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Clinical management of hypertension needs a comprehensive therapeutic approach including both somatic and psychological aspects to ensure long-term treatment success. We have developed and evaluated an integrated outpatient training program for hypertensive patients.The impact of the integrated training program was evaluated in an open label prospective single-center study of 120 consecutive patients. The outpatient training program consisted of moderate physical exercise, patient education (relaxation techniques and stress management) and individual psychotherapy as indicated. Training sessions were held twice weekly during the initial six-month period. Anti-hypertensive medications were managed by the program director in close cooperation with the primary care physician. Hypertension control, medication and program costs were monitored prospectively. Evaluated parameters were measured at study enrolment (T1), upon completion of the six-month program (T2) and at follow-up at 18 +/- 5 months (T3).Maximum exercise capacity increased from 85.1 +/- 1.3% at enrolment (T1) to 95.8 +/- 1.5% of the expected value at 6 months (T2) (p0.005). There was no change in body mass index, though a reduction in anti-hypertensive medication was observed (betablockers, -30.1%; thiazides, -20.9%; ACEI/ARB, -19.8%; calcium channel antagonist, -13.4%; alpha-blockers, -41.5%; p0.05; p0.01). Blood pressure fell from 144.6 +/- 1.8/ 88.1 +/- 0.9 at enrolment (T1) to 136.8 +/- 1.4/83.5 +/- 0.8 mm Hg at 6 month (T2) (p0.01). A similar decrease in systolic blood pressure at submaximal workload of 8.5 +/- 1.4 (6.6-11.2) mm Hg was observed. The daily costs for anti-hypertensive medications decreased 20.7% from EUR 0.92 to 0.73 (p0.01). The overall costs for the program were EUR 970 per patient. At follow-up at 18 +/- 5 months (T3), there was persistence in the reduction in medication use as well as an increase in exercise capacity. Blood pressure control had deteriorated but the values were lower than at enrolment (T1) (p = 0.1, p0.05).The integrated training program represents a comprehensive and effective approach to the treatment of hypertension. The costs of the program are likely to be offset by reduced expenses for anti-hypertensive medications over time at least in part.

Previous studies have shown an inverse association between smoking and the prevalence of Parkinson's disease (PD), suggesting that smoking may induce a biological protection against nigral neuronal damage. In 1993, we examined the frequency of cigarette smokers among 239 patients with PD and two control groups. In addition, the progression of parkinsonism and other clinical features were followed prospectively in smoking and nonsmoking PD patients over an 8-year period. Mortality in the two PD groups was also examined. We found a 50% higher prevalence of smokers in the control groups than in patients with PD. In contrast, during the follow-up period, there were no significant differences in progression of parkinsonism, cognitive impairment, and mood in smoking and nonsmoking patients with PD. Mortality was also similar in the two groups. The lack of influence on disease progression may indicate that cigarette smoking does not have a major neuroprotective effect in patients with already diagnosed PD.

Therapy of essential hypertension needs a comprehensive and broad assessment that includes somatic as well as psychological aims. We examined the effects of out-patient training for hypertensive patients on somatic parameters as well as locus of control and different relevant attitudes of patients. Psychological results are described in this paper. Out of the 50 patients analysis of somatic data distinguish so-called "responders" with clear improvement that permitted reduction of drugs from another group, called "non-responders", for which no reduction of drugs was possible. Analyses of psychological data show that "responders" develop a higher awareness of their body, a more positive attitude towards health, a freer attitude towards pleasure of life, sexuality, play and creativity. Their will to work and produce becomes less important. Internal locus of control (conviction that one is able to influence illness by oneself) is higher in "responders". Furthermore social external locus of control (conviction that following the suggestions of therapists is helpful) rises. Remnants of these effects were found in a follow up 18 months later.

Background: Alteplase is the only approved thrombolytic agent for acute ischaemic stroke. The overall benefit from alteplase is substantial, but some evidence indicates that alteplase also has negative effects on the ischaemic brain. Tenecteplase may be more effective and less harmfull than alteplase, but large randomised controlled phase 3 trials are lacking. The Norwegian Tenecteplase Stroke Trial (NOR-TEST) aims to compare efficacy and safety of tenecteplase vs. alteplase. Methods/Design: NOR-TEST is a multi-centre PROBE (prospective randomised, open-label, blinded endpoint) trial designed to establish superiority of tenecteplase 0.4 mg/kg (single bolus) as compared with alteplase 0.9 mg/kg (10% bolus + 90% infusion/60 minutes) for consecutively admitted patients with acute ischaemic stroke eligible for thrombolytic therapy, i.e. patients a) admitted

Vor genau hundert Jahren wurde das erste Mal der Nobelpreis fur Medizin verliehen. Diese Auszeichnung wurde im Jahre 1901 an Emil Adolph von Behring fur seine Arbeiten uber die Serumtherapie und deren Anwendung gegen die Diphtherie vergeben. Das Nobelpreiskomitee anerkannte damit die herausragende Bedeutung der Arbeiten und Entdeckungen Behring’s, durch die eine neue Dimension in der medizinischen Forschung eroffnet wurde. Behring’s Erkenntnisse beflugelten die Entwicklung der sich erst neu etablierenden wissenschaftlichen Disziplinen Mikrobiologie und Immunologie nicht nur in ihren theoretischen Grundlagen, sondern ermoglichten in relativ kurzer Zeit deren Umsetzung in der klinischen Praxis. Durch Behring’s Entdeckungen wurde in Form der Serumtherapie den Arzten erstmalig eine hochwirksames Heilmittel gegen eine, der gefurchteten Infektionskrankheiten zur Verfugung gestellt. Der Ehrentitel Behring’s, der ihn als „Retter der Kinder und Soldaten“ in die Geschichte der Medizin eingehen lies, scheint jedenfalls gerechtfertigt.

This is a brief comment on results in the common surgical treatment of breast cancer. Based on guiding-lines given by the surgical congress 1985 the decentralized treatment routine as it is common today has been analysed and its results have been applied to our regional structures. Under the premises of standardized diagnosis as well as surgical and postoperative treatment the decentralized treatment of breast cancer is still supported and considered useful. Main critical point in the whole therapy concept is the postoperative treatment, especially the adjuvant therapy. Looking for future solutions it seems to be more effective to reduce the amount of surgical facilities for the benefit of profiling the remaining ones. This could be applicable for the treatment of other diseases as well. The improvements that would result from this conceptional concentration would be profitable as well for the patients as for the surgeons.

Cell or cytodifferentiation marks the structural and physiological development of cells sequestering from mitotic cycles and acquiring specific functions within a plant. This process is sometimes also referred to as cell maturation. Cytodifferentiation has been the subject of general botany for generations, but recently seems to fade from textbooks (cf. Esau, 1965, Salisbury and Ross 1985, Strasburger et al., 1991, Eschrich, 1995), since it has triggered little experimentation to analyze its nature. Rather, a modern molecular approach is needed to substantiate the significance of cytodifferentiation or maturation.

To ascertain prospectively whether age is an independent prognostic factor for patients in a medical intensive care unit (MICU).The data recorded prospectively for all patients admitted to a MICU between October 1994 and April 1996 were analysed with regard to demographic items, admission diagnosis. APACHE II score, days spent in the MICU and mortality rate. The data were arranged by age group and admission diagnosis (APACHE II score).753 patients were admitted, 423 aged 65 or over (56.2%). Analysis of subgroups among the latter revealed a significant decrease in cardiovascular admission diagnoses with increasing age (65-74 years: 59%; 75-84: 55%; 85 or over: 32%), while the opposite trend pertained for pulmonary disease (65-74 years: 10%; 75-84%: 19%; 85 or over: 21%). There was a significant correlation for the total collective between mortality rate and severity of the disease on admission to the MICU (APACHE II score; P0.05). Those 65 years or older had a higher APACHE II score (17.4 vs 12.0; P0.05) and thus a higher mortality rate than the younger patients (25% vs12%; P0.01).Many of the patients admitted to a MICU were aged over 65 years. The incidence of cardiovascular ailments on admission decreased with increasing age, while the opposite trend was true for pulmonary disease. There was no difference in mortality rate between different age groups given similar disease severity.

PURPOSE To determine whether potential alteration in p53 function through p53 gene mutation or mdm-2 overexpression correlates with early treatment failure in childhood acute lymphoblastic leukemia (ALL). PATIENTS AND METHODS Diagnostic marrow samples from 34 children were analyzed for p53 gene alterations by western blot and SSCP/DNA sequence analysis and for mdm-2 overexpression by western blot analysis. These samples were derived from two groups of children with ALL: 17 good outcome patients who are in long-term continuous complete remission and 17 poor outcome patients who did not achieve a complete remission or relapsed within 6 months of achieving remission. RESULTS Two children within the poor outcome group were found to have p53 gene mutations. Furthermore, five poor outcome patients were shown to have greater than 10-fold overexpression of mdm-2 protein compared with the mean level of mdm-2 protein measured in the good outcome group. Aberrant p53 protein expression was found in only one good outcome patient, whereas no good outcome children were found to have elevated levels (> 10-fold) of mdm-2 protein. CONCLUSION We show for the first time that potential alteration in p53 function in childhood ALL is more common (P = .036) in cases of early treatment failure than in children who remain in long-term continuous remission.

Previous studies have indicated that p53 gene mutations were an uncommon event in acute lymphoblastic leukemia (ALL) in children. In one series of 330 patients, p53 mutations were seen in fewer than 3%. We analyzed bone marrow mononuclear cells derived from 10 children with ALL at diagnosis who subsequently failed to achieve a complete remission or who developed relapse within 6 months of attaining complete remission for p53 gene mutations and mdm-2 overexpression. We found that three children had p53 gene mutations, and four overexpressed mdm-2. Also, experiments comparing relative levels of mdm-2 RNA and protein in these patients demonstrated that mdm-2 overexpression can occur at the transcriptional and posttranscriptional level in primary leukemic cells. Although we were unable to link Waf-1 RNA expression with p53 status in childhood ALL, our data show potential p53 inactivation by multiple mechanisms in a large percentage of these patients and demonstrate that these alterations can be detected at diagnosis. Inactivation of the p53 pathway may, therefore, be important in children with ALL who fail to respond to treatment and may be useful for the early identification of children requiring alternative therapies.

BACKGROUND: Patients undergoing chemotherapy for treatment of malignancy frequently experience clinically significant anemia. Myelosuppressive chemotherapy impairs erythropoiesis, which may not fully recover between treatment cycles. Recombinant human erythropoietin (rHuEPO) has been effectively introduced in anemic patients suffering from chronic renal failure. The present study was designed to assess, first, whether rHuEPO treatment decreases transfusion requirements in chemotherapy-induced anemia and, second, whether high-dose rHuEPO application is safe. STUDY DESIGN and METHODS: Thirty consecutive anemic patients (hemoglobin

Laser processing is a high technology treatment which aims to produce specific properties locally on the surface of materials. These properties are strongly dependent on the microstructure formed during the processing, and since laser treatment usually induces local melting, the microstructure is formed during the resolidification of the liquid pool. Therefore, in order to progress further than an empirical approach to the optimisation of processing conditions and the development of appropriate alloys for laser treatment, it is necessary to understand the mechanisms of the formation of microstructure during solidification.

We present a potentially fatal case of acute methaqualone (M) poisoning with very low serum concentrations of M but extremely high levels of its metabolite, 2-methyl-3-(2-hydroxymethyl-phenyl)-4 (3H)-chinazoline (Met-1). A 23-year-old man was admitted to the intensive care unit 2 days after ingestion of 4-5 g M in an suicidal attempt. On admission he was somnolent and poorly responsive to painful stimuli. Physical examination revealed a heart rate of 95 bpm, a blood pressure of 125/65 mmHg, and a normal body temperature. His chest was clear to auscultation, respirations were shallow, and the skin was cyanotic. The electrocardiogram was unremarkable. The chest radiograph showed a normal heart size without pulmonary infiltrates or venous congestion. The pupils were dilated but reactive to light. The neurologic examination was further remarkable for increased limb reflexes, myoclonia, and positive pyramidal signs. During the next 2 days the patient became comatose and developed respiratory insufficiency due to non-cardiogenic pulmonary oedema, which was confirmed by chest radiograph and haemodynamic investigations by means of right heart catheterisation. He required mechanical ventilation for 6 days. Finally, he recovered completely and was discharged in good condition.A lumbar puncture revealed neither blood nor pleocytosis in the cerebrospinal fluid. Cranial computed tomography was carried out on an emergency basis, but no abnormality was disclosed. An electroencephalogram did not exhibit any significant pathological findings. Testing for infectious diseases or porphyria gave negative results. Toxicological screening based on enzyme immunoassays (ELISA) was negative for alcohol, tricyclic antidepressants, benzodiazepines, barbiturates, and morphine, but gave a positive result for M. From the moment of admission daily blood samples were taken and analysed by combined gas chromatography and mass spectrometry. These showed very low levels of M but extremely high levels of Met-1.After gastric lavage, continuous enteric lavage with activated charcoal and mannitol was initiated to minimise intestinal absorption. Since M was hardly detectable in the serum, haemoperfusion was not regarded as indicated for drug elimination and treatment was restricted to general supportive measures. To rule out a central anticholinergic syndrome, an anticholinesterase drug (physostigmine) was administered but remained without therapeutic effect.The presented case is the first report of a life-threatening intoxication after M ingestion primarily caused by Met-1. It supports the significance of this metabolite for the toxic effects of the drug. A toxicological screening test based on ELISA proved helpful due to its cross-reactivity with metabolites. In cases similar to ours, resin haemoperfusion may be indicated to remove the metabolites despite low detectable concentrations of the parent substance in the serum.

The medicinal value of monoterpene indole alkaloids continues to attract interest in their phytochemistry, chemical structure, biosynthesis, and chemothera-peutic activity. Structural complexity and non-profitability of total synthesis, perceived or real shortages in the supply of botanicals, and recent concerns for the environmental impact of wild cropping, made production of these alkaloids in vitro, i.e. by plant cells cultured in bioreactors, a viable prospect. The synthesis and accumulation of monoterpene indole alkaloids in cell cultures received great attention when commercial production of compounds like quinine (1), aj-malicine (2) and catharanthine (6), vinblastine (8) and vincristine (9) appeared attainable. Technologies aimed at increasing alkaloid accumulation by employment of production media, by precursor feeding, elicitation, semi-continuous culture, and by application of enhanced bioreactors were designed to achieve this goal. At present, however, efforts to further promote cell cultures as medici-nals have softened somewhat due to regulatory barriers, but also due to biological barriers. Vinblastine and vincristine, the most desirable Catharanthus alkaloids, did not occur in concentrations which would warrant commercial exploitation of an in vitro process. Research will be required to overcome these barriers. Research into the biosynthesis of monoterpene indole alkaloids, when supplemented with molecular biological approaches, appears to be the most sensitive approach.

1. Reocclusion is still a significant complication after percutaneous transluminal coronary angioplasty. The injury of coronary arteries resulting from PTCA plays an important role in the pathophysiology of both abrupt closure and late restenosis after an initially successful procedure. Cytokines play a pivotal role in the accumulation of circulating blood cells at the endothelium and are known to regulate their interaction with the vessel wall. 2. To obtain further information about this interaction, serum concentrations of soluble endothelial leukocyte adhesion molecule 1 (sELAM-1), leucocyte endothelial cell adhesion molecule 1 (sL-selectin), intercellular adhesion molecule 1 (sICAM-1), interleukin 2 receptor (sIL-2R) and interleukin 8 (IL-8) detected by enzyme-linked immunosorbent assay were monitored in 30 consecutive patients referred for elective PTCA. Fifteen patients who underwent elective coronary angiography without PTCA served as controls. 3. All patients underwent successful first PTCA. Within 24 h the serum concentrations of sELAM-1 increased gradually from 21.7 (SD 7.1) to 48.2 (SD 8.6) ng/ml (P < 0.01); levels of sL-selectin rose from 982.1 (SD 128.7) to 1541.3 (SD 104.6) ng/ml after 48h (P < 0.01). Serum levels of IL-8 remained stable initially, but peaked at the end of the observation time of 72 h (9.4, SD 3.8, versus 16.1, SD 4.9 ng/ml; P < 0.05). A positive correlation was found between the number of dilatations and the rise in these parameters (P < 0.01). No significant changes were found in the serum concentrations of sICAM-1 and sIL-2R after PTCA or in any of the parameters in patients after coronary angiography. 4. We conclude that PTCA induces a significant rise in the concentration of certain adhesion molecules in serum. Thus, we provide preliminary data on the potential role of cytokines for blood cell-endothelium interaction after PTCA. Further investigations and larger numbers of patients are needed to clarify the role of circulating cytokines for endothelial injury and restenosis after PTCA.

Altemans of action potential duration (APD) has been shown to be a precursor of ventricular fibrillation in ischaemic myocardium. We postulated that magnitude of alternans of APD during ischaemia depends not only on the severity of ischaemia but also on disturbed beat-to-beat restitution of APD. Monophasic action potentials were recorded simultaneously from right (RV) and left ventricular (LV) epicardial sites of isolated rabbit hearts. The inter-beat time courses of APD recovery were determined both during normal flow and ischaemia by interposing single cycle length changes ranging from 200 to 800 ms (=electrical restitution) simultaneously at the three recording sites. During normal perfusion, electrical restitution curves showed a steep initial recovery of APD, attaining steady-state values at extrastimulus cycle lengths of only 298±12 ms, with a high degree of uniformity between the three recording sites (inter-site variability 800 ms at 2 min, 5 min and 9 min of ischaemia, respectively (each P

Contemporary concepts of ischaemic ventricular tachyarrhythmias (VTA) are based on increased electrophysiological heterogeneity of the myocardium. We developed a multi-site monophasic action potential recording system for an isolated rabbit heart to study the effects of global ischaemia on the electrophysiological properties at different ventricular sites simultaneously. The hearts were paced from the right ventricle (RV), and conduction time (CT), action potential duration (APD) and total repolarization time (TRT = [CT + APD]) were measured during normal perfusion and ischaemia. The dispersion of these parameters was calculated as the maximal difference between simultaneous recordings. Inducibility of VTA by programmed extrastimulation (ES) was investigated under normal and ischaemic conditions. During global ischaemia, CT increased progressively, showing a faster and greater increase at the left ventricle (LV) than at the RV. After 10 min the prolongation of CT reached a plateau at the LV while it continued to rise in the RV. The dispersion of CT increased from 14.5 +/- 2.7 ms during normal perfusion to a maximum of 79.8 +/- 17.2 ms after 14 min of ischaemia (P < 0.0001). APD was uniform at the three sites (190.9 +/- 10.2, 185.0 +/- 8.6 and 179.3 +/- 9.8 ms, ns) during normal perfusion but changed non-uniformly during ischaemia. There was a transient lengthening of APD until 1 and 3 min of ischaemia at the LV sites followed by a rapid shortening of APD. At the RV site, APD continued to increase until 5 min of ischaemia and then shortened gradually. Consequently, dispersion of APD showed a rapid initial rise from 17.7 +/- 2.7 ms to 77.8 +/- 10.2 ms (P < 0.0001) followed by a slower final increase. TRT was uniform during normal perfusion (210.4 +/- 10.3, 213.1 +/- 7.8, 212.1 +/- 10.3 ms, ns) but became non-uniform during global ischaemia. The dispersion of TRT increased from 15.4 +/- 4.2 ms to 92.6 +/- 23.2 ms (P < 0.0001) during 14 min of global ischaemia. Both CT and APD contributed independently to TRT and could either augment or partially compensate for the ischaemic alterations of the other parameter. ES induced VTA only during ischaemia (3.7 +/- 1.1 VTA per heart, P < 0.0001) at coupling intervals between 220 and 380 ms. The dispersion of TRT of the last regular beat preceding VTA was 67.7 +/- 17.4 ms (P < 0.001). ES which triggered VTA showed a more than two-fold increase of CT dispersion compared to the last steady state beat (122.7 +/- 29.4%, P = 0.0001).(ABSTRACT TRUNCATED AT 400 WORDS)

OBJECTIVE To evaluate the effect of acute cardiogenic pulmonary edema on the concentrations of immune parameters in serum. DESIGN Prospective, controlled study. SETTING Medical ICU. PATIENTS Twenty-four consecutive patients with acute pulmonary edema who had significant clinical improvement within 30 mins and did not show any evidence of either tissue damage or infection. For comparison, 25 healthy, age-matched controls and 25 patients with mild chronic heart failure were also studied. INTERVENTIONS Treatment with oxygen, nitrates, and loop diuretics. MEASUREMENTS Lymphokines, acute-phase reactants, and cortisol concentrations were measured in serial serum and plasma samples. MAIN RESULTS Serum concentrations of soluble CD-8 antigen (soluble CD-8) decreased from 928 +/- 124 (SEM) U/mL on admission to 712 +/- 112 and 579 +/- 67 U/mL after 2 and 6 hrs, respectively (p less than .05, p less than .01), and returned to baseline values within 48 hrs (853 +/- 109 U/mL). Concentrations of soluble interleukin-2 receptor increased from 721 +/- 71 to 1078 +/- 112 and 1226 +/- 128 U/mL 12 and 36 hrs, respectively, after admission (p less than .05, p less than .01). Plasma cortisol concentrations were markedly increased on admission (56.9 +/- 4.7 vs. 13.1 +/- 1.3 micrograms/dL after recovery, p less than .001). Increased cortisol concentrations coincided with the nadir of soluble CD-8. Tumor necrosis factor-alpha remained within normal limits in all patients. Neither acute-phase reactants nor angiotensin converting enzyme activity showed significant changes during the observation period. CONCLUSION The present results indicate significant alterations in the serum concentrations of immune parameters as an effect of an uncomplicated acute cardiogenic pulmonary edema.

1. Plasma levels of endothelin were measured in 30 patients with chronic renal failure, 32 patients on chronic haemodialysis treatment and 25 renal graft recipients with stable renal graft function. 2. In patients with chronic renal failure as well as in patients on regular haemodialysis treatment, mean plasma levels of endothelin were significantly increased (4.59 ± 2.09 pg/ml, 10.08 ± 3.12 pg/ml, respectively) when compared with normal subjects (1.88 ± 0.6 pg/ml, P 3. In the group with chronic renal failure a positive correlation between the plasma level of endothelin and the plasma concentration of creatinine was observed (P 4. Renal graft recipients on cyclosporin A with stable renal graft function had a normal plasma level of endothelin suggesting that cyclosporin A nephrotoxicity is not mediated by endothelin. 5. Hypertensive patients with chronic renal failure or on regular haemodialysis and hypertensive renal graft recipients did not differ from the corresponding normotensive population with regard to the plasma level of endothelin, demonstrating that an increased plasma level of endothelin does not play a major role in the pathogenesis of renal hypertension.

Different laser surface treatments are briefly summarised. The principles which govern the formation of microstructures are presented. Macroscopic aspects of heat flux, which determine the local growth conditions, are discussed together with the formation of microstructures. Special emphasis is placed upon the effects associated with rapid solidification. Finally, the concept of microstructure selection maps, necessary for any rational alloy and process development, is introduced.

Due to the multitude of invasive procedures of today's intensive care medicine, infections from central venous catheters have gained increasing attention. The incidence of bacteremias arising from such devices ranges from less than 0.1 to 0.6 cases per 100 catheter-days. Factors influencing the incidence of catheter-associated infections are related to patient characteristics as well as the purpose and material of the catheter. Silicone catheters seem to carry a lower risk of infection than common polytetrafluorethylene catheters. The most frequently isolated bacteria in catheter-associated infections are coagulase-negative and coagulase-positive staphylococci, enterococci, and pseudomonas species. Septicemias due to Candida albicans frequently complicate the course of immune-compromised patients receiving total parenteral nutrition (TPE). Catheter-associated bacteremias (CAB) can arise from the contaminated hub, from which pathogens migrate intraluminally to the blood stream. When the catheter entry site is infected, bacteria may reach the blood via the extraluminal route and cause septicemia. Endemic outbreaks of CAB often originate from contaminated infusion fluids. As the clinical presentation of "catheter infections" is often uncharacteristic and insidious, a definite diagnosis depends on bacteriological examination of the catheter. Quantitative and semiquantitative culture techniques of the catheter tip help to distinguish colonization from contamination by numbers of colony-forming units per milliliter culture medium. Preliminary results can be obtained by simple Gram or acridine-orange staining of the catheter tip. The most important prophylactic measures to prevent CAB are strictly aseptic conditions when catheters are placed and meticulous care thereafter, preferably by specially trained nurses or "TPE teams".(ABSTRACT TRUNCATED AT 250 WORDS)

Nosokomiale Infektionen betreffen zu 30 – 40% die Harnwege [7, 10]. Ursache dafur ist unter anderem der haufig unvermeidliche Einsatz von transurethralen Blasenkathetern (TUBK) zur Versorgung der Patienten. Besonders im Rahmen der Intensivpflege kann auf eine instrumentelle Harnableitung nur selten verzichtet werden. Dieser Notwendigkeit liegt die exakte Flussigkeitsbilanzierung sowie pflegerische Aspekte bei den meist bewustseinsgestorten Patienten zugrunde. Gerade fur dieses Kollektiv aber ist wegen des meist reduzierten Abwehrpotentials sowie der langen Liegedauer der Katheter das Infektionsrisiko betrachtlich.

Described in this paper is a therapeutic concept by which to cope with Monteggia's fracture in childhood. It is based on experience obtained from 72 cases with injuries of that kind and their evaluation in a group study. Therapeutic approach to the individual case was determined by the following criteria: age of infant, localisation and shape of ulnar fracture, reducibility of capitulum radii, and accompanying injuries requiring treatment on the same arm. The need for surgical stabilisation of ulnar fracture was found to increase along with growing age of the affected child. High-stability anatomic reduction of the ulnar fracture proved to be a prerequisite for safe stabilisation of the radial capitulum. Close reduction has proved to be sufficient in many instances. Open reduction and internal fixation were found to be necessary in cases in which an ulnar fracture was irreducible or instable and/or a radial head was not reducible. Minimal osteosynthesis and plaster cast is considered to be an optional therapy for younger children, whereas ulnar stabilisation by means of plates is preferred for children in somewhat advanced age of childhood. The radial head may be fixed by trans-articular Kirschner's wire (WITT) or primary reconstruction of the annular ligament, using a strip of biceps or triceps tendon, or adaptation around the collum radii and ulna of the proximal radio-ulnar joint by means of a sling of Dexon or Vicryl suture.

1. We determined plasma levels of histamine in uraemic patients and examined their correlation with the presence of pruritus. 2. In 27 patients with chronic renal failure, plasma histamine levels were analysed by radioimmunoassay and were compared with those of 40 healthy adult subjects. The control population showed plasma histamine concentrations of 185 ∓ 33 pg/ml, which were significantly lower than those of the patients with renal insufficiency. The highest levels (552 ± 116 pg of histamine/ml) were found in 16 patients with chronic renal failure (mean serum creatinine 5.1 ∓ 1.0 mg/dl) and severe itching. 3. Twelve patients with pronounced pruritus who were on maintenance haemodialysis (serum creatinine 9.2 ±1.2 mg/dl) had a mean plasma histamine concentration of 515 ± 81 pg/ml. Fifteen patients on regular haemodialysis (serum creatinine 9.0 ± 1.5 mg/dl) and who experienced itching had plasma histamine levels (322 ±40 pg/ml) which were significantly lower (P < 0.01) than those of the patients with pruritus but which were elevated compared with those of the control population (P < 0.01). 4. No correlation could be found between increased plasma histamine levels and the type of dialysis membrane used or the method of sterilization of the membrane. 5. Haemodialysis alone did not reduce plasma histamine concentrations, although high concentrations could be detected in the ultrafiltrate. In six patients a rapid decrease in plasma histamine concentration from 565 ∓ 134 pg/ml to within the normal range could be detected after 60 min of combined haemodialysis and haemoperfusion. 6. Our results show that increased plasma levels of histamine are found in patients with renal insufficiency and pruritus, and we conclude that this mediator might be involved in the genesis of uraemic pruritus.

A technique was developed to surface immobilize plant cells and was scaled up in laboratory size bioreactors. This technique was shown not to hinder the biosynthetic potential of Catharanthus roseus immobilized cells and to induce a partial release (300 microg/L) of serpentine into the culture medium contrary to suspension cultured cells. The release pattern seemed to follow the biosynthesis trends of the product. This release mechanism could be stimulated by a factor of 10 within 2 h by increasing the pH of the culture from 5.0 to 5.5.

The scaleup of the technique of plant cell surface immobilization was performed successfully in specifically designed laboratory size bioreactors. The immobilizing matrix was formed into a vertically wound spiral providing for a high immobilizing area-to-volume ratio (0.8-1.2 cm(-1)). A modified airlift and a mechanically stirred vessel delivered a best bioreactor performance characterized by low biomass frothing and highly efficient plant cell attachment and retention (>or=96%). The growth of Catharanthus roseus cells investigated in these bioreactors was found not to be mass transfer limited. It required mild mixing and aeration levels (k(L)a approximately 10-15 h(-1)). The biomass formation pattern of surface immobilized plant cells generally exhibited a linear growth phase followed by a stationary phase characterized by the presence of residual carbohydrates in the medium, contrary to suspension cultures. This behavior was found to depend on the plant cell type and/or line cultured, as well as on the inoculum age. The space restriction and unidirectional growth of the SIPC biofilm combined with the limited availability of essential intracellular nutrients rapidly accumulated from the medium by the stationary phase inoculated plant cells all likely contributed to the culture behavior.

Preoperative consultation with patients on their imminent hospitalisation for surgery and on aspects of necessary anaesthesia was introduced at the Lübben District Hospital for planned operations in 1977. Five categories of diseases which required general surgery have now been evaluated, in this context. That consultation, based on outpatient practice, has proved helpful in reducing the time of hospitalisation, disability, and pre-admission waiting periods. Surgical and bed capacities were more effectively utilised, and duplicated examinations were avoided. Patients were given a say in surgical timing.

Recombinant human erythropoietin activates a broad spectrum of progenitor cells. Twenty uremic patients on regular hemodialysis received recombinant human Erythropoietin (rhEPO) in a dosage of 50 U/kg body wt (N = 9) and 80 U/kg body wt (N = 11), respectively, three times weekly. The number of circulating hemopoietic progenitor cells colony-forming unit-granulocyte-erythrocyte-macrophage (CFU-mix), burst-forming unit-erythroid (BFU-E) and colony-forming-granulocyte-macrophage (CFU-GM) in peripheral blood were assayed weekly by means of a commonly applied in vitro clonal assay. A significant increase of peripheral CFU-mix, BFU-E and CFU-GM could be observed within one week of supplementation therapy in both groups. The increase of BFU-E was followed by a rise of hematocrit within four and three weeks, respectively. These results suggest that the stimulatory in vivo effect of rhEPO administered in therapeutical doses is not restricted to the erythroid lineage but also includes progenitor cells committed to the myeloid lineage (CFU-GM) as well as the multipotent progenitors CFU-mix. The increment of circulating progenitor cells was seen with a dosage of 80 U/kg body wt and 50 U/kg body wt as well.

Upon exposure to a variety of elicitors, suspension cultures of the Papaver somniferum L. cell line PBI #2009, initiated more than ten years ago (2), produce the benzophenanthridine alkaloids, sanguinarine and dihydrosanguinarine (1). Cells of this line, which when unelicited accumulate, at best, only trace quantities of these alkaloids, release a portion of the product into the culture medium, suggesting a possible long-term, continuous use of the cell material. Because of the potential use of sanguinarine as an antibiotic in oral hygiene products (3), an effort was made to develop efficient production methodology by eliciting and re-eliciting surface immobilized cells. The results of these investigations are presented here.

A method for the analysis of ginkgolides by tlc was developed. It allows for the detection of ginkgolides A, B, and C at the 4-μg level, an 86% increase in sensitivity over previously published methods

6-Oxopiperidine-2-carboxylic acid (OCA; cyclic α-aminoadipic acid) was assayed in fermentations of Penicillium chrysogenum PQ-96 by isotachophoresis and HPLC. From 0.36 mg ml−1 to 2.41 mg ml−1 OCA was accumulated in fermentations during penicillin G biosynthesis.

Treatment of 29 cases of chronic lymphedema of various origins, mostly of the lower limbs, by manual lymph drainage massage resulted in significant changes of neurohormone excretion in the urine, whereas the secretion of 17-KS, thyroxine, minerals, and creatinine was not significantly changed. Comparison of the values of urinalysis before and after manual lymph drainage of the patients showed the following changes: 17-KS; -3.5% (non significant); 17-OH: -31% (significant); adrenaline: +50% (significant); noradrenaline: +19% (significant); serotonin: -22% (significant); 5-HIAA: +21% (significant); histamine: +129% (highly significant); thyroxine: -17% (nonsignificant); creatinine: -17% (nonsignificant); sodium: -1% (nonsignificant); potassium: -14% (nonsignificant). The corresponding values for ten controls were all non significant. These findings underline the importance of adrenaline and noradrenaline release by manual lymph drainage, which improves circulation. On the other hand, our results indicate the involvement of histamine and perhaps of serotonin in lymphedema formation, and suggest a combination of manual lymph drainage massage with antihistamine and antiserotonin treatment.

Papaver somniferum L. (opium poppy) cells were elicited with a Botrytis sp. homogenate and cultured by a semi-continuous process. Elicitation induced synthesis of sanguinarine and dihydrosanguinarine. Significant release of both alkaloids into the culture medium occurred. Medium exchange at 2-day intervals enabled product recovery from spent medium and maintained culture viability. Culture growth was not inhibited by elicitor treatment necessitating sub-culture prior to re-elicitation. Re-elicited cultures displayed an increasing sensitivity (reduced growth rate, higher alkaloid yield) to the elicitor with each successive treatment and did not survive a fourth elicitation.

Directional solidification experiments on dendrites from a melt of succinonitrile-1.3 wt% acetone dendrites have been carried out under the optical microscope. Tip temperatures, tip radii and initial secondary arm spacings have been measured under various growth conditions. The experimental results are in good agreement with Trivedi's theoretical model as far as dendrite growth is concerned. When the growth conditions are close to the cell-to-dendrite transition certain discrepancies appear. The initial secondary arm spacing of dendrites has been found to be approximately 2.1 times the tip radius, in agreement with estimates based on stability theory.

Cell division in soybean cells (Glycine max (L.) Merr.) grown as 100 ml batch cultures with a defined medium under continuous light has been partially synchronized by daily exchange of 2 5 of the cell suspension for an equal amount of fresh medium. Oscillations of the mitotic index showed 30 h periods, MI(max) = 25%. In cell suspensions maintained as a continuous culture partial synchrony was induced by flushing the cultures with N2-pulses of 1 10 sec every 3–4 sec for 90 min per 24 and 30 h, MI(max) = 12–15%. When the suspensions were grown as a batch culture and N2-pulses administered 8 × 30 min 24 h over a period of 4 days, cell division during the following period of constant aeration was synchronized for 1–2 cycles, MI(max) = 26%

Two cell lines of Vinca major L. cv. variegata produced strictosidine lactam as the main alkaloid. Quantities varied from 500–1000 μg/g DW in the high-yielding line and 1–100 μg/g DW in the low-yielding line. Transfer of cells to alkaloid production medium resulted in a 6–8 fold increase in alkaloid production with the high-yielding line, some increase in the low-yielding line and in both lines induced intense greening (up to 200 μg chlorophyll/g DW) indicating chloroplast differentiation. Though in the source plant leaves are the main storage site, no correlation between alkaloid accumulation and chloroplast differentiation could be found.

The measurement of sector areas of load-deflection curves in the Tattersall-Tappin test permits evaluation of the fracture energy dissipated by the microstructure during crack propagation. This method has been applied to the oriented pseudo-binary (Co, Ni)-Cr23C6 eutectic alloys which exhibit an irregular, continuous network of brittle carbides within a ductile (Co, Ni, Cr) phase. In spite of the complexity of the microstructure analysed, the method proposed for measuring the fracture energy seems to be capable of revealing the fundamental influence of the size, volume and properties of the phases on the fracture energy of the alloys. An increase in the fracture energy for crack propagation has been observed with: (a) an increase in the size (spacing) of the phases for a constant volume fraction; (b) an increase in the volume fraction of the ductile phase; (c) a progressive increase of the Ni content of the alloy (for values above 5 wt % Ni); the highest values being observed for the pure ternary system: Co-Cr23C6 and Ni-Cr23C6.