Early enzyme changes in skin wounds demonstrated by isoelectric focusing in polyacrylamide gel

Summary Esterase patterns in vital skin wound extracts were observed and compared to those seen in normal skin. Employing the relatively simple method of isoelectric focusing in polyacrylamide gel, it was demonstrated that three, consecutively appearing, characteristic changes were visible in the esterase zymograms of vital (pre-mortally) injured skin as compared with skin which was uninjured or post-mortally damaged. One of these characteristics (characteristic a), since it is found only in wound reactions and not in uninjured skin, may represent an enzyme specifically produced during the wound reaction process. All three features normally appeared within 30 min of trauma and the first change within 5 min, even though it had been generally assumed that vital reactions, i.e. wound reactions, could be demonstrated only after a longer period of time. It was possible therefore to determine victim survival time and distinguish between pre- and post-mortal wounds. Also the isoelectric focusing of enzymes apparently gives a more efficient pattern band separation than previous methods.

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Zusammenfassung Durch isoelektrische Fokussierung der Extrakte aus vital verletzter Haut wurden die -Naphthylacetat-spaltenden Enzyme aufgetrennt und mit gleichartig hergestellten Extrakten unverletzter Haut desselben Menschen verglichen. Es konnten 3 nacheinander auftretende Merkmale im Esterasemuster der verletzten Haut festgestellt werden. Die mit a, b und c bezeichneten Unterschiede im Esterasemuster sind für die frühen Wundreaktionen kennzeichnend. Das Merkmal a ist eine nur in vitalen Hautwunden nachweisbare Esterase-Fraktion, die innerhalb 5 min nach der Wundsetzung auftritt. Die Merkmale b und c erscheinen nach dem Merkmal a innerhalb 30 min nach der Verletzung. Der Nachweis von a, b, c in einer Wunde erlaubt eine Beurteilung der Überlebenszeit und ermöglicht außerdem eine Unterscheidung von vitalen und postmortalen Wunden. Die isoelektrische Fokussierung von Enzymen scheint leistungsfähiger zu sein als die bisher zur Kennzeichnung von Wundenzymen angewandten histoenzymatischen und elektrophoretischen Methoden.

     

A pattern of post-traumatic demineralization of bone simulating permeative neoplastic replacement: A potential source of misinterpretation

Long bones with a prominent endosteal trabecular pattern, particularly the herringbone configuration, when immobilized, will demineralize in a striking spotty pattern which may simulate neoplastic permeative replacement of bone. The recognition of this phenomenon will obviate needless concern and investigation.     

Agreement between emergency physician diagnosis and radiologist reports in patients discharged from an emergency department with community-acquired pneumonia

To evaluate the level of concurrence between radiologist reports and the diagnosis of community-acquired pneumonia (CAP) in patients discharged from an emergency department (ED), a retrospective chart audit of patients discharged with a diagnosis of pneumonia or possible pneumonia from the ED during a 2-year period was conducted. Emergency physician (EP) and radiology report (RR) diagnoses were categorized as pneumonia, possible pneumonia, non-pneumonia and normal, and categories from each were compared. 815 charts were analyzed. Of 671 EP diagnoses of pneumonia, 304 (45.3%) RRs reported pneumonia and 82 (12.2%), possible pneumonia. Of 815 EP diagnoses of pneumonia or possible pneumonia, 426 (52.3%) RRs were in agreement, while 216(26.5%) were of diagnoses other than pneumonia and 173 (21.1%) were read as normal. EPs and radiologists frequently disagree on whether a patient has pneumonia or not. Perhaps it is time to revisit the gold standard status of plain chest X-ray.Presented at the 9th International Conference of Emergency Medicine, Edinburgh, Scotland, 17–21 June, 2002.     

‘Hot’ and ‘cold’ lesions detected by gallium-67 scintigraphy in a pyogenic liver abscess

Most pyogenic liver abscesses appear to be not in a ⁶⁷Ga-citrate study; rarely, a warm or cold area may also be seen. We present a patient with a pyogenic liver abscess that had both cold and hot areas in the ⁶⁷Ga-citrate study. This striking finding is probably related to the different stages of evolution of the abscess.     

Cancer radioimmunotherapy with alpha-emitting nuclides

In lymphoid malignancies and in certain solid cancers such as medullary thyroid carcinoma, somewhat mixed success has been achieved when applying radioimmunotherapy (RIT) with -emitters for the treatment of refractory cases. The development of novel RIT with -emitters has created new opportunities and theoretical advantages due to the high linear energy transfer (LET) and the short path length in biological tissue of -particles. These physical properties offer the prospect of achieving selective tumoural cell killing. Thus, RIT with -emitters appears particularly suited for the elimination of circulating single cells or cell clusters or for the treatment of micrometastases at an early stage. However, to avoid non-specific irradiation of healthy tissues, it is necessary to identify accessible tumoural targets easily and rapidly. For this purpose, a small number of -emitters have been investigated, among which only a few have been used for in vivo preclinical studies. Another problem is the availability and cost of these radionuclides; for instance, the low cost and the development of a reliable actinium-225/bismuth-213 generator were probably determining elements in the choice of bismuth-213 in the only human trial of RIT with an -emitter. This article reviews the literature concerning monoclonal antibodies radiolabelled with -emitters that have been developed for possible RIT in cancer patients. The principal radio-immunoconjugates are considered, starting with physical and chemical properties of -emitters, their mode of production, the possibilities and difficulties of labelling, in vitro studies and finally, when available, in vivo preclinical and clinical studies.     

Das Problem der a-priori-Wahrscheinlichkeit bei Verwendung der Essen-Möller-Formel zur Berechnung der Vaterschaftswahrscheinlichkeit

Zusammenfassung Die Annahme der a-priori-Wahrscheinlichkeit, daß Nichtväter und wahre Väter gleichhäufig zur Begutachtung gelangen, wird an Hand von 408 Aktenfällen bestätigt.Die Berechnung der Vaterschaftswahrscheinlichkeit bietet, insbesondere bei Mehrverkehrsfällen, wertvolle Hinweise für die Vaterschaft oder Nichtvaterschaft eines Probanden, Hinweise, die durch die Angabe der Vaterschaftsausschlußchance aufgrund der Mutter-Kind-Konstellation nicht erbracht werden können. Auf Beziehungen zwischen der Vaterschaftsausschlußchance und der Vaterschaftswahrscheinlichkeit wird hingewiesen.

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The assumption of prior probability computing the plausibility of paternity by the Essen-Möller equation and its problem

Summary Among objectivists the assumption of firsthand probability, that non-fathers and true-fathers are being given an opinion on with equal frequency, yields to a rejection in calculating the probability of fatherhood according to Essen-Möller. By means of 408 cases it is shown, that this assumption does meet the actual situation. Non-fathers and true-fathers are observed equally frequent. Calculation of fatherhood probability renders a valuable reference to paternity or nonpaternity of a subject in cases of multiple intercourses. These references cannot be brought on by the statement of the exclusion chance of fatherhood based on the mother-child-constellation. The relationship between the exclusion chance and the probability of fatherhood is pointed out.

     

Effect of adrenergic receptor ligands on metaiodobenzylguanidine uptake and storage in neuroblastoma cells

The effects of adrenergic receptor ligands on uptake and storage of the radiopharmaceutical [¹²⁵I]metaiodobenzylguanidine (MIBG) were studied in the human neuroblastoma cell line SK-N-SH. For uptake studies, cells were incubated for 15 min with varying concentrations of -agonist (clonidine, methoxamine, and xylazine), -antagonist (phentolamine, tolazoline, phenoxybenzamine, yohimbine, and prazosin), -antagonist (proranolol, atenolol), -agonist (isoprenaline and salbutamol), mixed / antagonist (labetalol), or the neuronal blocking agent guanethidine, prior to the addition of [¹²⁵I]MIBG (0.1 M). The incubation was continued for 2 h and specific cell-associated radioactivity was measured. For the storage studies, cells were incubated with [¹²⁵I]MIBG for 2 h, followed by replacement with fresh medium with or without drug (MIBG, clonidine, or yohimbine). Cell-associated radioactivity was measured at various times over the next 20 h. Propanolol reduced [¹²⁵I]MIBG uptake by approximately 30% (P<0.01) at all concentrations tested, most likely due to nonspecific membrane changes. However, incubation with the other -agonists or antagonists failed to elicit significant reductions in uptake. In contrast, all of the -agonists significantly inhibited uptake (P<0.05); guanethidine >xylazine >clonidine=methoxamine. The -antagonists demonstrated a broad range of inhibition (phenoxybenzamine phentolamine prazosin yohimbine=tolazoline)(P<0.05). The mixed ligand, labetalol, inhibited MIBG uptake in a dose-dependent manner with an apparent IC₅₀ of 0.65 M. The retention studies demonstrated that unlabeled MIBG caused profound self-inhibition (P<0.01). Clonidine produced a modest inhibition of retention and yohimbine had no effect. Labetalol, phenoxybenzamine, guanethidine, and propranolol reduced uptake of [¹²⁵I]MIBG by neuroblastoma cells in culture. Although only labetalol has been reported to cause false-negative MIBG scans, our results suggest that these other drugs have the potential to interfere with MIBG imaging and therapy, particularly at high doses. Adrenergic drugs did not alter cytoplasmic retention of [¹²⁵I]MIBG in neuroblastoma cells but may have potential in tumors such as phenochromocytoma, where granular storage of MIBG has been observed. Inhibition of [¹²⁵I]MIBG retention by unlabeled MIBG supports the use of high specific activity radioiodinated MIBG for both diagnosis and therapy.     

Dose to patients through nuclear medicine procedures in a department in northern Greece

Diagnostic nuclear medicine procedures in a large hospital in northern Greece during 1984–1988 have been surveyed in order to estimate the radiation burden to the patients. The mean effective dose equivalent (EDE) was found to be 1.96 mSv/examination and 2.46 mSv/patient, allowing for the fact that a number of patients underwent more than one examination. Apart from EDE, absorbed dose has been calculated for bone marrow, thyroid, gonads, kidneys and bladder. Patients undergoing multiple examinations have been used to calculate true patient dose distribution as well as patient time-weighted dose distribution. Because of the predominance of renal examinations, 8.5 fatal renal malignancies are expected per 100000 patients.     

Genetic polymorphism of desialyzed alpha2 HS-glycoprotein by ultrathin isoelectric focusing

Summary The genetically determined polymorphism of ₂ HS-glycoprotein was analyzed by immunoblotting ultrathin-layer polyacrylamide gel isoelectric focusing in the pH range 4–6.5 and neuraminidase pretreated sera. In a Libyan population sample from Tripoli (n=110) three common phenotypes, ₂ HSG 1–1, 2–1, and 2–2, were observed. The allele frequencies were ₂ HSG¹=0.8364 and ₂ HSG²=0.1636. The theoretical exclusion rate in cases of disputed paternity is 11.8%.     

Vertragszahnärzte/Honorarverteilungsmassstab/individuelle Budgets

Abstrakt 1. Das Landesschiedsamt ist zum Erlass eines (Ersatz-)HVM befugt, wenn der angegriffene HVM die Gesamtvergütung nicht gleichmässig auf das gesamte Jahr verteilt.2. x85 Abs. 4 S. 3 SGB V fordert im Ausgangspunkt eine Vergütung (zahn-)ärztlicher Leistungen mit einheitlichem Punktwert (leistungsproportionale Vergütung).3. Solange nicht die Gefahr übermässiger Ausdehnung der vertrags(zahn)ärztlichen Tätigkeit i.S. des x85 Abs. 4 S. 5 SGB V (a.F.; heute: x85 Abs. 4 S. 6 SGB V) zu besorgen ist, ist die Vorgabe von Budgets, bei deren Überschreitung keine oder nur eine wirtschaftlich unbedeutende Restvergütung gewährt wird, nur dann mit dem Grundsatz der leistungsproportionalen Vergütung zu vereinbaren, wenn eine angemessene Korrelation zwischen dem abzudeckenden Versorgungsbedarf und der Budgetgrösse besteht.4. Ein HVM, der bei der Vergütung von Leistungen oberhalb einer zulässigen Leistungsobergrenze (Restleistungen) nicht sachgerecht die unterschiedlichen Auswirkungen auf die verschiedenen Arztuntergruppen berücksichtigt, ist wegen Verstosses gegen Art. 3 Abs. 1 GG rechtswidrig. (Nr. 1, 2, 4: Leitsätze des Bearbeiters; Nr. 2: amtlicher Leitsatz).     

Disco-vertebral destructive lesions (So-called Andersson Lesions) associated with ankylosing spondylitis

Radiological examination of 31 patients with established ankylosing spondylitis revealed 58 disco-vertebral destructive lesions. Careful assessment of their radiological features permitted differentiation into two main types, (1) inflammatory and (2) non-inflammatory. The inflammatory type may represent either an active inflammatory process or a late sequel to such a lesion. In this series 44 lesions were included in this category, with a marked predilection for the lumbar spine. Moreover, all were observed within the first decade following the onset of the disease.The non-inflammatory type reflects an attempt of a stress fracture in the diseased spinal column to repair by connective tissue, causing a pseudoarthrosis. Eleven such lesions were obseved in this series all occurring more than 12 years after the onset of the disease. In a much smaller group of three cases-here termed the ambivalent type — differentiation between the inflammatory and non-inflammatory types could not be established on radiological grounds alone. It is of interest that all three cases occurred within the first year after the onset of the disease.It is suggested that the term Andersson lesion should be used to include all disco-vertebral destructive lesions related to ankylosing spondylitis—be they of inflammatory or non-inflammatory pathogenesis —as the better known term Romanus lesion includes all types of circumscribed marginal destructive lesions of vertebral bodies without involvement of the disc in ankylosing spondylitis.     

Genetic polymorphism of Alpha-2-HS glycoprotein in Lombardy (Italy)

Summary 2HS-subtypes have been analysed in samples from 700 unrelated individuals from the Brescia area (Italy) by the isoelectric focusing technique and immunofixation. The observed allele frequencies were: 2HS*1= 0.7472; 2HS*2 = 0.2507; 2HS*V = 0.0021.     

γ-Glutamyltransferase test as a new tool for identification of seminal stains

Summary A simple qualitative method for identification of seminal stains based on a high activity of -glutamyltransferase (-GTP) in human semen is described. It employs the release of -naphthylamine from N--glutamyl--naphthylamide by the -GTP action; -naphthylamine couples with Fast Garnet GBC salt to produce a strong brownish-red color. The data on its simplicity, specificity, and stability show that the present method is suitable for medicolegal examination of seminal stains as a preliminary test.     

Three-dimensional display of myocardial perfusion detection of ischemic lesions using a new image subtraction method

A recent, commercially available computer program for the three-dimensional (3D) display of single-photon emission tomography (SPET) data was used to study myocardial perfusion in patients with coronary artery disease (CAD). To enable the detection of small ischemic lesions, the authors proposed a new distance-subtraction method: after suitable centering of the axial slices, 3D distance-shaded images of the stress study were subtracted from the corresponding views of the rest study. With this technique, small changes in surface-to-observer distance were highlighted, thus enabling us to detect nontransmural ischemic areas of the myocardium. General characteristics and possibilities of the subtraction technique were tested on a simple myocardial phantom. Some clinical results of the application of this method on CAD patients are presented and discussed. In CAD patients in whom only nontransmural ischemic lesions are present, the subtraction of distance-shaded images is decisive for a correct diagnosis.     

81mKr: Production,application, and use of computer for ventilation studies

Theoretical excitation functions have been used for the production of neutron-deficient rubidium isotopes by (, kn) reactions on ⁷⁹Br and ⁸¹Br. Krypton generators have been produced using the internal beam of the cyclotron of the Rudjer Bokovi Institute. New methods for target preparation and radiochemical separation have been developed.Preliminary clinical studies have been performed with the aim of investigating the possible use of krypton generators in conjunction with a gamma camera and a digital computer.The digital computer was used to normalize images of regional ventilation and to calculate and display isoventilation regions.Clinical examples of images of regional ventilation that permit resolution between nonventilated and well-ventilated regions are given.     

The value of bone imaging in multiple myeloma

In a series of 20 patients with a proven diagnosis of myeloma, both full radiographic skeletal surveys and full ratio-nuclide bone images were performed. When these were compared, they showed that (i) imaging underestimated the number of areas involved by 50%, but there were no false negative whole images when compared with the radiology, (ii) large lytic areas on X-ray show as cold areas on the bone image but small ones show as normal, (iii) images that show areas of increased uptake (hot) are almost always associated with fracture, and (iv) patients with bone pain very commonly had hot images corresponding to the region of pain.4th year medical student     

Transcatheter Closure of Patent Foramen Ovale in Patients with Platypnea-Orthodeoxia: Results of a Multicentric French Registry

Background Dyspnea and the decrease in arterial saturation in the upright position in elderly subjects is described as platypnea-orthodeoxia syndrome (POS). POS is secondary to the occurrence of an atrial right-to-left shunt through a patent foramen ovale (PFO).Methods This French multicentric study reports on 78 patients (mean age 67±11.3 years) with POS who had transcatheter closure of the PFO; frequently associated diseases were pneumonectomy (n=36) and an ascending aortic aneurysm (n=11). In all patients, the diagnosis was confirmed by transthoracic or/and transesophageal echocardiography. Five different closure devices were used: Amplatz (n=45), Cardioseal (n=13), Sideris (n=11), Das Angel Wings (n=8) and Starflex (n=1). Closure was successful in 76 patients (97%).Results Oxygen saturation increased immediately after occlusion from 84.6±10.7% to 95.1±6.4% (p < 0.001) and dyspnea improved from grade 2.7±0.7 to grade 1±1 (p < 0.001). A small residual shunt was immediately observed in 5 patients (3 with the Cardioseal device, 1 with the Sideris and 1 with the Amplatz) leading to the implantation of a second device in one case (Cardioseal). Two early deaths occurred unrelated to the procedure (one due to sepsis probably related to pneumonectomy, another due to respiratory insufficiency). Other complications were: a small shunt between the aorta and the left atrium, two atrial fibrillations and a left-sided thrombus which disappeared with anticoagulant therapy. At a mean follow-up of 15±12 months, there were 7 late deaths related to the underlying disease.Conclusion Percutaneous occlusion of the foramen ovale is safe and gives excellent results thanks to continuing improvement in available devices. This technique enables some patients in an unstable condition to avoid a surgical closure.     

Fixierung von Pulverschmauchspuren durch Haarspray

Zusammenfassung Da der Durchmesser eines Schmauchhofes als Kriterium der zu berechnenden Schußdistanz angesehen wird, ist es notwendig, das ursprüngliche Schmauchbild zu fixieren, um Veränderungen durch unsachgemäße spätere Behandlung zu vermeiden. Das Fixierungsmittel soll neben einer leichten Handhabung eine gute Klebeigenschaft zeigen, schnell trocknen, ohne später zu kleben und so wenig isolieren, daß die chemischen Nachweismethoden nicht beeinträchtigt werden. Wie Versuche ergaben, eignen sich hierfür Haarsprays am besten. Die Fabrikate Sprühgold (Firma Goldwell-Darmstadt) und Elnett (Firma L'Oreal-Paris) erwiesen sich in allen Anforderungen als optimal. In Versuchen konnten an beschossenen Textilien ohne Besprühen Verluste am Schmauchhofdurchmesser bis zu 37% gemessen werden bei meist erheblicher Abnahme der Schmauchdichte. Zwischen Webart und Oberflächenbeschaffenheit der Stoffe und Haftfähigkeit des Pulverschmauches besteht eine feste Relation. Die Rekonstruktion des Schußdistanz durch Vergleichsschießen kann bei früherer unsachgemäßer Behandlung der Textilien zu erheblichen Fehlern führen. Auch eine Fixierung von Schmauchteilen an der Leichenhaut durch Haarspray dürfte angebracht sein.

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Summary Improper handling of clothing from persons who have been shot (victims of shot wounds) leads to a considerable loss of powder-smoke residue. Through our experiments, we were able to demonstrate a decrease in diameter of the smoke-stained area up to 37%, along with considerable dimunition of the density of the smoke residue. There is a definite relationship between the kind of material and its surface condition and the adhesiveness of the powder-smoke. By spraying the smoke-stained areas with hair spray, we found that the loss of smoke residue particles can be reduced. The sprays Sprühgold (product of Goldwell, Darmstadt) and Elnett (product of L'Oreal-Paris) produce good results without affecting the chemical reaction for demonstrating the smoke stains.

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Herrn Prof. Dr. B.Mueller zum 68. Geburtstag in dankbarer Verehrung gewidmet.     

Immunochemical studies on blood group H and B substances from human hair

Summary Blood group H and B substances were extracted from urea-treated human hair of group O and B individuals, respectively, with methanol-ethyl ether (1:1,v/v) and chloroform-methanol (1:1,v/v). The blood group activities of H and B substances were destroyed by H-decomposing enzyme (-l-fucosidase) fromBacillus fulminans and B-decomposing enzyme (-d-galactosidase) fromClostridium sporogenes Maebashi, respectively. It is concluded therefore that the extract from the hair of group O contained blood group H-active glycolipid with -l-fucose as the non-reducing sugar and the one from group B contained blood group B-active glycolipid with -d-galactose as the non-reducing sugar.     

A pragmatic approach to metal artifact reduction in CT: merging of metal artifact reduced images

The purpose of this study was to improve metal artifact reduction (MAR) in X-ray computed tomography (CT) by the combination of two artifact reduction methods. The presented method constitutes an image-based weighted superposition of images processed with two known methods for MAR: linear interpolation of reprojected metal traces (LI) and multi-dimensional adaptive filtering of the raw data (MAF). Two weighting concepts were realized that take into account mean distances of image points from metal objects or additional directional components. Artifact reduction on patient data from the jaw and the hip region shows that although the application of only one of the MAR algorithms can already improve image quality, these methods have specific drawbacks. While MAF does not correct corrupted CT values, LI often introduces secondary artifacts. The corrective impact of the merging algorithm is almost always superior to the application of only one of the methods. The results obtained with directional weighting are equal to or in many cases better than those of the distance weighting scheme. Merging combines the advantages of two fundamentally different approaches to artifact reduction and can improve the quality of images that are affected by metal artifacts.Symbols LI linear interpolation algorithm - MAF multi-dimensional adaptive filtering algorithm - MAR metal artifact reduction - f(x, y) object function at (x, y) - F(), F() normalized filter function in the direction of the coordinates and - I primary X-ray intensity - I₀ transmitted X-ray intensity - N_D number of detectors per detector row - p attenuation - p(,), p(,) projection data (fan and parallel geometry) - p_th lower threshold of the attenuation of adaptive filtering - p_max maximum value of the attenuation of adaptive filtering - (x, y) image point - projection angle in fan geometry - angle within the fan relative to the central ray - , , z, , minimum functions for adaptive filtering - projection angle in parallel geometry - orthogonal distance of a ray to the center of rotation in parallel geometry