Measurement of ionized calcium with five types of instruments. An external quality assessment

An external quality assessment for ionized calcium determinations was carried out in 24 laboratories in Northern Europe. Both protein-free and protein-containing test materials were included in the study. The average within-laboratory variation (CV) for all test materials was 3.1, 1.7, 1.2, 1.8 and 1.3% for the AVL 980 (AVL, Graz, Austria), the Microlyte (Kone, Espoo, Finland), the Nova 2 (Nova Biomedical, Newton, Ma USA), the Orion SS-20 (Orion, Cambridge, Mass., USA), and the ICA1 (Radiometer, Copenhagen, Denmark) respectively. The corresponding interlaboratory CV was 3.1, 2.9, 3.1 and 2.4%. The variation between types of instruments was even larger and caused differences of up to 33%. The results indicate a need for well-defined protein-containing control material.

Continuous acid-base assessment of the human fetus during labour by tissue pH and transcutaneous carbon dioxide monitoring

Simultaneous monitoring of fetal tissue pH (t-pH) and transcutaneous carbon dioxide (Tc-PCO2) was performed in 30 labours. Both t-pH and Tc-PCO2 at delivery were positively correlated with pH (r = 0.69) and PCO2 (r = 0.68) of the umbilical artery blood. A tissue/transcutaneous standard base excess (t-SBE) was derived from the t-pH and the Tc-PCO2 and calculated for 13 fetuses at delivery; there was a correlation with standard base excess of umbilical artery blood. An analysis of t-pH and Tc-PCO2 changes during the last hour of labour revealed that only infants who were born with decreased pH of the umbilical artery blood had decreasing t-SBE, while all others had a constant t-SBE.

Correlations between PRL and chloride, sodium, potassium and calcium in amniotic fluid

The concentration of prolactin in amniotic fluid from 91 pregnant women (Group I: 51 specimens obtained at 15th-20th week of gestation; Group II: 40 specimens at term) has been correlated with the amniotic fluid concentrations of calcium, of the ions sodium, chloride, and potassium, and with the clinical data. When the week of gestation in multiple regression analyses was predetermined for inclusion in the first step, the amniotic prolactin concentration was found to be significantly correlated with sodium or chloride in both groups and the correlation coefficients in the two groups were alike. The correlation coefficients of potassium and of calcium differed between the two groups and no general pattern could be detected. The results indicate that the amniotic sodium and chloride concentrations could be of importance for the regulation of the amniotic prolactin concentration.

Affinity cytochemistry of vascular endothelia in brain tumors by biotinylated Ulex europaeus type I lectin (UEA I)

The vascularization of 50 tumors of the central nervous system (CNS) including 17 meningiomas, 25 neuroectodermal tumors, i.e., astrocytomas, oligodendrogliomas, mixed gliomas, glioblastomas, medulloblastomas, seven metastatic carcinomas, and one malignant hemangioendothelioma were investigated using biotinylated Ulex europaeus type I lectin (UEA I) in an indirect avidinbiotin-peroxidase procedure. The cytochemical staining pattern of UEA I on paraffin sections was compared with that of biotinylated Dolichos biflorus lectin (DBA), and with the immunocytochemical staining of factor VIII related antigen (F VIII/RAG) by polyclonal antisera using the PAP technique. UEA I visualized the endothelia of blood vessels with equal intensity, sensitivity, and reliability in normal brain and in tumor tissue with neovascularization. While large, medium, and small vessels were equally well demonstrated by UEA I and antibodies against FVIII/RAG, capillaries and endothelial sprouts were stained more consistently and intensely by UEA I. No reliable cytochemical staining could be obtained by DBA regardless of tissue or cell type investigated. It is concluded that UEA I is a highly useful cytochemical marker for the identification of vascular endothelia in paraffin sections of human brain tumors.

Immunocytochemical studies of serum proteins and immunoglobulins in human sural nerve biopsies

Post-embedding immunocytochemical studies on immunoglobulins (Ig) and other serum proteins were carried out on 38 human sural nerve biopsies using the PAP method. In addition to toxic, hereditary, metabolic, dysproteinemic, and vasculitic-neuritic neuropathies, morphologically normal sural nerves were included as controls. The intensity of the immunocytochemical reactions was strong for proteins, such as IgG, the light chains of Igs, and albumin, but weak or absent for others like complement component C3, IgA, ceruloplasmin, and alpha-1-antitrypsin (AAT) in normal nerve biopsies and in all pathologic groups. IgG, the light chains of immunoglobulins, and albumin could readily be detected in perineurium, endoneurial interstitium, and blood vessel walls. IgM, C3, and beta-lipoprotein (BLP) were largely confined to the walls of blood vessels and perineurium, thus indicating that they do not penetrate the blood nerve barrier. Only in a few cases, in vasculitic-neuritic and dysproteinemic neuropathies, staining of the endoneurial interstitium for IgM and C3 was observed. Increased staining for the corresponding heavy or light chains was not detected in the endoneurium in any of the neuropathies associated with gammopathy. The results stress that PAP immunocytochemistry is suitable for studying the blood-nerve barrier (BNB) and provides new aspects to the concept of the BNB with respect to the steady state of serum proteins between endoneurial and vascular spaces. It is suggested that, in addition to serum concentration and molecular weight of serum proteins, the permeability of the BNB is influenced by other yet undefined factors.

Torsion of the fallopian tube during pregnancy

We describe 3 cases of torsion of the Fallopian tube during pregnancy, caused by sactosalpinx, a cyst of the mesosalpinx, and an ovarian cyst. Other causes of torsion of the Fallopian tube are discussed. The difficulty of diagnosing this condition during pregnancy is emphasized.

Fetal transcutaneous carbon dioxide tension during the second stage of labour

Fifteen women were studied during the second stage of labour by measuring simultaneously fetal transcutaneous carbon dioxide tension (Tc PCO2 and maternal end-expiratory PCO2. A linear increase of Tc PCO2 with time was observed, predominantly because of changing maternal respiration patterns. The degree of maternal hyperventilation had no adverse effect on the status of the newborn infant.

Transcutaneous carbon dioxide measurements in the fetus during labor

Transcutaneous partial pressure of carbon dioxide (transcutaneous PCO2) was measured in 55 fetuses during labor with a carbon dioxide electrode applied to the fetal scalp by a suction ring. The application procedure was simple and reliable, with reapplication required only 0.6 times per patient. The transcutaneous PCO2 recordings were of good quality and were correlated to carbon dioxide tensions in the umbilical artery (r = 0.60, p less than 0.001) and vein (r = 0.69, p less than 0.001) as well as to capillary PCO2 obtained by fetal scalp blood sampling (r = 0.96, p less than 0.001). If fetal distress occurred, transcutaneous PCO2 was significantly higher than in the uncompromised fetus. Although transcutaneous PCO2 monitoring might be useful for surveillance of the fetus during labor, it must still be reserved for scientific purposes for the time being.

Developmental and application of insulin infusion profiles for therapy of type-I diabetics with portable insulin infusion systems

We studied the insulin requirements of seven insulin-dependent diabetics applying a glucose controlled insulin infusion system. The data were transformed into individually programmed and rectangular profiles. The MAGE, a measure of blood sugar fluctuations, was significantly lower when individually programmed step profiles were used (P less than 0.005) than it was when rectangular profiles were applied: 57.7 +/- 24.8 mg/dl vs 89.0 +/- 42.9 mg/dl. The average of measured blood glucose levels was significantly lower in individually programmed infusion profiles (P less than 0.025). The combination of individually programmed profiles and preprandial insulin bolus significantly reduced the postprandial blood glucose level and increase (P less than 0.001). Our investigations suggest that individually programmed insulin infusion profiles are able to smooth blood glucose fluctuations. When combined with an initial insulin bolus they may lead to a reduced insulin consumption after meals.

Preoperative evaluation of pediatric abdominal tumor volumes by computerized tomography

The volumes of two neuroblastomas and two Wilms' tumor masses were calculated by computerized tomography (CT) within 48 hours of surgical removal of the tumor. True volumes of the tumor masses were obtained by volume displacement. CT was very accurate in predicting volume with an error ranging from 1.5% to 7.5%. This accurate method of evaluating tumor volume will allow precise monitoring of the response of nonoperable tumors to chemotherapy and radiotherapy.

Multiple theoretical approaches to supervision: choices in family therapy training

The supervision techniques used in structural, strategic, family-of-origin, and experiential family therapy training are discussed and compared, with emphasis on the isomorphism between supervision and therapy in each school. The usefulness of each supervisory model is related to supervisees' needs at different levels of training. Recommendations are made about the sequence of family therapy training, including the utility of eclectic versus purist family therapy training programs for trainees at different levels of experience.

The role of computerized tomography in the diagnosis and management of patients with bilateral Wilms tumor

We report 2 cases of bilateral Wilms tumor. In both cases computerized tomography provided accurate data for the diagnosis of bilateral tumors and predicted surgical resectability, without nephrectomy, of the smaller tumor. In 1 patient computerized tomography demonstrated tumor growth while on chemotherapy and radiotherapy. The role of angiography in the management of these patients is discussed.

A new look at the neonatal bowel-contrast studies with metrizamide (Amipaque)

Metrizamide is the first water-soluble radiographic contrast agent which, because it is nonionic, can be used in isotonic solution and gives good visualization of the desired body structure. Its only major disadvantage is that it is very expensive. Metrizamide can be used to study the neonatal bowel in clinical situations where all the other existing contrast agents are contraindicated. The results of 55 metrizamide studies of the bowel in infants are reviewed. In necrotizing enterocolitis metrizamide aids in confirming or rejecting the diagnosis, identifying patients for surgery, and in evaluating the response to surgery. Metrizamide can identify the etiology in unusual cases of bowel obstruction. Metrizamide correctly identified a thoracic origin of free peritoneal air in four cases and a bowel origin in two cases. It identified bowel perforation in two patients in the absence of pneumoperitoneum. In six patients, the metrizamide study identified the cause for a gasless abdomen. It is concluded that metrizamide has a valuable role to play in evaluating a variety of neonatal bowel disorders.

On the rationale of the alpha-hydroxybutyrate dehydrogenase (HBD) determination

The discriminating power of HBD, LD and of the HBD/LD ratio in comparison with LD1/LD2 and LD5/LD4 ratios in acute myocardial infarction and hepatic disease is evaluated. The results demonstrate that there are no clinical reasons for the determination of the HBD when a method using the conditions of the Committee of Enzymes of the Scandinavian Society for Clinical Chemistry (SCE) is used.

Epidermolysis bullosa--pyloric atresia. An autosomal recessive syndrome

A sister and brother each had epidermolysis bullosa and pyloric atresia at birth. Both died in early infancy of complications related to epidermolysis bullosa. Electron microscopic studies of skin biopsy specimens disclosed findings consistent with a diagnosis of epidermolysis bullosa letalis. The existence of epidermolysis bullosa-pyloric atresia syndrome as a distinct clinical entity with autosomal recessive inheritance is supported by the findings in these patients.

Cross-reaction of snRNA and an Alu I-like sequence from rat with DNAs from different eucaryotic species

Sequence homologies to rat U1-snRNA and U2-snRNA were investigated in DNA from 23 eucaryotic species (3 lower eucaryotes, 4 plants, and 16 animals) using dot hybridization at various stringency conditions. Cross-hybridization among very distantly related species in e.g. plants-insects or mold-vertebrates is not the rule; there are, however, examples for stronger homologies like Rattus-Dictyostelium. Furthermore, DNA from all 23 species was analysed for sequence homologies with the repetitive DNA sequence B1 (an Alu I family equivalent) from rat. We observed a wide range of homologies covering some plants and insects, up to vertebrates. Hybridization at increasing stringency conditions revealed species with higher degree of homology to the rat B1 sequence: maize, chicken, and hamster.

Neonatal small left colon syndrome in twins

There are no previous reports of small left colon syndrome in twins. Small left colon syndrome is reported in 2 sets of twins. In 1 set 1 twin had clinical and radiographic signs of small left colon syndrome. The sib was clinically normal and had no radiographic studies. In the other set, both twins had identical clinical and radiographic findings of hyperplastic left colon. This suggests a genetic and/or environmental intrauterine, rather than a postpartum etiology for the small left colon syndrome.

Cellular immunity during follow-up of patients with sarcoidosis of varying duration

Cellular immunity was followed up at 3 month intervals for 1 year in 43 patients with sarcoidosis representing three well defined categories of the disease viz acute (12), subacute (20) and chronic (11). Twelve apparently healthy individuals served as controls. Each follow-up included the following tests: total number of blood lymphocytes, T cells, B cells, leucocyte migration tests with PPD, BCG and Kveim test material and stimulation tests of lymphocytes in vitro in the presence of PHA, Con A, PPD and PWM. Statistically, the most abnormal initial findings in all the tests were noted in acute sarcoidosis, followed by the subacute group. The acute group showed the most marked changes also during the follow-up. The smallest changes during the follow-up were seen in the patients with the chronic form of the disease. However, the inter-individual variation was considerable and no definite conclusions could be drawn from findings in a given case. Alterations in cellular immunity occur in sarcoidosis. They differ between different subgroups of patients and vary differently in course of time. Well defined criteria for inclusion of patients in an investigation and repeated studies of included patients will increase the information available from investigations of cellular immunity in sarcoidosis.

Metrizamide in neonatal and childhood small bowel obstruction

Metrizamide (Amipaque) has been used to image the bowel of four neonates and one older child with possible bowel obstruction. In each case, barium and hypertonic water-soluble agents, such as Gastrografin and Hypaque, were contraindicated. In each case, the metrizamide study provided unique formation altering the management of the patient. Metrizamide provides a new method of evaluating selected difficult cases of suspected bowel obstruction in the newborn, and in older children it may help to distinguish between postoperative ileus and mechanical obstruction.

Uterine plasminogen activator activity: modulation by steroid hormones

We have used a sensitive and quantitative assay to investigate the hormonal regulation of plasminogen activator (PA) activity in the rat uterus. PA activity is increased 5-fold (per U protein or DNA) by low physiological (0.1 micrograms) doses of estradiol, with increases in activity first observed at approximately 12 h. The stimulation of PA activity shows strict specificity among the steroid hormones, being stimulated by estrogens only or by high doses of dihydrotestosterone, which are known to affect the estrogen receptor system, and this stimulation is suppressed markedly by triphenylethylene antiestrogens. Comparative dose-response studies with a variety of estrogens of different uterotropic potencies indicate a good correlation between the potencies of different estrogens in stimulating PA activity and uterine growth (diethylstilbestrol = 17 beta-estradiol greater than estrone = 17 alpha-estradiol greater than estriol), with the exception of the zearalanol estrogen P-1496, which was consistently a potent stimulator of PA activity while being a very weak uterotropic agent. These studies suggest that increases in uterine PA levels may serve as a good marker of estrogen action in the uterus. Although the role of PA in uterine function remains unknown at present, its relatively large increase (up to 25-fold increase in content per uterus) may play a role in tissue remodeling during uterine growth.

[Ectopic hormone formation in multiple endocrine type IIa neoplasia (author's transl)]

A patient with high-grade osteoporosis had elevated levels of ACTH, cortisol and carcinoembryonic antigen (CEA). Computed tomography demonstrated enlarged adrenal glands. Despite intensive search no ACTH-producing tumour was found. A central Cushing's syndrome was thus possible, and a radiologically normal sella turcica made a microadenoma of the hypophysis a possibility. However, a one-time hypertensive crisis with elevated catecholamines raised the suspicion of an additional phaeochromocytoma and thus provided the first pointer to a multiple endocrine neoplasia. Bilateral phaeochromocytomas, discovered at adrenalectomy, as well as raised serum-calcitonin levels, strongly suggested coexistence of a C-cell carcinoma, which previously had not been demonstrated either by thyroid scanning or fine-needle biopsy. A total thyroidectomy revealed a multifocal and metastasizing C-cell carcinoma. On extraction it contained a high concentration of calcitonin, typical for a C-cell carcinoma. An unusual finding was of ACTH in extracts of both the C-cell carcinoma and the phaeochromocytoma. It was immunologically identical with the synthetic ACTH used as a standard.

[Diagnosis of focal nodular hyperplasia of the liver (author's transl)]

In two female patients with hypothalamic-hypophyseal Cushing's syndrome who had not taken oral contraceptives, upper abdominal sonography showed three liver tumours as chance findings. In one case the left lobe was involved alone and in one case both lobes. None of the three tumours could be demonstrated by means of computer assisted tomography. Autopsy in one case and liver arteriography and scan in other other led to the diagnosis of focal nodular hyperplasia of the liver. These cases demonstrate the importance of sonography in the recognition of liver tumours. A connection between the overpopulation of adrenocorticosteroids and the formation or enlargement of focal nodular hyperplasia of the liver cannot be excluded.

Comparison of biosynthetic human insulin and pork insulin during rest, food ingestion, and physical work in insulin-dependent diabetic subjects using a glucose controlled insulin infusion system

In six insulin-dependent diabetic subjects, we investigated whether differences between biosynthetic human insulin (BHI) and pork insulin are present as measured by an automatic glucose controlled insulin infusion system (GCIIS) (Biostator). The parameters measured were basal insulin requirement and food-dependent insulin requirement, as well as the blood sugar-lowering and insulin-saving effect of standardized physical work. The results show that BHI does not reveal any differences with regard to the basal food-independent and food-dependent insulin requirement compared to pork insulin in insulin-requiring diabetic subjects. Delayed food-dependent initial rise in blood sugar and insulin during physical work, which was observed with BHI, does not show any differences in the integral over 180 min. These investigations confirm the results found in vitro and in animal experiments. At the same time, they indicate discrete differences in the activity spectrum.

The influence of cord complications on fetal pH, neonatal Apgar score, and the acid base state and oxygenation of the umbilical artery and vein

Continuous monitoring of fetal scalp tissue pH (tpH), acid base and oxygenation measurements of the blood of the umbilical artery and vein, and APGAR scoring was performed in 152 deliveries. The effect of cord complication on tpH (120, 90, 60, 30, 15, 10, 5, and 0 minutes before delivery), the status of the umbilical artery and vein (pH, pCO2, base excess, standard bicarbonate, pO2, and oxygen saturation), and the APGAR scores (one and five minutes after delivery) were investigated. Thirty-two per cent of the deliveries were associated with on or more cord complication(s). Cord complications in general did not influence the APGAR scores, the acid base state, or the oxygenation of the fetus and newborn. In the very few cases of tight cord complication(s) tpH showed a marked decrease during the last 30 minutes of labour, the umbilical blood was slightly acidotic, but the APGAR scores were normal (8-10 one and five minutes after delivery). No cases of prolapse of the cord were found. Cord complications are very common but in most cases completely harmless.

Direct current conversion of maternal supraventricular tachycardia developed during the treatment of a pregnant heroin addict with ritodrine

During ritodrine (UtoparR) treatment for premature labor, a chronic heroin-addicted patient developed supraventricular tachycardia which was treated by direct current (d.c) conversion, d.c. conversion did not affect the fetus, as judged by the cardiotocogram. As heroin addicts run an increased risk or developing cardiac arrhythmia, caution is advised when treating these patients with beta-mimetics.

Physiological responses to low-intensity cardiac rehabilitation exercises

This study determined the oxygen consumption, heart rate, and blood pressure responses in healthy subjects to calisthenic exercises designed for convalescing patients with cardiac problems. Comparisons of the different exercises showed intersubject variability in oxygen consumption per unit of body weight and in cardiovascular responses. The exercises showing the greatest variability in oxygen consumption, however, were not always the exercises with the greatest variability in heart rate and blood pressure. Upper extremity exercises tended to evoke a greater demand on the cardiovascular system, especially if the isometric component was large. These data suggest the necessity of carefully monitoring cardiovascular response when using a variety of calisthenic exercises in the rehabilitation of patients such as those with cardiac limitations and should provide useful information for prescribing exercise.

Transcutaneous fetal oxygen tension and fetal heart rate pattern preceding fetal death. Case report

Simultaneous cardiotocography (CTG) and transcutaneous PO2 (tcPO2) measurements were made in a pregnancy complicated by membrane rupture and cord prolapse at 27 weeks gestation. A Caesarean section was not done because the fetus was judged to have little chance of survival and to be at very high risk of severe brain damage if it did. The fetus weighed 830 g and the CTG changes preceding fetal death were similar to those described by others. The tcPO2 was zero for periods of a few seconds to 20 minutes at 1 to 2 hours before fetal death, and the tcPO2 was constantly zero during the last 50 minutes of fetal life. Tracings showing the tcPO2/CTG changes preceding fetal death are reproduced.

Interactions of cimetidine and pirenzepine on peptone-stimulated gastric acid secretion in man

Combinations of H2-receptor antagonists and classical anticholinergics inhibit stimulated gastric acid secretion more than either drug alone. In double blind, placebo controlled, randomised studies we have compared the effects of single and combined intravenous bolus injections of cimetidine and pirenzepine on peptone-stimulated acid secretion and serum gastrin in man. Combined injection of 3.0 mg/kg cimetidine and 0.3 mg/kg pirenzepine suppressed stimulated acid secretion significantly more than either drug alone, and by 90% in healthy volunteers (n = 8) and patients with duodenal ulcer (n = 5). Side-effects (prolactin stimulation, blurred vision) were diminished by reducing the combined dosages to 1.5 mg/kg cimetidine, to 0.075 and 0.15 mg/kg pirenzepine in another series (n = 10). Postprandial gastrin was not affected by any combination. Combination of cimetidine and pirenzepine suppress food-stimulated gastric secretion more effectively than combination of H2-blockers with classical anticholinergics. Pirenzepine--unlike classical anticholinergics--may distinguish between different subclasses of muscarinic receptors and have a more selective antimuscarinic action. Its interaction with H2-receptor antagonists on parietal cell function seems to be synergistic. Such a combination could be of advantage in patients with gastrinoma, in patients with ulcers and hypersecretion resistant to single drug treatment, and in critically ill patients as prophylaxis of stress ulcer bleeding.

Continuous fetal scalp tissue pH monitoring during labor. An analysis of 152 consecutive cases

Continuous scalp tissue pH monitoring was performed in 152 consecutive cases. The success rate was 53 per cent. The average duration of pH monitoring was 151 minutes (range 0--609 minutes). A good correlation was found between tissue pH at delivery and blood pH in the umbilical artery (r = 0.78) and vein (r = 0.67). In no case with normal tissue pH (more than 7.20) and abnormal CTG was the Apgar score less than 8 one minute after delivery. A normal tissue pH almost always means that the fetus is not asphyxiated, but a low tissue pH reading may be caused by other factors than acidosis of the fetus. Continuous pH monitoring during labor remains a research method.

Continuous fetal pH monitoring and neonatal Apgar score

Results of continuous fetal tissue pH monitoring were compared to neonatal APGAR scores one minute after delivery in 81 successful tissue pH recordings. The sensitivity of the method (i.e. the ability of the method to find the low APGAR neonates) was 67 per cent using an APGAR score limit between 8 and 9 and a pH limit between 7.20 and 7.21. The specificity (i.e. the ability of the method to find the high APGAR neonates) was 73 per cent using the same limits. The sensitivity and specificity of continuous pH monitoring was equal to or better than the sensitivity and specificity of cardiotocography and discontinuous pH measurements on fetal scalp blood using APGAR score limits between 6 and 7. It is concluded that all fetal monitoring should include monitoring of the fetal pH when a pH electrode which can be used as a routine instrument has been developed. Unfortunately, such an electrode has not been developed yet.

Perinatal asphyxia in spite of a normal cardiotocogram and a normal acid base state at the time of delivery

The labor preceding delivery of a depressed neonate with normal acid base status is described. Cardiotocographic (CTG) monitoring was used during the 5.5 hours of active labor. Continuous tissue pH determination was performed during the last 100 minutes of labor. Although the CTG pattern was normal all the time, tissue pH declined to 7.02 one hour before delivery, but reached normal values thereafter. The depression of the neonate could only be explained by the episode of acidosis one hour before delivery.

Continuous measurement of transcutaneous fetal oxygen tension during labour

Transcutaneous scalp oxygen tension (tcPO2) was measured during labour in 40 fetuses, using a modified Clark electrode (Radiometer, Copenhagen). In 24 of the fetuses the recordings were of good quality during the second stage of labour. After delivery the acid-base status and oxygenation of the umbilical cord blood was measured. A correlation was found between the tcPO2 and umbilical artery oxygen saturation (r = 0.56, p less than 0.01) and umbilical artery PO2 (r = 0.56, p less than 0.01). Furuthermore, a positive correlation was found between the area beneath the recorded tcPO2 curve during the last 10 minutes and the umbilical artery pH (r = 0.50, p less than 0.05). The data suggest that continuous transcutaneous PO2 measurement may be of value in monitoring high risk patients during labour.

[Therapy of Amanita phalloides poisoning. Results of clinical and experimental studies]

On the basis of experimental and clinical results evidence accumulates that supportive therapy is still the milestone in the therapy of death cap poisoning. Today the letality is 20%. The main cause of the intoxication are the amatoxines which inhibit DNA dependent RNA Polymerase II or B. Parts of the supportive therapy are: diuresis with 150--200 ml urin/hour, careful corrections of disturbances in electrolyte and acid-base-metabolism, oral administration of charcoal and oral gut sterilization. In spite of a multitude of experimental and clinical reports on the effectivity of Penicillin G, thiocticacid and steroids there are no controlled studies to demonstrate the advantage of one regimen over the other. The time course of resorption and excretion of amatoxines clearly shows that hemoperfusion and/or hemodialysis are only of value if applied within the first 24 hours after poisoning. At this time neither anamnestic nor biochemical data give any clues to the probable course of the disease. Heterologous baboon liver perfusion may be lifesaving in coma hepaticum grade IV, but the small amount of cases so far does not yet allow any comments on its effectivity.

Normal values for fetal scalp tissue pH during labour

Normal values for fetal scalp tissue pH during labour were determined by using a glass electrode (Kontron-Roche). A total of 132 recordings was obtained and 84 (64 per cent) were of good quality. After a good quality recording had been obtained, there were 64 infants with an Apgar score of 9 or 10 at one and five minutes after delivery. The 64 recordings showed pH values (Mean +/- 2SEM) of 7.38 +/- 0.12 six hours before delivery and 7.28 +/- 0.12 at the time of delivery. Between the 5th and 55th minutes of the second stage of labour the pH (Mean +/- 2SEM) fell from 7.30 +/- 0.14 to 7.20 +/- 0.13.

[Gonadotropin secretion following pernasal stimulation with synthetic gonadotropin releasing hormone (GnRH) and a highly effective GnRH-analog in healthy men and prepubertal boys]

Potent long acting analogs of GnRH are of great interest especially in view of pernasal (p.n.) treatmen of hypogonadism of hypothalamic origin and of cryptorchidism. To find the necessary p.n. dosage of such a substance, serum LH and FSH were measured in 6 normal adult human males after p.n. application of various doses of D Leu6-des-Gly10-GnRH ethylamide. 50 microgram of the GnRH analog were necessary to obtain increased serum gonadotropins over a period of at least 8 hours. By repeated p.n. application of 200 microgram of synthetic GnRH every 2 hours in 6 normal adult males a considerable increase of serum gonadotropins could be demonstrated as well. Pernasal application of 200 microgram GnRH repeated at an interval of 1 hour in 3 cryptorchid boys produced a distinct increase of the serum gonadotropins. The intraindividual comparison of 200 microgram GnRH and 20 microgram of the GnRH analog in one boy showed equivalent net increases of the gonadotropins. With the analog the gonadotropin increase lasted for about 6 hours.

Improved lysozyme assay in biological fluids

We describe a simple, rapid, sensitive, and highly reproducible assay for lysozyme, with use of concentrated cell suspensions of Micrococcus lysodeikticus in Tris-buffered glycerol/water (40/60 by vol), pH 7.5. Stored at -20 degrees C, the cells' susceptibility to lysozyme remains unaltered over long periods. Almost identical concentration curves were obtained with different aliquots of the same preparation during eight months. Lysozyme activity was reflected in the decrease in absorbance of the reaction mixture after incubation for 15 min at 37 degrees C. Concentrations of egg-white lysozyme as low as 0.02 mg/L can be accurately assayed.