Anti-Chlamydophila immunoglobulin prevalence in sarcoidosis and usual interstitial pneumoniae.

Sarcoidosis and usual interstitial pneumoniae (UIP) are diseases of unknown aetiology affecting the lower respiratory tract. Although there are a number of studies investigating the causal role of these disorders, no micro-organism could be identified as the causal agent. The high incidence of Chlamydophila pneumoniae infections associated with lung injury encouraged the present investigations to screen patients with sarcoidosis and with UIP for their Chlamydophila-specific immune response. Thirty-nine patients with sarcoidosis, 26 patients with UIP and 34 controls were tested for the prevalence of Chlamydophila-specific antibodies in bronchoalveolar lavage fluids (BALF) and sera. Samples were tested for the presence of antibodies in a genus-specific test for Chlamydophila-lipopolysaccharide (LPS) and in a species-specific test for C. pneumoniae. This study revealed a significantly higher prevalence of Chlamydophila LPS-specific immunoglobulin (Ig)-G in the BALF of sarcoidosis patients (36.8%) compared to controls (8.8%) and patients with UIP (12.0%). Similar findings were observed in sera. The prevalence of C. pneumoniae-specific antibodies in BALF was significantly higher in sarcoidosis patients for IgG and IgA (IgG: 74.4%; IgA: 46.2%) and in UIP for IgG (IgG: 50.0%; IgA: 11.5%) compared to controls (IgG: 14.7%; IgA: 14.7%). The elevated prevalence of Chlamydophila-specific antibodies in sarcoidosis patients might implicate Chlamydophila as a causal agent. However, considering the high prevalence of Chlamydophila antibodies in the healthy population, the data presented might reflect Chlamydophila co-infections in pre-injured lungs seen in these patients.

AMPA/kainate receptor-mediated damage to NADPH-diaphorase-containing neurons is Ca2+ dependent.

While exposure times of several hours or more are needed for AMPA or kainate to induce widespread cortical neurodegeneration, the small subset of cortical neurons that contain high concentrations of the enzyme, NADPH-diaphorase (NADPH-d(+) neurons) were destroyed by brief (15-30 min) exposures. AMPA or kainate-induced degeneration of NADPH-d(+) neurons was decreased by removal of extracellular Ca2+ and increased by augmentation of extracellular Ca2+. More than 90% of NADPH-d(+) neurons exhibited kainate-activated Co2+ uptake, suggesting that they possess Ca(2+)-permeable AMPA/kainate receptor-gated channels. The heightened vulnerability of NADPH-d(+) neurons to AMPA or kainate toxicity may reflect rapid Ca2+ entry through these Ca(2+)-permeable channels.

Prognostic value of an automated sperm analysis in IVF or insemination therapy.

During the course of sterility treatment semenograms of 271 IVF and 316 insemination patients were carried out by two automated semen analysers. The parameters of these analyses were correlated to pregnancies resulting from the treatment. Semen samples were analysed in the ejaculate and after swim-up preparation. In addition, the swim-up suspension of IVF patients was measured again 18 h after sperm preparation. Patients were divided into three groups: (1) couples who achieved a pregnancy, (2) couples who did not achieve a pregnancy, and (3) IVF patients with no fertilization of the oocytes. Because of large standard deviations in the quality of ejaculates, the results in the IVF group show no significant differences in the semen parameters of husbands of pregnant and non-pregnant women. In contrast husbands of women with no fertilization have a significantly lower sperm motility. After swim-up preparation these differences no longer occur. A further measurement, taken 18 h later, reveals that there are no differences in the sperm parameters between the pregnant and non-pregnant group. However, the semen quality in the group with no fertilization is significantly reduced. The results of the insemination patients are similar to those of the IVF group. Thus, the results from automated sperm analysers cannot replace either the microscopic or biochemical analysis of an ejaculate and, moreover, cannot be used as prognosis for the fertilization capacity of sperms or a following pregnancy.

[Laparoscopy-assisted vaginal hysterectomy with the Endo GIA 30]. / Die laparoskopisch assistierte vaginale Hysterektomie (LAVH) mit dem Endo GIA 30.

The improvements in laparoscopic techniques have led to the development of laparoscopic assisted hysterectomy. We report on our experience since 1991 with this method on 30 patients using a Multifire Endo GIA 30. After cutting the upper ligaments and the uterine vessels, the uterus was removed through the vagina. To avoid urological complications, the distance between the ureter and the uterus was determined preoperatively by a combined sonographical-radiological procedure. To be absolutely safe from ureter lesions, it is recommended to use an illuminated ureter catheter. Laparoscopic hysterectomy should be used in selected cases only. In a critical indication situation with this technique, it is possible to avoid abdominal hysterectomy without loss of safety because of the excellent intraabdominal view, similar to laparotomy. There were no major complications with this procedure, except one ureter lesion, which was recognised intraoperatively. All patients remained in the hospital for only four days after the operation.

Haptoglobin as a sensitive marker of hemolysis in HELLP-syndrome.

In a prospective study we measured laboratory variables of hemolysis in 25 patients with HELLP-syndrome. Reduced haptoglobin levels were observed in all 25 patients at diagnosis. Elevated bilirubin and plasma hemoglobin levels were observed in 5/25 patients while an abnormal peripheral blood smear was found in 11/25 patients. Our results suggest that haptoglobin is a sensitive parameter for early detection of moderate hemolysis in HELLP-syndrome and should be included in laboratory screening to aid diagnosis.

Analysis of meiotic chromosomes in ejaculates of infertile patients with an increased number of immature germ cells in semen samples.

Seventy-one semen samples of 60 infertile patients with a suggested high number of immature germ cells were assigned for chromosomal analysis. The sperm probes of nine patients did not contain immature germ cell stages apart from spermatids. In 22 probands we could only find early prophase stages or not readable metaphase structures. Only 25 patients could be analysed cytogenetically. The semen sample of each patient contained degenerated germ cell structures associated with desynaptic and fragmented/pulverized metaphase cells. It follows that in each analysed probe we could detect anomalies which can be attributed to errors in the gametic development process and which are possibly connected with the existing teratozoospermia and oligozoospermia. The easy practicality for cytogenetic analysis represents the most important advantage of the described method. The analysis of immature germ cell stages in semen samples makes it possible to bypass or to reduce the incidence of tests biopsies for meiotic chromosome investigation.

[Pelviscopic salpingectomy in ruptured extrauterine pregnancy using an automatic stapler-incision instrument]. / Pelviskopische Salpingektomie bei rupturierter Extrauteringravidität mit Hilfe eines automatischen Klammer-Schneideinstrumentes.

The case report presented describes pelviscopic salpingectomy with ruptured tubal pregnancy carried out by an automatic stapling and cutting instrument. This instrument (EndoGIA 30) was developed for endoscopic intestinal surgery by the Autosuture company. It can be inserted via a 12 mm trocar and allows threefold clip suture of 3.3 cm length on each side of the automatically cut tissue. The clip suture is absolutely blood dry and does not pull anatomic structures out of shape. Unfortunately, the instrument is available for single use only and thus more expensive than the traditional "Semm's three-ligature method" (1979). Nevertheless, it will add an improvement to minimal invasive surgery. One of the indication for its use is to avoid laparotomy in individual cases.

[Diagnosis of early extrauterine pregnancy by serum and Douglas pouch fluid hCG level]. / Diagnose der frühen Extrauteringravidität durch hCG-Bestimmung aus Serum und Douglaspunktat.

In 44 patients with assumed ectopic pregnancy culdocentesis were carried out under transvaginosonographic control. In 23 cases, the clinical diagnosis ectopic pregnancy and in 16 cases, an early intact intrauterine pregnancy could be verified. Five patients had an early abortion. In all patients with an intact intrauterine pregnancy, the cul-de-sac liquid was serious. In 16 of the 23 cases of ectopic pregnancies, the fluid was bloody, 6 aspirates were bloody/serous and one serous. The findings in patients with an early abortion were as follows: three serous, one bloody/serous, one bloody. Further information could be gathered from the comparison of hCG-levels in simultaneously obtained serum samples and cul-de-sac liquid. All intact intrauterine pregnancies were associated with lower hCG-levels in the cul-de-sac liquid than in the serum (ratio: serum/cul-de-sac liquid greater than 1.3). In all ectopic pregnancies but one, we found an inverse constellation (ratio: serum/cul-de-sac liquid less than 0.7). In the described exceptional case the ratio was nearly 1 and when culdocentesis was repeated 5 days later, a ratio of 0.17 proved the clinically suspected ectopic pregnancy. In 3 cases of histologically confirmed intrauterine abortions, the hCG-level in the cul-de-sac liquid was lower than in the serum, in 2 cases of early abortions without histologically proved localisation the hCG-level was slightly above the level in the serum.

[CA-125 serum level in early pregnancy follow hMG/hCG stimulated and unstimulated cycles]. / CA-125-Serumspiegel in der Frühschwangerschaft nach hMG/hCG-stimulierten und nichtstimulierten Zyklen.

The CA-125-antigen could not only be identified in the epithelium of serous ovarian carcinoma, but also in the regular surface epithelium of the endometrium, the decidua and the peritoneum. The aim of this study was, to examine the pattern of CA-125 in the serum of women at early stages of pregnancy, after hMG/hCG-stimulation and subsequent insemination, IVF or GIFT. In particular, it was differentiated between simple or twin pregnancies, ovarian hyperstimulation syndrome and mole pregnancies. 16 patients, who spontaneously became pregnant after cyclus-monitoring, served as a control group. Among the total of 77 patients, 16 women with single pregnancies without stimulation showed an increase of CA-125 values to maximum amounts of 42.9 +/- 18.8 U/ml in the 8th week. 21 patients with single pregnancies after hMG/hCG-treatment and IVF, exhibited maximums of 97.5 +/- 66.8 U/ml in the 6th week, in cases of twins (n = 10) of 216.8 +/- 85.1 U/ml in the 7th week. Considering the group with the hMG/hCG-stimulation and following insemination (n = 20), maximum values of 91.4 +/- 57.3 U/ml were found in the 6th week, just as in the IVF-group. In cases of ovarian hyperstimulation syndrome (n = 5) as well as in such of a mole pregnancy (n = 5), drastically elevated values of 9519 and 1496 U/ml respectively, have been demonstrated. The decidua is regarded as a presumable source of high antigen levels in normal pregnancy, while the peritoneum is assumed to be such as for the ovarian hyperstimulation syndrome. Concerning mole pregnancy, the antigen levels could possibly emerge from the amniotic fluid.(ABSTRACT TRUNCATED AT 250 WORDS)

[Medical and psychosocial effects of methadone substitution in HIV infected substance-dependent patients]. / Medizinische und psychosoziale Effekte der Methadon-Substitution HIV-infizierter Drogenabhängiger.

After an average observation time of 12 months we can confirm that methadone substitution on an outpatient basis has proved significantly useful for a majority of chronically intravenously opiate-dependent HIV-infected patients of the stages CDC IV or WR 3-6 if methadone is given under controlled conditions, the improvement consisting in an amelioration of certain medical and psychosocial parameters. In 25 out of 30 patients methadone substitution resulted in termination of the previously existing intravenous heroin addiction. In the further course of treatment one of these 25 patients could then be induced to undergo a methadone withdrawal course followed by long-term withdrawal therapy. Since the patients were no longer dependent on heroin, they were no longer compelled to procure it under all circumstances, so that crime and prostitution connected with the pressure to obtain heroin by all means were now superfluous. This provided the most important prerequisites for medical and social care for the patients. The decisive factors determining the effectivity of substitution and hence a successful stabilisation are the integration of the patient in a network of care including the family doctor, outpatient HIV care by a relevant clinic, drug advice centre of AIDS help, and a Public Health Office. This also guarantees that the patients act responsibly in respect of their AIDS infection. In very few patients the permanent success of the treatment was at high risk due to unsatisfactory social care, lack of social security measures, progression of the underlying disease, a too low methadone dosage level, and partnership conflicts.

Index-of-refraction change in optically pumped solid-state laser materials.

Degenerate four-wave mixing measurements were made on several Nd(3+)-doped laser materials by resonantly pumping the Nd(3+) ions. The dominant contribution to the signal under these conditions is associated with the difference in polarizabilities of the Nd(3+) ions in the metastable state versus the ground state. Absolute measurements of the signal strengths imply a laser-induced polarizability change of the order of 0.01-0.05 A(3). The results indicate that, for the case of a single-shot laser amplifier system, the beam distortion induced by this population induced change in the refractive index is comparable with the distortion arising from thermal effects.

Pharmacokinetics of indoramin and its metabolite 6-hydroxyindoramin after single and multiple doses to cirrhotic liver patients.

Pharmacokinetic data obtained after intravenous and single and repeat chronic oral dosing of indoramin in nine patients with liver cirrhosis are described. Median plasma clearance is 11.2 ml/min/kg. Terminal disposition half-life is prolonged after intravenous as well as acute and chronic oral dosing (9.1 versus 10.7 versus 12.2 h). Median volume of distribution is 11.2 L/kg. Bioavailability is increased with a wide range of distribution from 12.2 to 75.4%. There is a slight tendency of accumulation during twice daily oral dosing that cannot be explained by the degree of prolongation of half-life. The kinetics of the main metabolite, 6-hydroxyindoramin, are substantially comparable to the kinetics of indoramin with a ratio of 6-hydroxyindoramin/indoramin calculated from the area under plasma concentration-time curve of 0.3, which is within the range of normal. All data suggest that the changed pharmacokinetics are due to altered liver perfusion as would be expected from a substance with a plasma clearance in the magnitude of liver perfusion in normal volunteers. It seems likely that, in patients with liver cirrhosis, similar alpha 1 blocking effects may be achieved with lower doses than in patients with normal liver function.

[Duodenal ulcer - multicenter double-blind study with proglumide]. / Ulcera duodeni - multizentrische Doppelblind-Studie mit Proglumid.

In a randomised multicenter double blind study we investigated the healing-rate with proglumid and an antacid drug, studying 70 in- and outpatients with florid duodenal ulcer. We evaluated the size and depth of 59 chronic duodenal ulcers in 52 patients with endoscopic and x-ray-investigations before and after four-week-treatment. Inpatients of the proglumid-group had a significant higher healing-rate than inpatients in the antacid-group (95% against 70%, p less than 0.05). As found in endoscopy the outpatients in the proglumid-group had a higher healing-rate, but because of the smaller number of patients the difference was not significant. Summarized the in- and outpatients, the proglumid-group had a healing-rate of 83%, the antacid-group of 60% (p less than 0.05). Bigger ulcers with a size more than 120 mm2 at the beginning showed a significant better healing with proglumid than with the antacid-drug (t/2 = 14.6 resp. 24.6 days). With x-ray-examination we could not find differences of healing between the two groups, but younger patients often were not examined. The symptoms of patients did not show a significant difference during the healing-course. We could not find any side-effects. Proglumid is an effective drug for the healing of chronic duodenal ulcers.