The influence of 8 and 16 mg nicotine patches on sleep in healthy non-smokers.

AIM AND METHODS: The purpose of this study was to determine whether sleep changes are a consequence of nicotine presence or withdrawal during the night, we examined 66 healthy non-smokers (33 males, 33 females, age: 20-25 years) after an adaptation night in a sleep laboratory setting. Subjects were randomized to receive placebo or either 8 or 16 mg nicotine patches during the day or during the night in a double blind, parallel group design. RESULTS: The 16 mg nicotine patch applied during the night caused a reduced sleep period time and sleep efficiency as well as an increased wake time. A reduced REM-sleep latency and subjective sleep quality rating were found in subjects receiving nicotine during the night. Arousals, apneas and periodic leg movements were not affected by nicotine. DISCUSSION: This study documents insomnia-like sleep changes in healthy non-smokers caused by nicotine in a dose-dependent manner. There was no evidence for sleep-related withdrawal symptoms after 13 h of nicotine application.

Increased spatial resolution in transillumination using collimated light.

In traditional transillumination of the breast (diaphanography), the abundance of diffuse light resulting from the use of extended noncollimated sources reduces the visibility of deep seated lesions. A prototype scanning imaging system has been developed to investigate the effectiveness of thin collimated light beams (1.5 mm cross section) synchronized with a similarly collimated detector to increase contrast in lesions normally lost due to the detection of diffuse light. The study demonstrates that detection of opaque 1.5 mm details is possible in phantoms simulating breast tissues 6 mm thick regardless of depth. This is about 10 times better than images obtained on the same samples using present transillumination methods. Furthermore, this study indicates that internal structures (lesions, cysts) in up to 12 mm thick excised breast sections can be visualized by exploiting their frequency-dependent attenuation. This is accomplished by inserting 50 nm interference filters in the input light path, which can be varied in a stepwise manner in the range of 400 nm to 1000 nm. These results demonstrate for the first time that images of lesion-bearing 1 cm or larger tissues can be obtained, thus opening promising possibilities for whole-breast imaging.

Anal sphincter substitute using autologous smooth muscle in a fold-over, half-cylinder, double plasty (SMFD-plasty): a new method of treatment of anorectal incontinence.

A new operative procedure for improving continence is presented. It is used in patients with intermediate and high types of anorectal anomalies. A smooth muscle fold-over half-cylinder double plasty (SMFD-Plasty) is performed in infants immediately following the pull-through which must be done exactly through the puborectal sling. Results in six neonates and 4 older children so far are excellent. This method is a suitable replacement, particularly for the function of the internal sphincter. Further modifications of this new method are presented. They are recommended for secondary surgery (second pull-through, levator plasty, secondary megacolon, and post pull-through anal prolapse) as well as a primary procedure for continence improvement in patients treated according to the posterior method of Pena and de Vries.

Complex long-segment intestinal dysganglionosis.

A case is reported with aganglionosis of the rectum, sigma, and descending colon; dysganglionosis with heterotopic ganglionic cells in the muscularis propria of the hypoganglionic transverse colon; and extreme hypoganglionosis (without detection of ganglionic cells) of the ascending colon and distal ileum. The ileum showed a transition zone with hypoganglionosis and intestinal neuronal dysplasia (IND) type B. As to the etiology of such complex intestinal innervation defects, pre- and perinatal perfusion deficits must be considered because their localization seems to be linked to the vascular anatomy of the colon. Early diagnosis may be difficult, causing a delay in operative treatment and multiple operations. Different manifestations of dysganglionosis may be found in the same patient. The classical continuum of distal aganglionosis followed by proximal hypo- or dysganglionosis and then normally innervated bowel may not always be present. Therefore, in children with recurrent (sub-)ileus after resection of an aganglionic bowel segment, additional dysganglionosis such as IND or hypoganglionosis or even complex intestinal dysganglionosis should be excluded by full-thickness colon and small bowel biopsies.

Acute multilocular osteomyelitis in infancy and childhood.

38 cases of acute multilocular osteomyelitis out of a total of 165 osteomyelitis patients were treated between 1974 and 1986 at the Department of Paediatric Surgery and Paediatric Diseases at the University of Mainz. Osteomyelitis in infants was separated from juvenile osteomyelitis because of the different problems inherent to this disease depending upon the age; likewise, multilocular remote involvement was separated from regional multiple involvement. It was found that distant involvement is of special importance in infancy. 6 of the 8 cases in this group presented with symmetrical involvement. This interesting phenomenon is described in this article for the first time in acute multilocular osteomyelitis; so far, it was known to occur only in chronic recurrent multifocal osteomyelitis (CRMO). The infants in this group were predominantly newborn who were particularly severely handicapped by predisposing factors such as necessary intensive-care measures or surgical interventions. Our findings showed that in this age group most of the problems occurred, namely: 3 deaths and 2 healing defects in 8 children. For this reason it is imperative to effect particularly close monitoring of multilocular acute osteomyelitis in infancy. This must be considered as a paediatric and paediatric-surgical emergency requiring not only accurate diagnostic measures but also early internistic and surgical treatment to improve the prognosis of this specific disease pattern.

Isolation of Mycobacterium paratuberculosis after oral inoculation in uninfected cattle.

Feces from cows naturally infected with Mycobacterium paratuberculosis was given to 6 uninfected heifers by orogastric intubation, to determine whether ingested organisms could be passively excreted and detected by bacteriologic culture of feces (ie, false-positive result). Heifers were paired, and each pair received a different dose of feces on days 1 and 2. Fecal samples were collected from the heifers 3 times daily. Mycobacterium paratuberculosis was detected in fecal samples of all heifers within 18 hours of being given the first dose of feces. The number of colony-forming units peaked on days 3 or 4, and organisms were no longer detected by day 7. The number of colony-forming units in fecal samples from the heifers was approximately proportional to the dose given. On days 15 and 16, the experiment was repeated with feces from a second infected cow. Results were similar to those in the first experiment. All heifers remained seronegative (agar-gel immunodiffusion test and ELISA) and had negative results to the intradermal johnin test throughout the experiment. Lymph node and intestinal tissues were obtained from all 6 heifers at slaughter on day 28. Mycobacterium paratuberculosis was not isolated from mesenteric lymph nodes from the ileocecal valve region, but was isolated from ileal mucosal samples from each heifer.

Health professional workstations and their integration in a hospital information system: the pragmatic approach MEDIAS.

Within the daily workload at a ward there is a considerable amount of information processing. It is the task of a systematic management of hospital information systems to provide health professionals with the right information in the right place at the right time. This paper deals with the consequences for the management of hospital information systems if health professional workstations are introduced as a means for this information logistic and with the experiences gained in the Heidelberg University Hospital. Health professional workstations are formally defined in the context of a three level graph-based model of hospital information systems. It is found that health professional workstations have communication needs not only on the physical level of computer systems in the hospital information system but also on the logical tool level, which is the level of application systems. On this level communication servers or brokers are of considerable importance. In Heidelberg there are about 200 health professional workstations (MEDIAS) in routine use.

Brucellosis in free-living African buffalo (Syncerus caffer): a serological survey.

The rose bengal and complement fixation tests were successfully applied to buffalo (Syncerus caffer) sera. An overall occurrence of 23% positive reactors was obtained, but Brucella infection does not appear to act as an effective culling agent in buffalo. Any eradication programme must take free-living buffalo into account as a possible source of re-infection for cattle.

The efficacy of bacteriological procedures for the isolation of Brucella abortus from abattoir material.

A process of emulsifying and centrifuging abattoir specimens before plating out is described. Brucella abortus was isolated more successfully by this process than by conventional methods, especially in low grade infections. The 5 different media used were equally effective in our attempts at isolation, but growth did not necessarily occur on all 5 plates. In dairy cows, specimens from supra-mammary lymph nodes, udder and iliac lymph nodes accounted for a high percentage of positive isolations.

The use of filter paper discs impregnated with thionin acetate, basic fuchsin and thionin blue in the identification of Brucella species.

Filter paper discs impregnated with solutions containing 0.25, 0.5 and 1 mg/milliliter of thionin acetate, 0.75 and 1.5 mg/milliliter of basic fuchsin and 0.5 mg/milliliter of thionin blue were used in the typing of Brucella species. All the strains used reacted as expected, proving this new technique to be reliable in the identification of Brucella species. The method is less expensive and the results easier to interpret than those obtained with methods previously used.

The incidence of Coxiella burnetii antibodies in cattle in the Transvaal.

With the use of the complement fixation test, 8,900 cattle were tested for antibodies to Coxiella burnetii. These were randomly selected from 178 different farms in 37 districts in the Transvaal. The percentage of cattle in the sample with positive antibody titres was equal to 7.78%, with a standard error of 0.28%. Because of the large size of the sample, asymptotic normality can be relied upon and the population confidence interval calculated. This was found to be greater than or = 0.07 and less than or = 0.085 at a 99% confidence level. Hence we are 99% confident that between 7% and 8.5% of the cattle in the Transvaal had antibodies to Coxiella burnetii during the period March 1985 to July 1986. The proportion of cattle with C. burnetii antibodies was also estimated for each of the 37 districts tested. Every district tested had some evidence of C. burnetii. The percentage of positive titres ranged from less than 1%-30% per district. This suggests that C. burnetii is probably an endemic disease of the cattle population of the Transvaal. A higher proportion of cattle had antibody titres in the central and south-eastern parts of the Transvaal. This distribution may be linked to the distribution of Boophilus species ticks which occur in the same areas of the Transvaal.

The use of cephalothin and triphenyltetrazolium chloride impregnated filter paper strips in the identification of Campylobacter species.

Filter paper impregnated strips using cephalothin at 30 and 60 micrograms/ml and triphenyltetrazolium chloride at 20 mg/ml were prepared and used in the typing of catalase-positive Campylobacter species. There was no difference in the sensitivity of campylobacters to cephalothin at 30 micrograms/ml and 60 micrograms/ml. Results were as reported by other workers except for a C. jejuni strain which was resistant to the triphenyltetrazolium. The technique is nevertheless inexpensive and the results are consistent and easy to interpret.

A rapid microtitration serum agglutination test for the detection of contagious equine metritis antibodies.

A microtitration serum agglutination test, based on that used for brucellosis, has been developed to detect antibodies in the sera of horses exposed to the contagious equine metritis (CEM) organism. Two known positive sera were tested 100 times in 15 separate tests. The results were reproducible to within a twofold range. The test is capable of being carried out within 100 min.

A short, reliable, highly reproducible complement fixation test for the serological diagnosis of contagious equine metritis.

A complement fixation test, using round-bottomed microtitration plates and an 8 channel microdiluter, based on that used for brucellosis by Herr, Huchzermeyer, Te Brugge, Williamson, Roos & Schiele, 1985, has been developed for use on the sera of horses to detect antibodies to the contagious equine metritis organism. The results with 2 known positive sera tested 116 times in 27 separate tests were reproducible for the most part within a twofold range. They seldom exceeded these limits and never exceeded a fourfold range. The test itself is capable of being carried out within 90 min. The test was slightly more sensitive when sera were inactivated in a hot air oven for 50 min at 58 degrees C, as compared to inactivation at 62 degrees C in a water-bath for 50 min. There were no false negative or false positive reactions and no anticomplementary activity in the sera tested.

The reproducibility of results in bovine brucellosis serology and their correlation with the isolation of Brucella abortus.

In both the complement fixation test (CFT) and the serum agglutination test (SAT) titres were reproducible for the most part within a twofold range. They seldom exceeded these limits and never a fourfold range. Brucella abortus was successfully isolated in 86% of serologically positive cases and evidence is presented to confirm the use of the 30 International Units/ml level in the CFT as being diagnostically significant. The SAT, when done in microtitration plates, is even more reproducible than when done in tubes. The incidence of infected animals aborting or calving down with negative titres was found to be low.

The relationship between the minimal and the 50% haemolytic dose in complement titrations.

The 50% spectrophotometric complement titration end-point (C'H50) was found to be more reproducible than the 100% end-point. The relationship of the 100% end-point (MHD) to the (C'H50) was 1:2, 5. The use of thrombin tubes induced clotting within 2 min and enabled the process of complement preparation to be completed well within 1 hour.

Wesselsbron disease: a cause of congenital porencephaly and cerebellar hypoplasia in calves.

Fifteen pregnant cows were inoculated subcutaneously and intravenously between 101-147 days of gestation with the wild-type Wesselsbron disease virus. In addition, 2 foetuses were injected directly through the uterine wall after surgical exposure of the pregnant horn. The clinical symptoms, viraemia and serology in the cows are reported, as also the gross- and histopathology and the virological and serological results of the calves and foetuses. Abortion was not an important manifestation of experimental Wesselsbron disease in cows, as it occurred in 3 animals only. Apart from a short temperature reaction in some cows no other clinical symptoms were recorded. A viraemia was not always present in these cows and, when detected, was of low magnitude and short duration. One cow, in which the foetus was ioculated at 115 days of gestation, aborted at 231 days. The foetus showed marked porencephaly and cerebellar hypoplasia.

The use of sensitivity discs in the identification of Campylobacter species.

Filter paper discs were impregnated with a solution containing 20 mg of triphenyltetrazolium chloride per millilitre, and used in the typing of catalase-positive Campylobacter species. Also used were filter paper discs impregnated with cephalothin at 30 micrograms/ml, 60 micrograms/ml and 3 mg/ml and nalidixic acid at the same concentrations, as well as commercially available discs containing 30 micrograms of, respectively, cephalothin and nalidixic acid. Results obtained proved the technique to be reliable and easier to interpret than previously used methods, and laboratory prepared filter paper discs compared favourably with commercial discs.

The use of meso-erythritol sensitivity discs in the typing of Brucella strains.

Sensitivity discs containing 1 and 2 mg meso-erythritol were found to give comparable results to the use of meso-erythritol incorporated into growth medium at 1 and 2 mg/ml. The discs proved easy and efficient when used in a disc ring together with benzyl penicillin and streptomycin sulphate discs.