[The pharmacokinetics of ampicillin in pregnant women with H-gestosis in the last trimester of pregnancy]

In this paper pharmacokinetic data of ampicillin in 9 pregnant women with H-gestosis are compared with those from 8 healthy pregnant women in the last trimenon. 5 g Ampicillin were given as an i.v. bolus-injection. Ampicillin was determined in serum and urine by a polarographic method. Important kinetic data, such as concentration in serum, distribution into the peripheral compartment and t1/2 beta do not differ. The non-significantly changed central distribution volume (V1) as well as the reduced renal excretion in combination with normal serum creatinin values have to be considered in connection with the general constriction of blood vessels in pregnant women with H-gestosis. From the kinetic data one cannot derive any necessity for changing the mode of application or the dose of ampicillin in pregnant women with H-gestosis.

[Pulse polarographic determination of piperacillin (Pipril) in serum and urine]

Two pulse polarographical methods for determination of the half-synthetic penicillin derivate piperacillin in serum and in urine are described. 3.7 X 10(-5) mol/l (20 micrograms/ml) can yet been proved in serum with the direct pulse polarographical determination. 1.85 X 10(-6) mol/l (1 microgram/ml) can quantitatively be determined after preceded hydrolysis. Both the methods are diffusion standards being well developed which can be evaluated in an adequate manner. The piperacillin concentrations determined by pulse polarography agree to the levels of the agar diffusion test. The precision is some reduced by the separations incorporated. Inspite of the hydrolysis, the pulse polarographical method of determination will offer more prompt and reliable results.

Comparison of histology and immunohistochemistry with thyroglobulin serum levels and radioiodine uptake in recurrences and metastases of differentiated thyroid carcinomas

The importance of lightmicroscopical and immunohistochemical features of 38 recurrent differentiated thyroid carcinomas (27 papillary carcinomas (PC), 11 follicular carcinomas (FC] for post-operative serum thyroglobulin (TG) concentrations was analysed in regard to pre-operative serum TG levels with tumour type, histological and cytological differentiation, volume fraction of TG synthesizing tumour cells (TG immunohistomorphometry), tumour volume and radioiodine uptake (RIU). Serum TG concentrations increased with tumour size and the number of TG synthesizing tumour cells (r = 0.5). PC and FC did not differ in their volume proportions of TG synthesizing tumour cells, while TG serum levels in FC significantly exceeded those of PC of similar size. The low TG serum levels found in PC might be explained by a specific defect in thyroglobulin secretion. Carcinomas with partial or total cytologic metaplasia (e.g. oxyphilic carcinomas) had low volume proportions of TG synthesizing cells and low serum TG levels. Thirteen of the 38 differentiated carcinomas (34.2%) showed both high TG serum levels and positive RIU, 17 (44.7%) disclosed only elevated TG serum levels and 6 (15.8%) a positive RIU. In two cases (5.3%) TG serum levels were not elevated and RIU's were negative. TG immunostaining was positive in all 38 cases. In summary, TG serum levels depend on the following morphologic factors in differentiated thyroid carcinomas: 1) Number of TG synthesizing tumour cells, 2) Mode of TG secretion and 3) Cytological differentiation of the tumour cells. Serum TG levels did not predict total body iodine scan.

[Pharmacokinetic studies of azlocillin in pregnancy]

Examining blood level values and urinary concentrations taken from pregnant and nonpregnant women, the pharmacokinetic dates of azlocillin have been evaluated. We used a computer program based on the two-compartment model. The evaluation of azlocillin concentrations in serum and urine has been realized with the two following methods: polarography and agar diffusion test. We found nearly equal values of serum concentrations when using both methods. There are no statistical differences between pharmacokinetic dates of pregnant and nonpregnant women. Therefore we state: It is not necessary to change the dosage and the application interval of azlocillin during pregnancy.

Growth and function of thirty-four human benign and malignant thyroid xenografts in untreated nude mice

Tissue was taken from 16 patients with benign thyroid lesions (10 nontoxic nodular colloid goiter, two follicular adenoma, one autonomous adenoma, one iodine-induced thyrotoxicosis, 2 Graves' disease) and 18 patients with malignant thyroid tumors [seven papillary, five follicular, five undifferentiated (anaplastic), and one medullalry carcinoma] and was xenotransplanted into the flanks of 124 syngeneic female BALB/c-nu/nu mice 6 weeks of age. Subsequently, without any further treatment, serum levels of thyroglobulin (TG), T3, T4, and thyroid-stimulating hormone were determined by radioimmunoassay at 4 or 5 weeks posttransplantation and at the end of the experimental time period of 4 months. All animals were autopsied. The grafts were examined by light microscopy and TG immunohistochemistry. Morphologically, the grafts of benign and malignant thyroid tumors showed features overall identical to the original tissue. Conversely, nontoxic nodular colloid goiter and Graves' disease grafts revealed a transformation to normofollicular structures. All benign thyroid grafts showed a stationary growth, as did most differentiated thyroid carcinomas. Tumor take rates in differentiated and in medullary carcinoma were 15%, and in undifferentiated carcinomas, 100%. In the cancer grafts, a correlation between resting phase (period until progressive tumor growth) and survival time of the corresponding patients was disclosed. All patients whose tumors were not taken by nude mice are still alive and show no signs of progressive tumor growth at 9 to 34 months after surgery. All but one patient with tumors revealing positive tumor take died within 3 months (resting phase, 3 weeks) or one year (resting phase, 7 to 14 weeks) after surgery. Integrity of hormonal function in benign and malignant xenografts at 4 months posttransplantation could be shown by significantly higher T3 and T4 serum concentrations in animals with benign thyroid tissues (T3, 1.69 +/- 0.13 nmol/liter; T4, 45.69 +/- 2.09 nmol/liter; S.E.) as compared to controls without grafted tissue [T3, 1.29 +/- 0.10 nmol/liter (p less than 0.05); T4, 33.39 +/- 2.71 nmol/liter (p less than 0.05)] and by increased TG serum concentrations in animals receiving benign (TG, 2.70 +/- 1.39 ng/ml) or malignant (e.g., TG in follicular carcinoma, 34.44 +/- 13.83 ng/ml; controls, 0.30 +/- 0.02 ng/ml) thyroid tissue. Thus, we conclude that benign and malignant thyroid xenografts in the nude mouse maintain full morphological and, regarding T3, T4, and TG serum levels, functional integrity for at least 4 months after transplantation.

[Sonographically controlled fine punch biopsy of the thyroid gland]

Under local anaesthesia and under ultrasound guidance punch biopsy with a cutting biopsy needle was performed in 50 patients, providing 65 biopsy specimens. In 57 instances the indications for biopsy were nodular goitre, in 8 diffuse parenchymal involvement. Focal alterations were reliably hit if they were larger than 1 cm in diameter. The punch biopsy was performed without clinical complications. In 60 of 65 instances (92%) a sufficiently large tissue specimen was obtained for adequate histological assessment. In 13 patients with clinical indications for operation, surgical intervention was avoided because the biopsy proved the tissue to be benign. In 7 patients the accuracy of the punch biopsy was demonstrated, agreeing with the findings of biopsy obtained at operation or post-mortem. A close positive correlation existed between echogenicity of thyroid lesions and their histologically demonstrated colloid content. Although punch biopsy under ultrasound guidance is technically more complex than fine-needle aspiration cytology, it has the advantage that structural histological changes can also be assessed. This increases the diagnostic accuracy of the morphological diagnosis.

Pharmacokinetic studies of azlocillin and piperacillin during late pregnancy

In this paper pharmacokinetic data of acylureidopenicillins (azlocillin and piperacillin) in pregnant women in the last trimenon are compared with those from nonpregnant controls. Four g of each drug was administered as slow bolus injection intravenously. The concentrations in serum and urine of both drugs were determined by polarographic and microbiological methods, for comparison. We used for evaluation of pharmacokinetic data a computer program based on the equations of a two-compartment open pharmacokinetic model. Our investigations show that there are not any different pharmacokinetic values of both antibiotics between pregnant women and healthy nonpregnant volunteers. We can state that both antibiotics are well determined by both analyzing methods which give us identical pharmacokinetic results.

Histopathologic types and clinical behaviour of occult papillary carcinoma of the thyroid

On studying 182 papillary neoplasms of the thyroid, 32 nonencapsulated lesions were found to be occult papillary carcinomas (maximum diameter 1.5 cm); out of these 32 patients 18 cases of cervical lymph node metastases were observed. Histologically, 4 circumscribed microcarcinomas, 3 partially encapsulated carcinomas, and 25 occult sclerosing carcinomas were distinguished. The mean diameter of the 4 circumscribed tumours as compared to that of the remaining 28 lesions proved to be statistically significantly smaller, but no significant differences could be observed regarding the rate of lymph node metastasis. One occult sclerosing carcinoma showed a morphologic pattern different from the remaining cases--namely that it had an exclusively solid appearance in the primary lesion and also in its lymph nodes metastases. The follicle cell origin of this lesion was established immunohistochemically by patchy thyroglobulin synthesis. The excellent prognosis of the occult category of papillary thyroid carcinoma was confirmed by a follow-up (mean 7.7 years, range 1.1 to 16.3 years), in which only 2 instances of eradicable recurrent lymph node metastases within the group of occult sclerosing carcinomas were recorded.

The encapsulated papillary carcinoma of the thyroid. A morphologic subtype of the papillary thyroid carcinoma

Of a total of 182 papillary neoplasms, 25 lesions (average size, 3.1 cm) were classified on cytologic and histologic grounds as being encapsulated carcinomas. In eight of these tumors (32.2%) cervical lymph node metastasis and/or intraglandular lymphatic spread was observed. It was not possible to separate on histologic grounds those that did metastasize from those that did not. The excellent prognosis for the encapsulated variant of papillary thyroid carcinoma was confirmed by a long follow-up period in which no evidence of recurrences or further metastasis was registered as compared with the time of initial diagnosis, whatever the mode of therapy. On the basis of these findings, the encapsulated papillary carcinoma can be regarded as an early or slowly growing form of the papillary thyroid carcinoma.

Transesophageal two-dimensional echocardiography: comparison of ultrasonic and anatomic sections

Conventional 2-dimensional echocardiography has become a well-established tool for evaluating cardiovascular diseases. Recent introduction of 2-dimensional transesophageal echocardiography has widened the ultrasonic examination possibilities of the heart and great arteries. The 6 standard transesophageal transducer positions that have proved representative and of diagnostic value are described. To facilitate structure identification and interpretation of anatomic relations, transesophageal recordings were compared with corresponding anatomic sections.

Adenolipoma (thyrolipoma) of the thyroid gland report of two cases and review of literature

Rare fat cell-containing adenomas (adenolipomas) found in the thyroid gland of two patients are presented. Previously documented cases are reviewed. An origin from embryonic rests for these tumours as for diffuse lipomatosis of the thyroid is discussed.

The encapsulated follicular carcinoma of the thyroid. A clinicopathologic study of 35 cases

In a retrospective study of 86 follicular carcinomas of the thyroid gland, 35 lesions were classified as encapsulated carcinomas (40.7%). In two of these, lymph node metastases were detected initially. Another patient presented with distant metastases. The biological behaviour of these 35 tumours was studied over a long-term follow-up period (0.4-19.1 years, mean 10.3 years) which featured three cases of death from thyroid carcinoma 0.4-5.0 years after thyroidectomy. Another patient suffered from local recurrence of a follicular carcinoma 13.9 years later. The morphological and clinical findings of those five patients who initially presented with metastases and/or whose follow-up registered the local recurrence of thyroid cancer or death as a result of it, were compared with the remaining 30 cases which were of a benign clinical course. Statistical analysis showed that the prognosis of encapsulated follicular carcinoma is more serious when tumours occur in patients older than 65 years of age and when the tumour diameter is 5.0 cm or more. There was a tendency towards poorer prognosis in those tumours exclusively composed of oxyphilic epithelium.

Lipid-rich cell adenoma of the thyroid gland. Report of a peculiar thyroid tumour

A thyroid adenoma consisting of lipid-rich follicle cells is presented which has not previously been described in this organ. The discussion focuses on the possibility of its metaplastic origin and on its histological analogy to lipid-rich carcinoma of the breast.

[Two-dimensional transesophageal echocardiography: a better presentation of intra-atrial structures]

In seven patients with suspected or detected abnormal intra-atrial structures on 2-dimensional echocardiography, transoesophageal echocardiography was diagnostic of left atrial myxoma in two, left atrial thrombus in two, cor triatriatum in two and right atrial membrane in one. The transoesophageal technique extends diagnostic possibilities. The accurate demonstration of atrial abnormalities in such cases by the transoesophageal technique obviates the need of invasive pre-operative angiographic and haemodynamic procedures.

[2-dimensional transesophageal echocardiography: comparison of echocardiographic and anatomic section pictures]

Conventional two-dimensional echocardiography has become a well established tool for evaluation of cardiovascular diseases. Recent introduction of two-dimensional transesophageal echocardiography has widened the ultrasonic examination possibilities for the heart and the great vessels. This paper describes 6 standard transesophageal transducer positions which have proven to be representative and of diagnostic value. In order to facilitate structure identification and interpretation of the anatomic relation transesophageal recordings were compared with corresponding anatomic sections.

The Turcot syndrome. Report of an additional case and review of the literature

Another unusual autopsy case of the Turcot syndrome is reported in a 23-year-old woman with polyposis coli, who developed primary carcinoma of the jejunum and glioblastoma multiforme of the left frontal lobe. Previously documented cases are reviewed. Discussion focuses on the occurrence of other extracolonic abnormalities observed with the Turcot syndrome.

[Studies on the pharmacokinetics of the compound preparation sulfamerazine/trimethoprim (Berlocombin-200) in pregnancy]

Pharmacokinetics of the sulphamerazine/trimethoprim-combination Berlocombin-200 was calculated by an one-compartment-model following therapeutic administration in pregnant women and compared with a control group. Distribution parameters are significantly changed, but elimination half-lifes of both the sulphonamide and trimethoprim are not influenced by repeated administration during pregnancy. There are no consequences concerning the dosage of Berlocombin in bacterial infections during pregnancy.

[Studies on the kinetics of nitrofurantoin (Nifurantin) in normal pregnancy, gestoses, pyelonephritis and labor (author's transl)]

After oral administration of 300 mg of nitrofurantoin (Nifurantin) to various groups of pregnants, to women in labour and nonpregnant women the blood level and renal excretion of nitrofurantoin were investigated. We stated that gravidity, pyelonephritis and EPH-gestosis did not alter neither the renal excretion nor the blood level. In contrast to this during labour the renal elimination of nitrofurantoin was diminished and the blood concentration was enhanced. The biotransformation of nitrofurantoin seems not to be changed by pregnancy.

[3H-Thymidine autoradiographic studies on proliferation of various smooth muscle cell populations pre- and postnatally (and its possible modification) (author's transl)]

The pre- and postnatal proliferative kinetics of vascular and gastrointestinal smooth muscle cells (and possible influences on it) are reported by means of their 3-thymidine labelling indices. The 3H-autoradiographic investigations were carried out on Wistar inbred rats, strain Chbb:THOM (SPF), and on genetic osteoarthrosis mice, strain C 57 black St. Louis (in vivo investigations). The results show that the smooth muscle cells of the colon have significantly higher 3H-thymidine labelling indices than the smooth muscle cels of the other parts of the gastro-intestinal tract. Prenatally the label indices were 40 times higher than during postnatal maturation. The 3H-thymidine labelling indices (as a parameter of cell proliferation) of fetal cells of the vascular wall as well as the smooth muscle cells of the aorta during postnatal maturation are just about 10% the values of gastrointestinal smooth muscle cells at the same time. Moreover, the fetal cells of the vascular wall show 10 times higher values for the 3H-thymidine labelling index than do the smooth muscle cells of the aorta during postnatal maturation. The finding that smooth muscle cells of the vascular wall have low proliferation rates and reach a stable state later than many other populations of smooth muscle cells is discussed with regard to its theoretical and practical-therapeutical importance using kallikrein for a drug example.

[The pharmacokinetics of cephalothin during the late stage of pregnancy and in the course of labour (author's transl)]

Using an open one- and two-compartment model, the authors studied the kinetics of cephalothin during pregnancy and in the course of labour as well as in a group of non-pregnant women. They found that the parenteral application of cephalothin leads to therapeutic levels in the serum, tissues and urine also during pregnancy and in the course of labour. The bearing of pregnancy and labour on the kinetics of cephalothin is but insignificant; consequently, no modification of the pharmacotherapy will be necessary.

[The influence of a single glucocorticoid administration on the DNA and the nitrogen-content as well as on the beta-glucuronidase activity of rat skin during postnatal development (author's transl)]

In the paper presented here the following parameters on the skin of pure-bred Wistar inbred rats were investigated during the early postnatal maturation period: DNA-content (according to Burton 1956), nitrogen-content (according to Strauch 1965), beta-glucuronidase activity (according to Fishman 1974), partly also protein-content (according to Lowry 1951). At the same time, we tested if a single i.p. injection of 6-methyl-prednisolone, applied exactly at the same time of the day 24 h preceding the killing, has an influence on the above mentioned quantities in comparison to the control group (possibly dosage-dependent). In the observation period (2nd, 4th, 6th, 9th, and 14th day) a linear, statistically significant increase of the nitrogen-content could be stated on the skin. After an initial increase up to the 4th day of life the DNA-content significantly decreases during the following postnatal maturation period until the 14th day. These results could be obtained both in the control groups, and in the animals treated with different dosages of 6-methyl-prednisolone. It is of importance that these parameters (especially the cell and the DNA-content respectively) were not statistically significantly changed by pretreatment with the glucocorticoid at any day investigated. The total activity of the further tested lysosomal indicator-enzyme beta-glucuronidase increases during the postnatal maturation period up to its maximum on the 9th day of life before it decreases till the 14th day. The applied dosages of the glucucorticoid led to a general increase of the enzyme activity, which, however, was only exceptionally statistically significant. This enzyme induction could also by discussed in terms of a maturation acceleration. Dosage-dependent differences could partly be demonstrated.

[Changes in skin DNA in newborn rats due to betamethasone in the last phase of pregnancy (author's transl)]

In an extensive series of experimental studies the DNA content of the skin of pure Wistar inbred rats was investigated to see whether any change occurred in the skin DNA content when the dams were pretreated with 1 mg betamethasone/kg b.w. s.c. on the 18th and 19th days of pregnancy. The newborn rats (age: 1, 2, 4, 9, 12, 15 days old) were sacrificed and the dams treated between 7.30 and 8.30 a.m. in order to avoid possible variations of the results due to the diurnal cycle. During the observation period there was a linear decline of DNA content between 1-day and 15-day old rats. This true for the control group as well as the treated animals. The finding that the DNA content in this tissue dropped in the first few days of life as a result of prenatal glucocorticoid application is of great importance.

Research on pharmacokinetics during pregnancy

The pharmacokinetics of some drugs important for treatment in pregnancy were studied in several groups, women in stage III of pregnancy, women in labour and non-pregnant women as a control group. The half-life of elimination of the drugs is one of the most important parameters in pharmacokinetics. The following drugs were used: noramidopyrine methane sulphonate sodium, aminophenyzone, pethidine, methaqualone, ampicillin, cephalothin, chlorsulfamethin, and indocyanine green. The results show that all drugs except cephalothin had a prolonged half-life during labour. In contrast to this the half-life of most of the drugs is diminished in pregnancy. The extent and direction of the changes depend on the pathway of elimination and on the rate of biotransformation of the drug.