Xanthochromia of the skull bone associated with HbA1c.

The color of the surface of 105 skull bones (part of the parietal bone) was determined using a portable spectral colorimeter (spectro color(®)). By this means it was possible to characterize the color objectively according to the L*a*b* color system defined by the "International Commission de l'Eclairage" (CIE). Biochemical markers of carbohydrate metabolism, HbA1c from venous blood, and glucose/lactate concentrations from vitreous humor, were also determined, for assessment of the ante-mortem plasma glucose concentration using Traub's sum formula. As biochemical markers for lipid metabolism disorder, cholesterol, triglycerides, high density lipoprotein (HDL), low density lipoprotein (LDL) and very low density lipoprotein (VLDL) were all determined from venous blood. There is a significant correlation of bone yellowing with HbA1c (p<0.001) and age (p<0.001). The literature asserts a significant correlation between diabetic condition and yellowing of the skull bone. Despite efforts to find the substance responsible for the yellowing of the bone in chronic metabolism disorder, no significant correlation was found between bone color and lipoproteins/bone extracted lipid acids.

Does an Early and Aggressive Combined Wrapping and Dangling Procedure Affect the Clinical Outcome of Lower Extremity Free Flaps?-A Randomized Controlled Prospective Study Using Microdialysis Monitoring.

Background The ideal starting point for flap training (FT) with the combined wrapping and dangling procedure is still a question of debate. Most units follow their own established protocols and currently evidence of flap compromise due to FT is still lacking. The aim of this study was to prove if an early and "aggressive" wrapping and dangling protocol could lead to metabolic changes, measured by microdialysis, indicating ischemia resulting in compromised flap perfusion. Methods Between 2010 and 2014, 49 patients with microvascular free flap reconstruction of the lower limb were included in this study. Patients were randomized into two groups. Group I started FT on the 7th postoperative day, and group II started on day 3. FT consisted of a combined wrapping and dangling procedure doubling its duration daily and ending at day 5. Flaps were monitored clinically and by microdialysis for ischemia-induced changes and metabolic parameters in the flap tissue in respect to different starting points of FT. Results All 49 patients in both groups were able to complete the postoperative FT without complications. Noninferiority of the early group could be proven and microdialysis results showed no differences between both groups. Conclusion We could prove by microdialysis that an early start of FT does not lead to compromised flap perfusion. Moreover, an early start of FT can lead to a reduced length of hospital stay. Furthermore, a reduced risk for deep vein thrombosis, pulmonary embolism, and pneumonia due to earlier mobilization might be an appreciated side effect.

Self-splicing of a mitochondrial group I intron from the cytochrome b gene of the ascomycete Podospora anserina.

We have shown that the second intron of the Podospora mitochondrial gene coding for cytochrome b (Cytb 12) splices autocatalytically, using in vitro transcripts generated from the T7 promoter. The reaction takes place at 37 degrees C in the presence of 50 mM TRIS-HCl pH 7.5, 60 mM MgCl2 and 1 mM GTP but shows a low efficiency even at high KCl concentrations of up to 1.2 M. Under these conditions, intron bI2 follows the conventional pathway of group I splicing, and all characteristic products, with regard to both transesterification and hydrolysis, could be identified. Moreover, the intron is capable of undergoing cyclization, thereby releasing the noncoded G and one additional nucleotide (U) from the 5' end. The 5' cleavage site is preceded by the same two nucleotides, indicating a base-pairing at the same site of the internal guide sequence (IGS) for both splicing and cyclization ("one-binding-site model"). In addition, products resulting from site-specific hydrolysis 138 nucleotides downstream of the 5' splice site were detected. Unusually, the shortened intron is also able to form a circular RNA and an alternative sequence that aligns the cyclization site to the catalytic core of the intron must be assumed.

[Detection of antibody-coated bacteria in the urine of adults with chronic pyelonephritis]. / Verlaufsbeobachtungen zum Nachweis antikörperbeladener Bakterien im Urin bei Erwachsenen mit chronischer Pyelonephritis.

Urine samples of 59 patients suffering from chronic pyelonephritis were tested repeatedly for antibody-coated bacteria (ACB). We demonstrated that the number of positive results increased with the frequency of the tests performed. It was observed, however, that antibody-coated bacteria were not found consistently in every sample during a longer period of observation.

[Leptospiroses with acute renal failure--report on 6 dialyzed patients]. / Leptospirosen mit akutem Nierenversagen--Bericht über 6 dialysierte Patienten.

From 1968 to 1981 6 patients with severe leptospiroses were treated: one with leptospirosis icterohaemorrhagiae (Weil's disease), two with leptospirosis copenhageni and three with leptospirosis grippotyphosa. The diagnosis must at first clinically be made from exposition anamnesis and symptoms. In three patients the agglutination lysis reaction had a negative result still between the 10th and 19th day after the beginning of the disease. In all 6 cases a hypercatabolic acute renal failure with azothaemia of high degree was present. The polyuric phase developed 10 to 18 days after the beginning of the disease, the serum creatinine values normalized 20 to 35 days after the beginning of the disease. The parenteral nutrition and the dialysis therapy were particular points in the complex therapy of the patients. 4 patients were haemodialysed - 3 of them after primary peritoneal dialysis - 2 patients were only peritoneally dialysed. On account of the hypercatabolism and the intestinal paralysis the haemodialysis is to be preferred, as a rule, to the peritoneal dialysis. Also in the haemodialysis of patients with leptospirosis modern developments should be taken into consideration: bicarbonate-containing dialytic solution and in haemorrhagic diathesis the heparin-free dialysis. All 6 own patients survived. When connecting these data with other reports from Central and South Europe the lethality of dialysed cases with leptospirosis is about 42% (25 of the 59 patients died). In 4 of 5 of our patients with leptospirosis a clear hyperamylasaemia was present, apparently the expression of the involvement of the pancreas.

Antibody-coating of bacteria in the urine in relation to various immunologic indexes.

Little is known about the immunologic aspects of antibody coating, though the test for determining antibody-coated bacteria in urine has been examined for its diagnostic uses by many authors after its inauguration in 1974. In adults with chronic pyelonephritis with and without antibody-coated bacteria in the urine, we tested whether bacterial coating is correlated with the homologous O-antibody titre in the urine. We also determined Ig levels in urine and serum, as well as homologous O-antibody titres in serum. By means of indirect immunofluorescence technique, we were able to show homologous O-antibodies in the urine of all patients with and without antibody-coated bacteria. IgG and IgA levels in urine were mostly raised, as were often the O-antibody titres in the serum. There were no significant differences in the immunologic parameters within the patient groups with or without antibody-coating. The presence of homologous O-antibodies in urine does not therefore necessarily lead to coating of the bacteria.

[Microbiological aspects of human pyelonephritis]. / Mikrobiologische Aspekte der Pyelonephritis des Menschen.

Issuing from the adhesive ability of bacteria to human mucous membranes the phenomenon of the adhesion of E. coli to uroepithelial cells is analysed in detail. Fimbrias and colonisation factors might be of importance. In own experiments the first clues concerning the numberous appearance of these adhesive factors could be got. In further investigations the author adopts a definite attitude to the problems of the rough forms of E. coli as the pathogenic agent of a pyelonephritis of man. It is to be assumed that by the occurrence of certain factors of virulence rough forms possess importance as causal agents of pyelonephritis.

[K antigen, colonization factor antigen, dulcitol fermentation, and hemolysin production in E. coli rough strains isolated from urine specimens (author's transl)]. / K-Antigen, Adhärenzfaktor, Dulcitol-Abbau und Hämolysin-Bildung bei E. coli-R-Stämmen aus Urin.

E. coli rough strains (as determined by spontaneous agglutination of in boiled saline suspension) isolated in significant amounts (>10(5)/ml) from from patients with urinary tract infections were investigated for some factors possibly related to virulence. The frequencies of capsular antigen, colonization factor antigen (CFA I), dulcitol fermentation, and hemolysin production are summarized in table 1. 270 (66.2%) out of 408 strains were found to be encapsulated as determined by the inagglutinability of the living strains in saline. 180 (44.1%) strains were able to ferment dulcitol, and evidence for hemolysin production could be demonstrated in 146 (35.8%) strains. The CFA I (demonstrated by a mannose resistant hemagglutination of human red blood cells) was detected in 62 (15.2%) of the E. coli rough strains tested. The frequency of single properties in the presence or absence of capsular antigen is shown in table 2 demonstrating no significant differences in both groups. The most frequent single factor was found to be the capsular antigen with 22.1%, followed by the double combination capsular antigen/dulcitol fermentation (16.7%), dulcitol fermentation alone (10%), and capsular antigen/hemolysin production (9.8%). There were only 5 strains possessing all four factors tested. On the other hand we found 35 (8.6%) rough strains with none of the properties. Some aspects of virulence of E. coli rough strains are discussed.

[Escherichia coli o serotyping in different patient groups with urinary tract infections (author's transl)]. / Escherichia coli-O-Serotypisierung bei verschiedenen Patientengruppen mit Harnwegsinfektionen.

Using 44 anti-O sera 789 Escherichia coli strains isolated from the urine of patients with urinary tract infections were typed. Of the 119 E. coli strains from the urine of children, 49.6% were O-typable; only 3.4% were rough strains. Of 357 strains from pregnant women, 47% were O-typable; 12.1% were rough strains. The largest proportion of O-typable E. coli strains was found among 314 strains isolated from adults with recurrent urinary tract infections (55.4% of the 314 strains); 8% were rough strains. The higher proportion of E. coli rough strains in adults, including pregnant women, indicate that once a pyelonephritis process has been established by virulent smooth strains in childhood, it can be sustained by rough strains at a later stage. Certain O serotypes were found to occur with a variable frequency in the individual patient groups. Enteropathogenic E. coli strains were seldom found in any of the three groups.

[Escherichia coli O Serotyping in different patients groups with urinary tract infections (author's transl)]. / Escherichia coli-O-Serotypisierung bei verschiedenen Patientengruppen mit Harnwegsinfektionen.

Using 44 anti-O sera 789 Escherichia coli strains isolated from the urine of patients with urinary tract infections were typed. Of the 199 E. coli strains from the urine of children. 49.6% were O-typable; only 3.4% were rough strains. Of 357 strains from pregnant women, 47% were O-typable; 12.1% were rough strains. The largest proportion of O-typable E. coli strains was found among 314 strains isolated from adults with recurrent urinary tract infections (55.4% of the 314 strains); 8% were rough strains. The higher proportion of E. coli rough strains in adults, including pregnant women, indicate that once a pyelonephritis process has been established by virulent smooth strains in childhood, it can be sustained by rough strains at a later stage. Certain O serotypes were found to occur with a variable frequency in the individual patient groups. Enteropathogenic E. coli strains were seldom found in any of the three groups.

[Problems of serological diagnosis of chronic pyelonephritis (author's transl)]. / Probleme der Serodiagnostik einer chronischen Pyelonephritis.

Using the passive hemagglutination test, 588 sera of patients with chronic pyelonephritis and 163 sera of pregnant women with persistent bacteriuria were investigated for the presence of antibodies aginst the enterobacterial common antigen (ECA). 10.2 percent of titers in the pyelonephritis group and 6.1 percent of titers of the pregnant women showed values higher than 1:16. The results were compared to a group of blood donors where 0.9 percent of the sera had pathological titers. The demonstration of ECA antibodies does not seem to be suitable for the diagnosis of urinary tract infections.

[Common antigen for serological detection of urinary tract infections during pregnancy (author's transl)]. / Das Common-Antigen zur serologischen Erfassung von Harnweginfektionen in der Schwangerschaft.

All urinary tract infections cannot be safely detected by bacterial urine testing during pregnancy. Therefore, the question was studied whether detection of antibody to the "enterobacterial common antigen" (ECA) might be important to screening of pregnant women for urinary tract infections. Tests were applied to 202 sera obtained from 42 pregnant women with urinary tract infection, with pathological titres having been recorded from 21.8 per cent.--Detection of antibody to ECA, consequently, is not believed to be helpful in improving diagnosis of urinary tract infections during pregnancy.

[Phage typing of rough E. coli strains isolated from urine (author's transl)]. / Lysotypie von aus Urin isolierten E. coli-Rauh-Stämmen.

A differentiation of E. coli rough strains is generally not well established in bacteriological urine diagnosis although these strains are relatively often isolated from urine samples of patients with urinary tract infections (see table 2). An exact characterization of rough strains seems to be necessary especially for the distinction between recurrent and reinfection during therapy and follow-up studies. The application of phage typing for characterization of E. coli rough strains isolated from urine is reported in the following paper, using a set of 13 phages (A-M) introduced by Marsik and Parisi (8). Out of 284 E. coli rough strains 166 (58.4 per cent) were found to be typable. Altogether 56 different phage patterns were observed. The most common phage patterns are presented in table 1. It is evident that GHK is the most frequent pattern occurring in 7 per cent of the strains investigated. The next most common patterns are M and BCDEIJLM (4.9 and 3.5 per cent, respectively). These, together with AM (3.2 per cent) and F (3.2 per cent) account for 21.8 per cent of all the rough strains tested. From the results it is concluded that phage typing may be a valuable tool for differentiation of E. coli rough strains.