Gray value differences to dentin of root posts radiographed with digital intraoral systems and conventional X-ray films.

This study compared the gray value differences to dentin of titanium and FRC root posts in anterior and posterior teeth radiographed with digital intraoral systems and conventional x-ray film. Radiographic images (n=5) of titanium or fiber-reinforced composite (FRC) root posts placed in extracted teeth were taken with six digital intraoral radiographic devices and conventional x-ray film (control group). Gray value differences were evaluated between the root posts and root dentin. Statistical analyses of the results were performed with three-way and one-way ANOVA with Bonferroni-Dunn's multiple comparisons post-hoc analyses (α=0.05). Significantly higher gray value differences of titanium and FRC posts were found in anterior teeth but not in molars for XIOS, Sidexis and Visualix digital intraoral systems, but not for RVG, DenOptix and VistaScan (FRC posts). Except for DenOptix with incisors and molars and VistaScan with molars, conventional x-ray films showed significantly lower gray value differences of titanium posts in incisors and molars compared to the corresponding digital radiographs.

[Diabetic foot syndrome-Part 1 : Definition, pathophysiology, diagnostics and classification]. / Diabetisches Fußsyndrom ­ Teil 1 : Definition, Pathophysiologie, Diagnostik und Klassifikation.

There are ca. 8 million persons with diabetes mellitus living in Germany. A late sequelae of diabetes is the diabetic foot syndrome (DFS), the prevalence of which is greatly increasing. It comprises all alterations of the foot as a result of diabetic polyneuropathy as well as microvascular and macrovascular (peripheral arterial occlusive disease, PAOD) alterations. Many of the ca. 250,000 newly diagnosed diabetic foot ulcers per year become chronic wounds. Despite intensive efforts for prevention, early diagnosis and adequate wound care, ca. 13,000 persons with diabetes undergo major limb amputation in Germany every year. With consistent treatment in interdisciplinary centers and by exhausting all possible methods of wound treatment, pressure relief as well as arterial revascularization, the major amputation rate in patients with diabetic foot problems can be reduced by 80%. With a suitable strategy of prevention, the recurrence rate of foot ulcers would be reduced.

[Diabetic foot syndrome-Part 2 : Revascularization, treatment alternatives, care structures, recurrency prophylaxis]. / Diabetisches Fußsyndrom ­ Teil 2 : Revaskularisation, Behandlungsalternativen, Versorgungsstrukturen, Rezidivprophylaxe.

Diabetic foot syndrome (DFS) is the most frequent reason for major amputations in Germany. The majority of foot lesions are triggered by repetitive pressure in diabetic polyneuropathy. Peripheral arterial occlusive disease (PAOD) impairs wound healing and is the main risk factor for amputations. The treatment of wounds and infections as well as timely revascularization are decisive. The use of endovascular and vascular surgical methods depends on the distribution pattern and length of the occlusion processes. Both procedures are complementary. Bypass surgery is of great importance for neuroischemic DFS. Multidisciplinary centers that provide revascularization in DFS can achieve an improvement of arterial blood flow in 90% of the cases and reduce the amputation rate by up to 80%. Due to the high recurrence rate of diabetic foot lesions, measures for secondary prophylaxis are of exceptional importance (podological and orthopedic technical care, foot surgery).

Intrarenal complement fixation by cytotxic antibodies.

The reactivity of histocompatibility antigens with serum antibodies and complement was studied in a short term model of allotransplantation. Lewis and DA rat kidneys were perfused with cytotoxic antisera and tissue sections analyzed for adsorption of fluorescent antibodies against gamma-globulin and complement (beta(1C) protein). Both, the presumed cytotoxic antibody and C were localized at similar sites in the endothelial lining and in the walls of the arterial vessels and of the larger veins. The pattern of immune globulin deposition was distinct from that observed in glomerulonephritis. It may thus become helpful in the differential diagnosis between graft rejection and glomerulonephritis. At the sites of the deposits, the endothelial cells appeared enlarged and their nuclei protruded into the lumen. The findings are in line with the hypothesis that an antibody-mediated local activation of serum complement may be involved in the destruction of allografted tissue.

Allograft rejection in C'6 defective rabbits.

27 skin allografts were transplanted in duplicate to 13 rabbits defective in the sixth component (C'6) of complement (C'). 14 were rejected within the normal period of time and 9 only after a significant delay. In four grafts, no rejection was observed. Grafts exchanged between C' active and C' defective littermates tended to persist viable longer on the C' defective partners. It is concluded that in a species of higher vertebrates, the rabbit, allograft rejection can proceed in the absence of C'6 and the biological functions depending on it. This includes the cytotoxic function of complement. However, the prolonged survival in C'6 defective rabbits of some allografts strongly suggests that two pathways may be operative in the rejection reaction. The results are consistent with the view that a mechanism independent of C'6 was alone fully effective in the majority of the donor-host combinations. A C'6-dependent mechanism became influential only in some specific donor-host combinations.

Deficiency of the sixth component of complement in rabbits with an inherited complement defect.

A strain of rabbits with an inherited complement deficiency was shown to lack the sixth component of the hemolytic complement system. A method was elaborated for the partial purification of this component from normal rabbit serum. Upon injection of partially purified rabbit C'6 into C'6-deficient animals, an antibody was obtained which specifically inhibited the hemolytic activity of C'6. The data suggest that C'6-deficient serum either lacks the C'6 molecule or contains it in a chemically modified and inactive form.

Noninvasive measurements of tissue perfusion in critical limb ischemia.

Critical limb ischemia (CLI) remains a challenge for an interdisciplinary therapeutic team due to chronic nonhealing wounds. Against this background, there is a necessity of quality control after revascularization. Beside the isolated evaluation of the macrocirculation by Ankle-Brachial or Toe-Brachial Index measurements, the microcirculation as an additional important factor of wound healing often remains underestimated. The following article gives an overview about the current investigation methods for noninvasive perfusion control of the CLI patient. Therefore, transcutaneous oxygen pressure (tcpO2), the "oxygen-to-see" method which is a combination of white light tissue spectrometry and laser-Doppler flowmetry, fluorescence angiography with indocyanine green, and multispectral optoacoustic tomography will be described.

The film-based printout using Tetenal Printing Solution II.

Digital radiography continues to gain in importance in today's surgeries. Compared to conventional x-ray films, it has the following advantages: archiving is improved, film processing is redundant, image post-processing is possible, radiographic images can be sent electronically, and radiation exposure times are shorter. Even though radiographic images are usually interpreted on the monitor, printouts are still required--as experience in general radiology shows--when patient's radiographs are passed on. Of course, printouts of digital images using a standard printer and ordinary paper are not suitable for assessment, due to the properties of the paper. Owing to the structures in the paper, a printout is not transparent, and loses all diagnostic value when inspected on a view box.

Immunochemical analyses of membrane-bound complement. Detection of the terminal complement complex and its similarity to "intrinsic" erythrocyte membrane proteins.

(1) Membranes of sheep erythrocytes lysed with antibody and human or rabbit complement were solubilized in non-ionic detergents (Triton X-100 or Berol EMU-043) and analysed immunochemically using antisera directed against individual complement components. The precipitation behaviour of membrane-bound C3, C5, C6 and C9 components of complement was examined by immuno-double diffusion, rocket- and crossed immunoelectrophoresis performed in agarose gels containing 1% non-ionic detergent. (2) Membrane-bound C5, C6 and C9 are antigenically altered compared with the native (serum) components. (3) Immuno-double diffusion in the presence of non-ionic detergents reveals formation of C5-C6-C9 complexes on the membranes; these complexes are stable in non-ionic detergent. No complex formation was detected in serum between native C5, C6 and C9 components. There was also no evidence for complexing between membrane-bound C3, C4 or membrane proteins and the "late-reacting" complement components. (4) The extractability of complement components by various manipulations has been studied by use of quantitative rocket immunoelectrophoresis. Up to 65% of membrane-bound C3 is readily extracted by dialysis of membranes against 1mM EDTA, pH 8.0, 100 mM EDTA, pH 8.0, 1.2 NaCl plus or minus EDTA, by extraction in isotonic buffers at 37 degrees C, by heating at 45 degrees C over several hours, or by treating membranes with 1 mM p-chloromercuribenzoate sulfonate. In contrast, less than 6% of the terminal complement complex can be eluted by any of the described methods or combination of methods. (5) Our data suggest that the terminal complement complex associates with membrane "core" components through apolar interactions.

A new screening test for C3 nephritis factor based on a stable cell bound convertase on sheep erythrocytes.

C3 nephritis factor (C3nef) activity was measured by the incubation of sheep erythrocytes with a mixture of normal human serum and patient's serum in EGTA followed by lysis of the washed cells with rat C in EDTA. The C convertase activity on the cells was dependent on the dose of patient's serum. Activation of human C3-C9 by the washed cells was shown by lysis of susceptible target cells (chicken erythrocytes). The test is specific for C3nef.

The fifth component of complement (C5): purification without activation.

In the course of our studies on the structural change of C5 by acidification (U. Rother et al., 1978), we found that the C5 preparations purified according to published methods contained more or less activated C56. When added to sensitive target cells (guinea pig or chicken erythrocytes), C5 mediated lysis by C7-C9 without the addition of C6 or any activation procedure. Generation of C56 was probably due to drastic changes in the physicochemical environment during purification. Such changes like high or low pH or high ionic strength were shown to cause activation. A method for purification of C5 is described in which polyethyleneglycol (PEG) or (NH4)2SO4 precipitation, as well as low or high pH, was avoided. As a last step, traces of C6 were removed by affinity chromatography. The resulting preparation was free of C56. Activation by acidification was not possible without the addition of C6. The total recovery of C5 was 12% with almost no loss of specific activity.

Glycophorin A inhibits lysis by the complement attack phase.

A glycoprotein from human erythrocyte membranes has been found to inhibit lysis of target cells by the attack-phase components C5-C9 from human complement. The inhibiting molecule was purified and identified as glycophorin A. Thus, glycophorin A may have a regulatory function in the lytic complement attack on isologous cells.

Failure of IgA cold agglutinin to activate C.

No complement (C) activation was observed when IgA cold agglutinin was reacted with its antigen on RBC. Neither C-consumption (CH50) nor C1 binding (classical pathway) nor conversion of factor B or C3 (alternative pathway) could be detected. In contrast, IgM cold agglutinins under the same conditions did activate the classical pathway. If the IgA was heat aggregated it was able to activate the alternative pathway as evidenced by factor B and C3 conversion. The result is consistent with the absence of in vivo hemolysis in patients with IgA cold agglutinins.

Isolation of late complement components by affinity chromatography. II. Purification of the human complement component C6.

We developed a new procedure for the rapid and gentle isolation of the human complement component C6 comparable to that described previously for C9. The procedure is based on affinity chromatography. As a first step, C6 is immunoabsorbed on insolubilized anti-C6 antibodies. These antibodies were derived from C6-defective rabbits (Freiburg strain). C6 was eluted with 3 M thiocyanate, pH 7.2, with a recovery of 15--23% of its hemolytic activity and a more than 270--fold purification. Impurities were removed in a second step by an "anti-impurity" column. The final product yielded a 12% recovery of the hemolytic activity and the purification factor was higher than 1300. The final product was homogeneous in SDS polyacrylamide and immunoelectrophoresis.

C5a-induced chemiluminescence of human granulocytes and its amplification by a serum factor.

Purified human C5a elicits a fast chemiluminescence (CL) response from isolated human granulocytes in the presence of Lucigenin (bis-N-methylacridinium nitrate). The reaction is inhibitable to more than 90% by superoxide dismutase (SOD) - final concentration 200 micrograms/ml -, to about 60% by catalase - final concentration 10 mg/ml - and to 30% by the hydroxyl radical scavenger D-mannit - final concentration 100 mM. Therefore O2- seems to be the oxygen radical responsible for most of the CL, while OH and H2O2 are also involved. Addition of normal pool serum to the cells for 1-2 min before stimulation with C5a strongly enhances the effect in a dose and time-dependent manner. Therefore the existence of a "helper activity" in serum amplifying the C5a-induced CL of granulocytes is postulated. This "helper activity" is, however, no specific for C5a, since CL responses elicited with the chemotactic peptide f-met-phe or by phorbol-myristate-acetate (PMA) are also enhanced by preincubation with serum. In contrast, ConA-induced CL is not enhanced but decreased. Therefore, though not unique to C5a-induced CL, the "helper activity" seems not to represent a general "adjuvans" effect of serum on the granulocytes, but to be restricted to certain stimuli.

Lysis of paroxysmal nocturnal hemoglobinuria erythrocytes by acid-activated serum.

Erythrocytes from paroxysmal nocturnal hemoglobinuria patients (PNH-E) are much more susceptible to lysis by acid-activated human serum than normal human erythrocytes. Acidification of normal human serum to pH 6.4 in the absence of erythrocytes generates this lytic activity independently of the alternative pathway of complement activation. A shift of pH of a mixture of purified human C5 and C6 to 6.4 at 0 degrees C generates a similar activity C(56)a that lyses PNH-E together with C7-C9 much more efficiently than normal erythrocytes. Since acid-activation of normal human serum occurs in the absence of C3, the acid-activated C56 appears to be the lytic principle in acidified human serum.

Effect of spleen exposure to ultrasound on cellular and antibody-mediated immune reactions in man.

Spleen exposure to ultrasound has been reported to influence antibody response to sheep red blood cell injection in mice (decreased hemagglutination and hemolytic titers and IgM, IgG2a and IgG2b levels and elevated IgG1 levels). In a controlled clinical trial, we investigated the possible immunosuppressive side-effect of splenic exposure (2.0 mW/m2, 3.5 MHz, 5 minutes) to ultrasound on the immune response to Rubella vaccination in 41 anti-Rubella antibody-negative volunteers. The measured parameters (blood cell count, IgA, IgM, IgG including subclasses IgG1-IgG4, isoagglutinins, anti-Rubella hemagglutinin and hemolysin titers, complement C3, skin tests to mumps and tuberculin, T, B and O lymphocytes, esterase-positive and negative T-cell subsets) suggest changes dependent on the time of vaccination, but provide no evidence of an immunosuppressive effect of ultrasound in man.

The role of complement in inflammation.

The inflammatory process may be initiated by a great variety of stimuli. Amongst the diverse pathogenic pathways that lead from the primary stimulus to the tissue response, the serum complement system (C) seems the most important and, certainly, it is the best analyzed of the mediator systems.

On the transport of various endogenous plasma proteins from blood to peripheral lymph in man.

A method to prepare peripheral lymph out of the foot of clinically healthy patients with respect to their blood capillaries and lymph vessels is presented. Following electrophoresis in molecular sieving polyacrylamide gel the lymph/plasma quotients of precentages of identical protein fractions in both body fluids as well as of their concentrations were graphically displayed dependent on their migration velocity within the gel. As the high or low lymph-plasma-relations are necessarily to be interpreted in the sense of a relatively high or low blood-lymph permeation the findings are speaking against an exclusive effect of the molecular sieving principle at the blood-tissue-barrier. An explanation for special lymph-plasma-relations would be provided by the assumption of a gel-filtration effect in the extravascular circuit of plasma-proteins. The results affirm the findings of former experiments on animals in an analogue model. The method as well as simplified variants might be useful for the investigation of peripheral nutritive disorders as well as of clinicopharmacological questionings.

Digital transversal slice imaging in dental-maxillofacial radiology: from pantomography to digital volume tomography.

With digital transversal slice imaging (TSI) as a supplementary program to pantomographic devices and digital volume tomography (DVT), images of the viscerocranium are now possible in several planes. The two procedures, TSI and DVT, are complementary. They should be applied where the indication justifies it in dentistry and maxillofacial surgery for diagnostic and forensic purposes. To minimize patient exposure to radiation, computer tomography (CT) should only be used in complex situations of the viscerocranium where soft tissues are involved or in tumor diagnosis.