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Non-invasive brain stimulation techniques such as repetitive transcranial magnetic stimulation (rTMS) offer a promising alternative to psychotherapeutic and pharmacological treatments for depression. This paper aims to present a practical guide for its clinical implementation based on evidence from the literature as well as on the experience of a group of leading German experts in the field.The current evidence base for the use of rTMS in depression was examined via review of the literature. From the evidence and from clinical experience, recommendations for the use of rTMS in clinical practice were derived. All members of the of the German Society for Brain Stimulation in Psychiatry and all members of the sections Clinical Brain Stimulation and Experimental Brain Stimulation of the German Society for Psychiatry, Psychotherapy, Psychosomatics and Mental Health were invited to participate in a poll on whether they consent with the recommendations.Among rTMS experts, a high consensus rate could be identified for clinical practice concerning the setting and the technical parameters of rTMS treatment in depression, indications and contra-indications, the relation of rTMS to other antidepressive treatment modalities and the frequency and management of side effects.

Der chronische Ruckenschmerz ist das Hauptsymptom der postmenopausalen Osteoporose. Dieser mindert die Mobilitat und Lebensqualitat der Patientinnen. Die Hypothese der vorliegenden Arbeit war, dass neben der Basistherapie ein Analgetikum notwendig ist. Gepruft werden sollte weiterhin, ob eine peripher wirksame oder zentral wirksame Analgesie zu bevorzugen ist. Es wurden 3 Patientengruppen prospektiv pseudorandomisiert verglichen. Gruppe 1 erhielt Alendronat, Vitamin D und Calcium, Gruppe 2 wurde zusatzlich mit Ibuprofen behandelt, Gruppe 3 erhielt als zusatzliches Analgetikum Tramadol. Bei 117 Patientinnen mit einer postmenopausalen Osteoporose wurden vor und 26 Wochen nach Therapie die Schmerzintensitat mittels visueller Analogskala (VAS) und die Lebensqualitat mittels IOF-Qualeffo 41 (International Osteoporosis Foundation-Quality of Life Questionaire 41) erfasst. In keiner Untersuchungsgruppe wurden therapieassoziierte Komplikationen beobachtet. Zum Nachuntersuchungszeitpunkt hatte sich die Lebensqualitat signifikant in den Gruppen 2 und 3 gegenuber der Kontrolle gebessert (p

Hemolysis in non- or rarely transfused patients with sickle cell disease may lead to higher iron stores. We prospectively studied their iron stores by using SQUID biomagnetic liver susceptometry. Liver iron concentration (LIC) and liver/spleen volume were measured at the Hamburg low T C -SQUID biosusceptometer facility in a total of 34 pediatric patients (age: 2–18 years). In vivo LIC values were measured in the normal range (median LIC = 185 μg/g-liver, range: 6–636 μg/g), with 21% of the patients having sub-normal LIC

Objectives To determine the effects of a 12-week, home-based resistance exercise program on strength, body composition, and activities of daily living (ADLs) in men and women with Charcot-Marie-Tooth (CMT) disease and to design an ADL-based resistance exercise prescription template. Design Double-blind, placebo-controlled study. Setting Testing in a university setting; exercise in patients' homes. Participants Twenty CMT patients who volunteered. Intervention Subjects progressively strength trained at home 3 d/wk for 12 weeks. Main outcome measures Timed ADLs, isometric strength, and body composition. Results Absolute strength was greater in men with CMT in only 4 of 10 baseline measures (P Conclusions Resistance training improved strength and ADLs equally in men and women. We designed an exercise prescription recommendation, based on ADL performance.

The etiology of sudden sensorineural hearing loss is still unclear and is thought to result from disturbances of microcirculation, infectious causes, or autoimmune disorders. So far standard therapy did not show clear improvement over spontaneous remission rate, which is assumed to be about 50% [Nakashima et al., Acta. Otolaryngol. Stockh. 514:14-16, 1994; Schuknecht and Donovan, Arch. Otorhinolaryngol. 243:1-15, 1986; Harris and Sharp, Laryngoscope 100:516-524, 1990; Mayot et al., Clin. Immunol. Immunopath. 68:41-45, 1993; Gussen, Ann. Otol. Rhinol. Laryngol. 85:94-100, 1976]. Elevated blood viscosity due to high fibrinogen levels is supposed to cause decreased cochlear blood flow and thus initiate sudden hearing loss. The specific lowering of fibrinogen immediately decreases plasma viscosity exactly to the desired extent and should lead to improved cochlear blood flow [Suckfull et al., Acta. Otolaryngol 119:763-766, 1999; Suckfull, Lancet 360:1811-1817, 2002; Walch et al., Laryngol. Rhino. Otol. 75:641-645, 1996; Suckfull et al., Otol. Neurotol. 23:309-311, 2002]. In a prospective uncontrolled pilot study on 36 patients with unilateral sudden onset sensorineural hearing loss (SHL) we tried to establish that 1-3 specific fibrinogen aphaereses alone improve recovery of hearing and that it is possible to lower fibrinogen to the target of 80-100 mg/dl without important side effects. Pure tone audiometry was carried out immediately before and after each aphaeresis as well as at 2 and 4 weeks and 6 months after treatment. Sixteen patients recovered spontaneously before undergoing fibrinogen adsorption. All 20 aphaeresis patients improved during immunoadsorption; in 60% of patients auditory thresholds returned to normal after the first immunoadsorption and treatment could be discontinued, in another 20% of patients complete recovery was reached after 4 weeks. The mean plasma fibrinogen concentration of the 20 patients before the first aphaeresis session was 308.1 +/- 51.5 mg/dl. Immediately after the first treatment session, the fibrinogen concentration was lowered to 100.7 +/- 25.3 mg/dl (P < 0.001). The second and third sessions also showed highly significant reductions in plasma fibrinogen. No important side effects were seen. In conclusion, specific fibrinogen adsorption is a promising new treatment modality that should be tested in a prospective, randomized controlled trial in patients with sudden hearing loss.

Resistance exercise and creatine supplementation independently improve strength and function in patients with certain neuromuscular diseases. The purpose of this study was to examine the effects of resistance training with and without creatine supplementation on muscle, strength, and function in patients with Charcot-Marie-Tooth (CMT) disease. Twenty patients with CMT consumed 5 g/day creatine or placebo while participating in resistance training for 12 weeks. Energy metabolites, muscle fiber type and size, strength, and timed activities of daily living were measured before and after training. There were no differences between creatine or placebo groups for any outcome. For the groups combined, exercise training increased type I muscle fiber diameter (48.2 +/- 14.2 microm vs. 55.4 +/- 14.8 microm), strength, and activities of daily living (ADL) times. Thus, patients respond to resistance training with muscle fiber adaptations, and improvements in strength and function. Creatine was not beneficial.

Data of 507 granulocyte donations from 183 donors were evaluated. No severe granulocyte colony-stimulating factor (G-CSF)-related side-effects were observed. Three donors complained of severe itching following infusion of hydroxyethyl starch (HES). A high proportion (85%) of the donors stated that they would donate granulocytes again. The mean granulocyte yield was 4.3 x 10(10). High-molecular-weight HES resulted in a significantly higher yield compared with low-molecular-weight HES. Mild, but no severe, adverse transfusion reactions were observed in 16% of the recipients. A leucocyte alloimmunization rate of 24% was found. G-CSF stimulation and transfusion of G-CSF-mobilized granulocytes were well tolerated by donors and recipients, respectively.

A Large Acceptance Detector System (LADS) has been designed and built at the Paul Scherrer Institute to study multiparticle final states following pion-nucleus absorption. It consists of a 28-sector cylinder of plastic scintillators of 1.6 m active length and 1.4 m diameter, two cylindrical wire chambers, and two 14-sector plastic scintillator end-caps which close each end. The nearly 4π solid angle coverage of this detector minimizes uncertainties associated with extrapolations over unmeasured regions of phase space. The design and the performance of the LADS detector are presented.

to examine the effect of cycle phase or a low dose oral contraceptive on exercise performance in young women.As controls, 15 men were tested twice by a maximal treadmill test (Vo2 max) and by an endurance run 14 d apart to determine performance variability from causes other than hormonal fluctuations. Ten women ages 18-30 were then tested for Vo2 max and endurance in the same way in both the follicular and the luteal phase (random order, ovulation assessed by sonography). They were then randomly assigned to placebo (n = 3) or oral contraceptive (1 mg norethindrone and 35 micrograms ethinyl oestradiol) (n = 7) for 21 days. Tests were repeated during the first and third weeks of treatment. Vo2 max and endurance tests were compared in the men and control cycle of the women by using independent t tests on percent change. The data for both cycles in the women were analysed by repeated measures ANOVA.There was no difference in per cent change in total test time, Vo2 max, or breathing frequency between the men and women in either test. Data obtained during the Vo2 max test revealed no difference between the follicular and luteal phases of the menstrual cycle for total test time [11.8 (SD 2.3) v 12.6 (2.3) min], Vo2 [41.6 (12.1) v 39.7 (11.4) ml.kg-1.min-1], or breathing frequency [26.8 (3.5) v 27.3 (9.9) breaths.min-1] respectively, or during the first and third weeks of treatment [total test time 12.0 (2.5) v 12.8 (2.4) min; Vo2 37.3 (7.4) v 41.0 (12.4) ml.kg-1.min-1; breathing frequency 27.8 (4.2) v 27.7 (3.4) breaths.min-1, respectively]. Data obtained during the endurance test revealed no difference between the follicular and luteal phase of the menstrual cycle for total test time [20.5 (15.7) v 16.2 (8.5) min], Vo2 [37.5 (9.4) v 32.9 (8.1) ml.kg-1.min-1], or breathing frequency [32.0 (6.0) v 33.2 (5.1) breaths.min-1, respectively], or during the first and third weeks of treatment [total test time 32.3 (34.9) v 30.6 (30.1) min; Vo2 33.9 (10.1) v 35.2 (8.6) ml.kg-1.min-1; breathing frequency 34.0 (5.9) v 34.8 (5.3) breaths.min-1, respectively].Neither cycle phase nor a low dose oral contraceptive containing 1 mg norethindrone adversely affects performance during a maximal treadmill test or endurance run.The authors examined the effect of cycle phase or a low dose oral contraceptive on the exercise performance of young women. As controls, 15 men were tested twice by a maximal treadmill test and by an endurance run 14 days apart to determine performance variability from causes other than hormonal fluctuations. 10 women aged 18-30 were then tested by maximal treadmill test and endurance in the same manner in both the follicular and luteal phase. They were then randomly assigned to placebo or oral contraceptive for 21 days. Tests were repeated during the first and third weeks of treatment. Maximal treadmill test and endurance tests were compared in the men and control cycle of women using independent t tests on percent change. Neither cycle phase nor a low dose oral contraceptive containing 1 mg norethindrone was found to adversely affect performance during a maximal treadmill test or endurance run.

History and clinical findings A 43-year-old woman was admitted after a suicide attempt with 1.5 g atenolol. Physical and neurological examination showed no abnormality, but psychiatric examination revealed symptoms of a major depression. Four weeks prior to admission a valsartan-hydrochlorothiazide combination had been added to the antihypertensive medication. Investigations Laboratory tests, electrocardiography, chest-x-ray, electroencephalography and cranial computerised tomography showed no abnormality. Diagnosis and course The depressive disorder resolved within ten days after discontinuation of valsartan and hydrochlorothiazide without specific treatment. Blood pressure was normal under treatment with metoprolol. Conclusion Depressive drug reactions can produce a substantial morbidity. This case of a drug induced affective disorder should heighten the awareness of unusual reactions to valsartan-hydrochlorothiazide therapy.

The purpose of this study was to profile waist-to-hip ratios and cardiovascular disease (CVD) risk factors in mildly-obese younger American women. Sixty sedentary, nonsmoking, premenopausal, healthy women 21 to 51 years of age participated in the study. Peak oxygen consumption (VO2), percent body fat, waist-to-hip ratios, and lipid profiles were determined. Subjects were then grouped according to waist-to-hip ratio for statistical analyses, wherein android had waist-to-hip ratios of >m 0.8 (n = 19) and gynoid < 0.8 (n = 41), respectively. The groups were not different with respect to age, peak VO2, and body mass. Gynoid had lower blood pressure at rest and during maximal exercise compared to android. Additionally, gynoid had lower percentage body fat, smaller subscapular and suprailiac skinfold measurements, and waist circumference than android. Android had higher total cholesterol, LDL-C, triglycerides, apoprotein B, and insulin compared to gynoid. HDL-C was not different between the groups. Significant correlations of low-to-moderate magnitude were observed between % fat and blood pressure, and between waist-to-hip ratio and cholesterol, triglycerides, LDL-cholesterol, apoprotein B, and insulin. Subscapular skinfolds were related to blood pressure and cholesterol, LDL-cholesterol, triglycerides, insulin, and apoprotein B. A positive relationship existed between insulin and blood pressure and triglycerides while a negative relationship existed between HDL-cholesterol and blood pressure. These data suggest that centralized obesity is associated with an increased risk of developing CVD as evidenced by higher blood pressure, less desirable lipid profiles, and higher serum insulin.

A large acceptance detector system (LADS) has been designed and built at the Paul Scherrer Institute to study multi-particle final states after pion-nucleus absorption. It consists of a 28-sector cylinder of plastic scintillator of 1.6 m active length and 1.5 m diameter, and two cylindrical wire chambers; two 14-sector endcaps of plastic scintillator close each end.

Eine Methode zur chirurgischen Unterstutzung einer forcierten Gaumennahterweiterung wird beschrieben. Hierbei werden gezielte Osteotomien im Bereich der Ansatzstelle des Processus zygomaticus der Maxilla und des dorsalen und mittleren Abschnittes des harten Gaumens durchgefuhrt. Die Ergebnisse an 14 patienten werden exemplarisch dargestellt. Bei fast allen Patienten erfolgte nach anschliesender Zahnbogenkoordination eine operative Korrektur der sagittalen und/oder vertikalen Kieferrelation. Die chirurgisch-orthopadische Gaumennahterweiterung erwies sich als effiziente und schmerzarme Methode zum praoperativen Ausgleich von transversalen Kieferdiskrepanzen und erleichterte das spatere operative Vorgehen.

SUMMARY: In patients with pathologically altered erythrocytes, red blood cell exchange is a very efficient therapeutic measure without important side effects. With increasing migration more patients with e.g. severe malaria or sickle cell anemia have to be treated. In minor or bidirectional ABO-mismatched stem cell transplantations after reduced intensity conditioning, hemolysis can be prevented by prophylactic erythrocytapheresis. Other rare indications for red blood cell exchange are advanced erythropoietic protoporphyria and babesiosis. Sickle cell anemia can be treated with hydroxyurea. Transfusions are administered when necessary, but this results in iron overload in the long term. An expensive but safe and very efficient treatment alternative is red blood cell exchange. In cases with stroke, acute chest syndrome and other severe complications, erythrocytapheresis reproducibly breaks the vicious circle of sickling and increasing oxygen deficiency. At the same time one can aim at an exact end hematocrit. In severe malaria, erythrocytapheresis both reduces parasite load to the designated extent and reconstitutes reduced oxygen transport capacity without serious adverse effects. Here we describe our experience of erythrocytapheresis in long-term prophylaxis of complications in sickle cell anemia and sickle cell thalassemia patients. The documentation of improved iron balance was carried out by liver susceptometry.

Level of physical activity has been found to be an independent risk factor for coronary heart disease. Because lifestyle and dietary habits are frequently established by early adulthood, we examined the physical activity, physical fitness, body composition, plasma lipids, and diets of a group of second-year medical students. Medical students were studied because of the presumption that they were knowledgeable about exercise and appropriate diet and would have future influence on their patients. A questionnaire which assessed physical activity was returned by 69 (89%) of the 80 students. Over 50% reported no hard or very hard physical activity either during the week or on weekends. Three subjects were smokers. Body composition, cardiovascular fitness, and plasma lipids were assessed in 20 subjects selected at random from the 69. Five of the 15 men, but none of the five women, had greater-than-desirable body fat. Cardiovascular fitness was at least average compared to normal values, but three had hypertension at rest and 12 had hypertensive responses to exercise. Seven of the men had LDL cholesterol above 130 mg/dl and three had LDL:HDL ratios greater than 3. There was a positive correlation (r = 0.5, p = 0.02) between hard/very hard activity assessed by questionnaire and VO2max and a negative correlation (r = 0.4, p = 0.05) between VO2max and percent fat. All 20 subjects reported above average to severe amounts of stress. Analysis of a 48-hr diet record of 22 students showed an average consumption of 47% carbohydrates, 17% protein, and 36% fat. The polyunsaturated/saturated ratio was 0.43.(ABSTRACT TRUNCATED AT 250 WORDS)

For the production of planar devices of any kind each type requires a seperate tool—the set of masks. The present and future masking techniques must cope with structures and separating distances which become increasingly smaller. Furthermore, the number of masks necessary for a set increases and the area required for individual systems as well as the diameter of the processed silicon wafers become larger. Attempts are made to cut work and time in the fabrication of masks and at the same time improve the quality. This is possible by the use of data processing systems for disentanglement, placement and design of the layout. In the fabrication of master artworks automatic machines are commonly used. Currently employed step-and-repeat machines are of the second generation. They show a number of improvements. New methods for processing emulsion and metal film masks become increasingly important. Interesting possibilities suggest themselves in the preparation of masks for semiconductor components by employing holographic and electron beam methods.

This paper will report on a 9K ECL array with a 99.6ps propagation delay. The chip is ECL 10K or 100K compatible, consumes 20W typical and has 256 logic pins plus 64 supply pins.

CERN’s Large Hadron Collider (LHC) [1][2] will be supplied with protons from the injector chain Linac2-PS Booster (PSB)-PS-SPS (Fig. 1). The required transverse beam brilliance (intensity/emittance) is almost twice that of current PS beams and the LHC bunch spacing of 25 ns must be impressed on the beam before its transfer to the SPS. The scheme involves new RF harmonics in the PSB and the PS, an increase of the PSB energy, and two-batch filling of the PS. After a successful test of the main ingredients, a project for converting the PS complex was launched in 1994. Major additions are (i) h=1 RF systems in the PSB, (ii) upgrading of the PSB main magnet supply from 1 to 1.4 GeV operation, (iii) new magnets, septa, power supplies, kicker pulsers for the PSB-PS beam transfer, (iv) 40 and 80 MHz systems in the PS, (v) beam profile measurement devices with improved resolution. A significant part of the effort is being provided by TRIUMF under the Canada-CERN co-operation agreement on the LHC.

In an open, uncontrolled pilot study, 5 men and 1 woman with suspected gram-negative sepsis were treated with a new whole-blood endotoxin adsorption system. Lipopolysaccharide (LPS) adsorption was carried out by hemoperfusion over high-affinity polymethacrylate-bound albumin (Fresenius Endotoxin Adsorber EN 500). All patients suffered from endotoxemia (>20 pg/ml LAL) and met at least two systemic inflammatory response syndrome (SIRS) criteria. Four patients suffered from pneumonia due to mechanical ventilation, one from peritonitis, and one from pneumonia and peritonitis. Endotoxin adsorption was very well tolerated, and efficient LPS removal was shown in all patients. Apache II score immediately before immunoadsorption was 23.5 and was 22.3 after the last treatment. All 6 critically ill patients improved substantially and were discharged from the intensive care unit. LPS whole blood immunoadsorption is a promising new method. No side effects have been observed thus far. A large controlled study to prove clinical efficacy in patients with severe sepsis is under way.

Dose-escalation during induction and consolidation therapy of de novo AML, including myeloablative chemotherapy supported with autologous peripheral blood stem cell transplantation, continously improve outcome. Therefore, quality control of transplants is getting increasing interest. We studied leukapheresis products (LPs), consecutively collected during postremission treatment of 20 patients (pts) with de novo AML for minimal residual disease (MRD) by 5-parametric flow cytometry and for myelodysplasia (MDS)-associated alterations, within the non-leukemic hematopoietic progenitor cells (HPCs), by paired lineage-selected colony assays for colony-forming units-megakaryocytes (CFU-mega) and burst-granulocytes-monocytes colony-forming units (CFU) to evaluate the predictive value of these transplant-associated parameters on outcome.

Utilization of very-low-calorie diets (VLCD) for weight loss results in loss of lean body weight (LBW) and a decrease in resting metabolic rate (RMR). The addition of aerobic exercise does not prevent this. The purpose of this study was to examine the effect of intensive, high volume resistance training combined with a VLCD on these parameters.Twenty subjects (17 women, three men), mean age 38 years, were randomly assigned to either standard treatment control plus diet (C+D), n = 10, or resistance exercise plus diet (R+D), n = 10. Both groups consumed 800 kcal/day liquid formula diets for 12 weeks. The C+D group exercised 1 hour four times/week by walking, biking or stair climbing. The R+D group performed resistance training 3 days/week at 10 stations increasing from two sets of 8 to 15 repetitions to four sets of 8 to 15 repetitions by 12 weeks. Groups were similar at baseline with respect to weight, body composition, aerobic capacity, and resting metabolic rate.Maximum oxygen consumption (Max VO2) increased significantly (p0.05) but equally in both groups. Body weight decreased significantly more (p0.01) in C+D than R+D. The C+D group lost a significant (p0.05) amount of LBW (51 to 47 kg). No decrease in LBW was observed in R+D. In addition, R+D had an increase (p0.05) in RMR O2 ml/kg/min (2.6 to 3.1). The 24 hour RMR decreased (p0.05) in the C+D group.The addition of an intensive, high volume resistance training program resulted in preservation of LBW and RMR during weight loss with a VLCD.

Lipoprotein(a) (Lp[a]) is associated with an increased cardiovascular risk. It is similar to low-density lipoprotein with an additional molecule of apo A covalently linked to apo B-100 by one disulfide bridge. Apo A is highly homologous to plasminogen. The kringle 4 motive of plasminogen is repeated between 10 and 40 times in apo (a). Currently, there is no drug therapy available to lower Lp(a). Since October 1993, we have carried out over 160 immunoadsorption treatments on 3 patients with elevated Lp(a) as their only risk factor and a history of myocardial infarction. Lp(a) was removed from plasma by sepharose coupled anti-Lp(a) columns. Lp(a) levels were lowered from above 170 mg/dl to below 30 mg/dl immediately after Lp(a) apheresis. To achieve this, the patient's plasma volume had to be treated 2 to 3 times. Nonspecific protein loss during column changes remained negligible. There were no serious unwanted effects during or after treatment. Minor circulatory problems (tachycardia, flush) occurred in 11% of the treatments but only with plasma flow rates above 55 ml/min. In 1 patient, coronary angiography after 2 years and in another patient after 1 year showed no progression. The third patient has not yet had repeat coronary angiography. Like the others, he reported subjective improvement after 1 year of apheresis. It is concluded that Lp(a) apheresis may retard progression of atherosclerosis in patients with selective Lp(a) elevation. Further studies to support this hypothesis are needed.

We present a patient with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) who was treated regularly with plasma exchanges (PE) because response to other therapies including i.v. immunoglobulins was not adequate. To reduce nonspecific protein losses due to repeated PE and increase IgG-removal, immunoadsorption (IA)-therapy using sepharose-bound protein A was initiated. Retrospective analysis of clinical data including muscle strength and walking distance shows that IA led to more rapid and greater functional improvement than PE in this patient with no relevant side effects. After 3 years of therapy lymphoma was diagnosed and treated. The patient had no relapses of CIDP for 17 months, when his functional status deteriorated again necessitating further IA-therapy. It is concluded that IgG removal by IA in CIDP is more effective and has fewer complications than PE. Due to the chronic course of CIDP requiring repeated interventions IA is also not more expensive than PE.

There is controversy over whether exercise and/or exercise intensity has an effect on total caloric intake or diet composition. The purpose of this study was to test the effect of exercise intensity without dietary manipulation on body composition and/or weight loss and to determine whether exercise intensity affected total caloric intake or diet composition in normal weight young women.Fifteen women aged 18 to 34 years with a maximal oxygen consumption average or below on the Palo Alto norms served as subjects. Subjects were randomly assigned to: 1) low heart rate intensity exercise group (LI, N = 7) which exercised 40 to 45 minutes approximately four times weekly at a mean heart rate of 132 beats per minute (bpm); 2) high heart rate intensity group (HI, N = 8) which exercised 40 to 45 minutes approximately four times weekly at a mean HR of 163 bpm. All subjects were given a maximal exercise test prior to and during weeks eight, 12 and 16. The first 4 weeks served as a control period, followed by approximately 11 weeks of exercise. Each subject recorded her dietary intake for 1 complete week, including a weekend, during weeks 2, 6, 10 and 14 of the study.VO2 max increased (p.05) in HI (29 +/- 6 ml/kg/minute to 38 +/- 7) but did not change in LI (36 +/- 5 to 38 +/- 7). Percent fat decreased in HI (p.05) (27 +/- 7 to 22 +/- 4) but was unchanged in LI (22 +/- 6 to 21 +/- 6). The weekly intake of total kcal, carbohydrate, protein and fat did change significantly for either group. The weekly intake of saturated fat declined significantly (p.05) in HI (21.2 +/- 5.8 g to 14.9 +/- 5.5 g); their weekly intake of cholesterol also decreased (p.05) between months 2 to 3 (249 +/- 109 mg to 159 +/- 58 mg). No other differences in dietary intake between groups were found.High heart rate intensity exercise training without dietary manipulation resulted in a decrease in body fat, but not weight change, as well as a decrease in the intake of saturated fat and cholesterol in normal weight young women. These changes were not observed after low heart rate intensity training.

We report three patients with severe, localized scleroderma, and with elevated titres of antinuclear antibodies, who were treated by plasmapheresis in combination with systemic steroid therapy. The therapeutic effectiveness of plasmapheresis was assessed on the basis of improvement in cutaneous and joint lesions. In all cases, significant improvement occurred after 2 months of therapy. Thus, in addition to treating systemic sclerosis, plasmapheresis can also be recommended for treatment of severe cases of localized scleroderma with elevated titres of antinuclear antibodies and antibodies to ss-DNA.

The acute effects of two psychological stressors (personally stressful imagery and threat of shock) on blood glucose (BG), heart rate, blood pressure, skin conductance, and subjective stress were studied in 22 noninsulin-dependent diabetic adults and nine healthy, nondiabetic subjects similar in age, weight, education and sex. The diabetic group's BG rose significantly after threat of shock (M change from rest = 18.4 mg/dL, p < .05), although the nondiabetic group's BG remained stable throughout the assessment. Significant increases in subjective stress ratings (p < .05) and skin conductance level (p < .05) paralleled the noninsulin-dependent diabetes mellitis (NIDDM) subjects' BG response to threat of shock. The findings suggest that some stressors can have hyperglycemic effects on individuals with NIDDM, although generalization of these findings to the natural environment remains to be demonstrated. The methodology used is contrasted with other studies that have failed to demonstrate stress effects on BG.

Sir .—Brucellosis is an infectious disease caused by a gram-negative coccobacillus passed from animals to humans by airborne spread, direct contact, and ingestion of infectious animal products. Infections with the species Brucella melitensis , associated with ingestion of contaminated goat and sheep milk products, are among the most invasive. 1 Brucellosis is unusual in US children, accounting for fewer than 10% of reported US cases. 2 Outbreaks are rare in brucellosis-free states, and Michigan had been brucellosis free since 1980. 3 We describe aningestion-associated outbreak of B melitensis infections that initially presented in a 15-year-old patient with prolonged fever and hemophagocytosis. Patient Report .—A previously healthy 15-year-old Hispanic boy presented with a 3-week history of fever, fatigue, weight Photomicrograph of bone marrow aspirate from the 15-year-old index patient demonstrating large activated histiocytes and erythrophagocytosis. loss, myalgias, lumbosacral pain, blurred vision, and epistaxis. Physical examination revealed mild hepatomegaly and a tender spleen

Testing the function of meter-thick radiation protective walls as built e.g. for the reactor stacks of nuclear power plants shows that the relative density variations of concrete multiplied by the number of the mean free paths of the radiation in concrete have an effect on the dose rate variations behind the protective wall. It is therefore necessary to carefully control the density of concrete. If ultrasonic testing of the walls has to be excluded because they are hermetically enclosed with a steel liner on either side and gamma-radiography fails due to the mass per unit area in the order of several tons/m2, then another method, the transmission with bremsstrahlung of adequate energy, e.g. of 10 MeV, can be applied. Such bremsstrahlung can be received from a mobile and portable linear accelerator. In the paper the first results of the determination of density variations in a model wall of concrete having masses per volume area in the range from 1800 kg ⋅ m−3 to 2400 kg ⋅ m−3 and linear dimensions 1,60 m ...

Weight training regimens are generally thought not to improve cardiovascular function or lipid parameters. To evaluate this further, we studied 25 men before and after supervised weight training three times each week for eight weeks. Mean plasma HDL-cholesterol level increased significantly with training, from 38.8 to 44.1 plasma HDL-cholesterol level increased significantly with training, from 38.8 to 44.1 mg/dl, while calculated LDL-cholesterol decreased from 132 to 121 mg/dl. Triglyceride values were unchanged. Percent fat decreased from 14% to 12.7% (P less than .05), and muscle mass increased from 32.4 kg before training to 37 kg after training (P less than .05). Maximal oxygen consumption (VO2max) increased significantly (from 45.2 to 49.2 ml/kg X min) during the eight-week period. LDL-cholesterol and triglycerides were negatively correlated with VO2max but changes in HDL-cholesterol were not accounted for by alterations in VO2max, muscle mass, or percent fat. This study suggests that weight training can be used to increase strength, alter body composition, improve plasma lipids, and enhance cardiovascular function.