[Immunoelectrophoresis used for identification of blood stains in forensic medicine]. / Apport de l'immunoelectrophorese pour l'expertise des taches de sang en medecine legale.

Conclusive evidence was obtained in this study that immunoelectrophoresis could be used in the identification of blood-stains in two particular cases: for diagnosis or approach to diagnosis of the age of a blood-stain, and for diagnosis of the human origin of a blood-stain that had been treated with petroleum products. Although many aspects should be investigated in more detail, it is certain that this method can be employed in combination with other methods.

Characteristic pattern of free amino acids in plasma and skeletal muscle in stable hepatic cirrhosis.

Free amino acid (AA) concentrations in plasma and quadriceps femoris muscle were determined in 19 healthy volunteers and in 16 patients with hepatic cirrhosis and portal hypertension. Nutritional state was impaired as judged by overt muscle wasting (9/16), triceps skinfold thickness less than 70% of normal in 8/14 (57%), and creatinine-height index below 70% in 5/12 (42%). In the plasma of patients the typical amino acid pattern of cirrhosis was to be observed: Elevation of tyrosine and methionine (p less than 0.01), uniform reduction of branched chain amino acids (p less than 0.001) resulting in a decreased molar ratio of BCAA/AAA from 2.85 +/- 0.05 in normal individuals to 1.35 +/- 0.12 in cirrhotics (p less than 0.001). Levels of the gluconeogenic AA glutamine, glutamate, aspartate, alanine, glycine, threonine, serine and lysine were lowered (p less than 0.05). In muscle of cirrhotics, intracellular AA concentrations exhibited a similar pattern with two major exceptions: Tyrosine and phenylalanine were augmented (p less than 0.001). Surprisingly, BCAA levels were altered heterogeneously; those of gluconeogenic BCAA decreased: Valine from 0.34 +/- 0.03 to 0.20 +/- 0.03 mmol/l (p less than 0.001), isoleucine 0.09 +/- 0.01 to 0.05 +/- 0.02 mmol/l. However, the concentration of ketogenic leucine remained unaltered in muscle. Nevertheless, the molar ratio of BCAA/AAA was considerably reduced from 3.70 +/- 0.04 to 0.81 +/- 0.08 (p less than 0.001). Most of the gluconeogenic AA exhibited reduced intramuscular concentrations, but glutamine levels were normal. The pattern of plasma and muscle free AA in hepatic cirrhosis is thus characterized by accumulation of aromatic AA and by depletion of gluconeogenic AA, especially BCAA.(ABSTRACT TRUNCATED AT 250 WORDS)

[Pericardial C-reactive protein. A marker of agonal cardiac disease ?]. / La protéine C-réactive péricardique. Un marqueur de la souffrance cardiaque agonique?

We studied the influence of the agonal period on the concentrations of acute phase proteins in biological fluids obtained from 26 autopsy cases. We found significant differences for C-reactive protein concentrations in serum and in pericardial fluid, between short and long agonies. The other acute phase proteins studied (alpha-1 antitrypsin, alpha-2 macroglobulin, haptoglobin) failed to show any significant difference in serum and pericardial fluid levels between the two types of agony. The increase in C-reactive protein level in the pericardial fluid is attributed to an "agonal pericarditis" which may result from an agonal myocardial necrosis. Our results could be of interest in forensic medicine.

[Carbohydrate infusions in internal diseases. A comparative study in metabolically healthy, liver diseased and diabetic patients. VIII. Continuous infusions of low dosage carbohydrate mixtures in patients with liver cirrhosis]. / Kohlenhydratinfusion bei internistischen Erkrankungen. Eine vergleichende Studie bei stoffwechselgesunden, leberkranken und diabetischen Patienten. VIII. Dauerinfusionen niedrig dosierter Kohlenhydratmischungen bei Kranken mit Leberzirrhose.

Basic caloric needs of patients with compensated liver cirrhosis and healthy controls were supplied for 48 h with mixtures of glucose, fructose, sorbite, and xylit. Mixed solutions (20% w/v) containing glucose + fructose (n = 6), glucose + sorbite (n = 36), glucose + xylit (n = 37) in a 1:1 ratio, and glucose + fructose + xylit (n = 6) in a 1:2:1 ratio as well as glucose alone (n = 6) were administered in a dosage of 0.25 g/kg/h each. Utilization of the monosubstances, corresponding blood levels, and the effects on parameters of carbohydrate and lipid metabolism were frequently controlled. In contrast to mixed solutions, infusion of glucose alone caused a pronounced increase of the insulin levels and hyperglycemia in some patients suffering from liver cirrhosis. In both groups infusion of glucose + xylit was accompanied by a rise of uric acid levels. In liver cirrhotics a permanent decrease of phosphate as well as an increase of xylit concentrations were observed. These changes were not seen with xylit lowered to 50%, in glucose + fructose + xylit infusion. Therefore, we recommend to restrict xylit in liver cirrhotics to 100/24 h. No significant changes of blood gas measurements, ph values, hyperlactatemia, or lactic acidosis were seen. There was no difference in the anticatabolic, antilipolytic, and antiketogenic effect of the solutions. The least changes of all controlled parameters were observed with glucose + fructose and glucose + fructose + xylit infusions.

Determination of anaerobic threshold by the ventilation equivalent in normal individuals.

In 131 untrained healthy volunteers, unsteady-state upright bicycle ergometry was carried out by means of computer-assisted on-line ergospirometry. In 11 males and 4 females capillary lactate and blood gas analyses sampled simultaneously at 1-min intervals revealed that it is possible to determine the 'anaerobic threshold' (AT) and a 'threshold of decompensated metabolic acidosis' (TDMA) from the respiratory gas exchange by controlling the ventilation equivalent for oxygen (VEO2 = VE/VO2) and carbon dioxide (VECO2 = VE/VCO2). There is no necessity of invasive measurements. Solely ergospirometrical tests in 66 males and 50 females, aged 20--65 years, showed the expected higher work load levels and VO2 at AT and TDMA in males. There was a significant negative correlation to age. In contrast, there are no differences with regard to sex in AT and TDMA for weight-corrected work rates. In the age group 20--39 years, AT is about 1 W/kg body weight, TDMA at about 2 W/kg body weight. The larger maximum exercise capacity weight corrected for males (3 W/kg) in comparison to females (2.6 W/kg) was dependent on a greater capability in the range of maximum exertion and not on a different level of AT and TDMA.

[Spiroergometrical criteria in the non-invasive evaluation of work-induced variation in lactic acid levels and acid-base equilibrium during unsteady-state exercise (author's transl)]. / Spiroergometrische Kriterien in der nichtinvasiven Beurteilung arbeitsinduzierter Anderungen von Laktatspiegel und Säure-Basen-Status während Unsteady-state-Belastung.

During an incremental exercise test the spiroergometric parameters Respiratory Quotient (RQ), Ventilatory Equivalent for oxygen (AEO2 = VE/VO2) and Ventilatory Equivalent for carbondioxide (AECO2 = VE/VCO2) initially decrease. These values then increase continuously at various work load levels until exhaustion. Experiments on 40 healthy untrained men between 20 and 40 years of age using upright bicycle ergometry and computer assisted on-line ergospirometry in which the work load was increased each minute by app. 16.3 watts show that the following 3 performance levels can be used to sufficiently describe the incremental exercise test: 1. Minimum AECO2 (77.9 +/- 22.3 watts approximately 1183 +/- 320.1 ml VO2 approximately 45.1 +/- 9.62% VO2 max), 2. Minimum AECO2 (148.5 +/- 32.7 watts approximately 1883 +/- 388.9 ml VO2 approximately 71.8 +/- 11.43% VO2 max), 3. Maximal power output (220.1 +/- 30.6 watts approximately 2638 +/- 442.3 ml VO2) (mean +/- SD). In addition simultaneous determinations of lactic acid levels and acid base equilibrium from arterialized capillary blood sampled at one minute intervals were carried out on a further 15 persons. It is shown that VO2 at the rise of AEO2 from its minimum is closely correlated with VO2 at the first significant increase of lactic acid levels (r = 0.942). There is less correlation between VO2 at the rise of AECO2 from its minimum and VO2 at the begin of the decompensation of the work induced metabolic acidosis (r = 0.854). The results indicate that through the use of spiroergometric parameters it is possible to obtain further information on the peripheral and cardiopulmonary adaptability of the organism under low submaximal work load conditions avoiding the necessity of invasive measurements.

[Cerebral tuberculoma in pregnancy]. / Zerebrales Tuberkulom in der Schwangerschaft.

Intracranial tuberculomas today are rare in industrialized countries. We report the case of a 29 year old female German patient who in the sixth month of her pregnancy presented with epilepsy and mild hemiparesis. Cranial CT showed a parietal contrast-enhancing lesion. Mediastinal tuberculosis was confirmed by biopsy. Both the mediastinal and the cerebral lesion together with the neurological signs resolved under therapy with antituberculous drugs, and the patient gave birth to a healthy child.

[Anaphylactic reaction to human insulin. Successful desensitization]. / Anaphylaktische Reaktion auf Humaninsulin. Erfolgreiche Hyposensibilisierung.

A 48-year-old woman with diabetes mellitus (type IIb) had to be treated with insulin because of poor blood-sugar control. Infiltrates at the sight of injection occurred with two different porcine insulin preparations, necessitating a switch to human insulin. After the third injection of the latter an anaphylactic reaction developed within minutes. During a pregnancy in 1968 the patient had briefly received bovine insulin. Tests now revealed an immediate-type allergy against all three available species insulins, which was successfully treated by hyposensitisation.

Reduced intraindividual variability of repeated cardiovascular reflex tests: an additional marker of autonomic neuropathy in insulin-dependent (type I) diabetes mellitus?

The particular questions asked in our study were: 1. does the individual reproducibility of the cardiovascular reflex tests differ between healthy controls and patients suffering from type I diabetes mellitus and 2. if there is a difference, do the different cardiovascular reflexes vary in this regard? Nine healthy controls (4 women, 5 men, age 31 +/- 2.1 years) and 11 type I diabetics (4 women, 7 men, age 30.9 +/- 5.6 years, duration of diabetes 3.23 years) underwent the following tests 6 times in a 12-h period (07:00 to 19:00): variation of heart rate during deep breathing (E/I ratio), variation of heart rate during lying and standing (tachycardia/bradycardia or 30/15 ratio), Valsalva maneuver (Valsalva ratio), response of diastolic blood pressure to sustained hand grip, and response of systolic blood pressure to posture. The test results did not indicate a diurnal fluctuation nor were they systematically influenced by antecedent insulin injections or meals, either in diabetic patients or in healthy controls. The 11 diabetics had significantly lower intraindividual variations of E/I and Valsalva ratios than the controls (p less than 0.05, p less than 0.001, respectively). In the diabetics with parasympathetic failure the intraindividual variabilities of all cardiovascular reflex responses were lower than those of the patients with an intact autonomic nervous system as well as those of the control subjects. On the contrary, in the diabetic patients without autonomic neuropathy, only the intraindividual variability of the Valsalva maneuver was significantly attenuated (p less than 0.025), compared with the healthy volunteers. To conclude, the more pathological the single test result, the greater is its reproducibility and its clinical significance.

Recovery of the hypothalamic-pituitary-adrenal axis from suppression by short-term, high-dose intravenous prednisolone therapy in patients with MS.

We have studied the recovery of the hypothalamic-pituitary-adrenal (HPA) axis from inhibition by short-term, intravenous high-dose, corticosteroid therapy (IVHDCT) without subsequent oral replacement therapy in 10 patients with relapsing-remitting or progressive multiple sclerosis (MS) using the human corticotrophin-releasing hormone (hCRH) test. There was significant HPA suppression with profoundly decreased basal and peak plasma ACTH and cortisol levels 24 h after cessation of therapy. However, at 48 h the pituitary response was greatly enhanced with peak ACTH concentrations rising by more than 100% over baseline values in 7 of 10 patients. Basal and stimulated ACTH concentrations returned to pre-treatment levels at 120 h. Basal and stimulated plasma cortisol levels remained subnormal in 6 patients 120 h after IVHDCT. We conclude that IVHDCT without oral replacement therapy in MS patients is endocrinologically safe.

Ultrasonographic diagnosis of melanoma metastases in liver, gallbladder, and spleen.

Ultrasonographic findings in the liver, gallbladder, and spleen of 42 patients with metastatic melanoma of the skin are described in a retrospective study stressing sonomorphologic results. Liver metastases were detected in 27 (64%) of the patients. Clinically asymptomatic melanoma metastases were found in the gallbladder of three patients and in the spleen of three others. The liver metastases were still in the initial stages in 10 patients, whose survival times averaged 8.4 months. The significance of upper abdominal ultrasonography in assessing the spread of metastasizing malignant melanoma during follow-up is emphasized.

Hormonal and metabolic changes in starving obese patients during exhaustive physical exercise.

Exhaustive graded exercise leads to changes of hormones, carbohydrate, and lipid metabolism in normal controls and obese patients after prolonged starvation. Concomitant with a large increase of plasma catecholamines, insulin concentration is reduced and blood glucose levels slowly increase. More glucose is made available by glycogenolysis and gluconeogenesis than can be oxidized in the mitochondria. Lactate associated metabolic acidosis appears. Starving obese patients in the basal state have reduced blood glucose concentrations, but their initial values for free glycerol, free fatty acids, and ketone bodies are much higher than in normal controls. This is caused by the starvation induced lipolysis. With exhaustive exercise adrenaline, noradrenaline, and free glycerol increase. In contrast, free fatty acids and ketone bodies decrease, because they are consumed as fuel. Prolonged starvation changes basal values of hormones and metabolites, but it does not change the quality of exercise-induced shifts in these values when compared with those of the normal controls.