Growth retardation and leaky SCID phenotype of Ku70-deficient mice

Ku70, Ku80, and DNA-PKcs are subunits of the DNA-dependent protein kinase (DNA-PK), an enzyme implicated in DNA double-stranded break repair and V(D)J recombination. Our Ku70-deficient mice were about 50% the size of control littermates, and their fibroblasts were ionizing radiation sensitive and displayed premature senescence associated with the accumulation of nondividing cells. Ku70-deficient mice lacked mature B cells or serum immunoglobulin but, unexpectedly, reproducibly developed small populations of thymic and peripheral alpha/beta T lineage cells and had a significant incidence of thymic lymphomas. In association with B and T cell developmental defects, Ku70-deficient cells were severely impaired for joining of V(D)J coding and recombination signal sequences. These unanticipated features of the Ku70-deficient phenotype with respect to lymphocyte development and V(D)J recombination may reflect differential functions of the three DNA-PK components.

The activation-dependent induction of APN-(CD13) in T-cells is controlled at different levels of gene expression

Recently, it was shown that aminopeptidase N (E.C. 3.4.11.2, CD13) is up-regulated during mitogenic stimulation of peripheral T-cells. In this study, we demonstrate that the half-life of APN mRNA was considerably prolonged in these cells leading to a 2.7-fold increase of APN transcript level. The apparent half-life time of the APN transcript was investigated by the RNA synthesis inhibitor-chase method using actinomycin D. The steady-state APN mRNA levels was determined by a competitive RT-PCR. The half-lives estimated in resting T-cells, natural killer cells and permanently growing tumour cells varied between 3.5 and 6 h. Finally, nuclear run-on assays revealed that the APN gene expression of stimulated T-cells is controlled by increased promoter activity as well. These studies suggest a control of APN gene expression at the post-transcriptional level in addition to promoter-mediated regulation.

Rapid mitogen-induced aminopeptidase N surface expression in human T cells is dominated by mechanisms independent of de novo protein biosynthesis

The membrane bound metalloprotease aminopeptidase N (APN, CD13, EC 3.4.11.2) is a well established marker of normal and malignant cells of the myelo-monocytic lineage. It is also expressed by leukaemic blasts of a small group of patients suffering from acute or chronic lymphoid leukaemia. Recently, the expression of the APN gene in T cell lines as well as the induction of APN gene and surface expression in human peripheral T cells by mitogenic activation have been demonstrated. Here, by means of cytofluorimetric analysis evidence is provided, that the induction of APN surface expression is partially resistent to the action of the inhibitors of protein biosynthesis, puromycin and cycloheximide, and is not prevented by tunicamycin, an inhibitor of glycosylation. These data suggest that the rapid mitogen-induced surface expression of APN, detectable 20 hours after stimulation is dominated by mechanisms not dependent on de novo protein biosynthesis or glycosylation. As shown by simultaneous analyses, the inhibitors used did also differently modify the induction of surface expression of other inducible glycosylated leukocyte surface antigens, namely CD25, CD69 and CD95.

[Effect of changed extracellular K(+) and Mg(2+)-concentration on intracellular Ca(2+) homeostasis, contraction coupling and force-frequency relations in the human myocardium]

The intracellular Ca(2+)-homeostasis may be affected by changes of the extracellular K(+)- and/or Mg(2+)-concentrations. Mg2+ reduces the Ca(2+)-influx via L-type Ca(2+)-channels, facilitates Ca(2+)-uptake into the sarcoplasmic reticulum, modulates the Ca(2+)-induced Ca(2+)-release and the Ca(2+)-binding to troponin C. The extracellular K+ activates the Na+/K(+)-ATPase and changes the membrane potential thereby affecting the mode of action of the Na+/Ca(2+)-exchanger. Especially when intracellular Ca2+ regulation is altered, for example in heart failure, Mg2+ and K+ exert beneficial effects on the frequency-dependent force-generation in human myocardium. Thus, extracellular Mg2+ and K+ influence contraction coupling in the human myocardium.

Increase in force of contraction by activation of the Na+/Ca(2+)-exchanger in human myocardium

AIMS

The aim of the present study was to investigate whether agents which enhance force of contraction via increasing intracellular Na+, i.e. cAMP-independently, remain effective in failing human myocardium.

METHODS

Cumulative concentration-response curves with (+/-)BDF 9148 (0.01-10 mumol l-1), a Na(+)-channel activator, and ouabain (0.01-0.1 mumol l-1), a Na+/K(+)-ATPase inhibitor, were performed on electrically driven left ventricular human papillary muscle strips (1 Hz, 37 degrees C; dilative cardiomyopathy, NYHA IV, heart transplantation, n = 16; nonfailing, donor hearts, n = 5). The beta-adrenoceptor agonist isoprenaline (0.001-1 mumol l-1) and Ca2+ (1.8-15 mmol l-1) were studied for control. In addition, Ca2+ response curves were obtained on skinned fibre preparations from left ventricular myocardium (NYHA IV, n = 7) in the presence of BDF 9148 (1 mumol l-1) or a high Na+ concentration (50 mmol l-1) to investigate a possible direct or indirect interaction of (+/-)BDF 9148 with the myofilaments.

RESULTS

While isoprenaline was significantly less effective in increasing force of contraction in failing human myocardium than in nonfailing myocardium (P < 0.01), in NYHA IV, (+/-)BDF 9148 and ouabain were as effective as in nonfailing human tissue. In failing and nonfailing myocardium, (+/-)BDF 9148 and ouabain exerted positive inotropic effects similar to those of Ca2+. However, the potency for (+/-)BDF 9148 to increase force of contraction was higher in NYHA IV than in nonfailing human myocardium (P < 0.05). Neither (+/-)BDF 9148 (1 mumol l-1) nor an increased concentration of Na+ (50 mmol l-1) altered the Ca2+ sensitivity or maximal developed tension of the contractile apparatus in experiments on chemically skinned left ventricular fibres.

CONCLUSIONS

The enhanced sensitivity of the failing human myocardium towards Na(+)-channel modulation is not due to a direct or indirect interaction of (+/-)BDF 9148 with cardiac myofilaments but may be due to an altered Na(+)-homeostasis in human heart failure.

The main neutral aminopeptidase activity of human lymphoid tumour cell lines does not originate from the aminopeptidase N-(APN; CD13) gene

Lymphocytes and related cell lines are predominantly CD13-negative, however, there are reports describing neutral aminopeptidase activity in or on these cells. The aim of this study was to answer the question, whether this activity originates from APN-gene expression. The total cellular activities (Ala-pNA hydrolysis) of lymphoid cell lines are up to 15 times higher than that of normal lymphocytes. Despite weak or lacking CD13 surface expression all lymphoid cell lines tested contain APNmRNA as quantified by competitive RT-PCR as well as low enzymatic activity in their particulate fractions. By isoelectric focusing two enzyme species with isoelectric points of 5.4 or between 3.5 to 4.8, respectively, were detected. To investigate whether these activities result from APN-gene we established transfectants lacking cellular APN expression of the CD13-positive histiocytic cell line U937 and the CD13-negative T-cell line H9. Studies on these transfectants proved (I) that the main neutral aminopeptidase activity expressed in lymphoid cells is definitively not related to APN and (II) that APN is also expressed in lymphoid cells, although on a low level only.

Induction of the membrane alanyl aminopeptidase gene and surface expression in human T-cells by mitogenic activation

The metal-dependent membrane alanyl aminopeptidase (amino-peptidase N, APN, CD13; EC 3.4.11.2) is a well-established marker of normal and malignant cells of the myelo-monocytic lineage. It is also expressed by leukaemic blasts of a small group of patients suffering from acute or chronic lymphoid leukaemia. CD13-specific monoclonal antibodies do not bind to the surface of normal B lymphocytes, and APN mRNA was not detectable by Northern analysis in normal lymphocytes or in T-cell lines. Recently the expression of the APN gene in T-cell lines as well as the ability of these cells to cleave chromogenic substrates preferred by APN have been demonstrated [Lendeckel, Wex, Kähne, Frank, Reinhold and Ansorge (1994) Cell. Immunol. 153, 214-226]. Here, by means of dot-blot hybridization and RNase protection assay, evidence is provided that human peripheral T-cells as well as derived cell lines contain significant amounts of APN mRNA, comparable to that in the promyeloic cell line U937, and that mitogenic activation of peripheral human T-cells leads to a more than 4-fold increase in their APN mRNA content. In the course of activation, T-cells increase their total alanine p-nitroanilide-hydrolysing activity to approx. 7-fold that of resting cells. Furthermore these cells become immunoreactive towards CD13 to a significant extent (up to 51%) as shown by surface staining and confirmed by activity staining and immunostaining after isoelectric focusing (pI of T-cell APN = 4.6). In addition it is demonstrated by fluorescence microscopy that viable, activated T-cells effectively cleave the fluorogenic aminopeptidase substrate bis-glycyl-rhodamine 110 and that the corresponding aminopeptidase activity is associated with the cell surface. We show that specific inhibitors of APN, probestin and actinonin, strongly decrease DNA synthesis in phytohaemagglutinin (PHA)-stimulated T-cells. In summary, evidence is presented that in the course of mitogenic activation human peripheral T-cells increase the expression of APN both at the transcriptional level and at the cell surface. This has been demonstrated both at the APN mRNA level and at the protein level with respect to aminopeptidase enzymic activity and CD13 immunoreactivity.

Regional expression of sodium pump subunits isoforms and Na+-Ca++ exchanger in the human heart

Cardiac glycosides exert a positive inotropic effect by inhibiting sodium pump (Na,K-ATPase) activity, decreasing the driving force for Na+-Ca++ exchange, and increasing cellular content and release of Ca++ during depolarization. Since the inotropic response will be a function of the level of expression of sodium pumps, which are alpha(beta) heterodimers, and of Na+-Ca++ exchangers, this study aimed to determine the regional pattern of expression of these transporters in the heart. Immunoblot assays of homogenate from atria, ventricles, and septa of 14 nonfailing human hearts established expression of Na,K-ATPase alpha1, alpha2, alpha3, beta1, and Na+-Ca++ exchangers in all regions. Na,K-ATPase beta2 expression is negligible, indicating that the human cardiac glycoside receptors are alpha1beta1, alpha2beta1, and alpha3beta1. alpha3, beta1, sodium pump activity, and Na+-Ca++ exchanger levels were 30-50% lower in atria compared to ventricles and/or septum; differences between ventricles and septum were insignificant. Functionally, the EC50 of the sodium channel activator BDF 9148 to increase force of contraction was lower in atria than ventricle muscle strips (0.36 vs. 1.54 microM). These results define the distribution of the cardiac glycoside receptor isoforms in the human heart and they demonstrate that atria have fewer sodium pumps, fewer Na+-Ca++ exchangers, and enhanced sensitivity to inotropic stimulation compared to ventricles.

Evidence for functional relevance of an enhanced expression of the Na(+)-Ca2+ exchanger in failing human myocardium

BACKGROUND

The present study aimed at investigating the expression of the Na(+)-Ca2+ exchanger and its functional role in human failing myocardium.

METHODS AND RESULTS

Na(+)-Ca2+ exchanger mRNA and protein levels were examined in nonfailing (NF, n = 8) and failing human myocardium (New York Heart Association functional class IV) with idiopathic dilated cardiomyopathy (DCM, n = 8) or ischemic heart disease (ICM, n = 6). The inotropic effect of the Na+ channel activator BDF 9148 was determined in electrically driven left ventricular papillary muscle strip preparations (1 Hz, 37 degrees C) from nonfailing (n = 8) and failing (n = 8) human hearts. Na(+)-Ca2+ exchanger mRNA levels were significantly increased, by 79% (P < .001) in DCM and by 58% (P < .01) in ICM compared with NF; protein levels increased by 36% (P < .001) and by 20% (P < .05), respectively. BDF 9148 increased the force of contraction concentration dependently, with a similar maximal effect in NYHA class IV and NF, but was more potent in NYHA class IV as demonstrated by a significantly smaller (P < .01) EC50 value (NYHA class IV, 0.18 [0.16 to 0.22] mumol/L; NF, 1.65 [1.3 to 3.0] mumol/L). In NYHA class IV, BDF 9148 (0.1 mumol/L) restored the positive force-frequency relationship and reduced the frequency-dependent increase in diastolic tension in relation to force of contraction.

CONCLUSIONS

The increased expression of the Na(+)-Ca2+ exchanger is a possible explanation for the increased inotropic potency of the Na+ channel activator BDF 9148 in failing human myocardium. The increase in exchanger molecules could be of functional relevance for the modulation of cardiac contractility by agents that increase the intracellular Na+ concentration. Enhancement of Na(+)-Ca2+ exchanger activity might be a powerful mechanism for increasing cardiac contractility in chronic heart failure.

Enhanced sensitivity of the failing human myocardium to cardiac glycosides and Na(+)-channel activators

Cardiac glycosides and Na+ -channel activators increase intracellular Na+ and thereby enhance the transport rate of the sarcolemmal Na+/Ca2+ exchanger. We tested the hypothesis of whether increased expression of the Na+/Ca2+ exchanger in failing human myocardium is accompanied by enhanced sensitivity of the failing human myocardium toward cardiac glycosides and Na+ -channel activators. We studied the positive inotropic effects of the new Na+ -channel activator BDF and the cardiac glycoside ouabain in human failing (New York Heart Association [NYHA] functional class IV, heart transplants for dilated cardiomyopathy, n = 11) and nonfailing (donor hearts, n = 5) myocardium on electrically driven left ventricular papillary muscle strips (1 Hz, 37 degrees C). The effectiveness of ouabain and BDF to increase force of contraction was similar in human nonfailing and failing myocardium. BDF was more potent to increase force of contraction in failing than in nonfailing tissue (p < 0.05). The time until maximal inotropic effect developed after ouabain was significantly shorter in NYHA IV (mean 150 +/- 16 min) than in nonfailing myocardium (mean 240 +/- 20 min). These results suggest that human failing myocardium exerts and enhanced sensitivity to cardiac glycosides and Na+ -channel activators, possibly because of enhanced expression of the Na+/Ca2+ exchanger or because of an altered intracellular Na+ -homeostasis.

Altered inotropism in the failing human myocardium

Beta-adrenoreceptor-cAMP-dependent inotropic interventions lose their effectiveness depending on the degree of myocardial failure. This blunted effect of beta-adrenoreceptor-dependent stimulation might be due to a downregulation of beta-adrenoreceptors and an increase of inhibitory G-proteins leading to decreased intracellular cAMP-concentrations. However, the maximal positive inotropic effect elicited by elevation of the extracellular [Ca2+] does not differ between failing and nonfailing human myocardium, indicating that terminally failing human myocardium is effective to increase force of contraction to the same degree as nonfailing tissue. Agents which increase force of contraction primarily via increasing the intracellular [Na+], e.g., cardiac glycosides and the Na(+)-channel activator BDF 9148, exert a higher potency in failing myocardium than in nonfailing tissue to increase force of contraction. This could result from an enhanced protein expression of the Na+/Ca(2+)-exchanger observed in diseased human hearts. Alterations in the intracellular Ca(2+)-homeostasis reported in failing myocardium lead to a negative force-frequency-relationship and a prolonged relaxation. As the protein expression of SERCA IIa and phospholamban seems to be similar in NYHAIV and nonfailing tissue, the reduced Ca(2+)- uptake may result from an altered regulation of these proteins, e.g., reduced phosphorylation of phospholamban or the SERCA IIa. After inhibition of the Ca(2+)-ATPase of the sarcoplasmic reticulum with the high specific inhibitor cyclopiazonic acid the former positive force-frequency-relationship became significantly less positive even in the nonfailing tissue and twitch course became similar to diseased hearts. These findings may be indicative for the importance of the Ca(2+)-reuptake mechanism into the sarcoplasmic reticulum in addition to the regulatory control at the site of the contractile apparatus for the regulation of contraction and relaxation in human myocardium.

Quantification of aminopeptidase N mRNA in T cells by competitive PCR

The aminopeptidase N (CD13, EC 3.4.11.2) is a well-characterized surface molecule expressed in a variety of cell types and species. Recent data indicate an expression of the APN mRNA and the corresponding aminopeptidase activity in human peripheral T cells and related cell lines as well. Here, the sensitive method of competitive PCR was used to quantify low amounts of APN mRNA in T cell lines. An APN cDNA fragment enshortened by a deletion of 87 bp was used as an internal APN-specific standard. The myelo-monocytic cell line U937 and the lymphoid T cell lines HuT78 and H9 contain 2.3 x 10(7), 5.9 x 10(6) and 5.6 x 10(6) copies/micrograms total RNA, corresponding to 160, 70 and 50 copies/cell, respectively. These data have been confirmed by determination of the APN activity, that represents a fraction only of the total cellular neutral aminopeptidase activity in hematopoetic cells. In the case of the CD13-positive cell line U937, approximately 60-70% of the total neutral aminopeptidase activity could be attributed to APN. In contrast, only a minor fraction (5-20%) of the cellular neutral aminopeptidase activity in the T cell lines H9 and HuT78 represents APN. The results suggest that APN gene expression within the hematopoetic system is not restricted to myelo-monocytic cells, instead a low APN expression may be a common feature of lymphocytes, at least of T cells, too.

A brief educational intervention for patients with rheumatic disease chosen to be presented in a clinic conference

Being presented in a case conference can be anxiety-provoking and intimidating for the patient. We observed that patients, at times, would show signs of apparent discomfort. A structured interview of the patient was designed to assess, address, and clarify concerns the patient might have beforehand. The patients' concerns were communicated to the staff. The structured interview was given to 31 patients before they were presented. An additional 14 patients were interviewed after the conference about their experience without the prior interview. One year later, we followed up by interviewing another 15 patients who had been selected for clinic conference cases. The structured interview revealed confusion on the patient's part about the purpose of the conference, and a desire for information about the physical setting and who would be there. Patients wanted to be introduced formally when entering the room and to be thanked when leaving, and preferred to be questioned directly about their symptoms. Of the 31 patients interviewed before the conference, 23 (74%) reported that the conference was a positive experience when questioned afterward, compared with only 9 of 14 (64%) of those who were not interviewed before the conference. The results of this study were presented to the clinic staff, and education of the patients was stressed as a primary responsibility. At the follow up, 12 of the 15 patients reported real understanding of the clinic conference purpose. The only patient who reported being uncomfortable with the clinic conference and unwilling to attend another was the only patient who reported not being informed about what the conference entailed. It can be too easy for medical staff to forget that what is routine to them is very unusual and can be very stressful to the patient.

Membrane association of the Rieske iron-sulfur protein

The mode of membrane attachment of the Rieske iron-sulfur proteins from cytochrome b6f complex of pea thylakoids and from cytochrome bc1 complex of yeast mitochondria has been studied using biochemical approaches. The relative sensitivity of the Rieske protein to trypsin in the thylakoid membrane shows that all trypsin sites of the Rieske protein are on the lumen side of the thylakoid membrane. In contrast to cytochrome f the chloroplast Rieske protein was extracted from thylakoids using chaotropic agents (NaSCN, urea), an alkaline pH and relatively low concentrations of Trinon X-100. The cytochrome bc1 complex Rieske protein from mitochondrial membranes of yeast was also released by NaSCN and alkaline treatment. The results presented here led us to the conclusion that the mitochondrial and chloroplast Rieske proteins are extrinsic and that their association with the rest of the complex involves hydrophobic interactions.

Expression of the aminopeptidase N (CD13) gene in the human T cell lines HuT78 and H9

The membrane-bound metalloprotease aminopeptidase N (APN, CD13, EC 3.4.11.2) is a well-established marker of normal and malignant cells of the myelomonocytic lineages. It is also expressed by leukemic blasts of a small group of patients suffering from acute or chronic lymphoid leukemia. CD13-specific monoclonal antibodies do not bind to the surface of normal B lymphocytes and APN-mRNA was not detectable by Northern analysis in normal lymphocytes or in T cell lines. A recent paper, however, describes the expression of CD13 on concanavalin A-stimulated T cells. Here, by means of enzymatic amplification of cDNA, cloning and sequencing of amplified cDNA fragments, in situ hybridization, and transcription start site mapping, evidence is provided that the human T cell lines HuT78 and H9 do contain APN-mRNA. Ala-pNA-hydrolyzing activity was detected in viable cells and cell homogenates as well as in size-fractionated protein fractions. Alanine-beta-naphthylamide (Ala-beta NA)-hydrolyzing activity was readily detectable after isoelectric focusing and blotting and was shown to be localized exclusively intracellularly in both cell lines. Usage of aminopeptidase-specific effectors revealed this activity to be distinct from CD13.

Multiparametric evaluation of brain functions in the Mongolian gerbil in vivo

We have developed the multiprobe assembly (MPA) by which metabolic, ionic and electrical activities can be monitored from the surface of the brain. In the present study we included optical fibers for the monitoring of intracapillary hemoglobin oxygenation by use of the Erlangen Microlight Guide Spectrophotometer (EMPHO-I) from the surface of the gerbil brain. The newly developed MPA provides simultaneous information about oxygen delivery (oxydeoxy Hb), tissue pO2 level, as well as the intracellular oxygen balance (intramitochondrial redox state). The ionic homeostasis was evaluated by monitoring extracellular K+ and Ca2+ activities reflecting the permeability changes of cation channels as well as the activities of Na+,K(+)-ATPase and other ion linked transport processes. The electrical activities were monitored by a bipolar electrocortical surface probe and DC steady potential. The subjects of the present study were Mongolian gerbils (Meriones unguiculatus) anesthetized and operated according to our routine techniques. After 30 min of recovery from the operation each gerbil was exposed to a short anoxia, graded hypoxia, ischemia as well as spreading depression. The results can be summarized as follows: 1. A clear correlation was recorded between the changes in oxydeoxy Hb spectra, tissue pO2 level and oxidation-reduction state of intramitochondrial NADH under oxygen deficiency situations (hypoxia, ischemia). 2. Blood volume changes under various perturbations monitored by various probes (366 reflectance and EMPHO-I) correlated very well with each other. 3. The degree of inhibition of Na+,K(+)-ATPase induced by oxygen deficiency could be interpreted by changes in extracellular levels of K+ measured by the surface mini-electrode. 4. Brain stimulation induced by spreading depression mechanism led to transient changes in ionic homeostasis and increase in energy requirements. The major HbO2 response was an increase in oxygenation due to the large CBF increase as monitored by the laser Doppler flowmeter. 5. Changes in oxy-deoxy Hb under fast scanning of 500-600 nm during 2-3 seconds of bilateral carotid arterial occlusion provided an indirect index for tissue O2 consumption.

Monitoring of redox-state of respiratory enzymes and myoglobin oxygenation in the working rat heart in normoxia and oxygen deficiency

The cellular oxygen supply in the isolated, hemoglobin-free perfused, working rat heart can be determined by measurements of myoglobin oxygenation. However, for a precise analysis of mitochondrial hypoxia and anoxia (pO2 < 0.01 Torr) redox-state of respiratory enzymes must be known. By use of the EMPHO (Frank et al. 1989) it is possible to perform a high speed spectrometry within very small tissue volumes. Because of the characteristic absorption spectra of oxygenated and deoxygenated myoglobin and of the oxidized and reduced cytochrome aa3 within the wavelength interval from 500 to 630 nm it is possible to isolate these two pigments from the remission spectra and to determine the oxygenation state of myoglobin and the redox-state of cytochrom aa3.

[Validation of the Child Speech Test using the Heidelberg Speech Development Test with six-year-old preschool children]

We present and discuss results from researches to validate a new test for diagnosing speech-competences of preschool children KISTE. 41 children (6;0-6;11) were tested both with KISTE and HSET. Correlations, factor- and clusteranalysis showed that the structure of both tests is different and that KISTE has a good differential validity for both aspects of speech: communicative and structural.

Spectrometric measurements in the anterior eye vasculature of the albino rabbit--a study with the EMPHO I

Intracapillary haemoglobin oxygenation (oxygen saturation) and haemoglobin concentration (corresponding with blood volume) were measured in different regions of the albino rabbit anterior eye segment using the Erlangen micro-lightguide spectrophotometer (EMPHO I). The tip of the microlightguide (active diameter 210 microns, cover diameter 0.5 mm) was placed in the vitreous by a goniometric mounting and controlled by a micromanipulator. After stepwise elevation of intraocular pressure (IOP) the haemoglobin oxygenation decreased slightly in the iris at an IOP-level of 60 mmHg, whereas in the three regions of the ciliary processes and in the peripheral choroid haemoglobin oxygenation did not decrease until values of 80 mmHg were applied. In contrast, haemoglobin concentration decreases when the IOP increases in all regions except in the pars plana where the haemoglobin concentration increased at 40 and 60 mmHg. The most pronounced reactive hyperaemia was found in the major ciliary processes. Quite passive changes of haemoglobin concentration were seen in the peripheral choroid. Effective regulatory mechanisms must exist which result in IOP-independent (20-60 mmHg) haemoglobin oxygenation, whereas pronounced changes in intracapillary haemoglobin concentration were observed. The decay of both parameters at IOP 80 mmHg is indicative of an exhaustion of their regulatory capacity. Epinephrine topically applied onto the conjunctival sac or injected into the common carotid artery led to a short-term decrease of haemoglobin concentration and, later, a hyperaemic response. A short-term haemoglobin deoxygenation was found especially in the major ciliary processes.

[Endosonographic staging of rectal tumors]

Pre-operative staging was performed in 81 patients with rectal tumours by means of endorectal sonography. In 87% of cases (70 out of 81), the endosonographic findings corresponded with the histopathological appearance; the recognition of T0 and 1 tumours, which is important in deciding surgical procedures, was possible in 94% (51 out of 54). Differentiation between T0 and T1 tumours (i.e. between adenomas and carcinomas infiltrating the submucosa) was not possible. Five out of ten of T2 and 14 out of 16 T3 tumours were staged correctly. One T4 tumour was placed in too low a stage. A comparison of the echo structure of adenomas and carcinomas in 76 patients showed that 28 out of 43 adenomas (65%) have homogeneous echoes, while 24 out of 33 carcinomas (73%) showed inhomogeneous low intensity echoes.

[The development of the assortment and requirements of the tissue bank of the District Institute for Blood Donation and Transfusion Leipzig]

Since the foundation of the tissue bank at the District Institute for Blood Donation--and Transfusion Service of Leipzig in 1966 the range of production and the assortment of nonvital tissue transplants has considerably increased. The amount of clinical establishments and their requirements is considerably increased, in which the realization of demands is not always possible without waiting periods. The main tissue conservation method is the cryo-drying. Besides the extreme cooling and cryo-preservation were used. Problems of transportation of cooled tissue conserves were discussed.

The effect of fluoride on the resorption of dentine by osteoclasts in vitro

Osteoclasts were isolated mechanically from bones of prehatch chicks and cultured on dentine for 24 or 39 h in medium without or with added sodium fluoride at concentrations of 0.15, 1, 15, or 30 mg/liter. Fixed and toluidine blue-stained specimens were examined by light microscopy and osteoclasts were counted, all cells were removed and resorption pits were counted. The dentine was then prepared for scanning electron microscopy (SEM) and pits located on a raster search using backscattered electron imaging. Stereophotogrammetric measurements were made of the depths, plan and true surface areas and volumes of pits, and the volume:area ratio and a three-dimensional form factor calculated for each. The presence or absence of a ring of demineralization around each pit was recorded. Pits with the same plan area were significantly (p less than 0.001) less deep in cultures containing 15 or 30 mg/liter NaF and the incidence of rings around pits was higher (controls 2.7%, 15 mg/liter 31.3%, 30 mg/liter NaF 39.7%). In one experiment, pits were larger in the specimen cultured with added 1 mg/liter NaF, but in a much larger series of 631 (251 in the control and 380 in the 1 mg/liter NaF cultures) pits measured, depths, volumes and volume:plan-area ratios were significantly lower (p less than 0.001), and rings round pits 2.5 times more common, in the fluoride-treated group. A complex interplay of stimulation of some cells in the culture with indirect stimulation of osteoclasts and direct inhibition of osteoclastic resorptive function may be operating at this concentration of fluoride. In vivo, therapeutic doses of sodium fluoride would be expected to act not only to increase the formation of osteoid but also to suppress osteoclastic activity.

Endoluminal sonography in follow-up of rectal carcinoma

Fourteen patients who had undergone local excision, anterior resection or low anterior resection for rectal carcinoma were examined by endoscopic ultrasonography. In two of three cases of local recurrent carcinomas, endoscopic sonography was superior to computed tomography in determining the depth of tumor infiltration. There were difficulties in differentiating scar tissue from local tumor formation when the mucosa appeared normal upon endoscopic examination. Only repeated follow-up examinations starting in the postoperative period, will allow a differentiation between scar tissue and local tumor recurrence.

[New endosonographic examination technic for improving the assessment of small rectal tumors]

Conventional endosonographic techniques of examination in early carcinoma and sessile rectal adenoma have shown unsatisfactory results. We therefore fill the rectal cavity directly with water. Using this technique the anatomy of the rectal polyp is preserved, and the separate layers are easier to differentiate, especially when the 10-MHz scanner is used. The clinical results in 56 patients show an improvement concerning the preoperative staging especially in those tumors which are not palpable.

Primary glucocorticoid receptor defect with likely familial involvement

A 29-year-old woman with moderately elevated blood pressure and signs of hyperandrogenism (hirsutism and acne) but without typical Cushing's syndrome symptoms has been followed for almost 6 years. Steroid and glucocorticoid receptor studies indicated a primary glucocorticoid receptor defect. Elevated androgen values were of special interest. Clinical manifestation of hyperandrogenism seemed not to be proportional to the biochemical findings. Therefore, the possibility of a partial androgen receptor defect should also be considered.

Endoluminal ultrasonic examination of sessile polyps and early carcinomas of the rectum

The results of conventional endosonographic techniques in the assessment of early carcinomas and sessile polyps of the rectum have been unsatisfactory. We therefore developed a new technique in which the rectal cavity is filled directly with water. Using this technique, the anatomy of small rectal tumors is preserved and the layers of the rectal wall are easier to differentiate, especially with a 10-MHz scanner. The clinical results in 66 patients demonstrate that this new technique is very accurate in the preoperative staging of adenomas and T1-carcinomas of the rectum.

[Endorectal sonography in rectal cancer]

35 patients with rectal cancer were examined in a prospective trial by endorectal ultrasound. In 27 patients the sonographic diagnosis of tumour penetration was correct as compared with histologic findings, in 7 patients infiltration depth was overestimated, and in one case underestimated. In 21 resected specimens, examined postoperatively in a water tank with the same equipment, ultrasonic examination was correct in 17; in no case was the infiltration depth underestimated. The different technical approaches in local sonographic staging of rectal cancer are discussed.

[Structure of the wall of the gastrointestinal tract: a comparative sonographic-morphologic study]

High frequency ultrasound can resolve the structure of the wall of the gastro-intestinal tract into three highly echogenic lines with poorly echogenic zones between them. Sequential removal of layers of the walls of fresh specimens of the gastro-intestinal tract showed the following correlation between the sonographic and histological findings: the innermost and outermost highly echogenic lines correspond to incident and exit echoes. The middle line corresponds with the sub-mucosa and the junctional zones of the mucosa/muscularis mucosa and sub-mucosa/muscularis propria. The intervening low echo lines correspond with the mucosa and muscularis propria.

[Sonography of pancreatic carcinoma. Sonomorphology, diagnostic accuracy and tumor staging]

Ultrasonography was performed in 125 consecutive patients with clinically suspected carcinoma of the pancreas. The most important diagnostic criteria were reflectivity and echo amplitude, which were locally decreased in 71% (50/70) and increased in 27% (19/70) of the cancers. The echogenicity and reflectivity did not differ in four endocrine active tumors and adenocarcinomas. The diagnostic accuracy was 83% (101/122); in 3 patients ultrasonography failed to provide adequate information. Dilation of the biliary tree was found in 68% (43/50) of the carcinomas and dilation of the Wirsungian duct in 52% (32/58). There was some difficulty in differentiating between pancreatic carcinoma and chronic pancreatitis because the echogenicity is similar for both and inflammatory and neoplastic pancreatic processes are also present in both diseases. Although only 2-3 cm in diameter, 87% (7/8) of the carcinomas were already in the T3 stage. Angiography to evaluate resectability is unnecessary only when vascular encasement, extensive infiltration of peripancreatic fat, or tumor thrombus has been demonstrated sonographically.

[Diffuse leiomyomatosis of the stomach]

Sonography and computed tomography were the first imaging methods enabling the visualization of intramurally growing tumours of the stomach. The article reports on a rare case of a diffuse leiomyoma that was diagnosed by means of computed tomography.

Inherited thyroxine-binding globulin excess. Study in a kindred

A three-generation family with hereditary high thyroxine-binding globulin (TBG) serum levels has been studied. All patients were clinically euthyroid and did not have a goiter. Four females of the eleven members of the kindred had elevated TBG (range: 34-56 micrograms/ml), total thyroxine (T4) and total triiodothyronine (T3) levels, but normal free T4 (fT4) and normal response of thyroid stimulating hormone (TSH) to intravenous application of thyrotropin-releasing hormone (TRH). Microheterogeneity of TBG studied by isoelectric focusing showed a normal pattern. No variations of the four main bands as seen in other causes of TBG excess like liver diseases, estrogen therapy or pregnancy could be measured. The changes in TBG concentration seem to be due to an abnormal gene expression controlling synthesis of TBG.

[Adrenomyeloneuropathy, a rare cause of primary adrenal cortex insufficiency]

Inherited via the X chromosome, adrenomyeloneuropathy is a rare cause of primary adrenocortical insufficiency. Neurological signs are of central and peripheral demyelinization, while endocrinologically it is characterized by Addison's disease and primary testicular insufficiency. In two patients with this condition the metabolic defect in the breakdown of long-chain fatty acids was confirmed by an increased hexakosan (C 26) blood level. One patient had an isolated failure of the zona fasciculata; in the other there was clinically manifest complete adrenocortical insufficiency. Both patients had incipient hypogonadism. In the second case, neurological symptoms preceded the endocrinological ones, while in the first both the family history and the adrenocortical insufficiency led to the diagnosis. In peripheral neuropathy in a young male, attention should always be given to signs of incipient adrenocortical insufficiency.