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A study on the dielectric response in frequency domain of a semiconducting glaze is presented. By modifying the electrical contacts to the glaze it was found that the observed polarization relaxation as well as the non-linear voltage dependence of the dc conductance arises due to a low-conductive barrier controlling conduction through the glaze. Structural and chemical analysis using scanning electron microscopy revealed that the outermost layer of the glaze mainly consisted of glass, containing very few tin oxide particles. With an equivalent circuit model, the thickness of the glassy layer was estimated to be about 4 /spl mu/m, while its resistivity was found to be in the order of 10/sup 8//spl Omega/m to 10/sup 9//spl Omega/m.

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.Laboratory tests, electrocardiography, chest-x-ray, electroencephalography and cranial computerised tomography showed no abnormality.The depressive disorder resolved within ten days after discontinuation of valsartan and hydrochlorothiazide without specific treatment. Blood pressure was normal under treatment with metoprolol.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.

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.

Under antidepressive treatment with amitryptiline (100 mg/d) a 71-year old woman developed delirious symptoms, hyponatremia and a grand mal seizure followed by cardiovascular arrest. A few month later she ingested 48 mg reboxetine with suicidal intent. Overdosing of reboxetine, a selective noradrenaline re-uptake inhibitor, proceeded without complications.

Semiconducting surfaces on outdoor insulators can improve performance under contaminated conditions. Numerous attempts have been undertaken to find suitable glaze compositions and today a range of reliable products is available. On the other hand, there are still concerns on the long-term stability of the semiconducting glazes and investigations aiming to find out the main ageing mechanisms, especially under DC voltage, are of great importance. In recent investigations, the authors found on insulator samples under natural field conditions, that similar surface changes took place under AC and DC voltage after several months of exposure. These changes were more severe for samples under DC stress. The aim of the investigations reported in this paper, was to model the ageing of samples with semiconducting glaze in the laboratory using the rotating-wheel-dip test. Besides the measurement of the voltage-current characteristics (I-V), dielectric spectroscopy was applied, in order to characterise the changes observed and to extend the knowledge concerning the conduction mechanism in the glaze before and after ageing.

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.

Elevated plasma lipoprotein (a) (Lp[a]) and cardiac events show a modest but significant association in various clinical studies. However, the influence of high Lp(a) on the gene expression in blood monocytes as a major cell involved in atherogenesis is poorly described. To identify genes influenced by elevated serum Lp(a), the gene expression was analyzed on a complementary DNA microarray comparing monocytes from a patient with isolated Lp(a) hyperlipidemia and coronary heart disease with monocytes from a healthy blood donor with low Lp(a). By using this approach, numerous genes were found differentially expressed in patient-versus-control monocytes. Verification of these candidates by Northern blot analysis or semiquantitative polymerase chain reaction in monocytes from additional patients with Lp(a) hyperlipidemia and healthy blood donors with elevated Lp(a) confirmed a significant induction of plasminogen activator inhibitor type 2 (PAI-2) messenger RNA (mRNA) in monocytes from male, but not from female, individuals with high Lp(a), indicating that this observation is gender specific. This led also to increased intracellular and secreted PAI-2 protein in monocytes from male probands with Lp(a) hyperlipidemia. Plasminogen activator inhibitor type 1 (PAI-1) mRNA was found suppressed only in the patients′ monocytes and not in healthy probands with high Lp(a) levels. Purified Lp(a) induced PAI-2 mRNA and protein and reduced PAI-1 expression in monocytes isolated from various controls. The finding that PAI-2 is elevated in monocytes from male patients with isolated Lp(a) hyperlipidemia and male healthy probands with high Lp(a) and that purified Lp(a) up-regulates PAI-2 in control monocytes in vitro indicate a direct, but gender-specific, effect of Lp(a) for the induction of PAI-2 expression.

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.

Colonization of host plants by the fire blight pathogen requires synthesis of capsular exopolysaccharide (EPS) (1). Erwinia amylovora synthesizes the homopolymer levan via a secreted levansucrase from sucrose in the environment and an acidic polymer. Amylovoran consists of repeating units with four galactose and one glucuronic acid residues as well as glucose in most of the subunits (8). Its biosynthesis requires the function of several sugar transferases and proteins for transport and polymerization encoded by genes of the ams cluster (2). The precursors for synthesis of the repeating units are presumably UDP-galactose, UDP-glucose and UDP-glucuronic acid. EPS- synthesis in a subcellular system has been described for Sinorhizobium meliloti (9). The molecular weight of amylovoran was recently determined by analytical ultracentrifugation and SEC/MALLS to be 1.1 x 106 (4). A DNA fragment from phage φ-Ealh was shown to encode for an EPS degrading activity (3).

Results from a 4{pi} solid angle measurement of the reaction {pi}{sup +}+{sup 4}He{yields}ppd at incident pion energies of T{sub {pi}}{sup +}}=70, 118, 162, 239, and 330 MeV are presented. Integrated cross sections are given for the final states with energetic deuterons (ppd) and (pd)p. The differential cross sections are described by a complete set of five independent variables and various other kinematic variables and compared to cascade and phase space models where deuterons were formed by a semiclassical pickup model. The data are investigated for signatures of initial and final state interactions: it is found that more than half of the (ppd) yield cannot be explained by these mechanisms. The remaining strength is reasonably well reproduced by 3N phase space models followed by pickup. (c) 2000 The American Physical Society.

Results from a $4\ensuremath{\pi}$ solid angle measurement of the inclusive reaction $({\ensuremath{\pi}}^{+},{\ensuremath{\pi}}^{0})$ on ${}^{2}$H, ${}^{3}$He, and ${}^{4}$He at incident pion energies of ${T}_{{\ensuremath{\pi}}^{+}}=70$, 118, 162, 239, and 330 MeV are presented. The single charge exchange total cross sections were determined, and are compared to previous results and simple models of $\ensuremath{\pi}$--few-nucleon interactions. On the helium isotopes a strong damping of the cross sections in the $\ensuremath{\Delta}(1232)$ energy region is observed. Total cross sections of the breakup reaction ${\ensuremath{\pi}}^{+}{+}^{2}$H $\ensuremath{\rightarrow}{\ensuremath{\pi}}^{+}\mathrm{pn}$ are also given.

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.

Maintenance of plasma glucose is important in endurance performance. Gluconeogenesis or carbohydrate ingestion maintain glucose after hepatic glycogen depletion. Lactate may also serve as a gluconeogenic precursor as well as a blood buffer.To determine if an 8% carbohydrate (CHO) sports drink with and without a 2% lactate (L) solution increased endurance performance, peak power, and delayed blood acidosis, seven trained cyclists participated in a double-blind randomized study (6 males and 1 female) performed a bicycle test to determine max VO2max HR and the HR associated with the first respiratory exchange ratio (RER) value greater than 1.0 (target HR). Four bicycle rides to exhaustion, separated by one week, were done at a constant workload at a HR 10 beats below each subject's target HR. After a 12-hour fast, subjects received 100 g CHO 2-3 hrs before each test. Mean exercise heart rate was 86-87% max HR. During the final 30 s of each ride the Wingate power test was performed. Subjects consumed either (placebo, 2% L, 8% CHO or 8% CHO plus 2% L) every 20 min. Blood samples were collected before, every 30 min during and immediately following the test.No significant differences were observed in total time (placebo: 95.3 +/- 25.8, 2% lactate: 95.7 +/- 30.0, 8% CHO: 105.2 +/- 37.2, 8% CHO + 2% lactate: 89.0 +/- 28.1 min) or peak power (placebo: 798.2 +/- 241.1, 2% L: 750.1 +/- 279.2, 8% CHO: 789.4 +/- 353.5, 8% CHO + 2% L: 716.3 +/- 331.3 Watts) among drinks. There were no differences in insulin, glucose, pH and HCO3- after the power tests among the drinks.Exercise performance is unaffected by oral supplementation with lactate.

Between January 1995 and June 1996, 24 inpatients at our hospital (mean age 55.6 years) were treated with electroconvulsive therapy (ECT). Clinical improvement was observed in 80% of the patients, including those without risk factors (NRG, n = 16), as well as those with concomitant cardiovascular diseases (RG, n = 8). During a mean period of observation of 224 days after the end of ECT 7 patients (35%) relapsed. The rate of relapse was higher in RG than in NRG patients (57.1 vs 23.1%). In all cases ECT was well tolerated; 285 applications of ECT did not result in mortality or persistent morbidity. However, RG patients may be at increased risk for the development of minor cardiovascular complications, which were noted in three RG patients (37.5%), but only in one patient (6.2%) in the NRG (Fisher's test, P = 0.09). Taken together, our results demonstrate that ECT is a safe treatment regimen for depression even in medically ill patients of old age.

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.

The pion absorption reaction (π+,3 p ) on Ar was studied at pion energies of 70, 118, 162 and 239 MeV, and on N and Xe at 239 MeV. The 3p cross section with a 50 MeV cut on the missing energy is presented. The existence of an initial state interaction (ISI) component to the reaction was investigated. The portion of the 3p cross section assigned to the ISI process is less than one half and at lower energies significantly so.

Neutron detection efficiencies for a 4 (pi) plastic scintillator detector were calculated with the Monte Carlo code of Cecil et al for various threshold of 2.5, 5, 7.5, 10 and 20 MeVee, assuming an isotropic distribution of neutrons emerging form the center of the target. A good agreement between the data obtained from the reaction (pi) +4He yields pppn with 120 MeV pions and efficiency calculations has been found. Proton reaction losses for 15, 20 and 35 cm thick plastic detectors were calculated using the GEANT code for proton energies up to 150 MeV. Reaction losses were extracted from the simulated spectra. Our correction curve for proton reaction losses gives slightly higher values than the data of Measday and Serre and the calculation of Janni.© (1997) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.

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.

A gene encoding a human liver carboxylesterase has been isolated and characterized. Analysis of three overlapping genomic λ clones revealed that the gene spans about 30 kb and is made of 14 exons being 39 to 379 bp in length. The encoded protein is 550 amino acids long and is highly homologous to carboxylesterases of various mammalian species. The transcription start site was determined by 5′-RACE PCR. An additional 900 bp of DNA from the 5′ flanking region of the gene was cloned and sequenced in order to elucidate the structure of the promoter. In this sequence several possible binding sites for transcription factors have been identified, but no TATA-box was present. When different parts of the putative promoter region were ligated in front of the luciferase gene and the constructs were transfected into CHO cells, the reporter gene was effectively transcribed, as demonstrated by the expression of enzyme activity.

Despite many published studies no parameter could be identified yet to acceptably and individually predict collection results in stem cell apheresis. We analyzed leukocyte counts and processed blood volume, absolute and relative CD34+ cell counts, and overall collection efficiency in 120 patients with hematological and solid malignancies (354 leukaphereses using the Cobe Spectra cell separator, a median of 3 per patient, span 1-9). Stem cells were mobilized into peripheral blood by conventional chemotherapy followed by daily doses of G-CSF. CD34+ progenitor cell counts were monitored through multiparametric flow cytometry. Blood and collection flows varied in the range of 45-90 ml/min and 0.7-1.5 ml/min, respectively. CD34+ progenitor cells were enriched 38-fold in the apheresis product as compared to peripheral blood at a processed blood volume lower than one total blood volume. Efficiency continuously declined, on to a 25-fold concentration at a processed blood volume above the 3-fold total blood volume. Total collection efficiency, calculated from the absolute content of CD34+ progenitor cells in peripheral blood and apheresis concentrate (a parameter for progenitor cell mobilization during the apheresis), reached a plateau at a processed blood volume above the 3-fold total blood volume. However, variation among individual patients was high. The concentration rate of CD34+ cells at a leukocyte count below 5,000/microliter averaged 50 and declined continuously to 8 at leukocyte counts between 45,000 and 50,000/microliter. To summarize, in 70% of patients with leukocyte counts below 5,000/microliter and CD34+ progenitor cell counts above 10,000/ml, more than 1.5 x 10(6) progenitors per kg body weight could be collected in a single leukapheresis. According to the presented data, the variation in overall collection efficiency is mainly due to: 1) varying mobilization of progenitors during the apheresis procedures itself and 2) dependence on peripheral leukocyte counts.

In photopheresis, 8-methoxypsoralen (8-MOP) is added to a mononuclear cell concentrate and then activated by UVA light, thus forming covalent bonds between DNA strands. Infusion of these modified cells that are not able to replicate any more seems to lead to the elimination of pathogenic T-cell clones and clinical improvement in patients suffering from cutaneous T-cell lymphoma, graft versus host reactions, and various autoimmune diseases. The original method described by Edelson et al. (1987) was improved by the following modifications proposed by Andreu et al. (1994): i) by using a cell separator (COBE Spectra) that produced purer concentrate with less red blood cells absorbing UVA light. ii) By applying 8-MOP directly into the collection bag, the drug side effects due to the oral application of the thousandfold dose and varying serum levels were avoided. iii) By irradiating the concentrate after collection, all cells received the same irradiation dosage. We treated 2 men with cutaneous T-cell lymphoma, 2 women with atopic eczema and 1 man with severe pustular psoriasis with overall 123 extracorporeal photochemotherapy (ECPC) sessions. In addition to routine laboratory analysis, detailed characterization of lymphocyte subpopulations was carried out by flow cytometry to differentiate T-helper and T-suppressor cells and their activation (HLA-DR, CD 25), B, NK cells, and monocyte subpopulations. The following mediators soluble were analyzed as well: Il-2-receptor and as indicators of acute phase reaction Il-8, neopterin and Il-1 beta. We observed a good clinical improvement independent of no significant trend in the immunological phenotype of circulating blood leukocytes. Our results suggest that ECPC effects are not mediated by a systemic immune response or alternatively are not measured in the blood compartment.

Lipoprotein(a) (Lp(a)) is an independent risk factor for arteriosclerosis. It consists of the Lp(a)-specific apo(a) which is bound to the apo-B of an LDL particle by a disulfide bridge. Apo(a) is homologous to parts of the plasminogen molecule: It consists of one kringle 5 and 10-40 kringles 4 of the plasminogen molecule. Due to the lack of alternative drug treatment, 3 patients with early onset of arteriosclerosis, rapid progression, and elevated Lp(a) as their dominating risk factor were treated weekly with specific Lp(a)-aphereses. Since October 1992, we carried out 229 immunoadsorptions (IA) with specific columns containing anti-Lp(a) antibodies covalently bound to sepharose. To reduce Lp(a) from preapheresis values of 142 +/- 53 mg/dl to 25 +/- 11 mg/dl immediately after apheresis, we had to adsorb 1.4-3 patient's plasma volumes. Lp(a) rise to preapheresis values took 3-4 days. Protein reduction caused by loss of plasma during column changes remained tolerable (total protein before IA: 71 +/- 4 g/l, after IA: 56 +/- 4 g/l. Immediately after IA, these values were measured after the application of 991 +/- 207 ml of ACDB with 5,000 IU of heparin as anticoagulant. Hemoglobin remained unchanged (before IA: 13.4 +/- 1.4 g/dl, after IA: 13.6 +/- 1.5 g/dl). Side effects were mainly flush and tachycardia. They were seen especially when using new columns and plasma flow rates above 55 ml/min and were immediately reverted by interrupting the IA. Control angiography performed after 2 years in 2 patients showed no progression of disease, in the 3rd patient, the stress test showed a significant improvement as did clinical parameters. In our hands, IAs are a safe and efficient method for Lp(a) reduction and secondary prevention of myocardial infarction. Therapeutic efficiency should further be proven by a controlled trial.

Multinucleon absorption cross sections have been measured in 3He and 4He with three unbound, energetic nucleons in the final state. The ratios of the different 3NA cross sections are difficult to understand in terms of only two-step processes. Similar difficulties appear in the decomposition of the 3NA yield into mechanisms. Although a part of this yield is identified to be due to two-step processes, a large fraction is well described by a simple phase space model. (AIP)

The absorption of 239 MeV positive pions on $^{3}\mathrm{He}$, $^{4}\mathrm{He}$, N, and Ar is studied. A strong enhancement is seen in the differential cross sections in the kinematic region associated with free $\ensuremath{\pi}\ensuremath{-}p$ scattering. This enhancement is interpreted as a clear signature of initial state interactions in the absorption of pions on nuclei.

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 emission of nn-, np-, nd- and nt-pairs following π−-capture in gaseous 4He has been studied in a coincidence experiment. Quasifree 2N-absorption is the dominant absorption mechanism with a ratio of r = 4.0−1.5+0.8 for absorption on a nucleon pair with isospin I = 0 and I = 1. Also collinear processes involving more than two nucleons have been observed, including NN final-state interaction with small relative momenta as well as emission of deuterons and tritons. Upper limits are given for phase-space-distributed, i.e. non-collinear 3N- and nnd-emission.

Physicians educate their patients by direct teaching and by serving as a role model. Through the use of questionnaires, we evaluated the degree to which physicians in West Virginia participate in these activities. Thirty-five percent of the 2,404 licensed physicians in the state returned completed questionnaires. Although 90% prescribed appropriate diets and recommended exercise for their patients, the physicians who responded were often less likely to follow their own advice. Twenty percent of the male physicians and 13% of the female doctors were obese; 30% had LDL cholesterol levels over 130 mg./dl.; 13% had HDL cholesterol values of less than 35 mg./dl.; and 8% had triglycerides over 250 mg./dl. Participation in regular exercise (30 minutes three times per week) was reported by 48% of the male physicians and 47% of the female physicians. Eight percent of the men were smokers, as were 1.9% of the females. These results suggest that the role model aspect of patient education may need to be improved among some West Virginia physicians. It is an inexpensive method of directing attention to lifestyle in order to decrease preventable disorders such as coronary artery disease, obesity, diabetes, and hypertension.

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.

Heart disease is a significant problem in women. Age, smoking, and hyperlipidemia are potent risk factors, as is the presence of diabetes. Hypertension is less of a risk factor in women than men. Diagnosis of coronary artery disease is most difficult in women, especially using non-invasive techniques, because of a lower prevalence of disease. Thrombolytic therapy may be associated with more bleeding in older, smaller women. Angioplasty and surgical bypass may be more difficult because of smaller coronary artery size in women. Exercise, aspirin, and estrogens appear to decrease the incidence and mortality of heart disease in women, but concern has been raised that the use of resources for the study, prevention and treatment of heart disease has a gender bias, with men receiving more than their fair share.

A method of surgical support of a rapid maxillary expansion is described. Specific osteotomies are performed on the attached region of the maxillary zygomatic process and the dorsal and middle part of the hard palate. The results of 14 patients are demonstrated. Almost all patients underwent surgical correction of sagittal and/or vertical jaw relations after a subsequent harmonization. This surgical orthodontic expansion proved to be an efficient and low pain method of preoperative correction of transverse maxillary deficiencies and facilitated the following skeletal surgery.

In recent years the collection of plasma has been increasingly carried out by apparative plasmapheresis. In the University Hospitals of Göttingen and Würzburg the plasmapheresis machines PCS from Haemonetics, Autopheresis-C from Baxter, as well as Plasmapur-Monitor from Organon-Teknika, were compared with each other and with the conventional centrifugation of blood bags; experiences in routine use were complemented by specific studies. Altogether, the apparative methods distinguished themselves through a high quality of retransfused blood and collected plasma. Furthermore, practicability, donor compatibility and donor safety resulted in good acceptance by both donors and staff.

Weekly plasma donations of 600 ml were carried out for ten weeks on 20 probands to compare the Plasma Collecting System, Autopheresis C, Plamapur Monitor and the conventional double bag centrifugation. In terms of compatibility for the donor the different systems appear comparable. The PCS tubing set has to be emptied by isotonic saline at the end of the procedure. In the Autopheresis C and Plasmapur Monitor special care should be taken not to mix up isotonic saline and anticoagulant solutions. The protein concentration is higher in the centrifugation systems, but platelet contamination is higher, too.

In myeloproliferative disorders many complications are caused by circulatory problems due to high leukocyte or platelet numbers and by hyperviscosity. With cytaphereses and mild cytostatics like Azathioprine, these problems are solved quickly and without major side effects. We report about plateletaphereses for polycythemia vera and megacaryocytic myelosis and leukocytaphereses for chronic myelogenous leukemia. In addition, erythrocytaphereses were carried out successfully in a patient with a combination of heterozygous sickle cell anemia and thalassemia minor.

Patients with non-insulin-dependent diabetes are at greatly increased risk for coronary artery disease. Although exercise training has been shown to decrease risk factors, the presence of obesity, older age, and a sedentary lifestyle make a high-intensity exercise program an unrealistic choice of therapy. Therefore, we examined the effect of a low-to-moderate-intensity (mean 69 per cent of maximal heart rate) walking program on lipids, glucose, insulin, glycosylated hemoglobin and cardiovascular fitness. Nine women and seven men, mean age 56, were randomly assigned to a control or an exercise group which exercised three times per week for two months. Supervised exercise sessions consisted of 40-45 minutes of walking and/or slow jogging. Subjects continued on their usual diets. The trained group showed a significant improvement in VO2max from 1.65 to 1.95 L/min. Resting systolic blood pressure decreased from 141 to 130 mm Hg after training, and resting heart rate decreased from 88 to 81. Glycosylated hemoglobin decreased in the exercise group in seven or eight subjects and in only two of eight controls. Triglycerides decreased in the exercise group from 285 to 223 mg/dl. Body weight, total and HDL cholesterol, glucose, and insulin did not change in either group. These data indicate that a low-to-moderate level of aerobic training, independent of dietary changes, is an effective and feasible method of improving cardiovascular risk factors: physical fitness, systolic blood pressure, plasma triglycerides, and glycemic control in non-insulin-dependent diabetic subjects.