External iliac artery occlusion in a young female cyclist.

After 8 years of high performance training in mountain biking, a top female athlete, aged 23, first complained of diffuse, exercise-induced pain in both thighs. Over a period of the next 4 years, a slight but continuous reduction in her performance was observed, despite having maintained her training regime during the first 2 years. Gradually, pain increased, at last occurring even when she climbed a few stairs. This led to a clinical, echo-Doppler, MR-angiographic and DS-angiographic examination, which showed a complete occlusion of the right iliac external artery with good collateralisation. The left external iliac artery evidenced only small intravascular lesions. Surgical treatment (endarterectomy plus patch angioplasty) eliminated the pain completely. Except for a lipoprotein (a) of 114 mg/dL, no other significant risk factors were found. The influence of a genetic (heterocygotic) low APC-ratio of 1.6 and free protein S of 53% is unclear. This is a typical case of a delayed diagnosis in an athlete. A complete occlusion of an external iliac artery is extremely seldom in young in female athletes. With no indication of a general atherosclerotic or inflammatory process nor congenital abnormalities, an exercise-induced, chronic traumatisation may have caused this pathological condition.

Antimalarial activity of extracts of Abutilon grandiflorum G. Don - a traditional Tanzanian medicinal plant.

The Tanzanian medicinal plant Abutilon grandiflorum G. Don was studied for its in vivo and in vitro antiplasmodial effects. The ethyl acetate extract showed prominent in vivo activity against P. vinckei vinckei in mice and in vitro against P. falciparum strains HB3 and FCB. The extract was only moderately cytotoxic if tested in vitro against the colon cell line HT29. In the in vivo study, the results were significantly influenced by the treatment schedule used, i.e. early treatment with higher doses was more successful than applying the same overall amount over a longer period. Phytochemical analysis of the extract provided no conclusive evidence for the observed parasitological effects.

[Lysis therapy of thrombosis of the superior mesenteric artery]. / Lysetherapie bei arterieller Thrombose der Arteria mesenterica superior.

INTRODUCTION: For surgeons the acute intestinal ischaemia is still a diagnostic and therapeutic challenge. If clinically suspected, the diagnostic procedures such as duplex sonography and arterial angiography should be carried out immediately. Although the diagnosis is often quickly clear, perioperative mortality rate remains high. We report the acute local thrombolytic therapy as an alternative treatment. CASE REPORT: A 80-year-old male patient was referred to our hospital with a complete occlusion of the superior mesenteric artery. Duplex sonography and the arterial angiogram confirmed the clinical diagnosis. Because the patient was assessed to be at high risk we decided to avoid an operation and local thrombolytic therapy using rt-PA and urokinase was carried out. RESULT: The local thrombolytic therapy was successful and led to a complete restoration of the arterial flow within the superior mesenteric artery. The clinical symptoms subsided and no complications were observed. CONCLUSION: Local thrombolytic therapy appears to be a suitable therapeutic option in patients suffering of mesenteric arterial occlusion. Although the duplex sonography often confirms the diagnosis with high accuracy the angiography remains the diagnostic gold standard.

Polymeric proanthocyanidins from the bark of Hamamelis virginiana.

Polymeric proanthocyanidins were isolated from the bark of Hamamelis virginiana L. in yields of about 5 %. Fractionation yielded fractions with similar structures but different molecular weights with DP between 17-29 (thiolysis) and 11-20 (GPC). Polymers were composed predominantly of epicatechin and epigallocatechin as chain extension units at ratio of about 1.3:1. Terminal chain units were catechin (approximately 95 %) and gallocatechin (approximately 5 %). All chain extension units were completely galloylated at position O-3, while chain terminating units were not galloylated. Predominant interflavan linkages were 4 --> 8-bonds.

[The importance of vascular injuries in sport accidents--a rare but serious complication]. / Die Besonderheit von Gefässverletzungen nach Sportunfällen - eine seltene, aber ernst zu nehmende Komplikation.

There are about 1.5 million sports injuries in Germany every year, but concomitant vascular injuries are rarely encountered. Only single cases have been reported in the literature. The records of 216 patients with vascular injuries who were admitted to the university hospital in Jena between 1987 and 1996 were retrospectively reviewed. Six patients sustained a vascular injury during the accident in different kinds of sport. Vascular repair was successfully performed in three cases. Organ resection was necessary in two cases and one patient was treated conservatively. Most vascular lesions are related to blunt trauma which might create delayed symptoms of ischemia. Therefore measurement of limb pressures, Doppler scan, duplex ultrasonography and angiography are adjuncts in patients evaluation. In case of bleeding or complete ischemia the prompt arterial reconstruction is indicated and subsequently minimizes the risk of reperfusion injury.

Spasmolytic effects of baccharis conferta and some of its constituents.

The Nahua of the Mexican state of Veracruz use Baccharis conferta in the treatment of a variety of gastrointestinal illnesses, especially diarrhoea associated with gastrointestinal cramps. The aerial parts of B. conferta were investigated phytochemically and pharmacologically using the guinea pig ileum assay as a model (histamine, KCI and electric stimulation). The crude ethanolic extract showed a dose-dependent antispasmodic effect that was particularly strong in flavonoid-rich fractions (e.g. IC50 value for fraction E.3.1 from the ethyl acetate fraction, in histamine-induced contraction, 10 microg mL(-1)). Several flavonoids (apigenin-4',7-dimethylether, naringenin-4',7-dimethylether, pectolinarigenin and cirsimaritin) were isolated, while others were identified in complex fractions by GC-MS. The flavonoids play an important role in the antispasmodic activity of this indigenous drug. Additionally, oleanolic acid and its methyl ester as well as erythrodiol were isolated. Oleanolic acid methyl ester shows weak antibacterial activity against M. luteusand E. coli (20 microg/spot in a TLC assay). The phytochemical as well as the pharmacological data provide some in-vitro evidence forthe use of B. conferta in thetreatment of gastrointestinal cramps.

Pheophorbide A from Solanum diflorum interferes with NF-kappa B activation.

Continuing our search for biogenic NF-kappa B inhibitors we investigated Solanum diflorum, used by the Istmo Sierra Zapotec Indians of Mexico in the treatment of inflammatory skin conditions. It became obvious very early that the active substance seems to be a degradation product of chlorophyll. Pheophorbide A was identified as one of the key compounds responsible for the NF-kappa B inhibitory activity. The compound interferes with NF-kappa B activation, was cytotoxic if exposed to light, but devoid of any cytotoxic activity in the dark.

[Influence of etiology and morphology of traumatic vascular injuries on outcome, risk of amputation and mortality]. / Einfluss von Atiologie und Morphologie von traumatischen Gefässverletzungen auf Outcome, Amputationsrisiko und Letalität.

In a retrospective trial 159 vascular injuries in 149 patients were registered between 1987-1996. Extremity vessels were injured in 76% of the cases. The same incidence was observed in blunt and penetrating mechanisms. Blunt vascular injuries were associated with an higher rate of live threatening organ damage, longer times of ischaemia (6.5 versus 3.0 h) and an higher mortality (9.7 versus 20.3%) than penetrating injuries. We have found an increased mortality rate in all cases with concomitant trauma of CNS, chest, abdomen or bones. The overall amputation rate in all peripheral vascular injuries has been 22.6%. The functional outcome has been reduced by nerve lesions, amputation and the sequelae of fractures.

Iridoid glycosides from Gmelina philippensis.

Six new iridoids, 6-O-alpha-L-(2"-O-, 3"-O-, 4"-O-tribenzoyl)rhamnopyranosylcatalpol, 6-O-alpha-L-(2"-O-, 3"-O-dibenzoyl, 4"-O-cis-p-coumaroyl)rhamnopyranosylcatalpol, 6-O-alpha-L-(2"-O-, 3"-O-dibenzoyl, 4"-O-trans-p-coumaroyl)rhamnopyranosylcatalpol, 6-O-alpha-L-(2"-O-benzoyl, 3"-O-trans-p-coumaroyl)rhamnopyranosylcatalpol, 6-O-alpha-L-(2"-O-, 3"-O-dibenzoyl)rhamnopyranosylcatalpol, and gmephiloside as well as five known monoacyl and diacyl rhamnopyranosylcatalpol derivatives were isolated from the aerial parts of Gmelina philippensis. Their structures were established by spectroscopic means. Additionally, the known iridoids catalpol, geniposidic acid, gardoside, and 8-epi-loganic acid were identified and quantified by GC and GC-MS. The taxonomic significance of rhamnopyranosylcatalpol derivatives and iridoid acids as chemical characters is discussed.

[Traumatic peripheral vascular injuries]. / Traumatische periphere Gefässverletzungen.

2-4% of vascular injuries need operative reconstruction. In polytraumatized patients the rate is even 10%. Arterial vascular repair should precede venous reconstruction and orthopaedic stabilization due to limb threatening ischemia. Penetration or blunt vascular trauma result either in acute blood loss, ischemia or compartmental compression. Reperfusion syndrome leads to vital threat of patient. Clinical assessment, measurement of limb pressures using a Doppler device and use of duplex ultrasonography are reliable adjuncts in the rapid evaluation. Arteriography is rarely indicated and should be spared for patients with abnormal physical examination. Minimizing ischemia (6-8 h) is an important factor in maximizing limb salvage. Vascular repair include direct anastomosis or lateral suture repair mostly combined with primary shortening of the extremity. In most cases autogenous vein graft is required. Rethrombosis, arteriovenous fistula and pseudoaneurysms are possible complications. Stabilisation of the fracture has priority over vascular reconstruction. The initial steps to success are surgical debridement, adequate bony stabilization mostly by external fixation, revascularisation of vascular injury, immediate fascial decompression and early soft-tissue reconstruction. The best results are obtained when a multidisciplinary approach is used combining expertise in orthopedic surgery, vascular surgery and plastic surgery.

Flavonoids activate wild-type p53.

Flavonoids are diphenyl propanoids widely distributed in edible plants. They play a dual role in mutagenesis and carcinogenesis. Some of them act as anticarcinogens or inhibit the growth of tumour cells, whereas others act as cocarcinogens, are mutagenic or able to induce DNA damage. To further elucidate this dual role, we investigated the influence of apigenin, luteolin and quercetin on the tumour suppressor protein p53, regarding p53 accumulation, cell cycle arrest, apoptosis, and biological activity. We found that incubation of the non-tumour cell line C3H10T1/2CL8 with these flavonoids resulted in induction of p53 accumulation and apoptosis. Apoptosis occurred out of the G2/M phase of the cell cycle. The G2/M arrest seems to be p53-dependent as it did not occur in p53 knockout fibroblasts which further supports the recent finding that p53 is involved in the G2/M checkpoint control. Differences between the flavonoids tested concerned p53 accumulation kinetics as well as the biological activity of accumulated p53 and might be due to different modes of flavonoid action. These data suggest that both aspects of flavonoid effects, i.e. inhibition of tumour growth through cell cycle arrest and induction of apoptosis, are functionally related to p53.

Inhibition of intestinal chloride secretion by proanthocyanidins from Guazuma ulmifolia.

The antisecretory activity of Guazuma ulmifolia bark was examined in rabbit distal colon mounted in an Ussing chamber. Chloride secretion was stimulated by cholera toxin and prostaglandin E2 (PGE2). Guazuma ulmifolia extract (GUE) completely inhibited cholera toxin-induced secretion if the extract was added to the mucosal bath prior to the toxin. Adding the extract after administration of the toxin had no effect on secretion. GUE did not inhibit PGE2-induced chloride secretion. These results indicate an indirect antisecretory mechanism. SDS-PAGE analysis of cholera toxin treated with GUE confirmed this presumption. GUE specifically interacted with the A subunit of the toxin. Preliminary phytochemical examinations showed that the most active fraction contains procyanidins with a degree of polymerisation higher than 8.

Biological and pharmacological activities and further constituents of Hyptis verticillata.

Several extracts of Hyptis verticillata and isolated compounds were evaluated for their anti-inflammatory, antibacterial, antisecretory, and cytotoxic properties. The aerial parts yielded (R)-5-hydroxypyrrolidin-2-one and essential oil with the main components alpha-pinene, beta-pinene, and thymol. Spectroscopic methods (UV, IR, 1H-NMR, 13C-NMR, mass, CD) fully characterized (R)-5-hydroxypyrrolidin-2-one, as it was isolated by a bioassay guided fractionation. The essential oil, (R)-5-hydroxypyrrolidin-2-one, as well as the previously isolated rosmarinic acid and dehydropodophyllotoxine contributed to the antibacterial effects of H. verticillata. Furthermore, rosmarinic acid showed significant capillary stabilizing effects. Sideritoflavone inhibited prostaglandin synthase to a significant extent and had antisecretory effects comparable to those of NPPB. The cytotoxicity of the aqueous extract, as demonstrated using KB and HT 29 cell lines, may be of toxicological relevance in cases of internal application.

Ellagitannins and complex tannins from Quercus petraea bark.

The ellagitannins 2,3-(S)-hexahydroxydiphenoyl-glucose, pedunculagin, vescalagin, and castalagin; the flavanoellagitannins acutissimin A, acutissimin B, eugenigrandin A, guajavin B, and stenophyllanin C; and the procyanidinoellagitannin mongolicanin have been isolated from the bark of Quercus petraea. The ellagitannin fraction had a weak antisecretory effect.

Proanthocyanidins from Quercus petraea Bark.

Flavanols and oligomeric proantho-cyanidins were isolated from oak bark ( QUERCUS PETRAEA) and characterized by acid hydrolysis, gel permeation chromatography, haemanalysis, and complete as well as partial thiolytic degradation. The proantho-cyanidins had an average polymerization degree of 6.1 and a procyanidin: prodelphinidin ratio of 6:4. The prevailing units of the oligomeric chains were (+)-catechin, (-)-epicatechin, and (+)-gallocatechin, minor units were (-)-epicatechin 3- O-gallate and (-)-epigallocatechin 3- O-gallate. The bark contains both hydrolyzable and condensed tannins. Although only 23% of the water-soluble oak bark tannins consisted of oligomeric proanthocyanidins, these contributed with 55% to the astringency of the total tannin fraction.

Indigenous phytotherapy of gastrointestinal disorders in a lowland Mixe community (Oaxaca, Mexico): ethnopharmacologic evaluation.

Gastrointestinal disorders are one of the major health problems in developing countries. Sixty-five plants used popularly in the treatment of such disorders in a Mixe Indian community in Oaxaca (Mexico) and collected during a fieldstudy of 15 months are described. According to indigenous criteria a plant is used in the treatment of a certain illness because of the plant's characteristic smell and taste. Plants with astringent properties are particularly valued to treat diarrhoea and dysentery. Bitter, aromatic and bitter-aromatic plants are especially employed to treat gastrointestinal cramps and pain. Additionally, the efficacy of these plants was evaluated using ethnobotanical, phytochemical and pharmacologic information on the plants. The majority of the plants contain chemicals that may produce the effects desired by the Mixe. Frequently tannin-containing drugs are used to treat diarrhoea and dysentery. A large number of the plants used by the Mixe in the treatment of gastrointestinal pain contain essential oil or bitter principles. As a result of this evaluation, plants were selected which should be studied phytochemically and pharmacologically with priority, to evaluate further their potential in the treatment of gastrointestinal disorders.

Parasitological and microbiological evaluation of Mixe Indian medicinal plants (Mexico).

Medicinal plants are an important health resource in many regions of the Americas and are of particular importance to many Indian communities. Based on a recent ethnobotanical study in Mexico, we investigated the activity of 29 plant extracts against Entamoeba histolytica, three bacteria (Bacillus subtilis, Escherichia coli, and Micrococcus luteus) and two fungi (Cladosporium cucumerinum and Penicillium oxalicum). After separation of these extracts between CH2Cl2 and H2O the resulting phases were also evaluated.