Entgleisung des Säure-Basen-Gleichgewichtes im Liquor Cerebrospinalis beim Delirium Tremens

Zusammenfassung Bei 9 Patienten, die wegen eines Alkoholdelirs zur Aufnahme kamen, wurden die Parameter des Säure-Basen-Haushaltes, Lactat, Pyruvat und Elektrolyte in Liquor cerebrospinalis und Blut 1. im Vollbild, 2. im Verlauf von 3 Tagen und 3. nach abgeklungenem Delirium tremens bestimmt.Der deutliche Lactat-, Pyruvat-Anstieg bzw. der erhöhte Lactat-Pyruvat-Quotient im Liquor cerebrospinalis weisen auf eine Störung der energieliefernden Prozesse des Gehirnparenchyms hin. Die metabolische Liquoracidose spiegelt hierbei die zugrundeliegende cerebrale Gewebshypoxie wider. Als Ursache einer solchen wird eine cerebrale Durchblutungsminderung im Delir, etwa im Rahmen eines sich entwickelnden Ödems, diskutiert. Die Liquoracidose löst eine Steigerung des Atemantriebes aus und läßt so eine respiratorische Blutalkalose entstehen. Der pCO₂-Abfall im Blut beeinflußt rückläufig den Säure-Basen-Zustand des Liquor cerebrospinalis. — Die klinische Schwere des Krankheitsbildes geht mit der Schwere der Stoffwechselveränderungen im Liquor cerebrospinalis parallel, die so als Maß für die cerebrale Gewebsstörung aufzufassen sind. Verlaufsuntersuchungen lassen dies besonders deutlich erkennen und ermöglichen eine prognostische Aussage. Das gegensätzliche Verhalten des Kalium im Liquor cerebrospinalis und Blut findet in Beziehung zum Säure-Basen-Haushalt seine Erklärung. Schließlich wird auch auf korrelationsstatistisch faßbare Zusammenhänge eingegangen.     

Über einflüsse von diabetes mellitus und geschlecht auf die sekretion der glandula parotis des menschen

Zusammenfassung An einem statistisch repräsentativen Untersuchungsgut werden unter den Bedingungen der relativen Ruhesekretion am isolierten Parotisspeichel des Menschen die Sekretionsrate Bowie der Gehalt an Natrium, Kalium und Gesamtprotein untersucht; dabei werden Alters- und Geschlechtsabhängigkeit sowie Abweichungen der Untersuchungsgrößen bei Vorliegen eines Diabetes mellitus geprüft. Aus den Untersuchungsergebnissen wird unter Zugrundelegung der sekretionstheoretischen Vorstellungen von Rauch und Yoshimura geschlosssen, daß sowohl bei Diabetikern als such in der Vergleichsstichprobe ein gleichsinniger Geschlechtsunterschied besteht; Männer produzieren mehr Ruhespeichel als Frauen, wobei der Speichel der Frauen mehr plasmatische Bestandteile (Kalium, Protein) enthält. Der Diabetes mellitus führt in allen Altersgruppen zu einer deutlichen Vermehrung des relativen Ruhespeichels mit gleichzeitiger Reduktion der plasmatischen Elemente, zu Abweichungen, welche als funktionelle Veränderungen im Bereich der Acini zu werten sind und der Altersverteilung des growth-onset-diabetes folgen. Unabhängig davon sinkt bei diabetischen Frauen der Natriumgehalt des Speichels zum Alter hin um so mehr, je weniger der Kaliumgehalt vom Normalen abweicht. Dieses zwcite Beeinflussungsprinzip folgt der Alters- und Geschlechtsverteilung des maturity-onset-diabetes und entspricht der von anderen Autoren nachgewiescnen Wirkung von ACTH und Cortison auf die Speicheldrüsen; es wird in der striären Phase der Speichelbereitung wirksam.

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Secretion of the parotid gland: the effect of diabetes mellitus in male and female patients

Summary Isolated parotid secretions at relative rest were examined in a series of patients that was statistically representive. Determined were the rate of secretion and its contents of sodium, potassium, and total protein. Differences related to age and sex were noted, and also aberrations encountered in cases of diabetes mellitus. Based upon the theoretical concepts of Rauch and Yoshimura, the results are taken to indicate that there are sex-related differences among diabetics but also among non-diabetics. The resting secretion is higher in men than in women, but the saliva of women shows relatively more potassium and protein. In diabetes, the resting secretion is increased in all age groups, while potassium and protein are reduced. These latter changes are seen as functional alterations in the azini, and they follow the age distribution of the growth-onset diabetes. In female diabetics, the sodium content decreases with age, and this decrease is more pronounced, the less the potassium content deviates from the normal. This second relation follows from the age and sex distribution of the maturity-onset diabetes, and it is related to effect of ACTH and cortisone upon the salivary glands that were demonstrated by others; the latter affects the phase of saliva production in the striated ducts.

     

A radioisotopic assay for proline oxidase activity.

We developed a radioisotopic assay for proline oxidase in which product deltal-pyrroline-5-carboxylate-14-C is reacted with o-aminobenzaldehyde and the radioactivity trapped as the dihydroquinazolinium compound is recovered by ion-exchange chromatography. The sensitivity of this method allows the measurement of proline oxidase activity in small specimens (10 to 20 mg.) of liver.     

Befunde in den Hauptentwicklungsstufen des Gebisses bei Dysgnathieträgern

Zusammenfassung In dieser Arbeit wurden die Gebisse von 31 männlichen und 45 weiblichen Dysgnathieträgern mit Hilfe des Berliner Meßsystems vermessen und die Ergebnisse mit Hilfe eines Computers ausgewertet. Es erfolgt der Vergleich der Parameter zwischen Probanden mit Progenie, Kreuzbiß, offenem Biß und Schmalkiefer. Die Veränderung der Werte wurden longitudinal in den Hauptentwicklungsstufen Milchgebiß, Wechselgebiß und im bleibenden Gebiß untersucht. Dabei werden auch nach der Behandlung noch zwischen den Anomaliegruppen bei einzelnen Werten signifikante Unterschiede gefunden.

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Summary In this study dental plaster casts of 31 male and 45 female subjects were measured using the Berlin measurement system and evaluated with the aid of a computer. The parameters of subjects with class III malocclusion, crossbite, open bite and class II/1 malocclusion were compared. The changes were studied longitudinally in the main developmental stages, namely the deciduous, mixed and permanent dentitions. Significant differences were found also following treatment between the malocclusion groups.

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Résumé On a mesuré les dentures de 31 hommes et 45 femmes présentant des dysgnathies à l'aide du système de mesure mis au point à Berlin; les valeurs ainsi établies on fait l'objet d'un traitement sur ordinateur. On a procédé à la comparaison des paramètres des sujets atteints de prognathie inférieure, occlusion croisée, béance et endognathie. On a étudié la modification des valeurs de manière longitudinale, en suivant les principales étapes d'évolution: denture lactéale, denture mixte et denture permanente. L'examen a permis, même après le traitement, d'établir, pour chacune des valeurs, des différences importantes d'un groupe d'anomalie à l'autre.

     

Dietary perturbation of calcium metabolism in normal man: compartmental analysis

The effect of dietary calcium intake on calcium metabolism was studied in eight normal volunteers by multicompartmental analysis of radiocalcium and balance data. In paired studies of six normal subjects on normal and high or low calcium intakes, necessary and sufficient criteria were used to determine changes in calcium metabolic parameters produced by alterations in dietary calcium. These changes involved gastrointestinal calcium absorption rate, renal and endogenous fecal rate constants, and bone resorption rate. Bone accretion rate and compartment sizes need not change between the paired studies. The changes of parameters involving kidney, gut, and bone were in a direction to support calcium homeostasis and were compatible with the pattern of changes produced by parathyroid hormone. However, the source of the stimulus for hormone secretion was not apparent since plasma calcium concentrations showed no significant difference between paired studies. The implications of these findings relative to control of hormone secretion, calcium regulatory mechanisms, and metabolic bone disease are discussed.     

Changes in proline synthetic and degradative enzymes during matrix-induced cartilage and bone formation.

Proline biosynthetic and degradative enzymes are unevenly distributed in differentiated mammalian tissues. Activities of the synthetic enzymes are relatively high in collagenous tissues, whereas activities of the degradative enzymes are high in noncollagenous tissues. In order to further characterize tissue-specific proline biosynthesis and degradation, we have determined proline enzyme activities during cartilage and bone formation induced by demineralized bone matrix. We can thus follow temporal changes in enzyme activity in a single tissue as different cell types develop. Ornithine aminotransferase and pyrroline-5-carboxylate reductase have peaks of activity which correlate with maximal type II collagen synthesis by chondrocytes. Both enzymes also are active during bone formation. In contrast, proline oxidase and pyrroline-5-carboxylate dehydrogenase are present at low levels and do not change as new cell types appear. Arginase activity peaks during the first 3 days and then rapidly decreases by the time cartilage and bone formation begin. These observations further substantiate the importance of proline biosynthesis in collagenous tissues. The close correlation between ornithine aminotransferase activity and type II collagen synthesis suggests that the pathway from ornithine to proline may be especially important during formation of type II collagen.     

Evaluating learning and knowledge retention after a continuing medical education course on total mesorectal excision for surgeons

The purpose of this study was to determine whether knowledge gained (as determined by a formal course test) by surgeons in a continuing education course on total mesorectal excision and rectal cancer management is retained 1 year later. A formal course test had been previously developed and validated. The test evaluated course content including pelvic anatomy, surgical techniques, imaging, pathology, adjuvant therapies, and cancer and functional outcomes. Validation was determined by the absence of change in pre- and posttest scores of the "expert" course instructors (n = 8, P = .6) and by a linear correlation in test scores with increasing level of general-surgery resident training (n = 16, P = .001). Significant learning by the 58 surgeons taking the course had been shown by improvement in test scores from before the course (mean score 19) to after the course (mean score 25.3, P = .001, out of a possible 33 total mark). At 1 year after the course, those course participants (n = 44, 76%) who had provided postcourse contact information were asked to complete the course test again. Responses were received from 18 surgeons (41% of those surveyed, 31% of the original course participants). The mean score on the test after 1 year was 23.8. Compared with the immediate posttest scores, there was no significant knowledge loss over the year (P = .09). We conclude that knowledge acquired during a continuing education course for surgeons on total mesorectal excision and rectal-cancer management is retained 1 year later.     

Subclinical acquired syphilis masquerading as membranous glomerulonephritis

Membranous glomerulonephritis (MGN) is one of the common forms of nephrotic syndrome in the adult population. The majority of MGN are idiopathic, but the secondary forms can be seen in the setting of autoimmune disease, neoplasia, infection and following exposure to certain therapeutic agents. Histologically, MGN is an immunologically mediated disease in which immune complexes deposit in the subepithelial space. Syphilis is a venereal disease that can also be acquired by exposure to infected blood. Untreated syphilis may progress and develop renal complications such as membranous glomerulonephritis (MGN) or diffuse endocapillary glomerulonephritis with or without crescent formation. Today, with increasing awareness of sexually transmitted diseases especially HIV infection coupled by the practice of protected sexual intercourse and advancement of medicine, we have seen fewer and fewer cases of acquired syphilis. Furthermore, majority will present with typical syphilitic symptoms of such as chancre, rash, fever and lymph node enlargement in which case the diagnosis is easily obtained. We are reporting a case of acquired syphilis masquerading as membranous glomerulonephritis without typical syphilitic symptoms.