Repetitive transcranial magnetic stimulation in the treatment of resistant depression: changes of specific neurotransmitter precursor amino acids

Repetitive transcranial magnetic stimulation (rTMS) for treatment-resistant major depression offers an alternative therapy, since more than every third patient is not responding to adequate antidepressive treatment. In this interventional study safety, symptom development and changes of serum concentrations of neurotransmitter precursor amino acids, of immune activation and inflammation markers, of brain-derived neurotrophic factor (BDNF), nitrite as well as of salivary amylase were measured before and after a frontal polar cortex stimulation using rTMS as add-on treatment in 38 patients with treatment-resistant depression. Out of these, 17 patients received sham stimulation as a control. Treatment was well tolerated: with the exception of one patient of the verum group, who described discomfort during the second treatment, no serious adverse effects were observed. Improvement of depression with a significant decrease in the HAMD-7 scale (p = 0.001) was found in patients treated with rTMS, but not in sham-treated patients. Furthermore, serum phenylalanine and tyrosine dropped significantly (p = 0.03 and p = 0.027, respectively) in rTMS-treated patients. The kynurenine to tryptophan ratio (Kyn/Trp) tended to decrease under rTMS (p = 0.07). In addition, associations between concentrations of BDNF and neopterin as well as serum nitrite levels were found in patients after rTMS treatment, which indicates an influence of immune regulatory circuits on BDNF levels. In the sham-treated patients, no changes of biomarker concentrations were observed. Results show that rTMS is effective in the treatment of resistant depression. rTMS appears to influence the enzyme phenylalanine hydroxylase, which plays a central role in the biosynthesis of neurotransmitter precursors tyrosine and dihydroxyphenylalanine (DOPA).

Determination of Deoxynivalenol in Soft Wheat by Immunoaffinity Column Cleanup and LC-UV Detection: Interlaboratory Study

An interlaboratory study was conducted to assess the applicability of a previously validated method for the analysis of deoxynivalenol (DON) in cereal and cereal products to soft wheat in the range of >0.13.0 g/g. The study evaluated a generic method to determine DON at levels that bracket the existing Canadian guidelines for DON in soft wheat destined for use in baby foods and nonstaple foods. Collaborators selected one of 2 approved brands of DON immunoaffinity column for cleanup and their choice of qualified C18 liquid chromatographic (LC) column. Separation was by LC with UV detection. Blind duplicates from 5 levels of naturally contaminated wheat and a pair of spiked wheat samples were successfully analyzed by 12 laboratories in 8 countries. For samples naturally contaminated with DON from <0.12.2 g/g, the relative standard deviation of repeatability (RSDr) ranged from 3.1 to 14.8. For reproducibility, the RSDR ranged from 21.0 to 32.9 and the HorRat range was 1.0 to 1.9. Recoveries of 0.5 g/g DON spiked into wheat ranged from 66 to 98, with an average of 84. The RSDr was 5.4, the RSDR was 12.6, and the HorRat value was 0.7.

Quantitative Determination of Paralytic Shellfish Poisoning Toxins in Shellfish Using Prechromatographic Oxidation and Liquid Chromatography with Fluorescence Detection: Collaborative Study

A collaborative study was conducted for the determination of paralytic shellfish poisoning (PSP) toxins in shellfish. The method used liquid chromatography with fluorescence detection after prechromatographic oxidation of the toxins with hydrogen peroxide and periodate. The PSP toxins studied were saxitoxin (STX), neosaxitoxin (NEO), gonyautoxins 2 and 3 (GTX2,3; together), gonyautoxins 1 and 4 (GTX1,4; together), decarbamoyl saxitoxin (dcSTX), B-1 (GTX5), C-1 and C-2 (C1,2; together), and C-3 and C-4 (C3,4; together). B-2 (GTX6) toxin was also included, but for qualitative identification only. Mussels, both blank and naturally contaminated, were mixed and homogenized to provide a variety of PSP toxin mixtures and concentration levels. The same procedure was followed with clams, oysters, and scallops. Twenty-one test samples in total were sent to 21 collaborators who agreed to participate in the study. Results were obtained from 18 laboratories representing 14 different countries. It is recommended that the method be adopted First Action by AOAC INTERNATIONAL.

Specific immunotherapy normalizes tryptophan concentrations in patients with allergic rhinitis

BACKGROUND/AIMS

An immune shift towards Th2-type immunity seems to be critical in the pathogenesis of allergic asthma and rhinitis. In a previous study, we found higher serum tryptophan concentrations in patients with seasonal tree or grass pollen rhinoconjunctivitis who underwent specific immunotherapy (SCIT) than in controls, and those with the highest levels at baseline responded less well to SCIT. In the present study, we examined whether 'booster immunotherapy' after cessation of SCIT had any influence on tryptophan metabolism during follow-up.

METHODS

Serum concentrations of tryptophan, kynurenine and neopterin were assayed in 19 patients (mean age: 26.2 years; 6 females) allergic to grass and/or tree pollen before and after they had received a booster immunotherapy with 4 injections of an allergoid vaccine (Pollinex Quattro; Bencard Vienna, Austria) over 8 ± 3 months outside the pollen season.

RESULTS

Serum tryptophan and kynurenine concentrations decreased after booster immunotherapy (mean ± SD, before immunotherapy: 81.1 ± 14.2 µmol/l, after immunotherapy: 61.4 ± 20.9 µmol/l and before immunotherapy: 2.25 ± 0.44, after immunotherapy: 1.69 ± 0.70 µmol/l, respectively; both p < 0.01); this was especially true in those responders who also tended to have lower baseline kynurenine concentrations as compared with nonresponders (p = 0.05). Finally, a correlation between changes in tryptophan metabolism and neopterin concentrations was observed after immunotherapy.

CONCLUSIONS

The decrease in tryptophan and kynurenine concentrations following booster immunotherapy in hay fever patients strengthens the hypothesis that tryptophan metabolism might be involved in the course of allergic responses. However, it is still unclear whether the abnormal tryptophan metabolism in pollinosis patients is related to indoleamine 2,3-dioxygenase and/or to a specific cytokine background.

Altered Immune Responses during Septicaemia in Patients Suffering from Haematological Malignancies

Septicaemia is a frequent complication in patients with haematological malignancies. In this study we analysed markers of inflammation/immune activation (C- reactive protein, interleukin-6, neopterin), tryptophan metabolites and mannose binding lectin (MBL) levels consecutively in 36 septic patients with haematological malignancies (HM) and “non-haematological” diseases [intensive care unit (ICU) patients]. During septicaemia different chronological sequences for inflammation markers CRP, IL-6 and neopterin were seen in HM and ICU patients. Septic ICU-patients presented with significantly increased tryptophan degradation and higher neopterin and CRP levels at baseline, while MBL levels were lower in this group compared to subjects with HM. Concentrations of inflammation markers Were linked to each other and associated with enhanced tryptophan degradation. Patients who died during follow-up of 28 days tended to have lower baseline MBL concentrations than survivors. Septic patients with HM showed an impaired pro-inflammatory immune response compared to patients with non-haematological diseases.

Accuracy of bedside antigen tests in the diagnosis of new influenza A/H1N1v infection

To evaluate the clinical reliability of two rapid influenza detection tests (RIDTs), we analyzed 107 specimens from patients with clinically suspected pandemic influenza A/H1N1v by these tests as well as by real-time PCR as a standard. Both RIDTs had a moderate sensitivity (28-32%), a high specificity (93-99%) and a negative predictive value of 80%. These results will impact on the clinical management and isolation precautions in patients with suspected infection. Although a positive RITD is mostly confirmatory, a negative result in the presence of high clinical likelihood of infection should be interpreted with caution and be re-evaluated by PCR.

In vitro testing for anti-inflammatory properties of compounds employing peripheral blood mononuclear cells freshly isolated from healthy donors

INTRODUCTION

Inflammation is crucially involved in a variety of diseases like autoimmune syndromes, cardiovascular and neurodegenerative disorders, cancer, sepsis and allograft rejection.

METHODS

Freshly isolated human peripheral blood mononuclear cells (PBMCs) are used as a screening assay for anti-inflammatory properties of compounds. Determinations of neopterin production by ELISA and of tryptophan degradation by HPLC are used as read-outs. Results are compared with further markers of immune response and oxidative stress.

RESULTS

Phytohaemagglutinin induced significant tryptophan degradation and neopterin formation in PBMC, which correlated with IFN-γ, TNF-α, soluble cytokine receptors and isoprostane-8. Addition of vitamin C and E suppressed the responses dose-dependently.

DISCUSSION

The determination of tryptophan degradation and neopterin production in PBMC reflects various pro- and anti-inflammatory cascades that are of relevance also in patients. It constitutes a robust and reliable approach to screen anti-inflammatory or immunosuppressive drugs and may improve throughput, speed and cost-effectiveness in drug discovery.

Serum hepcidin concentration in chronic haemodialysis patients: associations and effects of dialysis, iron and erythropoietin therapy

BACKGROUND

Hepcidin, a liver-derived peptide induced by iron overload and inflammation, is a major regulator of iron homeostasis. As hepcidin decreases gastrointestinal iron absorption and recirculation from monocytes, over-expression is associated with the development of anaemia.

METHODS

We studied the associations between circulating hepcidin levels and various laboratory parameters related to anaemia and/or inflammation in 20 patients on chronic haemodialysis. Furthermore, we determined the impact of dialysis and iron and/or erythropoietin (rhEpo) supplementation therapy on hepcidin serum concentrations. The patients were withheld from iron and rhEpo for 2 weeks before study entry. Hepcidin was measured by liquid chromatography-mass spectrometry (LC-MS/MS); serum iron and haematological parameters, cytokines and pro-hepcidin by commercially available enzyme-linked immunosorbent assays (ELISA) or standard automated methods.

RESULTS

While hepcidin levels at baseline were not correlated to pro-hepcidin, interleukin-6 or transforming growth factor-beta concentrations, we found significant associations with reticulocyte count (r = -0.55; P = 0.015), serum iron (r = 0.7; P = 0.004) and ferritin levels (r = 0.63; P = 0.004) and transferrin saturation (r = 0.69, P = 0.001). Dialysis using either a high or a low flux biocompatible dialyser resulted in a significant decrease of hepcidin concentrations, which returned to pre-dialysis values before the next dialysis session. When studying the effects of anaemia treatment, we observed a significant reduction of hepcidin levels following administration of rhEpo but not iron.

CONCLUSIONS

Hepcidin levels in stable haemodialysis patients appear to reflect systemic iron load, but not inflammation. Due to the negative association between reticulocyte counts and hepcidin, the reduction of circulating hepcidin concentrations by dialysis and/or rhEpo treatment may positively affect erythropoiesis.

Effect of stress-induced reversible ischemia on serum concentrations of ischemia-modified albumin, natriuretic peptides and placental growth factor

OBJECTIVE

There is controversy whether new biomarkers are able to identify myocardial ischemia in the absence of myonecrosis.

METHOD

We measured NT-pro BNP, NT-pro ANP, ischemia-modified albumin (IMA) and placental growth factor (PlGF) in patients undergoing nuclear stress testing for suspected ischemic heart disease. A thallium scan was used for detection of reversible myocardial ischemia and cardiac troponin T (cTnT) for exclusion of stress-induced myonecrosis. Of 195 patients, 24 with reversible and 62 with no perfusion defect were included in the analysis. Plasma levels were measured before, 18 min and 4 h after stress testing.

RESULTS

Of the 86 patients, 52 received an exercise stress and 34 dipyridamol. New myonecrosis indicated by cTnT could be excluded in all patients. Plasma levels of NT-pro BNP and NT-pro ANP before testing were significantly higher in patients who later developed reversible perfusion defects (NT-pro BNP 139.00 (58.25/367.01) pg/mL vs 327.45 (120.50/972.85) pg/mL, p<0.05; NT-pro ANP 732.5 (470.0/1220.0) pg/mL vs 1470.0 (694.0/1910.0) pg/mL, p<0.05). Plasma levels of NT-pro BNP, NT-pro ANP and PIGF did not change significantly after stress testing, IMA levels rose significantly after 4 h in patients with and without reversible perfusion defects.

CONCLUSION

The elevation of NTpro BNP and NT-pro ANP at baseline may represent the cumulative effect of repeated bouts of myocardial ischemia. A single brief episode of provoked ischemia does not cause a significant increase of the measured biomarkers beside from IMA after exercise stress test potentially indicating skeletal muscle ischemia.

The use of a polytetrafluoroethylene-covered stent graft for transjugular intrahepatic portosystemic shunt (TIPS): Long-term follow-up of 100 patients

PURPOSE

To retrospectively evaluate results and clinical outcome of transjugular intrahepatic portosystemic shunt (TIPS) after implantation of a polytetrafluoroethylene (PTFE)-covered stent graft.

MATERIAL AND METHODS

The stent graft was used in 112 patients with higher risk of primary (i.e. patients with Budd-Chiari syndrome) or secondary shunt failure (patients with occlusion of a previous uncovered stent), or a complicated TIPS procedure with an imminent technical complication requiring covered stent. Patients were scheduled at 3- to 6-month intervals for duplex-sonographic control of shunt function. Radiological revision was performed in patients with a decrease in shunt function by >25%, primary non-response, or relapse of the index symptom.

RESULTS

Twelve patients were lost to follow-up, and 100 patients were followed for 22+/-15 months. The actuarial rates of shunt patency were 90, 84, and 74% at 1, 2, and 3 years of follow-up, respectively. Two patients developed early (within 1 month) and 14 patients late shunt failure. Except for one transient rise in liver enzymes due to outflow obstruction by the stent graft, no technical complications were seen. Primary response to treatment was seen in 97% of patients treated for variceal bleeding and 84% of patients treated for refractory ascites. A relapse of the index symptom was seen in 13% of bleeders and 9% of patients treated for refractory ascites.

CONCLUSION

TIPS created with a PTFE-covered stent graft showed favorable long-term results.

Der akute Thoraxschmerz

Acute chest pain is the leading cause of hospital admissions worldwide and absorbs extensive financial and hospital resources for diagnosis and management. A missed diagnosis of acute myocardial infarction is still associated with a poor outcome and represents one of the most common reasons for lawsuits in the USA. The present article gives a summary on the features of cardiac and non-cardiac chest pain, provides an overview of diagnostic algorithms, and points out the important differential diagnoses.

Preliminary results of safety and efficacy of the interleukin 1 receptor antagonist anakinra in patients with severe lupus arthritis

BACKGROUND

Joint involvement occurs in most patients with systemic lupus erythematosus (SLE), and severe lupus arthritis is often refractory to conventional treatments. Anakinra is used in the treatment of rheumatoid arthritis, but its therapeutic potential has not been proved in patients with SLE.

OBJECTIVE

To determine the safety/tolerability and efficacy of anakinra in patients with SLE with leading joint involvement.

METHODS

In patients with SLE with active polyarthritis and no other uncontrolled systemic/organ manifestations, 100 mg/day anakinra was self administered subcutaneously for 3 months. Disease activity was assessed by VAS, number of swollen/tender joints, ECLAM score, and serological and immunological measures.

RESULTS

Four patients with SLE were studied; anakinra was safe in all four patients and no drug related serious adverse events occurred. A subjective benefit was seen in all patients and a trend towards better activity measures after 4 weeks. After an initial response, one patient left the study because of an arthritic flare after 6 weeks.

CONCLUSION

In this study anakinra was apparently safe and well tolerated and led to clinical and serological improvement. Anakinra might be an interesting alternative in individual patients with lupus arthritis not responding to conventional treatments.

Reproductive health-seeking by married adolescent girls in Maharashtra, India

In India, most adolescent girls 15-19 years old are married. A study was conducted in 1995-97 in Ahmednagar district of Maharashtra, India to gain insight into whether and how their reproductive health needs are met, especially for gynaecological problems, family planning and perceived fertility problems. It included a survey among 302 married girls of this age, and in-depth interviews with 74 girls, 37 husbands and 53 mothers-in-law. Girls were treated quickly for illnesses interfering with domestic work and were expected to conceive in the first year of marriage. Menstrual disorders and symptoms of reproductive tract infection often went untreated. There was an emerging need for delaying and spacing pregnancies; limiting the number of children was well established. Household work, protection of fertility and silence arising from embarrassment related to sexual health problems were the strongest factors influencing care-seeking. Husbands made the decision whether their wives could seek care and mothers-in-law sometimes influenced these decisions; girls had neither decision-making power nor influence. This study provides valuable input for the new reproductive and child health programme in Maharashtra.

Presynaptic modulation of the release of the co-transmitters noradrenaline and ATP

The release of both sympathetic co-transmitters, noradrenaline and ATP, is modulated via presynaptic receptors. However, the degree of the modulation may differ indicating that the ratio of the released co-transmitters changes upon presynaptic receptor activation. For example, alpha 2-autoinhibition affects the release of noradrenaline more markedly than the release of ATP. Some sympathetic axon terminals possess presynaptic P2-purinoceptors which are activated by endogenous ATP. These receptors are a novel kind of auto-receptor: they mediate a presynaptic negative feedback mechanism in which released ATP inhibits subsequent co-transmitter release.

P2-purinoceptor-mediated autoinhibition of sympathetic transmitter release in mouse and rat vas deferens

Effects of drugs acting at P2-purinoceptors on the release of newly taken up [3H]-noradrenaline were studied in slices of mouse and rat vas deferens. The slices were superfused and stimulated electrically, in most experiments by trains of 60 pulses/8 Hz. In mouse vas deferens, the P2-purinoceptor antagonists reactive blue 2 (1.8-100 microM) and brilliant blue G (10-300 microM) increased the stimulation-evoked overflow of tritium in a concentration-dependent manner as shown previously for suramin. Reactive blue 2, which preferentially blocks the P2Y-subtype, was the most potent compound and the compound with highest maximal effect, an increase by 104%. Pyridoxal phosphate-6-azophenyl-2',4'-disulfonic acid (PPADS), in contrast, caused a small increase only at a single concentration (30 microM). The effects of reactive blue 2, brilliant blue G and suramin were not additive. The P2 agonist adenosine 5'-O-(3-thio)-triphosphate (ATP gamma S) reduced the evoked overflow of tritium. As shown previously for suramin, reactive blue 2 30 microM and brilliant blue G 100 microM antagonized the effect of ATP gamma S. From the shift of the ATP gamma S concentration-response curve to the right, an apparent pKB value of 5.3 was estimated for reactive blue 2 and an apparent pKB of 4.5 for brilliant blue G. In rat vas deferens, reactive blue 2 (3-30 microM), brilliant blue G (10 microM) and suramin (30-300 microM) also increased the evoked overflow of tritium. As in the mouse, reactive blue 2 was the most potent compound and the compound with highest maximal effect, an increase by 90%.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparative QSAR studies of two series of 1,4-dihydropyridines as slow calcium channel blockers

Quantitative structure activity analysis was applied to two series of dihydropyridine (DHP) calcium channel blocking agents. One series of compounds was composed of DHPs substituted in the 4-position with an ortho or meta nitro substituted phenyl ring. The second group consisted of DHPs substituted at the 4-position with a novel thieno [3,2-c] pyridine ring. Both series consisted of compounds with unsymmetrical ester substitutions on the dihydropyridine ring. The antihypertensive activity of the compounds were determined in a spontaneously hypertensive rat model. Regression analysis indicated the antihypertensive activity of an i.v. dose correlated with the calculated octanol/water coefficent (clogP). Regression analysis did not find correlation with the in vitro potency and the clogP values.

Prejunctional modulation of noradrenaline release in mouse and rat vas deferens: contribution of P1- and P2-purinoceptors

1. Prejunctional purinoceptors modulating the release of noradrenaline were compared in mouse and rat vas deferens. Tissue slices were preincubated with [3H]-noradrenaline and then superfused and stimulated electrically, in most experiments by trains of 60 pulses, 1 Hz. 2. In mouse vas deferens, 2-chloroadenosine (IC50 0.24 microM), beta,gamma-methylene-ATP (IC50 3.8 microM), alpha,beta-methylene-ATP (IC50 2.9 microM) and 2-methylthio-ATP (only 30 microM tested) reduced the evoked overflow of tritium. 8-Cyclopentyl-1,3-dipropylxanthine (DPCPX), 10 nM, antagonized the effect of 2-chloro-adenosine (apparent pKB 10.2) as well as of beta,gamma-methylene-ATP (apparent pKB 9.6) and alpha,beta-methylene-ATP. Suramin, 300 microM, attenuated the effect of 2-chloroadenosine at best very slightly, antagonized the effect of beta,gamma-methylene-ATP (apparent pKB 4.5) and, when combined with DPCPX 10 nM, caused a further marked shift to the right of the concentration-response curve of beta,gamma-methylene-ATP beyond the shift produced by DPCPX alone. 3. In rat vas deferens, 2-chloroadenosine (IC50 0.20 microM), beta,gamma-methylene-ATP (IC50 4.8 microM), alpha,beta-methylene-ATP (IC50 3.0 microM) and 2-methylthio-ATP (only 30 microM tested) also reduced the evoked overflow of tritium. DPCPX, 10 nM, antagonized the effect of 2-chloroadenosine (apparent pKB 9.7) as well as of beta,gamma-methylene-ATP (apparent pKB 9.6) and alpha,beta-methylene-ATP. Suramin, 300 microM, did not change the effect of 2-chloroadenosine, attenuated the effect of beta,gamma-methylene-ATP at best very slightly and, when combined with DPCPX, caused at best a very small shift to the right of the concentration-response curve of beta,gamma-methylene-ATP beyond the shift produced by DPCPX alone.4. It is concluded that prejunctional purinoceptor mechanisms in mouse and rat vas deferens are similar. In either species, both nucleosides such as adenosine and nucleotides such as beta,gamma-methylene-ATP activate a common release-inhibiting receptor which is a Pl- or, more specifically, A1-purinoceptor.There seems to be no need to postulate the existence of a novel prejunctional P3-purinoceptor.Moreover, the sympathetic terminal axons possess an additional P2-purinoceptor in both species which is activated by some nucleotides such as beta,gamma-methylene-ATP and 2-methylthio-ATP, although the activation of the P2-purinoceptor by beta,gamma-methylene-ATP is difficult to demonstrate in the rat.

Axon terminal P2-purinoceptors in feedback control of sympathetic transmitter release

Extracellular ATP acts on P2-purinoceptors of peripheral effector cells, and this is the basis for its function as a (co-)transmitter in peripheral efferent neurons. ATP also acts on P2-receptors of neuronal cell bodies or dendrites, and this is the basis for its function as a fast excitatory transmitter at neuroneural synapses. A third site of action is axon terminals. In the vas deferens of the mouse, noradrenaline and ATP are postganglionic sympathetic co-transmitters, and exogenous ATP acts on P2-purinoceptors of the sympathetic terminals to inhibit release of noradrenaline. Here we show that two P2 antagonists, suramin and Reactive Blue 2, increase the release of noradrenaline in mouse vas deferens. The increase is only obtained when there has been preceding nerve activity and is largely independent of the postjunctional response. These findings indicate a physiological function for axon terminal P2-purinoceptors: they mediate a novel prejunctional negative feedback in which released ATP inhibits subsequent transmitter release.

[Adamantiades-Behçet disease: necrotizing systemic vasculitis with a fatal outcome]

Vascular involvement in Behçet's disease was first mentioned by Adamantiades and occurs in addition to the classic symptom triad. In the present work an unusually fulminant course of Adamantiades-Behçet disease with a lethal outcome is reported in a 43-year-old male patient of German origin. The first symptoms were painful oedemas of the joints, followed 1 year later by bipolar aphthous lesions and by multiple progressive ulcers of the skin and the oral mucosa. Histologically, pustule formation with underlying vasculitis was diagnosed. In spite of systemic treatment with azathioprine and high-dosed prednisolone, the course was progressive with multiple necrotizing ulcers, and the patient died 18 months after the onset of the disease with signs of heart insufficiency and cachexia. The autopsy findings revealed multiple lesions of ulcerating systemic vasculitis of the skin and other visceral organs, including the lungs and the central nervous system, and also endocarditis verrucosa ulcerosa of the mitral valve.

[The atypical course of syphilis in HIV infection]

We report on 3 HIV patients showing atypical courses of syphilis. Both the history and serology of the first patient proved a recent re-infection with T. pallidum, whereas the histopathological findings corresponded to an advanced stage of the disease (S II-III). The second patient showed the clinical picture of syphilis maligna with slowly converting and slightly positive serological reactions. The third patient had a refractory syphilis and an early relapse. Our observations suggest that syphilis might take an unusual course in HIV patients. Considering our total HIV clientèle (800 patients greater than or equal to WR 2) the frequency of these atypical cases must be rated very low (0.38%).

[Astemizole in urticaria--a multicenter study by 412 established dermatologists]

In the course of a multicenter study on 2122 patients treated by 412 dermatologists in general practice, we investigated the effect of astemizole (Hismanal) on urticaria. During 2 weeks of treatment with astemizole 10 mg daily, the percentage of the patients with severe or moderate affection dropped from 82.4% to 9.1%, while the figure of the patients with severe or moderate pruritus decreased from 83.9% to 7.8%. In 74% of the patients, the onset of action occurred during the first 24 hours. The peak of effect was reached within the first day in 36.6% of the patients, and within 2 days in 57.5% of the patients. The physicians observed an excellent outcome in 44.4% and good results in 31.9% of the patients. The therapeutic success was considered moderate in 12.0% and unsatisfactory in 9.6% of the cases. The incidence of side effects was very low, i.e., 5.4%. Slight sedation was observed in 1.9% of the cases.

PIXE analysis in different stages of psoriatic skin

Elemental distribution in psoriatic skin varies with the functional state of the keratinocytes, e.g., electrolytes influence cell metabolism and cell proliferation, and trace elements play a crucial role in a great number of enzymes. Elemental distribution in pinpoint lesions, old plaques, and uninvolved skin of 5 psoriatic patients and 4 healthy controls was studied by means of PIXE (proton-induced x-ray emission) analysis. This technique allows the simultaneous detection of elements with an atomic number greater than or equal to 14 along the epidermis and dermis in freeze-dried skin biopsies. Trace elements such as Fe, Cu, and Zn were determined down to a level of 1 ppm. In comparison with uninvolved skin, concentrations of P and K were elevated in psoriatic epidermis. In addition, increased levels of K were correlated with the stage of the psoriatic lesion. Zinc concentrations were significantly elevated in pinpoint lesions. The Zn concentration profiles within the epidermis and upper dermis showed high correlation to the P concentration profiles. Iron levels were decreased in old psoriatic plaques, whereas Cu concentrations varied considerably. In comparison to the controls, Cl concentrations were markedly decreased in the dermis of involved and uninvolved psoriatic skin, whereas epidermal Cl levels were unaffected. As high K levels prevent the Ca-induced differentiation of keratinocytes, high K levels may be the cause of the high cell differentiation in psoriatic skin. Elevated DNA- and RNA-polymerases might be the cause of elevated Zn levels in pinpoint lesions.

[Treatment of urticaria with the new H1 antihistaminic astemizole--with special reference to the time of onset of effect and maximum effect]

20 patients, 12 suffering from chronic urticaria, 2 from acute urticaria, 1 from pressure urticaria, 2 from cold urticaria and 3 from urticaria factitia were treated in an open pilot study with the new H1-antihistamine Astemizole. The dosage was in all cases 1 X 10 mg per day. The onset of action as well as the efficacy maximum were registered. Astemizole proved in this study to be a very effective antihistamine being able to achieve good results even in hard to cure cases like cold urticaria. On the 1. day 35% of the patients had noticed an onset of action. 75% of the patients had an onset of action within the first 2 days. The efficacy maximum was achieved within the first 2 days in 60% of the patients.

[Scarring linear IgA dermatosis in the adult]

A 54-year-old woman had a six-months history of a scarring blistering disease with clinical signs of dermatitis herpetiformis and bullous pemphigoid. Direct immunofluorescence examination showed homogeneously linear deposits of IgA along the dermo-epidermal junction. Electron microscopic studies revealed blistering above and beneath the lamina densa. Referring to this new case of a scarring linear IgA disease we discuss some other forms of scarring bullous diseases in adults.

[Comparison of tuberculosis cutis luposa and cutaneous leishmaniasis]

We present a comparative study concerning two cases of tuberculosis cutis luposa and cutaneous leishmaniasis, respectively. These two Turkish female patients had suffered from changes of the facial skin since 20 years (tuberculosis cutis luposa) and for 5 months (cutaneous leishmaniasis). The tuberculosis cutis luposa had been misdiagnosed as cutaneous leishmaniasis and surgically treated. Both cases showed an apple jelly-like color at the edges of the lesions with soft tissue. With tuberculosis cutis luposa, the lesions had a larger extension and a more hyperkeratotic picture. We discuss the different histopathologic changes of both cases. As bacteriologic culture revealed mycobacterium tuberculosis, on one hand, and histopathology leishmania species intrahistiocytically, on the other, we could finally make the corresponding diagnoses.

Evaluation of a novel antihypertensive agent, LY127210, in anesthetized and conscious spontaneously hypertensive rats

LY127210 (7,8-dimethoxy-1H-3-benzazepin-2-amine, hydrochloride) is a novel peripheral arterial vasodilator that reduces mean arterial blood pressure in anesthetized and conscious spontaneously hypertensive rats by all conventional routes of administration. The antihypertensive activity of LY127210 results predominantly from a decrease in total peripheral vascular resistance, and the degree of reflex tachycardia produced by LY127210 in conscious spontaneously hypertensive rats is significantly less than that produced by hydralazine at equivalent antihypertensive doses. The relative lack of reflex tachycardia produced by LY127210 appears to result from a direct bradycardic effect of the compound that occurs at the level of the myocardium at doses similar to those required to produce peripheral arteriolar vasodilation. It is proposed that the direct bradycardic effect of LY127210 serves to offset, at least in part, the tachycardia resulting from reflex stimulation of sympathetic outflow that occurs upon activation of the baroreflex loop as blood pressure is lowered. The results indicate that LY127210 may provide adequate control of blood pressure and may not require the concomitant administration of a beta-adrenoceptor antagonist to control reflex tachycardia, as is commonly necessary with hydralazine.

Plasma apoprotein changes after selective inhibition of hepatic triglyceride lipase in rat

Selective inhibition of hepatic triglyceride lipase (HTGL) by specific antibodies in rats led to an altered VLDL apoprotein composition. Apoprotein analysis by isoelectric focusing revealed a new protein band in VLDL and an increase in apoprotein E (apo E) content. Apoproteins in LDL and HDL remained unchanged. Electronmicroscopy showed a significant increase in particle size of VLDL from 452 to 497 A with no significant changes in LDL and HDL diameters.

Single bovine enamel particles examined by electron optics

Whole enamel scrapings from teeth of embryonic calves have been separated by density gradient centrifugation in organic solvents into fractions (1.6 less than p less than 2.4 g/cm3) representing progressive stages of mineral phase maturation. Single enamel particles or their small aggregates from such fractions were examined by transmission electron microscopy, electron diffraction, and high-spatial-resolution electron probe micro-analysis. The electron optical methods demonstrated the presence of poorly crystalline hydroxyapatite as the only detectable solid phase in all fractions. Octacalcium phosphate and brushite were not identified in the fractions. Changes in electron diffraction patterns were indicative of a progressive increase in apatite crystallinity with enamel maturation. Molar Ca/P ratios were found to range from 1.48 to 1.70, with a higher mean value obtained for lower-density fractions (p less than 2.0 g/cm3). Lower-density fractions contained some particles with high ratios (approximately equal to 2.0-4.0) and a non-uniform distribution of Ca and P, as revealed by electron probe mapping. These characteristics are suggested as possibly being related to carbonate phases in early enamel.

Pressor responses to norepinephrine in rabbits with 3-day and 30-day renal artery stenosis. The role of angiotensin II

Pressor responses to norepinephrine (NE) infusions were examined in normal rabbits, in rabbits with renal artery stenosis of over 30 days' duration (chronic renal hypertensive rabbits), and in rabbits with renal artery stenosis of 3 days' duration (3-day clipped rabbits). The 3-day clipped rabbits did not have hypertension, but they showed the same increased pressor responses to NE as did the chronic renal hypertensive rabbits, which was about 2.5 times that of the normal rabbits. Plasma renin activity (PRA) was the same in the 3-day clipped rabbits as in the normal group, but in the chronic renal hypertensive rabbits the PRA was significantly below normal. Infusions of angiotensin II (A II) in either subpressor or pressor amounts potentiated the pressor responses to NE in normal rabbits, whereas, in 3-day clipped rabbits and chronic renal hypertensive rabbits, A II in subpressor or pressor doses did not alter the pressor responses to NE. Infusion of the A II antagonist, [1-sarcosine, 8-isoleucine]angiotensin II, did not alter the pressor responses of normal rabbits to NE, but this A II analogue completely abolished the pressor hyperresponsiveness to NE in the 3-day clipped rabbits and greatly reduced the NE hyperresponsiveness in the chronic renal hypertensive rabbits; this A II antagonist did not alter the control arterial pressure in any of the three groups of rabbits. These studies show that the increased pressor response to NE in rabbits with renal artery stenosis occurs before the onset of hypertension and thus is not merely a result of the hypertension. Also, these results provide evidence that A II plays an important role in the increased pressor responses to NE in hypertensive and prehypertensive rabbits.