Epithelial thymus tumors--therapy and prognosis

One hundred and two patients with epithelial thymoma (ET) and carcinoma have undergone surgical treatment since 1957. In this series thymomas were classified according to Masaoka's clinical staging criteria (encapsulated, invasive) and according to Müller-Hermelink's histological criteria of the resected specimens (medullary and cortical differentiation) and compared to clinical symptoms and survival rates (mean follow-up time 66.4 months). We found that it is not always possible to differentiate intraoperatively fibrous adhesions from infiltrations of the thymic capsule or to recognise thymus carcinoma as such macroscopically if they have not already infiltrated the organ's capsule. All ETs with cortical differentiation after thymectomy showed a malignant course; in contrary ETs with medullary differentiation we found without relapses of metastases. ETs with both histological types (hybrid typs) and cortical dominance took in only two out of 57 cases a malignant course though five of them showed an invasion into the capsule according to clinical staging criteria stage II. Therefore classifying ETs only into two categories, encapsulated and invasive, according to surgical and gross findings, seems to be not always possible and insufficient for the clinical assessment of the malignity and prognosis.     

Amniotic fluid levels of human chorionic gonadotropin and its alpha and beta subunits in second-trimester chromosomally abnormal pregnancies.

Amniotic fluid from 135 pregnancies was assayed for human chorionic gonadotropin (hCG) and its free alpha (ahCG) and free beta (bhCG) subunits. Forty-six chromosomally abnormal pregnancies between 14 and 20 weeks' gestation were matched with 89 chromosomally normal samples. Compared with controls, trisomy 21 pregnancies exhibited significantly elevated levels of all three peptides, whereas trisomy 18 gestations gave rise only to significant elevation of ahCG. Female fetuses in both the trisomy 21 and trisomy 18 pregnancies provided significantly elevated levels of hCG and bhCG compared to their male counterparts. On converting the values to multiples of the median, it was determined that 6 of 7 trisomy 18 samples had abnormally elevated alpha/beta ratios, as did 6 of 21 Down's syndrome pregnancies. Further, 11 of 21 trisomy 21 gestations had abnormal amniotic fluid hCG levels. Using only ahCG, bhCG and their ratio, a 61 per cent sensitivity was found for these trisomies, with a 96 per cent specificity.     

Empfehlungen zu Blutuntersuchungen und klinischer Überwachung zur Früherkennung des Valproat-assoziierten Leberversagens Ergebnisse einer Konsensus-Konferenz vom 9.5.–11.5. 1997 in Berlin

Zusammenfassung Valproat ist ein weitverbreitetes Antiepileptikum mit einem breiten Indikationsspektrum, bei dessen Anwendung seltene, aber schwere Nebenwirkungen wie das Valproat-assoziierte Leberversagen auftreten k?nnen. Erstes Symptom ist dabei eine Befindlichkeitsst?rung des Patienten. Isolierte Ver?nderungen von Standardlaborparametern der Leber sind kein Frühindikator. Eine frühzeitige Diagnostik der Komplikation ist daher nach heutigem Wissensstand durch prophylaktische Laborkontrollen nicht m?glich. Entscheidend ist die rechtzeitige Erkennung der beginnenden Komplikation auf der Basis klinischer Kriterien, u.U. bei gleichzeitig ver?nderten Laborparametern. Ein sofortiges Absetzen der Valproins?ure und die gleichzeitige Gabe von Carnitin kann zu einer Unterbrechung des sonst fatalen Ablaufs der Komplikation mit anschlie?ender Erholung führen. Im Rahmen einer Konsensuskonferenz wurden der aktuelle Wissensstand über Früherkennung und Therapie der VPA-induzierten Hepatotoxizit?t diskutiert. Die Ergebnisse des Konsensus wurden mit dem Ziel einer Verbessung der Arzneimittelsicherheit in einer Empfehlung über Laborkontrollen, Frühdiagnostik und Therapie zusammengefa?t.      

A Safety Study of Albumex®5, a Human Albumin Solution Produced by Ion Exchange Chromatography

Human serum albumin solutions have been used as plasma replacement fluids for many years and adverse events associated with their use are rare. Albumex®5 is a new albumin solution manufactured by a combination of the Cohn fractionation process and a chromatographic technique. A multicentre, randomised study was conducted to compare the safety of Albumex®5 and 5% normal serum albumin (5% NSA) in patients undergoing large volume therapeutic plasmapheresis for a variety of disorders. Up to six exchanges were performed on each patient. A total of 208 evaluable exchanges were performed on 40 patients, 109 5% NSA and 99 Albumex®5. There were 9 adverse events (reaction rate of 8.3%) in 6 patients with 5% NSA and 12 events (reaction rate 12.1%) in 8 patients with Albumex®5. The difference is not statistically significant (p = 0.37, Fisher's exact test). None of the adverse events were considered serious. Only six reactions were thought to be possibly related to the product and three exchanges were modified as a result of an adverse event; one with Albumex®5 was interrupted and two with 5% NSA were slowed. Albumex®5 can be considered to be a safe product with a low adverse event rate.     

Gd DTPA: a review of clinical indications in central nervous system magnetic resonance imaging

Since its approval for clinical use in mid 1988, Gd DTPA has found widespread application as a contrast agent in MRI. This paramagnetic metal ion chelate is used primarily for enhancement of head and spine lesions. Indications for contrast agent use in MRI are summarized drawing upon experience in more than 600 patients and a review of the literature. Enhancement improves both lesion detection and categorization. In head examinations, we recommend use of Gd DTPA for studies of the internal auditory canal, metastatic disease, infarction, infection, meningeal disease, and primary neoplastic disease. In spine examinations, contrast enhancement is employed both for detection of neoplastic disease and in the postoperative back for the differentiation of scar from recurrent disk herniation. Gd DOTA and Gd DO3A-R are new agents within this same class of contrast media.     

Immunoreactivity of Presenilin-1 and Tau in Alzheimer''s Disease Brain

Mutations in the presenilin-1 gene (PS-1) on chromosome 14 are causative for early-onset familial Alzheimer's disease (AD). In order to study the localization of PS-1 in human brain, a polyclonal antibody, SB63, against a N-terminal epitope of PS-1 (²⁵VRSQNDNRERQEHND⁴⁰), was raised in rabbits and characterized. Immunolabeling with SB63 of formalin-fixed sections of hippocampus from cases of PS-1-linked AD (PS-1 I143T (AD/A), G384A (AD/B)), sporadic AD, and controls showed a predominant neuronal staining pattern with a stronger immunoreactivity in pyramidal neurons. Staining was mainly granular and localized in the neuronal cell body as well as in neuronal processes. In AD some dystrophic neurites surrounding the amyloid plaques were stained, but no immunoreactivity was observed in the amyloid core. Although PS-1 was present in tangle bearing neurons, colocalization of PS-1 and tau could not be detected using immunofluorescence double labeling. Our data indicate that the pattern of PS-1 immunoreactivity in the hippocampus does not substantially differ between PS-1-linked AD, sporadic AD, and controls.     

Organization of NADPH-diaphorase-reactive neurons and catecholaminergic fibers in human intermediolateral cell column

We studied the distribution of NADPH-d-reactive sympathetic preganglionic neurons (SPNs) and tyrosine hydroxylase (TH) immunoreactive fibers at T1, T4, T8, and T10 of human thoracic cord. NADPH-d-reactive SPNs were present at all segments. TH-immunoreactive fibers were distributed within the NADPH-d neuropil and appeared to contact SPNs. These interactions may be important for normal and pathological control of arterial pressure.     

Leukaemomycin-geblockte Mutanten des Streptomyces griseus und ihre Pigmente

In a continued search for leukaemomycin-blocked mutants of three leukaemomycin-producing strains IMET JA 3933, IMET JA 5142 and IMET JA 5570 of Streptomyces griseus, 32 mutants producing aerial mycelium and spores were detected. Furthermore, in all mutants cosynthetic capability has been observed. This report describes characterization of leukaemomycin-blocked mutants obtained by mutagenic treatment experiments using NTG and combined UV-/X-rays. According to the biosynthetic capability for anthracyclinones or other pigments the mutants could be divided into six classes. The first class contains 14 leukaemomycin-blocked mutants unable to synthesize anthracyclinones. Besides two classes of mutants (12)synthesizing well-known anthracyclinones as epsilon-rhodomycinone, 7-deoxy-epsilon-rhodomycinone, 11-deoxy-derivatives of daunomycinone, three new classes of mutants (6) synthesizing reddish-brown, brown and blue-violet pigments on solid media with structures not elucidated as yet, will be described.     

Reversible acute tubular necrosis following severe acute renal rejection

The clinical observation of 6 out of 250 renal transplant patients showed that acute renal rejection may lead to reversible acute tubular necrosis (ATN) necessitating intermittent haemodialysis treatment. Despite missing early response to high-dose (methyl-) prednisolone therapy (during a mean period of 4.7 days) all 6 patients developed spontaneous diuresis 14.5 days on average after onset of rejection while on maintenance immunosuppressive therapy. From the clinical course the conclusion was drawn that in severe cases of renal rejection with arteriographic and histological findings consistent with acute tubular necrosis, prolonged therapy with high doses of (methyl-) prednisolone is not desirable, since after reversal of immunological rejection the onset of spontaneous diuresis will be determined mainly by the duration of the healing and recovery phase of acute tubular necrosis.