The phosphoenolpyruvate carboxylase (ppc) gene family of Flaveria trinervia (C4) and F. pringlei (C3): molecular characterization and expression analysis of the ppcB and ppcC genes

Phosphoenolpyruvate carboxylase (PEPC) is a central enzyme of C4 and CAM photosynthesis but plants, in addition, contain various non-photosynthetic isoforms with characteristic and variable functions. The partial sequence and a detailed expression analysis of the PpcB and PpcC genes which encode non-photosynthetic PEPC isoforms in the C4 plant Flaveria trinervia and the C3 species F. pringlei is presented. Southern analyses showed that PpcB and PpcC sequences are most probably of single-copy in the genomes of F. trinervia and F. pringlei. With gene-specific probes the various ppc transcripts could be distinguished unequivocally from one another and the expression patterns of all ppc genes were compared. PpcB and PpcC transcripts of both F. trinervia and F. pringlei were detected preferentially in roots and stems and at low levels in leaves. Their accumulation patterns are thus similar to each other, but different from that of the PpcA genes which in F. trinervia encode the C4 isoform of PEPC. Transgenic analysis of the 5'-flanking regions of the PpcB genes of both F. trinervia and F. pringlei in tobacco revealed that the PpcB promoter/beta-glucuronidase reporter genes were preferentially expressed in the phloem and the roots. Comparison of the PpcB promoter/reporter gene with the accumulation pattern of the PpcB transcripts in F. trinervia and F. pringlei suggests that the expression of the PpcB genes is predominantly controlled by transcription.

[Neoplasms in nevus spilus]

Among 946 patients with nevus spilus we observed 5 patients (3 women and 2 men) with transformations on it-2 cases with malignant melanoma and 3 cases with spitz-nevus. Histologically the nevus spilus is a superficial variant on congenital pigmented nevus missing corial parts. Because of the risk of transformation a regular skin examination is advisable, a prophylactical excision of nevi spili as used in congenital pigmented nevi should be discussed.

[Results of cryosurgery in 394 patients with hypertrophic scars and keloids]

Cryosurgery with liquid nitrogen led to total or partial success in 64% of 336 patients with keloids and in 82% of 58 persons with hypertrophic scars. In 11% and 3% of the patients, respectively, the results were disappointing. In 19% and 12%, patients broke off the painful and long-term therapy. Nonetheless, in view of the results of other therapeutic methods, we prefer cryosurgery (either as monotherapy or combined with corticoids or conventional surgery) for keloids. For hypertrophic scars, however, the therapy is restricted to exceptional cases since nearly all lesions regress spontaneously within a few years.

[Rare keratoacanthoma variants]

Keratoacanthomas are made up of the same spinocellular differentiated cell material as squamous cell carcinomas, but they differ from the latter in origin and growth properties. The majority--in our series 98% of 741 examined cases--are of the "crateriform" type, which after rapid growth during the initial stage give way to spontaneous regression, mostly with complete restoration of the cutaneous structure. Less than 2% belong to the rare destructive variants with disturbed or absent regression and persistent invasive growth. Keratoacanthoma marginatum centrifugum, mutilating keratoacanthomas and aggregated keratoacanthomas can lead to extremely severe defects. None of the "conservative" treatment methods recommended in the literature up to now has proved effective, with the exception of surgery and radiotherapy with tumour ratio doses. Many publications are obviously based on uncritically interpreted individual observations.

[Keratoacanthoma of the external ear]

Six hundred and seventy-eight keratoacanthomas were treated in Hornheide during the past 30 years. Nearly 10% (67) were located on the auricles. One patient suffered from two tumors. The records of 8 patients were lost. Fifty-two of the remaining 59 cases involved males and only 7 patients were female. There was a striking difference between the sex incidence of the patients with auricular tumors and the overall total of the keratoacanthomas, with a nearly equal involvement of both sexes in the latter. The growth time of lesions before treatment was mostly defined in weeks or even days. The prevalence increased with age and only 2 patients were younger than 50 years. Therapy depended on growth stage, tumor diameter and localization. Therapeutic measurements ranged from excessive surgical treatment to no treatment. In practise, special dermato-oncologic experience is necessary for making any decisions concerning the best method of treatment.

Hyperparathyroidism induced by hypothyroidism

The coexistence of hyperparathyroidism and thyroid tumors and/or chronic thyroiditis has raised the possibility of an etiologic relationship. The present study was designed to test the hypothesis that the chronic elevation of thyroid-stimulating hormone (TSH) is related to the development of hyperparathyroidism. Three groups of 24 rats each were treated for 12 weeks as follows: group 1 received propylthiouracil (PTU) in their deionized water; group 2 received PTU and thyroid hormone to suppress TSH and to serve as a control group for possible direct effects of PTU; and group 3 was not treated at all and served as another control group. At 12 weeks, 95% of group 1 rats (PTU only) showed hyperplasia of the parathyroids with a 30% mean increase in circulating parathormone.

Sensitive detection of acetylene absorption in the visible by using a stabilized AlGaAs diode laser

Overtone transitions of C(2)H(2) at ~ 789 nm are investigated by means of an AlGaAs laser operating in an external optical cavity configuration. Relative amplitude noise is of a few parts in 10(6) (ppm) and permits an absorption detection limit of 0.2 ppm/km. Self-broadening and air broadening is measured for two components of the observed band [P(11) at 12646.966 and R(5) at 12688.699 cm(-1)].

[The status of Italian psychiatric reform: the example of Lombardy in comparison with Switzerland]

In Italy, the worldwide reduction in numbers of psychiatric beds since the fifties had led already by 1971 to a much lower per capita rate of beds than in most European countries. In Northern Italy the psychiatric reform of 1979 speeded up the ongoing reduction of beds, ameliorated conditions for hospitalized patients and built up ambulatory care. A comparison with three Swiss cantons shows that, in Lombardy, the largest and economically most developed Italian Region, the rate of patient contacts with outpatient services has probably reached or surpassed the level found in Switzerland. Contacts by home visits are much more frequent than in Switzerland. The number of psychiatric beds per 1,000 inhabitants is 0.7 in Lombardy and thus has been reduced to one third the Swiss bed-ratio. Comparisons of Italian with Dutch and Danish psychiatric register data show that the Italian psychiatric service as a whole reaches a considerably smaller segment of the severely disordered patients. The Region of Lombardy has recently been trying to increase the psychiatric bed-ratio by agreements with private hospitals. The shortage of beds is not compensated by the ambulatory services and is leading to increasing stress for the families of the severely disordered.

[How can one achieve compliance?--On the after-care of psychiatric patients after clinic discharge]

For 384 of 558 hospitalized psychiatric patients who were discharged within six months and for whom it was possible to plan aftercare, compliance was controlled by a phone call three months after discharge at the institution or practice to which the patient had been directed. Eighty percent of the ambulatory patients complied (schizophrenic patients: 84%). After three months 70 percent of the compliers still were in treatment. The hospital's arranging an appointment for the patient had the strongest influence on compliance. The success of this strategy is confirmed by the literature.

High phosphate diet-induced primary hyperparathyroidism: an animal model

Primary hyperparathyroidism (PHPT) is increasing in incidence and detection, primarily because of the aging of our population and the widespread use of automated serum calcium determination. As a result, a substantial number of "early" cases or "biochemical" PHPT are being detected. The indications for parathyroidectomy in such early cases of PHPT are currently under debate, primarily because of economic issues. These factors underscore the importance of research into the basic mechanisms and natural history of PHPT. We investigated an animal model of diet-induced PHPT that retains two crucial aspects of PHPT: elevation of endogenously produced parathyroid hormone (PTH), accompanied by gross and microscopic changes in the native parathyroid glands. Female Long-Evans rats were divided into six groups of 15 each and fed a control diet (Ca/P of 1:2) or a high-phosphate diet (Ca/P of 1:7) for 1-, 2-, or 3-month intervals. Compared with the control animals, serum PTH levels were elevated at all three time intervals in the experimental group, whereas serum calcium levels were decreased at all time intervals. Serum creatine levels were also elevated at all time intervals, whereas serum phosphorus levels did not change. Parathyroid histopathologic studies demonstrated no change at 1 month, whereas nine of 15 experimental animals showed mild hyperplasia at 2 months and 13 of 14 showed mild to moderate hyperplasia with gland enlargement at 3 months compared with control animals. Histopathologic examination of the kidneys showed no change at 1 month but focal parenchymal inflammation with calcium deposition at 2 and 3 months in the experimental groups. In conclusion, the high-phosphate diet successfully induced the earliest changes of PHPT: elevated PTH levels and parathyroid hyperplasia. However, because renal function was mildly compromised early on, some element of early secondary (renal) hyperparathyroidism may have supervened quickly. Because this model is simple, it may be useful to investigate this complex syndrome further, as well as its natural history and the complications it produces in other organs such as the kidneys.

Radiotherapy of primary human melanomas--experiences and suggestions

We treated 60 invasive primary human melanomas by soft X-rays. In 23 additional cases radiotherapy was applied after total excision of a primary melanoma. Only in two cases was a tumor observed in the field of irradiation during the follow-up period: a recurrence of a primary melanoma and a skin metastasis. Radioresistance cannot be unequivocally assumed in either case. Since deeply situated in-transit metastases cannot be destroyed by soft X-rays in spite of our good results we regard radiotherapy of invasive primary melanomas as a second choice treatment to be administered if impaired general health, excessive tumor growth in certain localisations or refusal of the patient do not allow a major operation. Nodular parts of primary melanomas should be excised before radiotherapy to obtain material for histopathological confirmation of the diagnosis and to determine the thickness of the tumor. X-rays of lower hardness can subsequently be applied.

[Anti-androgen treatment in a retrospective evaluation of 19 sex offenders]

Of 54 sexual delinquents treated with Cyproteron, 19 were followed up 2-16 years later. Though treatment was initiated under pressure of detention, the subsequent sexual and social development and the opinions of the patients on treatment were surprisingly favorable.

[Cryosurgical treatment of precancerous cheilitis abrasiva]

Between 1984 and 1988, 44 patients suffering from cheilitis abrasiva praecancerosa were treated with cryosurgery using a nitrous oxide cryoprobe. A single treatment proved sufficient in 35 patients (80%). 9 patients (20%) developed a recurrent lesion 4 to 28 months after cryosurgery. All recurrences appeared within the first year. On account of the recidivity of the disease, we recommend a careful follow-up of the patients. On the other hand, cryosurgery has the advantage that it can be applied in elderly persons as well as in patients with concomitant internal diseases. In pracancerous lesions, the common drawbacks of a surgical therapy such as diminution of the lower lip and impairment of the superficial sensitivity can be avoided with the help of this technique. Invasive carcinomas of the lower lip, however, should not be treated with cryosurgery.

Laser measurement of the (16)O-(18)O isotope shift at optical frequencies

We demonstrate the full resolution of isotope shifts in atomic O by means of sub-Doppler laser optogalvanic spectroscopy of (18)O-enriched samples. The measurements are performed to within a few percent accuracy on four transitions ranging from 605 to 646 nm and involving excited states. Previously published values from conventional spectroscopy are either unavailable or are one order of magnitude less accurate and in marginal agreement with our data.

Sustained antidepressive effect of repeated partial sleep deprivation

In a naturalistic clinical trial we administered three partial sleep deprivations (PSD) within one week to a diagnostically heterogeneous sample of 30 depressed patients and applied serially three dexamethasone suppression tests (DST). We observed that this PSD treatment induced sustained clinical improvement independently from nosological attribution. Abnormal DST results prior to PSD treatment failed to predict clinical course, and normalized after beneficial response.

Laser cooling of a direct-current atomic discharge

Light-induced heating and cooling of a positive column discharge are demonstrated by combining the optogalvanic and optoacoustic detection. The phenomena that we have observed for laser radiation resonant with several Ne and He transitions are compared with a simplified energy model.

Parathyroid cysts: a report of eleven cases including two associated with hyperparathyroid crisis

Eleven parathyroid cysts were found in 325 patients who underwent parathyroid operations. Ten cysts were located in the neck and one was located in the mediastinum. The cysts ranged in size from 1.6 to 10 cm with a mean of 3.9 cm. The patients who had cysts included six women and five men, and their ages ranged from 28 to 72 years with a mean of 51 years. In contrast to other reports that have suggested that most parathyroid cysts are nonfunctional, all but one of our patients had hyperparathyroidism, as evidenced by hypercalcemia, hypophosphatemia, and elevated parathyroid hormone level, which was corrected by cyst removal. The nonfunctional cyst first appeared to be an asymptomatic neck mass. Two patients had acute hyperparathyroid crises, which required emergency operations. It is postulated that the crises may have been the result of spontaneous necrosis of preexisting parathyroid adenomas. This is supported by the pathologic findings of degeneration and early organization as well as by the presence within the cyst of sanguineous fluid that contained a parathormone concentration greater than 100 times normal serum levels.

Effects of radiation on parafollicular C cells of the thyroid gland

While radiation has well-recognized effects on follicular cells of the thyroid gland, those on parafollicular C cells are not yet established. Low-dose radiation that has been proved to be nonablative and carcinogenic to follicular cells was administered to 8-week-old Long-Evans rats to study the changes in C cell number and function. Circulating calcitonin levels were significantly reduced in animals that had undergone radiation at age 24 months. Mean calcitonin values were 0.66 (+/- 0.20) ng/ml and 1.64 (+/- 0.59) ng/ml for control males and females compared with 0.14 (+/- 0.06) ng/ml and 0.11 (+/- 0.01) ng/ml for males (P less than 0.05) and females (P less than 0.001) that had undergone radiation, respectively. These levels correlated well with C cell population density in thyroid glands in the control group and in the group that had undergone radiation as evidenced by light microscopy. Routine hematoxylin and eosin staining showed C cell hyperplasia in 77% of control animals of both sexes compared with 4% in animals that had undergone radiation (P less than 0.005). Immunoperoxidase staining with an anticalcitonin antibody showed virtual absence of C cells in most animals that had undergone radiation compared with diffusely scattered cells in animals in the control group. Medullary carcinomas occurred in 14% of animals in the control group compared with 3% of animals that had undergone radiation (P less than 0.05). These data indicate that the radiation dosage that is carcinogenic to the follicular epithelium causes lethal injury to C cells and thus suggest that C cells are more sensitive to radiation than are follicular cells. This increased sensitivity could explain the virtual absence of C cells, decrease in calcitonin levels, and reduced numbers of medullary carcinomas in the animals that had undergone radiation.

[Isolation and forced injection in the opinion of affected patients and patient care personnel. An accompanied quarter year sample]

All cases of seclusion and emergency sedation at a regional psychiatric university hospital were studied for a period of 3 months. The patients involved, and their nursing staff, were questioned on the day following the above mentioned incidents and the patients again after their remission from the exceptional state that had caused them. Every sixth patient underwent, at least once, either seclusion or emergency sedation, or both. These occurred most frequently during the first week of hospitalization, and in patients with a predominantly negative attitude. Women showed violent behaviour more often than men and also admitted to it more frequently. Seclusion was generally better accepted than emergency sedation. In less than half the cases the patients clearly rejected the past coercive measure; cases of total acceptance, however, were even less frequent, though acceptance tended to increase with remission. The authors dealt with the legal status of coercive measures. They also stressed the importance of discussing them afterwards both with patients and nursing staff in order to preserve the self-respect of all concerned.

[Quantitative amino acid determination in the serum and cerebrospinal fluid in endogenous depressions]

The levels of 20 amino acids were measured in the plasma and cerbrospinal fluid of 41 patients with endogenic depressions. The plasma levels of 12 amino acids were found to be significantly lower in the patients than in the control group, but cerebrospinal fluid levels were significantly lower only in the case of taurine, glutamine, phenylalanine and aginine. Comparison of the same amino acid levels in treated and non-treated patients showed that serine and alpha-aminobutyric acid serum concentrations were higher in the nontreated patients. The tyrosine and phenylalanine levels in the cerebrospinal fluid of the patients who had received medicamentous treatment were higher than in the other group.

[Recovery curves of the soleus H-reflex in endogenous depression]

H-reflex recovery curves were plotted for 37 patients suffering from endogenic depressions and 18 control subjects. Psychopathological examinations were performed at the same time. The stimulability returned significantly later and maximum stimulability was significantly delayed in the depressive patients, particularly in the case of severely inhibited unipolar depressions.

Successful autotransplantation of parathyroid adenomas in seven patients

The autotransplantation of normal as well as adenomatous parathyroid tissue is currently being used with increasing frequency. In the present report, we describe our experiences with the successful transplantation of adenomatous or hyperplastic parathyroid tissue in seven patients. Prior to transplant surgery, six of these patients had recurrent or persistent primary hyperparathyroidism. The last patient was on hemodialysis for chronic renal failure and was presumed to have tertiary hyperparathyroidism. A large superior mediastinal parathyroid adenoma was found at a second neck exploration. In all patients, the only remaining parathyroid tissue was either adenomatous or hyperplastic. A total of 30 to 75 mg of this parathyroid tissue was diced and transplanted into single subfascial pockets of the forearm muscles (6) or sternocleidomastoid muscle (1). Following transplantation, all patients required transient calcium and vitamin D supplements for six to 12 weeks. In follow-up studies of ten months to 12 years, all patients have remained eucalcemic with normal parathyroid hormone levels. The use of a single subfascial pocket (versus the popular method of multiple implants) may explain the lack of recurrent hyperparathyroidism in our small population.

Subtotal parathyroidectomy for primary hyperparathyroidism. Long-term results in 292 patients

Subtotal parathyroidectomy was performed in a consecutive series of 292 patients with primary hyperparathyroidism. We evaluated the long-term postoperative results during a period of 16 years. Patients ranged in age from 14 to 83 years and included 176 women and 116 men. Of these, 16% had a history of exposure to radiation in childhood or adolescence, while thyroid disease requiring some form of thyroidectomy coexisted in 91 (31%) of the patients. Histologic information on three or more parathyroid glands was obtained in 73% of the cases. We considered 285 patients (97.6%) cured after their first operation. The remaining seven patients (2.4%) had persistent hyperparathyroidism. However, five were cured after a sternum-splitting mediastinal exploration and one after a second neck exploration. The seventh remains hypercalcemic despite a subsequent mediastinal exploration. Temporary postoperative hypoparathyroidism occurred in 10% of our cases and permanent hypoparathyroidism in 1%. There have been no instances of recurrent hyperparathyroidism.

[Mental illness without institutions. A field study in the Canton of Fribourg in 1875]

In 1875, the government of the Canton of Fribourg decided that a field study should be carried out on the number of mentally ill people in their territory. This happened in view of the construction of a new state mental hospital. With the support of members of the local administration, an experienced psychiatric expert examined 164 mentally ill persons, 147 at home and 17 in general hospitals and homes. In the author's report, the sick person's case history, his present state and proposals for treatment cover on average two pages per patient. Almost all of the mentally ill described in this report can quite easily be classified according to the main categories of modern nosology: there are 69 schizophrenics, 28 cases of affective psychoses, 28 mental retardations, and 39 further mental disorders, most of them identifiable as well. The case histories of the patients, too, correspond with the courses of mental illness as we know them today. There is a very high tendency to develop chronic symptoms. 25 patients lived temporarily or permanently like prisoners, locked in and/or tied up, some of them in repellent conditions. This study disproves the following hypotheses: 1. that the symptoms and the course of psychiatric illnesses have changed significantly since the last century, due to the development in civilisation; 2. that the absence of psychiatric hospitalism and psychiatric labelling prevents the worst and most characteristic kind of schizophrenic and affective disorders and their chronification; 3. that the mentally ill were better cared for in a pre-industrial and agricultural society without psychiatric care such as the community described in the Fribourg report.

Castration induces a marked reduction in the incidence of thyroid cancers

Although thyroid disease in humans predominates in females, the prognosis of thyroid cancer in males is much less favorable. To further explore the role of male sex hormones, we utilized the experimental model of radiation-induced follicular cancer in the rat, studying the effects of castration on tumor development. Microscopic evidence of tumor formation was correlated with the biochemical parameters serum thyroxine (T4), thyrotropin (TSH), and thyrocalcitonin (TC) at 24 months. The incidence of follicular carcinomas in intact males ws 58%, compared to 28% in comparable females. Castration of males caused a reduction in the incidence to 22%. Mean circulating levels of TSH were markedly elevated in all three irradiated groups. Mean T4 levels were reduced significantly only in irradiated castrated animals. TC levels were reduced in all irradiated groups. We conclude that although elevated levels of TSH probably play a significant role in the development of radioactive iodine-triggered follicular thyroid neoplasms in the rat, male sex hormone may also play an important role beyond their known effect on basal and thyrotropin-releasing hormone-stimulated TSH.

[Treatment trials with hemofiltration/hemodialysis in pernicious catatonia]

Two juvenile patients affected for the first time with pernicious catatonia were treated repeatedly with combined hemofiltration and hemodialysis. During the first two or three sessions, the distinct psychopathological improvement only persisted during the session itself and in a lesser degree during the following hours. It was only after further treatments that the therapy effect lasted longer and passed over into a continuous remission tendency. The findings might support a toxin hypothesis (in a broad sense) with respect to the genesis of catatonia and encourage a continuation of the studies.

[The status of extracorporeal detoxication procedures as a therapy method in schizophrenia]

The literature on the problem of extracorporeal detoxication in chronic schizophrenia was critically studied. For the statistically considered 132 cases of chronic schizophrenia without uraemia treated with haemodialysis, haemoperfusion and haemofiltration which are published in the literature (including 12 own cases) it was found that 38 per cent are considered as improved. The insufficient comparability of the examination methods and the want of clearness with respect to the specific therapy influence (placebo effect, etc.) leave the question open whether these are in fact efficient methods of treatment for some cases of chronic schizophrenia. A final decision on this requires continued, methodically more strictly controlled, and above all standardised examinations. The results obtained until now make efforts in this direction appear reasonable.

Subtotal parathyroidectomy: normalization of circulating parathormone

Subtotal parathyroidectomy was performed in 52 consecutive patients with primary hyperparathyroidism. The postoperative results, 6-24 months following the operation, were evaluated according to a calcium-parathormone normogram. In 48 patients the values returned to the normal zone. Two patients had persistent hypercalcemia. The other two patients remained in the hyperparathyroid zone of the normogram, with moderate elevations of serum parathormone, in spite of normocalcemia. The significance of the failure to achieve normal circulating parathormone levels in patients with postoperative eucalcemia is discussed. The importance of serum parathormone and calcium relationship in the evaluation of patients following parathyroidectomy is emphasized.

[Increasing suicides of psychiatric inpatients: reality or artefact? (author's transl)]

In several countries the suicide rate for psychiatric inpatients has increased more than that for admissions and suicides in the general population. This was also the case in our clinic. This hypothesis was tested: today, because of more liberal management, suicides are committed during hospitalization that in an earlier and more restrictive age would have taken place after discharge. All suicides taking place 1960-1979 in the clinic's main catchment area were examined for previous hospitalization. The hypothesis was not supported. Over twenty years neither the suicide cases nor all discharged patients changed significantly in distribution of age, sex, number of previous admissions, duration of hospitalization, or diagnosis. Therefore, none of these variables explain the increase. In both decades, on the other hand, patients that committed suicide during their stay at the clinic had been hospitalized longer; those that committed suicide within three months after discharge had been hospitalized for a shorter time than the sum of discharged patients. Among the suicides that occurred after discharge, the percentage of depressives and addicts was higher and the percentage of schizophrenic patients was smaller than among all discharged patients. A change in patient management (more time off, more working outside, more open wards) has preceded the increase in suicides; medical staff, however, has doubled over the decades considered here. Rising pressure for resocialization to avoid hospitalism may heighten suicidal behavior. Preventive measures are discussed.

[The increase in suicide in psychiatric hospitals. Facts, causes and prevention]

In the psychiatric clinics of five countries and in ours as well, suicides have significantly increased since the twenties, and many times more than in the general population. This trend is probably not due to change in the sociographic and diagnostic composition of admitted patients but to more liberal hospital treatment and more active rehabilitation. In order to prevent suicide in the clinic, it has to be kept in mind that what proves to be an asset for the great majority of patients may be detrimental for a minority.