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Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) are rare, predominantly drug-induced, acute life-threatening diseases of skin and mucosae. SJS and TEN are nowadays considered as variants of one disease entity with varying degrees of severity called epidermal necrolysis (EN). EN is associated with high morbidity and mortality and constitutes a major disease burden for affected patients. The guideline "Diagnosis and treatment of epidermal necrolysis (Stevens-Johnson syndrome and toxic epidermal necrolysis)" was developed under systematic consideration of existing scientific literature and in a formal consensus process according to regulations issued by the Association of Scientific Medical Societies in Germany (AWMF) to establish an evidence-based framework to support clinical decision-making. The interdisciplinary guideline commission consisted of representatives from various specialist societies and of patient representatives. The guideline is aimed at specialists in the fields of dermatology, ophthalmology, plastic surgery, intensive care, and pediatrics in hospitals and offices, as well as other medical specialties involved in the diagnosis and treatment of EN. The guideline is also aimed at patients, their relatives, insurance funds, and policymakers. The second part is concerned with the topics of supportive therapy in the acute phase of EN and outpatient follow-up treatment., (© 2024 The Author(s). Journal der Deutschen Dermatologischen Gesellschaft published by Wiley‐VCH GmbH on behalf of Deutsche Dermatologische Gesellschaft.)

Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) are rare, predominantly drug-induced, acute, life-threatening diseases of skin and mucosae. SJS and TEN are nowadays considered variants of one disease entity with varying degrees of severity called epidermal necrolysis (EN). EN is associated with high morbidity and mortality and constitutes a major disease burden for affected patients. The guideline "Diagnosis and treatment of epidermal necrolysis (Stevens-Johnson syndrome and toxic epidermal necrolysis)" was developed under systematic consideration of existing scientific literature and in a formal consensus process according to regulations issued by the Association of Scientific Medical Societies in Germany (AWMF) to establish an evidence-based framework to support clinical decision-making. The interdisciplinary guideline commission consisted of representatives from various specialist societies and patient representatives. The guideline is aimed at specialists in the fields of dermatology, ophthalmology, plastic surgery, intensive care, and pediatrics in hospitals and offices, as well as other medical speciallved in the diagnosis and treatment of EN. The guideline is also aimed at patients, their relatives, insurance funds, and policymakers. This first part focuses on the diagnostic aspects, the initial management as well as the immunomodulating systemic therapy., (© 2024 The Author(s). Journal der Deutschen Dermatologischen Gesellschaft published by Wiley‐VCH GmbH on behalf of Deutsche Dermatologische Gesellschaft.)

Cardiac surgery patients not only undergo a highly invasive procedure but are at risk for a diversity of postoperative complications. Up to 53% of these patients suffer from postoperative delirium (POD). This severe and common adverse event increases mortality and prolonged mechanical ventilation and extends the intensive care unit stay. The objective of this study was to test the hypothesis that standardized pharmacological management of delirium (SPMD) may reduce the length of stay in the intensive care unit (ICU), duration of postoperative mechanical ventilation, and the incidence of postoperative complications such as pneumonia or bloodstream infections in on-pump cardiac surgery ICU patients. In this retrospective, single-center observational cohort study, 247 patients were examined between May 2018 to June 2020, who underwent on-pump cardiac surgery, suffered from POD, and received pharmacological POD treatment. 125 were treated before and 122 after SPMD implementation in the ICU. The primary endpoint was a composite outcome, including the length of ICU stay, postoperative mechanical ventilation time, and ICU survival rate. The secondary endpoints were complications including postoperative pneumonia and bloodstream infections. Although the ICU survival rate was not significantly different between both groups, the length of ICU stay (control group: 23 ± 27 days; SPMD group: 16 ± 16 days; p = 0.024) and the duration of mechanical ventilation were significantly reduced in the SPMD-cohort (control group: 230 ± 395 h; SPMD group: 128 ± 268 h; p = 0.022). Concordantly, the pneumonic risk was reduced after SPMD introduction (control group: 44.0%; SPMD group: 27.9%; p = 0.012) as well as the incidence for bloodstream infections (control group: 19.2%; SPMD group: 6.6%; p = 0.004). Standardized pharmacological management of postoperative delirium in on-pump cardiac surgery ICU patients reduced the length of ICU stay and duration of mechanical ventilation significantly, leading to a decrease in pneumonic complications and bloodstream infections., (© 2023. The Author(s).)

Background: Double-lumen endobronchial tubes (DLT) continue to be the most widely used method for obtaining lung isolation during anesthesia. We compared recommendations for DLT size selection with radiologically assessed lower airway dimensions gathered from a large patient population., Methods: For this retrospective comparative study, we assessed computed tomography (CT) scans of 150 adults with no known airway pathologies. Using these scans, we measured the diameter and length of the trachea and the diameter of the mainstem bronchi. These airway dimensions were then compared to the dimensions of left-sided DLTs of three different manufacturers. Size selection was based on one standard textbook's recommendations., Results: We found the recommended DLT sizes were occasionally too small but more often too large, particularly in the endobronchial airway. With the DLT Vivasight-DL ® , mismatching occurred in 28.7% (43/150) of the patients at the distal mainstem bronchus and 8% (12/150) at the tracheal level. This mismatching happened most often in females (left distal mainstem bronchus 34/68, 50%; trachea 9/68, 13.2%). Conversely, the DLT was more often too small for male patients in both the left main bronchus (SHER-I-BRONCH ® : 8/82, 9.8%) and the trachea (SHER-I-BRONCH ® : 2/82, 2.4%). The endobronchial tube portion was more often too long in females (Vivasight ® DLT: 11/68, 16%) than males (9/82, 11%)., Conclusions: A considerable proportion of the recommended DLT sizes from all three manufacturers was incompatible with individual patient's lower airway dimensions.

Background: Tube size selection is critical in ventilating patients' lungs using double-lumen endobronchial tubes (DLTs). Little information about relevant parameters is readily available from manufacturers. The aim of this study is to provide reference data for relevant dimensions of conventionally available DLTs., Methods: In this study in a benchmark in vitro setup, several dimensional parameters of four sizes of left-sided double-lumen endobronchial tubes from six different manufacturers were assessed, such as distances and diameters of tube shaft, cuff lengths, and diameters as well the angle at the tip., Results: Endobronchial tubes of ostensibly the same size revealed wide variation in measured parameters between brands from different manufacturers. In some parameters, there was an overlap between different sizes from the same manufacturer, i.e., diameters and distances did not increase with increasing nominal endobronchial tube size. The information about dimensions of endobronchial tubes provided by manufacturers' leaflets is insufficient., Conclusions: Endobronchial tube size selection carries unnecessary uncertainty because clinically relevant parameters are unknown and vary considerably between different manufacturers., Competing Interests: MW is a medical consultant for Medicoplast GmbH (Illingen, Germany)., (Copyright © 2019 Niels Hegland et al.)

Objective: To assess whether high frequency oscillations (HFOs, >150 Hz), known to occur in basal ganglia nuclei, can be observed in the thalamus., Methods: We recorded intraoperative local field potentials from the ventral intermediate nucleus (VIM) of the thalamus in patients with Essential Tremor (N = 16), Parkinsonian Tremor (3), Holmes Tremor (2) and Dystonic Tremor (1) during implantation of electrodes for deep brain stimulation. Recordings were performed with up to five micro/macro-electrodes that were simultaneously advanced to the stereotactic target., Results: Thalamic HFOs occurred in all investigated tremor syndromes. A detailed analysis of the Essential Tremor subgroup revealed that medial channels recorded HFOs more frequently than other channels. The highest peaks were observed 4 mm above target. Macro- but not microelectrode recordings were dominated by peaks in the slow HFO band (150-300 Hz), which were stable across several depths and channels., Conclusion: HFOs occur in the thalamus and are not specific to any of the tremors investigated. Their spatial distribution is not homogeneous, and their appearance depends on the type of electrode used for recording., Significance: The occurrence of HFOs in the thalamus of tremor patients indicates that HFOs are not part of basal ganglia pathophysiology., (Copyright © 2018 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.)

Allogeneic hematopoietic cell transplantation (alloHCT) in older patients requires the weighing of risks and benefits for this potentially curative treatment while facing age-related limitations. Comprehensive geriatric and quality of life (EORTC QLQ C-30) assessements (CGA/QOL) in addition to disease-specific data were obtained in 108 consecutive patients (≥60 years) pre-HCT, at day +30, +100, and +180. Median follow-up of 106 patients alive at alloHCT was 43.5 months, median age 66 years (range 60-78). Eighty-six (81.2%) had advanced disease risk at HCT and 99 (91.7%) patients received reduced intensity conditioning (RIC). Median PFS was 13.4 months with 38.3% (95% CI: 28.6-47.4) alive and in remission at 2 years; median OS was 15.6 months with 43.9% (95% CI: 34.3-53.4) alive at 2 years. Prognostic factors for PFS were: age: HR 1.084 (95% CI: 1.032-1.137, p = 0.0011); HCT-CI: HR 1.13 (95% CI: 1.001-1.274, p = 0.048); for OS: age: HR 1.08 (95% CI: 1.031-1.139, p = 0.0017), Karnofsky Index: HR 0.97 (95% CI: 0.954-0.996, p = 0.02); EORTC QLQ C-30 fatigue: HR 1.09 (95% CI: 1.004-1.185, p = 0.039); Up-and-Go: HR 3.26 (95% CI: 1.001-10.6, p = 0.049). Follow-up assessments as time-dependent covariates were highly prognostic for OS and PFS. CGA/QOL confer additional prognostic utility in older alloHCT recipients.

Molecular magnesium hydride with a terminal metal-hydrogen bond [Mg(iPr 2 TACN·AliBu 3 )H] 2 supported by a monoanionic TACN-type ligand (TACN = 1,4-di-isopropyl-1,4,7-triazacyclononane) rearranges to form the dinuclear magnesium hydride [Mg(iPr 2 TACN·AlHiBu 2 )(μ-H)] 2 , exhibiting a rare MgH-Al interaction.

The reactivity of the molecular magnesium hydride [Mg(Me 3 TACD·Al i Bu 3 )H] (1) featuring a terminal magnesium-hydrogen bond and an NNNN-type macrocyclic ligand, Me 3 TACD ((Me 3 TACD)H = Me 3 [12]aneN 4 = 1,4,7-trimethyl-1,4,7,10-tetraazacyclododecane), can be grouped into protonolysis, oxidation, hydrometalation, (insertion), and hydride abstraction. Protonolysis of 1 with weak Brønsted acids HX such as terminal acetylenes, amines, silanols, and silanes gave the corresponding derivatives [Mg(Me 3 TACD·Al i Bu 3 )X] (X = C≡CPh, 3; HN(3,5-Me 2 -C 6 H 3 ), 4; OSiMe 3 , 5; OSiPh 3 , 6; Cl, 7; Br, 8). Single-crystal X-ray diffraction of anilide 4 showed a square-pyramidal coordination geometry for magnesium. No correlation with the pK a values of the acids was detected. Oxidation of 1 with elemental iodine gave the iodide [Mg(Me 3 TACD·Al i Bu 3 )I] (9), and oxidation with nitrous oxide afforded the μ-oxo-bridged compound [{Mg(Me 3 TACD·Al i Bu 3 )} 2 (μ-O)] (10) with a linear Mg-O-Mg core, as characterized by single-crystal X-ray diffraction. The Mg-H bond reacted with benzaldehyde, benzophenone, fluorenone, and CO 2 under insertion but not with the olefins 1,1,2-triphenylethylene, tert-butylethylene, and cyclopentene. The unstable formate, prepared also by salt metathesis of iodide 9 with potassium formate, revealed κO,κO' coordination in the solid state. Hydride abstraction with triphenylborane gave the ion pair [Mg(Me 3 TACD·Al i Bu 3 )(thf)][HBPh 3 ] (16), which catalyzed the hydroboration of polar substrates by pinacolborane.

Objective: The role of inflammation in cognitive alterations in a post-operative setting is still not fully understood. Surgical interventions can cause systemic inflammations which eventually can induce neuroinflammation. However, the main causes of functional changes after surgery are still elusive. In this study, we investigated the role of CD38, a TNFα-inducible NADH + cyclase and hydrolase. We assume that CD38 overexpression impairs mitochondrial ATP synthesis. Within the hippocampus, the resulting cellular death could lead to cognitive impairment., Methods: Seventy-nine Wistar-HAN rats were subjected for three hours either to partial hepatectomy under sevoflurane anaesthesia ('surgery'), sevoflurane anaesthesia alone ('anaesthesia') or control. Rats were randomly selected to determine levels of CD38, TNFα, IL-6, and ATP, for GFAP immunohistochemistry and for Morris Water Maze testing., Results: Plasma TNFα and IL-6 levels were significantly higher in the surgery group in the immediate post-operative phase. GFAP expression and hippocampal CD38 concentration were significantly elevated 24 h after the intervention in the surgery group as compared to anaesthesia alone and controls. ATP levels did not differ significantly between the three groups. No treatment differences in spatial cognition parameters were found., Conclusions: Surgery in the form of partial hepatectomy activated the peripheral immune system and induced hippocampal glial activation and a CD38 increase. These changes, however, were not associated with rats' cognitive impairment ≥24 h after surgery.

A complex featuring a terminal magnesium hydride bond supported by an NNNN macrocyclic ligand, [Mg{Me3 TACD⋅Al(iBu)3}H] (3), was formed from its labile Al(iBu)3 adduct. Use of Al(iBu)3 to block the amido nitrogen of the NNNN macrocyclic ligand was essential to prevent aggregation. The structurally characterized compound 3 reacted with BH3 to give the BH4 derivative, whereas Me3 SiCCH and PhSiH3 led to the corresponding acetylide and silyl derivative under H2 elimination. Pyridine is inserted into the MgH bond to give selectively the 1,4-dihydropyridinate., (© 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Large magnesium hydride aggregates [Mg13 (Me3 TACD)6 (μ2 -H12 )(μ3 -H6 )][A]2 ((Me3 TACD)H=1,4,7-trimethyl-1,4,7,10-tetraazacyclododecane; A=AlEt4 , AlnBu4 , B{3,5-(CF3 )2 C6 H3 }4 ) were synthesized stepwise from alkyl complexes [Mg2 (Me3 TACD)R3 ] (R=Et, nBu) and phenylsilane in the presence of additional Mg(II) ions. The central magnesium atom is octahedrally coordinated by six hydrides as in solid α-MgH2 of the rutile type. Further coordination to six magnesium atoms leads to a substructure of seven edge-sharing octahedra as found in the hexagonal layer of brucite (Mg(OH)2 ). Upon protonolysis in the presence of 1,2-dimethoxyethane (DME), this cluster was degraded into a tetranuclear dication [Mg2 (Me3 TACD)(μ-H)2 (DME)]2 [A]2 ., (© 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Allogeneic hematopoietic cell transplantation (HCT) is a curative approach for several diseases predominantly affecting elderly patients. Overall survival is compromised by treatment-related mortality (TRM), GvHD, and relapse. Pretransplant clinical risk indicators in elderly patients qualifying for HCT are highly desirable. Pro-BNP is known as a predictor of death in patients with an increasing variety of clinical conditions and frequently used as a routine parameter for organ complications in the allogeneic transplant setting without well-established scientific evidence. Our hypothesis was that pre-HCT NT-pro-BNP could aid in identifying elderly patients at risk for early mortality. We retrospectively evaluated NT-pro-BNP values in 177 consecutive patients of ≥60 years HCT (2005-2010). In 29.4 % of cases, NT-pro-BNP values were within our institute's normal range (<125 pg/ml). Analysis of different NT-pro-BNP cutoff points by receiver operating characteristics curve for mortality at day +100 revealed no single cutoff value with satisfying specificity and sensitivity. The individual outcome of patients with extremely high NT-pro-BNP values was not associated with an increase in mortality or cardiovascular morbidity. NT-pro-BNP values of patients succumbing to TRM did not differ significantly from those alive or having died of relapse-median 276 vs. 217 pg/ml. In conclusion, pre-HCT NT-pro-BNP was of no convincing prognostic relevance for day 100 mortality.

The crystal structure of the title compound, [Cu(ClO(4))(2)(C(4)H(12)N(2))(2)], (I), is reported at 100, 250 and 400 K. The Cu(II) cation in this complex is coordinated in a distorted octahedral mode characteristic of Jahn-Teller systems. The coordination of the perchlorate ligands via longer, and presumably weaker, axial Cu-O distances varies significantly as a function of temperature. One of the Cu-O distances increases between 100 and 250 K, and one of the Cu-O-Cl angles expands between 250 and 400 K. At all temperatures, the complex forms a two-dimensional N-H···O hydrogen-bond network in the (001) plane.

Aims: Atrial fibrillation (AF) occurs often in patients after coronary artery bypass grafting (CABG) and can result in increased morbidity and mortality. Previous studies using P-wave signal-averaged electrocardiogram (P-SAECG) have shown that patients with a longer filtered P-wave duration (FPD) have a high risk of AF after CABG. We have shown that patients with an FPD > or = 124 ms and a root-mean-square voltage of the last 20 ms of the P-wave 20 < or = 3.7 microV have an increased risk of AF after surgery. Accordingly, the aim of this study was to investigate whether or not prophylactic peri-operative administration of amiodarone could reduce the incidence of AF in this high-risk group undergoing CABG identified by P-SAECG., Methods and Results: In this prospective, double-blinded, placebo-controlled, randomized study, 110 patients received either amiodarone (n = 55) or placebo (n = 55). During CABG, two patients of both groups died. Amiodarone was given as 600 mg oral single dose one day before and from days 2 through 7 after surgery. In addition, amiodarone was also administered intravenously during surgery in a 300-mg bolus for 1 h and as a total maintenance dose of 20 mg/kg weight over 24 h on the first day following surgery. The primary endpoint was the occurrence of AF after CABG. The secondary endpoint was the hospitalization length of stay after CABG. The baseline characteristics were similar in both treatment groups. The incidence of post-operative AF was significantly higher in the placebo group compared with the amiodarone group (85 vs. 34% of patients, P < 0.0001). The prophylactic therapy with amiodarone significantly reduced the intensive care (1.8 +/- 1.7 vs. 2.4 +/- 1.5 days, P = 0.001) and hospitalization length of stay (11.3 +/- 3.4 vs. 13.0 +/- 4.3 days, P = 0.03). In the amiodarone group, concentrations of amiodarone and desethylamiodarone differed significantly between patients with AF and sinus rhythm (amiodarone: 0.96 +/- 0.5 vs. 0.62 +/- 0.4 microg/mL, P = 0.02; desethylamiodarone: 0.65 +/- 0.2 vs. 0.48 +/- 0.1 microg/mL, P = 0.04)., Conclusion: The incidence of post-operative AF among high-risk patients was significantly reduced by a prophylactic amiodarone treatment resulting in a shorter time of intensive care unit and hospital stay. Our data supports the prophylactic use of amiodarone in peri-operative period in patients at high risk for AF after CABG.

Atrial fibrillation (AF) after coronary artery bypass grafting (CABG) results in a prolonged hospital stay associated with higher costs. In our study P wave triggered P wave signal averaged ECG and chemoreflex-sensitivity (CHRS) was performed on 101 consecutive patients with sinus rhythm before CABG in order to evaluate the utility of these methods to predict AF. A CHRS below 3.0 ms/mm Hg was predefined as a pathological CHRS. Postoperative AF was observed in 37 (37%) of 101 patients. Patients with AF were older (68.4+/-6.9 vs. 63.8+/-9.4 years, p<0.01), had a longer filtered P-wave duration (FPD) (133.6+/-10.2 vs. 123.6+/-14.9 ms, p<0.0001), a lower root mean square voltage of the last 20 ms of the P wave (RMS 20) (2.86+/-0.88 vs. 5.10+/-2.73 microV, p<0.0001) and a significantly lower CHRS (3.32+/-1.83 vs. 4.17+/-2.19 ms/mm Hg, p<0.05). A cut-off point (COP) of FPD> or =124 ms and RMS 20< or =3.7 microV achieved a specificity of 75%, a sensitivity of 78%, a negative predictive value of 86%, a positive predictive value of 64% and an accuracy of 76% for prediction of AF. The predictive power was lower for a pathological CHRS which achieved a specificity of 63%, a sensitivity of 60%, a negative predictive value of 73%, a positive predictive value of 48% and an accuracy of 61%. A stepwise logistic regression analysis of all preoperative variables identified COP (odds ratio 8.21; 95% CI, 2.02-33.37, p<0.003) as independent predictor. Patients with postoperative AF stayed longer in the intensive care unit (2.9+/-1.7 vs. 1.3+/-0.5 days, p<0.0001) and in hospital (13.5+/-4.3 vs. 11.4+/-1.1 days, p<0.0004). The results of our study show that the risk for AF after CABG could preoperatively be predicted with P wave signal averaged ECG and an analysis of CHRS. The predictive power of the COP could be used for a preoperative risk stratification and a corresponding prophylactic therapy in order to reduce costs.

The carbohydrate binding glycoprotein Anti-AHP binds to the plasma membrane of the (transformed) L-cell both in agglutination reactions and by the immunofluorescence technique. On the surface of (normal) mouse embryo fibroblast cells Anti-AHP receptors were not detectable. Anti-AHP is suitable as another marker for L cells. The random distribution of the binding sites at 4 degrees C changes with elevated temperatures (clustering, capping of sites). Anti-AHP inhibits the growth of L cells much more than that of fibroblasts. It does not act as a mitogen for the investigated cells.

The combined application of psoralen and UVA radiation to skin grafts induced a prolongation of the survival time of the grafts in mice. This was observed using the H-Y barrier, an allogeneic barrier without H-2 disparities, and a strong H-2 incompatible barrier. The effect is probably due to a reduction of antigen-presenting cells, or to other, unknown mechanisms.

Histamine inhibits the chemiluminescence response of human lymphocytes to Concanavalin A by interfering with early triggering events. The inhibition seems to be mediated via H2 receptors, acts immediately, and is reversible by washing. A longer incubation in a histamine-containing medium induces a refractory state of the cells. The inhibitory effect described here is compared with the inhibitory action of histamine in the lymphocyte transformation test.

Literature review. Mast cells and basophils are included not only in anaphylactic but also in complement activating and cell-mediated immune reactions. A histamine release can be induced via the IgE mechanism, the anaphylatoxins, the histamine releasing activity, and by other reactions. Histamine and several other mediators induce a local inflammation reaction either by a direct action on their target cells or indirectly by the activation of other humoral and/or cellular effector systems. Histamine influences several immune reactions. Here, its influence on histamine receptor-bearing lymphocytes is discussed more in detail. Using in vitro test systems, it has been shown that histamine has a dual effect, it induces a suppression when applied in higher concentrations, while low concentrations are stimulating. In vivo, histamine receptor-bearing lymphocytes have suppressive functions, mediated by H2 receptors. Some preliminary evidence for the inclusion on histamine in the immunoreagulation of patients with several diseases is presented.

The histamine binding capacity of cells in various lymphoid organs has been determined by flow cytofluorometric (FCF) analysis of histamine receptors. Using fluoresceinated bovine serum albumin conjugated to histamine (HIS-BSA-FITC) as a staining reagent two distinct lymphocyte subpopulations of differing fluorescence intensity have been identified in each organ investigated. The thymus has a low number of histamine-receptor bearing cells, while bone marrow, lymph nodes and spleen reveal increasing binding capacities to the histamine conjugate. It is suggested that there exists a different susceptibility of distinct lymphocyte subpopulations for histamine, thereby enabling its controlled immunoregulatory activity.

A rosetting of isolated rat mast cells with complement coated zymosan does not induce a histamine release. However, this procedure potentiated the release induced by ATP. Treatment of rats with prednisolone diminishes the number of the rosette forming mast cells.

Using polyvalent antisera directed against solubilized human erythrocyte ghosts in the immunoelectrophoresis we obtained some precipitation arcs. Antisera against the purified spectrin allowed the identification of spectrin in the crossed immunoelectrophoresis.

In 43 recipients of allogenic cadaver kidneys before and three times a week after transplantation to the discharge from the hospital care the antibody titre against the Thomsen-Friedenreich-antigen (Anti-T) was determined and the score value was calculated from the agglutination intensity. A prognostic significance of the value got before operation could not be found. No changes of the titre appeared under the influence of the postoperatively performed immunosuppression as well as in connection with rejection crises. In 9 patients with clinically manifest systemic infections (8 cytomegalovirus infections, 1 bacterial infection) unequivocal (greater than or equal to 8 fold) increases of the anti-T-titre could be proved. These findings speak for an infection-induced formation of these cross-reacting anti-T-antibodies.

The guinea pig alveolar surfactant reduces the contraction of the isolated guinea pig ileum, induced by Angiotensin II. It is tentatively proposed, that the surfactant system suppresses the reactivity of lung blood vessels towards contacting stimuli.

2-Cyanoethylurea (2; CEU or BA 1-4) obtainable from 1-carboxamido-2-cyanoaziridine (2; BA l) by ring fission possesses immunomodulating properties like its parent compound containing the intact aziridine ring, as well as other 2-cyanoaziridine (1) derivatives. As was shown in a mouse model, CEU accelerated the time of rejection of skin allografts (immunostimulation) and reduced the prolonged tolerance time of mice immunosuppressed with cyclophosphamide to values found in normal control animals (immunorestoration).

Using fluoresceine isothiocyanate labeled protamine sulfate it is possible to stain rat mast cell fractions of isolated periotoneal cells in a selective way. The cells are not degranulated, though they have lost their histamine completely. The method shows the dissociation of the mediator release and the extrusion of the granules.

By means of fluorescein-labeled anti-AHP agglutinin isolated from the albumen gland of the snail Helix pomatia L. L cells were detected in air dried and fixed monolayer preparations, smear preparations or cryostat sections of tumours induced in two different host systems. The tumours consisting of L cells could be clearly distinguished from the surrounding normal host tissues, and also single tumour cells lying separtely in the host tissued were identified in the same unequivocal manner. The cells were marked by characteristic granular fluorescence caused by specific agglutinin binding within the cell membrane. With these results the previously expressed thesis that anti-AHP agglutinin might be used as a marker for L cells is confirmed for L cells grown in suitable host systems, too.

The cyst fluid of cestodes from various animals kept in zoological gardens was examined for the presence of A-, B-, H- and P1-blood group activity. While the results in the ABH-system were negative, the cysts from 2 of 13 animals examined (1 elk and 1 reindeer) presented P1-blood group activity.

Antisera produced in rabbits against Triton X-100 solubilized human erythrocyte ghosts formed several several precipitation lines in immunoelectrophoresis and immunodiffusion tests against the solubilized ghosts. The antisera were used for detecting several membrane components during chromatographic separation. A membrane component was partially isolated using gel filtration on SEPHADEX G-200 (fraction F1/F2). Spectrin (Tektin A) was shown to be the main moiety of these fractions. Associated proteins (haemoglobin, GAPD) could not be detected by the antisera against whole ghost solubilisate.

Protamine sulfate, known for a long time as a histamine releaser, was labeled with a fluorescent dye (FITC). This conjugate was shown to stain selectively the mast cell fraction of rat peritoneal cells. Within a few seconds, the protamine was found inside the cells. Although the cells had lost their histamine completely, no granules were found outside the cells. In the electron microscope, the protamine treated mast cells showed a loss of the electron density of their granules, a vacuolization, and other signs of histamine release. Evidence for a direct connection between the vacuoles and the extracellular fluid was gained by incubating mast cells in FITC-labeled human serum albumin followed by the addition of unlabeled protamine. After washing, the fluorescence was found to be located inside the cells, demonstrating an influx of the FITC-HSA under the influence of protamine. The protamine-induced release reaction is increased after addition of Ca2+, reduced by lowering the temperature, addition of 2-deoxyglucose, or cytochalasin B. Disodium cromoglycate also diminished the histamine release in a dose dependent manner. Protamine did not induce a loss of lactate dehydrogenase from the mast cells. The release reaction is mediated by the cell membrane, as shown by the releasing activity of insolubilized protamine. We conclude that the protamine-induced release is a non-cytotoxic reaction, fulfilling some criteria of the anaphylactic histamine release.

Three substances known to act on N-acetylneuraminic acid (NANA), were tested for their activity on rat peritoneal mast cells. Both neuraminidase, which splits off NANA, and the lectin from Cepaea nemoralis directed against NANA are histamine releasers. Periodate itself did not trigger the cells but inhibited the releasing action of other substances. The results provide further evidence for the role of NANA in the triggering of mast cells. A cytotoxic substance, benzyl-polyethylene imine, triggers mast cells without affecting NANA. In addition, the role of histamine-BSA conjugates as histamine releasers is described.

The supernatant of mitogen- or antigen-stimulated mononuclear cell cultures is known to contain a large number of biologically active molecules. In the present study, we have stimulated human mononuclear cells and rat spleen cells with Con A or antigen (PPD) respectively to produce lymphokines, such as histamine releasing factor (HRF), which is capable of causing histamine release from rat mast cells and human basophils. Histamine was measured fluorimetrically by Shore et al. This assay is sensitive and reproducible: replicates varied by less than 15% in triplicate samples.

Using rat complement-treated zymosan particles a rosetting of purified rat peritoneal mast cells could be demonstrated. The question was investigated whether the binding of activated complement could be a trigger of histamine release. Varying the degree of complement label on the zymosan particles, the time and temperature of incubation and the dependence on Ca2+ ions, we could not induce a release of histamine in any case. The addition of labeled zymosan increased slightly the mediator release induced by ATP. The immunologic significance of the complement receptors on mast cells is still unclear.

The protamine sulfate-induced release of histamine from mast cells in a non-cytotoxic reaction, similar to the 48/80-induced secretion. Polyethylene imine was found to be a less potent releaser. It is a cytotoxic substance without specificity for mast cells and acts on membranes generally. Although the two agents are related concerning their molecular weight and polybasicity, their mode of action on mast cells is clearly different.

One of the two lectins, occurring in the albumen gland of the snail, Cepaea nemoralis L., is shown to be a histamine releaser from isolated rat mast cells as well as in vivo. The release reaction is induced in the same dosage range as the agglutination of human red blood cells occurs. Both the reactions are inhibitable by the addition of N-acetyl-neuraminic acid. The releasing activity of the lectin seems to be a counterpart to the triggering action of polycations, because its specificity is directed against this sugar.