Steroid receptors and proliferative activity in non-neoplastic and neoplastic endometria

In the glands of cyclic endometria, proliferative activity (PA), as revealed by expression of the Ki-67 antigen, is highest in the proliferative phase (P) and early secretory phase (S1). The PA decreases in the middle secretory phase (S2). In the stroma the PA is low during the whole cycle. In P and S1, the oestrogen receptor (ER) and the progesterone receptor (PR) are strongly expressed in glands and stroma. The number of positive cells and the staining intensity decreases in S2, particularly in the glands. In atrophic endometria, fibro-glandular polyps and in endometria with arrested secretion the PA is low in both glands and stroma. ER and PR can be detected in glands and stroma. The PA in atypical hyperplasias is only slightly higher than in cyclic endometria and endometria with simple hyperplasia. The ER and PR levels are comparable to those in proliferative endometria. The PA of endometrial adenocarcinomas is positively and the ER and PR negatively correlated with the degree of de-differentiation. No ER-negative carcinoma displays the PR. Immunohistologically, non-neoplastic receptor positive tissue can be seen in many ER- and PR-negative carcinomas. These structures may falsify the biochemical receptor analysis.

Enzyme linked immunosorbent assays (ELISA) for the quantitative determination of human leukocyte collagenase and gelatinase

A competitive and a sandwich enzyme linked immunosorbent assay (ELISA) were developed for human leukocyte collagenase and gelatinase. The competitive assay could detect 0.5 ng collagenase and 0.05 ng gelatinase. The detection limit of the sandwich ELISA was 0.05 ng for collagenase and 0.02 ng for gelatinase. No cross reactivity between human leukocyte collagenase and gelatinase was detected. The sandwich ELISA was used to determine plasma levels of these enzymes. The 90% range for collagenase was between 0 and 50 micrograms/l; the 90% range for gelatinase was between 27 and 94 micrograms/l.

Functional characterization of monoclonal antibodies directed against fibrin binding domains of tissue-type plasminogen activator

Fibrin interacts with tissue-type plasminogen activator (tPA) via the finger and the kringle 2 domains. Three monoclonal antibodies against tPA, designated MPW3VPA, MPW6VPA, and MPW7VPA, which react with epitopes in the tPA molecule involved in fibrin binding, were characterized. The IgM monoclonal antibody MPW6VPA, directed against an epitope close to the finger and epidermal growth factor domains, stimulated plasminogen activation only in the absence of CNBr-fibrinogen fragments by increasing kcat in a dose-dependent fashion, an effect which was not restricted to the intact molecule. These results suggest that MPW6VPA mimics the initial effect of fibrin bound to the tPA molecule, which results in a change of kcat values. The MPW6VPA effect was reversed by another antibody, MPW3VPA, also directed against epidermal growth factor and finger domains. The latter antibody also inhibited plasminogen activation by tPA in the presence of CNBr-fibrinogen fragments in a dose-dependent, apparently noncompetitive way. No effect of MPW3VPA was seen in the absence of CNBr-fibrinogen fragments. MPW7VPA directed against kringle 2 of tPA inhibited plasminogen activation by tPA only when CNBr-fibrinogen fragments were present. This inhibition was apparently competitive and dose-dependent. These data suggest that MPW3VPA interferes with the first phase of fibrin binding to tPA, whereas MPW7VPA interferes with the second phase of fibrin binding to the tPA molecule via kringle 2, resulting in Km changes.

[Enzyme diagnosis in progressive muscular dystrophies, especially in the Duchenne type]

The serum activities of muscular enzymes are important for the diagnosis and follow-up of muscular diseases. They reflect the degeneration of muscular tissue. The serum enzyme activities (creatine kinase (CK), creatine kinase MB (CKMB), Aldolase (ALD), Lactat-dehydrogenase (LDH), a hydroxy-buty-rat-dehydrogenase (a-HBDH), glutamat-oxalacetat-transaminase (GOT), and glutamat-pyruvat-transaminase (GPT) in Duchenne muscular dystrophy show an increase during the first three years of life, a maximum between the age of 3 and 4 and an asymptotic decline thereafter. Taking the blood samples under non-standardised conditions the coefficients of variation (VK) differed considerably. For a -HBDH the lowest value was obtained (VK = 0.37). The VK-value of ALD was comparatively high (VK = 0.68). The correlation among the enzymes themselves was high and a-HBDH correlated closest to LDH and a-HBDH also to GPT. Thus we conclude that LDH, ALD- and GPT-determinations may be abandoned in Duchenne dystrophy. In Duchenne muscular dystrophy the course of the different enzyme activities can be described by an heuristic mathematical formula (y = Ae-at + bte-ct). With its aid it is possible to calculate the value of the constant c individually for each patient, if at least 4 enzyme values distributed over 3 or more years are available. The evaluation of the enzymes and clinical data of 88 Duchenne patients has shown that the value of constant c is individually correlated to the speed of progression of the disease. This proved most reliable in the case of the CK (r = 0.43 resp. 0.76) and CKMB (r = 0.45). The mean of the constant c in the group of Duchenne patients (n = 88) was -0.29/year, in Beckers dystrophy (n = 7) -0.14/year and in limb girdle dystrophy (n = 12) -0.21/year. In Duchenne muscular dystrophy the calculation of constant c renders it possible to select patients with similar velocity of progression to reinforce the "power of therapeutic studies". The evaluation of pilot studies may be more objective, if the enzyme values actually measured under therapy are compared with those prospectively estimated by mathematical analysis of the course of the enzyme values before treatment.

A double-blind placebo controlled trial of diltiazem in Duchenne dystrophy

The role of calcium accumulation in the pathogenesis of Duchenne muscular dystrophy (DMD) has already been discussed. Several trials with different calcium-blocking drugs have revealed no clinical benefit. In addition, the present study includes histological investigations and computer tomography to verify therapeutic effects. In a randomized placebo-controlled double-blind study, 13 DMD patients aged from 3-10 years (mean, 7 years) were treated with 5 mg/kg diltiazem daily for 1 year. Compared with before therapy, the number of calcium-positive muscular fibres was remarkably reduced in the treated DMD patients, but not in the placebo group. The evaluation of all other biochemical and clinical parameters revealed no significant effects of the diltiazem therapy. The muscular X-ray density measured by computer tomography decreased under treatment. After the evaluation of the double-blind study, the code was broken. Therapy, however, was continued in the treated group and started in the placebo group. After 3 years of diltiazem therapy the clinical status of all 26 patients of the study and 20 additional DMD patients who were treated with diltiazem was compared with 46 untreated DMD patients of the same age and stage in our department. No obvious clinical benefit of diltiazem therapy could be observed.

Plasminogen activation by tissue plasminogen activator in the presence of stimulating CNBr fragment FCB-2 of fibrinogen is a two-phase reaction. Kinetic analysis of the initial phase of slow plasmin formation

Plasminogen activation by tissue-type plasminogen activator (t-PA) is stimulated by fibrin. In a purified system maximal fibrin-enhanced plasmin formation occurs with a delay after an initial phase of slow plasmin formation (lag phase). In the present study purified stimulating CNBr-fragment FCB-2 of fibrinogen was used, and kinetics of plasminogen activation by t-PA were analyzed with respect to the lag phase. At constant FCB-2 concentration the duration of the lag phase decreased with increasing concentrations of t-PA and plasminogen. During this period the rate of plasmin formation/min increased linearly with time with a slope dependent on the initial concentrations of FCB-2, plasminogen, and t-PA. Plasmin pretreatment of FCB-2 resulted in a dose- and time-dependent shortening of the lag phase, and at plasmin concentrations greater than or equal to 1 nM and preincubation times greater than or equal to 3 min maximal plasmin formation occurred without a lag phase. Kinetics during the phase of maximal and constant plasmin formation were not influenced by plasmin pretreatment of FCB-2. We therefore conclude that maximal t-PA-dependent plasmin formation in a system stimulated by purified FCB-2 requires plasmin modification of FCB-2.

A mathematical analysis of creatine kinase activity in the course of Duchenne muscular dystrophy

Recently, clinical follow-up studies have shown that the age of first symptoms and the speed of progress may vary considerably in Duchenne muscular dystrophy (DMD). Prognostic factors would be of interest not only for the patients themselves, but also for the selection of DMD patients for therapeutic studies. Creatine kinase (CK) activity reflects the dystrophic degeneration of the muscle cells. Therefore, the coherence of the course of CK activity and its relationship to the clinical state was investigated with the aid of a heuristic mathematical formula. Two constants were calculated, b and c. The data of 88 DMD patients proved the validity of the mathematical formula. Constant b seemed to be of no clinical relevance. The height of constant c was related to the age at which the ability to walk was lost (r = -0.76). This constant provides an objective individual assessment of the prognosis in DMD. In addition, the mathematical analysis of the CK course opens the way for a prospective CK estimation, which is relevant for the evaluation of therapeutic trials.

Pharmacological studies on the intrinsic sympathomimetic activity of the beta-adrenoceptor antagonist mepindolol

1-Isopropylamino-3-(2-methyl-4-indolyloxy)-2-propanol (mepindolol, Corindolan) is a beta-adrenoceptor antagonist with significant intrinsic sympathomimetic activity (ISA): positive chronotropic effects in atria of the rat amount to 24% of those elicited by the full agonist isoprenaline. Relaxant effects in blood vessels approach 50% of those of isoprenaline. This vasorelaxant effect is completely blocked by the specific beta 2-adrenoceptor antagonist ICI 118 551 (erythro-dl-1-(7-methylindan-4-yloxy)-3-isopropylaminobut an-2-ol), suggesting that the vasodilatory effects of mepindolol are elicited by stimulation of vascular beta 2-adrenoceptors. In the anaesthetized cat mepindolol acutely lowers arterial blood pressure by reducing total peripheral resistance without exhibiting significant cardiodepressant action, whereas propranolol, lacking ISA, lowers blood pressure by a marked reduction of cardiac output and left ventricular contractility, however, total peripheral resistance is significantly increased.

[Recent clinical knowledge of cytoplasmic substances in myogenic and neuromuscular diseases, especially in muscular dystrophy, Duchenne type]

Up to now there has been no known causal therapy of numerous myogenic and neuromuscular diseases. Among other disorders the genetic muscular dystrophies--especially the malignant Duchenne type, as well as the spinal and neuromuscular dystrophies--cause considerable problems in therapy. Nevertheless there are possibilities of positively influencing the clinical picture and course of the disease by skillful physical training and symptomatic medication. It is sometimes possible, by means of such therapy, to obtain--within limitations imposed by irreparable lesions-stabilization of the clinical state with prolongation of walking ability and amelioration of other motor functions. Nevertheless, such improvement is only transient, because in all patients the process progresses sooner or later. Significant effects were registered of so-called cytoplasmic substances or "biological response modifiers" (particles of protoplasm consisting of nuclei, mitochondria, microsomes and membranes of fresh organic material from healthy young animals and animal fetuses) in an uncommonly large collective of boys with Duchenne muscular dystrophy, as evaluated by follow-up control of the serum enzyme index and creatinine creatine excretion rate. The role of calcium and the possible effect of proteinase-inhibitors are discussed among other pathogenetic aspects. Reference is also made to potential therapeutic effects of cytoplasmic substances in spinal and neuromuscular atrophies on the basis of initial preliminary clinical experience in this field.

Pharmacokinetics and pharmacodynamics of the stable prostacyclin analogue, ZK 36 374, in the cat

The pharmacokinetics and the pharmacologic effect on blood pressure and heart rate of ZK 36 374 were studied simultaneously in the unanaesthetized cat following intraarterial injection of 20 micrograms/kg of tritium-labelled drug. After a rapid distribution phase the plasma level of radioactive substances declined with a half-life of 44 min. The disposition of the unchanged drug was biphasic with half-lives of 7 min and 36 min. 1.5 min after injection, the systolic and diastolic blood pressures were depressed by 40 and 57% and the heart rate rose by 18%. The kinetics of the pharmacologic action was biphasic and strictly parallel to the plasma drug level. Accordingly, there was a highly significant (p less than 0.001) logarithmic correlation between the blood pressure depression and the concentration of unchanged ZK 36 374 in the plasma. ZK 36 374 was totally metabolized and excreted nearly equally with urine and feces in the form of more than eight metabolites.

Early and late administration of a PGI2-analogue, ZK 36 374 (iloprost): effects on myocardial preservation, collateral blood flow and infarct size

A number of investigations have reported that prostacyclin or prostacyclin analogues protect the ischaemic myocardium when administered early after myocardial ischaemia. Thus far, there are no reports describing whether these substances exert a cardioprotective effect when administered later than 0.5 h after coronary artery occlusion. Adult cats were subjected to acute coronary artery ligation for 5 h and administered the vehicle or ZK 36 374 (iloprost) (1.19 micrograms X kg-1 X min-1), a prostacyclin analogue, beginning at 0.5, 2 or 4 h. Compared with the MI-vehicle cats, ZK 36 374 prevented a decrease in myocardial creatine kinase specific activity, the loss of free amino nitrogen and the fall in percentage bound cathepsin D in the ischaemic area when infusion was started at 0.5 or 2 h (P less than 0.05). In addition ZK 36 374 started at 4 h still showed a significant protective effect against myocardial creatine kinase specific activity and amino nitrogen concentrations but not against cathepsin D. In a separate group of animals, regional myocardial blood flow and late coronary resistance were determined with radioactive labelled 15 +/- 1 micron microspheres. ZK 36 374 consistently reduced late diastolic coronary vascular resistance and increased coronary blood flow in nonischaemic regions of the myocardium (P less than 0.05) but only attenuated the further increase in late coronary resistance in the ischaemic myocardial regions. The infarcted area (NTB-staining) amounted to 9% of the total left ventricle after 5 h and was not reduced by ZK 36 374 (P greater than 0.05). In conclusion, ZK 36 374 exerted a significant biochemical cardioprotective effect when administered to 0.5, 2 or 4 h. The mechanism of cardioprotection does not appear to be due to increased myocardial perfusion but rather to some direct cellular action whose exact nature has yet to be elucidated.

[Mitral valve insufficiency in coronary heart disease]

On 121 consecutive patients with coronary heart disease coronary angiography and quantitative left ventricular angiography was done with the view to aortocoronary bypass surgery. 24 (20%) had mitral regurgitation (MR) by angiographic criteria, 20 of them had MR grade I/IV, four had MR II/IV. In 23 out of 24 patients with MR quantitative left ventriculography revealed localized contraction disorders. MR was clinically diagnosed in 15 out of 24 patients. In eleven patients (48%) contraction abnormalities were localized in the inferior wall, in five cases (22%) in the anterior wall and in seven cases (30%) both in the anterior and posterior wall. Of the latter group patients with MR showed a significantly lower ejection fraction than patients without MR (p less than 0.05). Furthermore the MR-group showed larger akinetic areas, preferentially located in the inferior segments 0 degrees-240 degrees and in the anterolateral segments 60 degrees-90 degrees. Three vessel disease was more frequent in this group (43%) than in the group without MR (23%). Patients with inferior wall asynergy frequently showed combined stenosis or occlusion of the right and circumflex coronary artery. In conclusion, MR in coronary heart disease is most often associated with localized contraction disorders of the left ventricle; posterior wall infarctions, multiple vessel disease and large akinetic areas are more frequent. However, the hemodynamic significance of MR in patients with chronic myocardial infarction is usually insignificant.

[Significance of the E point-septum distance for the evaluation of left ventricular function in coronary disease--a study using M-mode echocardiography]

In 121 patients (pts) with angiographically proven coronary artery disease, left ventricular (LV) cineangiograms were quantitatively evaluated. 79 pts showed regional wall abnormalities. In this group the relationship between echocardiographic parameters of global (LV) function (mitral-septal separation, systolic and diastolic diameter, and fractional shortening) and ventriculographic parameters was investigated. Mitral-septal separation showed the best correlation to the angiographic ejection fraction (EF) (r = -0.72). The measurement of this parameter allows the diagnosis of a reduced EF independently of the dilatation of the left ventricle, and is easy to perform and to reproduce. Mitral-septal separation discriminated well between the reference group and all infarction subgroups (posterior wall, anterior wall, and double infarction) with reduced EF. The modification of the mitral-septal separation measurement according to D'Cruz et al. showed no advantage over that proposed by Massie et al. Both are clearly dependent upon septal excursion, which has to be taken into consideration when mitral-septal separation is being evaluated. The sensitivity of mitral-septal separation (greater than 7 mm) for the detection of reduced LV function (less than 55%) was 0.66; the specificity was 0.80. There was greater sensitivity for anterior wall infarctions than for posterior wall infarctions (0.73 vs 0.44). Because of the relatively high number of false negatives, only a pathologic mitral-septal separation is diagnostically useful.

[Qualitative and quantitative analysis of regional contraction disorders using levocardiograms]

In 74 patients with proven myocardial infarction (typical history and enzymes, diagnostic ECG, and stenosis of the vessel supplying the asynergic region of more than 75%) the results of qualitative analysis of left ventricular cineangiograms were compared to those of quantitative analysis using the radial axis method of Mathes. There was a significant difference in interpretation between the two methods if the physiological movements of the heart were not taken into account in the qualitative analysis. After correction for systolic anterior movement and downward movement of the aortic valve during systole, a mean accuracy of 92% resulted. The radial axis method discriminated well between normokinetic and asynergic wall segments. However, this method proved less useful for the detection of asynergies in the apical, anterobasal, and posterobasal regions. A radial axis angle of between 15 degrees and 20 degrees is considered to be optimal. The quantitative analysis seems to be particularly useful for the interpretation of borderline cases, and should be carried out routinely in addition to the qualitative analysis.

[Electrocardiogram and M-mode echocardiography in the diagnosis of chronic transmural infarct. Correlations and determination of the accuracy of both methods based on quantitative levocardiography]

In a comparative study of 121 consecutive patients who had had coronary angiography for coronary heart disease, the diagnostic informations obtained by M-mode echocardiography and electrocardiography in chronic transmural infarction were compared. Wall excursion by echocardiography did not allow sufficient separation of normal and asynergic segments. Changes in systolic wall thickness, on the other hand, provided satisfactory sensitivity and good specificity in the recognition of segmental contraction disorders: posterior wall thickening of 0.64 and 0.76, respectively, septal thickening of 0.45 and 0.91, respectively. In 53% of patients the ECG and echocardiogram provided findings similar to those by angiography. False-positive findings occurred in 10% of electrocardiograms, 14% of echocardiograms. False-negative findings in the ECG occurred in 13%, in the echocardiogram in 25%. Both methods combined had a specificity of nearly 100% with regard to the diagnosis of posterior-wall and anterior-wall infarction, and a positive predictive value of 0.92 (posterior) and 0.93 (anterior wall infarction). M-mode echocardiography and ECG findings provide reliable diagnosis of both the anterior and posterior wall chronic transmural infarction.

[Electrocardiography and quantitative levocardiography in chronic transmural infarct. A correlative study]

For evaluation of a connection between the electrocardiographic diagnosis and localisation of chronic infarction and the angiographic results left ventriculography data of 97 patients with coronary heart disease were assessed quantitatively according to the method of Mathes. According to electrocardiographic criteria of infarction six subgroups were distinguished: anteroseptal, anterior, anterolateral, inferior, inferiolateral, and posterolateral. Asynergies were demonstrable in 87% of patients with infarct electrocardiograms, normal ventricular function was seen in 80% of patients without infarct ECG. Asynergies were seen in 75% of electrocardiographically diagnosed anterior wall infarcts and in 92% of posterior wall infarcts. The sensitivity of the ECG in chronic infarction was 83%, the specificity 84%. Pronounced differences in the number of involved segments were found between inferior and inferiolateral infarction. In contrast, no clear-cut differentiation of electrocardiographic findings judged by segmental involvement in the left ventriculography was seen for the anterior wall. The extent of the anterior wall infarction diagnosed by electrocardiography did not correlate with results of left ventriculography. The ECG is a suitable means for detection of segmental disturbances of contraction also in the chronic infarction stage. However, localisation and extent of the lesion can only be assessed within limits.

Adrenal insufficiency, myopathic hypotonia, severe psychomotor retardation, failure to thrive, constipation and bladder ectasia in 2 brothers: adrenomyodystrophy

Two brothers are described who manifested primary adrenal insufficiency, dystrophic myopathy, severe psychomotor retardation, failure to thrive, fatty degeneration of the liver, megalocornea, chronic constipation, and terminal bladder ectasia until their death at 3 8/12 and 1 7/12 years, respectively. The differential diagnosis to similar syndromes is discussed. This combination of problems apparently has not yet been described. The term adrenomyodystrophy is suggested.

[Comparative studies of transplant reaction of differently preserved corneas in perforating keratoplasty of rat eyes]

We examined the healing process of transplanted rat corneas in relation to the swelling of the grafts. Rat corneas were stored parallel in Macrodex 6% (Knoll) and MK medium (McCarey and Kaufman) at 4 degrees C for 48 h and successively applied in penetrating keratoplasty. The healing process was investigated by observation with a slit lamp and histological methods. Graft swelling before transplantation did not influence the healing process. We concluded that decreased graft swelling is not paralleled by improved wound healing in rat corneas. This phenomenon confirms our previous observations of bovine corneas, that decreased water uptake in vitro is not paralleled by increased vitality of the corneas.

The geniculocortical system in the early postnatal kitten: an electrophysiological investigation

The transmission of neuronal impulses in the central visual system in kitten 7-42 days old has been investigated using electrophysiologic techniques. It was found that shortly after birth the axonal conduction velocities in the geniculocortical, in the corticogeniculate and in the commissural pathways of areas 17, 18, and 19 are less than 1.2 m/s, increasing up to maximal 10 m/s at the end of the first postnatal month. The monosynaptic delays across geniculocortical and commissural synapses in area 17 as measured during the third and fourth postnatal week are extremely long (between 2.8 and 6.1 ms) and do not change significantly during this time. During the first postnatal month, visual cortical neurons fatigue rapidly to visual and electrical stimulation; also, the proportion of neurons receiving polysynaptic inputs is much smaller than in the adult animal. Accordingly, neurons having complex receptive fields are rarely found in area 17 during the first postnatal month. Our experiments show that the geniculocortical and also the intracortical transmission of neuronal impulses are still immature at the end of the first postnatal month; at this time the systems for orientation and direction selectivity in the visual cortex are almost fully developed.

[Treatment of gonarthrosis]

In an open study in 89 out-patients the effect of superoxide dismutase (Orgotein) in gonarthrosis (n = 75), post-operative or post-traumatic irritation (n = 8) and chondropathy (n = 6) was investigated. Orgotein (4 mg) was give intra-articularly once weekly for several weeks. The overall rating showed efficacy of this new antiphlogistic compound in 81 out of 89 patients (91%). In eight patients the results of treatment were insufficient. In 65 (80%) out of the 81 successfully treated patients no relapse appeared. Six patients reported reappearance of slight complaints so that in 75 out of 81 successfully treated patients, even after repeated controls, a long lasting pain relief could be achieved. Only in three cases the tolerance of Orgotein was not assessed as "very good" ("good" in one case and "moderate" in two cases). The patients reacted--despite good tolerance of the first injections--after the 4th or 5th injections with irritation and swelling as well as effusion; these symptoms were reversible within 24 hours.

Serum levels of myoglobin and creatine kinase in Duchenne muscular dystrophy

Using a sensitive myoglobin-radioimmunoassay (Mb-RIA) serum Mb was measured in 50 patients with Duchenne muscular dystrophy (DMD) and compared with the serum creatine kinase (CK) activities. The Mb concentrations (normal range 4-60 ng/ml) measured ranged between 160-6,000 ng/ml and did not only show a significant correlation to the CK but also an inverse relationship to the age of the patients. It is suggested that Mb is an essential adjunct in the diagnosis of DMD.

Second and third visual areas of the cat: interindividual variability in retinotopic arrangement and cortical location

1. The cortical location and the retinotopic arrangement of the second (V2) and third (V3) visual areas in the cat have been investigated with single and multiple unit recordings in anaesthetized and immobilized animals.2. V2 and V3 are arranged side by side anterior and medial to V1 and occupy the lateral gyrus and the postlateral sulcus. In addition, V2 spreads to postlateral parts of the lateral sulcus and, occasionally, to the posterior suprasylvian gyrus. The contralateral lower hemifield is represented on the lateral gyrus, the area centralis and the horizontal meridian are found in most animals in the anterior part of the postlateral sulcus, and the representation of the upper hemifield occupies the posterior part of the postlateral sulcus.3. The detailed retinotopic arrangement of the visual field maps shows two characteristic features. First, the retinotopy at the V2/V3 border differs between lower and upper hemifield. In the lower hemifield the periphery of the fields is represented, whereas in the upper hemifield the border between the representations is formed by a sector running along the horizontal meridian about 5-10 degrees in the upper hemifield. Thus the lower field arrangement resembles that of rodents, and the upper field arrangement is similar to that of primates. Secondly, the periphery of a part of the visual field is not continuously represented, but forms patches or islands (Donaldson & Whitteridge, 1977). The islands are bounded by visual field representations closer to the vertical meridian. The way the visual field is represented at the border between V2 and V3 introduces discontinuities into the visual field maps: adjacent parts of the visual field are not represented adjacently in these two prestriate areas.4. Cortical location and detailed retinotopic arrangement vary considerably from animal to animal, so that a representative map of V2 and V3 cannot be constructed. For example, the representation of the periphery of the horizontal meridian may be located either in the anterior portion of the postlateral sulcus or some mm more posteriorly, where the sulcus turns laterally. The representation of the area centralis in V3 is found either at the transition zone between lateral and postlateral sulcus, on the posterior suprasylvian gyrus, or in the posterior part of the postlateral sulcus.5. The entire hemifield is represented in V2 at least in some animals. In V3 the uppermost part of the vertical meridian seems not to be represented. In other animals only a restricted part of the contralateral visual field is represented in V2 or in V3. In these cases the receptive fields cover not more than 50 degrees out in the lower hemifield or on the horizontal meridian. In a few cases the periphery of the horizontal meridian and the upper hemifield are not at all represented in V3, or only in an incomplete manner.6. The magnification factors (Daniel & Whitteridge, 1961) become progressively smaller from V1 to V2 to V3. Hence cortical volume occupied decreases from V1 to V3. In V1 and in V2 the magnification is highest along the lower vertical meridian. In V2 the magnification along the horizontal meridian is the smallest, whereas in V1 the magnification decreases progressively from the lower vertical, to the horizontal and to the upper vertical meridian. The relationship between retinal ganglion cell densities and cortical magnification factors is discussed.

[Screening for elevated creatine kinase activities for the early diagnosis of Duchenne muscular dystrophy]

A screening test for the determination of creatine kinase in a dry spot of the whole blood is used for the early identification of boys with Duchenne muscular dystrophy and girls with carrier properties of this hereditary disease. In the absence of an effective medical therapy, such screening leads to genetic counselling of the affected families with the purpose of avoiding the birth of further cases of Duchenne muscular dystrophy in the same families. The first results of a voluntary screening program in Germany are discussed.

[Cardiomyopathy in Duchenne muscular dystrophy. Part 2: serum enzymes, vector-cardiography, and echo-cardiography in 143 patients (author's transl)]

To diagnose a possible latent or manifested cardiomyopathy, 143 male patients between 2 and 21 years of age with confirmed Duchenne muscular dystrophy were examined for serum enzymes, by electrocardiography, vector-cardiography, and echo-cardiography. The results contain information on 1. the quantitative cellular myocardial degeneration process, 2. the disturbed cellular depolarization and nerve-conduction processes in the area of the right and left ventricular myocard, and 3. the disturbed left ventricular function which, in the initial state, is only documented by a discrete decrease of contractility caused by a manifested decreased ejection output. The pathological contraction and relaxation process of the heart muscle cell and its dependency on calcium ion transport as pathogenic background is discussed.

Creatine kinase in human erythrocytes: a newly detected genetic anomaly

In a family of Italian origin, we found four members with a considerable activity of creatine kinase inside their erythrocytes. All other clinical and hematological findings were normal. The enzyme anomaly seems to be inherited in the autosomal mode. The creatine kinase CK) activity in freshly drawn blood was about 12 U/g Hb. The activity was higher in young red cells than in older ones. Studies with specific antibodies against human CK isoenzymes revealed the CK activity in the probands' red cells to be due to about 90% to the BB-isoenzyme normally found in brain and nerve tissue. The presence of CK in the erythrocytes does not seem to have any consequences for the energy metabolism of the cells. Creatine concentration was slightly elevated, but creatine phosphate could not be detected.

Creatine kinase isoenzyme patterns in Duchenne muscular dystrophy

Serum creatine kinase isoenzymes were studied in 41 patients suffering from Duchenne type muscular dystrophy and 20 mothers of patients (carriers) by cellulose acetate electrophoresis. Both the MM and MB types were found in all cases of Duchenne type dystrophy patients, and in carriers with highly elevated total creatine kinase activity BB was not observed above the detection limits of the methods used. However, a so-called atypical CK--BB band has been demonstrated.

[Duchenne-type muscular dystrophy: problems, early diagnosis, early treatment (author's transl)]

The aetiology and pathogenesis of the Duchenne-type muscular dystrophy (pseudohypertrophic muscular dystrophy) are still largely unknown. The possibilities of treating the disease are rather limited. Treatment is the more successful, the earlier diagnosis was possible, and the earlier treatment is initiated. The CK-Screening Test is an important aid for early diagnosis. The CK-Screening Test is also valuable for genetic consultation and advice, because it helps to identify women who are conductors or carriers of the disease. Current hypotheses on aetiology and pathogenesis are mentioned. Progress made in the fields of biochemistry, including enzyme histochemistry, and electron microscopy, raise hopes of finding more efficient therapeutic possibilities in the future. The many interests of patients with muscular diseases are being looked after by the European Alliance of Muscular Dystrophy Associations (EAMDA). Thirteen European associations are members of this organisation, including the German association "Bekämpfung der Muskelkrankheiten e.V." The number of sponsoring members of the EAMDA is at present about 300,000. 3 international congresses have already been held on the problems of muscular diseases. The fourth congress is scheduled to take place in Montreal in 1978.

Freeze-fracturing studies of mitochondrial myopathy. A correlated clinical, biochemical and morphological investigation

Freeze-fracture studies of pathologically changed mitochondria in situ from muscle biopsies of a 9.5-year-old girl with a mitochondrial myopathy were correlated with clinical, biochemical and histochemical investigations. In the ultrathin sections giant mitochondria with densely packed cristae membranes - often reoriented to concentric circles - and, in addition, paracrystalline mitochondrial inclusions were found. The freeze fracture faces of such transformed mitochondria and preparations of their inner and outer membranes provided a morphological insight in the macromolecular structure of the mitochondrial membrane under such pathological conditions. The results lead to the hypothesis that part of the transformed mitochondria stay active functionally for an extended period by maintaining the delimitation from the cytoplasm and by preserving the macromolecular membrane architecture. This hypothesis could explain the slow progression of the myogenic symptoms.

[Liver disease in homozygous alpha1-antitrypsin deficiency (author's transl)]

Among twelve patients with homozygous alpha1-antitrypsin deficiency (Pi-type Z), five cases of infantile liver disease were diagnosed. The course of the disease was extremely variable; only one patient died of liver cirrhosis at the age of fourteen. In four cases the clinical, biochemical and histological (2 cases) findings became normal over a follow-up period of one to fifteen years. The results of these observations demonstrate that in alpha1-antitrypsin deficiency even when associated with proven liver disease the prognosis need not be unfavorable.