Protein deficiency in primates. IV. Pregnant rhesus monkey.

Young adult female rhesus monkeys, maintained in a seminatural environment, when pregnant 30 days were fed a balanced semisynthetic diet containing 15.3 percent casein (13.4 percent protein) or 0.5, or 0.25 that amount for the remainder of thir pregnancy. The diets, made isocaloric by the addition of carbohydrates to replace the missing casein, supplied 4, 2, or 1 g protein/kg per day if the animals ate 120 kcal/kg per day, an assumption that was reasonably accurate. We studied the responses of monkeys delivering normal young at term. All monkeys were clinically healthy during the experiment. All reduced their total plasma protein concentration, principally by decreasing their albumin concentration. Greatest loss occurred in the low-protein group. Albuminuria was a common finding in all groups. Food consumption though varying throughout pregnancy, remained fairly comparable from group to group. Weight gain of the highest protein group was greatest; that for the lowest protein group barely covered the weight of the products of conception. Blood pressure declined during pregnancy while blood glucose rose. There were no morphologic changes in hair bulbs and only suggestive changes in liver cells that pointed to increased vacuolation. Increased metabolic efficiency during pregnancy enables the mother to safely pass through a long pregnancy during most of which she is fed a low-protein diet. Nonpregnant aminals suffer more under the same circumstances.

Invasive amebiasis in naturally infected New World and Old World monkeys with and without clinical disease.

Histopathological preparations of cecum and colon from monkeys naturally infected with invasive Entamoeba histolytica were examined to determine the distribution of amebae in the tissues and the types of lesions, if any, associated with them. Infections were studied in 3 New World species (10 Callicebus moloch, 1 C. torquatus, and 2 Aotus trivirgatus) and 3 Old World species (8 Macaca mulatta, 6 Erythrocebus patas, and 1 Cercopithecus aethiops). Amebiasis was recorded as the principal or a contributing cause of death of all of the 13 New World monkeys and in 6 of the 15 Old World monkeys; amebiasis was detected in the rest of the monkeys only after tissues were re-examined specifically for amebae. Amebae causing no apparent damage were found in the lamina propriae, mainly at the muscularis mucosae. Most frequent were colonies or aggregates of amebae in the crypts between the epithelium and basement membrane, causing either no evident necrosis or changes ranging from necrosis and disarrangement of adjacent cells to complete destruction of the epithelium and reduction of the cells to pyknotic bodies. A lesion interpreted as possibly characteristic of carrier-state invasive amebiasis was destruction of the epithelium in patches of mucosal crypts, not leading to ulceration. Uncommon but present in both New and Old World monkeys were typical areas of surface erosion and classical flask-shaped ulcers. The observations show that in some species of Old World monkeys amebiasis can be invasive without causing clinical disease.

Renal excretion of cystathionine and creatinine in humans at different ages.

The renal excretion of cystathionine is not age-dependent when related to body surface. Regarding the urinary creatinine concentration as reference, the excretion of cystathionine in adults is lower than in infants and children. However, this is probably due to a higher urinary concentration of creatinine in adults compared to that in children. Premature infants excrete more cystathionine in their urine than mature infants. The same is true for premature infants on a methionine-enriched formula compared to premature infants on a low methionine formula.

Fibroelastosis of the right ventricle in two brothers of triplets.

We present an autopsy report of endocardial fibroelastosis of the right heart in two brothers of triplets. Beside this anomaly no other macroscopical malformations in the hearts were found. Morphologically an unusual hypertrophy of the subendocardial myocardiocytes in the right heart was observed. A history of tocolysis (sympathomimetic drugs for treatment of premature labour) was the main reason for publishing this case report. We could not answer the question if the drug was causative or only coincident with the observed lesions.

[Radionuclide ventriculography--a noninvasive method of diagnosis and quantification of tricuspid valve insufficiency]. / Die Radionuklidventrikulographie--eine nichtinvasive Methode zur Diagnose und Quantifizierung der Trikuspidalklappeninsuffizienz.

The diagnosis of tricuspid regurgitation (TR) is difficult to make by simple clinical methods or by invasive techniques. Contrast echocardiography and Doppler echocardiography have improved diagnostic results, but a golden standard is still not available. Radionuclide ventriculography (RNV) is a well-established method for the detection and quantification of a volume load on the left ventricle: the regurgitation fraction can simply be derived from the regurgitant index as the ratio of enddiastolic-endsystolic count-rate differences between the left and right ventricle. In left heart valvular regurgitation a regurgitant index exceeding the upper normal limit can be expected. This study was performed to evaluate the diagnostic accuracy of an abnormally low regurgitant index in detecting TR, which is accompanied by an isolated volume load on the right ventricle. A series of 33 patients with TR on physical examination and cardiac catheterization underwent RNV and was compared with 48 patients with right ventricular enlargement or pressure load on the right ventricle. In addition, the specificity of the method was evaluated in 470 consecutive patients with various forms of heart disease. In 18 out of 20 subjects with isolated TR a regurgitant index below the lower normal limit was found. The remaining 2 cases with minor TR had a regurgitant index within the normal range, which is 0.89 to 1.97 in this laboratory. In patients with additional volume load on the left ventricle, the sensitivity of the method was found to be low, as could be expected from the principle of the method. The time-activity curve over the liver was usually in phase with that recorded over the atria in subjects with TR. Therefore, the additional examination of a region of interest over the liver was particularly useful in these patients with concomitant aortic or mitral valve regurgitation. None of the 48 patients with right ventricular enlargement or pressure load on the right ventricle had a falsely positive result. A total of 17 out of 470 consecutive patients had a regurgitant index below the normal range; left ventricular function was severely impaired in 9 of these patients. The remaining subjects had a regurgitant index slightly below the lower normal limit. In conclusion, RNV has a high sensitivity in the diagnosis of TR in patients without left heart valvular regurgitation and a high specificity in patients without severely impaired left ventricular function and without left-to-right shunt through an atrial septal defect.(ABSTRACT TRUNCATED AT 400 WORDS)

Pathophysiological aspects of predominant preload lowering on pulmonary circulation, gas exchange, and the biventricular function in patients with chronic obstructive lung disease.

A group of 21 patients with various degrees of chronic obstructive pulmonary disease underwent radionuclide ventriculography with hemodynamic monitoring to assess the extent to which pulmonary artery pressures and pulmonary vascular resistance can be lowered by the vasodilator molsidomine. Molsidomine (N-carboxy-3-morpholino-sydnonimin-ethylester) is similar to nitroglycerin in its mode of action. After hemodynamic and radionuclide data acquisition, at rest and during submaximal exercise in the steady state, 2 mg molsidomine was injected intravenously. Rest and exercise measurements were repeated 45 min after molsidomine injection. In patients with mild to moderate disease (group 1), pulmonary artery resting pressures decreased by 12% (p less than 0.05) at rest by 22% (p less than 0.01) during exercise after the administration of the drug. Total pulmonary resistance during exercise decreased significantly (p less than 0.01) as a result of marked decrease of pulmonary artery pressure (PAP) compared with a minimal decrease in cardiac index (CI). In patients with severe disease (group 2), only the resting values of PAP decreased while the relationship between pressure and flow was unchanged. During the exercise period, the preload parameters of the right and left ventricles decreased by an average of 30%. With regard to gas exchange, only the arterial PO2 at rest decreased slightly but significantly (p less than 0.05) after molsidomine, while the coefficient of oxygen delivery was not affected by the drug. However, in four patients arterial PO2 was markedly reduced by the drug. Right ventricular ejection fraction increased significantly (p less than 0.01) both at rest and during exercise in group 1 and during exercise in group 2 after administration of molsidomine.(ABSTRACT TRUNCATED AT 250 WORDS)

Soarian--workflow management applied for health care.

OBJECTIVES: To describe and comment on functionality and architecture of the software product Soarian developed by Siemens, to identify key differentiators to related products, and to comment on predecessor systems and beta versions. This has been done in the framework of a conference on health information systems of the IMIA. METHODS: Analyzing existing literature. Site visit of a predecessor system at Haukeland Sykehus, Bergen. Pilot of a beta version at the Erlangen University Medical Center, elaborating on major characteristics in discussion rounds. RESULTS: Soarian is a functional comprehensive, clinically oriented software product to support health care processes and to be used for health care professional workstations. It is a software product, designed and written completely new. Three major key differentiators were identified in comparison to related software products: Soarian's workflow engine, its embedded analytics, and its 'smart' user interface. The targeted reduced installation time is stated to be 12 months or less. CONCLUSIONS: Soarian has good chances to become one of the major software products for health care professional workstations in the international market to support patient-centered, shared care. Its global design may help to better support and maintain national or language specific versions. The first installations of Soarian will be critical, as they will show how the system will be accepted. To use such software products efficiently, organizational aspects within hospitals as well as between health care institutions have to be considered, e.g. strategic IT planning.

Dermatophilosis in a titi monkey (Callicebus moloch).

The occurrence of dermatophilosis in the titi monkey is reported. Lesions were principally in the epidermis of the skin and were characterized by parakeratosis, necrosis, abscess formation, acanthosis, and hyperkeratosis. The cause, Dermatophilus congolensis, was demonstrated as a gram-positive filamentous organism with both horizontal and vertical septums.

Naturally occurring and experimentally induced eastern encephalomyelitis in calves.

Eastern encephalomyelitis virus was isolated from the brain of 2 calves with encephalomyelitis. Using the isolant from 1 of these calves, the disease was reproduced in a clinically normal calf. Histopathologic features conformed with those described for eastern encephalomyelitis in the horse.

The Erlangen university hospital communication hub--proprietary and standardised communication.

The University of Erlangen-Nuremberg contains 22 hospitals and 11 autonomous medical departments which are spread out over a large area in the city of Erlangen. The necessary connections of these units and their computer based subsystems to each other and to the medical computer centre via fibre optics cables is complete. The internal cabling of the individual units is largely completed. Based on this network the Erlangen communication hub allows medical subsystems of the Erlangen university hospitals to exchange data by two completely different methods. Since 1995 a communication data base, which is implemented using the relational data base system ADABAS D, contains data from the most important hospital systems. This data can be accessed by other medical systems. Thus the communication data base allows subsystems which do not have a standardised interface to implement proprietary system interconnections via access based on SQL. The capabilities of this interconnection are dependent on both the implementation and the data which is made available by the communication data base. This contains mainly basic patient data and the results of tests performed by various laboratory systems. In addition to this proprietary communication system we have since the end of 1996 a communication server which can also handle standardised message formats such as HL7, EDIFACT, DICOM3. Future subsystems which possess standard interfaces will be connected via this server. The connection of the patient management system IS-H and the central laboratory system to the database has been proceeding since the beginning of 1997.

[Relation of peak flow and spirometry values in patients following bone marrow transplantation]. / Relation zwischen dem Peak Flow und spirometrischen Werten bei Patienten nach Knochenmarkstransplantation.

In about 30% of patients who were subjected to bone marrow transplantation, progressing interstitial and rarely obstructive pulmonary diseases can result in death. Early identification of curable diseases such as pulmonary changes during a "graft versus host reaction" would be desirable. Retrospective evaluation of 159 lung functions in 60 patients after bone marrow transplantation, however, revealed only moderate sensitivity of the peak flow value to vital capacity and FEV1, so that only pathological levels of this parameter will signify noticeable reductions in spirometric values.