[The interoperability of IIEF-5 with EPIC-26 : Sexual function after radical prostatectomy]

BACKGROUND

In the past, the IIEF‑5 (International Index of Erectile Function 5 ) was predominantly used to measure erectile function in prostate cancer patients. Following international developments, the domain "sexuality" of the EPIC-26 (Expanded Prostate Cancer Index Composite 26) is increasingly used in Germany.

OBJECTIVE

The aim of this work is to create a practicable comparison of the domain "sexuality" of the EPIC-26 with the IIEF‑5 for treatment in Germany. This is particularly necessary for the evaluation of historical patient collectives.

MATERIALS AND METHODS

For the evaluation, 2123 patients with prostate cancer confirmed by biopsy from 2014-2017 who completed both the IIEF‑5 and the EPIC-26 were considered. Linear regression analyses are calculated to convert IIEF‑5 sum scores to EPIC-26 sexuality domain scores.

RESULTS

The correlation between IIEF‑5 and the EPIC-26 domain score "sexuality" was 0.74, suggesting a high degree of content convergence between the constructs measured. While the standard error of the predicted values is relatively small, the prediction intervals are very wide. For example, for the critical IIEF‑5 value of 22, the predicted value is 78.88 with a 95% prediction interval of 55.09 to 102.66.

CONCLUSION

IIEF‑5 and the Sexuality scale of the EPIC-26 measure a similar construct. The analysis shows that conversion of individual values is associated with great uncertainty. However, at the group level, the observed EPIC-26 "sexuality" score could be predicted quite accurately. This opens up the possibility of comparing the erectile function of cohorts of patients/test persons, even if this was collected with different measuring instruments.

[Quality criteria in urology : How to obtain comparable results?]

The standardization of procedural flow and medical documentation increasingly allows further possibilities. The best-known example of process standardization is the centralized treatment of complex clinical pictures, while patient-reported outcome measurements (PROMs) enable standardized documentation. Using the example of prostate cancer, existing literature on the topic of quality optimization in medicine is discussed. The following key points are addressed: (1) Increasing use of standardized PROMs for outcome documentation. (2) The transfer of complex clinical pictures to dedicated specialized centers has been shown to increase the quality of patient care as long as standardized PROMs are used. (3) Healthcare policymakers benefit from the use of PROMs and increasingly pursue a "value-based healthcare" approach.

Prediction of the drilling path to surgically pin the femoral neck from the spatial location of pelvic and femoral anatomical landmarks: A cadaver validation study

Several clinical applications rely on accurate guiding information when drilling along the femoral neck (e.g., pin insertion in case of neck fracture). Currently, applications rely on real-time X-ray imaging, which results in irradiation issues for the surgeon conducting the operation. The goal of this paper was to develop an X-ray-free method that would allow for a pathway to be drilled between the lateral aspect of the femoral diaphysis (the so-called piercing point), the femoral neck and the head centres. The method is based on on-the-fly computational predictions relying on a biomechanical database that includes morphological data related to the femoral neck and head and various palpable anatomical landmarks located on the pelvis and the femoral bone. From the spatial location of the anatomical landmarks, scalable multiple regressions allow for the prediction of the most optimal drilling pathway. The method has been entirely validated using in vitro experiments that reproduce surgical conditions. Further, a surgical ancillary prototype that integrates the method of guiding the pin drilling has been developed and used during in vitro and in situ validation using nine hip joints. Pin insertion was controlled after drilling using medical imaging and show successful result for each of the nine trials. The mean accuracy of the estimated hip joint centre and neck orientation was 6.0 ± 2.8mm and 7.1 ± 3.8°, respectively.

[Primary Tumour Treatment in Patients with Metastatic Prostate Cancer]

Prostate cancer (PCa) with distant metastasis at diagnosis (M1) is associated with an unfavourable prognosis. Therefore, according to current treatment guidelines, local treatment (radical prostatectomy or irradiation of the prostate gland) is not recommended in men with M1 disease. However, M1 patients inevitably develop castration-resistant disease progression leading to local complications in half of men. Hence, local treatment, if reconcilable with a good quality of life, would have the potential to prevent future local symptoms. Furthermore, evolving data from genomic studies suggest that local treatment might have the potential to reduce further spread of lethal cancer clones by eliminating the primary tumour or nodal metastasis. This leads to the experimental concept of cytoreductive preventative local treatment. According to large US-American and German cancer registries, there is a growing body of evidence pointing towards a survival benefit for M1 patients who receive local treatment in combination with systemic therapy. These data provide the basis to generate the hypothesis of a better response to systemic tumour therapy in metastatic prostate cancer, which would be the rationale for prospective randomised trials, but would not suffice for a treatment recommendation to be given. While there is a dynamic paradigm shift in the systemic treatment of hormone-naive M1 prostate cancer, local treatment for primary tumours will only have a chance to be established in this indication if prospective randomised trials are successfully completed.

[Systematic analysis of treatment results as a quality control instrument using the example of a large European center]

BACKGROUND

Measurement of the quality of treatment has become increasingly important in hospitals. An easy and practical solution in data acquisition is the Patient-Reported Outcome Measurement (PROM).

METHODS

In this article the historical development, general conditions, and difficulties of using the outcome measurement in our patients are describe. In addition, we illustrate the wide range of benefits due to our survey. Based on data from 2008-2013, the functional and oncological results of treatment in our clinic are shown. The main focus lies on the PROMs, e.g., urinary continence evaluated with the daily pad use, sexual function with the IIEF-5 questionnaire, and postoperative complications.

CONCLUSIONS

A systematic and standardized outcome measurement may help to improve the quality of treatment, provides factual information for patients, and supports medical development.

Adherence of the indication to European Association of Urology guideline recommended pelvic lymph node dissection at a high-volume center: Differences between open and robot-assisted radical prostatectomy

PURPOSE

Contemporary adherence of the indication to European Association of Urology (EAU) guideline recommendation for pelvic lymph node dissection (PLND) at either open (ORP) or robot-assisted radical prostatectomy (RARP) at a high-volume center is unknown. To assess guideline recommended and observed PLND rates in a high-volume center cohort.

METHODS

We relied on the Martini-Clinic database and focused on patients treated with either ORP or RARP, between 2010 and 2013. Actual performed PLND was compared to European Association of Urology (EAU) guideline recommendation defined by nomogram predicted risk of lymph node invasion >5%. Categorical and multivariable logistic regression analyses targeted two endpoints: 1) probability of guideline recommended PLND and 2) probability of no PLND, when not recommended by EAU guideline.

RESULTS

Within 7868 PCa patients, adherence to EAU PLND guideline recommendation was 97.1% at ORP and 96.8% at RARP (p = 0.7). When PLND was not recommended, it was more frequently performed at RARP (71.6%) than at ORP (66.2%) (p = 0.002). Gleason score, PSA and number of positive biopsy cores were independent predictors for both either PLND when recommended, or no PLND when not recommended (all p < 0.05). Clinical tumor stage, age and surgical approach were also independent predictors for no PLND when not recommended (all p < 0.05).

CONCLUSIONS

Adherence of the indication to EAU guideline recommended PLND is high at this high-volume center. Neither ORP nor RARP represent a barrier for PLND, when recommended. However, a high number of patients underwent PLND despite absence of guideline recommendation. Possible staging advantages and PLND related complications needs to be individually considered, especially, when LNI risk is low.

Tendon and fascial structure contributions to knee muscle excursions and knee joint displacement

BACKGROUND

Semitendinosus and gracilis muscles whose tendons are used in surgical reconstruction of the anterior cruciate ligament maintain their contractile ability, and a limited decrease of hamstring muscles force is observed postoperatively despite important changes. The goal was to quantify the influence of the myofascial structures on excursions and moment arms of knee muscles to attempt explaining the above-mentioned post-surgical observations.

METHODS

Hamstring harvesting procedures were performed by a senior orthopaedic surgeon on seven lower limbs from fresh-frozen specimens. Femoro-tibial kinematics and tendons excursion were simultaneously recorded at each steps of the surgery.

FINDINGS

No significant difference was demonstrated for excursions and moment arms after tenotomies and gracilis tendon harvesting (P≥0.05). The first significant semitendinosus excursion (P<1.17×10(-4)) and moment arm (P<6.88×10(-5)) decrease was observed after semitendinosus tendon harvesting (46% of the initial excursion).

INTERPRETATION

Gracilis and semitendinosus myofascial pathway is crucial for force transmission towards the knee joint.

Does HistoScanning™ predict positive results in prostate biopsy? A retrospective analysis of 1,188 sextants of the prostate

PURPOSE

The role of HistoScanning™ (HS) in prostate biopsy is still indeterminate. Existing literature is sparse and controversial. To provide more evidence according to that important clinical topic, we analyzed institutional data from the Martini-Clinic, Prostate Cancer Center, Hamburg.

METHODS

Patients who received prostate biopsy and who also received HS were included in the study cohort. A single examiner, blinded to pathological results, re-analyzed all HS data in accordance with sextants of the prostate. Each sextant was considered as an individual case. Corresponding results from biopsy and HS were analyzed. The area under the receiver-operating characteristic curve (AUC) for the prediction of a positive biopsy by HS was calculated. Furthermore, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were assessed according to different HS signal volume cutoffs (>0, >0.2 and >0.5 ml).

RESULTS

Overall, 198 men were identified and 1,188 sextants were analyzed. The AUC to predict positive biopsy results by HS was 0.58. Sensitivity, specificity, PPV and NPV for HS to predict positive biopsy results per sextant, depending on different HS signal volume cutoffs (>0, >0.2 and >0.5 ml) were 84.1, 27.7, 29.5 and 82.9 %, 60.9, 50.6, 28.8 and 79.7 %, and 40.1, 73.3, 33.1 and 78.8 %, respectively.

CONCLUSIONS

Positive HS signals do not accurately predict positive prostate biopsy results according to sextant analysis. We cannot recommend a variation of well-established random biopsy patterns or reduction of biopsy cores in accordance with HS signals at the moment.

Wechselbeziehungen zwischen dem Milchleistungsniveau, der Fruchtbarkeit und dem Krankheitsgeschehen bei Holstein Friesian Milchkühen

Abstract. Title of the paper: Relationship between milk yield, fertility and amount of disease of Holstein Friesian dairy cows Data of 1 841 lactations of 353 Holstein Friesian dairy cows and data according to their reproductive fertility and diseases were analysed over a period of five years in a breeding farm in Thüringen (Germany). As a result the lowest success of first service has been achieved at a lactation (ranged) between 9 000 and 11 000 kg. The time between calving and the following first service varied according to the first disease in last lactation. With rising milk yield the frequency of diseases and the success of first service tend to decrease. Cows achieving a 305 day milk yield of more than 11 000 kg showed with 56 % the lowest frequency of diseases. In average 60 % of all dairy cows need to be treated once in a lactation. The diseases of highest prevalence are in the field of reproductive fertility and udder health. For heifers a decreased success of first service has been detected if they showed an increased prevalence of illness.

[Midshaft clavicle fractures--classification and therapy. Results of a survey at German trauma departments]

INTRODUCTION

The therapy of the midshaft clavicle fracture, in particular dislocated midshaft fractures, remains controversial. Therefore the objective of this study was to obtain data about the current treatment for midshaft clavicle fractures.

METHODS

In a countrywide anonymous survey 240 German orthopaedic trauma departments were asked about their diagnostic and therapeutic procedures for midshaft clavicle fractures. A total of 142 questionnaires (59%) were returned and evaluated.

RESULTS

More than 80% of the hospitals dispense with a standardised fracture classification for midshaft fractures. Simple fractures are generally conservatively treated, in the majority using a figure-of-eight bandage (88%). On average 26% of all clavicle fractures are operatively stabilized, independent of whether the treatment was performed at a trauma centre or any other hospital (p=0.45). Indications for operative treatment of midshaft fractures include severe additional injuries in the shoulder region (81-95%), young and active adults (52-64%) and dislocated midshaft fractures (56-75%). All departments use plate fixation for midshaft fractures; in particular the reconstruction plate (56%) is most frequently applied. Alternatively, if the fracture pattern is considered suitable for intramedullary fixation, this procedure is performed by 43% of the clinics, although this operative technique is used significantly more often in trauma centres (55%) than in other hospitals (31%) (p=0.01).

CONCLUSION

This survey demonstrates a high rate (26%) of German trauma hospitals operating clavicular midshaft fractures. This result is consistent with recently published studies showing better results for operative treatment of dislocated midshaft clavicular fractures compared to conservative therapy.

Co-expression and prognostic value of gross cystic disease fluid protein 15 and mammaglobin in primary breast cancer

Gross cystic disease fluid protein (GCDFP-15) and mammaglobin are both widely used and accepted markers for epithelia of breast origin. We aimed to evaluate their relation of expression on parallel whole tissue sections in primary breast cancer by immunohistochemistry and also to correlate it with clinico-pathological parameters including patient survival. Primary breast carcinomas from 165 patients with a mean clinical follow-up of 73 months were immunostained using commercially available antibodies against GCDFP-15 and mammaglobin. An immunoreactive score (IRS) was calculated based on the cytoplasmic staining intensity and the number of cells stained. Cytoplasmic expression of GCDFP-15 and mammaglobin was observed in 73.3% and 72.1% of invasive breast carcinomas respectively. 91.8% of breast cancer cases expressed at least one of both markers. Both markers strongly correlated with each other and were significantly associated with lower tumour grading. Additionally, GCDFP-15 negativity was significantly associated with shortened disease-free survival times in univariate and multivariate analyses. We demonstrated the strong correlation of GCDFP-15 and mammaglobin with each other and showed that only very few primary breast cancers are completely negative for both markers. The significantly longer disease free survival times for patients with GCDFP-15 positive tumours clearly warrants further study.

Two kinase activities are sufficient for sea urchin sperm chromatin decondensation in vitro

Decondensation of compact and inactive sperm chromatin by egg cytoplasm at fertilization is necessary to convert the male germ cell chromatin to an active somatic form. We studied decondensation of sea urchin sperm nuclei in a cell-free extract of sea urchin eggs to define conditions promoting decondensation. We find that egg cytosol specifically phosphorylates two sperm-specific (Sp) histones in vitro in the same regions as in vivo. This activity is blocked by olomoucine, an inhibitor of cdc2-like kinases, but not by chelerythrine, an inhibitor of protein kinase C (PKC). PKC phosphorylates and solubilizes the sperm nuclear lamina, one requirement for decondensation. Olomoucine, which does not inhibit lamina removal, blocks sperm nuclear decondensation in the same concentration range over which it is effective in blocking Sp histone phosphorylation. In a system free of other soluble proteins, neither PKC nor cdc2 alone elicit sperm chromatin decondensation, but the two act synergistically to decondense sperm nuclei. We conclude that two kinases activities are sufficient for sea urchin male pronuclear decondensation in vitro, a lamin kinase (PKC) and a cdc2-like Sp histone kinase.

Electroconvulsive thresholds of inbred mouse strains

The electroconvulsive threshold (ECT) test is used commonly in the screening of anti-epileptic drugs in rodent models, but little is known about its genetic or mechanistic basis. Thresholds for minimal clonic, maximal tonic, or psychomotor (partial) seizures were determined in 16 different inbred mouse strains in two different laboratories. A wide range of thresholds was observed, suggesting that a variety of neuroexcitability alleles exist in inbred strains. Although there was generally good cross-strain correlation between the three seizure types, several outlier strains were detected, showing that genetically encoded differences can affect the ability of a particular seizure type to spread through the brain. Furthermore, the relative seizure susceptibility of a strain was comparable between the two laboratories, suggesting that despite different test sites, instrumentation, and personnel, the ECT assay is portable and that common inbred strains can often be relied upon as calibration standards. Last, the ECT paradigm was also sensitive enough to detect single locus differences, laying the groundwork for mutation screens for new neuroexcitability models.

Internal exposure to polychlorinated dibenzo-p-dioxins and polychlorinated dibenzofurans (PCDDs/PCDFs) of Bavarian chimney sweeps

This study was carried out to evaluate the internal exposure to polychlorinated dibenzo-p-dioxins and polychlorinated dibenzofurans (PCDDs/PCDFs) of chimney sweeps in Bavaria compared to a control group without occupational exposure. The PCDD/PCDF concentrations in the blood fat of 227 chimney sweeps were compared with the concentrations in samples from 60 controls. Using an internal standard containing 17 (13)C(12)-labeled PCDD/F congeners, the samples were cleaned up after fat elution using standard methods. The statistical analysis was adjusted to account for demographic differences, dietary habits, smoking status, and both occupational and nonoccupational contact with chlorinated hydrocarbons. Detailed information on the type of heating in the households swept, the length of time the chimney sweeps had carried out the profession (min 34, med 195, max 466 months) and the protective measures employed, were used to examine the influence of the working conditions specific to chimney sweeps on the internal PCDD/PCDF exposure. The correlation between blood-fat PCB concentrations as well as urinary chlorophenol concentrations and the exposure to PCDDs/PCDFs was evaluated. The sum of PCDD/PCDF components in chimney sweeps, expressed by International Toxic Equivalents (I-TEQ), was significantly increased compared to the control group (median: 26.36 versus 20.75 pg I-TEQ/g blood fat). For 37 chimney sweeps (16.3%) the sum of PCDDs/PCDFs exceeded the 95th percentile of the control group, i.e., 38.23 pg I-TEQ/g blood fat. Multiple regression analysis revealed that in addition to occupation, the variables age, district, and proximity to a waste incineration plant seem to have an effect on the internal PCDD/PCDF exposure. An additional influence on the internal exposure could not be determined for any of the special aspects of the work. We identified no high correlations between the concentrations of PCBs and chlorophenols and PCDDs/PCDFs. This study revealed significantly higher internal exposure to PCDDs/PCDFs in chimney sweeps than in the control group. The differences are small and within the range of the internal exposure to PCDDs/PCDFs in blood found in the general population in Germany since 1989. Further investigations in to PCDD/PCDF-related diseases in these study groups were not carried out.

A novel recombinant single-chain hepatitis C virus NS3-NS4A protein with improved helicase activity

Hepatitis C virus (HCV) nonstructural protein 3 (NS3) has been shown to possess protease and helicase activities and has also been demonstrated to spontaneously associate with nonstructural protein NS4A (NS4A) to form a stable complex. Previous attempts to produce the NS3/NS4A complex in recombinant baculovirus resulted in a protein complex that aggregated and precipitated in the absence of nonionic detergent and high salt. A single-chain form of the NS3/NS4A complex (His-NS4A21-32-GSGS-NS3-631) was constructed in which the NS4A core peptide is fused to the N-terminus of the NS3 protease domain as previously described (Taremi et al., 1998). This protein contains a histidine tagged NS4A peptide (a.a. 21-32) fused to the full-length NS3 (a.a. 3-631) through a flexible tetra amino acid linker. The recombinant protein was expressed to high levels in Escherichia coli, purified to homogeneity, and examined for NTPase, nucleic acid unwinding, and proteolytic activities. The single-chain recombinant NS3-NS4A protein possesses physiological properties equivalent to those of the NS3/NS4A complex except that this novel construct is stable, soluble and sixfold to sevenfold more active in unwinding duplex RNA. Comparison of the helicase activity of the single-chain recombinant NS3-NS4A with that of the full-length NS3 (without NS4A) and that of the helicase domain alone suggested that the presence of the protease domain and at least the NS4A core peptide are required for optimal unwinding activity.

Construction, expression, and characterization of a novel fully activated recombinant single-chain hepatitis C virus protease

Efficient proteolytic processing of essential junctions of the hepatitis C virus (HCV) polyprotein requires a heterodimeric complex of the NS3 bifunctional protease/helicase and the NS4A accessory protein. A single-chain recombinant form of the protease has been constructed in which NS4A residues 21-32 (GSVVIVGRIILS) were fused in frame to the amino terminus of the NS3 protease domain (residues 3-181) through a tetrapeptide linker. The single-chain recombinant protease has been overexpressed as a soluble protein in E. coli and purified to homogeneity by a combination of metal chelate and size-exclusion chromatography. The single-chain recombinant protease domain shows full proteolytic activity cleaving the NS5A-5B synthetic peptide substrate, DTEDVVCCSMSYTWTGK with a Km and k(cat) of 20.0 +/- 2.0 microM and 9.6 +/- 2.0 min(-1), respectively; parameters identical to those of the authentic NS3(1-631)/NS4A(1-54) protein complex generated in eukaryotic cells (Sali DL et al., 1998, Biochemistry 37:3392-3401).

The politics of the health district reform in the Republic of Benin

The analysis of health policy reform focuses mostly on the contents of reforms. Walt and Gilson (1994) draw attention to the fact that the environmental context as well as the actors involved are of crucial importance to the process of policy adoption. This paper describes and analyses the process of adoption of the new concept of so-called 'sanitary zones' in the Republic of Benin as part of the health sector reform. The analysis of the reform is based on the examination of documents and interviews carried out in Benin in February 1997. The main findings show that the reasons for the specific policy choice do not emerge clearly. The main problems identified are: the role of the hospital, the incongruous administration, resistance against the reform and the question whether the government actually has the political will to change. Possible solutions to these constraints are offered in the conclusion.

Extra- and intracellular action of quaternary devapamil on muscle L-type Ca(2+)-channels

1. The quaternary derivative of the potent verapamil-analogue, (-)-D888, (qD888, 4-cyano-4-(3,4-dimethoxyphenyl)-N-[2-(3-methoxy phenyl)ethyl]-N,N,5-trimethyl-1-hexanaminium) was synthesized as a novel membrane-impermeable probe to study the localization of phenylalkylamine (PAA) effector domains on L-type Ca2+ channels. Channel block by qD888 was investigated in smooth muscle-like (A7r5) cells after extra- and intracellular application by use of the whole-cell configuration of the patch clamp technique. 2. Extracellularly applied qD888 inhibited Sr2+ (Isr) (IC50 = 90 microM) and Na+ (IC50 = 27 microM) inward currents through L-type Ca(2+)-channels mainly in a resting-state-dependent manner. Structurally closely related quaternary PAAs (e.g. D890) were ineffective after extracellular application. 3. QD888 also blocked Isr from the cytoplasmic side, as did other quaternary PAAs (D890, D575). Intracellular block was clearly dependent on channel opening, which resulted in pronounced use-dependence. 4. We conclude that qD888 blocks L-type Ca2+ channels not only from the intracellular side, via interaction with the classical PAA binding domain, but also from the extracellular channel surface. The properties of Ca2+ channel block together with previous biochemical and structural data suggest that extracellular block may be mediated by a site that also confers tonic block by quaternary benzothiazepines.

Titanium distributions in zone melted materials measured by SIMS

Using a zone melting apparatus the influence of the different solidification processes on the Ti distribution has been investigated in model alloys and a technical steel. The concentration profiles after the conventional zone melting process have been measured using secondary ion mass spectrometry and were used for the determination of the distribution coefficients of Ti in pure Fe-Ti- and Fe-C-Ti-alloys. The registration of lateral elemental maps helps to identify and to eliminate measuring artefacts and allows the investigation of dendritic solidification structures.

[Between isolation and new hope: the psychosocial status of HIV-infected women]

HIV-infected women were an increasingly larger group among the risk groups in Germany. In order to illuminate the psychological situation of HIV-infected women in Germany, 100 women with HIV disease were enrolled in a basic study. 72% of the patients were intravenous drug addicted, 28% were infected through other means. The study population comprised patients of all stages of infection. We found 52% in the first stages, 28% in ARC and 20% with AIDS. Evaluated data included medical, socio-demographic, and data regarding the patients' history of drug abuse. The SCL-90-R, a psychological symptom inventory, was applied. Questions about differences between the two groups of HIV-infected women (iv drug addicted vs non-drug addicted) were answered first. Second, we described three clusters of HIV infected women with regard to different levels of psychological distress. Important factors to distinguish between these clusters are the subjective impact of physical distress (e.g. suffering from HIV-associated symptoms) and loss of joy and interest in sex. In order to illuminate the psychosocial situation, we discuss the specific situation of three patients.

Calcium entry blockers and activators: conformational and structural determinants of dihydropyrimidine calcium channel modulators

Dihydropyrimidines 4, 6, and 15, uniquely designed to unambiguously establish structural and conformational determinants for DHP receptor occupation and for modulation of calcium channel function, were prepared and examined for calcium channel modulation. Our results confirm and firmly establish a preference for syn-orientation of an unsymmetrically substituted aryl moiety at the DHP receptor (15d vs 15e). We propose a normal vs capsized DHP boat model to explain structural and conformational requirements for modulation of calcium channel function that requires an obligatory left-hand side alkoxy cis-carbonyl interaction for maximal DHP receptor affinity, the effect of channel function being determined by orientation of the 4-aryl group. Enantiomers having an up-oriented pseudoaxial aryl group (normal DHP boat) will elicit calcium antagonist activity, whereas enantiomers having a down-oriented pseudoaxial aryl group (capsized DHP boat) will elicit calcium agonist activity. Single enantiomers of macrocyclic lactone 15b demonstrate opposite channel activity. Antagonist activity resides in enantiomer 15b-A (S-configuration, left-hand side alkoxy cis-carbonyl with up-oriented pseudoaxial aryl group and normal DHP boat), whereas agonist activity resides in enantiomer 15b-B (R-configuration, left-hand side alkoxy cis-carbonyl with down-oriented pseudoaxial aryl group and capsized DHP boat). Moreover, this model is consistent with and provides a rational explanation of previous literature in this area, most notably the observation of chiral inversion and potency diminution upon replacement of ester by hydrogen in the Bay K 8644 series.

[Use of the Glasgow Coma Scale in pediatric craniocerebral trauma]

Over five years the applicability of a modified Glasgow Coma Scale was analysed in 38 children (mean age 7.2 +/- 3.8 years) with head and associated injuries (47.4%). The score was estimated after the accident and in the course of intensive therapy. At the beginning of the treatment on the intensive care unit, the cases were staged according to the severity of the head injuries (Glasgow Coma Scale: 4-8, 9-12 and 13-19 points). At the stage evaluated as between 4 and 8 points, 50% of the patients died and the survivors were ventilated (11.7 +/- 10.7 days) and intensively treated (45.7 +/- 31.5 days). All patients had had neurological damage. Additional injuries worsened the prognosis in the acute phase. 42.9% of the patients received intracranial pressure monitoring. In the patients between 9 and 12 points, the time of ventilation (3.7 +/- 2.9 days) and of intensive therapy (19.5 +/- 13.3 days) decreased. Over 13 points, all patients had a shorter duration of treatment (10.8 +/- 8.8 days) and a quick and good recovery. The Glasgow Coma Scale has the advantage of an examination with a quantitative analysis and resulting effective diagnostic and therapeutic measures. Even the inexperienced physician can use the Glasgow Coma Scale with success at the site of the accident.

[Formaldehyde determination in tobacco smoke--studies under experimental and actual conditions]

The estimation of an external exposure to formaldehyde in tobacco smoke requires a reliable analytical method. The gas chromatographic determination of formaldehyde shows in comparison to photometric methods a higher sensitivity and specificity. In the main stream smoke of various kinds of cigarettes the amount of formaldehyde vary between 3.4 micrograms to 8.8 micrograms/cigarette, this is equal to concentration between 2.3 to 6.1 ppm. In the air of lounges in hospitals formaldehyde concentrations up to 0.19 ppm can be detected after smoking of 15 cigarettes over a period of 1.5 h. In kindergartens without tobacco smoke the formaldehyde concentrations in air range from 0.005 to 0.01 ppm. The smoking of 30 cigarettes and one pipe in a non ventilated room over 1.5 h exceeded formaldehyde concentrations between 0.21 to 0.45 ppm. The concentration declines to 0.08 ppm within 2h after termination of smoking. The MAK-value of 0.5 ppm is not exceeded; in contrast to this the indoor limit of 0.1 ppm recommended by the German Bundesgesundheitsamt is exceeded in the vicinity of the smoker. The formaldehyde concentrations in tobacco smoke reported in the older literature can not be confirmed; this is due to the nonspecificity of the photometric methods. On the basis of our results can be concluded that the irritating effects of tobacco smoke to the mucous membranes are the result of the sum of irritating effects caused by several compounds and particles in the smoke and not only the impact of formaldehyde.

Polyarthritis as the initial symptom of secondary syphilis: case report and review

The differential diagnosis of the patient with acute polyarthritis is lengthy. We present the case of a young man with acute inflammation of the knees and ankles in whom a diagnosis of acute rheumatic fever was initially considered. The clinical course and laboratory findings suggested that secondary syphilis was also a likely etiology of his problem. We believe that in some patients with acute polyarthritis, secondary syphilis must be seriously considered as part of the differential diagnosis.

Preparation and evaluation of a soluble derivative of the antiallergic compound trans-2, 3b, 4, 5, 7, 8b, 9, 10-octahydronaphtho [1, 2-c:5, 6-c'] dipyrazole (LC-6)

In the present report we describe the preparation of LC-6.2HCl, a soluble derivative of the synthetic bispyrazole LC-6. Because the latter was practically insoluble in aqueous and organic media, experiments which indicated that it had antiallergic activity were confined to in vivo studies following its oral administration. The availability of soluble LC-6.2HCl made it possible to administer the drug i.v. or i.p. Through these routes it exhibited greater antiallergic activity than by the oral route, as judged by lower ID50's and by the achievement of 100% PCA inhibition. The latter result had not previously been attained orally with the base. Furthermore, when injected i.v. or i.p. LC-6.2HCl showed prolonged inhibitory activity, a valuable attribute of the parent compound. The in vivo activity of the soluble salt, which we describe, further establishes the potential therapeutic value of the drug.

[The "Perthes-Braun-syndrome". A sign of severe blunt thoracic trauma in childhood]

"Perthes-Braun-Syndrom" is told to be sign of severe blunt thoracic trauma. We report about 7 patients up to the age of 14 years, who showed symptoms of thoracic compression. The syndrome appears in different expression with main symptoms as subconjunctival bleedings and petechias of the upper part of the body. In 6 of the described cases the syndrome was associated with severe intrathoracic lesions. In is concluded that intensive supervision is indicated in patients with "Perthes-Braun-Syndrome" because of delayed appearance of cardial and pulmonary symptoms.

[Bacterial elimination and antibiotic concentration in the gall-bladder during biliary tract infections treated with mezlocillin (author's transl)]

A transpapillary indwelling catheter was placed in 15 patients with choledocholithiasis and threatened occlusion by stone. Ten of the 15 patients had marked biliary stasis, four had signs of acute cholangitis. In all patients E. coli was present in the gall-bladder in a concentration of greater than or equal to 10(5)/ml when the catheter was first inserted. The bacteria were sensitive to mezlocillin, at a minimal inhibitor concentration between 1.5 and 16 micrograms/ml. All patients received mezlocillin, 5 g twice daily, in a short-term infusion. Immediately before and regularly thereafter bile samples were taken to measure antibiotic concentration and bacterial counts (by membrane filtration). Mezlocillin was excreted in the bile in very high concentrations in patients without biliary stasis. But while the concentrations were markedly lower in those with stasis, they were still 10 to 100 times the minimum inhibitory concentration of mezlocillin against the appropriate strains. In keeping with the high mezlocillin concentration, bacterial counts fell much more quickly in the patients without stasis than in those with alkaline phosphatase concentration above 250 U/l. These differences were even more marked after two or three days. Bacterial elimination from bile was complete in two of three patients with normal alkaline phosphatase activity, but in only one of five in whom it was elevated.

Synthesis and study of the potential antiallergic activity of some pyrazole derivatives

The synthesis and study of the oral antiallergic activity of a series of monopyrazole derivatives (2-14) considered as analogues of active bispyrazole 1 are described. None of the compounds showed significant inhibition of the rat passive cutaneous anaphylaxis (PCA), with the exception of the already known 5-aminoindazole (2). The activity of this compound, is however, lower than that of compound 1.

Synthesis of potential antiprogestins II

Alkylated derivatives of 17-acetoxyprogesterone were prepared in order to test the hypothesis that bulky groups in certain positions of the steroid molecule have the effect of transforming progestogens into antiprogestogens. These groups might exert binding influence outside the area occupied by progesterone itself. The compounds were tested for competitive affinity against tritiated progesterone and receptor from rabbit uterus cytosol. The low affinity of all derivatives makes it unlikely that they would be active as antiprogestational agents.