Showing papers in "Wiener Klinische Wochenschrift in 1989"

n-3 fatty acids and cardiovascular disease--observations generated by studies in Greenland Eskimos.

Abstract: Polyunsaturated fatty acids of the n-3 type (n-3 PUFAs) may offer some protection against ischaemic heart disease (IHD). Part of the evidence has been derived from our investigations on Greenland Eskimos. Through six expeditions to Greenland, we have studied Eskimos living on their traditional sea diet. We found favourable changes in lipids and lipoproteins, together with a reduced platelet reactivity in the Eskimos - findings of importance for their low incidence of IHD. In this survey we intend to review studies on the effects of an increased intake of n-3 PUFAs, focusing on lipids and platelets. We conclude that beneficial changes in general have been obtained. However, individual patients and patient groups likely to profit from supplementation with n-3 PUFAs need to be further defined. The optimum dose needs to be established, and the effect and safety to be documented by highly needed long term studies.

Isolation and effects of some garlic components on platelet aggregation and metabolism of arachidonic acid in human blood platelets.

Abstract: Effects of aqueous extract of garlic, of materials extracted in two organic solvents, viz., ether and chloroform in succession, and of some fractions obtained after TLC of the aqueous extract were examined on platelet aggregation induced by several aggregating agents. Their effects were also investigated on the formation of thromboxane and lipoxygenase products from endogenous arachidonic acid in intact platelets. The aqueous extract inhibited aggregation induced by all aggregating agents and so did the materials extracted in two organic solvents. Only two fractions obtained from TLC of the aqueous garlic extract were examined for effects on epinephrine- and arachidonic acid (AA)-induced aggregation; they were found to be antiaggregatory. The material extracted in ether (MEE) inhibited the incorporation of labelled AA into platelets in platelet-rich plasma. Garlic extracts (MEE and material extracted in chloroform, MEC) at higher dosage inhibited the degradation of platelet phospholipids and reduced the formation of thromboxane (TxB2) and lipoxygenase-derived products from labelled platelets. The two organic extracts at low dosage, while not affecting the degradation of platelet phospholipids, inhibited the cyclooxygenase and lipoxygenase enzymes. A concomitant increase in the amount of released AA was observed in the treated platelets. Similar effects in relation to dosage were observed with the aqueous extract of garlic.

The high autopsy rate in Vienna

Abstract: In 1983 34% of all persons who died in the Republic of Austria were autopsied. We examined the frequency of postmortem examinations in the capital city, Vienna, between 1983 and 1987 in view of this high overall autopsy rate. The annual autopsy rate in all 9 pathology institutes and the department of legal medicine of the University of Vienna was on average 51 to 53%. There was a slight statistically verifiable decline in 1987. The reason for this high necropsy rate is that Austrian law permits the autopsies without the consent of next of kin if it appears indicated for medical, scientific or educational reasons; further more the fact, that the chairman of the department is at the same time the coroner for the hospital. A high autopsy rate is necessary to maintain a high standard of diagnostic accuracy even in modern medicine. The diagnoses were inaccurate or incomplete in 15% of all cases. The high autopsy rate is the basis for extremely accurate mortality and morbidity statistics and provides the basis for long range public health planning. Medical students develop an insight in disease patterns, which cannot be gained in any other way. The pathology departments of Vienna introduce a new city-wide computer-supported diagnostic file system, which will provide a baseline for comparative scientific studies.

[L-carnitine therapy and myocardial function in children treated with chronic hemodialysis].

Abstract: Six out of 14 chronically hemodialysed children with significantly decreased serum carnitine levels were substituted with L-carnitine (15-30 mg/kg/day-Biocarn) up to normal and above normal carnitine levels. None of these patients were digitalised. During the time of investigation plasma carnitine levels were investigated monthly and, simultaneously, three echocardiographic parameters in M-mode were quantitatively und qualitatively determined: shortening fraction (SF-%), ratio of left ventricular pre-ejection/ejection time (LVPT/LVET) and velocity of circumferential fibre shortening (Vcf). Carnitine substitution produced measurable changes in echocardiographic parameters, and a significant quantitative improvement in left ventricular function and performance: after 6 months of carnitine substitution a 24% improvement was seen, after 18 months a 44% mean improvement. No side effects of carnitine were observed; the compatibility was good. Beside these positive effects all patients reported decreased dialysis-associated spasms and polyneuropathic symptoms and increased somatic ability.

[A case of possible lovastatin-induced pancreatitis in concomitant Gilbert syndrome].

Abstract: A patient is described in whom treatment with the cholesterol-lowering agent Lovastatin (Mevacor MSD) led to a slight to moderate elevation of amylase and bilirubin with the occurrence of symptoms attributable to mild pancreatitis. These symptoms were sufficiently severe to require discontinuation of the drug. The concomitant existence of Gilbert's syndrome in this patient may have been causally related to the non-tolerance of this valuable drug. Although a penetrating ulcer cannot be ruled out in the differential diagnosis, the overall evidence favours the diagnosis of Lovastatin pancreatitis, a so far unpublished complication.

Microcirculation in parenteral Ginkgo biloba extract therapy

Abstract: 15 patients with arteriosclerotic lesions in the extracranial brain arteries, randomly selected, were treated with an infusion of 250 ml physiological NaCl and 25 ml Ginkgo biloba extract (Tebonin). A second group (n = 15) received 250 ml NaCl without drugs stimulating blood flow. The skin microcirculation was measured in vivo by means of a helium-neon laser at one of the 4 extremities. Perfusion increased significantly (p less than or equal to 0.01) in response to Ginkgo biloba extract als composed with the response in the control group. The results justify the administration of Ginkgo biloba extract in vascular diseases.

Carnitine deficiency, mitochondrial dysfunction and the heart. Identical defect of oxidative phosphorylation in muscle mitochondria in cardiomyopathy due to carnitine loss and in Duchenne muscular dystrophy.

Abstract: Cardiomyopathies are often caused by a metabolic defect. Carnitine deficiency and mitochondrial defects in the metabolism of acyl-CoA, including defects in oxidative phosphorylation, start the same circular mechanism of mitochondrial doom. Patients with cardiomyopathy due to carnitine loss are cured by carnitine supplementation. In such a patient we found defective oxidative phosphorylation in isolated muscle mitochondria. The stimulation of the respiratory rate with all substrates by ADP was decreased, probably the cause of inhibition of the adenine nucleotide translocator by accumulating long-chain acyl-CoA. The same condition was encountered in patients with Duchenne muscular dystrophy, who often get cardiomyopathy in the course of the disease process.

[Considerations of the placebo problem in acupuncture. Reflections on usefulness, ethical justification, standardization and differentiated use of placebos in acupuncture].

Abstract: 28 different acupuncture placebos were found in 28 controlled studies, making a comparison of the results impossible. The following differentiation of acupuncture placebos is proposed: 1.a) Real placebos without intrinsic effect, 1.b) Pseudoplacebos with intrinsic effect, 2.a) Placebos without damage of physical integrity (not incisive), 2.b) Placebos with damage of physical integrity (incisive), for example the usual method of placebo-acupuncture-needling outside the known acupuncture points with or without additional stimulation. Painful pseudoplacebos with damage of the physical integrity should only be used in short-term trials on experimentally induced pain in healthy volunteers. For therapeutic studies with really sick persons, only real placebos, painless and without damage of the physical integrity, should be used, e.g. mock-TENS or laser. In order to prevent the patient from knowing the group determination, a third group with another correct treatment is essential, e.g. correct acupuncture, mock-TENS and real TENS or laser. A genuine acupuncture placebo is as unthinkable as placebo-surgery. Since single- or double-blind trials cannot be correctly carried out in acupuncture therapy it appears desirable to replace them by follow-up studies.

[Systemic side effects in immunotherapy of allergic diseases--a comparative study].

Abstract: Data on systemic side effects (SSE) of specific immunotherapy of allergic diseases recorded in 99 publications over the past 10 years were evaluated and compared with the figure of 0.4% SSE, according to number of injections, published in 1987 by the authors of the present study. The latter figure ranks among the lowest of comparable publications and under present conditions represents the standard. Reasons for the small number of side effects may be found in persistent use of antihistamine premedication before each injection and reduction of vaccination dosage to 50,000 SQ units maximally. Chemically modified allergens are by no means less liable to produce side effects than other allergens. The comparison was undertaken with respect to the following preparations: Alavac P, Allergovit, Allpyral, Alutard, Aquagen (ALK aqueous), Conjuvac, Diephuis, Migen, Novo Helisen, Pangramin Depot, Pharmalgen, Pollinex, Reless, Spectralgen, Stallergenes Depot, and some vaccines, prepared by the authors themselves.

Incides of lipid peroxidation in patients with hypercholesterolemia and hypertriglyceridemia.

Abstract: Peroxidation of lipoproteins has received attention recently in connection with its possible initiation and propagation of atherosclerosis. We studied indices of lipid peroxidation in plasma of 30 patients with either hypercholesterolemia or both hypercholesterolemia and hypertriglyceridemia, and compared them with those of 19 healthy subjects. In the patients lipid hydroperoxides measured both iodometrically and as thiobarbituric acid-reactive substances (TBA-RS) were significantly increased, while concentrations of thiol groups remained unchanged. There was no correlation between concentrations of hydroperoxides and TBA-RS, possibly because the two methods assessed different breakdown products of lipid peroxidation. Lipid hydroperoxide levels, but not those of TBA-RS were correlated with LDL-cholesterol and triglyceride levels. In 6 patients administration of vitamin E at a daily dosage of 300 mg for 4 to 6 weeks depressed elevated hydroperoxides by 33%, and TBA-RS by 44% on average.

Psychiatric and parasitologic aspects of dermatozoon delusion

Abstract: Patients suffering from delusional parasitosis are not only seen by psychiatrists, but more often by dermatologists and parasitologists. Previous results published by researchers of differing specialities led to somewhat contradictory opinions concerning these patients. The main goals of the present study were, on the one hand, to examine the various and partly controversial hypotheses, which were mostly based on single case observations in a substantial sample of 107 patients with delusional parasitosis and, on the other hand, to investigate possible differences between patients who consulted the parasitologist initially and those who saw the dermatologist first and were subsequently treated by a psychiatrist. Hence, 34 patients treated by one of the authors (M.M.) at a special outpatient clinic for patients with delusional parasitosis of the Second Dermatological University Department, Vienna, have been compared with 73 patients who consulted the other author (E.K.) at the Institute of Parasitology of the University of Veterinary Medicine, Vienna. Some similarities, but also marked differences were found between the two groups: the sex ratio was similar in both groups but they differed with regard to age, social background (size of household) localisation of "parasites" and the mode of "infection". The results demonstrate the necessity of developing differentiated medical care programmes which take into account these differences.

Essential fatty acids and the complications of diabetes mellitus.

Abstract: In animals and humans with diabetes mellitus there is evidence that normal metabolism of essential fatty acids is impaired. The main dietary essential fatty acids, linoleic acid of the n-6 series and alpha-linolenic acid of the n-3 series, must both be 6-desaturated and converted to further metabolites if they are to exert all their desirable effects on the body. 6-desaturation is impaired in diabetes and a lack of adequate rates of formation of the 6-desaturated metabolites may be involved in the abnormalities in membrane function, in lipid metabolism and in haemostasis and the microcirculatory system which are seen in diabetes. Attempts to overcome the block by giving very large amounts of dietary linoleic acid, or to by-pass the block by giving 6-desaturated metabolites such as gamma-linolenic acid and eicosapentaenoic acid, have both given promising results.

Bombesin-like peptides as growth factors.

Abstract: Bombesin-like peptides (BN-LP) are involved in the regulation of many important functions, including sensory transmission, regulation of central autonomic pathways, thermoregulation, pituitary, gastric and pancreatic secretion, food intake and satiety. They also stimulate cellular proliferation in a developmental and tissue-specific manner. Their role in pathogenesis appears to be related to their properties as growth factors, especially in the lung, where BN-LP can induce growth of normal and neoplastic epithelial cells. The formulated hypothesis of autocrine control of small cell lung cancer growth by BN-LP will be tested using specific synthetic bombesin antagonists.

[Effects of omega-3-fatty acids on the prostaglandin system in healthy probands].

Abstract: Epidemiological comparisons of Greenland Eskimos and mainland Danes suggested that a diet rich in marine lipids mainly containing polyunsaturated fatty acids may be associated with a reduction in the incidence of occlusive vascular disease. Fish oils contain the Omega-3 polyunsaturated fatty acid eicosapentaenoate (timnodonic acid, EPA, 20:5n-3), which is incorporated into the platelet membrane after dietary intake instead of arachidonic acid (20:4n-6), the main substrate for prostaglandin synthesis. After incorporation of the fatty acids into the platelet membrane the overall effect of prostanoids with three double bonds derived from EPA proves to be less atherogenic. Since only TxA2 is a potent vasoconstrictor and platelet agonist whilst TxA3 is virtually biologically inert.

Dietary fatty acids, serum lipids, platelet biochemistry and function.

Abstract: Dietary fatty acids of the n-6 mainly linoleic acid (LA) series, and of the n-3, such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) series both reduce plasma cholesterol levels and platelet responses to aggregating agents. The potency of n-3 fatty acids, which are present in relatively high concentrations in fish oils, is at least one order of magnitude greater than that of LA. The effects of fish oils appear to be related to the incorporation of EPA into plasma lipoproteins and cell phospholipid pools, thus modulating metabolic processes within specific lipid pools. Inhibition of platelet function and modifications of the activity of other blood cells, such as leukocytes, is attributed to interference with the eicosanoid system. Competition of EPA with arachidonic acid (AA) for the oxygenases and/or generation of less active metabolites from this precursor are the major mechanisms of action. Feeding studies in experimental animals indicate that exogenously administered n-3 fatty acids undergo distribution among the major plasma lipid classes and platelet phospholipids quite different to that of endogenous AA. In addition, the generation of inositolphosphates by stimulated platelets is decreased by dietary n-3 fatty acids in a manner independent of the effects on the eicosanoid system. It appears that polyunsaturated fatty acids (PUFA) of the n-6 and n-3 series are differently handled in various lipid pools and that early steps of cell activation, in addition to the generation of eicosanoids, are affected by dietary fatty acids. This indicates that fatty acids modulate key steps in the regulation of cell function and biochemistry.(ABSTRACT TRUNCATED AT 250 WORDS)

Do passive smokers have an increased risk of thrombosis

Abstract: In contrast to the proven association between active smoking and vascular injury, as well as hemostatic imbalance, such a relation is not jet proven for passive smoking. Vascular damage induced by smoking, however, can be seen in the materno-fetal circulation of smoking mothers, being much more pronounced in the umbilical system than in fetal vessels. These lesions show fast recovery after birth. In non-smokers acute exposure to passive smoke induces a short-lasting activation of platelet function and the prostaglandin system, followed by a quick recovery. Chronic exposure of non-smokers to passive smoke, however, results in changes of these parameters comparable to those seen in smokers, characterized by an activation of platelet function and a decrease in platelet sensitivity to the antiaggregatory prostaglandin I2. These results suggest that in non-smokers with atherogenic risk factors passive smoking may contribute to the incidence of atherosclerosis, as well as acute complications (thrombosis).

["Induced detoxification treatment" of opiate dependent patients--a new therapy concept].

Abstract: Induced detoxification treatment of opiate addicts by means of naloxone was developed at the intensive care unit of the Department of Psychiatry at the University of Vienna. Two methods were tested 1. Rapid opiate withdrawal by means of a staggered naloxone regimen. 2. Ultrashort opiate detoxification during general anaesthesia using high doses of naloxone. In an open trial 15 patients were treated with staggered doses of naloxone while under tiapride. The various discomforts were satisfactorily reduced, and the detoxification syndrome was limited to 50 hours. In a second open trial 6 patients were administered 10 mg naloxone under general anaesthesia. All naloxone induced withdrawal syndromes can be suppressed by barbiturate anaesthesia. They do not appear even after the effect of the anaesthesia wears off if the patient is kept on a naloxone regimen as long as opiates remain present in the circulatory system. Both methods shorten detoxification treatment and provide smooth transition to a naltrexone maintenance programme.

The use of disposable draping materials in the operating room and its effect on the postoperative wound infection rate

Abstract: In a consecutive study we analyzed the influence of gown and drape material on the postoperative wound infection rate. 1033 operations were included in this study. In 354 operations conventional cotton gowns and drapes were used, while in 679 operations, a disposable gown and drape system was utilized. The use of disposable gown and drape material reduced the postoperative wound infection rate in our surgical department. The greatest reduction -43% - was seen in clean wounds. Within this group gallbladder operations showed a reduction of 59% and hernia operations showed a reduction of 46%. A slight reduction was also seen in clean-contaminated and contaminated wounds, while in dirty wounds there was no difference. However, due to the relatively low numbers involved the results were not of statistical significance. An analysis of the costs over a 12-month period showed a reduction of 7.5% when the disposable gown and drape system was used. With respect to ease of handling and wear the disposable material was preferred by the operating-staff, both doctors and nurses.

Radioimmunometric determination of histamine in myeloproliferative syndromes

Abstract: Quantitative analysis of histamine is increasingly used in clinical haematology. The present study demonstrates the properties of and potential indication for a novel histamine radioimmunoassay (RIA) in clinical haematology. The sensitivity of this test assay corresponds to a histamine level of 0.1 to 0.5 nM, the non-specific cross reaction with endogenous histamine metabolites appears to be less than 0.1%. The total histamine levels in the peripheral blood of healthy donors (n = 10) ranged from 10 to 100 ng/ml, the plasma histamine values from 0.02 to 0.6 ng/ml blood. Increased levels of total histamine were measured in myeloproliferative syndromes, i.e. in patients with chronic myeloid leukemia (CML) (8 of 9), myelofibrosis (OMS) (2 of 4), and polycythaemia vera (PCV) (1 of 2). An excessive increase in total histamine was observed in healthy rhesus monkeys (n = 10) treated with recombinant human interleukin-3 (rhIL-3). The total histamine value correlated with the absolute number of circulating blood basophils (correlation coefficient: 0.9). The calculated content of histamine per basophil was found to be 0.5 to 1.5 pg. Plasma histamine values in patients suffering from myeloproliferative syndromes were within the normal range. In contrast, a moderate to marked increase in plasma histamine values was observed in monkeys during IL-3 treatment. The radioimmunometric analysis of histamine clearly represents a useful new test system in clinical haematology, especially in the follow up of malignant as well as IL-3-induced myeloproliferation.

Dietary lipids, platelet function and arterial thrombosis.

Abstract: In rats, diets rich in polyunsaturated fatty acids of the (n-6) and (n-3) families (P) lower arterial thrombosis tendency, whereas long-chain saturated fatty acids (S) are prothrombotic. Monounsaturated fatty acids seem to behave neutrally as to arterial thrombus formation. Consequently, the P/S ratio is an important determinant of the thrombogenicity of a dietary fat, the effect of which is probably mediated by an influence on platelet aggregability. In man, the dietary fat type also affects platelet aggregation. Methodological problems, however, resulted in equivocal results, especially with respect to diets enriched with fish oil. Thus, more research is required with methods that are able to quantify thrombotic risk in a reliable way. Nonetheless, the available evidence already justifies an active policy to increase the consumption of (poly)unsaturated fatty acids at the expense of long-chain saturated fatty acids.

Comparative studies of the effectiveness of specific immunotherapy in house dust mite allergy

Abstract: In a prospective study, 60 patients with allergic rhinoconjunctivitis and/or asthma due to house dust mites were chosen for hyposensitization treatment with Migen (M) or Pharmalgen (P). Immunotherapy stretched over a whole year and every 3 months clinical results were evaluated by the patient's symptom score, by results of skin prick and conjunctival provocation tests, as well as by RIA and ELISA regarding the total and specific IgE and also specific IgG and IgG4 levels. Out of 30 patients of the M group, 15 were followed up over the whole therapeutic regimen, 4 of whom showed a very good, 7 a good to moderate clinical outcome and 4 showed no improvement at all. In the P group, 17 out of 30 patients were followed up whereby 9 showed a very good and 8 a good to moderate response. In both groups of patients a statistically significant decrease in skin and conjunctival sensitivity to mite allergens was observed after 12 months of therapy. However, there was no correlation between this observation and the failure or success of immunotherapy. Furthermore, in both groups there was significant increase in total and specific IgE (with a slight decrease after 6 to 12 months) and also in specific IgG and IgG4 (especially in the P group), but again these changes in antibody levels gave no indication of a good or bad clinical outcome. Hence, we believe other reasons than the usually presented thesis of inducing "blocking antibodies" by immunotherapy to be responsible for the well-known effects of hyposensitization.

Influence of tidal volume on the compliance of the respiratory system in mechanically ventilated newborn infants.

Abstract: We measured the compliance of the respiratory system (Crs) at 4 different tidal volumes (VT = 2.5, 5.0, 7.5, 10.0 ml/kg) in 29 mechanically ventilated newborn infants and determined the VT associated with the highest Crs ("optimal" VT) and with the lowest Crs ("worst" VT). Crs depended on the VT in all newborn infants investigated. The "optimal" VT most frequently observed was 2.5 and 5.0 ml/kg and the "worst" VT most frequently observed was 2.5 and 10.0 ml/kg. Mean Crs at the "optimal" VT was 62.3% higher than at the "worst" VT. The "optimal" VT was lower (2.5 ml/kg) in newborn infants with controlled ventilation than in newborn infants with intermittent mandatory ventilation (5.0 ml/kg). We conclude that it may be useful to determine the VT associated with the highest Crs in order to avoid unnecessarily high inflation pressures for the mechanical ventilation of newborn infants. Further studies are needed to assess long-term effects of such a Crs guided respirator therapy.

[Thromboxane A2 and granulocyte elastase after severe trauma--relationship to complications and survival rates].

Abstract: Of 64 polytraumatized patients with a mean injury severity score of 33.1, 42 showed marked systemic release of thromboxane B2 and granulocyte elastase during the initial 18 hours after trauma, reaching peak arterial levels of greater than 1,000 pg/ml and ng/ml, respectively. If those patients ("responders": plasma TXB2 greater than 250 pg/ml) were compared with the remaining 22 ("non-responders": TXB2 less than 250 pg/ml) the following became obvious: "Late" mortality (greater than 3 d) was 31% in responders, which is significantly higher than in non-responders (9%). No correlation was observed between "early" mortality (less than 3 d) and mediator release. There was no difference in the incidence of the adult respiratory distress syndrome (ARDS) (38% versus 32%) or the late sepsis syndrome (17% versus 18%) between responders and non-responders. Morbidity, however, differed markedly in that ARDS in responders was associated with significantly higher elastase levels, a higher mortality and 10 times higher incidence of sepsis as compared to responders without ARDS. ARDS in non-responders, by contrast, did not change elastase maxima or the mortality rate as compared to non-responders without ARDS. It is concluded that TXB2 is not a predictor of posttraumatic ARDS, but is related to a complicated course, in particular to sepsis and mortality. Elastase with high probability predicts ARDS and/or the late sepsis syndrome. Simultaneous determination of TXB2 further enhances the predictive value of elastase.

[Tumor diagnosis by immunoscintigraphy with anti-CEA antibodies (Tc-99m MAK BW 431/26)].

Abstract: We evaluated the clinical application of the monoclonal antibody MAb, BW 431/26, which is easy to label with Tc-99m for tumor localization. This is an anti-CEA antibody and a murine immunoglobulin (Ig G1, Isotype). We investigated patients with colorectal carcinoma (n = 14), with colorectal carcinoma recurrences (n = 24), breast carcinoma (n = 2), stomach carcinoma (n = 1), carcinoma of the urinary bladder (n = 3), lung carcinoma (n = 2) and patients with an elevated CEA level. In primary colorectal tumors (n = 14) all carcinomas were correctly localized by IS and ECT technique. In these patients the diagnosis was already known. The planar pictures showed a false negative result in 3 patients. In patients with colorectal recurrences the investigations were performed twice in 2 patients and three times in 1 patient. In these 31 ECT investigations we found 17 true positive results, 12 true negative results, 1 false positive result and 1 false negative result. The lesions were already visualized within 4 to 6 hours, but 24-hour pictures are desirable. SPECT pictures are absolutely necessary because sensitivity is considerably improved thereby. Elevated CEA levels increase the probability of a positive IS low CEA levels do not exclude positive tumor visualization. HAMA was found in only 1 patient, but follow-up investigations are indicated.

[High CA-125 values in miliary tuberculosis and ascites].

Abstract: High levels of CA-125, the specific tumour marker for epithelial ovarian cancers are also found in inflammatory diseases of the pelvis. This case report of a 28 year-old woman with pathological CA-125 levels demonstrates the association between this finding and ascites caused by miliary tuberculosis. Tuberculostatic chemotherapy led to normalisation of the CA-125 levels within 8 weeks.

Tumor markers in gynecology

Abstract: The employment of tumour markers in gynaecology has gained increasing importance in recent times. Beta HCG for chorionic carcinoma and alpha 1 fetoprotein for germ cell tumours are an essential part of postoperative surveillance. Initial analyses of the amylase isoenzymes are available. CEA, TPA, and CA 125 are recognized as established tumour markers. Very promising results have been obtained using SCC in patients with cervical carcinoma. Neopterin, a marker for cell-mediated immunity, provides good prognostic information.

[Silent ischemia in long-term ECG in the early post-infarct period].

Abstract: 101 consecutive patients (73 m, 29 f; 48 AMI, 53 IMI) under 70 years were assigned to 24 hour-Holter monitoring in the third week after first transmural infarction. ST-segment analysis could be performed in 88 patients (89%). 18 patients (20%) had episodes of ischemia which were silent in 95%. One third of these episodes occurred in the absence of physical exercise. Ischemic events displayed a circadian rhythm with a maximum between 6 and 12 a.m. There was no correlation between ischemia and the occurrence of ventricular arrhythmia. In addition, we show that visual control of automatic ST-segment analysis is a prerequisite for routine use in clinical practice.

[Total cholesterol findings in Austria--an overview of epidemiologic studies].

Abstract: Hyperlipoproteinaemia is the most important public health risk factor for ischaemic heart disease. This publication gives a review of six Austrian epidemiological studies covering more than 87,000 people in all. The results are not representative for Austria, but give a picture of the epidemiology in Austria. Mean values were calculated age-standardized (age-adjusted when ten-year age groups are registered) to the Austrian population of 1985, for the age group 20 to 79 years. This age range covers 99.77% of the adult male population aged 20 or more, and 95.70% of the women. Mean total cholesterol level for the six studies is 224.2 mg/dl in men and 227.3 mg/dl in women. These results are similar to those of a representative study in the province of Vorarlberg in western Austria (220.0 mg/dl, and 227.4 mg/dl respectively). Variation range is 20.4 mg/dl in men, and 22.5 mg/dl in women; the coefficient of variation is 3.9% in both, men and women.

Tumor markers in bronchus cancer

Abstract: Small cell lung cancers are neuroendocrine tumours and therefore produce a lot of peptide hormones (calcitonin, ACTH, ADH), as well as the neuropeptide chromogranin A, which are all useful tumour markers. Furthermore, the tumour-associated antigens CEA and TPA, as well as the enzymes neuron specific enolase (NSE) and creatine kinase BB are used as markers in small cell lung cancer. At present, NSE appears to be the best marker for small cell lung cancer; elevated serum NSE levels are found in 65 to 85% of the patients. The serum level of the tumour markers is related to the stage of the tumour. When tumour regression occurs following therapy, elevated pretreatment levels decrease to the normal range. If the marker level increases again, tumour progression is indicated and this can be an early and sensitive sign denoting recurrence. Metastases in the central nervous system can be detected early by marker determination in the cerebrospinal fluid. At present, CEA appears to be the most valuable tumour marker for non-small cell lung cancer, but TPA may also be a useful marker.