Intolerance to tartrazine in aspirin-induced asthma: results of a multicenter study

One hundred and fifty-six German, Italian and Polish patients with confirmed aspirin-induced asthma underwent open oral challenges with increasing doses of tartrazine up to 25 mg. All positive challenges were repeated under double-blind conditions. Only 4 of 156 patients (all Polish) had positive reactions in a double-blind test, as evidenced by a fall in FEV1 greater than 25% from baseline and corresponding clinical symptoms. Sixty-five patients who tolerated 25 mg tartrazine well received 50-3,000 mg tartrazine and none showed adverse reactions. Thus, intolerance to tartrazine appears to be rare among Central-European and South-European patients with aspirin-induced asthma, its frequency amounting to about 2.6%.     

Incidence of next-day anterograde amnesia caused by flurazepam hydrochloride and triazolam

The incidence of next-day anterograde amnesia was evaluated in hospitalized patients who received flurazepam hydrochloride or triazolam. A blinded observer assessed memory and daytime drowsiness in 154 patients after the bedtime ingestion of flurazepam hydrochloride (n = 54), triazolam (n = 49), or no hypnotic drug (n = 51). The hypnotic agents were administered before midnight. At approximately 0800 the next morning, the patients were shown a picture of an object on colored construction paper and asked to remember it as well as the color of the background. Both the observer and patient assessed drowsiness using the Stanford Sleepiness Scale. The observer also made a note of the items on the patient's breakfast tray. Patients were then revisited at 1100 and asked to recall the object in the picture, the color of the background, and at least three items from their breakfast tray. Ten of the 54 patients in the flurazepam group failed to recall all three items compared with only two in the triazolam group and two in the control group. The 14 patients who experienced memory impairment were significantly more drowsy at 0800 than those who were able to recall the items. Next-day anterograde amnesia occurred more frequently in patients who received flurazepam hydrochloride than in those who received triazolam or no hypnotic drug. This effect may be related to the next-day drowsiness caused by flurazepam and its slowly eliminated active metabolite.     

The significance of the HBe system in an area highly endemic for hepatitis B virus

Summary A group of 164 consecutive patients with chronic liver disease and 60 healthy HBsAg carriers were investigated in an area highly endemic for hepatitis B virus (HBV). Eighty-two of the 164 patients (50%) were found to be HBsAg-positive and only 39 (24%) had no HBV markers. A statistically significant correlation was found in the HBsAg-positive patients between the HBe system, their age and the time which had elapsed since their acute episode. Thus, the prevalence of HBeAg decreased with increasing age and with increasing time since their acute episodes. Furthermore, a statistically significant correlation was found between the presence of HBeAg and active chronic liver disease. Of the patients with chronic active hepatitis with or without cirrhosis, all patients below the age of 13 years were HBsAg-positive and 72% were also HBeAg-positive. The data suggest that the HBeAg-positivity in HBsAg carriers is of limited duration and that the seroconversion from HBeAg to anti-HBe is related to a histologically less active or inactive stage of the disease.

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Die Bedeutung des HBe-Systems in einem hochgradigen Hepatitis-B-Virus-Endemiegebiet

Zusammenfassung In einem hochgradigen Endemiegebiet für das Hepatitis-B-Virus (HBV) wurden 164 nacheinander eingewiesene Patienten mit chronischer Lebererkrankung und 60 gesunde HBsAg-Träger untersucht. 82 der 164 Patienten (50%) waren HBsAg-positiv und nur 39 (24%) hatten keine HBV-Marker. Bei HBsAg-positiven Patienten wurde eine statistisch signifikante Korrelation zwischen dem HBe-System, dem Alter der Patienten und dem zeitlichen Abstand zur akuten Erkrankung festgestellt. Entsprechend war die Prävalenz von HBeAg um so geringer, je länger die akute Erkrankung zurücklag. Zwischen dem Vorhandensein von HBeAg und chronisch aktiver Lebererkrankung fand sich ebenfalls eine statistisch signifikante Korrelation. Alle Patienten mit chronisch aktiver Hepatitis mit oder ohne Zirrhose, die jünger als 13 Jahre waren, waren HBsAg-positiv, 72% von ihnen auch HBeAg-positiv. Daraus läßt sich schließen, daß HBeAg-Positivität bei HBsAg-Trägern von begrenzter Dauer ist, und daß die Serokonversion von HBeAg zu anti-HBe mit einem Stadium geringer histologischer Aktivitätszeichen oder mit einem inaktiven Krankheitsstadium korreliert.

     

Arthrography of the knee: a comparative study of the accuracy of single and double contrast techniques

Single and double contrast arthrographic techniques were compared in 951 patinets with suspected meniscal injuries. Exploratory surgery of the knee was performed in 384 of these patients and good clinical follow-up was obtained in 135 patients. In the latter two groups of patients, the single contrast technique was 97% accurate in assessing the medial meniscus and 96% accurate in assessing the lateral meniscus. Double contrast arthrography was 97% accurate in assessing the medial meniscus and 93% accurate in assessing the lateral meniscus. Numerical differences in the results from the two techniques were not statistically significant. Therefore both techniques can be considered equally effective diagnostically.     

Acute viral hepatitis: factors possibly predicting chronic liver disease.

A number of clinical, biochemical, immunological and morphological variables were recorded at first admission of 500 consecutive patients with biopsy verified acute viral hepatitis in the period February 1969-June 1972. In February 1973, 28 of these patients had a morphologically documented chronic liver disease: 4 cirrhosis of the liver, 15 chronic aggressive hepatitis, and 9 chronic persistent hepatitis. 74 patients were followed up until morphological normalization took place. The initially recorded variables in the two groups were compared, and the following factors were significantly higher in the group with subsequent development of chronic liver disease:--frequency of drug addicts, median of the highest gammaglobulin, ANA, SMA, partial destruction of the limiting membrane, incidence of piecemeal necrosis, and pronounced plasma cell infiltration in the portal tracts. These preliminary results suggest that factors in the initial phase of acute viral hepatitis can be helpful to some extent in predicting the course and prognosis of the disease.     

Impeded cerebellar development and reduced serum thyroxine levels associated with fetal alcohol intoxication

Pregnant albino rats were placed on a complete liquid diet (Ensure) containing either 9% ethanol or an isocaloric amount of sucrose between the third and twentieth day of gestation. The pups born to these rats were sacrificed either day 11 or day 14 postnatum and morphometrical, histological and biochemical analyses were done on their cerebellums and cerebrums. Pups that were exposed to ethanol in utero had significantly smaller body weights, cerebrums and cerebellums than pair-fed controls. The cerebellar mass was reduced by 10% and the cerebral weight by 3% in the pups exposed to alcohol when body weights were normalized to that of pair-fed controls. Cerebellar aspartyl aminotransferase (EC 2.6.1.1) activity was reduced at day 11 and 14 in ethanol treated pups compared with controls. Serum T4 levels were also reduced in the ethanol treated group. Histological analyses revealed that the external granule cell (EGC) layer of ethanol treated pups was significantly thicker at 11 and 14 days postnatum than that of pair-fed control pups. Cerebellar ornithine decarboxylase (ODC, EC 4.1.1.17) activity was higher at day 11 in the ethanol treated pups than in controls. The reduced mass, AAT activity, T4 serum levels and the increased thickness of the ECG layer indicate a delayed or impeded maturation of cerebellum in ethanol treated pups. These data are considered from the viewpoint that ethanol, other drugs such as methadone and prenatal stress (malnutrition) may cause delayed cerebellar maturation by reducing serum T4 levels in the early postnatal period (day 5-14).     

The Effect on the Splanchnic Blood Flow and Cardiac Output of Various Carbon Dioxide Concentrations during Fluroxene (Fluoromar®) Anaesthesia An Animal Study

Seven dogs premedicated with pethidine 10 mg/kg body weight, were anaesthetized with mebumal natrium 25 mg/kg body weight i.v. and gallamoni jodidum 80 mg, together with O₂-N₂O in a ratio of 1 to 1. Thereafter four dogs were constantly hyperventilated and three constantly hypoventilated under stepwise increasing anaesthesia with fluoromar® (= fluroxene), up to 6% inspiratory concentration. A change was made between the groups at this fluoromar concentration, from hyper- to hypoventilation and vice versa, after which the fluoromar concentration was reduced stepwise to 0% inspiratory. During the course of this anaesthesia, the related values for flow, pressure and resistance in the systemic and splanchnic circulations were measured at fluoromar concentrations: 0–1 1/2–3-6-6-3-1 1/2-0%. The relative changes in the systemic circulation during increasing concentrations of fluoromar are independent of hypo- or hypercapnia, while the absolute magnitudes of the measured parameters are strongly dependent on the CO₂ tensions. The hypercapnic dogs had the highest cardiac output, stroke volume and most rapid pulse, as well as the lowest peripheral resistance. The same group of dogs had the lowest liver blood flow and the greatest splanchnic resistance. The mean pressures in the aorta, right atrium and portal vein were not different between the groups. A straight line dependence at 6% fluoromar, was demonstrated between cardiac index and Pa_co2: cardiac index (1-min^-1-m^-2) = 1.22 + 0.23 ± Pa_co2 (kPa), ((cardiac index (1-min^-1-m^-2) = 1.22 + 0.03 ± Pa_co2 (mmHg)), and peripheral resistance and Pa_o2: peripheral resistance (kPa 1^-1 min) = 12.85—0.5 ± Pa_co2 (kPa), ((peripheral resistance (dyn-sec-cm^-5 ± 10^-3) = 7.72-0.04 ± Pa_co2 (mmHg)). The pressure in the portal vein appears to rise and the liver flow to fall with rising carbon dioxide tension, but the relationship is not significant. In the latter half of the investigation only small changes were demonstrated which could be related to the falling concentration of fluoromar. These were slight rises in the mean pressure of the aorta and cardiac frequency, similar for both groups. In addition, a slight rise in the peripheral resistance and splanchnic resistance were observed in the hypocapnic group. No changes were seen in the cardiac output and liver flow in any of the groups during falling fluoromar concentrations. The absolute magnitude of the measured parameters in relation to the CO₂ tension reflects the conditions in the first half of the investigation, but the difference between the groups is less pronounced. This was partly due to the smaller difference in Pa_co2 between the groups in this part of the investigation and partly due to the time and experimental course.