Thyroid hormone stimulates hepatic IGF-I mRNA expression in a bony fish,the tilapia Oreochromis mossambicus,in vitro and in vivo

To gain more knowledge about the physiological regulation of hepatic insulin-like growth factor-I (IGF-I) production in bony fish, we examined the potential influence of thyroid hormone (T3, 3,5,3'-triiodothyronine) on the expression of IGF-I in the liver of the tilapia Oreochromis mossambicus, using in vitro and in vivo methods. The in vitro experiments were performed using a recently established primary hepatocyte cell culture and IGF-I expression was determined by means of semiquantitative RT-PCR. T3 (100 nM) significantly enhanced the synthesis rate of IGF-I mRNA in short (>8h) and long (>42h) time courses. The stimulating effect of T3 was detected already after 1h. After 4h, the IGF-I mRNA expression was more than 150% of the starting amount. In long time courses, after 6h the IGF-I mRNA value was about 170% of that in untreated cells and at the end of the experiment, it was still three times higher than in the control. In addition, the increase in IGF-I mRNA expression evoked by T3 (1 nM to 1 microM) was dose-dependent. In the in vivo approach, 10 individuals of tilapia received 4 daily intraperitoneal injections of T3 (6 microg/g body weight). IGF-I mRNA was assessed using dot blot technique with a tilapia specific IGF-I cRNA probe. The T3 treatment led to an increase of the IGF-I mRNA level up to 45% in the liver compared to the untreated animals. In conclusion, our results show that T3 directly stimulates the hepatic production of IGF-I in the tilapia in vitro and in vivo and indicate that in tilapia liver regulatory mechanisms seem to exist, as they are discussed for mammals.     

Acute coronary syndrome after diclofenac induced coronary spasm

Zusammenfassung Wir berichten über einen 67-jährigen Patienten, der mit dem Bild eines akuten Vorderwandmyokardinfarktes im Rahmen eines akuten Koronarsyndroms in die Klinik eingeliefert wurde. Die sofort durchgeführte Herzkatheteruntersuchung zeigte einen frischen Thrombus im proximalen Ramus interventrikularis anterior (RIVA) bei sonst unauffälligen Koronararterien. Nach PTCA mit Stent-Implantation in den proximalen RIVA war der Patient vollkommen beschwerdefrei. Die CK, CKMB sowie das Troponin T blieben im Normbereich. Im Verlauf entwickelte der Patient eine Podagra des rechten Großzehengrundgelenkes, welches mit Colchicin, Diclofenac und lokaler Kühlung behandelt wurde. Fünf Stunden nach Gabe von Colchicin sowie Diclofenac klagte der Patient über heftige Angina pectoris-Symptomatik mit elektrokardiographischen Zeichen eines akuten Hinterwand- und Vorderwandmyokardinfarktes. Eine erneute durchgeführte Herzkatheteruntersuchung zeigte ausgeprägte Vasospasmen der rechten Koronararterie. Nach intrakoronarer Verapamil- und Nitroglycerin-Gabe waren die Koronarspasmen deutlich rückläufig und der Patient war beschwerdefrei. Anamnestisch berichtete der Patient, dass er am Abend ca. 6 h vor dem akuten Koronarsyndrom ebenfalls Diclofenac eingenommen hätte. Bei zweimaliger in unmittelbarem Zusammenhang mit der Diclofenac-Einnahme stehenden akuten Koronarsymptomatik ist von einem Diclofenac induziertem Vasospasmus auszugehen.     

Cardiovascular medicine in the updated German diagnosis-related groups (G-DRG) for the year 2004

Based on the medical and economical data of 137 German hospitals including 12 university hospitals, the Institut für das Entgeltsystem im Krankenhaus (InEK) was again authorized by the German Ministry of Health to calculate and develop a refined version of the German diagnosis related groups (G-DRG) for the year 2004. The catalogue of these updated GDRGs was published on October 15' 2003. Furthermore, the grouper programs containing the current algorithms and the cost data on which the new G-DRGs were based have been published in the last few weeks.With regard to cardiovascular DRGs, a number of changes have been introduced in the G-DRG system which have profound consequences for all departments that treat patients with these diseases. In this review, we want to present in detail the key points of this update concerning the DRGs, extra reimbursement for special interventions, and new codes for diagnoses and procedures. Furthermore, the new rules for readmissions of patients in the same hospital are summarized.In conclusion, a number of improvements have been implemented in the updated G-DRG system which had in part been suggested by several national medical societies. These provide the basis for more precise and detailed DRGs but require on the other hand, a precise and complete coding to allow correct grouping procedures. From an economical point of view, it could hardly be summarized whether these improvements would lead to an adequate reimbursement for the treatment costs of patients with cardiovascular diseases since the case-mix of the various departments may vary widely.     

Bland-White-Garland syndrome in an adult

We report about a 47-year-old woman, who presented with a history of cardiac failure. Echocardiography showed an impaired left ventricular function, clinically significant mitral regurgitation and pulmonary hypertension. Diagnosis of a Bland- White-Garland syndrome was made by coronary angiography. Subsequent therapy consisted of ligation of the anomalus origin of the left coronary artery, implantation of a Mammaria interna graft to the left coronary artery and replacement of the mitral valve by a mechanical prosthesis. One year after operation, left ventricular function was still impaired. At a 3-year follow-up, left ventricular function improved continuously.     

Paraneoplastic paralysis in a patient with malignant fibrous histiocytoma.

A patient presented with lower limb paralysis and a large malignant fibrous histiocytoma (MFH) on her back. Metastatic disease to the spine was excluded and the diagnosis of paraneoplastic paralysis was made. This may be the first described case of a neuromyopathic paraneoplastic syndrome in malignant fibrous histiocytoma. Tissue culture and electron microscopy assisted in establishing the diagnosis of the tumour. A hitherto unrecognised endocrine factor may account for the hypokalaemia which was a feature in this patient.     

The Sublethal Effects and Accumulation of Cadmium in the Terrestrial Isopod Porcellio laevis Latr. (Crustacea, Isopoda)

This study investigated the sublethal effects of CdSO₄ on the terrestrial isopod species Porcellio laevis and its capacity to accumulate and compartmentalize cadmium. The ability of P. laevis to discriminate between uncontaminated and CdSO₄-contaminated leaves was also studied. It was shown that sublethal effects in terms of mass changes of exposed isopods occur at cadmium concentrations between 10 and 80 mg/kg. Moreover, P. laevis can be considered as a so-called macroconcentrator, accumulating and storing cadmium in its hepatopancreas tissue. However, the accumulation capacity is not proportional to the cadmium concentrations in the leaves presented as food, as shown by decreasing concentration factors with increasing cadmium concentrations in the diet. This is probably an effect of the isopod's ability to discriminate between different cadmium concentrations in the food, as shown by means of feed-choice experiments, in which P. laevis was able to avoid contaminated leaves. Received: 24 February 1998/Accepted: 6 July 1998     

A MULTIDISCIPLINARY DIAGNOSTIC/GENETIC STUDY ON THE 105 PATIENTS WITH MENTAL RETARDATION OF THE E.S. LE GRANGE SCHOOL

A comprehensive genetic/diagnostic survey was undertaken at a special school for the mentally retarded involving 105 patients. Cytogenetic, biochemical and clinical investigations were undertaken to establish the contribution of the genetic factors to the problem of mental retardation. Apart from obtaining information about specific children, identifying families at risk, and providing genetic counselling in nearly 50% of cases, data was obtained which could be compared with other similar surveys. According to the aetiological grouping of the patients, 6.7% could be attributed to perinatal damage, 17.1% to chromosomal defects, 4.8% to biochemical disorders, 5.7% to other genetic causes, 12.4% to other prenatal damage, 1.9% to infections, and 51.4% to unknown causes. No individual with the marker X syndrome was found in this group.     

Klinische besonderheiten und elektronenoptische befunde der tumoren des paraganglionaren Glomus tympanale

Zusammenfassung Die Tumoren des paraganglionaren Glomus tympanale stellen sine klinische Einheit dar. Wegen ihres auf die Paukenhöhle beschränkten Wachstums sollten sic von den Tumoren des Glomus jugulars abgegrenzt werden. Dementsprechend kann auch das therapeutische Vorgehen weit konservativer gestaltet werden als bei den Tumoren des Glomus jugulare. Im elektronenmikroskopischen Bild erweisen sich die epitheloiden Zellen auch des Glomus-tympanale-Tumors als innersekretorisch aktiv; die katecholaminhaltigen Granula scheinen im Golgi-Feld zu entstehen und werden ins Gefä ßsystem abgegeben. Daß die Tumoren des Glomus tympanale trotzdem keine Kreislauffunktion ausüben, haft sich zwanglos aus der Kleinheit des Tumors und der deshalb geringen Katecholaminmenge erklären.

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Clinical evidence and electron-microscopical observation of the tumours of paraganglion tympanic glomus

Summary Tumours of the paraganglion tympanic glomus represent a clinical unit. Because of their growth limited to the tympanic cavity they should be separated from the jugulare tumours. The therapy can be a much more conservative one than that of the tumours of the jugulare glomus. In the electron microscopical picture the epitheloid cells of the glomus tympanic tumours also demonstrate an endocrine activity; the catecholamin granules seem to originate within the Golgifield and are delivered into the vascular system. The fact is that the tumours of the tympanic glomus still do not show an influence on blood circulation, this can be easily explained by the smallness of the tumours and the resulting small quantity of catecholamin.