Application of the optimized CO-rebreathing method for determination of hemoglobin mass in patients with polycythemia vera.

Determination of red cell volume (RCV) might contribute to establishing the diagnosis of polycythemia vera (PV). A novel simplified method to detect RCV through CO rebreathing is nowadays applied in healthy young individuals but was not tested in a clinical or PV setting. The aim of the present study is to evaluate whether this spirometric approach is applicable in older subjects and contributes to PV diagnosis in a proof-of-concept approach. At first, RCV was determined by the optimized CO-rebreathing method in healthy subjects >50 years of age (n = 81, age 66 ± 9 years). Failure rate and age distribution of subjects who failed with CO rebreathing were analyzed. Then, RCV was measured in male PV patients (n = 7) and compared to healthy male controls (n = 35). RCV values in relation to several anthropometric references (body weight, body surface area (BSA), lean body mass (LBM)) were calculated to determine the sensitivity and specificity of established RCV thresholds when using optimized CO rebreathing. In healthy subjects, test failure rate was 9.9 %, but failure was not associated with age. Sensitivity and specificity (sens/spec) to detect PV was 100 %/83 % using the criteria of the PV study group. Using criteria based on BSA, sens/spec was 14 %/100 %. An arbitrary threshold of 50 ml/kg LBM yielded sens/spec of 100 %/97 %. In conclusion, this proof-of-concept indicates that optimized CO rebreathing is applicable in older subjects and allows determining RCV for the diagnosis of PV. Normalized values for RCV measures obtained from CO rebreathing are needed to grant sufficient sensitivity and/or specificity.

[AR-DRG effects on geriatrics in Germany]. / AR-DRG Auswirkungen auf die Geriatrie in Deutschland.

The parties of the self-governing Health Service are at present preparing the introduction of a general case, flat rate compensation system for the hospital section on behalf of the legislature. The system is based on the performance definitions and case classifications of the Australian DRG System, Version 4.1. The relative evaluation of the individual DRG for the implementation into the system in Germany will be based on German cost and benefit data. For this purpose a calculation of case-specific treatment costs based on a representative selection of hospitals will be made. The geriatrics field will have to adapt itself to these regulations in the same way as all other medical disciplines. Difficulties are arising due to the inconsistent classification of cost and benefit data in connection with the classification. The geriatric field is under-represented in the calculation of relative evaluation and, therefore, the spectrum of benefit cannot be shown in the planned calculation system. Analogous to the calculation of German relative cost evaluation, the geriatric section will define in a project the actual costs for their treatment cases and determine the consecutive relative evaluation.

Performance of the Personality Inventory for Youth validity scales.

Response sets as well as cognitive and academic deficits compromise the validity of child and adolescent self-report of emotional adjustment. Three studies using clinical and asymptomatic samples of 4th to 12th grade students detail applications of the four validity scales of the Personality Inventory for Youth (PIY), namely, (a) Validity (VAL) a scale of six highly improbable statements, (b) Inconsistency (INC) consisting of pairs of highly correlated statements, (c) Dissimulation (FB) constructed of statements that were infrequent and characteristic of intentional distortion, and (d) Defensiveness (DEF) an extension of the Lie scale of the parent-report Personality Inventory for Children. The effects of minimizing, malingering, and random response sets on the PIY validity scales are reported. The importance of such validity scales derived from child and adolescent response is discussed.

[Guide to geriatric treatment in Bremen]. / Leitfaden Geriatrie im Land Bremen. Aufbau einer Organisationsstruktur für geriatrische Medizin an der Klinik für Medizinische Geriatrie und Rehabilitation im Zentralkrankenhaus Bremen-Nord.

The demographic pressure exerted on the national health care system has led to the establishment of specialised geriatric centres. These centres aim at an early, patient-related coordination of the medical aspects of treatment with a concept for rehabilitation. Acute geriatric care, rehabilitation, and social medicine are practically integrated in contrast to the segmentation practised in other branches of medical care. The necessary assessment of patients in terms of "disease sequelae" according to the ICD is inadequate while the ICIDH as an alternative still has no legal foundation. The "Guide to Geriatric Treatment in Bremen" provides the necessary organisational structure with regard to aspects of quality assurance. To this end, guidelines for patient identification by means of expert medical evaluation and geriatric assessment on the basis of the ICIDH were developed as well as rules for the overall organisation and interaction of the geriatric centres with other specialties, with health insurers, and with the medical services of health insurers. The total duration of treatment of a patient was established as the primary parameter for determining professional and economic efficiency. The introduction of a specific nomenclature to be used by all parties involved reflects the "geriatrification" of the system.

Carbohydrate-deficient transferrin for identification of drug overdose patients at risk of an alcohol withdrawal syndrome.

BACKGROUND: Chronic alcohol abuse is frequent in patients admitted to the intensive care unit with acute drug overdose. During detoxification, an alcohol withdrawal syndrome may develop in patients with a history of chronic alcohol abuse. Withdrawal or delirium is associated with serious risks, necessitating early identification of patients at risk. Since the information obtained from the patients or their relatives on alcohol consumption is often unreliable, biochemical markers may be helpful. Carbohydrate deficient transferrin is considered a highly specific marker (reported maximum specificity 97%, sensitivity 40-85%) for identifying alcohol abuse. METHODS: In 20 patients with acute drug overdose and suspected alcohol abuse, carbohydrate deficient transferrin was determined by an immunoturbidimetric assay on admission to the intensive care unit. Eight of the patients had carbohydrate deficient transferrin levels above the "positive" threshold and nine in a suspicious range. A "false" negative carbohydrate deficient transferrin was found in three patients who were thought to have changed their drinking habits prior to hospitalization. A "positive" carbohydrate deficient transferrin test is assumed to be associated with ingestion of more than 60-80 g ethanol/d for a period of more than seven days. RESULTS: In all patients, clonidine (30-210 micrograms/h i.v.) was started. None developed delirium. Since alcohol addiction is frequently denied, determination of carbohydrate deficient transferrin may be useful for its early diagnosis but the sensitivity of this parameter requires further evaluation.

The problem of assessing brain damage in psychiatric samples: use of personality variables in prediction of WAIS-R scores.

Detection of IQ decrements due to brain injury in patients with preexisting psychiatric disorders was examined. Subjects included 280 male and female adult psychiatric patients who were free of identified neurological disorders. Subjects were administered the MMPI and WAIS-R. Original (Barona, Reynolds, & Chastain, 1984) and revised (Barona & Chastain, 1986) Barona formulae were used to calculate premorbid IQ based on demographic variables. Multiple regression analyses were utilized to predict Wechsler IQ scores from the predicted Barona (original and revised) IQ scores along with MMPI clinical and validity scale raw scores for the experimental group (N = 186). The Barona equations overpredicted current IQ scores. The addition of MMPI variables when predicting current IQs resulted in significant increments in R(2)(p <.01). Cross-validation on a second sample (N = 94) yielded similar results when MMPI variables were added to all the original Barona formulae and the Barona PIQ revised formula. The MMPI may provide a means of incorporating pathology and personality characteristics into the detection of brain damage in psychiatric patients.

Anti-ischemic and antianginal effects of 60 mg isosorbide-5-mononitrate in patients treated chronically after myocardial infarction.

25 patients with stable angina pectoris after acute myocardial infarction were given single and maintenance doses of isosorbide-5-mononitrate (IS-5-MN) in a controlled-release formulation. For evaluation of the efficacy of this treatment, a score based on exercise tests and patient's complaints including additional antianginal medication were used 4 weeks after the acute event. For assessment of anti-ischemic effect non-invasive parameters including heart rate, arterial blood pressure, changes in ST segments, frequency of premature ventricular beats and systolic time intervals were used before medication, 5 h after the initial dose and 7 days after maintenance therapy. The therapeutic concept of interval treatment was found to be effective. Nitrate tolerance did not develop. Measurements of plasma levels under steady-state conditions revealed minimum values of 100 ng/ml and maximum levels of 460 ng/ml which is in between the threshold for anti-ischemic effect and development of nitrate tolerance, respectively.

[Late arrhythmias following accidental electric shock?]. / Späte Herzrhythmusstörungen nach Stromunfall?

Long-term continuous ECG monitoring was undertaken in 31 males and 4 females, aged 17-75 years (33.1 +/- 14 years), hospitalized after accidental electric shock (25 at work, 10 at home). In all cases the voltage had been below 1000 V. ECG monitoring lasted for at least 24 hours (mean of 43.2 +/- 21 hours), in nine patients for 48 hours. In 31 patients no abnormalities were recorded, but in four the ECG registered complex arrhythmias already on the first record. But in only one of the latter was the arrhythmia clearly due to the electric shock. There were no late arrhythmias. It is concluded that long-term ECG monitoring is not required after electric shock if the initial ECG is normal.

Synthesis of cartilage matrix by mammalian chondrocytes in vitro. II. Maintenance of collagen and proteoglycan phenotype.

The in vitro phenotype of bovine articular chondrocytes is described. Chondrocytes plated at high density in roller-bottle and dish cultures were maintained in vitro. The major matrix macromolecules, collagen and proteoglycan, synthesized by these cells were characterized during the course of the culture period. The chondrocytes synthesized mainly Type II collagen, which was found predominantly in the cell-associated matrix. The media contained a mixture of Type II and Type III collagens. Type I collagen was detectable in neither the medium nor the cell-associated matrix. The proteoglycan monomers found in media and cell-associated matrix had the same hydrodynamic sizes as monomers synthesized by cartilage slices or those extracted from adult articular cartilage. The majority of proteoglycans synthesized by the cells were found in high molecular weight aggregates which were readily recovered from the media and were extractable from cell-associated matrix with low ionic strength buffers. The results demonstrate the long-term in vitro phenotypic stability of the bovine articular chondrocytes. The advantages of the in vitro system as a model for studying the effects of external agents, such as drugs and vitamins, are discussed.

The stimulatory effect of testosterone propionate and 17 beta-estradiol on 5'-methylthioadenosine phosphorylase activity in rat target tissues.

The effect of castration and subsequent administration of 17 beta-estradiol and testosterone propionate on 5'-methylthioadenosine phosphorylase activity in rat target tissues was studied. Castration 34 days earlier resulted in a 95% reduction in ventral prostate 5'-methylthioadenosine phosphorylase activity and 16 days earlier in a 67% reduction in uterine 5'-methylthioadenosine phorphorylase activity. Four days of testosterone propionate administration stimulated ventral prostate 5'-methylthioadenosine phosphorylase activity 32% above castrate levels, which represented more than 50% of the intact control levels. 17 beta-Estradiol on the other hand stimulated uterine 5'-methylthioadenosine phosphorylase activity 35% above castrate controls within 24 h and with 3 days of continuous hormone treatment to within 97% of the intact control levels. However, castration and subsequent 17 beta-estradiol administration did not affect 5'-methylthioadenosine phosphorylase activity in rat liver and lung. Both prostate and uterine 5'-methylthioadenosine phosphorylase were shown to metabolize 5'-methylthioadenosine to 5-methylthioribose through a 5'-methylthioribose 1-phosphate intermediate. The data suggest aht 5'-methylthioadenosine is not allowed to accumulate in rat target tissues even under conditions which are known to stimulate polyamine synthesis.

5-methylthioribose 1-phosphate: a product of partially purified, rat liver 5'-methylthioadenosine phosphorylase activity.

5'-Methylthioadenosine phosphorylase from rat liver has been purified 112-fold. A molecular weight of 90 000 for the enzyme was estimated from gel filtration on Sephadex G-150. The Km for 5'-methylthioadenosine was 4.7 . 10(-7) M, while the Km for phosphate was 2 . 10(-4) M. The products of the reaction were isolated and identified as adenine and 5-methylthioribose 1-phosphate. In addition to 5'-methylthioadenosine the nucleoside analogues 5'-ethylthioadenosine and 5'-n-propylthioadenosine also served as substrates for the enzyme. The 7-deaza analogue 5'-methylthiotubercidin was found to be an inhibitor of the reaction, but was inactive as a substrate.