[Outcome after artificial amniotic fluid instillation in early oligohydramnios]

We report on the foetal outcome of 50 pregnancies with severe oligohydramnios in the second and early third trimesters in which artificial fluid instillation (AFI) had been performed. Through the AFI, rapid diagnosis was possible or was made easier or additional malformations were detected or could be excluded. The AFI-associated risk was an induction of labour and a possible iatrogenic rupture of membranes in 3/50 cases. A total of 47 pregnancies could be evaluated to the end, 37 ended in intrauterine death, spontaneous abortion or, in case of a diagnosed lethal malformation, in induced abortion. Ten babies were born alive, but within a period of six months 6 of them died. From the total group, 4 children (8%) are alive and healthy. Survivors are from pregnancies with PROM, with severe IUGR or from the group of idiopathic oligohydramnios. Twenty-seven foetuses had structural, chromosomal or functional anomalies (urogenital, intestinal, heart, skeletal, central nervous, complex malformations). Our data demonstrate a poor prognosis in case of early oligohydramnios. AFI enables early and correct diagnosis. It provides a better basis for counselling and managing of these pregnancies. The risk of AFI with possible induction of labour and iatrogenic rupture of membranes has to be considered both in indication and counselling. However, the risk is limited with regard to the very poor prognosis even without invasive diagnosis.

Family environment of eating disordered and depressed adolescents

We designed this study to replicate previous findings which suggest a relationship between the qualities found in family environments and specific eating disorders through the examination of subjects' reports of family environments. We also attempted to refine previous findings of such relationships by adding an additional psychiatric contrast group. Subjects included patients with the following diagnoses: (1) Anorexia nervosa, restrictor type; (2) anorexia nervosa with bulimic features; (3) normal weight bulimia; and, as a psychiatric control population (4) major depression. In contrast to previous findings, subjects in each diagnostic group do not differ statistically either from each other or from a normative population with regard to reported family environments. However, when we grouped subjects by self-reported level of depression, those with a high level of depression described family environments that are significantly different, independent of the severity of illnesses or diagnoses. We discuss the use of self-report instruments in measuring such complex phenomena as family environment.

Efficient secretion of attacin from insect fat-body cells requires proper processing of the prosequence

The attacins constitute a group of immune proteins induced after bacterial infection in the moth Hyalophora cecropia. They are synthesized as preproproteins and undergo post-translational modification during transport to the hemolymph. The processing and transport rates of attacin were studied in its natural host as a response to infection. Monensin totally inhibited the processing from proattacin to attacin and the radiolabeled proattacin remained intracellular. This observation indicated that the prosequence is removed at or after the trans-Golgi compartment. It is also suggested that the processing of the prosequence does not occur in acidic vesicles, as the process was not inhibited by the weak base chloroquine. To study prosequence function, the attacin gene and genes with mutations in the prosequence were cloned into the baculovirus Autographa californica nuclear polyhedrosis virus. The processing of proattacin and the transport of attacin were studied by pulse-chase experiments with fat body isolated from Trichoplusia ni larvae. The rate of secretion from fat body was lowest for proattacin, which could not be processed to attacin, intermediate for attacins lacking the prosequence and highest for natural attacin. We could not detect any biological activity for proattacin.

[Is there an intermittent HELLP syndrome?]

A case of an HELLP-syndrome in the 32nd week of gestation with complete remission of pathological biochemical data and clinical symptomatic within five days is reported. Twenty days later a Caesarean section because of severe fetal growth retardation was performed. Because of this case it has to be discussed, if an "intermittent" HELLP-syndrome does really exist?

Concordance of parent-child temperament ratings in a clinical sample of adolescent girls

Fifty-six adolescents meeting DSM-III-R criteria for anorexia nervosa, bulimia, and major depression, were asked to complete self-assessments of temperament using the Dimensions of Temperament Survey--Revised (DOTS-R). Parents independently rated their children using a parent version of this scale. We found that parents and patients agreed significantly on all nine subscales. This high correlation suggests that parents' perceptions of their adolescents' temperaments concur with the adolescents' self-perceptions. These findings suggest that the observation of temperament remains concordant even in parent/child dyads often characterized by significant conflict.

[Effectiveness of local prostaglandin instillations in tubal pregnancy in relation to preoperative beta-HCG level]

33 patients with tubal pregnancy and beta-HCG level less than 2500 mIU/ml were treated with local, laparoscopic Prostaglandin-injection. Re-operation was not necessary and beta-HCG fell to undetectable levels in 73% (p = 0.05). Serial beta-HCG correlated poorly with outcome. In patients with an increasing beta-HCG success was limited to 55% (p = 0.59). In contrast patients with falling or stable beta-HCG values had success rates of 85.7% (p = 0.22) and 83.5% (p = 0.30) respectively. Our data suggests there may be a clinical advantage to the use of prostaglandin-injection for the conservative management of early ectopic pregnancy. However the utility of preoperative serial beta-HCG values in predicting success showed a trend, without reaching statistical significance.

Psychopathology in anorexia nervosa and depression

It has been hypothesized that anorexia nervosa is characterized by ineffectiveness, interpersonal distrust, and lack of interoceptive awareness. The Eating Disorder Inventory differentiates patients with anorexia nervosa from weight-preoccupied women on the basis of these subscales. To test further the specificity of these characteristics to anorexia nervosa, the Eating Disorder Inventory scores of 20 adolescent girls diagnosed with anorexia nervosa were compared with those of 21 girls with major depression and 21 girls with both anorexia nervosa and depression. Analyses of variance and discriminant function analysis revealed no significant differences in the scores of the three groups. By 2-year followup, subjects initially diagnosed with only anorexia nervosa showed less psychopathology than those with an additional diagnosis of depression. These findings raise further questions about the overlap between depression and anorexia nervosa and leave open the question of characteristic psychological features in anorexia nervosa.

["Pseudothrombosis" of the lower leg, induced by a ruptured Baker's cyst]

A sudden onset of unilateral swelling and tenderness on pressure of the calf with no history of trauma is suggestive of vein thrombosis. Baker cysts, especially if ruptured, mimic the clinical picture of deep vein leg thrombosis. The examination method of choice is duplex sonography. We report on a 30-year-old man who was admitted to our hospital with signs of deep vein leg thrombosis. Phlebography revealed normal venous circulation. Examination by duplex sonography showed a ruptured Baker cyst. No intra-articular lesions of the knee joint were revealed by arthroscopy. Histological examination of the biopsy specimens of the synovia showed no specific pathologic condition. The clinical signs improved with conservative treatment.

Time-dependent neuroplasticity in mesostriatal projections after unilateral removal of vibrissae in the adult rat: compartment-specific effects on horseradish peroxidase transport and cell size

In adult rats the mystacial vibrissae were clipped on one side of the snout, and the influence of this sensory deprivation on crossed and uncrossed striatal afferents from the substantia nigra, ventral tegmental area, and retrorubral area was examined with the horseradish peroxidase tract tracing technique. Unilateral removal of vibrissae was found to affect crossed and uncrossed nigrostriatal projections in a time-dependent manner. One to three days after hemivibrissotomy an apparent neuronal asymmetry was found in the crossed nigrostriatal projection arising in the rostral part of the substantia nigra, with more labeled neurons in the projection to the caudate-putamen on the side of vibrissae removal. This asymmetry resulted mainly from an asymmetry in the subset of nigrostriatal neurons reported to project to the striatal matrix ("dorsal cell type"). In contrast, 4-20 days after hemivibrissotomy reversed asymmetries were found in crossed and uncrossed nigrostriatal projections, with more labeled neurons in the projections to the caudate-putamen of the hemisphere opposite to vibrissae removal (the sensory deprived hemisphere). The asymmetry in the uncrossed projection was found throughout the substantia nigra, but was also most substantial in the projection from its rostral part. The asymmetry in the crossed projection was again restricted to the rostral substantia nigra; interestingly, however, it was limited to the subset of neurons reported to terminate in the striosomes ("ventral cell type"). Evidence was also found for time-dependent changes in size of neurons of the crossed nigrostriatal projections, as well as for changes in striatal afferents from the ventral tegmental area. The time course of these apparent changes in strength of mesostriatal projections is similar to the known time course of recovery from behavioral asymmetries induced by hemivibrissotomy, which is suggestive of a functional relationship between neuronal and behavioral changes. Moreover, the finding of a differential influence of hemivibrissotomy on nigrostriatal afferents to striosomes and matrix is indicative of a functional dissociation of these two systems.

Control of turning behavior under apomorphine by sensory input from the face

It has been shown that peripheral manipulation of sensory input by removal of vibrissae on one side of the rat's face induces turning behavior which is directed towards the contralateral vibrissae-intact side, under the influence of the dopamine receptor agonist apomorphine. In the present experiment, we examined whether rats under apomorphine turn towards the side with more sensory input, or simply away from the manipulated side. Thus, an experimental manipulation was designed to increase sensory input. Sensory stimulation was applied by attaching a clip into the fur on one side of the face. Rats injected with apomorphine in doses of 0.5-5.0 mg/kg (but not with 0.05 mg/kg or vehicle) exhibited turning behavior towards the side of the clip. This sensory stimulation was also found to influence spontaneous behavioral asymmetries. These results show that an imbalance in sensory input is sufficient to produce turning under apomorphine.

Nodular focal fatty infiltration of the liver in acquired porphyria cutanea tarda

A case is reported of acquired porphyria cutanea tarda (PCT) due to administered valproate acid in an epileptic patient. Sonography (US) and computed tomography (CT) showed multiple nodular, well-defined lesions of the liver. Biopsy confirmed the diagnosis of focal fatty infiltration and revealed additionally the signs of hepatic involvement in PCT. Focal fatty infiltration should be considered in patients with multiple liver lesions if there is a predisposing condition. PCT can be a further cause of this type of infiltration.

Biologically active and amidated cecropin produced in a baculovirus expression system from a fusion construct containing the antibody-binding part of protein A

A synthetic antibody-binding part derived from protein A from Staphylococcus aureus was used as a fusion partner in a eukaryotic expression system employing Autographa californica nuclear polyhedrosis as a vector. This, in conjunction with an efficient signal sequence, facilitated the purification of the antibacterial peptide cecropin A from the medium of Spodoptera frugiperda cells infected with a recombinant virus. In order to increase further the concentrations of fusion protein, Trichoplusia ni larvae were used as host. Cecropin A could be obtained after cleavage of the fusion protein with CNBr. Biological activity as well as the correct structure including the C-terminal amide group was shown using electrophoresis with detection of antibacterial proteins and mass spectroscopy.

Testing the psychogenic vomiting diagnosis. Four pediatric patients

We treated four patients with chronic vomiting during childhood in whom a tentative diagnosis of psychogenic vomiting was made after an extensive evaluation. In each case, the diagnosis was reconsidered during the course of treatment, as observations about the patients and their response to interventions accumulated. In three instances, these observations did not fit those expected if the diagnosis of psychogenic vomiting was correct. This led to a reexamination of the organic evaluation and the discovery of an undiagnosed organic contribution to the vomiting. In the fourth patient, gastric emptying studies confirmed that there was a strong psychological contribution to the vomiting, and helped to more carefully define this contribution. Family and individual psychotherapy and treatment were aided by the greater clarity in diagnosis.

Expression of post-translational processing of preprocecropin A using a baculovirus vector

A cDNA fragment encoding preprocecropin A was inserted into the baculovirus Autographa californica nuclear polyhedrosis virus downstream of the polyhedrin promoter. The gene was expressed in recombinant-infected last instar larvae of Trichoplusia ni and in diapausing pupae of Hyalophora cecropia. The identity of the recombinant product was established by electrophoresis with detection of antibacterial activity and mass spectrometry. The prepropeptide had been correctly processed including removal of signal peptide and pro-part. Biologically active and amidated cecropin A was exported to the hemolymph. The yield of recombinant protein in H. cecropia reached a level of 600 micrograms/ml hemolymph and about 70% of the material was amidated.

[Comparison of biochemical and Doppler sonographic monitoring of high-risk pregnancies]

We performed in 113 patients at least three simultaneous determinations of serum-HPL and oestriol in 24-hour urine samples, as well as Doppler flow studies at the arcuate artery (AA), umbilical artery (UA), foetal aorta and internal carotid, because of suspicion of IUGR. The diagnostic value was studied with regard to IUGR, placental weight and mode of delivery. Concerning the detection of IUGR, the superiority of Doppler parameters (AA, UA) is shown. In the total number of patients, the rates for sensitivity and specificity for UA (78/91%) and AA (58/89%) exceed the hormone parameters. Oestriol, in particular, (13/63%) shows a marked difference, but even HPL (37/63%) cannot compete with respect to diagnostic value.

The ward atmosphere of a child psychosomatic unit: a ten-year follow-up

Using the Ward Atmosphere Scale, we reassessed the ward atmosphere of a psychosomatic unit for children and adolescents that has been operating successfully for 10 years. There was remarkable stability in essential treatment program characteristics despite the complete turnover in patients and a 60% turnover in staff. There was substantial correlation between patient and staff perceptions in 1988 and across time (Spearman's rho: 0.951-0.660, all p values less than 0.05). Patients and staff subgroups differed somewhat in their relative emphases on certain program dimensions but, overall, the program still correlated highly with the therapeutic community cluster described by Moos (Spearman's rho: 0.660-0.809, all p values less than 0.05). This stability was achieved despite multiple health care changes, most notably shortened length of stay. Stability was probably due to high staff/patient ratio, continuity of the medical direction, and focus on milieu maintenance in staff meetings.