Treatment of hypertensive emergency. Comparison of a new dosage form of the calcium antagonist nitrendipine with nifedipine capsules.

OBJECTIVE: To present the efficacy and tolerability of a new oral dosage form of the calcium antagonist nitrendipine compared to nifedipine capsules in patients with hypertensive emergency. DESIGN: Multicenter randomized double blind clinical study. SETTING: 23 study centres (hospitals) in Germany. PATIENTS: 161 patients between 20 and 70 years with acutely elevated blood pressure (systolic 200-250 mmHg, diastolic between 110-140 mmHg) with and without concomitant clinical symptoms. INTERVENTIONS: Double blind treatment with 10 mg nifedipine or 5 mg nitrendipine. Nifedipine was administered as capsules, nitrendipine was given from a small plastic tube (vial), containing 1 ml alcoholic solution. Every patient received in addition to the test medication a placebo corresponding to the other product. Patients with insufficient treatment after 45 min were given either an additional capsule of 10 mg nifedipine or a further vial containing 5 mg nitrendipine according to their group and maintaining the double dummy procedure. MEASUREMENTS AND RESULTS: Blood pressure and heart rate were measured repeatedly during 4 h, before and 90 min after beginning of the treatment a 12 channel resting ECG was recorded. At 45 min after administration the blood pressure had fallen significantly from 216.0/117.4 mmHg to 170.0/93.3 mmHg under nifedipine and from 216.9/117.3 mmHg to 177.4/94.4 mmHg under nitrendipine. 61.6% of the nifedipine patients and 58.8% of the nitrendipine patients had already reached blood pressure values < 180/100 mmHg after 45 min and in both groups 83% of these patients were still in this limit at the end of the observation period after 4 h. Tolerability was very good in both groups. CONCLUSION: The new dosage form of nitrendipine (vial with 1 ml of alcoholic solution) represents an alternative in the treatment of hypertensive emergency.

Influence of secretagogues on asynchronous secretion of newly synthesized pancreatic proteins in the conscious rat.

The secretion of newly synthesized pancreatic enzymes was studied in pancreatic duct cannulated rats after intravenous injection of 100 microCi of [35S]methionine. Secretion rate was stimulated by intravenous infusion of either cerulein (0.2 microgram/kg h) or carbachol (10 nmol/kg h) starting simultaneously with or 180 min before the injection of the labeled methionine. Secretory proteins were analyzed by sodium dodecyl sulfate (SDS) gel electrophoresis or by nondenaturing gel electrophoresis followed by determination of the radioactivity associated with the individual proteins. Similar to unstimulated controls in all experiments, an early secretion of newly synthesized trypsinogen and chymotrypsinogen was found, whereas amylase and lipase were secreted only after a certain lag period. The results suggest that the intracellular transit of endoproteases is faster than that of other enzymes, irrespective of whether or not secretagogues were applied.

The pH as an important determinant of sperm-mucus interaction.

OBJECTIVE: To determine the clinical significance of endocervical mucus pH on sperm-mucus interaction during infertility investigation. PATIENTS AND MATERIAL: Two hundred sixteen couples with a median duration of infertility of 4 years (range, 1 to 19 years) presenting at the infertility unit of the Women's University Hospital of Heidelberg, Germany. MAIN OUTCOME MEASURES: Determination of endocervical pH by colorimetric and electrometric measurement and correlation of results with the outcome of postcoital testing (PCT) and other parameters of infertility investigation (semen and cervical mucus [CM] quality, microbial colonization of cervix and ejaculates, medical history, hormonal status, and specific medication) and the subsequent fertility in a prospective study. In vitro experiments with the sperm-cervical mucus penetration test (SCMPT) used as biological model. RESULTS: The colorimetric determination of endocervical mucus pH is an easy method, suitable for routine clinical use, correlating significantly with electrometric measurement of pH. Median pH was 7.0 (range, 5.4 to 8.2). The mucus pH was significantly related with the results of PCT, even when mucus and semen variables were taken into account. No significant relationship was seen between the cervical index and mucus pH and the microbial colonization of cervix and ejaculates. The pH of endocervical secretions correlated with the peripheral hormonal status: low pH levels were significantly more frequent in patients with hyperandrogenemia, indicated by high testosterone and/or dehydroepiandrosterone sulfate levels before medication was started, and in hyperandrogenemic patients treated with dexamethasone than in the other women. Oral administration of estrogens led to a subtle alkalinization of the CM. With regard to subsequent fertility 6 months after pH testing, the pregnancy rate was significantly lower in women offering reduced mucus pH on occasion of the PCT in the group of couples with primary infertility and in couples with oligozoospermia of the male partner. The significant influence of pH on sperm-mucus interaction was confirmed in vitro with the SCMPT. CONCLUSIONS: The results indicate that the pH of the CM, easily determined with pH indicator paper, is an important parameter of mucus quality with significant influence on spermatozoal viability in CM, which correlates with peripheral hormonal status and can be affected by oral medication with estrogens. Therefore the routine determination of pH on occasion of the PCT is recommended during infertility investigation.

Screening for subclinical inflammation in ejaculates.

OBJECTIVE: To determine the clinical significance of albumin determination in ejaculates by means of an easy office test to screen semen samples for subclinical infection-inflammation. PATIENTS: One hundred fifty-nine randomly chosen males of couples with longstanding infertility (median duration of infertility 4 years (range 1 to 19 years) without clinical signs or symptoms of genital tract infection. SETTING: Outpatient Infertility Clinic of the University of Heidelberg, Germany. MAIN OUTCOME MEASURES: Screening of ejaculates for subclinical infection-inflammation by means of a ready-to-use kit for semiquantitative detection of albumin in addition to determination of leukocytes rates by means of monoclonal antibodies for differentiation of round cells and measurement of granulocyte elastase concentration in semen samples. Evaluation of sperm quality by means of standard sperm analysis including determination of local antisperm antibodies with the mixed antiglobulin reaction, evaluation of sperm functional capacity in vitro with the standardized sperm-cervical mucus (CM) penetration test, and semen cultures. All tests were performed from aliquots of the same ejaculates. RESULTS: Screening of semen samples for elevated albumin with the modified paper strips proved to be very easy, quick, and suitable for routine use. Positive results were not related markedly to medical history and outcome of clinical examination as well as to standard parameters of sperm analysis and were not influenced by local antisperm antibodies of the immunoglobulin (Ig)G and/or IgA class and microbial colonization. However, albumin-positive semen samples were significantly less frequent in case of very good outcome of the sperm-CM penetration test. A significant relationship was found with high rates of leukocytes of the round cells in semen samples (total range 0% to 96%) and the concentration of granulocyte elastase (total range 1 to 880 micrograms/L). CONCLUSIONS: The results of this prospective study suggest that the determination of albumin in semen samples with ready-to-use test kits might be a valuable additional marker for subclinical infection-inflammation of the male genital tract and therefore suitable for screening during infertility investigation.

Differentiation of round cells in semen by means of monoclonal antibodies and relationship with male fertility.

OBJECTIVE: To differentiate round cells in semen samples of subfertile men and evaluate the clinical significance during infertility investigation. PATIENTS: One hundred and eight randomly chosen couples with a median duration of infertility of 4 (range, 1 to 20) years presenting at the outpatient infertility clinic of the University of Heidelberg, Germany. MAIN OUTCOME MEASURES: Differentiation of round cells in semen by means of monoclonal antibodies (mABs) and a streptavidin-biotin system for staining. Correlation of results with medical history, outcome of clinical examination, sperm analysis, microbial screening of both partners, evaluation of sperm functional capacity in vivo by means of the postcoital test (PCT) and in vitro with the standardized crossed sperm-cervical mucus penetration test (SCMPT) and the subsequent fertility in a prospective study. RESULTS: The method used for differentiation of round cells proved to be practical and suitable for routine use. The percentage of leukocytes ranged from 0% to 58% with a median of 3%. Number of round cells and percentage of leukocytes did not differ markedly with regard to andrologic history, clinical findings, for example, varicocele, results of standard sperm analysis, and microbial colonization of semen samples. However, high rates of leukocytes of the round cells correlated with reduced sperm count and morphology and results of PCT. Leukocyte-positive (> 15% leukocytes) specimens were also significantly more frequent in case of inadequate SCMPT and reduced sperm penetration ability in vitro. CONCLUSIONS: In asymptomatic patients (in terms of genital tract infection), the majority of round cells consist of immature germ cells and < 5% are white blood cells. The streptavidin-biotin system and the mABs used in this study proved to be useful to identify patients with elevated rates of leukocytes in semen possibly reflecting subclinical genital tract infection with influence on sperm functional capacity and subsequent fertility. Thus the procedure can be recommended to be included in a comprehensive evaluation of male fertility.

Induction of immunoresponse by subclinical male genital tract infection?

OBJECTIVE: To determine the relationship of subclinical infection or inflammation of the male genital tract, as evaluated with seminal markers, with local antisperm antibodies as potential parameter of immunoresponse. PATIENTS: One hundred ninety-one randomly chosen males of subfertile couples who were asymptomatic in terms of genital tract infection. SETTING: Outpatient Infertility Clinic of the University of Heidelberg, Germany. MAIN OUTCOME MEASURES: Determination of leukocytes rates in semen using an immunocytochemical method for differentiation of round cells and measurement of polymorphonuclear (PMN) granulocyte elastase concentration in seminal plasma in addition to semen cultures as screening for subclinical infection of the male genital tract. Determination of local antisperm antibodies (Ab) with the mixed antiglobulin reaction ([MAR] immunoglobulin [Ig] G and IgA) in aliquots of the same ejaculates. RESULTS: Leukocyte rates of the round cells ranged from 0% to 93%, leukocytospermia was found in 6.8%. This was not related significantly to the presence of local antisperm antibodies of the IgG or IgA class. There was also no significant association of antisperm Ab with the concentration of PMN granulocyte elastase in seminal plasma and the outcome of semen cultures. CONCLUSIONS: The results of this prospective study suggest that when the rate or number of leukocytes or the concentration of PMN elastase in semen are taken as markers for subclinical infection or inflammation of the male genital tract, this is not associated significantly with the production of local antisperm Ab of the IgG or IgA class as indicator of immunoreaction.

Clinical relevance of sperm morphology assessment using strict criteria and relationship with sperm-mucus interaction in vivo and in vitro.

OBJECTIVE: To determine the relationship of the differentiated morphological pattern of semen samples according to strict criteria and sperm-mucus interaction in vivo and in vitro. PATIENTS: One hundred sixty-three randomly chosen couples with long-standing infertility (median duration of infertility 4 years, range 1 to 19 years). SETTING: Outpatient clinic of the fertility unit at the Women's University Hospital of the University of Heidelberg, Heidelberg, Germany. MAIN OUTCOME MEASURES: Sperm morphology assessment using strict criteria (Tygerberg or Norfolk classification) parallel to standard methods of sperm analysis: Evaluation of the cervical factor of patients' female partners, including a microbial screening of genital secretions of both partners; Examination of sperm migration ability in vivo under hormonally controlled conditions for the cervical mucus (CM) quality and in vitro with the crossed sperm-CM penetration test performed with CM of patients' partners, as well as with CM and spermatozoa of donors; Determination of the selection capacity of CM with regard to sperm morphology by means of a biological model; Prospective analysis of the differentiated morphological pattern with respect to couples' subsequent fertility within 6 months. RESULTS: Using stict criteria, amorphous sperm heads were the most frequently found sperm anomaly (severely amorphous forms: median, 28%; range, 4% to 62%). The morphology index offered a median of 45% (range, 7% to 80%). Results correlated significantly with routine sperm analysis, including standard morphology. The morphological pattern differed significantly in samples offering adequate or inadequate ability to penetrate CM in the standardized sperm-CM penetration test or in the postcoital test, with the percent of severely amorphous heads as the most important parameter. Neck and tail defects did not play an important role. During passage of mucus columns in vitro, the rate of pathological spermatozoal forms was reduced significantly, from a median of 65% to a median of 38%. Better functional capacity of spermatozoa with normal head morphology also was reflected by a significantly higher pregnancy rate under natural conditions of conception. CONCLUSIONS: Sperm morphological properties, determined with strict criteria, are important factors for sperm ability to penetrate the mucus barrier at the uterine cervix before reaching the site of fertilization, but sperm morphology is only one among other parameters determining the complex phenomenon of sperm-mucus interaction.

Evaluation of polyacrylamide gel as substitute for human cervical mucus in the sperm penetration test.

OBJECTIVE: To compare polyacrylamide gel as synthetic medium with human cervical mucus (CM) for the in vitro sperm-penetration test during infertility investigation. PATIENTS: One hundred sixty-nine randomly chosen couples with a median duration of infertility of 4 (range, 1 to 16) years presenting at the infertility unit of the Women's University Hospital of Heidelberg, Germany. MAIN OUTCOME MEASURES: Evaluation of sperm migration in polyacrylamide gel used in four different concentrations (1.5%, 1.6%, 1.7%, 1.8%) in the capillary tube test in parallel with CM of patients' female partners and CM of fertile donors, obtained under standardized conditions. Correlation of migration test results with outcome of semen analysis including microbial cultures and testing for local antisperm antibodies by means of the mixed antiglobulin reaction, postcoital testing, and the subsequent pregnancy rate after control for female infertility factors in a prospective study. RESULTS: Sperm ability to penetrate the synthetic medium (concerning all concentrations) correlated significantly with the penetration of human CM, although polyacrylamide proved to be a stronger barrier. Sperm velocity and duration of progressive motility were markedly reduced in polyacrylamide. Polyacrylamide results correlated with the outcome of standard sperm analyses but not with sperm antibody testing. No clear differentiation was obtained with regard to subsequent fertility (19% after 6 months), although adequate sperm migration in polyacrylamide 1.8% was significantly more frequent in the fertile group. CONCLUSIONS: In analyzing the intrinsic motility, penetration testing with polyacrylamide gel provides important information not obtained by routine sperm analysis. However, particularly with regard to immunological factors and fertility prognosis, human CM should be preferred whenever possible.

Herpes simplex virus infection of the uterine cervix--relationship with a cervical factor?

OBJECTIVE: To determine the prevalence of genital herpes simplex virus (HSV) in women of reproductive age and to evaluate a potential relation of asymptomatic HSV shedding with a cervical factor. DESIGN: Prospective study. SETTING: Outpatient infertility clinic of a university hospital. PATIENT(S): Randomly chosen asymptomatic women (n = 1,262) with a median age of 30 years. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Prevalence of cervical HSV, cervical index parameters, and other variables of CM quality, including CM penetrability in vivo and in vitro. RESULT(S): The prevalence of HSV infection of the uterine cervix was 5.2% (identified with cell culture). There was a tendency toward increased viscosity of the CM in HSV-positive women, but no significant relation with the other variables of CM quality (amount, spinnbarkeit, ferning, cervical appearance, and cellularity of the CM), or with the summarized Insler score or the cervical index according to World Health Organization guidelines. Postcoital testing and the in vitro penetration test, using either partners' or donors' semen, showed that the penetrability of the CM did not differ significantly between women with and without cervical HSV shedding. Asymptomatic cervical HSV infection was not significantly associated with bacterial colonization of the lower genital tract, with leukocyte counts in cervical secretions, with the pH of the CM or the vaginal fluid, or with antisperm antibodies in the CM. CONCLUSION(S): The results suggest that in asymptomatic women under controlled endocrine conditions, cervical HSV infection is not a significant cause of impaired quality and penetrability of the CM.

Chromosome analyses in cell cultures of the Chinese hamster after application of cadmiumsulphate.

Cell cultures of a Chinese hamster cell line were treated with CdSO4 in concentrations of between 10(-4) and 10(-8) mol/l for different time periods. After a treatment of 16 h the mitotic index was reduced. Strong stickiness and pycnosis of chromosomes occurred at the highest concentrations. A treatment period of 3 h with concentrations of 10(-5) and 10(-4) mol/l without additional application of Colcemid and hypotonic solution yielded a stathmokinetic effect. The mitotic index increased, mitoses were blocked in metaphase stage and "initial C-mitoses'' and "C-mitoses'' were present. Structural chromosome aberrations were present in the recovery period of more than 12 h following a treatment of 1 h with 10(-4) mol/l CdSO4. The observed aberrations were mainly of the chromatid type.

[General practitioners' choice of treatment for young women with metrorrhagia as evaluated by vignettes]. / Praktiserende laegers behandlingsvalg hos yngre kvinder med metroragi vurderet ved vignetundersøgelse.

A consensus conference on menstrual disorders concluded that a discrepancy exists between the large number of curettages performed annually on fertile women and the actual findings of cancer of the endometrium in this group of patients. Based on three written simulated consultations (vignettes) with 42-year-old women with metrorrhagia but without increased risk of cancer a decision analysis was performed among 695 general practitioners in Denmark and the Faroe Islands. The first choice of treatment was curettage in 43% of the responders. It was found that a large proportion of doctors decided on curettage when the patient had developed anaemia. The choice of curettage was associated with the doctors' assessment of need to exclude cancer of the endometrium, while doctors who gave high priority to non-invasive treatment and cessation of bleeding were less likely to refer for curettage. A larger proportion of male than female doctors chose curettage as primary treatment.

Evidence in vivo of asynchronous intracellular transport of rat pancreatic secretory proteins.

Labeled proteins which appeared in pancreatic juice after the intravenous (i.v.) injection of [35S]methionine into conscious rats with chronic pancreatic duct fistulae were separated by gel electrophoresis and measured by determination of the radioactivity of each of the separated bands. Radioactivity appeared in the secreted proteins 20 min after injection of the label. In the subsequent 10 min, 6.44% of the radioactivity was found in trypsinogen, whereas 100 min later only 3.4% of the radioactivity was associated with this enzyme. The values at 10 and 100 min for amylase were 10.85% and 21%, respectively, showing an earlier appearance of labeled trypsinogen than of amylase. Chymotrypsinogen behaved similarly to trypsinogen. Early secretion of labeled proteases was also demonstrated by separation of pancreatic proteins by two-dimensional gel electrophoresis followed by fluorography. In pancreatic duct cannulated rats, zymogen granules were prepared 30 and 60 min after injection of the labeled methionine. Determination of the radioactivity of the individual proteins demonstrated a similar time course of the labeling pattern in the zymogen granule fraction to that in pancreatic juice. The results of the experiments suggest an asynchronous secretion of newly synthesized rat pancreatic proteins.

Morphologic distribution of transforming growth factor alpha in the gastrointestinal tract--its presence in neuroendocrine cell type of the colon mucosa.

Among the growth factor proteins of the epidermal growth factor (EGF)-family especially the transforming growth factor alpha (TGF-alpha) and EGF can be detected in the mucosa of the gastrointestinal tract. In this study, immunohistochemistry on 15 different human tissue probes of gastrointestinal and colonic mucosa was carried out to visualize possible deposits for TGF-alpha in the mucosa and to compare different compartments of the upper and lower gastrointestinal epithelium. Most interestingly, in the colon there is a strong TGF-alpha-like immunoreactivity in neuroendocrine cells as evidenced by double labeling experiments with common neuroendocrine markers and by immunoelectron microscopy. In the upper gastrointestinal epithelium, however, all neuroendocrine cell types are negative for TGF-alpha, but parietal cells of the gastric corpus epithelium show strong cytoplasmic immunostaining for TGF-alpha. The neuroendocrine cells of the colon-harboring TGF-alpha-like immunoreactivity in their neurosecretory granules belong morphologically to the so-called L-cell type. Along with the well-known presence of EGF-receptor in the mucosa of the gastrointestinum, TGF-alpha, which is very likely to be released by this neuroendocrine cell type of the colon, acts in a paracrine mode. These findings represent the first morphologic indication that in the colonic epithelium growth regulation is under neuroendocrine control.

Fate of radioactive exocrine pancreatic proteins injected into the blood circulation of the rat. Tissue uptake and transepithelial excretion.

[35S]methionine or [35S]methionine-labeled exocrine pancreatic proteins were injected into the bloodstream of conscious rats. Samples of blood, urine, bile, and pancreatic juice were collected at varying intervals through 7 h. Injection of [35S]methionine resulted in the appearance of trichloroacetic acid--soluble radioactivity [( 35S]methionine) in bile and urine within 4 min and trichloroacetic acid-insoluble radioactivity in blood, bile, and pancreatic juice after 20 min. Analysis of these body fluids by two-dimensional isoelectric focusing/sodium dodecyl sulfate gel electrophoresis and fluorography indicated that rat serum, biliary, and pancreatic proteins were labeled, respectively. After the injection of [35S]methionine-labeled pancreatic proteins, half of the trichloroacetic acid-insoluble radioactivity disappeared from the serum in 10-15 min. Radioactive proteins appeared after 5 min in urine and bile, and, over the course of the experiment, accounted for 1%-2% and 0.3%-0.5% of the injected radioactivity, respectively. Analysis of individual radioactive proteins excreted into bile by two-dimensional isoelectric focusing/sodium dodecyl sulfate gel electrophoresis indicated preferential transhepatic transport of negatively charged pancreatic proteins. The majority of pancreatic proteins (approximately 97%) were taken up by a variety of body tissues, particularly kidney, liver, spleen, and lung. Trichloroacetic acid-soluble radioactivity, largely representing [35S]methionine, appeared sequentially in serum, urine, and bile within 2-12 min. At later experimental time points (greater than 60-90 min), radioactive rat serum, biliary, and pancreatic proteins appeared in blood, bile, and pancreatic juice, respectively. After the injection of 35S-labeled guinea pig pancreatic proteins into the blood circulation of the rat, trichloroacetic acid-insoluble radioactivity, observed in pancreatic juice after 60-90 min, exclusively represented rat exocrine pancreatic proteins as judged by the two-dimensional gel procedure. These studies indicate that pancreatic proteins are removed from the blood circulation by at least three separate pathways: (a) uptake and degradation by a variety of tissues in the body (approximately 97% of injected radioactivity), (b) excretion of intact proteins into urine (1%-2%), and (c) transport of intact proteins into bile (0.3%-0.5%). Transport of exocrine pancreatic proteins from the blood circulation to pancreatic juice could not be demonstrated.

Isolation and characterization of secretory actin . DNAase I complex from rat pancreatic juice.

DNAase I isolated from rat pancreatic juice was always found in association with a protein of molecular weight 43 000. This association leads to inhibition of the isolated rat pancreatic DNAase I activity by 66%. The molecular weight of the complex was found to be 74 000 by gel filtration indicating a 1 : 1 molar association of both proteins. Since the protein of molecular weight 43 000 has a number of properties similar to skeletal muscle actin such as filament formation, nucleotide binding, inhibition of the rat pancreatic DNAase I activity and comigration with skeletal muscle actin on polyacrylamide gels in the presence of dodecylsulfate, it is concluded that DNAase I is bound to actin in rat pancreatic juice in a 1 : 1 complex. It is demonstrated that a protein fraction from bile is able to activate the DNAase I enzymatic activity of the rat secretory actin . DNAase I complex.

New aspects for the therapy of Crohn's disease.

Although the exact etiology and pathogenesis of Crohn's disease is still unknown, inadequate immune responses as in the expression of antigen specific suppressor T-cells are involved. The established therapy is only symptomatic and only partly successful. Based on the suspected immunopathogenesis, there are several attempts for an improved therapy especially in the field of immunomodulation. Therapeutic activity is claimed for T-lymphocyte apheresis, for blood transfusions or substances as methotrexate, chloroquine, immunoglobulin or Factor XIII. Several studies for cyclosporin are promising.