Antioxidant inhibition of porphyrin-induced cellular phototoxicity

Porphyrins such as protoporphyrin IX (PP IX) and uroporphyrin I (UP I) can be phototoxic to human cells. To study the protective ability of antioxidants (beta-carotene, lycopene, ascorbic acid and alpha-tocopherol), against such porphyrin phototoxicity, membrane destruction experiments (Jurkat cells) and human cell cultures (fibroblasts) were performed. Both beta-carotene and lycopene and also the combination of beta-carotene, ascorbic acid and alpha-tocopherol offered cell protection against PP IX phototoxicity. Investigations of both cell membrane protection and of cell growth showed differences in terms of the protection afforded by the anti-oxidants. Thus, for PP IX, carotenoids alone, and in combination with ascorbic acid and alpha-tocopherol, showed higher protection factors in general than UP I. However, for membrane protection there was significant protection against UP I by the combination of beta-carotene, ascorbic acid and alpha-tocopherol but not by any of these anti-oxidants alone. The membrane protection against PP IX by beta-carotene, and especially lycopene, is significant presumably because of the high lipophilicity of all these molecules. However, the hydrophilic UP I will cause phototoxicity mainly via H(2)O(2), radical or singlet oxygen production in the aqueous phase, and these reactive species may be generated some distance from the cell membrane. This may lead to the little or no protection observed for UP I by the individual antioxidants. Nevertheless, a combination of beta-carotene, ascorbic acid and alpha-tocopherol offers membrane protection against the phototoxicity of both porphyrins. This is believed to occur as a result of synergistic processes. Our results suggest that the treatment of porphyria cutanea tarda and erythropoietic protoporphyria may be improved by the use of a combination of the antioxidants studied.

Short-term and long-term outcomes after bilateral lung volume reduction surgery : prediction by quantitative CT

OBJECTIVES

To evaluate selection criteria and duration of benefit for patients undergoing lung volume reduction surgery (LVRS).

METHODS

Eighty-nine consecutive patients with severe emphysema who underwent bilateral LVRS were prospectively followed up for up to 3 years. Patients underwent preoperative pulmonary function testing, 6-min walk, chest CT, and answered a baseline dyspnea questionnaire. CT scans in 65 patients were analyzed for emphysema extent and distribution using the percentage of emphysema in the lung, percentage of normal lower lung, and the CT emphysema ratio (CTR, an index of the craniocaudal distribution of emphysema). All patients underwent at least 6 weeks of pulmonary rehabilitation prior to surgery. Outcome measures were FEV(1), 6-min walk distance, and transitional dyspnea index (TDI).

RESULTS

Compared to baseline, FEV(1) was significantly increased at 3, 6, 12, 18, 24, and 36 months after surgery (p < or = 0.008). The 6-min walk distance increased from 871 feet (baseline) to 1,110 feet (3 months), 1,214 feet (6 months), 1,326 feet (12 months), 1,342 feet (18 months), 1,371 feet (24 months), and 1,390 feet (36 months) after surgery. Despite a decline in FEV(1) over time, 6-min walk distance was preserved. Dyspnea as measured by TDI improved at 3, 6, 12, 18, 24, and 36 months after surgery. A high CTR was the best predictor of a 12% increase over baseline and an absolute increase of 200 mL in FEV(1), although with a low area under the receiver operating characteristic curve. In addition, the sensitivity and negative predictive value of the CTR were limited. No radiographic or physiologic predictor was able to consistently predict a successful increase in walk distance or TDI.

CONCLUSION

LVRS improves pulmonary function, decreases dyspnea, and enhances exercise capacity in many patients with severe emphysema, although improvement wanes 36 months after surgery.

Fibroblasts require protein kinase C activation to respond to hyaluronan with increased locomotion

Hyaluronan (HA) stimulates the motility of some but not all cell types. Here, we show that HA-promoted random motility of ras-transformed 10T1/2 (C3) fibroblasts requires activation of protein kinase C and is associated with rapid uptake of HA in a CD44 and RHAMM-dependent manner. The addition of HA to parental 10T1/2 fibroblasts (parental cells) does not stimulate random motility, but these cells can be 'primed' to respond to HA by treatment with the phorbol ester, PMA, for 4-6 h. This effect of PMA requires protein synthesis, PKC activity and is associated with enhanced uptake of HA. These results suggest that the ability of cells to respond to HA is regulated by a protein kinase C-dependent process that may promote uptake of HA.

Provider encouragement of breast-feeding: evidence from a national survey

OBJECTIVE

To examine the influence of provider encouragement on breast-feeding among women of different social and ethnic backgrounds in the United States.

METHODS

A nationally representative sample of 2017 parents with children younger than 3 years was surveyed by telephone. The responses of the 1229 women interviewed were included in the analysis. Respondents were asked to recall whether their physicians or nurses had encouraged or discouraged them from breast-feeding. The effects of provider encouragement on breast-feeding initiation and duration were evaluated by multivariate logistic regression. The sample was then stratified to allow subset analyses by race and ethnicity, education, income class, age group, and marital status.

RESULTS

More than one-third (34.4%) of respondents did not initiate breast-feeding. Three-fourths (73.2%) of women reported having been encouraged by their physicians or nurses to breast-feed; 74.6% of women who were encouraged initiated breast-feeding, compared with only 43.2% of those who were not encouraged (P < 0.001). Women who were encouraged to breast-feed were more than four times (relative risk 4.39; 95% confidence interval 2.96, 6.49) as likely to initiate breast-feeding as women who did not receive encouragement. The influence of provider encouragement was significant across all strata of the sample. In populations traditionally less likely to breast-feed, provider encouragement significantly increased breast-feeding initiation, by more than threefold among low-income, young, and less-educated women; by nearly fivefold among black women; and by nearly 11-fold among single women.

CONCLUSION

Provider encouragement significantly increases breast-feeding initiation among American women of all social and ethnic backgrounds.

Physician perceptions of barriers to care for inner-city Latino children with asthma

This article describes physician perspectives on barriers to quality primary care experienced by inner-city children with asthma and presents policy recommendations to reduce these barriers. The authors interviewed 30 physicians who take care of children with asthma in an inner-city Latino neighborhood, conducted a qualitative analysis of interview themes, and used a consensus group method to recommend policy actions. Inner-city physicians described significant access, quality of care, and other barriers in providing state-of-the-art primary care for asthma. Physicians recommended that eliminating financial barriers to care, including lack of health insurance and/or comprehensive health coverage for necessary medications and equipment, is the most important required policy action. In addition, inner-city physicians recommended that medical care and public health programs provide bilingual education for children with asthma and their families and train primary care physicians about how to provide effective asthma care to children with asthma in the inner city.

Rapid hyaluronan uptake is associated with enhanced motility: implications for an intracellular mode of action

Texas red-labeled hyaluronan (TR-HA) is rapidly taken up in a CD44 independent manner into ras-transformed 10T1/2 fibroblasts, where it accumulates in both cell ruffles/lamellae, the perinuclear area, and the nucleus. HA does not accumulate in the cell ruffles/lamellae of parental 10T1/2 cells. Addition of HA to ras-transformed cells promotes their random motility but has no effect on 10T1/2 cell motility. 10T1/2 cells can be modified to take up HA into cell ruffles by exposure to phorbol ester or direct microinjection of HA into cells. Both treatments significantly stimulate 10T1/2 cell motility.

Enhanced protection of human cells against ultraviolet light by antioxidant combinations involving dietary carotenoids

Antioxidants like beta-carotene, alpha-tocopherol and ascorbic acid should be able to protect human cells against damage due to ultraviolet light. Cultured human fibroblasts have been irradiated with UVA or UVB light after incubation with the antioxidants or combinations of them. The efficiency of the protection by the antioxidants in dietary concentrations is estimated by cell counting following cell culture. In the case of UVA irradiation we find synergistic effects of combinations with beta-carotene as the main protector. On the other hand, only additive effects of the tested combinations are observed in the experiments with UVB light. Our experiments show a protective effect of dietary antioxidants against human tissue cell damage by ultraviolet light.

A review of major nursing vocabularies and the extent to which they have the characteristics required for implementation in computer-based systems

Building on the work of previous authors, the Computer-based Patient Record Institute (CPRI) Work Group on Codes and Structures has described features of a classification scheme for implementation within a computer-based patient record. The authors of the current study reviewed the evaluation literature related to six major nursing vocabularies (the North American Nursing Diagnosis Association Taxonomy 1, the Nursing Interventions Classification, the Nursing Outcomes Classification, the Home Health Care Classification, the Omaha System, and the International Classification for Nursing Practice) to determine the extent to which the vocabularies include the CPRI features. None of the vocabularies met all criteria. The Omaha System, Home Health Care Classification, and International Classification for Nursing Practice each included five features. Criteria not fully met by any systems were clear and non-redundant representation of concepts, administrative cross-references, syntax and grammar, synonyms, uncertainty, context-free identifiers, and language independence.

Using molecular techniques to identify new microbial biocatalysts

Evolution has favoured microorganisms that produce efficient enzymes with substrate-adapted biocatalytic activities. Progress in molecular techniques, especially expression cloning, molecular screening, protein engineering and in vivo and in vitro shuffling, have paved the way for greater speed and accuracy in cloning enzyme genes from microorganisms and generating versions with improved properties. Recently, two new approaches have been added: screening directly from uncultivated microorganisms and generating additional hits by database mining using bioinformatic tools.

[Adults with congenital heart defects--clinical spectrum and surgical management]

Two hundred adults who underwent surgery for congenital heart disease at our institution within a four year period were the basis for this report. Clinical data was obtained, i.e. demographic details, past medical history, physical findings, EKGs, echocardiograms, catheterization and angiography material as well as the New York Heart Association (NYHA) class. Intraoperative findings, perioperative management, complications and morbidity and mortality were assessed. After discharge the patients were followed on an outpatient basis. Again the clinical findings, laboratory results and NYHA class were recorded. Age ranged from 16 to 75 years (mean = 38). There were 114 females and 86 males. 178 patients had primary surgical correction, 18 were reoperated after prior correction and 4 underwent palliation. Eighty-three percent of the patients were symptomatic preoperatively. Seventeen percent were diagnosed per chance, for example by a preemployment physical examination, without a prior history of heart disease. The patients were grouped according to related diagnoses (Table 1). Among the 130 patients with left to right shunts, 112 had an atrial septal defect, 7 a ventricular septal defect, 5 a persistent ductus arteriosus, and 6 partial anomalous pulmonary venous return. Atrial flutter or fibrillation occurred in approximately 10% of all patients with atrial septal defects. It was terminated either by rapid overdrive pacing or DC cardioversion. Postoperatively the patients with pulmonary hypertension were monitored invasively with arterial lines and thermodilution catheters. Therapy consisted of alkalization, hyperventilation and sedation. There was only one postoperative death in this patient group due to marked pulmonary hypertension (1/130 = 0.8%). Nineteen adults had obstruction to right or left ventricular outflow. Surgery included valvotomy, infundibulectomy and valve replacement by homograft or mechanical valve. One patient with multiple previous surgeries expired due to bleeding (3%). Thirteen patients had coarctation. All of them were hypertensive, some on medication. Surgery consisted of aortic patchplasty or interposition of a graft. There was no mortality. Perioperative antihypertensive therapy was necessary in most patients and consisted of nifedipin, nitroprussid or propanolol intravenously. Upon follow up 11 patients became normotensive, 8 of these without the need for medication. Fifteen cyanotic patients underwent 11 corrective and 4 shunt procedures (3 with tricuspid atresia, 10 with Tetralogy of Fallot and 2 with complex cyanotic heart disease. Three died due to low cardiac output or dysrhythmias (20%). The survivors improved their clinical status markedly. Seven adults with Ebstein's disease had valve reconstruction and/or ASD closure. Five had recurrent supraventricular tachycardia, 2 paradoxical emboli with neurological symptoms and 4 out of 7 had decreased exercise tolerance. One patient died postoperatively because of dysrhythmias (14%). Sixteen patients had a variety of defects, i.e. status post Rastelli operation and conduit obstruction, status post Tetralogy of Fallot with pulmonary valvar disease, corrected transposition with left AV valve insufficiency, congenital mitral valve disease and double aortic arch, no deaths. The overall operative mortality was 6/200 = 3%. the late mortality was 4/200 = 2%. The morbidity included 7 reoperations due to bleeding. Five patients needed short-term hemodialysis. One patient developed hemiplegia and two patients had permanent decrease of their left ventricular function. The mean length of follow up was 21 months. The clinical status improved from a NYHA class mean of 2.1 +/- 0.9 to 1.2 +/- 0.45 (p < 0.001). In Germany significant numbers of adults with operated and unoperated congenital heart disease do exist. Detection of these patients can be difficult due to inconspicuous murmurs or stable clinical status.

Phase I clinical evaluation of Gd-EOB-DTPA as a hepatobiliary MR contrast agent: safety, pharmacokinetics, and MR imaging

PURPOSE

To determine the safety, pharmacokinetics, and magnetic resonance (MR) imaging results of gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA) as a contrast agent for use in hepatobiliary MR imaging.

MATERIALS AND METHODS

Gd-EOB-DTPA was tested at doses of 10, 25, 50, and 100 mumol per kilogram of body weight. Results of laboratory tests, clinical measurements, and pharmacokinetic data were obtained in 44 healthy volunteers in a double-blind, randomized, placebo-controlled design. MR images were obtained in another 16 healthy volunteers before and up to 6 hours after fast intravenous administration of Gd-EOB-DTPA.

RESULTS

Gd-EOB-DTPA was well tolerated, with no important side effects or changes in laboratory parameters. Homogeneous enhancement of liver parenchyma was observed immediately after injection of the contrast agent. Peak liver signal intensity was noted 20 minutes after injection, followed by plateaulike enhancement over about 2 hours. The common bile duct was hyperintense within 10 minutes after injection in all volunteers.

CONCLUSION

Gd-EOB-DTPA is safe and efficient for MR imaging of the liver.

Validation of an in vivo wound healing model for the quantification of pharmacological effects on epidermal regeneration

BACKGROUND

Non-invasive assessment methods such as measurement of the transepidermal water loss (TEWL) allow a continuous follow-up of cutaneous processes with impairment of the epidermal barrier function.

OBJECTIVE

The aim of the trial was to establish an in vivo model for the assessment of drug effects on epidermal regeneration.

METHODS

Twenty healthy volunteers were included in this double-blind randomized trial. After setting four suction blisters on the volar aspect of the forearm, the epidermis was removed to create a standardized subepidermal wound. Thereafter the wounds were treated topically for 6 h daily during 14 days. The following treatments were to be compared: a clobetasol 17-propionate preparation under occlusion, a corticoid-free cream under occlusion, no treatment and occlusion (aluminium chamber), no treatment and no occlusion. Daily measurement of TEWL above the wounds was performed.

RESULTS

The 0.05% clobetasol 17-propionate preparation caused a dramatic delay in TEWL decrease, whereby the untreated unoccluded field showed a continuous decrease over the observed period of 14 days. Occlusion and corticoid-free treatment led to a weak but significant delay of TEWL decrease when compared to the untreated unoccluded test field.

CONCLUSION

This model seems to describe re-epithelialization in a reliable manner and can be used for in vivo assessment of drug effects on migrating and proliferating epithelial cells.

Contrast-enhanced MR imaging of liver and spleen: first experience in humans with a new superparamagnetic iron oxide

The aim of this prospective study was to obtain the first human safety and magnetic resonance (MR) imaging results with a new formulation of superparamagnetic iron oxide (SPIO) (SHU 555 A). The SPIO was tested at four iron doses, from 5 to 40 mumol/kg. Laboratory tests and clinical measurements were done in 32 healthy volunteers for up to 3 weeks after administration. MR imaging at 1.5 T was performed before and 8 hours to 14 days after fast intravenous injection (500 mumol Fe/min) of the SPIO (six subjects per dose). Results of this phase I study demonstrate that SHU 555 A at a concentration of 0.5 mol Fe/L was well tolerated. A dose-dependent minor increase in activated partial thromboplastin time, which remained within the normal range, was seen. All doses of SPIO caused a signal loss in both liver and spleen (P < .05) with a spin-echo sequence (TR = 2,300 msec, TE = 45 msec). The signal losses in the liver 8 hours after contrast agent injection were 58%, 79%, 82%, and 87% for the 5, 10, 20, and 40 mumol Fe/kg doses, respectively. The corresponding signal losses in the spleen were 23%, 45%, 65%, and 78%, respectively. The doses that reduced signal intensity by half were 3.1 mumol Fe/kg for the liver and 12.8 mumol Fe/kg for the spleen. The results suggest that the new SPIO formulation is a safe and efficient MR contrast agent.

Pharmacokinetics, dose proportionality, and tolerability of gadobutrol after single intravenous injection in healthy volunteers

RATIONALE AND OBJECTIVES

Gadobutrol is a new gadolinium-based hydrophilic and neutral macrocyclic contrast medium for magnetic resonance imaging. In this article, the authors report on the first application of gadobutrol in humans, up to a dose of 0.5 mmol/kg.

METHODS

Gadobutrol was investigated after single intravenous administration in two phase-1 studies testing low (0.5 mol/L) and high concentrations (1 mol/L) in healthy, male volunteers using a double-blind, randomized, placebo-controlled study with n = 55 for the low concentration (0.04, 0.1, 0.2, 0.3, and 0.4 mmol/kg body weight), followed by n = 36 for the high concentration (0.3, 0.4, and 0.5 mmol/kg body weight). Vital signs and laboratory parameters were measured for all dose groups investigated, whereas for the calculation of the pharmacokinetic parameters, the dose groups 0.04, 0.1, and 0.4 mmol/kg body weight were selected.

RESULTS

Gadobutrol was well tolerated up to doses of 0.5 mmol/kg, and no relevant changes in vital signs and laboratory parameters occurred. The terminal disposition half-life of gadobutrol in plasma was approximately 1.5 hours. Total clearance approximated renal clearance and approximated the value of 120 mL/min, indicating glomerular filtration as the main pathway of elimination. The steady-state volume of distribution indicated predominantly extracellular distribution of gadobutrol. No metabolites were detected. The renal excretion rate was linear over the large dose range tested, indicating dose-proportionate, first-order kinetics of gadobutrol.

CONCLUSION

Single intravenous administration of gadobutrol was well tolerated up to the dose level of 0.5 mmol/kg body weight. These factors suggest that gadobutrol will be a safe magnetic resonance imaging contrast agent.

Comparison of the local and systemic side effects of methylprednisolone aceponate and mometasone furoate applied as ointments with equal antiinflammatory activity

BACKGROUND

The therapy for skin diseases with topical glucocorticoids is limited by their local and systemic side effects. A glucocorticoid with an improved benefit-to-risk ratio is desirable.

OBJECTIVE

A new topical corticoid, methylprednisolone aceponate (MPA) 0.1% ointment, was compared with the same formulation of mometasone furoate.

METHODS

The two ointments were compared with respect to suppression of UVB light-induced erythema (n = 20) and with respect to atrophogenicity and appearance of telangiectasia (n = 20) in two double-blind trials with intraindividual comparisons in healthy volunteers. In a third trial, serum cortisol levels were measured in volunteers receiving extensive (60% of body surface) cutaneous application of MPA (n = 10) or mometasone furoate (n = 11).

RESULTS

MPA and mometasone furoate were equally effective in suppressing UVB light-induced erythema. Atrophogenicity, as well as the incidence and severity of telangiectasia, were significantly more pronounced with mometasone furoate than with MPA. Both ointments decreased serum cortisol levels and did not differ significantly in this respect. However, the incidence of serum cortisol level suppression was higher in the mometasone furoate group than in the MPA group.

CONCLUSION

MPA ointment has equal antiinflammatory activity and similar cortisol suppression but significantly fewer local side effects than mometasone furoate.

Activity of topically applied methylprednisolone aceponate in relation to other topical glucocorticosteroids in healthy volunteers

Topical glucocorticosteroids are useful in the treatment of various skin diseases. Although there are already many corticosteroids available, there is still need for highly potent and well tolerated ones. The anti-inflammatory activity of methylprednisolone aceponate (MPA, CAS 86401-95-8) has been investigated in 165 healthy volunteers of either sex. UV-B irradiation or cellophane tape stripping has served to produce erythema. First, the dose response relationship of MPA ointment (0.01%, 0.05%, 0.1% and 0.5%) has been evaluated. MPA effects have been related to those of the vehicle and difluocortolone 21-valerate 0.1% (DFV) ointment. Then the activity of 0.1% MPA (cream, ointment and fatty ointment) has been related to those of the respective vehicles as well as commercially available preparations of five corticosteroids: betamethasone 17,21-dipropionate 0.64% (BDP), betamethasone 17-valerate 0.1% (BV), clobetasol 17-propionate 0.05% (CP), hydrocortisone 17-butyrate 0.1% (HCB), prednicarbate 0.25% (P). In each experiment, MPA activity significantly exceeded that of the respective vehicle (p < or = 0.05). MPA 0.01-0.5% ointment exhibited strong anti-inflammatory activity, at least corresponding to that of 0.1% DFV ointment. A dose-dependent activity could only be observed in the UV-B-erythema test using 3 fold MED (minimal erythema doses) for irradiation, a test model differentiating strong corticosteroids. The comparison of 0.1% MPA formulations with respective reference preparations showed the following results: On stripped skin no significant differences could be detected which is demonstrated in the example of cream formulations.(ABSTRACT TRUNCATED AT 250 WORDS)

Dose-response relationship of topically applied methylprednisolone aceponate (MPA) in healthy volunteers

Topical glucocorticosteroids are useful in the treatment of various skin diseases. Although many corticosteroids are available today, there is still a need for highly potent compounds with minimal adverse effects. Methylprednisolone aceponate (MPA) has recently been synthesized. Its activity has been evaluated using the vasoconstrictor assay and the poison ivy test (rhus dermatitis) in 19/20 healthy volunteers of either sex. Comparable blanching was found with MPA in a cream vehicle, in an ointment and a fatty ointment. Vasoconstriction and suppression of experimentally-induced poison ivy contact dermatitis were dose-dependent in the concentration range 0.01% to 0.5% MPA. Concentrations of MPA of at least 0.05% were significantly active. Following the highest dose, blanching was close to the maximum which can be obtained. This finding, and the improvement of rhus dermatitis, suggest that MPA belongs to the highly potent local glucocorticosteroids.

[99mTc-anti-granulocyte antibodies (BW 250/183) in the detection of appendicitis]

Scintigraphy with 99mTc-labeled anti-granulocyte antibodies (AGAb) was performed in 50 patients with suspected appendicitis. Sequential and static imaging as well as SPECT of the pelvis and abdomen was performed 2 h p.i. In all patients the diagnosis was confirmed either histologically or by long-term follow-up. 13 patients had histologically proven acute appendicitis. In 11 patients the appendix scan had been positive and in 2 patients the scan had shown no significant tracer uptake in the right lower abdomen. The remaining 37 patients turned out not to have acute appendicitis. 29 out of these patients had negative and 3 had positive scan findings. In 5 patients the scan was equivocal. Out of these patients 2 had pathologic findings on the left side of the abdomen which turned out to be acute diverticulitis in one patient and acute peritonitis in the other. The remaining 3 patients with unclear scintigraphic findings had no acute appendicitis. Scintigraphy with AGAb is fast and easy to perform and thus superior to cell labeling methods for diagnosing acute appendicitis. Sensitivity for the diagnosis of acute appendicitis was 85% with a specificity of 91%. Chronic or scarred non-granulocytic appendicitis--in which there is often no definite indication for surgery--was negative in our study except for two cases.

Molluscum contagiosum in three horses

Suspected molluscum contagiosum was diagnosed in 3 horses in the Chingola district of Zambia. The horses were found to be suffering from a slow progressive skin disease with lesions on the chest, shoulders, inner and lateral aspects of the fore- and hindlimbs, the face, fetlocks, pasterns and on the lateral surfaces of the body. The lesions varied from 4 to 20mm in diameter, were hairless but covered by soft keratin projections which, when removed, left a raw elevated base tightly adherent to the epidermis. These lesions bled profusely when the animals were groomed. Older lesions were well circumscribed, raised above the surface, devoid of hair and after removal of grey-white keratin flakes, had a depigmented waxy appearance. Microscopically cytoplasmic inclusions containing many pox virions were found. Attempts at culturing the virus were unsuccessful.

A survey of helminths in domestic cats in the Pretoria area of Transvaal, Republic of South Africa. Part 1: The prevalence and comparison of burdens of helminths in adult and juvenile cats

The helminths found in 1,502 necropsied cats were examined. The findings indicated that 65% of the cats were infested. The most prevalent helminths encountered were Ancylostoma tubaeforme (41%), Ancylostoma braziliense (25%), Dipylidium caninum (23%), Toxocara cati (11%), Taenia taeniaeformis (7.7%), Ancylostoma caninum (3.3%), Joyeuxiella fuhrmanni (2.5%), Ancylostoma ceylanicum (1.4%), and Physaloptera praeputialis (1.3%). The following helminths were recorded in fewer than 1% of the cats: Centrorhynchus spp., Pterygodermatites spp., Toxocara canis, Aleurostrongylus abstrusus and Vogeloides spp., This is the first record of the lungworms, A. abstrusus and Vogeloides spp. in cats in the Republic of South Africa. The helminths in adult and juvenile cats are compared. Of the cestodes, Joyeuxiella fuhrmanni (4%) and Taenia taeniaeformis (12%) are more prevalent in adult cats. Dipylidium caninum is marginally more common in adults (24%), and is the most common helminth in juvenile cats, being present in 21% of cases. More adult cats have Ancylostoma tubaeforme (58%), Ancylostoma braziliense (36%), Ancylostoma ceylanicum (2.4%) and Physaloptera praeputialis (1.9%) than do juvenile cats. However, juvenile cats were found to harbour more Toxocara cati (41%), Toxocara canis (0.5%) and Ancylostoma caninum (5.2%). Juvenile cats harbour appreciable numbers of both cestodes and nematodes, thus any treatment should be aimed at the elimination of both, with a broad spectrum anthelmintic.

Funktionell-morphologische Differenzierung der FSH- und LH-Zellen im Hypophysenvorderlappen

The identification of pituitary FSH and LH cells in states of pharmacological treatment influencing the pituitary FSH and LH production was performed by histological staining at the isoelectric points of these hormones in the cat. The intensity of the stained material in the hormone-producing cells was determined by a microphotometric technique. As a physiological control, the FSH and LH levels in blood were measured by a radioimmunoassay.

Right-heart echocontrast in the anesthetized dog after i.v. administration of a new standardized sonographic contrast agent. 3rd communication: comparison of various contrast agents employed in contrast echocardiography

Right-ventricular contrast provided by the new standardized sonographic contrast agent SH U 454, which consists of pure galactose microparticles, with 300 mg microparticles/ml and by 5 other currently employed ultrasonic contrast media was examined by 2 D echocardiography in 10 anesthetized female beagle dogs (6.8-12.7 kg) following i.v. administration. With a 5-min interval between injections each animal was given 3 injections of 2 ml of each formulation in random order using an injection speed of approximately 2 ml/s. The echocardiographic investigation was recorded on videotape and the contrast assessed blind using a visual score system (rating 0-5) by two investigators working independently and also by a videodensitometer. Only SH U 454 caused an intense, homogeneous and reproducible opacification of the right heart chambers. By comparison with other formulations for right-heart echocontrast, SH U 454 was significantly superior (p less than 0.05) in every parameter assessed.

Right-heart echocontrast in the anesthetized dog after i.v. administration of a new standardized sonographic contrast agent. 1st communication: dose-response relationship

The newly developed standardized sonographic contrast agent SH U 454, which consists of pure galactose microparticles, was examined for opacification of the right heart by 2 D echocardiography in 10 anesthetized female beagle dogs (6.8-12.7 kg) following i.v. administration. The right ventricular contrast of SH U 454 was investigated in 4 concentrations: 100, 150, 200 and 300 mg microparticles/ml suspension. With a 5-min interval between injections each animal was given 3 injections of 2 ml of each formulation in random order using an injection speed of approximately 2 ml/s. The echocardiographic pictures were recorded on videotape and the contrast assessed blind, using a visual score system (ratings 0-5), by two investigators working independently and also by a videodensitometer which measured 3 additional parameters. The contrast obtainable with SH U 454 is dose-dependent. SH U 454 containing 300 mg microparticles/ml was in every case significantly superior (p less than 0.05) to the suspension containing 100 mg/ml. All the videodensitometer values revealed a significant difference (p less than 0.05) between the 200 and 100 mg/ml concentrations. Only the concentration containing 300 mg/ml yielded contrast adequate for diagnostic purposes in respect of every parameters after every injection and in every dog.

Right-heart echocontrast in the anesthetized dog after i.v. administration of a new standardized sonographic contrast agent. 2nd communication: dependence of the intensity of contrast on the interval between preparation of the suspension and its injection

The right-ventricular echocontrast provided by 5 different concentrations of the new standardized sonographic contrast agent SH U 454 (100, 150, 200, 300 and 400 mg microparticles/ml), which consists of pure galactose microparticles, was examined in 3 anesthetized female beagle dogs (8.6-9.3 kg) in order to assess the influence of the period of time which elapsed between preparation of the suspension and its injection. Each animal was given 2 ml of an SH U 454 concentration by intravenous injection at a speed of approximately 2 ml/s immediately after preparation of the suspension and 1, 2, 3 and 5 min thereafter. Evaluation of the intensity of contrast was performed blind by two investigators working independently and using a visual scoring system (ratings 0-5) and also by a videodensitometer. The videodensitometer provided a quantitative evaluation of the maximum intensity of contrast, the duration of contrast and the area under the videodensitometer curve. The intensity of the contrast of the prepared suspension subsided at a constant rate over a period of 5 min for all the concentrations tested. However, the difference between the starting value t0min and the terminal value t5min was small. On the whole, very little difference was found over the 5-min period in the intensity of the contrast provided by any of the SH U 454 concentrations examined. Thus, for the injection the examiner has a timeframe of at least 5 min after preparation of the suspension.

[Quantification of myocardial perfusion defects using 2-dimensional contrast echocardiography]

Ten closed-chested beagles were employed to determine whether reproducible echocontrast imaging of the myocardium could be obtained following injection of the new ultrasonic contrast medium Echocon into the aortic root, and whether myocardial perfusion defects could be successfully diagnosed by this method. The change in intensity of contrast in the myocardium was measured by videodensitometry simultaneously in the supply areas of the left anterior descending and left circumflex branches of the left coronary artery before and during occlusion of the circumflex branch by means of a balloon catheter. Injection of Echocon into the aortic root led to reproducible echocontrast imaging of the entire myocardium. The occlusion of the circumflex branch caused a significant reduction (p less than 0.01) in intensity of contrast in the supply area of the circumflex branch, whereas no differences by comparison with the starting values were identifiable in the supply area of the left anterior descending branch. The correlation factor between the sizes of the perfusion defects ascertained by echocardiography and by planimetric measurement using a pathological anatomical approach was found to be r = 0.89. The injection of Echocon into the aortic root did not induce any significant changes in the aortic or pulmonary pressure, or in heart rate. Only slight flattening of the T-waves, which never lasted longer than 15 seconds, was observed in 50% of the animals. Contrast echocardiography of the myocardium could thus contribute to the diagnosis of coronary heart disease, i.e. perfusion defects.

[Human testing of the nuclear spin tomographic contrast medium gadolinium-DTPA. Tolerance, contrast affect and the 1st clinical results]

In an initial clinical trial we examined the tolerance and the influence exercised on signals in nuclear magnetic resonance tomography by gadolinium-DTPA. In an open study, 4 dosages between 0.005 and 0.25 mmol Gd-DTPA/kg body-weight were tested on 5 healthy volunteers each. To ensure renal elimination of Gd-DTPA, NMR images were produced (0.35 T Magnetom) visualising the kidneys and urinary bladder before and more than 60 minutes after application of the contrast medium. The article shows in what manner the image is influenced by the dosage of the contrast medium and also by the time interval elapsing between injection of the contrast medium and production of the NMR tomogram. - Finally, first clinical results of NMR tomography contrast medium application are demonstrated in the case of 5 patients with cerebral tumours.

[Comparative review of normal echocardiographic values from the premature infant to the adolescent]

Normal M-mode echocardiographic values were analyzed from premature and term newborn infants with a body weight of 500 to 4000 g (n = 105) as well as from children ranging in age from one to 15 years with a body surface area of 0.4 to 1.6 m2 (n = 80). Standardized positioning of the recorded M-mode beam was assured through 2-dimensional echocardiographic monitoring. The maximal diastolic dimension of the right and left ventricles as well as the diastolic dimension of the aorta and the maximal dimension of the left atrium were assessed. The normal values were found to demonstrate linear relationships with weights up to 4000 g and, for larger children, with body surface areas from 0.4 to 1.6 m2. A review of values reported in the literature, of which there is a scarcity in the premature age, showed good general agreement of the mea values. The normal ranges, however, differed markedly, in some cases to such an extent that interpretation of individual echocardiographic findings would be rendered quite problematic. The explanation for these discrepancies appears most likely based on inconsistencies in spatial orientation and, subsequently, inaccurate measurements. It is apparent that establishment of normal values in a large patient population prerequisites guidelines for standardization which should include monitoring of the M-mode beam with two-dimensional echocardiography as well as use of tracings of superior quality only.

[Heart catheterization in newborn and young infants. Description of the method]

The data of 343 newborns and young infants were reviewed who, from 1968 until August 1982, had undergone heart catheterization. Variations in frequency of catheterization and diagnoses as well as lethality were investigated. The first rise of heart catheterization performances could be noted in the years of 1968 and 1969 (by routine application of the Rashkind procedure), another remarkable rise took place in the years from 1971 to 1975, probably due to better feasibilities of modern cardiac surgery. Later on, a new dynamic plateau was developed. With the utilization of echocardiography, a significant decrease of heart catheterization performances in certain diagnostic groups (HLH, PFC) was registered. Nowadays, however, new diagnostic challenges (infants with low gestational age, respiratory problems, PDA) require heart catheterization. Comparison of the different diagnostic groups' lethality rate reveals that children undergoing heart catheterization, in order to rule out TGA, demonstrate a remarkably higher lethality rate (27%) than children suffering from TGA (3.7%). Introduction of echocardiography has decreased this risk significantly.

[Primary pulmonary hypertension in children]

Case report of an infant who, having been under cardiological observation since birth, developed the clinical symptoms of primary pulmonary hypertension at 12 months. The ECC showed right-ventricular hypertrophy, which progressed rapidly. Heart catheterization confirmed the suspected diagnosis of pulmonary hypertension without cardiovascular malformation. Treatment with isoproterenol and tolazoline was initiated but was unsuccessful: the child died at 18 months. The diagnosis was supported by the histopathology.

[Comparison of 2-d-echocardiographic and hemodynamic findings in patients with atrial and ventricular septal defects (author's transl)]

57 patients (age 2 to 79 years) with atrial septal defect and 28 patients (age 1 month to 60 years) with ventricular septal defect were examined to find out whether the 2-d-echo allows to predict the shunt flow and the hemodynamic parameters of the pulmonary system. In 96% of the patients with asd, the defect could be demonstrated in the subcostal view. In 68% of the patients with vsd, the defect was shown in the long axis or the subcostal view. There was a low correlation between the size of the defect and the quotient of pulmonary to systemic flow (for asd: r = 0.73; for vsd: r = 0.62). Also, the quotient of pulmonary to systemic flow related rather poorly to the quotient of pulmonary artery diameter to aortic diameter as determined in th short axis (for asdii: r = 0.75; for vsd: r = 0.73). Nor relation could be found between echocardiographic parameters and pulmonary artery pressure with one exception: if contrast-echocardiography revealed a right-to-left shunt in patients with vsd, the pulmonary pressure exceeded the systemic pressure by 50%. The results show that in patients with asd or vsd the hemodynamic situation cannot be exactly judged from echocardiographic findings alone. The consideration of several echocardiographic parameters, however, seems to allow a distinction between hemodynamically relevant and irrelevant defects, which might be helpful for clinical purposes. For patients with asd, a shunt volume of minor importance (Qp:Qs less than 1.5:1) is found if the defect does not exceed 35% of the atrial septum length and if the quotient of pulmonary to aortic diameter is less than 1. In patients with vsd, the demonstration of the defect itself and a quotient of pulmonary to aortic diameter larger than 1 means that a shunt volume with Qp:Qs greater than 1.5:1 can be expected. Unsatisfactory results concerning the pulmonary pressure are obtained even when applying the contrast-echocardiography.

A new technique for noninvasive evaluation of femoral arterial and venous anatomy before and after percutaneous cardiac catheterization in children and infants

A new ultrasonic method was applied to image the femoral artery and vein in children for evaluation of short- and long-term effects of cardiac catheterization with femoral percutaneous cannulation. Sixty-six children and infants (aged 5 days to 20 years) were studied with a 9 megahertz electronically focused real time scanner. Adequate studies were obtained in 46 patients before catheterization, in 26 of 30 short-term follow-up studies and in 14 long-term follow-up studies. Femoral arterial size could be quantitatively measured at the inguinal ligament and a correlation existed between imaged femoral arterial diameter and body weight (r = +0.82) or body surface area (r = +0.80). Short-term follow-up ultrasonic imaging studies allowed diagnosis of spasm and other complications of percutaneous femoral arterial puncture. Long-term follow-up studies were performed 4 months to 3 years after catheterization in 14 patients who had no complications recorded at the time of catheterization. These revealed significant differences between vessels on the catheterized and uncatheterized (control) sides in only 3 of the 14. High resolution ultrasonic imaging can provide anatomic and functional information about femoral arteries and veins and appears to be of assistance in planning cardiac catheterization and in studying the short- and long-term effects of percutaneous femoral cannulation.

[Recommendations regarding the standardization for image orientation and nomenclature in two-dimensional echocardiography (author's transl)]

The American Society of echocardiography has agreed upon recommending both nomenclature and image orientation in two dimensional echocardiography. This recommendation and the basic consideration are explained. It seems reasonable to follow this in Germany in order to have better overall understanding by more uniformity.

Abolition of resistance to Klebsiella pneumoniae by anti-polymorphonuclear leucocyte IgG

Antipolymorphonuclear leucocyte IgG (APS IgG) was prepared from crude horse antipolymorphonuclear leucocyte antiserum (APS). The APS IgG was less toxic than the crude APS and had a powerful and specific effect on rabbit polymorphs in vivo and in vitro. In rabbits infected with Klebsiella pneumoniae it suppressed the normal polymorph response and greatly reduced resistance to infection. Anti-Klebsiella pneumoniae antibody greatly enhanced protection in normal rabbits, but had much less effect on APS/IgG-treated rabbits. It was concluded that the principal cellular defence against K. pneumoniae was the polymorph and that macrophages made only a relatively small contribution to resistance.

Noninvasive assessment of surgical systemic to pulmonary artery shunts by range-gated pulsed Doppler echocardiography

Suprasternal range-gated pulsed Doppler echocardiography was used to evaluate surgical shunt patency in children with cyanotic congenital heart disease and right ventricular outflow obstruction following systemic artery to pulmonary artery anastomoses. Normal patients had laminar Doppler auditory signals and time interval histogram flow patterns because right pulmonary artery turbulence was not present during systole or diastole. Patients with pulmonary valvar stenosis had turbulence during systole only. In all nine postoperative patients with surgical shunts, turbulent systolic and diastolic time interval histograms and abnormal auditory signals were present. A typical shunt murmur was not audible to auscultation in six of the postsurgical patients at the time of the study. Suprasternal range-gated pulsed Doppler echocardiography affords an accurate, safe and simple noninvasive bedside means for confirming shunt patency in patients who have undergone surgical systemic artery to pulmonary artery anastomoses.

[The usefulness of range-gated pulsed Doppler echocardiography. A review (author's transl)]

Single-crystal RGPD Echocardiography has clearly become a useful noninvasive ultrasonic method which enlarges the capabilities of investigating the heart. Recording of flow direction and showing disturbed flow allows additional clarification and confirmation of various diagnoses. This single-crystal technique does not allow flow quantification at the present time. The TIH and auditory signal displays of Doppler shift as presently utilized in commercial devices allow qualitative observation but require much experience in test performance and evaluation. The future here is probably in the area of spectral analysis. Present instrumentation employs M-mode echo for Doppler sample localization. Drawbacks include inprecise sample beam localization and non-variable sample volume size. Further, standardization of the Doppler signal is necessary. Combination with 2-D echo in the future will allow more precise sample beam localization and accuracy in flow quantification. The latter area has particular promise and is under investigation but is not yet commercially available.

[Recommendations regarding the standardization in m-mode- and two-dimensional echocargiography in the U.S.A. (author's transl)]

After a long discussion a standardization of quantitative measurements is m-mode echocardiography as well as standardization for displays of two-dimensional echocardiograms in the long and short axis views of the left ventricle was agreed upon in the U.S.A. in 1978. It seems to be reasonable to follow the recommendations in Germany also in order to have more uniformity in echocardiographic diagnosis. Standardization would help for the overall understanding of data between laboratories.

Enzymatic attack on immobilized substrates. 2. Diffusional limitations in the alpha-chymotrypsin-catalyzed hydrolysis of polyacrylamide-bound l-phenylalanine 4-nitroanilide

1. The chymotrypsin-catalyzed hydrolysis of polyacrylamide-bound L-phenylalanine 4-nitroanilide was studied. As a spacer, one or two 6-aminohexanoyl residues were inserted between the matrix and ligand. 2. In the course of the enzymatic hydrolysis of polyacrylamide-bound substrates, enzyme adsorption by the gel substrates was observed. A quasi equilibrium of enzyme partitioning was reached after approximately 20-min incubation time. The enzyme adsorption could be described by the Langmuir adsorption isotherm. 3. The substrates attached via spacers to the matrix were completely hydrolyzed. 4. The initial course of the product vs time curves, as well as the dependence of the initial hydrolysis rates on enzyme concentration or substrate concentration, have been interpreted by the Nernst reaction theory. From the results obtained it has been concluded that the inital rate of the hydrolysis of polyacrylamide-bound L-phenylalanine 4-nitroanilide depends on the velocity of enzyme diffusion into the matrix.

[Echocardiographic normal data for premature and normal newborn infants (author's transl)]

Sufficient echocardiographic analysis of premature infants has not yet been presented. Therefore echocardiograms of 105 babies without cardiovascular disease weighing 0.6--4.0 kg were analyzed. Normal data for right ventricular dimension, diastolic left ventricular inner dimension, left atrium, aorta, septums left ventricular posterior wall, cardiac depth, amplitude and closing velocity of the anterior mitral leaflet have been established. All measurements are a linear function of bodyweight with a very good correlation.