Über die sogenannten Myxome des Herzens

Zusammenfassung Die 15jährige Patientin litt wiederholt an Angina, die wohl über einer latenten Sepsis zu einer Endokardveränderung führte. Diese bedingte einen Thrombus des linken Vorhofes in der Gegend der Fossa ovalis. Aus der Zeit rühren embolische Narben der Milz und der linken Niere her. Unter eintretender Organisation des Thrombus wurde er durch den Blutstrom zu einem polypenförmigen Gebilde abgeglättet und ausgezogen. Er reichte nun durch das Ostium venosum sin. hindurch in die linke Herzkammer hinein und täuschte klinisch eine Insuffizienz der Klappe mit Stenose des Ostiums vor. Der organisierte Thrombus entartete in seinem größten Teile schleimig, während der neu angebildete Teil an der Basis auch jetzt noch wie ein typischer organisierter Thrombus aussah. Mikroskopisch konnte ich alle Bestandteile nachweisen, die die Autoren in den Myxomen beschrieben. Auch fand ich entzündliche Elemente, ebenso hyalines Fibrin, besonders in dem jüngeren, basalen Teile des Gebildes. Aus alledem komme ich zur Diagnose Thrombus myxomatodes und meine, daß auch alle die bisher beschriebenen primären Tumoren des endokards, außer den bösartigen Gewächsen, organisierte Thromben darstellen.Mit 5 Textabbildungen.     

Incidence and determinants of moderate COPD (GOLD II) in male smokers aged 40–65 years: 5-year follow up

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a major health problem with an estimated prevalence of 10-15% among smokers. The incidence of moderate COPD, as defined by the Global Initiative for Chronic Obstructive Lung Disease (GOLD), is largely unknown. AIM: To determine the cumulative incidence of moderate COPD (forced expiratory volume in 1 second/forced vital capacity ratio [FEV1/FVC] <0.7 and FEV1 <80% predicted) and its association with patient characteristics in a cohort of male smokers. DESIGN: Prospective cohort study. SETTING: The city of IJsselstein, a small town in the Netherlands. METHOD: Smokers aged 40-65 years who were registered with local GPs, participated in a study to identify undetected COPD. Baseline measurements were taken in 1998 of 399 smokers with normal spirometry (n = 292) or mild COPD (FEV1/FVC <0.7 and FEV1 >or=80% predicted, n = 107) and follow-up measurements were conducted in 2003. RESULTS: After a mean follow-up of 5.2 years, 33 participants developed moderate COPD (GOLD II). This showed an estimated cumulative incidence of 8.3% (95% CI = 5.8 to 11.4) and a mean annual incidence of 1.6%. No participant developed severe airflow obstruction. The risk of developing moderate COPD in smokers with baseline mild COPD (GOLD I) was five times higher than in those with baseline normal spirometry (one in five versus one in 25). CONCLUSIONS: In a cohort of middle-aged male smokers, the estimated cumulative incidence of moderate COPD (GOLD II) over 5 years was relatively high (8.3%). Age, childhood smoking, cough, and one or more GP contacts for lower respiratory tract problems were independently associated with incident moderate COPD.     

Use of soluble recombinant TNF receptor to improve detection of TNF secretion in cultures of tumor infiltrating lymphocytes.

The accurate quantitation of picogram amounts of TNF is possible by ELISA and is useful in many areas of biomedical research, including studies of TNF release in vitro by stimulated lymphocytes and macrophages, and of serum levels in patients with cancer and sepsis. However, we show in this report that the detection of recombinant TNF standards by ELISA falls over time with incubation at 37 degrees C, and is further decreased when incubated with tumor infiltrating lymphocytes (TIL), making accurate quantitation difficult. We demonstrate that the soluble dimeric form of the TNF receptor can prevent this decrease, both in the presence and absence of TIL. In contrast, the soluble monomeric TNF receptor was much less effective in preventing this decrease. In addition, the dimeric but not the monomeric TNF receptor was found to inhibit bioactivity of TNF as measured by L929 cytotoxicity. The dimeric TNF receptor does not interfere with the detection of recombinant TNF standards by ELISA, and entirely stabilizes TNF levels incubated over 48 h at 37 degrees C in the presence and absence of TIL. This protection is specific, and the TNF receptor does not stabilize interferon-gamma. The dimeric form of the soluble TNF receptor has proven useful in detecting TNF released by TIL transduced with the TNF cDNA that are currently being used in studies of the gene therapy of cancer with TIL. The dimeric TNF receptor may also prove useful in the accurate quantitation of TNF released by stimulated lymphocytes and macrophages in vitro, and in the quantitation of serum TNF levels in patients.     

Shear stress induced membrane currents and calcium transients in human vascular endothelial cells

We have measured membrane currents induced by shear stress together with intracellular calcium signals in endothelial cells from human umbilical cord veins. In the presence of extracellular calcium (Ca²⁺]_o), shear stress induced an inward current at a holding potential of 0 mV which is accompanied by a rise in intracellular Ca²⁺ ([Ca²⁺]_i). In the absence of extracellular calcium shear stress was unable to evoke a calcium signal but still induced a membrane current. The voltage dependence of the shear stress induced current was obtained from difference currents evoked by linear voltage ramps before and during application of shear stress. Its reversal potential E_rev shifted from –2.3±0.8 mV (n=4) in a nominally Ca²⁺ free solution to +1.5±1.6 mV at 1.5 mM [Ca²⁺]_o (n=4) and to +21.9±4.4 mV (n=7) at 10 mM [Ca²⁺]_o. From our data we conclude that shear stress opens an ion channel that is 12.5±2.9 (n=7) times more permeable for calcium than for sodium or cesium.     

Chest radiography in general practice: indications, diagnostic yield and consequences for patient management

BACKGROUND: Chest radiography (CXR) is frequently performed in Western societies. There is insufficient knowledge of its diagnostic value in terms of changes in patient management decisions in primary care. AIM: To assess the influence of CXR on patient management in general practice. DESIGN OF STUDY: Prospective cohort study. SETTING: Seventy-eight GPs and three general hospitals in the Netherlands. METHOD: Patients (n = 792) aged > or =18 years referred by their GPs for CXR were included. The main outcome was change in patient management assessed by means of questionnaires filled in by GPs before and after CXR. RESULTS: Mean age of the patients was 57.3+/-16.2 years and 53% were male. Clinically relevant abnormalities were found in 24% of the CXRs. Patient management changed in 60% of the patients following CXR. Main changes included: fewer referrals to a medical specialist (from 26 to 12%); reduction in initiation or change in therapy (from 24 to 15%); and more frequent reassurance (from 25 to 46%). However, this reassurance was not perceived as such in a quarter of these patients. A change in patient management occurred significantly more frequently in patients with complaints of cough (67%), those who exhibited abnormalities during physical examination (69%), or those with a suspected diagnosis of pneumonia (68%). CONCLUSION: Patient management by the GP changed in 60% of patients following CXR. CXR substantially reduced the number of referrals and initiation or change in therapy, and more patients were reassured by their GP. Thus, CXR is an important diagnostic tool for GPs and seems a cost-effective diagnostic test.     

Bestimmung der Bindung von Trijodthyronin an Serumproteine mittels Dextran-Gel-Filtration

Zusammenfassung 1. Es wird eine Methode zur gleichzeitigen Bestimmung des sog. freien und des proteingebundenen Anteils von in vitro zugesetztem L-Trijodthyronin-¹³¹Jod im Serum mittels Dextran-Gel-Filtration angegeben. In der beschriebenen Form ist diese Technik für die routinemäßige Anwendung in der Klinik zur Bestimmung der Bindungs- und Transportverhältnisse von Trijodthyronin geeignet.2. In sog. Verdrängungsversuchen wurde nichtmarkiertes Trijodthyronin dem Inkubationsgemisch von Serum und L-Trijodthyronin-¹³¹Jod zugesetzt. Die zugesetzten Trijodthyroninmengen erschöpfen die Gesamtbindungskapazität der Serumproteine in dem gewählten Konzentrationsbereich keineswegs. Im Gegensatz zum Verhalten der prozentualen Anteile des sog. freien und des proteingebundenen Trijodthyronins steigt die absolute Menge des proteingebundenen Trijodthyronins dabei steil an. Man findet eine Kurve, die nicht einer einfachen Sättigunskurve entspricht, sondern eine Resultante aus Sättigungskurven verschiedener Trijodthyronin-bindender Proteine und Verdrängungskurven kompetitiv gebundener Substanzen (z.B. Thyroxin) darstellt.3. Dextran-Gel wirkt nicht als einfaches Molekülsieb für Trijodthyronin. Es greift vielmehr durch Adsorptionsvorgänge kompetitiv in die Serumproteinbindungsverhältnisse des Trijodthyronins ein. Die physiologische Bedeutung des sog. freien Anteils an Trijodthyronin wird diskutiert.4. Die Methode zur Bestimmung des proteingebundenen Jods (PB¹²⁷I) mittels alkalischer offener Veraschung (Barker) wurde technisch vereinfacht und bezüglich ihrer Reproduzierbarkeit untersucht. Die¹³¹Jodausbeute aus zugesetztem L-Thyroxin-¹³¹Jod lag bei diesem Verfahren bei ca. 80%.

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Summary 1. A method allowing the simultaneous determination in serum of the socalled free and the protein bound part of 1-triiodothyronine-¹³¹I added in vitro, using dextran gel filtration, is presented. Assessment of serum protein binding and transport of triiodothyronine can be conveniently performed for clinical purposes by this procedure.2. In socalled discharge experiments non-labelled triiodothyronine is added to incubation mixtures of serum and l-triiodothyronine-¹³¹I. The amount of added triiodothyronine did not exhaust the total binding capacity of serum proteins for triiodothyronine. In contrast to the behaviour of the percentages of socalled free and protein bound triiodothyronine the absolute amount of protein bound triiodothyronine was rising linearly with rising concentrations of triiodothyronine added. The curve obtained was interpreted as resulting from saturation curves of different triiodothyronine binding proteins and discharge curves of competitively bound substances, e.g. thyroxine.3. Dextran gel is not acting merely as molecular sieve for triiodothyronine, but rather competing actively with serum proteins for triiodothyronine, adsorbing the latter. The physiological rôle of the socalled free triiodothyronine is discussed.4. With addition of l-thyroxine-¹³¹I 80% of¹³¹iodine was recovered, when the method ofBarker for determination of serum protein bound¹²⁷iodine (open alkaline ashing) was used.

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Mit Unterstützung der Deutschen Forschungsgemeinschaft.

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Herrn Prof. Dr. Dr. h. c.Carl Krauspe in Verehrung zum 70. Geburtstag gewidmet.     

Vestibular responses in the Rhesus monkey ventroposterior thalamus. II. Vestibulo-proprioceptive convergence at thalamic neurons

Summary The vestibular thalamic relay in the Rhesus ventrobasal complex, identified in a previous field potential study (part I, Deecke et al., 1974), has now been investigated with neuronal recordings in the thalamus in order to clarify its functional role. In part I, short latency responses (2.5 msec) were found in the corner between VPL, VPM and VPI nuclei, largely including dorsal portions of the VPI nucleus. Field potentials of somewhat longer latency (4–5 msec) were recorded in VPL and in other thalamic nuclei, including the posterior nuclear group.Neuronal responses were recorded in thalamic nuclei of awake flaxedilized Rhesus monkeys. Cells not responding to vestibular stimulation (round window polarisation of either labyrinth) were ignored. The great majority (80%) of those neurons responding to labyrinth polarisation showed convergence with deep somatic (proprioceptive) input from joints and muscles of vertebral column and limbs. 60% of these bimodal neurons responded to movement of cervical joints. Very few vestibularly responsive cells received cutaneous (6.6%), non-optokinetic visual or auditory (2.6% each) input. Proprioceptive fields tended to be large, frequently involving more than one joint, and could be even bilateral. For a few cells the pattern of vestibulo-proprioceptive convergence could be fitted to a coordinated body position that might occur during normal locomotion. 78% of the cells responded to polarisation of both labyrinths, indicating strong bilateral projection.     

Performance characteristics of four immunoassays for antiepileptic drugs on the IMMULITE 2000 automated analyzer

Carbamazepine, phenobarbital, phenytoin, and valproic acid are commonly used antiepileptic drugs that show complicated pharmacokinetic behavior Nonisotopic immunoassays are used routinely to monitor these drugs, and assay specificity is important to obtain accurate results. By using samples from subjects receiving each of these antiepileptic medications, competitive immunoassays for them were evaluated on an IMMULITE 2000 automated chemiluminescent analyzer (Diagnostic Products, Los Angeles, CA). Phenytoin assays were evaluated using an additional set of samples from patients with abnormal renal function. All 4 methods were linear, had imprecision of less than 10%, and compared well with other commercial immunoassays. A positive bias was observed for phenytoin measured in samples from uremic patients compared with a high-performance liquid chromatography reference method. The molar cross-reactivity of carbamazepine-10,11-epoxide was 12% in the carbamazepine assay. Phenytoin metabolites and fosphenytoin had substantial cross-reactivity in the phenytoin assay. All antiepileptic drug assays performed well and are suitable for use in monitoring patients receiving antiepileptic drug therapy. One possible exception is the phenytoin assay with samples from patients with renal insufficiency.