[Providing and maintaining jobs for psychiatric patients--how can it be done?]. / Arbeitsplätze für psychisch Behinderte vermitteln und erhalten--wie soll das gehen?

An innovative project has produced some good results in the placement of psychically disabled people in the general labour market. The "foster colleague model" provides support for the client directly at her or his place of work by a specially trained member of company staff (the "foster colleague"). This method has so far managed to provide 18 formerly psychically ill people with employment and helped to keep them in work.

[Cardiovascular pharmacology. An example of the need of clinically relevant pharmacological research]. / Herz- und Kreislaufpharmakologie. Ein Beispiel der Notwendigkeit kliniknaher pharmakologischer Forschung.

Like all other scientific disciplines, preclinical pharmacological research is subject to permanent changes. New measuring devices and the possibility of continuous on line data acquisition have markedly influenced basic research in this field. Another aim of modern cardiovascular pharmacology is the testing of promising drugs in clinically relevant animal models of disease, particularly under conditions, referring to the everyday situation in patients, e.g. physical activity. Investigations carried out in this way allow an exact assessment of the clinical efficacy of new drugs, and are, thus, clearly indispensable, also from the ethical point of view, before primary evaluation of the drug in man.

[Pathogenesis and therapy of nontraumatic compressive radial nerve paralyses--report of an unusual case]. / Zur Pathogenese und Therapie nicht-traumatischer kompressiver Radialislähmungen--Bericht über einen ungewöhnlichen Fall.

A case of nontraumatic radial nerve palsy at the level of the canalis spiralis is reported. Aetiologically a variation of branching of this nerve combined with an inflammatory swelling is discussed. After the surgical treatment a satisfactory recovery of motor function was seen. The necessity for a careful and thorough examination is demonstrated to diagnose or localise such non-traumatic lesions.

Catecholamines in the plasma and urine of patients with alcoholic liver damage under resting and exercise conditions.

Heart rate and plasma catecholamines were determined in 16 patients with alcoholic fatty liver and 14 patients with alcoholic cirrhosis of the liver. The measurements were performed at rest and after exercise on the bicycle ergometer, on average 11 days after admission to hospital. In comparison with a control group, the mean heart rate of the patient group was significantly increased at rest and under graduated loading. Significantly increased plasma catecholamine concentrations under resting conditions were observed in both groups of patients, the increase being more pronounced in the cirrhotics (increased with progressive liver damage, significant differences being found between the control group and each of the two groups of patients). During exercise under a load of 50 or 100 watts, the increases in adrenaline, noradrenaline and dopamine concentrations were greatest in patients with alcoholic cirrhosis. With reference to the initial values, however, the increases in concentration were identical in all three groups. In the patients, metabolism of the catecholamines remained unchanged after an average of 11 days abstinence from alcohol; they showed a significantly diminished elimination of vanillylmandelic acid in the urine and, compared with the greatly elevated plasma catecholamine levels, they showed only a moderate increase in the excretion of catecholamines. The results reported here support the assumption that changes in catecholamine metabolism compatible with an increased sympathetic activity are present in chronic alcoholics without advanced liver damage.

Effects of the acylcarnitine-transferase blocking agent sodium 2[5-(4-chlorophenyl)-pentyl]-oxirane-2-carboxylate (POCA) on metabolism and regional function in the underperfused canine myocardium.

We investigated the effects of sodium 2[5-(4-chlorophenyl)-pentyl]-oxirane-2-carboxylate (POCA) on regional myocardial function and metabolism in anesthetized, thoracotomized dogs subjected to a 53.5% reduction in flow through the circumflex branch of the left coronary artery (LCX). Regional function in the area supplied by the LCX and the left anterior descending coronary artery (LAD) was assessed by means of two pairs of subendocardially inserted ultrasonic transducers. Hemoglobin content, oxygen saturation, pH, PCO2, PO2, lactate, glucose, and free fatty acids were determined in arterial and local venous blood obtained from the area supplied by the LCX. POCA (20 mg/kg/20 min i.v.) induced a transient decrease in left ventricular power and cardiac output. Arterial free fatty acid (FFA) levels increased continuously throughout the experiment, whilst arterial glucose levels showed a continuous decrease. FFA uptake, lactate release, and oxygen uptake were reduced in the underperfused area by POCA. At the same time, POCA induced a transient increase in end-diastolic segment length and a sustained decrease in systolic shortening during the ejection phase in the underperfused area. No changes in regional function were observed in the area perfused by the nonconstricted LAD.

[Differential diagnosis and surgical indications in lumbar intervertebral disk recurrence]. / Differentialdiagnose und Operationsindikation beim lumbalen Bandscheibenrezidiv.

This retrospective study concerns 48 patients who underwent reoperation some time after lumbar disc surgery because of persistent or recurring leg pain. During the same period (January 1980 to October 1982) 821 primary lumbar discectomies were done. Surgical findings at reoperation of 48 patients: 30 patients (3%) had a recurrent disc herniation at the previous site, 9 patients (1%) had disc herniations at a new site only, and 9 patients (1%) had only considerable epidural scar formation. The preoperative differentiation between symptoms related to recurrent disc herniation and those related to epidural scar formation is difficult, because in this situation myelography can not be relied upon. In our series of 48 patients, myelography showed in 27% of the cases false positive or false negative results. The clinical signs and symptoms are therefore of paramount importance.

[Doppler sonography after extra-intracranial anastomosis operations]. / Doppler-Sonographie nach extra-intrakraniellen Anastomosenoperationen.

Extra-intracranial anastomosis are thought to improve the regional cerebral blood flow in patients with a stenosis or occlusion of the carotid system and prevent the later occurrence of ischemic cerebral diseases. Doppler-sonography has been used for a follow up of the effectiveness of the surgical procedure. We believe that minor hemodynamic improvements after surgery cannot be detected by Doppler-sonography. However this method is very useful in demonstrating the patency of the anastomosis.

Characterization of [3H]-adenosine binding to media membranes of hog carotid arteries.

Binding of [3H]-adenosine to a microsomal fraction derived from media strips of hog carotid arteries was studied by a centrifugation technique. Specific binding was very rapid, readily and completely reversible, and temperature dependent. Under the chosen conditions of incubation, at 4 degrees C and in the presence of deoxycoformycin, about 95% of the bound radioactivity was chromatographically identified as adenosine. Scatchard analysis revealed a small number (1.7 pmol/mg protein) of high affinity (KD = 0.23 mumol/l) and a large number (21.6 pmol/mg protein) of low affinity binding sites (KD = 4.3 mumol/l). 5'-Phosphorylated adenosine compounds. 5'-deoxyadenosine, 2-chloroadenosine, and adenosine-5'-N-ethylcarboxamide, all derivatives of adenosine with pronounced vasodilatory properties, were most potent in displacing [3H]-adenosine from its binding sites with IC50 values ranging from 1.8 to 14.3 mumol/l. However, 2-chloroadenosine and (--)N6-phenylisopropyladenosine were weaker competitors of binding than adenosine, which disagrees with the pharmacological findings. Moreover, the IC50 of aminophylline was much higher than the concentration required for half-maximal inhibition of the biological actions of adenosine. This partial lack of specificity may be due to nonreceptor binding of [3H]-adenosine at the low affinity sites.

[Normal pressure hydrocephalus (author's transl)]. / Der Normaldruckhydrozephalus.

Report on 21 patients with the syndrome of normal pressure hydrocephalus. All patients were treated by implantation of a shunt-system (ventriculo-atrial shunt). In only 50% of the cases to result was good (complete remission of the clinical signs). The prognosis depends upon the etiology and the duration of the disease. The best results can be expected in cases of normal pressure hydrocephalus following subarachnoid hemorrhage.

Effect of a 5'-substituted adenosine analogue (744c96) on insulin and glucagon release in isolated rat islets of Langerhans.

The effect of adenosine-5'-(N-ethylcarboxamide) (744-96), a highly vasoactive adenosine analogue, was investigated on insulin and glucagon release from isolated rat islets of Langerhans. The compound inhibited glucose-induced insulin release in a dose-dependent manner (concentration range 10(-8) to 10(-5 M). No effect of 744-96 was observed on basal or on arginine-induced glucagon release. By contrast, 744-96 (5 microgram/kg i.v.) produced a significant increase in plasma glucagon and glucose levels in normal as well as in reserpinized rats. The observed failure to promote glucagon release from isolated islets may be attributable to the isolation procedure, to a release of glucagon in vivo from non-pancreatic stores, or to a non-specific effect of 744-96 on glucagon secretion.

Effects of glucagon on liver metabolism in intact dogs.

Chloralose-anaesthesized dogs, starved for 24 hours, were used to determine the effects of 10 microgram/kg glucagon, administered i.v. as a single bolus injection, on liver substrates in situ (glycogen, glucose-1-phosphate, glucose-6-phosphate, glucose, fructose-6-phosphate, fructose-1,6-diphosphate, triose phosphates, glycerol-3-phosphate, phosphoenolypyruvate, pyruvate, lactate, citrate, malate, ATP, ADP, and AMP). liver samples were obtained by instant deep-freezing with Wollenberger clamps on four consecutive occasions at 10-minute intervals. Heart rate and blood pressure were continuously monitored. Serial liver sampling per se had no significant effects on liver metabolism or systemic haemodynamics in a group of control animals. In a second group glucagon, administered after the initial freeze-clamp sampling to obtain baseline values, led to a marked activation of the glycogenolytic pathway resulting in glucose release from the liver.

[Cerebral arachnoid cysts in children with local bulging of the skull (author's transl)]. / Arachnoidaezystem mit lakaler Schädelasymmetrie bei Kindern

A series is reported of 9 cases of supratentorial arachnoid cysts in children under the age of 14 years. The predominant clinical and radiological sign is local bulging of the skull, caused by the underlying cyst. The characteristic angiographic findings and anomalies in the phlebogram are discussed. Operative measures (trephination and ventriculo-auricular shunt) aim at restoration of the disturbed cerebrospinal fluid circulation and resection of the wall of the cyst. Selection of patients for operative measures and results of treatment are discussed.

The determination of the myocardial extracellular space in the cat in vivo: a comparative methodological study.

The myocardial extracellular space (ECS) was determined in cats in vivo by means of the ECS indicators, inulin and sulfanilic acid and, additionally, as glucose space. Experiments were carried out in cats subjected to bilateral kidney ligation (single injection) and in intact cats (single injection or infusion of indicator). The heart was clamped by instant deep-freezing in situ; this technique was compared, in renally-ligated cats, with excision and subsequent freezing of the heart in liquid nitrogen. The myocardial blood content was significantly decreased, and the myocardial lactate concentration significantly increased in excised, as compared with in situ-clamped hearts. Renally-ligated cats showed marked hypotension. The mean myocardial blood content was also significantly lower than in intact animals. A highly significant correlation was found between myocardial blood content and blood pressure for all experiments with instant deep-freezing. The mean inulin ECS value in renally-ligated cats was 22.7 +/- 1.5 ml. In accordance with the fact that the ECS is dependent on the tissure blood content, the corresponding values in intact animals were significantly higher, 25.9 +/- 2.5 ml (single injection) and 26.3 +/- 3.9 ml (infusion), calculated per 100 g tissue wet weight. Similar values were obtained for the glucose and sulfanilic acid ECS. If the interstitial space, an expression independent of the tissue blood content is used as space parameter, no significant differences were found under any of the present experimental conditions.