furthermore the oil-adjuvant vaccines induced higher HI-A titers, which correlate with protection, compared to the A1(OH)3-potentiated vaccine. The results show that type B strains are pathogenic and constitute a distinct immunotype and thus a Coryza vaccine should contain three serotypes to obtain a broader protection against all serotypes.


Plasmid profile analysis, phage typing, and antibiotic sensitivity of Salmonella dublin from clinical isolates in the United States. One hundred clinical isolates of Salmonella choleraesuis subsp. choleraesuis serovar dublin (Salmonella dublin) were examined for phage sensitivity, antibiotic resistance patterns, and plasmid content. Computer analysis of the lysis patterns observed by using 27 typing phages divided the S. dublin isolates into 26 groups. One lytic pattern (Designated pattern 16) contained 52% of the isolates examined whereas 16 isolates had unique patterns, and nine patterns had fewer than ten members. Although 14 antibiotic resistance patterns were observed among the 100 isolates, 79% of the isolates grouped in three major patterns. Seven plasmid groups were identified and designated A-G based on the large plasmids found in the isolates. Of the 100 isolates, 28 contained the plasmid profile of Group A, 28 were Group B, 7 were Group C, 34 were Group D, and 1 isolate each was observed in Groups E, F, and G. The strong association between antibiotic resistance pattern and plasmid type suggest that the drug resistance genes are plasmid borne.


Relationship between the immune response of sheep and the population dynamics of bacteria isolated from fleecerot lesions. In sheep wetted by rain, proliferation of bacteria in the skin-fleece microenvironment invariably discolours the fleece and causes a dermatitic condition known as fleecerot. The changes in population dynamics of fleece bacteria were analysed by carrying out skin washings at randomly selected sites on the back of sheep before, and at 48 h and 96 h after exposure to rain. Gram-positive rods belonging to Bacillus species (10(2)-10(4) cfu/cm2) predominated in dry fleece. Gram-positive cocci (e.g. Micrococcus and Staphylococcus species) as well as Gram-negative rods (pseudomonads) were also present but in lower abundance (less than 10(2) cfu/cm2). Fleece bacterial populations generally increased in numbers during the first 24-48 h of wetting. By 96 h however, skin washings showed a preponderance of Pseudomonas aeruginosa (10(4)-10(6) cfu/cm2) and to a lesser extent, pigmented Micrococcus species. Growth of fleece bacteria was associated with a characteristic green or yellow/orange staining of fleece. Fewer species of bacteria were isolated from sheep showing green staining while those animals with yellow/orange discolourations appeared to have a more mixed microflora composition. The predominance of P. aeruginosa in the wet fleece of sheep displaying either green or yellow/orange bacterial stain, was accompanied by a significant serological response against this species. Since skin bacteria have never been observed to penetrate cutaneously in skin sections biopsied from fleecerot sites, it must be concluded that the sheep skin is sensitized by continuous exposure to antigens that are associated with or released by P. aeruginosa.


The bactericidal effect of N-acetyl-beta-D-glucosaminidase on bacteria. The bactericidal activity of N-acetyl-beta-D-glucosaminidase (NAGase) on some of the potential bacterial pathogens of the cow was determined. NAGase treatment significantly decreased the mean log10 number of Actinomyces pyogenes (P less than 0.01) and Staphylococcus aureus (P less than 0.05) after 2 and 4 hours of incubation at 37 degrees C. Similarly NAGase treatment significantly (P less than 0.05) reduced the mean log10 number of Streptococcus agalactiae and Pseudomonas aeruginosa after 4 hours incubation at 37 degrees C. NAGase did not reduce the numbers of Escherichia coli or Enterobacter aerogenes after either 2 or 4 hours incubation. Since NAGase and presumably other lysosomal enzymes are free on normal mucosal surfaces such as the uterus it is suggested that this direct bactericidal activity may be an important component of the normal defense mechanisms.


Immunity to Toxocara vitulorum repeated infections in a rabbit model. Eleven rabbits were infected with 10 embryonated eggs of Toxocara vitulorum per g body weight on Days 0, 35 and 72. Embryonated eggs and larvae were enumerated in feces on Days 1-3 after each infection. Two rabbits were killed and larvae were enumerated in small intestine, liver, lungs, skeletal muscles, heart, kidney, brain, eye, uterus, and mammary glands on Days 5, 15, 30, 65 and 101. Serum was obtained on Days 0, 5, 15, 30, 42, 50, 65, 78, 86 and 101 to perform enzyme-linked immunosorbent assays (ELISAs) and Western blots against an extract of embryonated eggs. Between 4 and 10% of the administered parasites, almost all embryonated eggs, were found in the feces after the first or second infection, but 32% (27% of them larvae) after the third. Yields of tissue parasites were 4.1% of the administered dose on Day 5, 2% on Day 15, and 0.8% on Day 30 of the first infection, 0.1% on Day 30 of the second infection, and 0.06% on Day 30 of the third. Larvae were found only in liver, lungs and muscle, including heart. Larva content declined steadily in liver and lungs from Day 5 to 30 of the first infection, was absent in the liver at Day 30 of the second, and in both organs at Day 30 of the third. Muscle larva content increased from Day 15 to 30 of the first infection, and persisted throughout the third infection. Production of IgM antibody was minimal, IgG and the sum of IgMGA antibodies increased slightly or moderately after the first and second infections, but dramatically after the third. Western blots revealed the first antigens (12) by Day 15 of the first infection. Their total number increased with time and number of infections, but some antigens disappeared, whereas new antigens appeared in the course of the observations. Four antigens (32,500-41,000 mol.wt.) may be related to protection. Comparison of the Western blot patterns of two rabbits showed differences in the antigens, recognizable for each rabbit.


Modulation of calf immune responses by Ostertagia ostertagi: the effect of diet during trickle infection. The effects of Ostertagia ostertagi infection and diet on antibody responses to O. ostertagi third stage larval (L3) antigen and to an unrelated antigen, Keyhole Limpet Haemocyanin (KLH) were determined in calves experimentally infected with 3000 L3 on alternate days for 6 weeks. Calves were given one of two diets, and were either infected or not infected with O. ostertagi L3. The diets were either high (H) or low (L) in protein/energy and were within the range of normal husbandry practice in the UK. Both IgG1 and IgG2, but not IgA, responses to L3 antigen were increased in the L-diet compared with the H-diet. IgA responses to L3 antigen were not affected by dietary treatment. The effects of diet and infection on anti-KLH IgG1 were independent of each other; IgG1 anti-KLH responses were decreased by infection and by the L-diet compared with the H-diet. The data suggest that there is a strong interrelationship between diet and immunity during nematode infections.


Phenotyping of lymphocyte subsets in the vascular and epithelial lesions of a cow with malignant catarrhal fever. Surface marker analysis of lymphoid cells infiltrating the vascular and epithelial lesions of a cow with malignant catarrhal fever (MCF) was conducted by immunohistochemistry using ten monoclonal antibodies. The majority of lymphoid cells in these lesions had BoCD8, BoCD6 or BoCD2, but they rarely possessed N-cell (BoCD5+/BoCD4-/BoCD8-, non-T non-B) markers. Similar reactivity was seen in lymphoid cells of perivascular infiltrates in the liver, heart and brain, and in T-dependent areas of lymph nodes. These results suggest involvement of cytotoxic T-lymphocytes in the pathogenesis of MCF.


Flow and image cytometric study of pancreatic neuroendocrine tumours: frequent DNA aneuploidy and an association with the clinical outcome. Eighteen pancreatic neuroendocrine (NE) tumours were analysed for nuclear DNA content by image cytometry (ICM) and flow cytometry (FCM). The DNA indices (DIs) obtained by ICM were somewhat higher than those obtained by FCM, but a major disagreement was present only in 1 case. Thirteen patients had been followed up at least for 6 years after the diagnosis or until death. At 6 years of follow-up all 4 patients with a tumour with a DI greater than or equal to 1.8 by ICM had died from their NE tumour or had metastatic disease, whereas all 9 patients with a smaller DI had no evidence of the disease (P = 0.001). The DIs calculated from the FCM data also correlated well with the final outcome (P = 0.01). A high incidence of DNA aneuploidy was found by both methods in histologically and clinically benign NE tumours; 12 (67%) were DNA aneuploid by FCM and 16 (89%) by ICM. It is concluded that pancreatic NE tumours are frequently DNA aneuploid, and both cytometric DNA methods give prognostic information in these tumours. The presence of DNA aneuploidy should not be considered as a sign of malignant behaviour in pancreatic NE tumours, whereas a large DI is associated with poor prognosis.


Intimal fibrosis (phlebosclerosis) in the saphenous vein of the lower limb: a quantitative analysis. The influence of pre-existing phlebosclerosis on the patency rate of aorto-coronary bypasses is uncertain. To examine this influence, extensive quantitative histological investigations of the intimal thickness of the left saphenous vein were made in 30 cases. In almost all veins the intima was thickened by collagen and elastic fibres as well as by fusiform cells which were assumed to be smooth muscle cells. The innermost layers also contained increased collagen adding to the intimal thickening. Three different methods to measure the intimal thickness were tested morphometrically: planimetric, a four-point method and a so-called method of estimate. The latter is the most time-saving and effective method. The average intimal thickness showed considerable deviations, but the intimal thickness in individual veins did not deviate greatly. As a rule, a specimen with an intimal thickness of less than 100 microns belonged to a vein with mild or moderate intimal thickening, but specimens with an average intimal thickness of 100-250 microns usually derived from a vein with moderate or pronounced intimal fibrosis. However, extreme values allowed a more precise statement to be made. A specimen with a nonsclerotic intima suggested at best a mild intimal fibrosis of the vein in the lower limb, whereas a specimen with marked intimal thickening derived from a vein with severe phlebosclerosis.


Argyrophilic nucleolar organizer region counts in multiple myeloma: a histopathological study on bone marrow trephine biopsies. Argyrophilic nucleolar organizer region (Ag-NOR) analysis was performed on bone marrow biopsies from 90 patients with multiple myeloma (MM) at presentation. The pattern of AgNOR expression and its relationship to histological features were evaluated. The mean AgNOR number per plasma cell was directly correlated with the degree of MM differentiation (3.18 for G1, 4.36 for G2, 6.13 for G3; P less than 0.0001), with the percentage of bone marrow plasma cells (BMPC%) (3.06 for BMPC% less than or equal to 20, 4.28 for BMPC% 21-50, 5.14 for BMPC% greater than 50; P less than 0.0001), with the pattern of medullary involvement (3.63 for interstitial, 4.44 for nodular, 5.17 for diffuse involvement; P less than 0.001) and with medullary fibrosis (5.23 for cases with fibrosis, 4.29 for cases without fibrosis; P less than 0.05). The plasma cells of G1 MM showed 2-3 large AgNORs, tightly grouped in a central nuclear cluster; those of G2 MM showed a central nuclear cluster composed of 4-5 medium-size dots and/or two clusters of 2-3 dots; the G3 MM plasma cells showed many small dots scattered in the nucleolus or dispersed in the nucleus. Our results indicate the diagnostic value of AgNOR analysis in MM and suggest the use of this method for identifying clones of atypical plasma cells with different proliferative activity in bone marrow biopsies. It allows simultaneous evaluation of the morphology and kinetics of MM cells in routinely fixed, decalcified, paraffin-embedded material.


Immunohistochemical evaluation of E-cadherin adhesion molecule expression in human gastric cancer. E-cadherin (ECD) is one of subclasses of the cadherin family which plays a major role in the maintenance of intercellular adhesion in epithelial tissues. An immunohistochemical study of ECD expression was performed on gastric adenocarcinoma from 103 patients using our monoclonal antibody for human ECD (HECD-1). ECD was strongly expressed in normal gastric epithelium without exception; however, various staining patterns were observed in cancer tissues. The frequency of tumours with preserved ECD expression (Pre-type) and reduced ECD expression (Rd-type) was 42% and 58% respectively. Tumours with a high frequency of Rd-type expression particularly included: undifferentiated tumours (85%, 46/54), Borrmann's type 4 (90%, 9/10), tumours larger than 2.6 cm in diameter (65%, 53/81), tumours invading beyond the subserosa layer (78%, 46/59), and tumours with infiltrative growth (87%, 41/47). Furthermore, the frequency of Rd-type expression in cases with peritoneal dissemination (82%, 9/11) or lymph node metastasis (73%, 43/59) was significantly higher than that in cases without dissemination or metastasis. These results suggest that ECD might play a key role in the genesis of histological differentiation, and that the reduction of ECD expression may affect the mode of invasion and metastasis of human gastric cancer cells.


Nodular regenerative hyperplasia of the liver associated with metastases of pancreatic endocrine tumour: report of two autopsy cases. Two autopsy cases with multiple hepatic metastases of pancreatic endocrine tumours and nodular regenerative hyperplasia of the liver (NRH) are reported. The tumour cells were positive for glucagon, insulin, gastrin and vasoactive intestinal polypeptide immunohistochemically and the serum gastrin was elevated in one case. In the other, tumour cells were positive for insulin. Controls failed to show NRH in the non-metastatic part of 35 autopsies of livers with multiple hepatic metastases. A combination of hepatotrophic hormonal factor(s) and disturbed hepatic circulation associated with hepatic metastases may be important in the development of NRH.


Fibrosarcoma in association with a total knee joint prosthesis. A case of fibrosarcoma of the proximal tibia, arising at the site of a cemented Richards total knee joint replacement with cobalt chrome alloy is reported. The patient, an 80-year-old man, received the endoprosthesis because of osteoarthritis of the knee 4 years ago. The literature on malignant tumours occurring in association with endoprostheses is summarized and briefly discussed.


Immunohistological detection of tissue factor in normal and abnormal human mammary glands using monoclonal antibodies. Tissue factor (TF) is the primary cell-bound initiator of the coagulation protease cascade. The cytological distribution of TF in various tissues may be described on the basis of immunohistochemistry with epitope-defined monoclonal antibodies and the extravascular distribution of TF apparently represents a haemostatic envelope ready to activate coagulation when vascular integrity is disrupted. The present study localized TF in human breast cancer tissues when compared with normal breast gland tissues and benign disorders of the mammary gland. By use of a cocktail of three epitope-defined monoclonal antibodies, TF was detected only in the myoepithelia of the resting breast gland. In proliferating disorders like fibrocystic disease or in fibroadenomas, both myoepithelia and luminal epithelia showed TF expression. Of 115 breast cancers 93 reacted with anti-TF, in an inhomogeneous manner in terms of intensity and number of positive cells. There was a tendency for more positive and intensely stained cells to be found in well-differentiated structures such as tubules. Invasive ductal carcinomas exhibiting more positive and more strongly stained cells were less commonly metastatic to lymph nodes when compared with the tumours with no detectable or very low TF immunostaining. A semi-quantitatively recorded score of TF immunostaining correlated with the procoagulatory activity measured (7 fibroadenomas and 24 carcinomas). The results of this study suggest that proliferation and differentiation of the mammary gland is associated with enhanced TF expression in the epithelia which are negative for TF staining in the resting gland. Malignant growth is characterized by randomly expressed epithelial TF, which expression is enhanced and more frequent in well-differentiated tumour cells.


Carcinoma-associated perisinusoidal laminin may signal tumour cell metastasis to the liver. The perisinusoidal space of the liver shows extensive modulation of the extracellular matrix in response to various pathological conditions. We studied perisinusoidal laminin expression immunohistochemically using polyclonal and monoclonal antibodies in 110 human liver specimens obtained at autopsy. In normal adult liver the perisinusoidal spaces contained only minimal amounts of immunoreactive laminin. In 86% of patients dying from cancer with liver metastasis, however, a distinct increase in the amount of perisinusoidal laminin could be demonstrated. The perisinusoidal space also contained laminin in cancer patients without liver metastasis. In 3 cases of leukaemia sinusoids were laminin negative. In cirrhosis and chronic passive congestion there was, as expected, laminin immunoreactivity in the perisinusoidal space. The results obtained using polyclonal antibodies against laminin were confirmed using chain-specific monoclonal antibodies against B2 laminin. In an ex vivo assay, viable tumour cells (Panc-1 and clone A) were found to bind with remarkable specificity to frozen sections of liver tissue containing perisinusoidal laminin as opposed to liver tissues without laminin. We suggest that this perisinusoidal laminin may directly on indirectly mediate tumour cell metastasis to the liver.


[Non-enzymatic glycosylation of dietary proteins by glucose and fructose]. Preliminary evaluation of glucose and fructose as glycosylation agents of some animal and vegetable food proteins has been presented. The study was conducted using the method of radioactive indicators. It has been shown that fructose binds proteins to a higher degree than glucose, and it can make for increasing glucose glycosylating activity in their combination in the product.


[Effects of polyunsaturated fatty acids in the ration on the structure of peripheral lymphoid organs, immunological parameters and nonspecific resistance of rats]. It has been established that the fatty component of the ration, with the rest ingredients being unchanged, alters the immunologic status of the body. When fatty portion of the ration was substituted for sunflower oil (omega 6) active macrophage-plasmocytic reaction in the lymphoid organs, elevation of the humoral immunity parameters and suppression of the T-cell system were recorded. The reaction to immunization was less pronounced when equal ratios of sunflower and ichtyenic oils were used. When the fatty component of the ration was completely substituted for ichtyenic oil, a decrease in T-lymphocyte number and focal necrotic changes in the lymphoid organs were observed. The fatty component of the rations used produced no significant effect on the bactericidal activity of the blood serum.


[Effects of pectin in the ration on cholesterol metabolism in rats]. Inclusion into the ration of 2.5 or 5% of apple pectin during 20 days did not significantly change the blood serum composition: cholesterol content decreased as compared to the control, the number of general bile acids increased. When apple pectin was added to the animals' ration containing egg powder, the amount of cholesterol excreted with feces increased depending on pectin content in the food.


[Effects of polyunsaturated fatty acids on Krebs cycle in the rat kidney in chronic phosphorus intoxication]. The investigation of Krebs cycle state in kidney homogenates of August rats subjected to oral intoxication with oil solution of yellow phosphorus in a dose of 0.3 mg/kg, has shown that under conditions of balanced nutrition the activity of NAD-dependent isocitrate dehydrogenase, succinate dehydrogenase and accumulation of the substrate fund of the cycle decreased 3.5-fold as compared to the control. The addition of polyunsaturated fatty acids to the ration produced a positive effect on Krebs cycle state: dehydrogenase activity was not significantly changed, accumulation of Krebs cycle substrate was two-fold lower. However, this ration did not completely abolish the toxic action of yellow phosphorus on Krebs cycle.


[A comparative study of the effects of vegetable oils and cholesterol on enzymes of the mouth and jejunal mucosae]. The influence of sunflower and olive oils and their combination with cholesterol on the activity of lysosomal hydrolases and lipid peroxidation (LPO) in the mucosa of the mouth and jejunum was studied. It was shown that in the presence of cholesterol in the oral mucosa the activity of N-acetylhexosaminidase increased and there was a tendency to decreasing cathepsin D and acetyl esterase activity, and LPO processes were found to be suppressed. Cathepsin D and B activities in the jejunum mucosa increased in response to cholesterol administration. The changes revealed in the activities of N-acetylhexosaminidase, proteinase, acetyl esterase, catalase and glutathione peroxidase in the oral mucosa, as well as cathepsins in the jejunum depend on the character of lipid additives.


[Adaptation of rats to unusual protein products during transition to definitive nutrition]. The authors studied the adaptation of initial and final links of the proteolytic chain, and intermediate nitrogen metabolism, to unusual products--protein concentrate from yeast-saccharomyces and anchovy. A number of enzymes in the organs-producers were found to be activated due to intensification of a limited proteolytic reaction. It was established that the changes in the functioning of the proteolytic stage of the digestive-transport conveyor led to shifts in the amino-acid pool in the blood serum of experimental animals.


[Prospects of the use of beta-carotene enriched food products in the prevention and therapy of radiation injuries]. Radio-protective effectiveness of short-term (19 and 4 h before, 4 and 24 h after irradiation), long-term (3 times/week during 30 days after irradiation) and delayed (1 or 2 days after irradiation) enrichment with crystallized beta-carotene, in single doses of 0.1, 1.0 or 5.0 mg was evaluated in experimental acute external gamma-irradiation (0.029 Gy/sec) within the range of absorbed doses 9--6 Gy. The results obtained have permitted the authors to recommend the ration enriched with carotinoid for prevention and therapy of acute radiation injuries.


[Nutritional and vitamin status of preschool children]. The actual nutrition of children in nurseries taking into account the losses of food substances during food cooking and realization is inadequate to the current physiological standards for all food substances, especially, with respect to vitamins and mineral elements. This inadequacy has been proved by the laboratory and clinical parameters of vitamin status of children. In the winter-summer period when vitamin deficiency in the rations is most pronounced, deviations in the content of vitamins and their metabolites in the blood and urine, as well as the incidence of hypovitaminosis symptoms in children are more frequently recorded and in the most pronounced form.


[A comparative study of vitamin status of children 5-6 years of age in different children's institutions]. A total of 205 children were under observation (48 children aged 1.5-3 years in a Baby's Home--spring, 1987; 85 children aged 3-6 years in nurseries with 24-hour stay--spring, 1987; 77 children aged 3-6 years in a Children's Home--spring, 1989). As a result of nutrition reorganization in these institutions vitamin consumption increased due to a more rational selection of food products and the vitamin status of children improved. This was more expressed in vitamin excretion levels, than in the incidence rate of microsymptoms of vitamin deficiency. Additional vitaminization with multivitamin compounds is necessary to eliminate vitamin deficiency in preschool children of isolated institutions.


[Dynamics of mental and physical capacities of Moscow's schoolchildren administered vitamins]. Mental and physical capacities were studied in schoolchildren aged 6-10, 11-13 and 14-17 years in the autumn-spring period during vitamin administration of "Undevitum". The six-month vitamin administration produced a positive effect on the functional state of the schoolchildren that was expressed in the improvement of their mental and physical capacity parameters.


[Evaluation of the effectiveness of prophylactic vitamin administration to school children in Moscow]. The influence of prophylactic vitamin administration to schoolchildren in Moscow was studied basing on the parameters of their providing with vitamins, physical development and health. It was established that as a result of prophylactic vitamin administration of "Undevitum" during 6 months the morbidity rate (especially, of acute respiratory diseases) decreased that produced a definite economic effect. The prophylactic vitamin administration to schoolchildren in the winter-spring period has been recommended.


[Effects of prophylactic vitamin administration to Tallin's schoolchildren on their health and physical development]. Data are presented on the influence of prophylactic vitamin administration to schoolchildren in two schools on their health. The morbidity rate significantly decreased, the levels of lysozyme in the saliva, hemoglobin in the blood and total protein in the blood serum rose in the children who received multivitamin "Undevitum" during 5-7 months, as compared to those who were not given the vitamins. Vitamin administration did not influence the physical development of schoolchildren.


Giant cell tumor of the small bones of the hands and feet: metatarsal giant cell tumor. Giant cell tumors (GCTs) of the small bones of the hands and feet are very rare. The prevalence of hand involvement is 5.8 percent and of the feet is 3.6 percent. When GCTs occur in these locations, they appear to represent a distinctive more aggressive form of tumor. They occur more often in a younger patient population, are more commonly multifocal, and are associated with higher risks for local recurrence and pulmonary metastasis. This article presents a rare case of GCT of the metatarsal bone and discusses the presentation, distinctive characteristics and treatment of this tumor when it occurs in these locations.


Treatment of giant intracranial aneurysm with carotid ligation, saphenous vein bypass graft. Giant intracranial aneurysms pose difficult problems for neurosurgeons. This article describes the technique of extracranial-intracranial saphenous vein bypass graft and carotid artery ligation as treatment to remove a giant intracranial aneurysm.


Exercise testing for the primary care physician. In the primary care setting, exercise testing is frequently used to evaluate patients with known or suspected coronary artery disease. Appropriate utilization requires knowledge of the indications as well as the contraindications and interpretation of the variables generated by the test. While ST segment changes are widely regarded as the most important variable generated by the exercise test, other variables including ventricular arrhythmias, blood pressure response, ischemic symptoms, workload, and exercise capacity are also important and useful in interpretation. Consideration of the question being addressed, the clinical context, and the test adequacy are all important for proper interpretation. Interpretation concerning both diagnostic and prognostic questions should employ principles of both the categorical and probability approaches.


[Biochemical indicators of vitamin provision to Orenburg's schoolchildren and effectiveness of prophylactic vitamin administration]. The study of providing with vitamins of schoolchildren in Orenburg conducted in the spring of 1985-1986 has revealed decreased content of ascorbic acid in 92%, vitamin E in 62%, vitamin A in 39%, folic acid in 38%, vitamin B12 in 14% of the children, the incidence rate of vitamin deficiency among the children in the senior forms was higher as compared to that in the junior forms and in boys it was more frequent than in girls. Additional intake of multivitamin "Undevitum" by schoolchildren during 2-4 months led to a significant improvement of their providing with vitamins that was expressed in normal vitamin levels and elimination of cases of deep vitamin deficiency.


[Effects of prophylactic vitamin administration of physical fitness of schoolchildren in the Arctic Regions]. The effectiveness of prophylactic vitamin administration to schoolchildren in the Arctic region was evaluated in the biochemical investigation of schoolchildren by the assay of vitamins C, A, E, B1, B2, B6, B12 and folic acid in their blood serum before and after "Undevitum" intake. Deficiency of a number of vitamins was detected. It was shown that regular consumption of multivitamin "Undevitum" produced a positive effect on the parameters of their physical activity, the highest effect was observed in children with the normotensive reaction to loading, and it was less expressed in those with pathological hemodynamic reactions to the loading.


[Effects of the preparation Undevit on the indicators of vitamin provision of Norilsk's schoolchildren]. The effect of the prophylactic use of multivitamin "Undevitum" on parameters of vitamin providing of schoolchildren in Norilsk was studied. The results of the investigation showed a positive effect of the prophylactic vitamin administration on providing with vitamins of schoolchildren in Norilsk and proved the necessity of conducting mass vitamin administration to schoolchildren.


[Experiences with total parathyroidectomy and autotransplantation of intraoperatively selected parathyroid tissue in reactive renal hyperparathyroidism]. Surgery is indicated in cases of therapy-resistant reactive renal hyperparathyroidism with clinical symptoms and signs. The method of choice is total parathyroidectomy, with autotransplantation of parathyroid tissue into the forearm musculature. Twenty-two patients were parathyroidectomized. In 19 cases the intraoperative selection of tissue for autotransplantation was made by means of a stereoscopic magnifying glass. With one exception, only fragments of type 1a glands and type 1a-like areas obtained from type 2 glands were transplanted. In 18 of the 22 cases parathyroid hormone levels decreased from 1131 +/- 657 preoperatively to 87 +/- 53 pg/ml postoperatively. In 4 patients with postoperative values over 200 pg/ml a transplant-related recurrence of hyperparathyroidism or a remaining 5th gland in the cervical region was suspected. In all 22 patients serum calcium, as well as alkaline phosphatase levels returned to normal and the clinical signs of hyperparathyroidism disappeared.


[Providing with vitamins of river transport workers of the Western and Eastern Siberia and oil men of the Tyumen Region]. The investigation of providing with vitamins of river transport workers in Western and Eastern Siberia and of oil men in the Tyumen Region conducted in the summer period of 1984-1986 has revealed significant deficiencies of vitamins C, E, B1, B2, B6, A and carotene in them. Vitamin administration to the workers with "Undevitum" resulted in a significant improvement of their vitamin status that was expressed in elevation of their biochemical parameters and in diminution of the percentage of subjects with vitamin deficiencies.


[Technique of recurrent laryngeal nerve exposure within the scope of interventions of the thyroid gland]. In anatomical preparations performed during autopsy we developed a well-defined approach for the identification of the recurrent laryngeal nerve during surgery on the thyroid gland. The principle of this concept is to visualize the nerve near the branching of the inferior thyroid artery, where it shows a 30 degree angle to the trachea in a direction running from caudal lateral to cranial medial and lies in front of, behind, or between the branches of the artery. This preparation mode has been prospectively performed in 100 patients undergoing thyroid surgery. In 159 (= 97.6%) sides of the neck out of 163 we identified the nerve at the typical site. The topographical relation of the recurrent nerve to the inferior thyroid artery revealed the following differences for the right and left side of the neck: On the right side the nerve was found to be behind in 48%, in front in 33% and between the branches of the artery in 15% of cases. In contrast, on the left side the nerve was found to be dorsal in 53%, ventral in 23% and between the branches in 23%. Of 163 nerves at risk we observed primary nerve palsy in 2 cases (1.2%), and a definitive palsy rate of 0.6% at the 3-month follow-up. In conclusion, we recommend the described approach for the identification of the recurrent laryngeal nerve during thyroid surgery whenever complete mobilisation of the thyroid lobe (e.g. thyroidectomy, lobectomy, resection of retrotracheal adenomas) is necessary.


[Providing with vitamins of different population groups in Sverdlovsk]. The investigation on providing with vitamins of varying population groups: preschool children, schoolchildren, students of trade schools and higher schools, workers and employees was conducted in Sverdlovsk. Low levels of vitamin C were detected in the blood of 40-92%, folic acid--in 10-76%, vitamin A--in 4-28%, carotene--in 8-60%, tocopherol--in 4-50% of the examinees. Vitamin B1 deficiency was noted in 36-68%, vitamin B2--in 17-71%. The highest deficiency of ascorbic acid was recorded in workers and students of trade schools and higher schools, of folic acid--in workers and adolescents of 15-18 years, of vitamins B1, E, A and carotene--in children and adolescents, vitamin B1--in employees. The mass character of vitamin deficiencies and their negative effects on the health of the population have necessitated broad-scale prophylactic measures: production of vitamin-enriched foods, regular use of multivitamins.


[Laparoastoma (open packing) in the treatment concept of infected pancreatic necroses]. Out of 284 patients with acute pancreatitis 73 (26%) had pancreas necrosis. Of these 73 cases 43 patients with infected pancreas necrosis were treated surgically, whereas conservative treatment proved successful in the remaining 30 cases with so-called sterile necrosis. Our interdisciplinary treatment combined delayed surgery for the better demarcation of the necrotic tissue, with extended intensive care therapy and epigastral laparostomy; through this laparostomy surgical revision with necrosectomy and peritoneal lavage was performed daily for 15 (+/- 6) days, necessitating long-term artificial respiration for an average of 15 (4/168) days. The mortality rate in the 43 patients with infected pancreas necrosis amounted to 16.2% (n = 7); none of the patients with sterile necrosis died. In cases of multiple organ failure the mortality rate was significantly higher (30%) than with failure of only one organ system (4.3%). The mortality rate in all cases with pancreas necrosis (n = 73) amounted therefore to 9.5%. Serious complications of laparostomy occurred in 28% (n = 12) of the 43 patients, whereby 8 of these cases were gastrointestinal fistulae, with a fatal outcome in one patient. The overall mortality rate in the total group of 284 patients with acute pancreatitis was 2.8%.


[A combined endoscopic surgical treatment concept in acute biliary pancreatitis]. This paper presents the results of a combined endoscopic-surgical approach with management of acute biliary pancreatitis in 91 patients. The diagnosis was always made by means of endoscopic-retrograde cholangiography. Papillary or bile duct stones, or unmistakable signs of previous stone passage, and in exceptional cases flow obstruction due to preiampullary diverticuli were considered criteria for a positive diagnosis. All 91 patients were subjected to endoscopic sphincterotomy with/without stone extraction subsequent to the diagnostic cholangiogram. Endoscopic intervention was performed as soon as possible after admission to hospital, but by 48 hours at the latest. Cholecystectomy was carried out in all patients who were free of risk factors and without previous cholecystectomy, during the disease-free interval. The complication rate of this combined endoscopic-surgical approach amounted to 10.9%; the mortality rate was 3.3%. The achieved results suggest that endoscopic sphincterotomy with stone extraction in the acute phase of biliary pancreatitis is the method of choice in order to interrupt the process of this disease. In combination with the final surgical treatment of gallstone disease by cholecystectomy to avoid recurrences, the prognosis of acute biliary pancreatitis can be significantly improved by using this combined endoscopic-surgical management.


[Reconstruction-plasty of iatrogenic choledochal stenoses using human pericardium. An experimental study in the domestic pig]. The effect of human pericardial patch plastic for reconstruction of iatrogenic common bile duct stenosis was investigated in experiments performed in pigs. All patches (n = 8) were overgrown with immature biliary epithelium detectable on light and electron microscopy within 6 weeks. No restenosis nor any fistula developed during this observation period. Liver function tests, especially bilirubin, were not suitable parameters for the detection of biliary obstruction (preoperative value 0.38 +/- 0.09 mg/dl; 1 week after subtotal stenosis 3.36 +/- 1.53 mg/dl; 2 weeks after subtotal stenosis 1.49 +/- 0.62 mg/dl; 3 weeks after subtotal stenosis 0.50 +/- 0.27 mg/dl; 6 weeks after pericardial patch plastic 0.33 +/- 0.05 mg/dl, mean +/- SD. Ultrasonographic measurement of the common bile duct diameter was the diagnostic method of choice. Preoperative dimension 4.5 +/- 0.5 mm; 1 week after subtotal stenosis 8.5 +/- 2.0 mm; 2 weeks after subtotal stenosis 10.5 +/- 1.8 mm; 3 weeks after subtotal stenosis 14.0 +/- 3.6 mm; 6 weeks after pericardial patch plastic 9.0 +/- 1.6 mm, mean +/- SD.


[Extracorporeal shock wave treatment of calcium containing gallbladder calculi]. A total of 50 patients--37 female and 13 male--with an average age of 50 +/- 27 years (23-86 years), suffering from rim-calcified gallbladder stones, underwent extracorporeal shock-wave lithotripsy (ESWL), using an ultrasound-guided overhead module of Lithostar Plus (Siemens Company). The total number of stones was 87, with an average diameter of 16 +/- 7 (7-38) mm. 29 patients had a solitary stone, 13 had two and 8 patients three or more stones. All patients received adjunct medication of 10 mg/kg body weight chenodeoxycholic and ursodeoxycholic acid 14 days prior to ESWL as a single bedtime dose. An average number of 5,300 +/- 2,200 shock waves (1,200-15,000) was applied for stone disintegration. The corresponding energy amounted to 750 bar. 29 patients needed one, 21 two or more treatments. After ESWL a variety of clinical abnormalities was observed: flank pain (15%), transient microhaematuria (33%) and transient macrohaematuria (2%). Subsequent to ESWL 5 patients suffered from complications such as biliary obstruction 3 weeks to 9 months after treatment and had to undergo ERCP. Three times endoscopic papillotomy was performed to remove stones from the common bile duct. Up to now 4 patients have undergone cholecystectomy: acute cholecystitis (n = 3), recurrent colicky pain (n = 1). 20 patients have been followed up over a 12-month period; 12 of them are completely free of stones and fragments.


[Autotransplantation of the spleen in rats: development, function and cytokine expression in intra-omental and subcutaneous regeneration]. The implantation of splenic tissue at different implantation sites (intraomental and subcutaneous) into one animal (Lewis rats) results in the development of splenic nodules at both sites. In a quantitative immunohistological analysis of splenic compartments such as red pulp (RP), periarteriolar lymphoid sheaths (PALS), marginal zone (MZ) and follicles (F) the T-cell reduction was related to the T(helper) cells in the MZ and T(supp/cyt) cells in the PALS. In contrast, the cell density of B cells and ED-1+ macrophages in the PALS and T(supp/cyt) cells in the MZ was increased. Significant differences between the implantation sites were restricted to CD5+ cells (thymocytes and T cells) in the MZ and OX-33+ cells (B cells with LCAB antigen) in the PALS. The reorganisation of the compartments of subcutaneous implants showed a delay of one week as compared with omental ones. Functional assays like haemolytic plaque assay, mitogen stimulation and mixed lymphocyte assay elicited an analogous delay of the functional maturation of IgM-positive B cells, a reduced proliferation of both transplant groups after pokeweed mitogen (PWM) stimulation, a decreased response after lipopolysaccharide (LPS) stimulation in solely subcutaneous replants and no differences concerning the mitogens concanavalin A (ConA) and phytohaemagglutinin (PHA). Both transplant groups showed a significantly reduced allogeneic response. The results of the functional analysis and the abnormal mRNA expression of Il-5, Il-6 (Interleukin 5 and 6), GMCSF (Granulocyte-Macrophage-Colony-Stimulation-Factor) and IFN-gamma (Interferon gamma) in subcutaneous replants indicate subtle molecular alterations (independent of a spleen-like immunoarchitecture) at this site.(ABSTRACT TRUNCATED AT 250 WORDS)


[Effects of surgical therapy of extreme obesity on physical and psychological outcome]. More than 400 patients with morbid obesity were treated surgically in our unit over the past 18 years. Three different methods (intestinal bypass, bilio-intestinal shunt and vertical banded gastroplasty) were used. In order to assess any postoperative increase in life quality and to compare the three different techniques, 25 matched patients from each group were followed up and the findings compared with a group of non-operated morbidly obese persons. Psychological tests were also supplied. Irrespective of the technique performed a significant increase in quality of life was obtained in 75% of the cases.


[Prevention and treatment of postoperative fistulae--new indications for fibrin gluing]. The additional sealing of bronchial and gastrointestinal sutures and anastomoses, respectively, by means of fibrin sealant helped to significantly reduce the postoperative dehiscence rate; this rate amounted to 3.6% for additionally sealed bronchus stump occlusions and to 4.2% in gastrointestinal operations, whereby naturally in emergency abdominal operations the rate was higher (7.7%) than in elective surgery (3.8%). Eight postoperative bronchus stump fistulae and eleven out of the twenty-five gastrointestinal anastomotic dehiscences could be closed using a fibrin clot. Furthermore, fibrin occlusion of the pancreatic duct following Whipple's operation for the protection of the pancreatic-digestive anastomosis (n = 67) has turned out to be a success, since no postoperative pancreatic fistulae occurred, which resulted in the very low mortality rate of 1.5%. One more indication for fibrin sealing was the prevention of postoperative lymph fistulae by additional wound sealing (n = 123) and the fibrin occlusion of these fistulae (n = 18); the postoperative lymph fistulae rate amounted to only 3.3%. All 4 cases, as well as 14 other cases of existing lymph fistulae were healed quickly by instillation of fibrin. These relatively new, partly endoscopic, procedures using fibrin sealing proved to be very successful, because on the one hand postoperative fistulae could be largely avoided and on the other hand they could be treated without further operation.


[RU 486--death hides behind this formula]. Today we are faced with a new abortion method: until the 49th day of pregnancy a pregnant woman will loose her child as a consequence of an artificial miscarriage by taking the hormone drug RU 486. It opens a new perspective as a new contraceptive method, an abortion method and a new possibility for family planning in Third World Countries. This pill has been developed and produced by the French chemical company Roussel-Uclaf and is available in France, Great Britain and China. Permission to operate on the German market hinges on 3 conditions: that there is new abortion legislation in Germany, the exclusion of misuse is guaranteed and a representative group requires the application.


[Ethical controversy surrounding RU 486: data and arguments]. By RU 486 being synthesized (1980) a pharmacological alternative to surgical methods of abortion has been created. Since 1988 Mifepristone is applied for termination of pregnancies under severe control. Major pros and cons in debates about RU 486 in medical publications are analyzed, their relations to central ethical principles being worked out clearly. As consequences of the analysis of arguments the authors formulate four conditions for the use of Mifepristone as method of abortion which should be considered in further research and practice.


[Mifepristone (RU 486)].

[Mifepristone (RU 486)]. The antiprogestin RU 486 converts the early pregnant uterus by increasing the sensitivity of the myometrium to prostaglandin (PG). These effects of antiprogestin have resulted in the development of nonsurgical procedures to abort embryos based on a combination of RU 486 and different PG-analogues administered vaginally or intramuscularly. RU 486 also has a softening effect on the cervix which may be used as pretreatment in second and third trimester abortions. The effects, mode of action, dangers, and the many other postulated clinical implications (like breast cancer, meningioma, ectopic pregnancy, fetal death in utero, induction of labour, initiation and promotion of lactation, endometrial or ovarian cancers, leukemia, Cushing's syndrome, uterine adenomyosis, acute uremia, leiomyosarcoma, hypertension, etc.) are discussed.


[Long-term therapy of immune neutropenia with high-dose 7S immunoglobulin in a child]. A 15 month old girl with suspected immune neutropenia was treated with high dose immunoglobulin because of recurrent infections over a period of 9 months. Before therapy her neutrophil counts were below 0.5 G/l. With monthly intravenous immunoglobulin her neutrophils remained above 0.5 G/l with one exception. Even after 9 months the patient responded well to therapy, she did not experience new episodes of infections. We suggest that in case of recurrent infections high dose immunoglobulin therapy should be considered in patients with immune neutropenia before the occurrence of life threatening infections.


[Placebo forte: contribution to the demystification of a therapy principle]. Placebo effects are an important component in the success of any therapy. Several forms of placebos exist. Their effects are due to phenomena some of which are difficult to define. They comprise changes in subjective as well as objective variables. Thus they exceed the frequently cited "suggestion". The discriminative use of placebos in therapy can be helpful.


[Ultima ratio in the treatment of the terminal form of eclampsia in puerperium]. The described Novocaine blockade of the ganglia in the sympathetic chain which control renal vascular function has closed the fatal gap in the treatment of terminal eclampsia of pregnancy, which has existed up to now. By removing the inhibition of renal function, toxic substances are excreted, thus resolving the vicious circle of generalized vascular spasm, hypertension, and decreased blood supply to the brain, kidneys, liver, and optic fundus.


[24-hour blood pressure measurement in normal children and adolescents]. Blood pressure was continuously monitored over 24 h in 33 healthy children and adolescents (18 girls, 15 boys, age 6-17 years) using a portable monitor. The results were compared with European blood pressure centiles for normal children and adolescents. On average, 67% (57-88%, median and quartiles) of the measurements were completed. The day's mean for systolic blood pressure for girls was 0.04 (-0.67-1.00) standard deviations above the mean of the reference group with corresponding body-height, and for diastolic blood pressure, 1.08 (0.50-1.63) standard deviations. The corresponding values for boys were 0.42 (0.09-0.45) for systolic and 1.11 (1.00-1.39) for diastolic blood pressure. Mean systolic blood pressure for girls decreased during the night by 10% (5-13%) compared to the day time measurements, and the diastolic blood pressure decreased overnight by 23% (12-28%). Systolic blood pressure for boys decreased overnight by 8% (6-11.5%), and diastolic blood pressure decreased by 15% (12-19%).


[Rhythm analysis of individual 24-hour blood pressure profiles of patients with essential hypertension]. Circadian rhythms in ambulatory blood pressure profiles of eight primary hypertensive patients were analyzed by nonlinear fit of a combined cosine function. Significant circadian variation in systolic blood pressure was found in each patient, and in diastolic blood pressure in seven out of eight patients. The eight primary hypertensive subjects revealed typical circadian blood-pressure profiles with two daytime maxima and a single nighttime minimum. Whereas daytime maxima differed between the subjects, all nighttime minima occurred within a narrow range of 1:54 a.m. to 4:42 a.m. The PHARMFIT-program allows to analyze in more detail the circadian blood pressure profiles obtained by ABPM in single patients as well as in a group of hypertensives.


[Disordered 24-hour blood pressure rhythm in normotensive and hypertensive asthma patients]. Asthmatic patients typically show a nocturnal increase in bronchial obstruction. In 100 asthmatic patients, we investigated if there is also a reduced decline of blood pressure; we used 24-h blood-pressure monitoring. The whole group consisted of 50 hypertensive asthmatic patients (group 1, 48.8 +/- 11 years, 30 females, 20 males), 25 normotensive asthmatic patients (group 2, 49.6 +/- 10 years, 22 females, 3 males) and 25 antihypertensive-treated asthmatic patients (group 3, 50.2 +/- 8 years, 15 females, 10 males). 52% of group 1, 52% of group 2, and 44% of group 3 patients showed no sufficient nocturnal systolic and diastolic blood pressure decline (less than - 15%). When we looked only for systolic blood pressure that was also the case in 82%, 92%, and 64% of the patient groups', respectively. There was no significant difference in daytime blood pressure between hypertensives (group 1) without (142 +/- 9/93 +/- 5 mmHg) and with 142 +/- 12/92 +/- 6 mmHg) sufficient nocturnal blood pressure decline, however, nighttime blood pressure (135 +/- 14/84 +/- 5 mmHg versus 123 +/- 14/72 +/- 6 mmHg) was significantly (p less than 0.0001) different. This was also true for the normotensive asthmatic patients (group 2). The results cannot be explained by differences in heart rate, degree of asthma, or in anti-obstructive medication.


[Ambulatory 24-hour blood pressure monitoring of children and young adults with autosome dominant polycystic kidney degeneration]. Autosomal dominant polycystic kidney disease (ADPKD) is the most frequent inherited kidney disorder leading to terminal renal failure. About 8% of the dialysis patients suffer from ADPKD, the gene frequency in the general population being about 1:1000. Many facts contribute to the hypothesis that arterial hypertension plays a major role in the pathophysiology of ADPKD. We observed a prevalence of 30% of hypertension in patients with ADPKD and normal serum-creatinine, and of 80% in patients with terminal renal failure. The time of onset of abnormalities of blood pressure regulation is of great interest, since an increase of blood pressure, even in the normotensive range, accelerates the rate of progression. To answer this question, we examined the time of onset of abnormalities in blood-pressure regulation in 23 probands and 23 control patients in a cross-sectional study. The results document abnormal circadian blood-pressure changes and higher blood pressures, although still within the normotensive range, in asymptomatic carriers of the ADPKD-trait, even before and more definitely after onset of puberty. Even at an age when circadian blood pressure is not significantly different, there is an increased LVM as evidence of target organ damage. The findings suggest that (intermittent) increases in blood pressure and blood-pressure-dependent target organ damage precede overt hypertension and renal failure by years or decades.


[24-hour blood pressure measurement in children and adults with type I diabetes mellitus: relation to duration of diabetes, obesity, albuminuria]. Early antihypertensive therapy in patients with diabetes mellitus reduces cardiovascular risk and improves long-term prognosis. Therefore, mildly hypertensive patients have to be discriminated from patients with "white coat" hypertension. 24-h-blood pressure profiles were recorded in 153 patients (age 7.9-26 years, duration of diabetes 0-21 years). The fraction of elevated blood pressure readings allows to classify these profiles independent of the age of the patient. This parameter was not related to either duration of diabetes or nocturnal excretion of albumin. In contrast, blood pressure correlated significantly with age- und sex-adjusted weight (z-score). Among 38 patients with elevated blood pressure recordings during outpatient visits, 24 (63%) displayed a normal 24-h-profile (less than 30% of blood pressure values are above the 95% limit for the respective age). These data indicate that hypertension might be independent of the metabolic derangement during the first years of diabetes.


[The value of noninvasive 24-hour blood pressure measurement in patients with renoparenchymal, renovascular or severe essential hypertension]. 210 patients receiving antihypertensive treatment underwent non-invasive ambulatory blood-pressure monitoring for the first time. 44 suffered from chronic renal failure, 51 had been renal transplanted, 36 had chronic glomerulonephritis, 36 had renovascular hypertension, and 43 had essential hypertension with severe end-organ damage. We analyzed the Circadian rhythm and the rate of insufficient antihypertensive treatment. While mean daytime systolic and diastolic blood pressure were not different between groups, patients with chronic renal failure, renal transplant or glomerulonephritis showed a very high rate (95-72%) of absent nighttime blood-pressure reduction. In patients with renovascular hypertension or complicated essential hypertension there was a lower rate (69-40%) of absent nighttime blood pressure reduction. The ambulatory blood-pressure monitoring led to a modification of antihypertensive treatment in 78% of patients because of nighttime hypertension. We think that ambulatory blood-pressure monitoring is an essential tool for physicians treating patients with renal disease or complicated essential hypertension.


[Circadian blood pressure rhythm in hyperthyroidism and primary hyperparathyroidism]. Some secondary forms of hypertension are characterized by an abnormal circadian blood-pressure rhythm. Therefore, the circadian blood-pressure variability was investigated in a prospective study using ambulatory blood-pressure monitoring in patients with hyperthyroidism and in patients with primary hyperparathyroidism. Both endocrine disorders are often associated with hypertension. Out of 17 patients with hyperthyroidism 73% were hypertensive, and out of 15 patients with hyperparathyroidism 80% were hypertensive. The blood-pressure profiles were compared to profiles from controls comprising normotensive subjects and patients with essential hypertension. The patients with hyperthyroidism and hypertension had a blunted circadian blood-pressure curve with only a small nocturnal reduction of systolic and diastolic blood pressure as compared to control patients. In patients with hyperthyroidism and normal blood pressure, the circadian blood-pressure rhythm was normal; however, in these patients the circadian heart-rate curve was blunted. All patients with hyperparathyroidism (with and without hypertension) had a normal circadian blood pressure and heart-rate rhythm. From these observations we conclude that in hyperthyroidism the circadian regulation of blood pressure or heart rate is significantly blunted. The circadian blood pressure and heart-rate curve is normal in primary hyperparathyroidism.


[Blood pressure variability and transient myocardial ischemia in patients with essential hypertension]. To determine whether myocardial ischemia is accompanied by variation in heart rate and/or blood pressure, ST-segment analysis on Holter-ECG and ambulatory blood pressure monitoring was performed in 78 patients (64 males/14 females) with essential hypertension. Thirteen out of 55 patients (24%) with angiographically proven coronary artery disease (CAD) showed ST-segment depression (ST-D; group A pos). We observed 41 ST-D (1-11 ST-D; median: 2) lasting from 1 min to 70 min 15 s (median: 4 min 42 s) and an average depression of 185 +/- 48 mV. In comparison, in 6 of 23 patients (26%) with a normal angiogram 24 ST-D (1-10; median: 3; group B pos), which showed longer duration (1 min to 109 min 20 s; median: 11 min 10 s) and less depression (137 +/- 47 mV) have been found. 73.3% of all ST-D in group A pos and all in group B pos were preceded by an average increase in heart rate of 13 bpm. Exclusively, 12 episodes of ischemia (29.3%) in patients with CAD and 8 (33.3%) in patients without CAD were accompanied by an increase in blood pressure, which was more distinct in group A pos. Transient myocardial ischemia can be shown in hypertensive heart disease unrelated to CAD. A clear correlation between an increase in blood pressure and ST-D could not be proven.


[Analysis of circadian blood pressure profiles using Fourier analysis]. Blood pressure is subject to considerable circadian and situational fluctuation. In 24-h blood-pressure monitoring the severity of arterial hypertension is generally classified on the basis of the arithmetic mean of the diastolic blood pressure between 07.00 and 22.00 hours. In the present study Fourier analysis was used to generate continuous functions from the discrete blood-pressure values measured during 24-h blood-pressure monitoring in a sample of 50 normotensive persons aged from 25 to 80 years. A common reference profile was then constructed from these 50 profiles. This reference profile is characterized by the fact that the sum of the integrals over the squares of the distances between the individual profiles and the reference profile is the smallest possible. The reference profile is thus the best approximation of all normotensive profiles and practically ignores individual blood pressure fluctuations. The individual 24-h profiles of 80 patients with untreated arterial hypertension were classified on the basis of the daytime mean as mild, moderate or severe arterial hypertension and also each is described by a Fourier series. The pathological profiles were then compared with the normotensive reference profile. The comparison was made, not only with respect to the absolute pressure over 24 h, but also with respect to the circadian fluctuations in blood pressure. Comparison of the profiles shows that the Fourier analysis of 24-h blood-pressure profiles presented here permits reliable analysis and classification of arterial hypertension and can thus be used for more precise evaluation of the influence of antihypertensives on 24-h blood-pressure profiles.


[Evaluation parameters of ambulatory blood pressure monitoring: mean values versus percent values]. In 1039 ambulatory blood pressure (BP) recordings, we studied if mean values or blood-pressure load (% of elevated readings) is superior for evaluation. There was a nonlinear correlation between the two parameters with high correlation coefficients (syst. r = 0.98, diast. r = 0.97). At very high (low) BP levels the differentiation of the percentage-scale is insufficient, whereas in the central BP range it is too detailed as compared with the accuracy and reproducibility. Due to the nonlinear correlation with BP, treatment effects cannot be easily compared by percentage-values, since identical BP differences correspond with varying percentage. Intervals between readings are usually shorter during daytime than during nighttime. In contrast to the BP load, the resulting problems for 24-h statistics can be easily avoided by calculation of weighted mean values (from hourly means). In summary, weighted mean values are rather suited for evaluation of ambulatory blood pressure than is BP load.


[PHARMFIT--a program for the evaluation of digitally collected cardiovascular parameters]. The PHARMFIT program allows the non-linear fit of simple and combined cosine functions to data from long-term monitoring of cardiovascular parameters and the statistical evaluation of the quality of fit. With the SYNOPS utility a statistical comparison of different fit models can be achieved. As an example, the systolic blood-pressure data obtained in a hypertensive subject by ambulatory blood-pressure monitoring (ABPM) over a period of 36 h is used. The program demonstrates that the fit of a combined cosine function including a 24-h and a 12-h period describes the data better than a simple 24-h cosine function. The quality of fit is significantly improved by inclusion of the first harmonics. The PHARMFIT program can help to get a better analysis of ABPM data.


[Analysis of long-term blood pressure measurements during sleep]. Fifty patients with sleep-related breathing disorders and arterial hypertension underwent diagnostic polysomnography for two nights; EEG, EOG, EMG, and respiratory signals were recorded in parallel with invasive blood pressure. Computerized evaluation was performed to calculate systolic and diastolic blood pressure values, as well as heart rate beat-to-beat. All signals were stored once per second for further evaluation. These time series were analyzed in respect of underlying periodicities by means of spectral analysis. It was possible to distinguish four different groups of patients according to the compressed spectral arrays. Pronounced peaks of different extents were found that reflected both periodicities of respiration (3-5 s) and periodicities of sleep apnea (30-60 s). A comparison of spectral analysis of blood pressure and heart rate showed that systolic blood pressure is suited best to recognize periodicities related to respiration and apneas.


[24-hour blood pressure changes in elderly people with isolated systolic hypertension, essential hypertension and normotension]. In order to evaluate circadian blood-pressure (BP) profile characteristics typical of old age, we compared circadian BP profile in elderly subjects with isolated systolic hypertension (ISH; greater than 160/less than 90 mmHg), essential hypertension (EH; diastolic BP greater than or equal to 95 mmHg), and normotension (N; less than 140/less than 90 mmHg). Each group consisted of 18 subjects, approximately matched in age and sex, (age range 60-82 years; mean age 67.5 years). Ambulatory 24-h BP-monitoring was carried out using a SpaceLabs 90202 with measurements made every 30 min. In ISH, causal systolic BP is higher and circadian systolic BP is lower than in EH (n.s.). Circadian diastolic BP is lower than in EH and higher than in N; both are statistically highly significant (p less than 0.001, u-test, Wilcoxon). The decrease during the resting period is 6 mmHg in EH and 17 mmHg in ISH. In ISH there is a considerable difference of 39 mmHg between casual BP and circadian 24-h BP, in contrast to N and to EH, and this is due to a particular hyperreactivity. This discrepancy is typical of old age and holds the danger of over-treatment, if only causal BP is taken into consideration.


[Ambulatory blood pressure measurement in children and adolescents with kidney transplants]. Arterial hypertension (HT) is a common complication after renal transplantation. We evaluated ambulatory blood pressure profiles during 24 h in 30 pediatric patients (pts) aged 6-22 years who had been transplanted 2 months to 7 years previously. Creatinine clearance was 14-121 (median 57) ml/min/1.73 m2. Twenty-three pts were being treated with ciclosporin. Sixteen pts received antihypertensive drugs. Using the monitor Nippon Collins 630 (Baxter), blood-pressure (BP) values were taken every 20 min during the day and overnight (10 p.m.-7 a.m.). Five out of 10 pts with elevated office BP readings were normotensive by ambulatory blood pressure monitoring (ABPM). Ambulatory hypertension was discovered in one child with normal office BP. Echocardiography was performed in 23 pts. Five of six pts with significant left-ventricular hypertrophy (LVH), but none of the 17 pts without LVH had ambulatory HT (p less than 0.01). The physiological decline of BP during the night was significantly reduced when compared to 21 subjects of similar age with essential HT (-9.2% vs. -15.4%; p less than 0.02); no correlation was found with renal function or prednisone dose. Ciclosporin tended to reduce the day-night gradient (-14.5% vs. -9.2%; p = 0.11). One child showed a severe nocturnal BP rise of 25 mmHg. We conclude that abnormalities of nyctohemeral BP rhythm, as described in transplanted adults, can be observed to a lesser extent in children. ABPM allows a better evaluation of BP compared to office BP and, thus, may contribute to a better management of these patients.


[Long-term 24-hour blood pressure measurement in genuine gestosis and hypertensive pregnancy]. The clinical implications of diminished circadian blood pressure variations during hypertensive pregnancies are not fully understood. We used the COS-INOR-method to quantify circadian blood pressure amplitudes of 32 patients with preeclampsia (GG) and 21 patients with superimposed pre-eclampsia (PG). The two groups did not significantly differ in body weight, age, and gestational date at admission. No differences could be detected in 24-h blood pressure values between the two groups (GG: 127 +/- 14/82 +/- 12 mmHg, PG: 128 +/- 16/86 +/- 9 mmHg). Circadian amplitudes of systolic blood pressure variations (GG: 5.9 +/- 5.5 mmHg, PG: 4.5 +/- 6.9 mmHg) and diastolic blood pressure variations (GG: 3.8 +/- 3.0 mmHg, PG: 5.3 +/- 4.1 mmHg) did not differ significantly. The slope between successive changes of mean arterial blood pressure and successive changes in heart rate was significantly higher in patients with superimposed pre-eclampsia (GG: 0.16 +/- 0.27 mmHg/bpm, PG: 0.36 +/- 0.24 mmHg/bpm, p less than 0.005). We conclude that patients with pre-eclampsia and superimposed pre-eclampsia do not differ in 24-h blood pressure and circadian blood pressure variability, however, if blood-pressure variability is related to heart-rate variability differences become apparent that might be due to altered blood-pressure regulation.


[24-hour blood pressure measurement in type-2 diabetic patients with and without nephropathy]. 24-hour ambulatory blood-pressure measurements were obtained according to criteria of the German Hypertension League in 61 non-insulin-dependent diabetic patients after admission to hospital under clinical routine conditions. 30 patients had no signs of nephropathy; 15 patients showed signs of proteinuria of more than 0.5 g/d and/or renal insufficiency, and 16 patients were on chronic hemodialysis renal replacement therapy. Despite antihypertensive therapy, the majority of NIDDM patients with nephropathy and/or dialysis therapy were hypertensive. Hypertension of non-nephropathic patients showed a better response to therapy. About 50% of all patients with nephropathy had a higher mean arterial blood pressure at night than during the daytime. In about 25% of all diabetics with nephropathy, we found, during night time, an especially pronounced increase of both systolic and diastolic blood pressure of more than 5% above the daytime values. Diabetic patients without nephropathy already show a reduced night/daytime variation of blood pressure, however, inverse circadian rhythm as a sign of prognostically non-favorable autonomic neuropathy was found almost exclusively in the nephropathic diabetic patients.


[Comparison of 24-hour blood pressure measurement with ergometry in patients with hypertension]. 24-h-Ambulatory blood pressure monitoring and bicycle ergometry were compared in 112 patients with untreated mild to moderate essential hypertension. Patients with high blood-pressure values above 220 mmHg during ergometry showed a significantly higher number of blood-pressure peaks above 180 mmHg. There was no significant correlation between the level of the blood-pressure rise during ergometry and the mean values of blood pressure during the 24-h period neither in the night- or the daytime period, nor of the peak values of the 24-h profile. Blood-pressure values during ergometry in patients with high numbers of systolic blood-pressure peaks above 180 mmHg during ambulatory monitoring did not differ significantly from patients with blood-pressure peaks above 180 mmHg during ambulatory monitoring. Patients with marked blood-pressure rise during ergometry seem to demonstrate a higher number of blood-pressure peaks during daytime. On the other hand, patients with an elevated number of blood-pressure peaks do not necessarily show a high blood-pressure rise during ergometry.


[Diagnostic significance of absent nocturnal blood pressure decrease in 24-hour long-term blood pressure measurement]. Patients (pts) with essential hypertension normally exhibit a typical diurnal variation with a nocturnal blood-pressure (BP) decreased. A lack of this periodicity is often reported in pts with secondary hypertension. 24-h BP measurement was therefore performed in 308 pts with essential hypertension, and in 172 pts with secondary hypertension, in order to evaluate the diagnostic value of nocturnal BP decrease. Diagnoses of the secondary hypertensives were: renoparenchymatous hypertension (n = 29), diabetic nephropathy (n = 24), morbus Conn (n = 6), renal artery stenosis (n = 32), pheochromocytoma (n = 5), hemodialysis pts (n = 30), and kidney transplantation (n = 44). Pts with essential hypertension showed a mean systolic and diastolic BP decrease during the nighttime period of 22 +/- 7 mmHg and 17 +/- 5 mmHg, respectively. In contrast, the corresponding values in secondary hypertension were 5.7 +/- 9.2 mmHg (systolic decrease) and 5.2 +/- 5.9 (diastolic decrease). Pts with pheochromocytoma who had a nighttime increase in BP demonstrated the greatest difference from the essential hypertensives, followed by pts with either diabetic nephropathy or after kidney transplantation. A lack of nocturnal BP decline (less than 10% of the daytime values) was detected in 69.8% of pts with secondary hypertension, but only in 5.2% of pts with essential hypertension. In summary, these results suggest that the absence of a nighttime decline in BP during 24-h ambulatory monitoring is an indication of secondary hypertension and should lead to further investigations. Furthermore, a nightly hypertension is associated with a higher risk of complications.(ABSTRACT TRUNCATED AT 250 WORDS)


[ST-segment depressions and spontaneous changes in blood pressure and heart rate in simultaneous 24-hour recording in hypertensive patients]. In 15 patients with essential hypertension (but without coronary heart disease) simultaneous 24-h monitoring of the ST-segment and blood pressure was performed. Twenty-six periods with significant ST-segment depressions were recorded. In 10/26 periods with ST-segment depressions blood pressure was elevated, heart rate was increased in 20/26 ST-segment depressions. During nine periods with ST-segment depressions angina pectoris was reported, and 27 anginal attacks without ST-segment depressions were observed. These data show ischemic episodes in hypertensive patients without coronary heart disease being associated with spontaneous increases of blood pressure and/or heart rate.


[Wake up time, thrombocyte aggregation and the risk of acute coronary heart disease. The TRIMM (Trigger and Mechanisms of Myocardial Infarct) Study Group]. A circadian variation in the incidence of acute coronary artery disease (CAD) was observed, but the correlation to possible triggering external factors and pathophysiologic mechanisms is unclear. In the "Trigger and Mechanisms of Myocardial Infarction" (TRIMM) Study, 573 patients (61 +/- 10 years; 74% male) underwent a systematic interview within 2 weeks after myocardial infarction. From 8.00 to 11.00 a.m. (peak) the relative risk of myocardial infarction was 1.9 (1.6-2.3). After statistical adjustment for individual wake-time the relative risk during the initial 3 hours after awakening was 2.7 (2.2-3.3). In 24 hour studies at platelet aggregability in 10 patients with CAD the threshold concentration of ADP (from 4.8 +/- 0.8 to 2.6 +/- 0.4 mumol, p less than 0.02) and epinephrine (from 7.3 +/- 2.3 to 1.8 +/- 0.9 mumol, p less than 0.02) decreased significantly between 6.00 and 9.00 a.m. indicating an increase of aggregability. The temporal coincidence of clinical events and physiological changes suggests a causal relationship. Further possible important factors in increasing the risk of CAD during the morning include the increase of blood pressure enhancing the risk of plaque rupture and of coronary tone at the same time of day. These results are important in determining the acute mechanisms of CAD and in improving its prevention.


Molecular cloning and analysis of autonomous replicating sequence of Candida maltosa. A Candida maltosa chromosomal DNA fragment which confers high frequency transformation of C. maltosa and autonomous replication of recombinant plasmids was cloned and sequenced. Analysis of the nucleotide sequence of the cloned DNA revealed a sequence homologous for C. maltosa autonomously replicating sequence (ARS) elements. Vector pRJ1 for C. maltosa was constructed, which contained a 1.3 kb ARS sequence, pICEM-19H and the ADE1 gene of C. maltosa. Southern blot analysis suggested that the copy number of pRJ1 in C. maltosa was approximately 20 per genome. The sequence analysis also revealed an open reading frame, encoding a polypeptide with high homology (70%) to the RS15 protein of Brugia pagangi. This open reading frame has an intron with canonical sites for correct splicing in Saccharomyces cerevisiae.


Efficient secretion in yeast based on fragments from K1 killer preprotoxin. The alpha and beta components of the secreted K1 killer toxin of Saccharomyces cerevisiae are derived from residues 45-147 and 234-316, respectively, of the 316 residue preprotoxin (ppTox). The beta N-terminus is produced by Kex2 cleavage after Lys Arg233; when beta la (the mature sequence of beta-lactamase) is fused at this site and the fusion is expressed from the PGK promoter in pDT17, a multicopy plasmid, unexpectedly modest levels of beta la secretion resulted. Over-expression of Kex2 failed to increase beta la secretion while a kex2-null mutation reduced secretion by 98%. beta la secretion in a Kex+ strain was not enhanced by inactivation of the alpha toxin component or by deletion of most of its central hydrophobic segments. However SP-beta la, produced by deletion of ppTox residues 35-176, expressed 10-fold higher beta la activity and the precursor was now secreted with similar efficiency in a kex2-null strain. Fusions of beta la to ppTox at Ala34 or Ala46 also led to efficient secretion in both KEX2 and kex2-null strains. Since these beta la fusions differ only in segments well downstream of the signal peptide and all had similar transcript levels, the efficiency of beta la secretion is apparently determined by the efficiency with which these fusions are translocated to the Golgi compartment where Kex2 is active. Efficiency is high for the shorter fusions, but is 10% or less for the longer fusions; even this fraction is apparently diverted to the vacuole if not cleaved by Kex2. SP-beta la was the most efficient construct tested; secreted beta la reached 4% of total cell protein, modestly exceeding levels produced by fusion to the MF alpha 1-encoded prepro alpha-factor, suggesting potential for the production of foreign proteins in yeast.


Genetic and molecular analysis of DNA43 and DNA52: two new cell-cycle genes in Saccharomyces cerevisiae. Two Saccharomyces cerevisiae genes previously unknown to be required for DNA synthesis have been identified by screening a collection of temperature-sensitive mutants. The effects of mutations in DNA43 and DNA52 on the rate of S phase DNA synthesis were detected by monitoring DNA synthesis in synchronous populations that were obtained by isopycnic density centrifugation. dna43-1 and dna52-1 cells undergo cell-cycle arrest at the restrictive temperature (37 degrees C), exhibiting a large-budded terminal phenotype; the nuclei of arrested cells are located at the neck of the bud and have failed to undergo DNA replication. These phenotypes suggest that DNA43 and DNA52 are required for entry into or completion of S phase. DNA43 and DNA52 were cloned by their abilities to suppress the temperature-sensitive lethal phenotypes of dna43-1 and dna52-1 cells, respectively. DNA sequence analysis suggested that DNA43 and DNA52 encode proteins of 59.6 and 80.6 kDa, respectively. Both DNA43 and DNA52 are essential for viability and genetic mapping experiments indicate that they represent previously unidentified genes: DNA43 is located on chromosome IX, 32 cM distal from his5 and DNA52 is located on chromosome IV, 0.9 cM from cdc34.


A Ser/Thr-rich multicopy suppressor of a cdc24 bud emergence defect. MSB2 was identified previously as a multicopy suppressor of a temperature-sensitive mutation in CDC24, a gene required for polarity establishment and bud formation in Saccharomyces cerevisiae. The inferred MSB2 product contains 1306 amino acids, 42% of which are Ser or Thr. Its Ser+Thr-richness and hydrophobicity profile suggest that Msb2p may be an integral membrane protein containing a long, periplasmic, N-terminal domain and a short, cytoplasmic, C-terminal domain. Cells that lack MSB2 display no obvious mutant phenotypes. MSB2 is located between the centromere and KSS1 on the right arm of chromosome VII. Although physical mapping suggests that MSB2 and LEU1 (on the left arm of chromosome VII) are approximately 40 kb apart, the genetic map distance observed between leu1 and an msb2::URA3 marker was only 2.3 cM.


Sequence of a segment of yeast chromosome XI identifies a new mitochondrial carrier, a new member of the G protein family, and a protein with the PAAKK motif of the H1 histones. We have entirely sequenced an 8.3 kb segment localized on the left arm of chromosome XI of Saccharomyces cerevisiae. Five new open reading frames have been uncovered. One of them encodes a new mitochondrial carrier protein which is dispensable for growth on glycerol medium. Another could be a new member of the G protein family. A third possesses the PAAKK motif common to H1 histones.


[Trypsin inhibitor activity in Basidiomycetes]. 46 species of 10 families of basidiomycetes were screened for trypsin-inhibitor activity. These mushrooms were extracted with water to estimate the inhibitor activity. High inhibitor activity (trypsin inhibition higher than 50%) was estimated in 8 species of 5 families.


Prophylactic laryngo-tracheal aerosolized lidocaine against postoperative sore throat. A randomized, double-blind study was carried out on 193 ASA I-II surgical patients to assess the effect of aerosolized lidocaine on sore throat, hoarseness and cough in connection with tracheal intubation. The study group received aerosolized lidocaine 100 mg 2 min before tracheal intubation, using a spray. The control group received no spray. The patients underwent a standardized general anaesthesia. The patients were interviewed when leaving the recovery room and the next day in the ward. Specific questions were asked regarding sore throat, cough and hoarseness. There were no significant differences between the two groups, which suggests that topical anaesthesia of the mucosa of the upper airway is ineffective as a means of ameliorating airway complaints in connection with tracheal intubation.


The effect of combined high frequency ventilation with and without continuous positive airway pressure in experimental lung injury. Combined high frequency ventilation (CHFV) with 8 mmHg (1.0 kPa) continuous positive airway pressure (CPAP) and without CPAP (CHFV0) were compared to each other, and to continuous positive pressure ventilation (CPPV) with 8 mmHg (1.0 kPa) CPAP in pigs with oleic acid induced lung injury. The respiratory rate was 15 min-1 and the high frequency (HF) rate 360 min-1. Arterial carbon dioxide tension (PaCO2) was adjusted to 5 kPa and 25% oxygen was used. After CHFV, CPAP was briefly discontinued to allow the establishment of CHFV0 in order to examine the cardiovascular and pulmonary effects of combined high frequency ventilation alone. Mean arterial oxygen tension (PaO2) was 15.8 +/- 3.9 kPa during CPPV, 15.5 + 3.2 kPa during CHFV and 13.2 +/- 5.1 kPa during CHFV0 (ns). The peak airway pressure and the pericardiac pressure were lowest during CHFV0. CHFV provoked significant cardiovascular depression (mean arterial pressure, stroke index, left and right ventricle stroke work index). When compared to CPPV, a non-significant trend towards improved cardiovascular function was found during CHFV0. With similar mean airway pressures (during CHFV0) or the same CPAP (during CHFV) as during CPPV, no further improvement in oxygenation due to HF waves was found. Airway pressure was the major factor causing alterations in cardiovascular function, not the ventilation technique.


Single-dose oral omeprazole for reduction of gastric residual acidity in adults for outpatient surgery. Omeprazole is a substituted benzimidazole that causes dose-dependent intracellular inhibition of gastric acid secretion in humans. This double-blind study examined the effect of omeprazole in decreasing gastric acidity and gastric residual volume in outpatient adults. Unpremedicated outpatients, ASA I-III, 18 years or older (n = 17), were randomly assigned to receive omeprazole 80 mg, or placebo by mouth the night before scheduled elective outpatient surgery. The patients were fasted for 8 h prior to surgery. After the patient was anesthetized, an orogastric tube was inserted with proper placement verified by auscultation for gastric sounds. Gastric residual contents were withdrawn into a Luken's trap, and pH was then determined and gastric volume indexed to weight (ml.kg-1). Data were analyzed by a t-test, with P less than 0.05 considered statistically significant. Patient characteristics of both groups were similar. There was a statistically significant difference between the two groups for pH (P = 0.02), but not between the two groups for gastric volume indexed to weight (P = 0.07).


A dose-range study of intrathecal meperidine combined with bupivacaine. Twenty-one patients were included in a randomized study to receive either 10 mg of 0.5% hyperbaric bupivacaine alone or combined with 0.05, 0.1, 0.2, 0.3, 0.4 or 0.5 mg.kg-1 meperidine for spinal anaesthesia. Sensory blockade was assessed by pin prick, motor blockade by the Bromage scale, and postoperative analgesia by VAS scores and by the time before the first demand for analgesia. Spinal meperidine did not change the duration of sensory blockade, but induced a dose-related increase in postoperative efficient analgesia. Spinal meperidine might be considered as a means to obtain postoperative analgesia in the hours immediately following surgery.


Acupuncture treatment of severe knee osteoarthrosis. A long-term study. Acupuncture treatment of patients waiting for arthroplasty surgery. 29 patients with a total of 42 osteoarthritic knees were randomized to two groups. Group A was treated while Group B served as a no-treatment control group. After 9 weeks Group B was treated too. Analgesic consumption, pain and objective measurements were registered. All objective measures were done by investigators who were "blinded" as to Group A & B. In the second part of the study 17 patients (26 knees) continued with treatments once a month. Registration of analgesic consumption, pain and objective measurements continued. Total study period 49 weeks. Comparing Group A to B there was a significant reduction in pain, analgesic consumption and in most objective measures. In Group A + B combined there was an 80% subjective improvement, and a significantly increased knee range movement - an increase mainly in the worst knees. Results were significantly better in those who had not been ill for a long time. In the second part of the study, it was shown that it was possible to maintain the improvements. Acupuncture can ease the discomfort while waiting for an operation and perhaps even serve as an alternative to surgery. Seven patients have responded so well that at present they do not want an operation. (USD 9000 saved per operation).


Haemodynamic changes during spinal anaesthesia with slow continuous infusion or single dose of plain bupivacaine. Forty elderly patients, scheduled for orthopaedic surgery of the hip or knee were studied. Twenty patients received a single-dose spinal anaesthesia with 3 ml of plain 0.5% bupivacaine (SDSA group). Twenty patients received continuous spinal anaesthesia using a 32- or 22-gauge catheter. A bolus of 1.0 ml of plain 0.5% bupivacaine was given to ten patients and 0.5 ml to another ten, continued by an infusion at a rate of 2 ml/h. The spread of analgesia and haemodynamic changes (central venous pressure, arterial pressures, need for sympathomimetic medication) were registered. The mean dose of bupivacaine was 2.9 ml (range 1.5-5 ml) in the CSA group (3.0 ml in the SDSA group). Eight patients in the CSA group needed medication for pain during surgery compared to five patients in the SDSA group (n.s.). The median level of pinprick analgesia at 60 min was T11 in the CSA and T6.5 in the SDSA group (P less than 0.01). The mean maximum decreases in CVP and MAP were quite similar in the CSA and SDSA group (2.1 vs 2.8 mmHg (0.3 vs 0.4 kPa) and 17 vs 21 mmHg (2.3 vs 2.8 kPa), respectively) (n.s.). Six patients in the SDSA group and four patients in the CSA group needed sympathomimetic medication. It is concluded that titration of bupivacaine for spinal anaesthesia caused only minor haemodynamic changes which were similar to those after single-dose spinal bupivacaine.


Recovery and discharge of patients after long propofol infusion vs isoflurane anaesthesia for ambulatory surgery. Fifty unpremedicated patients scheduled for outpatient restorative dentistry and/or oral surgery lasting 2 to 4 h were anaesthetized with either propofol infusion or isoflurane inhalation. Before induction of anaesthesia with propofol (2.5 mg.kg-1), all patients were given 75 mg of diclofenac and 0.01 mg.kg-1 vecuronium intravenously. Intubation was facilitated with suxamethonium (1.5 mg.kg-1) and anaesthesia was maintained in random order either with propofol infusion (12 mg.kg-1.h-1 for the first 20 min, 9 mg.kg-1.h-1 for the next 20 min, and 6 mg.kg-1.h-1 for the rest of the anaesthesia) or with isoflurane (inspired concentration 1-2.5%), both with nitrous oxide and oxygen (30%). The patients breathed spontaneously using a non-rebreathing circuit. Patients given propofol infusion became re-orientated faster (11.0 +/- 5.5 min vs. 16.5 +/- 7.5 min; P less than 0.01) and at 30 min walked along a straight line better (P less than 0.01). At 60 min, none of the propofol patients displayed an unsteady gait, whereas 11 of the 25 isoflurane patients did (P less than 0.001). None of the patients receiving propofol had emesis at the clinic, compared with 10 of the 25 patients receiving isoflurane (P less than 0.001). The overall incidence of emesis was 2 of 25 and 14 of 25 in the propofol and isoflurane groups, respectively (P less than 0.01). Patients receiving propofol were discharged home earlier than patients receiving isoflurane (80 +/- 14 min and 102 +/- 32 min, respectively; P less than 0.01). It is concluded that propofol allows early discharge of patients, even after long anaesthesias.


Continuous coeliac plexus blockade plus intermittent wound infiltration with bupivacaine following upper abdominal surgery: a double-blind randomised study. In this double-blind trial, we observed the effect of intermittent wound infiltration with local anaesthetic plus continuous coeliac plexus blockade on postoperative pain relief, pulmonary function, the neuroendocrine and acute phase protein response following upper abdominal surgery. In Group A (n = 10) patients received bupivacaine intermittently into the wound and continuously into the coeliac plexus following an initial bolus. A total of 862.5 mg of bupivacaine was used over 12 h with no observed toxicity. Group B (n = 10) received equal volumes of saline. Although pain relief was poor in both groups, the bupivacaine group used less morphine postoperatively and had lower pain scores than the saline group 4 h after operation (P less than 0.05). Pulmonary function was significantly reduced in both groups with no statistical difference between the two. Significant reductions in serum glucose and cortisol were achieved (P less than 0.05), suggesting that afferent neural blockade was partially effective in attenuating the neuroendocrine response. However, the postoperative rise in interleukin-6 was not affected by this technique. It is concluded that total afferent neural blockade cannot be achieved with peripheral wound and coeliac plexus administration of relatively large doses of local anaesthetic during upper abdominal surgery.


Recovery following thiopentone or propofol anaesthesia assessed by computerized coordination measurements. Quantitative measurements of coordination ability and performance speed were carried out on 76 female day-case patients undergoing minor gynaecological operations. The women were assigned at random to the anaesthetic agent used, propofol 2.5 mg/kg or thiopentone 4 mg/kg. Spacing control, timing control and performance speed were recorded using a newly developed computerized coordination ability test system. The patients were tested once before the operation and 0.5, 1 and 2 h after awakening. Postoperatively the initial impairment and the subsequent regression towards preoperative test results were very similar whether the anaesthetic agent was propofol or thiopentone. Although the test apparatus was able to detect even minor differences, no postoperative test showed statistically significant differences between the two groups. We find it reasonable to conclude that there is no difference in recovery of coordination ability following propofol- or thiopentone-induced anaesthesia.


Atelectasis and lung function in the postoperative period. Thirteen patients with healthy hearts and lungs, and with a mean age of 68 years, who were scheduled for lower abdominal surgery during isoflurane anaesthesia with muscular paralysis, were investigated with arterial blood gases, spirometry, pulmonary x-ray and computed tomography (CT) of the chest before and during anaesthesia, as well as during the first 4 postoperative days. Before anaesthesia, lung function and gas exchange were normal in all patients. Pulmonary x-ray and CT scans of the lungs were also normal. During anaesthesia, 6 of 13 patients developed atelectasis (mean 1.0% of intrathoracic transverse area in all patients). Two hours postoperatively, 11 of 13 patients had atelectasis and the mean atelectatic area was 1.8%. Pao2 was significantly reduced by 2.1 kPa to 9.8 kPa. On the first postoperative day, the mean atelectasis was unaltered (1.8%). None of the atelectasis found on CT scanning could be detected on standard pulmonary x-ray. Forced vital capacity (FVC) and forced expired volume in 1 s (FEV1) were significantly decreased to 2/3 of preoperative level. Pao2 was significantly reduced to less than 80% of the preoperative level (mean 9.4 kPa). There were significant correlations between the atelectatic area and the impairment in FVC, FEV1, and Pao2. Spirometry and blood gases improved during the succeeding postoperative days, and atelectasis decreased. No patient suffered from pulmonary complications, as judged from clinical criteria and pulmonary x-ray, in contrast to the findings of atelectasis in 85% of the patients by computed tomography.


A regression model for identifying patients at high risk of hypotension, bradycardia and nausea during spinal anesthesia. We analyzed the predictive value of a number of demographic and anesthesiological variables with respect to the three most common complications during spinal anesthesia: hypotension, bradycardia, and nausea. A stepwise logistic regression model was created, using data from a prospective study of 1752 patients to combine the predictive value of all entry variables. The highest risk factors for hypotension were: age greater than or equal to 50, a sensory level above Th6, receiving bupivacaine as a local anesthetic, body mass index greater than or equal to 30, and receiving opiate as a premedication. An anesthetic level above Th6 and age below 50 were primarily associated with bradycardia. Females and those with a high sensory level or receiving opiate as a premedication were at significant risk of nausea. The model was also reliably predictive for a separate group of 200 consecutive spinal anesthesia patients. Thus, the risk model may be clinically useful in identifying high-risk patients requiring additional attention.


Premedication for outpatient cataract surgery: a comparative study of intramuscular alfentanil, midazolam and placebo. The effects of i.m. alfentanil and midazolam on anxiety, sedation, hemodynamics, oxygen saturation and intraocular pressure were studied in 90 patients scheduled for outpatient cataract surgery with regional anesthesia. The study was randomized, double-blind, placebo-controlled, and performed on outpatients with ASA physical status I-III and mean age 67.7 +/- 11.7 years. Alfentanil (12.5 micrograms/kg) administered into the deltoid muscle had a marked anxiolytic and short sedative effect, and was associated with stable hemodynamics. Midazolam (20 micrograms/kg) administered similarly had a more prolonged anxiolytic and sedative effect, which impaired co-operation in some patients during surgery. The regional blockade was associated with a significant reduction of oxygen saturation (SpO2), regardless of the premedication used (P less than 0.05). A slight reduction of intraocular pressure (IOP) was found after premedication, but the change was not statistically significant. We conclude that i.m. alfentanil is well tolerated, and its anxiolytic and short sedative effects make it especially suitable as premedication for day-case cataract surgery.