Showing papers in "Wiener Klinische Wochenschrift in 1987"

Photodynamic therapy of malignant brain tumors

Abstract: The combination of haematoporphyrin derivative (HPD) and visible light at 630 nm, termed as photodynamic treatment (PDT), provides a new tool in tumour therapy, causing selective tumour destruction initiated by photochemical reactions. Up to now 13 patients with malignant brain tumours (12 glioblastoma multiforme, 1 leiomyosarcoma) were treated with 40-80 J/cm2 light following parenteral or direct injection of HPD (5 mg/i.a. or 1 mg/ccm tumour volume). In 5 patients the PDT was followed by subsequent radiotherapy with 4 Gy. The patients with recurrent tumour showed a median survival time of 5 months, whereas the 6 patients with primary manifestations have survived so far for periods of up to 9 months. However, the follow up period is too short to allow final conclusions to be reached on the effect of PDT in the treatment of malignant brain tumours.

[Acute AIDS-retrovirus infection. Clinical picture in a patient with HTLV-III seroconversion].

Abstract: The case report is presented of a patient belonging to a group at high risk for the development of AIDS who suffered from an acute mononucleosis-like illness coincident with seroconversion.

Surgical treatment of gastric cancer today.

Abstract: The utilization of radical operation in gastric cancer cases has led to the development of various operation techniques. With the improvement in perioperative management it can be said that age no longer is a restriction. A study of gastric cancer prognosis indicates an upward trend in survival since 1960 along with the increased detection of early cancer. This suggests the most importance of early detection in increasing the therapeutic results obtained in cases of gastric cancer. In cases with advanced cancer, 5-year survival rate of 44.7 per cent was attained through such aggressive actions as extended dissection of lymph nodes and combined resection of surrounding organs with evaluation of the macroscopic classification of the cancer.

[Campylobacter pylori, gastritis and peptic ulcer].

Abstract: In the course of routine gastroduodenoscopic examination of 218 patients bioptic mucosal specimens were examined bacteriologically for the presence of Campylobacter (C.) pylori. The organism was isolated from 52 out of 53 patients (98%) with duodenal ulcer, 7 out of 9 with gastric ulcer (78%), 24 out of 31 with mucosal erosions (77%), 10 out of 10 with duodenitis (100%), 16 out of 16 with chronic active gastritis (100%) and from 40 out of 73 patients (55%) with inactive chronic gastritis. By contrast, all specimens from 26 patients with endoscopically and histologically normal mucosa were negative for this bacterium. The rate of elimination of C. pylori from mucosal specimens was investigated as a first step towards studying the influence of antibiotic therapy upon healing of gastric and duodenal ulcers. For this purpose 30 patients with duodenal ulcers were treated either with ranitidine alone (15) or together with bacampicillin (15), which was shown to be highly active in studies with ampicillin in vitro. After 4 weeks the organism was still found in specimens from all patients treated with ranitidine alone, but also in 12 out of 15 patients given combined therapy. This result demonstrates that systemic antimicrobial chemotherapy with bacampicillin is insufficient to eradicate C. pylori from the stomach and the duodenum.

[Plasmapheresis treatment in 3 simultaneously occurring autoimmune diseases: Hashimoto thyroiditis with hyperthyroidism, autoimmune thrombopenia and autoimmune hemolytic anemia].

Abstract: A 49 year-old women with a 2-year history of a Coombs-positive autoimmune haemolytic anaemia was hospitalized with Hashimoto's thyroiditis and thyrotoxic crisis. The clinical course was further complicated by an autoimmune thrombocytopenia. Primary resection of the thyroid thus seemed to be too risky, so we decided to perform therapeutic plasma exchange. This led to clinical improvement, enabling us to perform a thyroidectomy. The present investigation reveals the high efficiency of plasmapheresis in the treatment of combined autoimmune diseases. Therapeutic plasma exchange resulted in a reduction of both the relevant autoantibodies and the level of circulating thyroid hormones.

[Non-Hodgkin's lymphoma of the stomach: surgical therapy and prognosis].

Abstract: This study reports 43 patients (male: n = 17, female: n = 26) with non-Hodgkin's lymphoma of the stomach, who underwent surgery between 1. January 1977 and 31. December 1986. The main clinical symptoms were abdominal pain, weight loss and vomiting. Symptoms preceded diagnosis by 13 weeks. Barium meal and endoscopy were useful diagnostic procedures. The biopsy specimens indicated malignancy in 80% of cases. Operations performed were: total gastrectomy (n = 18), distal resection (B I: n = 4, B II: n = 14), partial duodenopancreatectomy (n = 3), proximal gastric resection (n = 1), local excision (n = 1) and explorative laparotomy (n = 2). Perioperative mortality was 0%. Peritonitis occurred in 1 patient due to leakage of the duodenal stump. According to the Ann-Arbor system we found stage I in 19, stage II in 10 and stage III in 14 cases. The histological type according to the Working Formulation showed low grade of malignancy in 15 and high grade of malignancy in 28 patients. All patients underwent postoperative chemotherapy and/or radiotherapy with respect to tumour staging and morphology. 24 patients are alive without relapse, 16 patients died intercurrently. The data were collected retrospectively and analysed by means of Kaplan-Meier survival functions. For comparisons we used the Breslow and the Mantel test. We investigated the prognostic significance of: sex, clinical symptoms, localisation of the tumour, type and radicality of operation, lymphadenectomy, splenectomy, splenic infiltration, tumour size and depth of infiltration, staging and grading. The 2-year survival rate was 82%, the 5-year rate was 55%.(ABSTRACT TRUNCATED AT 250 WORDS)

In vivo degradation of immune complexes in the kidney by orally administered enzymes

Abstract: Preformed immune complexes were deposited in kidney glomeruli of rabbits after i.v. injection. In vivo disintegration of these complexes by orally administered enzymes was investigated. 3 rabbits were given labelled trypsin and papain and the radioactivity and enzyme activity determined in the blood. The radioactive fraction showed an active enzyme concentration of 3-5 mg%. 13 experimental rabbits and 3 control animals received three i.v. injections of 5 ml preformed soluble immune complexes at 12-hour intervals. 24 hours after the last injection the experimental animals were fed 1600 mg enzyme mixture. All animals were sacrificed 4 hours later and the glomeruli of the kidney were investigated by immunofluorescence. All control animals showed large amounts of immune complexes in the glomeruli. Experimental animals, which had all received oral enzymes showed no immune complexes any more, or only residual immune complexes in some glomeruli. This observation pointed to in vivo disintegration of immune complexes by orally-administered enzymes as providing the basis for the treatment of immune complex diseases.

[Effect of high-dose prednisolone on lung fluid in patients with non-cardiogenic lung edema].

Abstract: The influence of high-dose prednisolone on extravascular lung water (EVLW) was studied in a randomized trial in patients with noncardiac pulmonary edema. The patients were treated every 6 hours for 48 hours with 2 g of prednisolone-hemisuccinate or placebo. In the prednisolone-group (n = 7) EVLW decreased from 16.4 +/- 6.2 before to 11.8 +/- 5.1 ml/kg after treatment (p less than 0.05). Additionally alveolar-arterial oxygen gradient (AaDO2/FiO2), pulmonary vascular resistance and heart rate decreased, while arterial oxygen tension (PaO2/FiO2) and mean arterial pressure increased (p less than 0.05). In the placebo-group (n = 7) EVLW increased slightly from 17.5 +/- 3.1 before to 19.3 +/- 10.3 ml/kg after treatment. Additionally all other parameters did not change significantly in this group. Although no statistical significant difference was found between the two groups of treatment, a decrease in EVLW was observed in all prednisolone-treated patients, whereas a pronounced increase in EVLW was found in 3 placebo-treated patients. Probably, those patients would have benefited from high-dose prednisolone treatment. High-dose prednisolone reduced EVLW and improved hemodynamics and gas exchange in patients with noncardiac pulmonary edema, whereas placebo did not achieve comparable effects. Therefore, high-dose prednisolone appears beneficial in noncardiac pulmonary edema in respect of EVLW, hemodynamics, and gas exchange.

Isolated accessory liver (hepar succenturiatum) at the neck of the gallbladder. Case report with review of the literature

Abstract: We report on a 34 year-old female patient whose gallbladder was removed because of cholecystolithiasis. On histological examination of the fatty tissue surrounding the neck of the gallbladder an accessory liver was detected. Accessory liver tissue is nearly always an incidental finding at operations and autopsies. It arises in the vicinity of the gallbladder from residual liver cells in the caudal part of the embryonic liver anlage. In the differential diagnosis ectopic liver tissue has to be distinguished from other heterotopic tissues. Accessory livers may also be found in certain other organs and structures which lie in close proximity to the liver during fetal life.

[Long-term effect of combination glibenclamide-insulin treatment in the secondary failure of sulfonylurea therapy--results of a one-year double blind study].

Abstract: The long-term efficacy of combined insulin-glibenclamide treatment was investigated in 79 secondary drug failure patients by means of a double-blind, randomized placebo-controlled study. During a one-year follow-up period the patients on insulin plus glibenclamide required significantly lower exogenous insulin doses. Coincidentally, C-peptide concentrations were significantly raised in the verum versus the placebo group. Additionally, the administration of glibenclamide resulted in a decreased level of hyperglycaemia during the first six months of the observation period. Glibenclamide withdrawal after six and again after twelve months of the combined therapy provoked a deterioration of glycaemic control, as well as a lowering of the C-peptide concentrations. The findings demonstrate a prolonged beneficial effect of the combined treatment, in contrast to the solely short-term effects predicted by numerous studies. The metabolic improvement must be ascribed in part to the beta-cytotropic effect of glibenclamide. Extrapancreatic pathways via receptor/postreceptor mechanisms cannot be excluded.

[Hemolytic graft versus host reaction cause by immune "auto"-anti A1 formation in an A1 recipient following transplantation of an O kidney. With a review of studies up to now from the literature].

Abstract: The serological data are given of a patient with acquired haemolytic anaemia due to "auto"-antibodies of Anti A1 specificity induced by a group O kidney graft in an A1 recipient as a Graft-versus-Host (GvH) reaction. The gamma-globulin markers Gm (a,x,f) were tested for differentiation between auto- or alloantibody character of the patients "Auto"-Anti A1. The possibility of in vivo neutralization of the Immune-Anti A1 by blood group substance A in the plasma of the patient could not be proven, though initially presumed. The disadvantages of using ABO compatible, but not identical organ donors is pointed out, firstly the possibility of giving rise to ABO induced GvH reactions and, secondly, the reduced chance of group O recipients on the waiting list getting group O graft. A search of the literature revealed 46 similar cases, which are reviewed and their characteristics are discussed.

[Wild silk-induced asthma. A contribution to the knowledge of inhalation allergies caused by wild and tussah silk-filled bed quilts]

Abstract: In the silk industry occupational IgE-mediated hypersensitivities to different allergens are well known. Since the use of silk waste for the filling of bed quilts a great number of patients suffering especially from silk-asthma could be observed. Immunological investigations showed clearly that in this context sericin and also antigens from an insect of the genus anthrenus in the silk material are of allergenic importance. On the basis of typical case histories from the occupational and private scene the diagnostic difficulties of silk allergy are discussed.

Value and indications for bronchoalveolar lavage combined with transbronchial lung biopsy

Abstract: Bronchioloalveolar lavage (BAL) enables diffuse interstitial lung disease to be divided into lymphocytic and granulocytic alveolitis. The combination of BAL and transbronchial lung biopsies using modern flexible fiberoptic bronchoscopes allows the subdivision of lymphocytic alveolitis into sarcoidosis, exogenic allergic alveolitis (synonym: hypersensitivity pneumonitis: EAA) and granulomatous pneumonias caused by infectious agents. The use of immunohistochemical surface markers of lymphocytes in conjunction with BAL provides further differentiation of lymphocytes into T- and B-, T-helper and T-suppressor types, natural killer cells (NK cells) and cytotoxic T-cells. A predominance of T-suppressor lymphocytes is an indication of EAA, whereas a predominance of T-helper lymphocytes is positively correlated with sarcoidosis. Other markers, e.g. HLA-DR, when expressed on the surface of alveolar macrophages, merely indicate activation unrelated to a specific type of lymphocytic alveolitis. BAL is also a new and promising diagnostic tool for pneumoconioses and other types of lung disease caused by inhaled industrial pollutants. Ferruginous bodies and silica crystals, free or ingested by alveolar macrophages, can be found more easily than by scraping tissue blocks or from multiple sections of transbronchial biopsies. BAL cells can easily be processed for electron microscopy and inhaled foreign material can be analysed in an electron microscope using X-ray diffraction analysis (EDAX) or electron spectroscopic imaging (ESI). BAL is also of value in the diagnosis of peripheral lung carcinomas, in addition to cytological sputum analysis, brush smears, transthoracic fine needle aspiration and transbronchial biopsies. BAL is a valuable diagnostic tool in cases of unusual pneumonia where fungi can be visualized by silver impregnation techniques and viruses by antibodies using immunofluorescence microscopy.

[Effectiveness of recombinant human erythropoietin in the treatment of transfusion-dependent anemia in patients on chronic dialysis].

Abstract: Recombinant human erythropoietin (r-HuEPO) has recently become available for clinical trial and has been used for the first time in Austria for the treatment of transfusion dependent patients on chronic haemodialysis. Inclusion criteria into the study were baseline haemoglobin levels of less than or equal to 6 g/dl and transfusion requirements of greater than or equal to 1 unit of blood per month. r-HuEPO (CILAG/AMGEN/ORTHO) was administered intravenously 3 times weekly at the end of dialysis. The initial dose was 100 U/kg body weight at each administration and was increased by 25 U/kg if Hb levels failed to increase by greater than 5% of baseline at intervals of 3 weeks. All 9 patients studied showed an increase in Hb values to the desired value at least greater than or equal to 10 g/dl within 6 to 16 weeks and none of the patients required further blood transfusions. All patients reported subjective improvement of life quality and markedly increased working ability. Apart from minor episodes of bone pain and subfebrile temperatures after r-HuEPO administration no major side effects were noted. These preliminary results show that r-HuEPO (CILAG/AMGEN/ORTHO) is a safe and effective form of therapy for renal anaemia and one which opens new horizons in the management of patients on chronic haemodialysis.

[Positive diagnosis of irritable colon: a scored chart or standardized anamnesis?].

Abstract: The diagnostic score of Kruis to diagnose the irritable bowel syndrome (IBS) has recently gained widespread application We therefore evaluated the case histories of 373 patients attending the gastroenterological outpatient department retrospectively using the questionnaire of these authors In contrast to Kruis et al's findings, by applying their discriminating score the diagnosis of irritable bowel syndrome was made in only 51% of the patients who underwent complete gastrointestinal survey without pathological findings However, the group of IBS was significantly separable from malignant or inflammatory disease We therefore conclude that the diagnosis of IBS should only be made by ruling out organic disease (except in the case of young people with normal physical and laboratory check up findings and a good response to treatment) For these patients we simplified the questionnaire, omitting calculations

[Labile disulfide bonds and free thiol groups in human IgG. III. The "sigma S value" in gynecologic neoplasms].

Abstract: The immunoglobulins G contain labile disulfide bonds which can easily be opened by dithionitrobenzoic acid in the subclass G1, and free SH groups in the subclass G2. The "sigma S value" is a photometrically determined quantitative measure of both groups added together. 57 cases of different gynaecological malignant tumours gave a mean sigma S value of 1.02 +/- 0.24 and 7 cases of stage 0 a sigma S of 1.05 +/- 0.25, whereas in 45 cases of benign diseases the sigma S was found to be 1.45 +/- 0,21. The difference between the values in the malignant and benign cases was highly significant (p less than 0.001). The sigma S in the benign cases lies within the normal range ascertained with healthy serum donors. These results are in accordance with results formerly obtained with malignant tumours in other locations. This leads us to the assumption that the shift in sigma S may be functionally and/or symptomatically associated with malignancy. The decrease in sigma S is interpreted in terms of a decrease in the percentage of subclass G1 in the total IgG.

Etiology of erysipelas

Abstract: Bacterial cultures were taken from 31 patients by scarification from the dermal compartment of recent erysipelas foci. Pathogenic organisms were isolated from the dermis while cultures from the skin surface remained sterile in 5 patients; Streptococcus pyogenes was cultured in 2 of these patients and Staphylococcus aureus in the other 3 patients. Our findings indicate that staphylococcal erysipelas does exist and we suppose that Staphylococcus aureus is able to induce erysipelas, above all in the presence of dysfunction of lymph vessels. When treatment with penicillin G is not successful, erysipelas caused by staphylococci has to be considered. In these cases treatment has to be changed to penicillinase-resistant penicillin.

Pathologic findings in colorectal cancers and discussion of their significance for tumor therapy according to stage

Abstract: The histological degree of differentiation is a valuable determinant of the malignancy of colorectal carcinomas. It correlates well with the tumour stage and has a prognostic relevance similar to the Dukes stages. Well and moderately well differentiated colorectal carcinomas showed significantly lower lymph node metastasis (35% and 45% of the cases, respectively) than the poorly differentiated tumours (70%). Among 20 carcinomas limited to mucosa and submucosa, only one poorly differentiated carcinoma produced lymph node metastases. The histological degree of differentiation of a given tumours assessed consecutively in biopsy and surgical material was identical in 81%. The degree of differentiation had to be corrected from moderate to well in only 9% of cases and in 8% from well to moderate. These corrections were without prognostic relevance. The prognostically important correction from moderate to poor histological degree of differentiation had to be made in only 2% of the cases. Therefore, the histological degree of differentiation can be accepted as an important preoperative criterium for the selection of adequate tumour therapy. An increased risk of tumour infiltration of resection margins was found only in cases with resection distances less than 1 cm from the tumour, whereas tumour infiltration of resection margins was minimal (below 1%) for distances of more than 1 cm. Consideration of the histological degree differentiation, clinical stage of tumour and sufficient distances of resection margins from tumours should lead to increased numbers of resections with preservation of sphincter function despite radical surgery.

[Subacute cutaneous lupus erythematosus: clinical aspects, immunology and therapy].

Abstract: Subacute cutaneous lupus erythematosus (SCLE) is a distinct subset of cutaneous lupus erythematosus which is defined by clinical and immunological characteristics. With regard to clinical expression and prognosis, SCLE assumes an intermediate position within the spectrum of LE between purely cutaneous discoid and systemic lupus erythematosus. The main clinical characteristics of SCLE are extensive papulosquamous or anular lesions and photosensitivity. The disease is frequently associated with Sjogren's syndrome and systemic symptoms, mainly arthralgia. Renal involvement is, however, rare. Circulating Ro-antibodies represent the main autoimmune phenomenon. An immunogenetic disposition to develop SCLE is evidenced by the detection of the HLA-B8, DR3-phenotype in a large proportion of patients. Drug therapy comprises primarily glucocorticosteroids and antimalarials, but retinoids have recently also proved highly effective.

[Epidemiology, clinical aspects and therapy of infections with Chlamydia trachomatis serotype D-K].

Abstract: Chlamydia trachomatis serotype D-K is one of the most important pathogens of communicable diseases. 3 to 5 million new infections are observed annually in the USA. 10% to 30% of young sexually active persons in the age group 15 to 20 years are affected. The organism was isolated from 20% to 30% of patients attending dispensaries for sexually transmitted diseases, 5% to 10% of gynaecological outpatients, 1% to 8% of pregnant women and 0% to 5% of asymptomatic control persons. In men, C. trachomatis was found in 30% to 70% of patients with urethritis (15% to 25% simultaneously with gonorrhoea), in 30% to 60% of persons suffering from nongonoccocal urethritis and in 65% to 70% with postgonoccocal urethritis. 20% of newborns from mothers with positive cultures develop pneumonia and 37% conjunctivitis. Complications such as endometritis, salpingitis, periappendicitis, perihepatitis, ectopic pregnancy, premature birth, proctitis, cystitis, deferenitis, epididymitis, reactive arthritis, morbus Reiter, conjunctivitis, pneumonia (in infants and adults) may cause long lasting disease and may leave behind irreversible sequelae. Treatment with tetracyclines or erythromycin is always effective.

Energy metabolism in patients with severe heart failure

Abstract: Resting energy expenditure was measured by indirect calorimetry in 11 patients (8 men, 3 women) with severe heart failure The study was done after an over night fast (10-12 h) 5 patients suffered from idiopathic cardiomyopathy, 5 patients from coronary heart disease and 1 patient from congestive heart failure following from viral myocarditis The cardiac index was 209 +/- 05 l/min/m2, the pulmonary capillary wedge pressure 246 +/- 80 mm Hg Resting energy expenditure was 1175 +/- 0176 kcal/min/173 m2 The basal energy expenditure calculated according to Harris and Benedict was 1008 +/- 0055 kcal/min/173 m2 The difference was statistically significant (p less than 005) Respiratory quotient was 0775 +/- 006 as a result of a high oxidation rate for fat (648% of total energy expenditure) These results show that after an overnight fast the caloric requirements of patients with severe heart failure are increased This increased energy expenditure could be an explanation for the malnutrition often found in patients with severe chronic heart failure

[Tracheobronchial lavage--a supplementary measure in the initial management of meconium aspiration syndrome].

Abstract: Pulmonary lavage - a supplementary measure of resuscitation in newborn infants with severe aspiration of meconium stained amniotic fluid. During 1984-1985 150 mature newborn infants who had aspirated heavily-stained or pea soup-like amniotic fluid were resuscitated at the University Hospital of Obstetrics and Gynaecology in Graz. In 109 of these infants (controls) routine aspiration of both the upper and lower airways was accomplished as soon as possible, whilst in the remaining 41 infants (lavaged) pulmonary lavage with saline was additionally performed via an endotracheal tube after aspiration to clear the trachea and the upper bronchi from thick meconium which could not have been removed as efficiently otherwise. The incidence of manifest meconium aspiration syndrome was significantly higher (22%) in the lavaged infants than in the controls (8%). Mechanical ventilation was performed in 36% of the lavaged infants, whereas only 5.5% of the controls had to be ventilated for more than 1 hour. The mean duration of ventilation, however, was shorter (Mh = 5.1 hrs vs Mh = 69 hrs) and the average age at discharge lower in the lavaged. Three infants died, two of whom had severe malformations. Only one death in the lavaged infants was attributable to severe meconium aspiration syndrome already manifest at birth. Three infants (two lavaged, one control) showed radiological evidence of pneumothorax, but without clinical appearance of respiratory distress. Since the lavaged group naturally contained the more severely distressed infants, with a high incidence of caesarean section on account of intrauterine asphyxia and lower Apgar scores at one and five minutes, the high incidence of radiologically confirmed meconium aspiration syndrome was not surprising.(ABSTRACT TRUNCATED AT 250 WORDS)

The present role of monoclonal antibodies in the diagnosis and therapy of brain tumours.

Abstract: Monoclonal antibodies already have an established role as tumour markers for use in histological and cytological diagnosis of tumours, such as to distinguish between astrocytomas, oligodendrogliomas and ependymomas. Most recently monoclonal antibodies are employed in combination with radioisotopes or cytostatic agents for radioimmuno-localisation and antibody-targeted therapy. In a preliminary study involving 12 patients with malignant gliomas the distribution of the antibody UJ = 13A labelled with J-131 has been examined. The ratio of radiolabel in normal to malignant tissue ranged from 3.1 to 12.8, however the absolute amount of labelled antibody reaching the tumour was around 0.001% of the injected dose. A phase I trial is presently conducted with an intrathecal radio-antibody therapy in cases of leptomeningeal malignancies resulting from various types of neoplasia. A clinical improvement was seen in 4 out of 5 cases, without serious side-effects. Such an antibody-guided irradiation would be most suitable for radiosensitive targets such as medulloblastomas, neuroblastomas and some tumours of the pineal region. The rapid advances that are currently made in our understanding of immunoregulation and T-cell function, as well as new technologies to gain human monoclonal antibodies by B-cell immortalisation and recombinant DNA technology and our preliminary results justify the great hope we have in immunotherapy.

Economic aspects of serologic syphilis tests in routine screening in Viennese hospital facilities

Abstract: 971, 786 patients in Viennese municipal hospitals were routinely screened by serological testing for syphilis between January 1980 and December 1984, leading to the detection of 28,090 cases of untreated latent infection. The annual incidence varied between 7463 and 4623 cases. Roughly one third of patients with untreated syphilis develop severe late manifestations: 10.4% show cardiovascular involvement, 6.5% get neurosyphilis and 15.8% have a gumma. The mortality rate is 85% in cardiovascular disease and 64% in neurosyphilis, whilst irreversible incapacity is the fate of the remaining 15% and 36% of these patients, respectively. Calculations on the basis of the current costs for treatment of the acute diseased and for nursing of incapacitated patients reveal that routine screening of all in- and out-patients of the Viennese municipal hospitals is completely justified from the medical and the economic point of view and should, therefore, be reinforced.

[Hepatic and peripheral insulin resistance as a cause of hyperglycemia in non-insulin-dependent (type 2) diabetes mellitus: a review].

Abstract: In diabetic patients, fasting hyperglycaemia is attributed to both, reduced clearance by peripheral tissues and augmented endogenous glucose release. In normal-weight, non-insulin-dependent diabetic patients, basal hepatic glucose production (HGP) was determined by means of tracer kinetic analysis. HGP was enhanced to 3.00 +/- 0.20 mg/kg X min as compared to 1.90 +/- 0.05 in healthy, non-diabetic subjects, even though hyperglycaemia and fasting hyperinsulinaemia prevailed. HGP correlated positively with fasting blood glucose (r = 0.577; P less than 0.01). Glucose clearance rate was reduced by 20%. Marked hyperinsulinaemia during an isoglycaemic (0.75 mU/kg X min) insulin clamp study suppressed HGP by only 82% as compared to greater than 95% in healthy subjects. Furthermore, significant residual HGP was also observed when hyperglycaemia was augmented by exogenous glucose administration. Thus, in the fasting state, HGP is increased and directly correlated with severity of hyperglycaemia. Due to a reduction in glucose clearance, blood glucose concentration rises until glucose utilization rate equals HGP. Under conditions of hyperinsulinaemia and hyperglycaemia, suppressibility of HGP is diminished. Thereby, HGP and diminished glucose clearance by peripheral tissues contribute to basal as well as postprandial hyperglycaemia in type 2 diabetic patients.

Cyclosporin therapy in minimal change nephritis

Abstract: In 5 cases with minimal change nephritis Cyclosporine A has been added to the conventional steroid therapy, when relapse of nephrotic syndrome occurred while reducing the daily prednisolone dose. The intended cyclosporine trough level ranged from 250 ng/ml to 450 ng/ml whole blood, estimated by the RIA method. Proteinuria disappeared in 4 out of the 5 cases, in the other one urinary protein excretion was strikingly reduced. In the 4 cases with complete remission of proteinuria prednisolone was tapered. These patients have cyclosporine A as the sole immunosuppressive drug since 56 weeks and do not show proteinuria. Side effects of cyclosporine therapy have been slight deterioration of kidney function in 2 out of the 5 cases and the occurrence of hypertension in 4 patients.

Local use of cytostatic drugs following removal of glioblastomas

Abstract: Local application of Methotrexate after removal of glioblastomas enables a high chemotherapeutic concentration to be achieved in the wall of the surgical cavity without appreciable side effects on sensitive structures of the body. This procedure, followed by intravenous chemotherapy may prevent local recurrence, on the assumption that glioblastoma recurrences originate in the operation site. Five groups (269 patients) subjected to different strategies of postoperative therapy were compared in terms of average survival time. The group given local chemotherapy following total or subtotal removal of the tumour, then intravenous chemotherapy after 8 days, followed by radiotherapy, demonstrated an average survival time of 75 weeks. In this group the number of living patients at the time of investigation was particularly high, namely 56. The longest survival time was 355 weeks, and this patient was symptomless. There were no side effects or complications of local cytostatic therapy with 50 mg Methotrexate.

Sarcoid granuloma in green tattooing

Abstract: The case report is presented of a 34-year old man with the sudden appearance of multiple granulomas at the site of green tattoo markings which had been undertaken 8 years previously. Unusual was his case history of an anaphylactic reaction after the ingestion of green pistachio nuts. A non-immunological food intolerance without cross-reaction to the dye of the green tattoo namely phthalocyanine, was detected. Aerosil, colloidal silica, was found to be the trigger substance; it was present exclusively in the green dye, and was responsible for the patient's sarcoid reaction. Excision of the green tattoos employing pedicle flaps was successful. At the latest follow-up examination no features of sarcoidosis were detected.

[Immunoscintigraphy with a technetium 99m-labeled monoclonal antibody in patients with melanoma].

Abstract: In 24 patients with malignant melanoma the clinical feasibility of immunoscintigraphy (ISC) with a Tc99m-labeled F(ab)2 fragment of an anti-melanoma monoclonal antibody was evaluated. This antibody (225.28S) recognizes a human high molecular weight melanoma associated antigen with restricted tissue distribution, which is expressed on melanoma cells in about 90%. The results of ISC were related with the clinical stage of the patients and the level of invasion of the primary tumor (Clark level). Results of ISC indicate the possibility that patients with the highest Clark level have a higher incidence of false negative scintigrams than those with lower levels of invasion of the primary tumor. In 3 out of 5 patients with Clark level 5 false negative scintigrams were found, whereas in 14 patients with lower Clark levels ISC was true positive, however, the number of metastases was underestimated. 14 of 18 patients with clinical stage II-IIIb had positive scans visualizing 27 of 59 metastases. Thus overall sensitivity was 77% and regional sensitivity 46%. Scintigraphically lesions in lymph-nodes, liver and skin were frequently detected, whereas ISC was less sensitive for lung, bone and brain metastases. No false positive findings were observed by ISC (specificity 100%). Relating the sensitivity and specificity of ISC to the prevalance of disease post-test likelihoods for a normal and an abnormal test result were calculated. Post-test likelihood for the disease with an abnormal scintigraphic finding is 100%. However, with a disease prevalance of 75%, according to our patients, the predicitive value of a normal test result is 60%, thus the post-test likelihood for the disease remains rather high (40%).(ABSTRACT TRUNCATED AT 250 WORDS)