Photochemical and photobiological studies of a furonaphthopyranone as a benzo-spaced psoralen analog in cell-free and cellular DNA

Photobiological activities of the benzo-spaced psoralen analog furonaphthopyranone 3 have been investigated in cell-free and cellular DNA. The molecular geometry parameters of 3 suggest that it should not form interstrand crosslinks with DNA. With cell-free DNA no evidence for crosslinking but also not for monoadduct formation was obtained; rather, the unnatural furocoumarin 3 induces oxidative DNA modifications under near-UVA irradiation. The enzymatic assay of the photosensitized damage in cell-free PM2 DNA revealed the significant formation of lesions sensitive to formamidopyrimidine DNA glycosylase (Fpg protein). In the photooxidation of calf thymus DNA by the furonaphthopyranone 3, 0.29 +/- 0.02% 8-oxo-7,8-dihydroguanine (8-oxoGua) was observed. With 2'-deoxyguanosine (dGuo), the guanidine-releasing photooxidation products oxazolone and oxoimidazolidine were formed predominately, while 8-oxodGuo and 4-HO-8-oxodGuo were obtained in minor amounts. The lack of a significant D2O effect in the photooxidation of DNA and dGuo reveals that singlet oxygen (type II process) plays a minor role; control experiments with tert-butanol and mannitol confirm the absence of hydroxyl radicals as oxidizing species. The furonaphthopyranone 3 (Ered = -1.93 +/- 0.03V) should act in its singlet-excited state as electron acceptor for the photooxidation of dGuo (delta GET ca -6 kcal/mol), which corroborates photoinduced electron transfer (type I) as a major DNA-oxidizing mechanism. A comet assay in Chinese hamster ovary (CHO) AS52 cells demonstrated that the psoralen analog 3 damages cellular DNA upon near-UVA irradiation; however, no photosensitized mutagenicity was observed in CHO AS52 cell cultures.

[Bilateral candida endophthalmitis in 2 i. v. drug-dependent patients with oral L-methadone substitution]

BACKGROUND

Controlled therapy programs for former i.v. heroin abusers supervised by physicians offer levomethadone (L-Polamidon) as an oral substitute for heroin to allow social stabilisation of the addict. As well they reduce the risk of bloodborne infections (e.g. HIV and hepatitis) by giving up "needle sharing". Assuming that i.v. drug abuse is one of the major risk factors for Candida endophthalmitis in young, otherwise healthy patients, in case of strict oral substitution no onset of Candida endophthalmitis should be expected.

CASE REPORT

The clinical courses of two HIV-negative and primarily i.v. heroin addicted young male white patients are presented. While participating in an exclusively controlled, oral program of methadone substitution for several months, both patients developed bilateral Candida endophthalmitis.

CONCLUSION

A persisting i.v. abuse, either of heroin or of L-methadone, parallel to the supposingly strict orally applied substituting drug L-methadone has definitely to be suspected leading to the Candida endophthalmitis.

Logics and logistics of community intervention against osteoporosis: an evidence basis

Under designations like small areas action research and intervention, directed 'ground-up' health promotion and prevention in the population form an important part of the ongoing medical systems development. There is recent evidence of the success of community intervention against cardiovascular disease. In osteoporosis, however, there is still a lack of conclusive data on both the logics and logistics of such an approach. Since 1988, a county health policy program has been formulated and implemented in Ostergötland, Sweden, following the principles and guidelines of the WHO HFA 2000 declaration. Vadstena (n approximately 7,600) was chosen for a local and generalizable osteoporosis prevention project mediated by the primary care organization by means of health promotion and education in the community. In the present report we emphasize that community intervention is an important new advancement of the medical systems, where the basic research questions include operational and management aspects as equally vital and measurable requisites and results as other performance and outcome variables. We found that a community intervention trial against osteoporosis is both motivated and feasible and in this report wish to provide evidence on these crucial issues of logics and logistics.

[Intravenous spiral CT angiography for assessment before orthotopic liver transplantation: comparisons between tomography, MIP, 3-dimensional surface imaging and intra-arterial DSA]

To analyse the efficacy of intravenous spiral CT angiography (SCTA) for the evaluation before orthotopic liver transplantation (oLT) compared with DSA.

METHODS

Spiral CT was performed on 31 potential recipients of a liver graft in order to examine hepatic vessels, coeliac axis, splenic artery and superior mesenteric artery. The arterial vessels were reconstructed in "Maximum Intensity Projection (MIP)" and "Shaded Surface Display (SSD)"-technique. The axial images, MIP and SSD were compared in 25 patients with DSA with regard to the visualisation of the vascular anatomy, detectability of stenosis and vascular diameters.

RESULTS

The type of arterial liver supply could be determined via SCTA in all patients. Stenosis of the coeliac axis was seen in ten patients on the DSA, MIP and SSD and in eight patients on the axial images. Occlusion of the hepatic artery was clearly visualised in two patients on the DSA, axial images and MIP and in one patient on the SSD. There was no false positive diagnosis with SCTA. SSD was seen as the best technique to visualise the vessels without overshadowing. There were no significant differences between the diameters measured from the axial images, MIP and SSD images in transversal direction and the DSA images (p > 0.05).

CONCLUSION

SCTA is a greatly promising method for the imaging of vessels supplying the liver before oLT, and may convey more diagnostic information than DSA.

Experience with zinc protoporphyrin as a marker of endogenous iron availability in chronic haemodialysis patients

BACKGROUND

Ferritin and the percentage of transferrin saturation (TS) are established parameters with which to evaluate endogenous iron availability during treatment of renal anaemia with recombinant human erythropoietin (rHuEpo). Zinc protoporphyrin (ZPP) has been proposed as another valid marker in this setting.

METHODS

We determined the following parameters in 127 patients, including 117 haemodialysis patients: haemoglobin, erythrocytes, haematocrit, mean corpuscular volume (MCV), iron, ferritin, transferrin saturation and ZPP. Of the patients treated in a cross-sectional study, 38.5% were treated with rHuEpo; 30.7% with intravenous iron; and 13.6% with intravenous iron and rHuEpo simultaneously. Median ferritin was 304 ng/ml and median transferrin saturation was 21.2%.

RESULTS

Including cases with manifest storage iron deficiency, a concordant elevated ZPP ( > 40 mumol/mol haem) and a decreased transferrin saturation ( < 20%) were found in 23 of our dialysis patients (19.6%) while 55 cases (47%) were classified as concordantly negative. However, as many as 39 cases (33.3%) showed discrepant results: in 16 cases (13.6%) ZPP was elevated but transferrin saturation was in the normal range, while in 23 cases (19.6%) the opposite results were observed.

CONCLUSIONS

We conclude that beyond the border of manifest storage iron deficiency, defined as a ferritin < 30 ng/ml in male and < 15 ng/ml in female patients, ZPP and TS cover different ranges of functional iron deficiency which is reflected in the lack of a correlation of ZPP to any other of the above-mentioned parameters. Our data suggest that a TS < 20% as a diagnostic, and thus intervention, criterion in the evaluation of functional iron deficiency and iron substitution beyond manifest storage iron deficiency might result in overestimation of iron requirements. It remains to be shown in a longitudinal study, also reflecting the course of haemoglobin and the mean rHuEpo dose, whether ZPP or TS is the more appropriate parameter in the evaluation of functional iron availability.

Genotoxicity induced by furocoumarin hydroperoxides in mammalian cells upon UVA irradiation

The mutagenicity and micronucleus induction by the furocoumarin hydroperoxides 1a and 2a and, for comparison, their corresponding alcohols 1b and 2b were investigated in L5178Y tk+/- mouse lymphoma cells and AS52 Chinese hamster ovary cells. The furocoumarin hydroperoxide 1a enhanced the micronucleus frequency in L5178Y tk+/- mouse lymphoma cells significantly, while its alcohol 1b exhibited a rather moderate effect. In contrast, both the furocoumarin hydroperoxide 2a and its alcohol 2b induced high frequencies of micronuclei. Only the furocoumarin hydroperoxide 1a, but not its alcohol 1b, was mutagenic in both L5178Y tk+/- and AS52 cells. On the other hand, the furocoumarin hydroperoxide 2a and its alcohol 2b were mutagenic. For all furocoumarin derivatives 1a,b and 2a,b no mutagenicity and genotoxicity was observed in the absence of UVA light. The multifunctional furocoumarin hydroperoxides may serve as potential photochemotherapeutic agents.

A case of pure red cell aplasia: follow-up on different immunosuppressive regimens

A 66-year-old patient was admitted to our hospital in January 1992 for further evaluation of severe normocytic anemia. Hemoglobin (Hb) was 3.5 g/dl, reticulocyte count 1%. Bone marrow showed a nearly complete lack of red cell precursors, thus favoring the diagnosis of acquired pure red cell aplasia (PRCA). Immunosuppressive therapy with prednisolone was started but had to be supplemented with azathioprine because of a further rapid decrease in Hb to 3.7 g/dl after an initial transfusion of 6 U red blood cells. However, with this regimen a renewed decrease in Hb to 6.6 g/dl was noted, and further transfusions were required. Therefore therapy was switched to cyclosporine A (CyA) while tapering off prednisolone. Four months after the initial diagnosis a positive parvovirus B19 IgM antibody was found. After the failure of hematological remission with three immunosuppressive regimens a course of high-dose intravenous immunoglobulins (IVIG) was administered in July 1992. Six weeks after IVIG therapy a peak hemoglobin concentration of 12.3 g/dl was noted, and further transfusion was not required. CyA was tapered off in October 1992. One month later CyA was reinstituted because of a relapse of PRCA but was unsuccessful until January 1993. At this time immunosuppressive CyA therapy was discontinued because of a periodontal abscess. In February 1993 a second IVIG infusion was given, and a second remission of PRCA was noted, showing an increase in hemoglobin up to 14.5 g/dl by November 1993. At the last follow-up visit in February 1994 our patient was still in complete hematological remission.

A cost-effectiveness study of leg ulcer treatment in primary care. Comparison of saline-gauze and hydrocolloid treatment in a prospective, randomized study

OBJECTIVE

The majority of leg ulcer patients in Sweden are managed by primary health care personnel. To compare, in a primary care setting, the healing results and the expenses of two commonly used wound dressings for leg ulcers.

DESIGN

Thirty patients with leg ulcers of venous or mixed venous/arterial aetiology were randomized to treatment with saline-soaked gauze or with the hydrocolloidal dressing [HCD: DuoDERM (ConvaTec, A Bristol-Myers Squibb Company, Princeton)]. All patients were bandaged with the same compression of low-stretch-type [Comprilan (Beiersdorf AG, Hamburg)].

SETTING

Vårdcentralen Marieberg, Primary Health Care Centre, Motala, Sweden.

OUTCOME MEASURES

Healing/reduction of ulcer area, pain, costs for material, nursing time, kilometres driven were registered during a six-week period.

RESULTS

Two patients dropped out of the study, one in the gauze-group due to erysipelas, and one in the HCD-group for social reasons. A total of 1234 dressing changes were analysed. Costs for material were similar in the two groups. When the total care including nursing- and travelling time and kilometres driven were analysed, the mean cost for treatment with gauze dressings was 4126 Swedish Kronor (SEK), and with HCD, 1565 SEK. Seven patients in the HCD-group and two in the gauze-group healed during the study. The reduction of the ulcer area was 19% in the gauze-group and 51% in the HCD-group (p < 0.16).

CONCLUSION

The total care, analysed in an authentic clinical setting, must be considered when different wound-care methods are discussed. In this study the use of HCD showed lower costs than use of gauze-dressings. As regards healing there was a tendency to improved healing with HCD, but no significant difference. Patients in the HCD-group reported significantly less pain at dressing changes (p < 0.003) than patients in the gauze-group.

Film-induced amusement changes in saliva cortisol levels

The present study, aimed at investigating effects of film-induced amusement on saliva cortisol levels, was performed on 52 healthy male volunteers, aged 19-31 years. They were assigned to an amusement or a control condition. Saliva cortisol and affective film ratings were the dependent variables. During amusement 50% of the subjects showed changes in saliva cortisol correlated positively with ratings of funniness. Thus, cortisol secretion may be linked to emotional arousal, regardless of the emotional valence.

[Tuberculosis--a small-scale epidemic in a Turkish extended family]

In a Turkish joint family including 15 family members seven persons suffered from pulmonary tuberculosis within a period of five months, namely, three adults and four children. Pulmonary tuberculosis also occurred in a boy from the neighbourhood. This infection chain originated from a girl of nineteen years of age.

[The effect of midazolam on blood circulation and respiration during spinal anesthesia in urology]

Ten urological patients with spinal anesthesia were sedated with midazolam 0.03 mg/kg i.v. A similar group (n = 10) was given placebo instead of midazolam (2 ml 0.9% NaCl). Patients who received midazolam slept lightly but were rousable. During the operation 2 l/min oxygen was administered via a nasal cannula; pO2 and pCO2 remained within normal limits throughout the procedure. No cardiovascular side effects such as hypotension or other reaction such as vomiting, nausea, or confusion were observed after midazolam. At the end of the operation all patients were fully awake and cooperative.

Stress reactions in response to the procedure of LHRH tests as measured by salivary and serum cortisol and psychological variables

Serum and salivary cortisol release and mood ratings were measured in response to the procedure of LHRH tests in 12 medical students professionally familiarized with venipunctures (familiarized subgroup) and in 5 non-medical students (unfamiliarized subgroup). There were significant differences in cortisol and mood ratings between both groups. Only the unfamiliarized subgroup showed significant increases of cortisol and higher values for tension and anxiety. Relations between cortisol, tension and anxiety confirm an effect of experimental stress on the secretion of cortisol during the procedure of LHRH tests. Novelty and subjective mood states appear to have predictive values with regard to stress-induced endocrine reactions.

Familial trisomy 3q25----qter. Report of two cases

Two girls with the trisomy 3q2 clinical syndrome are presented. Their fathers were twins and carried a t(3;8)(q25;p23). Case 1, aged 8 months, had a 46,XX,der(8) complement. Case 2, died at 5 months of age before cytogenetic study, was considered to have the same karyotype. Both cases combined showed the majority of phenotypical features of trisomy 3q2 syndrome, including facial appearance, glaucoma, and visceral malformations. This observation suggests that the trisomy 3q25----qter is sufficient to produce the syndrome which shows variable expression in these cases.

Bone grafting at the stage of mixed dentition in cleft lip and palate patients

Our results of bone grafting to the alveolar process during the mixed dentition were investigated in 55 consecutively treated patients (66 clefts). The amount of remaining bone and gingival retraction at the tooth mesial to the cleft after 3 and 12 months was measured and correlated with the following anatomical conditions present during surgery: width of the cleft, rotation of the adjacent incisor, stage of eruption of the tooth distal to the cleft. It was also considered if any deciduous lateral incisor or canine was extracted during surgery and if any flap dehiscence took place postoperatively. It was found that flap dehiscence resulted in significantly less bone at 3 months and at 1 year after surgery. Furthermore, extraction of a deciduous tooth was found to be significantly correlated to less bone 1 year after surgery, in which cases there were also persisting gingival retractions. The other factors had no significant influence on the outcome of surgery.

Facial morphology and occlusion at the stage of early mixed dentition in cleft lip and palate patients treated with delayed closure of the hard palate

Cephalometric radiographs and dental study casts were analyzed in a group of 23 seven-year-old cleft lip and palate patients, 16 with unilateral and 7 with bilateral cleft. The patients' primary surgical procedures had been completed except for closure of the cleft in the hard palate. For comparison, similar records from another group of patients, 18 with unilateral and 8 with bilateral cleft lip and palate, were studied. In these cases the cleft of the hard palate had been repaired in infancy, using a vomer flap procedure. The results indicated that midfacial growth and dental occlusion of the unilateral cleft sample was significantly better in patients whose closure of the hard palatal cleft had been delayed to the stage of mixed dentition than where repair had been performed with a vomer flap in infancy. No differences were found, however, between similar subgroups with bilateral cleft lip and palate.

Isokinetic torque levels for knee extensors and knee flexors in soccer players

The knee extensor and knee flexor strengths were measured isokinetically (30 degrees, 180 degrees/s) and isometrically with a Cybex II device in three groups of male soccer players (national team players, n = 13; division I, n = 15; division IV, n = 180) and a group of nonsoccer players (n = 32). There were difference in strength between soccer players and nonsoccer players and between players from different divisions. Correction for body surface area did not affect the results. The knee flexor/knee extensor ratio (H/Q ratio) was significantly higher for soccer players than for nonsoccer players. The fast-speed/slow-speed ratio for knee extensors was higher for nonsoccer players and for national team players than for players from divisions I and IV.

Monosomy 16q: a distinct syndrome. Apropos of a de novo del(16) (q2100q2300)

A 2-month-old boy with delayed growth and development, brachycephaly, large anterior fontanelle, low-set folded ears, micrognathia, aortic coarctation, floppy abdominal muscles, and pes varus, was found to have a 46,XY,del(16)(q2100q2300) de novo karyotype. This observation corroborates both the distinctness of the 16q monosomy syndrome and the pathogenetic role of the band 16q21.

Molecular cloning of a pea mRNA encoding an early light induced, nuclear coded chloroplast protein

cDNA clones were isolated for a chloroplast protein, the mRNA of which is induced to maximum levels within 2-4 h after onset of illumination in five day old, etiolated pea seedlings.The cDNA library was constructed from poly(A)(+)-mRNA which was isolated from 4 h illuminated seedlings. The extremely short induction period of the early light induced protein(ELIP)-mRNA established the basis of our screening procedure. Colony hybridization experiments were performed with(32)P-labelled cDNA probes, synthesized from RNA of seedlings which had been exposed to different programs of illumination. Plasmid DNAs were isolated from colonies showing strong hybridization signals exclusively with cDNA corresponding to the 4 h-mRNA. Hybrid released translation of preselected plasmids p 17/C2 and p17/C4 revealed a peptide of Mr 24 000. After posttranslational importin vitro, the processed product of Mr 17 000 appears in the chloroplast. Using these clones, the expression of the ELIP-mRNA was investigated by DOT-hybridization. The ELIP-mRNA reaches maximum levels within 2-4 hours after onset of illumination. Our results correspond precisely to thein vivo characteristics and indicate positive identification of the sought clones.

Duration of stretching effect on range of motion in lower extremities

The duration of the effect of contract-relax stretching on range of motion (ROM) in the lower extremities was measured on eight male volunteers. The stretching procedure was performed as one isometric contraction, followed by relaxation and then a passive extension of the muscle being stretched. The treated muscle groups were the adductors, hamstrings, rectus femoris, iliopsoas, gastrocnemius, and soleus. The total stretching time was 15min. Six ROMs were tested 0, 30, 60, and 90min after the stretching procedure. There was a significant increase in hip abduction (+17% +/- 3), knee flexion (+4% +/- 1), hip flexion (+4% +/- 2), ankle dorsiflexion with knee flexed (+18% +/- 7), and ankle dorsiflexion with knee straight (+16% +/- 5). The increase remained for 90min for all ROMs except for ankle dorsiflexion with the knee straight.

Muscle strength and flexibility in different positions of soccer players

One-hundred eighty soccer players were tested for muscle strength in knee extension and knee flexion and for flexibility in the lower extremity. The strength measurements were done with a Cybex II isokinetic device (Lumex, Bay Shore, New York). The range of motion (ROM) was measured according to a method described by Ekstrand et al. (1982). The players were divided into groups according to their player position: goalkeepers, defenders, midfielders, and forwards. The results showed a significantly higher knee extensor torque in goalkeepers and defenders than in forwards (P less than 0.05). The knee flexion/knee extension ratio (H/Q ratio) was significantly higher for forwards compared to goalkeepers (P less than 0.001) and defenders (P less than 0.01). The goalkeepers were significantly more flexible than the other players in hip flexion (P less than 0.001), knee flexion (P less than 0.01), and ankle dorsiflexion (P less than 0.001).

Kinetic interactions between azlocillin, cefotaxime, and cefotaxime metabolites in normal and impaired renal function

Cefotaxime (CTX) kinetics, alone and in combination with azlocillin (AZ), were determined in 18 subjects with either normal or impaired renal function. After the single dose and with increasing renal insufficiency, total CTX clearance fell from 266 to 71 ml/min/1.73 m2. At the same time the terminal t1/2 rose from 1.1 to 2.8 hr. Regardless of the degree of renal function, CTX clearance in combination with AZ in all patients was only 50% to 60% of that with CTX alone. This reduction in total body clearance was due to a parallel decrease in renal and nonrenal clearance. In advanced renal failure, particularly after AZ, the terminal t1/2 of the CTX metabolites increased up to 1000% to 1500% of normal. On the basis of these findings, CTX dosage adjustment is recommended only in patients with a glomerular filtration rate (GFR) below 20 ml/min. After AZ, however, dosage reduction of CTX seems to be advisable at an earlier stage of renal impairment (GFR 40 ml/min).

Incidence of soccer injuries and their relation to training and team success

One hundred-eighty players in a male soccer senior division of 12 teams were observed prospectively for 1 year to study the risk of soccer injuries in relation to exposure and to establish the connection between training, injuries, and team success. Totally, more than 100 hours of practice were analyzed. All injuries were examined by the same orthopaedic surgeon. On the average, each team played 36 games and had 95 practice sessions with 66% attendance of selected players. A direct correlation was noted between team success and the amount of training. Teams with more than average training showed a diminishing number of injuries. A high practice-to-game ratio seems to be advantageous. One injury every third game and every ninth practice session was documented. For the individual player the incidence of injury was 7.6/1000 practice hours and 16.9/1000 game hours. The incidence of injury was higher at training camps. Correlation was noted between the design of the training and the incidence of injuries. The duration of warming up seemed adequate, but its content did not appear to be satisfactory from a clinical point of view. Redesign of the warm-up with more emphasis on flexibility and the addition of a cool-down is suggested to reduce injuries.

Cephalometric radiography and computed tomography in infants undergoing major craniofacial surgery--a comparison

Craniofacial growth after surgery in children is not completely understood. We have therefore formed a programme for pre- and postoperative studies with both roentgencephalometric- and computed tomographic investigations. This regimen results in overlapping information. Thus, an assessment of the advantages and disadvantages of the two methods was made and exemplified in four patients. In our experience both cephalometry and CT are essential for the diagnosis, surgical planning and follow-up of surgically treated children with craniofacial anomalies. To minimize the radiation doses and the diagnostic procedures which in these cases often includes general anesthesia, patients with isolated, asymmetrical conditions such as plagiocephaly, might be followed with CT only, since roentgencephalometry can not add much information.