[Anesthesia in children and adolescents with congenital heart defects]. / Anästhesie bei Kindern und Jugendlichen nach angeborenen Herzfehlern.

The incidence of congenital heart defects (CHD) has remained constant over many years; however, due to improved therapeutic options an increasing number of children and adolescents even with complex heart defects now reach adulthood. The increasing prevalence of adults with persisting or surgically corrected CHD as well as age-dependent non-cardiac comorbidities will increase the need for medical and non-cardiac surgical treatment in this population. Although elective medical care for these patients should be reserved for highly specialized centers, emergency treatment might become necessary in a non-specialized hospital setting as well. Due to the variety and complexity of CHD it is difficult to provide standardized guidelines for the anesthetic management. The treatment of patients with complex CHD requires a profound understanding of the underlying CHD and the current state of the hemodynamics by the anesthesiologist. Furthermore, typical comorbidities, such as chronic heart failure, altered coagulation and arrhythmia also have to be taken into account to ensure successful perioperative treatment. Especially in patients with shunt lesions or passive pulmonary blood flow the anesthetic management often substantially affects the hemodynamics and may be the starting point of severe decompensation. Awareness of anesthesia-induced changes of pulmonary and/or systemic vascular resistance as well as of preload alterations are the basis for successful anesthetic management. Finally, a multidisciplinary approach including cardiologists and radiologists in the planning is absolutely essential to achieve an optimal postoperative result for the patient.

Assessment of lead exposure in schoolchildren from Jakarta.

Children attending schools in urban areas with high traffic density are a high risk group for lead poisoning. We assessed the magnitude of lead exposure in schoolchildren from Jakarta by analyzing blood lead concentrations and biomarkers of heme biosynthesis. A total of 131 children from four public elementary schools in Jakarta (two in the southern district and two in the central district) were enrolled in the study. To evaluate lead pollution in each area, soil samples and tap water were collected. The mean blood lead concentration was higher in the central district than in the southern district (8.3 +/- 2.8 vs. 6.9 +/- 3.5 microg/100 ml; p<0.05); 26.7% of the children had lead levels greater than 10 microg/100 ml. In 24% of the children, zinc protoporphyrin concentrations were over 70 micromol/mol hemoglobin; in 17% of the samples, hemoglobin was less than 11 g/100 ml. All other values were within the physiological range. Blood lead concentration and hematological biomarkers were not correlated. Analyses of tap water revealed lead values under 0. 01 mg/l; lead contamination of soil ranged from 77 to 223 ppm. Our data indicate that Indonesian children living in urban areas are at increased risk for blood lead levels above the actual acceptable limit. Activities to reduce pollution (e.g., reduction of lead in gasoline) and continuous monitoring of lead exposure are strongly recommended.

Therapeutic optimization of atrioventricular delay in cardiosurgical ICU patients by noninvasive cardiac output measurements versus pulse contour analysis.

BACKGROUND: Optimizing atrioventricular (AV) delay improves cardiac output and postoperative outcome. Impedance cardiography (ICG) is a non-invasive method for CO measurement. This study evaluates the ability of two ICG methods to determine the optimal AV delay (OAVD) and to compare ICG with invasive PICCO measurements. METHODS: In 14 cardiosurgical ICU patients (age 70.4 +/- 12.0 yrs) with temporary pacing wires, OAVD was determined by pulse contour analysis (PICCO) and ICG (conventional ICG [CI] and electrical velocimetry [EV] ICG monitors). Cardiac output (CO) and stroke volume (SV) were measured during DDD pacing with AVD varying from 70 to 270 ms in 20-ms increments. RESULTS: Measured OAV showed a linear correlation between PICCO and ICG: CI (r = 0.82, P < 0.0002) and EV (r = 0.84, P < 0.0002). The mean OAVD deviation between PICCO and ICG was 15.7 +/- 21.0 ms (CI) and 17.1 +/- 20.5 ms (EV). Hemodynamic parameters (SV increase OAVD against worst case) improved significantly (+ 11.7 +/- 7.2 %, P < 0.0001). CONCLUSION: Inappropriate selection of AVD can compromise the hemodynamic situation of cardiosurgical patients. As it is totally noninvasive, ICG is a reliable and effective tool for tailoring AVD. Both systems (CI and EV) offer valid OAV determination.

[Experiences with the Russian electrostimulation instrument Lenar I used during delivery]. / Erfahrungen mit dem sowjetischen Elektrostimulationsgerät "Lenar I" bei der Anwendung unter der Geburt.

Experiences are reported an the soviet electral stimulation device "Lenar I" using during delivery in 19 patients. The are shortening of first stage of labour, sedation and analgesia, while the fetus is in a good condition.

[Hyperthyreosis and gravidity (author's transl)]. / Hyperthyreose und Gravidität.

An account is given of incidence, diagnosis, therapy, and clinical peculiarities of hyperthyreosis in gravidity, with reference being made to literature as well as to the authors' own experience. It is strongly suggested that thyreostatic treatment may yield good success even under the conditions of gravidity, provided that certain peculiarities are taken into due consideration. Conclusions then are drawn for efficient organisation of medical attention to pregnant patients with thyroid diseases.

[Drug poisoning in the 39th week of pregnancy--a case report]. / Tablettenintoxikation in der 39. Schwangerschaftswoche--Eine Kasuistik.

It is reported on an intoxication with nitrazepam at the end of pregnancy. The fetal cardiotachogram showed a silent oscillation type for more than 20 hours. A cesarean section could not be performed, therefore the pregnancy was terminated by spontaneous delivery 20 hours later after the beginning of labour. Although a fetal endangering by a silent oscillation type could not be excluded, due to the metabolism of nitrazepam in the mother the newborn baby did not show major intoxication symptoms.

Studies of the correlation of morphological and biochemical parameters in human ejaculate in various andrological diagnoses; 2nd report: biochemical parameters.

In this report the authors present the results about biochemical analyses in human ejaculate. The following parameters were determined ATP, ADP, pyruvate, lactate, alpha-ketoglutarate, fructose, myokinase, phosphoglucoseisomerase, phosphoglycerate-kinase, ATPase, acid phosphatase. It was found a relationship between age and fructose content, this was equally for pyruvate, whilst the converse was observed for lactate. No age dependend relationship was observed for the other substrates. For ATP and ADP distinctly higher values can be demonstrated in normozoospermia. A special study of the extent to which the encyme activities in sperm plasma are associated with the respective pH values measured shows that pH values above 7.2 correlate with distinctly lower activities for acid phosphatase, PGI and MK.

Correlation studies of morphological and biochemical parameters in human ejaculate in various andrological diagnoses. 3rd report. Correlations between morphological and biochemical parameters.

The result of a study of correlations between morphological and biochemical parameters in human ejaculate is presented in conclusion of an extensive study of these parameters. Basing on these results, for which a statistical significance of p less than 0.05 was calculated, it can be stated that higher fructose concentrations are associated with lower sperm density; at the same time, the higher fructose concentrations correlate with a higher percentage of non-motile and of pathologically changed spermatozoa. Similar associations can be established for certain substrates which result from fructolysis. The possibility of diffusion of enzymes from the cellular components must be considered as regards the increased activities of PGK, PGI and ATPase in seminal plasma in the presence of greater sperm density. Reliable conclusions about associations between morphological characteristics and enzyme activities can be expected in the future from appropriate measurements in the cellular elements (spermatozoa, round cells) of the ejaculate. The study results provide a further insight into the biochemistry of seminal plasma and into the associations between morphological and biochemical parameters in the ejaculate.

Intracytoplasmic sperm injection of in vitro-matured equine oocytes.

Intracytoplasmic sperm injection (ICSI) was performed on equine oocytes matured in vitro. The oocytes were aspirated from abattoir ovaries and matured in vitro for 36 h at 38 degrees C. ICSI was performed using frozen/thawed stallion semen after swimup in medium containing human serum albumin. Sperm-injected oocytes were either 1) cultured in vitro for 10, 20, or 72 h; 2) transferred to oviducts of pseudopregnant mice; or 3) transferred to a synchronized mare after initial in vitro culture. The transferred ova were recovered after 72 h, and all ova were subsequently fixed, stained, and processed for light and transmission electron microscopy. Single pronucleus formation was observed in 2 out of 12 presumptive zygotes 10 h postinjection, at which time abundant cortical granules were observed in the subplasmalemmal region. Twenty hours postinjection, however, 2 pronuclei were observed in 6 of 12 injected oocytes (fertilization rate 50%), and almost all cortical granules were released. The cleavage rate in vitro was 16% after 72 h in culture, and the most advanced embryo stages obtained were 6- to 8-cell embryos. The cleavage rate in vivo was very low since only 1 of 10 recovered had cleaved to the 2-cell stage. Thus, in conclusion, ICSI fertilization of equine oocytes did result in fertilization, pronucleus formation, and cortical granule release. However, the observed fertilization rate and oocyte activation was not paralleled by substantial cleavage of the zygotes.

Neutral sugar composition of proteins of human seminal plasma from different andrological diagnoses.

The neutral sugar content of proteins of human seminal plasma from different clinical diagnoses has been determined by gas-liquid-chromatography. Galactose, mannose, glucose and fucose were the predominant carbohydrates. Sometimes small quantities of arabinose, rhamnose, xylose and ribose were detected. Our analysis indicate that the concentration of galactose and fucose was distinctly higher in the group with azoospermia.

[Amino acid composition of human semen from different clinical diagnoses]. / Verteilung der Aminosäuren im Humansperma unter diagnostischen Gesichtspunkten.

The amino acid analysis of human semen shows for the different clinical diagnoses the predominant amino acids aspartic acid, serine, glycine, leucine and lysine. Analytical data indicate that there were differences in the amino acid composition between oligo- or azoospermia and terato- or asthenozoospermia by aspartic acid, glutamic acid, threonine, glycine, alanine and isoleucine.

[The correlation of morphological and biochemical factors in human ejaculate in various andrological diagnoses. I. Relationship between ejaculate volume, number, motility and morphology of the spermatozoa with regard to age]. / Untersuchungen zur Korrelation morphologischer und biochemischer Messgrössen im menschlichen Ejakulat bei verschiedenen andrologischen Diagnosen I. Mitteilung: Beziehungen zwischen Ejakulatvolumen, Zahl, Motiltät und Morphologie der Spermatozoen unter Berücksichtigung des Lebensalters

This first report from a study conducted to determine correlations between morphological and biochemical parameters in human ejaculate presents the results based on the measurement of predominantly morphological criteria in patients of various clinical diagnosis groups. The allocation of the 525 patients, who were recruited into the study during the period 1972/73 in the Department of Andrology, Hamburg-Eppendorf, to the diagnosis groups normozoospermia (196), asthenozoospermia (92), oligozoospermia (181) and azoospermia (56) was performed in accordance with the Recommendations for Andrological Nomenclature (1970). The following data were evaluated for this report: height (cm), weight (kg), age (years), ejaculate volume (ml), number of spermatozoa (mill./ml), motility (percentage of highly motile, motile and non-motile spermatozoa), round cells (mill./ml), morphology (percentage of normal-shaped/pathological spermatozoa), changes to the head, middle and tail sections (percentage of the pathological spermatozoa). Relationships between a dependent biological variable (y) and a variable to be assumed independent (x) were obtained by adaptation of polynomials of the 3rd degree: y = b0 + b1 + b2x2 + b3x3. The coefficients (b) which did not differ significantly (p greater than 0.05) from zero were eliminated step by step in regression analyses with breakdown and the resulting mean curves within the ranges covered by the sample depicted graphically. For the time being, the relationships found are described only in the sense of a collection of material. The increased occurrence of pathological spermatozoa in advancing age together with lower values for highly motile spermatozoa could be regarded as a result of a lower organ effectiveness of testosterone, which is protein-bound to an increased extent with advancing age. At the present time there is no explanation for the larger numbers of spermatozoa found with increasing age. The positive correlation between higher sperm counts and high motility, and between high motility and a lower percentage of pathological forms corresponds to expectations from earlier studies. The number of changes to the head, middle and tail sections increase proportionally in keeping with an increasing percentage of pathological forms. When the changes to the head, middle and tail sections are placed in relationship to the diagnosis groups normozoospermia, asthenozoospermia and oligozoospermia a disproportional percental participation becomes noticeable.

Free amino-acid composition of human seminal plasma in different andrological diagnoses.

The free amino acid content of human seminal plasma was studied 30 min after ejaculation. Serine, threonine and tyrosine were the principal amino acids. A comparison of the amino acid concentration of four andrological diagnoses indicates that there was a connection between certain amino acids and spermatozoa.

[Protein composition of human sperm from oligozoo-, teratozoo-, asthenozoo- and azoospermia]. / Zusammensetzung der Proteine des Humanspermas bei Oligozoo-, Teratozo-, Asthenozoo- und Azoospermie.

The amino acid analysis of seminalplasma and spermatozoa shows for the different andrological diagnoses that the predominant amino acids were aspartic--and glutamic acid, serine, glycine and lysine. Analytical data indicate that there were differences between plasma and spermatozoa for a lot of amino acids. No differences in the protein composition of the ejaculates were found between the various groups of andrological diagnoses.

[L-fucose content in human semen]. / L - Fucosegehalt im Humansperma.

Human semen contains beside the major carbohydrate fructose: galactose, glucose, sorbitol and inositol. By means of gas-liquid chromatography it is possible to identify also L-fucose. Our method requires the removal of hexosamines, amines and amino acids after hydrolysis. The gas-chromatographic separation of the carbohydrates is achieved in form of their trimethylsilyl derivatives. By this method the fucose content of several freeze dried human semen samples of different diagnosis could be determined.

[Isolation and analysis of glycolipids from human semen]. / Isolierung und Analytik von Glykolipiden aus Humansperma.

Glycolipids from human semen of two different diagnoses were separated from a total lipid extract by silicic acid column chromatography. Fatty acids and carbohydrates were determined by gas-liquid chromatography. Quantitative differences in the fatty acid and carbohydrate contents were found between the two diagnose groups.

[Fatty acid composition of neutral lipids of human semen]. / Die Fettsäureverteilung in den Neutralfetten des Humanspermas.

The fatty acid composition of neutral lipids of human semen was determined by gas liquid chromatography. Qualitative and quantitative differences in the fatty acid contents were not found between pooled semen from oligozoospermic and astheno- or teratozoospermic patients. The neutral lipids contained relatively high proportions of unsaturated acids.

[Free fatty acid composition of human semen in different clinical diagnoses]. / Analyse der freien Fettsäuren des Humanspermas unter unter diagnostischen Aspekten.

The composition of free fatty acids of human semen from different clinical diagnosis was determined by gas liquid chromatography. The major components were palmitic, stearic, myristic and oleic acid. The analyses indicate that the percentage composition of palmitic acid was distinctly lower in the group with azoospermia.

Wound infection due to Absidia corymbifera and Candida albicans with fatal outcome.

A case of a mixed infection due to Candida albicans and the zygomycete Absidia corymbifera in a 38-year-old, previously healthy, Caucasian male is presented. The infection developed following serial rib fractures, and ruptures of kidney, liver and biliary tract as well as a pancreatic contusion resulting from a traffic accident. During intensive care treatment the patient underwent several surgical procedures but subsequently experienced multi-organ failure and sepsis. Some weeks later, fungal growth was observed macroscopically on the patient's skin and wounds. From wound swabs C. albicans and A. corymbifera were grown. Histopathology of abdominal tissue yielded pseudohyphae and coenocytic hyphae. Although surgical debridement and antifungal treatment with amphotericin B and 5-flucytosine were started immediately, the patient died in therapy-refractory septic multi-organ failure.

Refined crystal structure of beta-lactamase from Citrobacter freundii indicates a mechanism for beta-lactam hydrolysis.

Beta-Lactamases (EC 3.5.2.6, 'penicillinases') are a family of enzymes that protect bacteria against the lethal effects of cell-wall synthesis of penicillins, cephalosporins and related antibiotic agents, by hydrolysing the beta-lactam antibiotics to biologically inactive compounds. Their production can, therefore, greatly contribute to the clinical problem of antibiotic resistance. Three classes of beta-lactamases--A, B and C--have been identified on the basis of their amino-acid sequence; class B beta-lactamases are metalloenzymes, and are clearly distinct from members of class A and C beta-lactamases, which both contain an active-site serine residue involved in the formation of an acyl enzyme with beta-lactam substrates during catalysis. It has been predicted that class C beta-lactamases share common structural features with D,D-carboxypeptidases and class A beta-lactamases, and further, suggested that class A and class C beta-lactamases have the same evolutionary origin as other beta-lactam target enzymes. We report here the refined three-dimensional structure of the class C beta-lactamase from Citrobacter freundii at 2.0-A resolution and confirm the predicted structural similarity. The refined structure of the acyl-enzyme formed with the monobactam inhibitor aztreonam at 2.5-A resolution defines the enzyme's active site and, along with molecular modelling, indicates a mechanism for beta-lactam hydrolysis. This leads to the hypothesis that Tyr 150 functions as a general base during catalysis.