Treating tibial fractures with a modified Sarmiento method

There is still no unanimous agreement on the appropriate primary treatment of tibial fractures. One fraction advocates conservative treatment, and another advocates open reduction and internal fixation. Between these extremes is the functional treatment developed by Augusto Sarmiento. The authors adopted Sarmiento's method in 1976 and present a prospective study of 317 cases treated between 1976 and 1988 in which the union rate was 98.7%. They describe the Sarmiento method as ideal for closed, spiroid (whether comminuted or not) tibial fractures resulting from low-energy forces.

The role of hypertension, left ventricular hypertrophy and psychosocial risks in cardiovascular disease: prospective evidence from blue-collar men

Epidemiological studies have demonstrated that, compared with the population as a whole, there is increased cardiovascular morbidity and mortality among lower socio-economic groups. To explore determinants of the increased risk within this group, a prospective 6.5 year investigation of a cohort of 416 middle-aged (40.8 +/- 9.6 years) male blue-collar workers was undertaken. In addition to established somatic and behavioural risk factors, psychosocial influences that measured chronic occupational stress in terms of an imbalance between high effort and low reward were assessed. Multivariate logistic regression analysis shows that hypertension (odds ratio (o.r.) 3.85; 95% CI 1.59-9.34), left ventricular hypertrophy (o.r. 3.62; 95% CI 1.06-12.37), hyperlipidaemia (o.r. 2.55; 95% CI 1.08-6.00), status inconsistency (measuring low reward at work) (o.r. 2.86; 95% CI 1.04-7.80) and 'immersion' (measuring high intrinsic effort at work) (o.r. 3.57; 95% CI 1.22-10.47) independently contribute to the prediction of fatal or non-fatal cardiovascular events (acute myocardial infarction, stroke). Expected probabilities of cardiovascular events are clearly elevated if the combined effects of left ventricular hypertrophy and psychosocial risks are analysed. In conclusion, increased incidence of cardiovascular disease among lower socio-economic groups is explained by a co-manifestation of established risk factors including left ventricular hypertrophy (by ECG) and psychosocial factors measuring chronic stress at work.

[Cigarette smoking and psychosocial work stress in middle-management employees]

The association between psychosocial work stress and cigarette smoking is analyzed in a socioeconomically and professionally homogeneous group of 163 middle managers (40-55 years; 48.4 +/- 4.5) in a large industrial company. Psychosocial stress is defined in terms of an imbalance between effort spent and reward obtained at work. The relative risk of regular smoking is 4.34 (odds ratio after controlling for age; 95% CI 1.50-12.54) in those middle managers who suffer from a marked imbalance between effort and reward, compared to those who are free from this type of psychosocial stress at work. This effect persists in the older age group although the proportion of smokers decreases with age. Within the group of regular smokers, every second middle manager suffering from a marked imbalance between effort and reward is a heavy smoker (greater than or equal to 20 cigarettes/day) whereas in the group experiencing less stress at work, only 28% heavy smokers are found. However, due to small numbers this difference is not statistically significant. In conclusion, the data reported in this study demonstrate an association between psychosocial stress at work in terms of high effort and low reward and the risk of regular smoking. This association is not confounded by age, socio-economic status or type of occupation.

Identification and determination of the two principal metabolites of minocycline in humans

A chromatographic method has been developed for the quantification of minocycline in human serum and urine. The chromatographically determined concentration of minocycline correlated well with the microbiologically active concentration in serum. Two metabolites, 9-hydroxyminocycline and N-demethylated minocycline, could be isolated and identified as the principal metabolites of this tetracycline antibiotic. The structure of the 9-hydroxy compound was proved by nuclear magnetic resonance analysis for the first time. About 15% of the drug was actively converted in the body into a substance less microbiologically active than the parent compound and excreted in the urine within 96 h after the application.

Phase I/pharmacokinetic reevaluation of thioTEPA

Because the initial evaluation of N,N',N''-triethylenethiophosphoramide (thioTEPA) preceded the standardized approach to the Phase I trials, uncertainty surrounds the recommended dose. Since it has recently been demonstrated that an almost 100-fold increase in dose can be administered in bone marrow transplant regimens, we conducted a Phase I reevaluation of thioTEPA. ThioTEPA was administered i.v. in 50 ml 5% dextrose in water over 10 min. Twenty-seven patients were entered at doses ranging from 30 to 75 mg/m2. The major toxic effect was myelosuppression; thrombocytopenia greater than or equal to grade 3 occurred in four of seven patients, and leukopenia greater than or equal to grade 3 in two of seven patients at 75 mg/m2. Among eight patients at 65 mg/m2 only two had greater than or equal to grade 3 myelosuppression making this the recommended new phase II dose for the majority of patients. Moderate (grade 2) easily controlled nausea and vomiting was the only other major side effect. There was no alopecia or mucosal or neurological toxicity. Three partial remissions were observed among nine previously treated ovarian cancer patients. Plasma concentrations of thioTEPA and its major active metabolite triethylenephosphoramide (TEPA) were measured by gas chromatography. The half-life of thioTEPA ranged from 51.6 to 211.8 min, and its pharmacokinetics was dose dependent; total body thioTEPA clearance decreased with increasing dose. The half-life of TEPA was considerably longer than that of the parent compound (3.0 to 21.1 h); as a result, the area under the plasma concentration-time curve (AUC) of TEPA was severalfold greater than that of the parent compound. The ratio of TEPA AUC to thioTEPA AUC decreased with increasing dose, suggesting that formation of TEPA is a saturable step in elimination. The AUC and total body clearance of thioTEPA, but not of TEPA, were closely correlated with neutrophil but not platelet toxicity.

Psychosocial and biobehavioral characteristics of hypertensive men with elevated atherogenic lipids

Epidemiologic studies demonstrated an excess risk of ischemic heart disease (IHD) among individuals who simultaneously exhibit hypertension and elevated atherogenic lipids (coronary high risk (CHR)-status). Yet, relatively little is known about factors which contribute to the development of CHR-status during early and middle adulthood. The present study explores the role of selected biobehavioral and psychosocial factors in explaining CHR-status using data from a prospective 6.5 years investigation of a cohort of 416 middle-aged (40.8 +/- 9.6 years) male blue-collar workers. Multivariate logistic regression analysis shows that overweight (odds ratio (o.r.) 4.14), smoking (o.r. 2.19), low promotion prospects at work (o.r. 2.71), competitiveness at work (o.r. 2.79) and feelings of sustained anger (o.r. 5.41) independently contribute to the explanation of CHR-status. Furthermore, the operational definition of CHR-status is validated by estimating its power in predicting IHD incidence in the study cohort. In conclusion, co-manifestation of hypertension and elevated lipids is more likely to exist among those blue-collar men who exhibit distinct work-related characteristics in addition to established biobehavioral risks such as overweight and smoking. In view of the high prevalence of CHR-status and of IHD among men in the lower socio-economic strata this finding is also of interest for health policy.

Hydroxylation of chlorzoxazone as a specific probe for human liver cytochrome P-450IIE1

Human cytochrome P-450IIE1 has been implicated in the oxidation of a number of substrates, including protoxins and -carcinogens. To date, no drugs have been identified that are exclusive substrates for the protein and are applicable for use as noninvasive probes of the in vivo function of the enzyme in humans. Chlorzoxazone was found to be oxidized only to 6-hydroxychlorzoxazone in human liver microsomes. Results of steady-state kinetics are consistent with the view that only a single enzyme catalyzes the reaction. The microsomal reaction was strongly inhibited by rabbit anti-P-450IIE1 and, in a competitive manner, by known P-450IIE1 substrates. Rates of chlorzoxazone 6-hydroxylation in different human liver microsomal preparations were well correlated with levels of immunochemically measured P-450IIE1 and rates of (CH3)2NNO oxidation. Chlorzoxazone 6-hydroxylation was also found to be catalyzed by purified human liver P-450IIE1. These results provide strong evidence that P-450IIE1 is the primary catalyst of chlorzoxazone 6-hydroxylation in human liver. Rates of chlorzoxazone 6-hydroxylation vary considerably among human liver samples, and chlorzoxazone 6-hydroxylation may have potential use as a noninvasive probe in estimating the in vivo expression of human P-450IIE1 and its significance as a risk factor in the toxicity and carcinogenicity of a number of solvents, nitrosamines, and drugs.

Numerical 3D-stimulation of pulsatile wall shear stress in an arterial T-bifurcation model

The structure of pulsatile blood flow and wall shear stress in a 90 degrees T-bifurcation model is analysed numerically. The nonlinear Navier-Stokes equations for time-dependent incompressible Newtonian fluid flow are approximated using a newly developed pressure correction, finite element method. The wall shear stress is calculated from the finite element velocity field. The investigation shows viscous flow phenomena such as flow separation and stagnation and the distribution of high and low wall shear stress during the pulse cycle. Furthermore, the effect of a sharp corner at the bifurcation edge on the wall shear stress is analysed. Detailed local flow investigation is required to examine fluid dynamic contribution to the development of arterial diseases such as atherosclerosis and thrombosis.

Phase I trial of 5-fluorouracil, leucovorin, and cisplatin in combination

The ongoing evaluation of combination chemotherapy with 5-fluorouracil (5-FU) and cisplatin in several tumors prompted a phase I clinical trial of cisplatin with 5-FU modulated by leucovorin. A total of 26 patients were treated with varying doses of 5-FU by continuous i.v. infusion for 5 days; 200 mg/m2 leucovorin was given by daily bolus injection for 5 days; and 20 mg/m2 cisplatin was infused over 2 h on each day of treatment. Courses were repeated every 21-28 days. The starting dose of 5-FU was 300 mg/m2. Poor-risk patients (extensive prior radiation, performance status of 2 or worse) did not tolerate the initial dose; the maximum tolerated dose of 5-FU in this group was 200 mg/m2 daily. Good-risk patients tolerated 300 mg/m2, but a majority had excessive toxicity at higher doses. The dose-limiting toxicity was gastrointestinal (mucositis/diarrhea) and/or myelosuppression; additional side effects included were nausea and vomiting (less than or equal to grade 2) and ataxia (one patient). Among 13 patients with colorectal cancer, 4 partial responses were observed. The marked reduction in the tolerable dose of 5-FU occasioned by the addition of modulating doses of leucovorin is noteworthy. The responses observed support further investigation of this regimen in phase II trials.

Low status control, high effort at work and ischemic heart disease: prospective evidence from blue-collar men

An inverse relation between socio-economic class and occurrence of ischemic heart disease (IHD) in advanced societies is an often replicated finding from empirical studies. Yet, the processes which produce these effects remain an open question. One promising explanation concerns the prevalence of stressful working life, especially of distinct 'job strain' occupations. Based on these considerations, we develop a refined concept of work-related socio-emotional distress which considers a mismatch between high workload and low control over occupational status (e.g. job insecurity, poor promotion prospects, status inconsistency) as crucial distress-provoking conditions. Moreover, we assume that the effect of this condition on IHD risk is substantially increased by the presence of a distinct individual pattern of coping with work demand ('need for control'). Based on data from a 6.5 years prospective study on IHD incidence (n = 21) in a cohort of 416 middle-aged blue-collar men this concept is tested using logistic regression analysis. Results indicate that status inconsistency [multivariate odds ratio (o.r.): 4.4], job insecurity (o.r. 3.4), work pressure (o.r. 3,4) and 'need for control' (o.r. 4,5) independently predict IHD occurrence after adjusting for major confounding somatic and behavioral coronary risk factors. In conclusion, a refined model of work-related socio-emotional distress substantially contributes to the explanation of high IHD incidence among blue-collar men.

Pulsatile non-Newtonian blood flow simulation through a bifurcation with an aneurysm

Blood flow is analysed by means of computer simulation in an idealized arterial bifurcation model which is pathologically altered by a saccular aneurysm. The theoretical study of the flow pattern and the paths of fluid particles is carried out under pulsatile Newtonian and non-Newtonian flow conditions. The governing equations are solved numerically with the use of the finite element method. The results show the disturbed blood flow in the bifurcation and the relatively low intra-aneurysmal flow circulation. In addition to the study of basic flow patterns in the segment, a comparison of non-Newtonian and Newtonian results is carried out. This comparison proves that for the considered large artery model under physiological flow conditions where the yield number is relatively low there is no essential difference in the results.

The prognosis of cranioplasty following large craniectomy in children

The experience acquired during 10 years treatment of 33 children having undergone a large craniectomy with an average follow-up time of 5.3 years is presented. Different methods of primary and delayed closure of the skull defect are documented and discussed. Whenever possible the deep frozen conserved skull flap was reimplanted. The problem of skull flap resorption and insufficient spontaneous ossification and the alternative of a heterologous cranioplasty with methylmethacrylate (MMA) in cases of insufficient reossification is considered. The decision to use MMA as a secondary skull defect graft should be delayed at least one year after craniectomy, since a spontaneous reossification of the defect is possible until adolescence.

[Frequency and severity of throat complaints following general anesthesia with the insertion of various endotracheal tubes]

Laryngeal and pharyngeal complaints following general anaesthesia are well-known problems. The frequency, extent, and intensity reported in several studies are at variance. Such transient postoperative problems should not be considered equivalent to traumatic airway injuries caused by endotracheal intubation. A decrease in the incidence of slight airway complications was to be expected with the introduction of low-pressure-cuff tubes, however a few studies have reported just the opposite result. This study was designed to investigate the incidence, intensity, and duration of postoperative airway symptoms with special emphasis on cuff construction (low-pressure-high-volume cuff (LPC) vs high-pressure-low-volume cuff (HPC)). Our double-blind study included 500 patients. The acceptance criteria were: operation outside the head and neck region, no throat pack or gastric tube. The subjects were divided randomly into five groups, each group consisting of 100 patients: Group A: red rubber tubes (HPC); Group B: latex-spiral tubes (HPC); Group C: PVC tubes (LPC); Group D: PVC tubes with rediffusion system (LPC); Group E: face mask. The patients of groups A-D underwent oral intubation using lidocaine gel 2%; adequate cuff inflation was determined just after intubation. The patients were questioned every 24 h for 2 days postoperatively using an analogue scale and "open" and "closed" questions. The single groups were comparable in age, sex, height, weight, number of smokers, duration of operation (only groups A-D), and preoperative diseases of the upper airways.(ABSTRACT TRUNCATED AT 250 WORDS)

Wall shear stress distribution in the human carotid siphon during pulsatile flow

Wall shear stress distribution in the carotid siphon, which is a multiple curved segment of the internal carotid artery, is investigated numerically under physiological flow conditions. The computer simulation of flow through the model segment is based on the time-dependent, three-dimensional Navier-Stokes equations, solved numerically with a finite element method. The study shows the behavior of the wall shear stress-vector field and identifies the zones of high and low wall shear stress values during the cardiac cycle.

[An uncommon syndrome: the trapped popliteal vein. Apropos of a case]

A case of trapped popliteal vein, an exceptional syndrome, is reported in which the clinical appearance was that of a deep phlebothrombosis, compression being detected on phlebographic images. The etiology (combined congenital malformation and acquired muscle hypertrophy in this case) was revealed during exploratory surgery, which also allowed treatment by excision of the compressing agent without any direct vascular gesture.

Determination of protein C in plasma

Three new methods to characterize the function of protein C in plasma are described and compared to established procedures. Two methods make use of a snake venom derived specific protein C activator which allows rapid, sensitive and standardizable assays in plasma without sample pretreatment. The other technique is a two dimensional immunoelectrophoresis in the presence of calcium or EDTA, respectively.

[Congenital cystic dilatation of the common bile duct in adults. Apropos of a case diagnosed ultrasonically]

The authors report the observation of a thirty years old woman presenting a choledochal cyst demonstrated by echography. This rare condition is characterized by a segmentary dilatation of the distal portion of the commun bile duct needing surgical treatment. The described case is distinguishable from usual forms by a few own particularities.

Dose-finding study with bopindolol in arterial hypertension

Bopindolol is a new beta blocker with a long duration of action which exerts antihypertensive effects at very low dosage. The aim of this study was to define the optimal dosage of bopindolol in outpatients with mild to moderate hypertension and to compare it to atenolol in term of tolerance and efficacy, both administered once daily. Forty physicians (the Swiss Cooperative Study Group) participated as investigators in this study. They had recruited 257 hypertensive patients whose diastolic blood pressure was between 95 and 105 mm Hg (age 19-69 years; mean +/- SD, 49.3/49.9 +/- 10/11) in a multicentric double-blind study. After a 2-week placebo period patients were randomized to one of four treatment groups: bopindolol 1 mg, bopindolol 2 mg, atenolol 50 mg, and atenolol 100 mg. After 4 weeks of active treatment, if diastolic blood pressure was above 90 mm Hg, the dosage was doubled. A detailed evaluation was performed after 8 weeks of active treatment. If necessary, a diuretic was then added and patients were followed for the next 10 months in an open study. Compared to placebo, blood pressure was significantly lowered in the four treatment groups. At 4 weeks, 8 weeks, and 12 months, there was no significant difference between the blood pressures of the treatment groups. Bopindolol was as well tolerated as atenolol. Bradycardia was more common with atenolol. During this 12-month study, bopindolol 1 mg per day appeared to be an effective and a safe antihypertensive treatment. With the exception of the lower incidence of bradycardia, bopindolol is indistinguishable from atenolol in terms of side effects pattern and frequency.

Accuracy and interobserver variability of coronary cineangiography: a comparison with postmortem evaluation

The accuracy of interpretation of coronary cineangiography by two independent observers was tested against postmortem findings in 27 patients who died within 6 months of cardiac catheterization. Variations in cineangiographic interpretations between the angiographers were also evaluated. Two patients had normal coronary arteries, while the remaining 25 patients had significant coronary artery disease. Significant stenosis was defined as 75% or greater reduction in luminal diameter. Of 326 coronary segments that could be evaluated postmortem, 15% could not be evaluated cineangiographically. The respective overall accuracy of the two observers was 89 and 88% with an accuracy of 96 and 100% for the left main coronary artery, 91 and 93% for the left anterior descending artery, 84 and 86% for the right coronary artery and 89 and 79% for the left circumflex coronary artery. Cineangiographic assessment of luminal status distal to a significant proximal lesion was possible in more than 70% of major vessels with accuracy levels of 86% for both observers. Of 96 distal vessels inadequately opacified cineangiographically, 49 (52%) were found to be free of significant lesions. Both angiographers agreed in their assessment of 86% of the 340 coronary segments. Interobserver agreement was significantly better for the left main, right and left anterior descending coronary arteries than for the left circumflex coronary artery (p less than 0.05). Accuracy was 93% for 244 segments that were adequately opacified and assessed the same by both angiographers. Cineangiography can thus be used to evaluate coronary anatomy with a high degree of accuracy and minimal interobserver variability.

[Parasitic disease in schoolchildren in a village in Swiss Jura]

In a village of the Swiss Jura we examined 134 schoolchildren (7 to 16 years old) clinically, parasitologically and serologically for parasites. Half of the children showed an insufficient hygiene of hands, feet and/or anus. In 7 out of 107 anus-scotch-tests there were eggs of Enterobius vermicularis. Protozoans could be demonstrated in 8 of 133 MIF-stool-samples (2 cases of Giardia lamblia, 2 Endolimax nana and 4 Jodamoeba bütschlii). Using the procedure of enrichment of Telemann no helminth eggs were detected. Altogether parasites were found in 10% of the children. 31 children have antibodies against Toxoplasma gondii (IF titre greater than or equal to 1:40). 5 children showed a positive Toxocara-serology, additional 5 an uncertain positive reaction. The immunodiagnostic of Echinococcosis (ELISA, IF, IHA, CIE) was doubtfully positive in 4 children. In this study, intestinal protozoans and E. vermicularis were the most commonly occurring parasites followed by asymptomatic toxocariasis.

[Diagnosis of traumatic rupture of the thoracic aorta. Apropos of a series of 15 observations]

Urgent diagnosis of the rupture of the aorta is emphasized. If deceleration is one of trauma factors and the chest Xray shows a widening of the mediastinum and/or a tracheal deviation towards the right, the diagnosis must be ascertained by angiography. If positive, the patient must be immediately transfered to a specialized surgical unit.

[Determination of the primary structure of alfalfa mosaic virus (strain S) coat protein. II. Complete sequence of the protein (author's transl)]

The alfalfa mosaic virus protein was submitted to the action of cyanogen bromide. Four peptides were isolated. Study of these peptides allowed us to determine the order. Then protein was submitted, after S-carboxymethylation or S-aminoethylation, to the action of different proteolytic enzymes: trypsin, chymotrypsin, thermolysin and papain. The peptides issued from these different hydrolysis were separated on Dowex 50 X4 and Dowex 1 X2, and their amino acid composition was determined. The use of classical methods of sequence determination, of mass spectrometry and for one case the use of a sequencer, lead to the obtention of the primary structure of all the tryptic peptides. The studies of chymotryptic, thermolytic and papainic hydrolysates, and of cyanogen bromide rupture, allowed us to isolate the overlapping peptides which were necessary for the reconstitution of the complete proteic chain.

Unstable angina pectoris: national cooperative study group to compare medical and surgical therapy. I. Report of protocol and patient population

A preliminary report is presented of a prospective randomized trial conducted by eight cooperative institutions under the auspices of the National Heart and Lung Institute to compare the effectiveness of medical and surgical therapy in the management of the acute stages of unstable angina pectoris. To date 150 patients have been included in the randomized trial, 80 assigned to medical and 70 to surgical therapy; the clinical presentation, coronary arterial anatomy and left ventricular function in the two groups are similar. Some physicians have been reluctant to prescribe medical or surgical therapy by a random process, and the eithical basis of the trial has been questioned. Since there are no hard data regarding the natural history and outcome of therapy for unstable angina pectoris, randomization appears to provide a rational way of selecting therapy. Furthermore, subsets of patients at high risk may emerge during the process of randomization. The design of this randomized trial is compared with that of another reported trial. Thus far, the study has shown that it is possible to conduct a randomized trial in patients with unstable angina pectoris, and that the medical and surgical groups have been similar in relation to the variables examined. The group as a whole presented with severe angina pectoris, either as a crescendo pattern or as new onset of angina at rest, and 84 percent had recurrence of pain while in the coronary care unit and receiving vigorous medical therapy. It is anticipated that sufficient patients will have been entered into the trial within the next 12 months to determine whether medical or surgical therapy is superior in the acute stages of unstable angina pectoris.

Studies on the species, amount and base composition of nucleic acids in psoriatic scales and normal horny layer

The amount of RNA as well as DNA is considerably increased in psoriatic scales as compared with normal horny layer; RNA was characterized as a low-molecular tRNA; as concerns the base composition of DNA, no particularities in comparison with other DNA species were found, and the base composition of tRNA revealed that cytosine and guanosine are in excess; pseudouridine could not be detected in psoriatic tRNA.

[Studies on the primary structure of turnip yellow mosaic virus protein. II. Primary structure of the tryptic peptides of aminoethylated protein]

The sequence of the 7 tryptic peptides obtained from the oxidized protein of turnip yellow mosaic virus have been published in 1970. The other peptides obtained, being insoluble, could not be analysed. The protein was reduced, then alkylated with ethyleneimine and split with trypsin. In this paper we submit the sequence of the 14 peptides obtained, which have been separated on Dowex 50-X4 and Dowex 1-X2. These 14 peptides account for the 189 residues constituting the turnip yellow mosaic virus subunit (mol. wt 20,133).

[Studies on the primary structure of turnip yellow mosaic virus protein. III. Primary structure of the chymotryptic peptides of aminoethylated protein. Complete sequence]

The complete sequence of the protein of turnip yellow mosaic virus is given. The isolation of the peptides obtained by cleavage of the aminoethylated protein with chymotrypsin is described. The present study includes the overlapping sequences which allow the correlation of the different tryptic peptides already described. Some hypothesis concerning the secondary and tertiary structure of the protein in the viral particle are also given.

Substratwahlversuche mit Microhedyle milaschewitchii Kowalevsky (Gastropoda, Opisthobranchia: Acochlidiacea)

Microhedyle milaschewitchii Kow. obtained from a sublittoral shellsand near Rovinj (Yugoslavia) prefers a grain size range of 0.5 to 2 mm in simple-choice experiments. This fraction predominates in the natural substrate (73.1%). Light did not affect the behaviour of the animals which are much less thigmotactical than Protodrilus. Sterile sands are rejected when offered together with natural substrate, but are equally attractive after having been incubated with sand bacteria for ten days. Similarly dried sand is not accepted by the animals. There is no significant preference between quartz and chalk sands, both containing bacteria. Optimal grain size and living microorganisms apparently are essential for the colonization of a substrate.