Proteases and antiproteases related to the coagulation system in plasma and ascites — An approach to differentiate between malignant and cirrhotic ascites

Summary The concentrations of several proteases and antiproteases known to be present in ascites were tested in plasma and ascitic fluid with regard to their ability to separate ascites according to malignant or nonmalignant disease. Seventeen patients with proven malignant ascites and 37 with ascites due to liver cirrhosis were included. Activities of plasminogen, ₂-antiplasmin, antithrombin-III, and factor V, and the concentration of ₁-protease inhibitor were significantly higher in the plasma of patients with malignant ascites than in cirrhotic patients. Fibronectin, plasminogen, ₂-macroglobulin, ₁-protease inhibitor, antithrombin-III, and albumin revealed higher concentrations or activities in malignant ascites than in cirrhotic ascites. Due to a wide variation of most parameters, only fibronectin, antithrombin III, and ₁-protease inhibitor in ascites had a sensitivity and specificity higher than 90% for malignant ascites. When the specific protein/albumin ratio was used, only the accuracy of fibronectin was increased reaching a sensitivity and specificity of 100%. The plasma/ascites gradients of the proteins assessed differed significantly, that of fibronectin being much higher (22±7) than that of all other proteins. In malignant ascites fibronectin concentration was only correlated with ₁-protease inhibitor concentration but not with the concentration or activity of all other proteins, while in cirrhotic ascites most proteins revealed a positive correlation.The determination of the fibronectin concentration or the fibronectin/albumin ratio in ascites can differentiate malignant and nonmalignant ascites. All other proteases and antiproteases assessed are of lesser value for this purpose, although most are significantly increased in ascites and plasma of patients with malignant disorders.Abbreviations ₂AP ₂-Antiplasmin - ₁PI ₁-Protease inhibitor - AT III Antithrombin III - FDP Fibrin(ogen) degradation products - FM Fibrin monomers - ₂MG ₂-Macroglobulin - PTT Partial thromboplastin time - RT Reptilase time     

Rezidivierende Meningitis bei familiärem Mangel der achten Komponente des Komplementsystems

Summary An 18-year-old man suffered from recurrent bacterial meningitis. Investigation of the complement system revealed deficiency of the 8th complement component (C8) in the patient and his sister. Genetic defects of the terminal complement components C5 to C8 predispose toNeisseria infections, probably due to a lack in bacteriolytic activity. It is to be noted that 1 year ago the patient had been hospitalized for a culture-proved pneumococcal meningitis.

     

Plasma levels of atrial natriuretic peptide are raised in essential hypertension during low and high sodium intake

Summary Plasma levels of -human atrial natriuretic peptide (hANP) were measured in 17 patients with primary hypertension (11 females, 6 males, aged 22–61; blood pressure systolic 154±7 mmHg, diastolic 92±4 mmHg) and in 9 normotensive controls (4 males, 5 females, aged 20–71; blood pressure systolic 117±4 mmHg, diastolic 76±2 mmHg) during unrestricted sodium diet, at the 4th day of a low sodium intake (40–60 mEq/day) and at the 6th day of sodium loading (280–320 mEq/day) both after an overnight rest and after 4 h of upright posture. In the controls, plasma levels of hANP at 8:00 a.m. were lowered from 73±11 to 49±7 pg/ml during low sodium diet and increased to 128±37 pg/ml after high salt intake. Plasma ANP levels were significantly lower after 4 h of upright posture during unrestricted, low and high sodium intake. In the hypertensive group, plasma ANP levels were elevated during unrestricted diet (203±43 pg/ml), during the low sodium period (139±31 pg/ml), and after high sodium intake (267±63 pg/ml) compared to the controls. All levels were lowered by upright posture. The absolute decrease was more pronounced compared to the normotensives, the relative decline was similar in both groups. In the hypertensives, plasma ANP levels significantly correlate with systolic and diastolic blood pressure (r=0.468,r=0.448,P<0.05) and with urinary aldosterone during unrestricted diet (r=0.536,P<0.05). There was an inverse correlation between plasma ANP levels and plasma renin concentration during low and high sodium intake (r=–0.469,r=–0.496,P<0.05).These studies demonstrate raised circulating plasma ANP levels in patients with essential hypertension. The modulation of ANP by different sodium intake and by upright posture is maintained similar to the changes in plasma ANP in normotensive controls. Raised ANP levels in the hypertensives are correlated with low renin secretion and high aldosterone excretion. High ANP levels, therefore, might indicate sodium retention in essential hypertension.Abbreviation ANP atrial natriuretic peptide Supported by a grant from Ministerium für Wissenschaft und Forschung, NRW     

Intensivtherapie und Prognose des akuten Kreislaufstillstandes

Zusammenfassung Anhand von 115 im Zeitraum von 2 1/2 Jahren beobachteten Episoden von akutem Kreislaufstillstand bei 90 Patienten werden die Kriterien und Behandlungserfolge der Intensivtherapie des akuten Kreislaufstillstandes dargelegt. Während die Basis-Therapie mit externer Herzmassage, künstlicher Beatmung, Natriumbicarbonatinfusionen und elektrischer Defibrillation eindeutig feststeht, bietet die medikamentöse Führung noch immer Probleme. Zehn eigene Verlaufsbeobachtungen zeigen, daß betaadrenergische Sympathomimetica auch bei bestimmten Fällen tachysystolischer Herzrhythmusstörungen günstig wirken. Der Versuch der elektrischen Stimulation des Herzens mit einer extern angelegten epikardialen Schrittmachersonde bei akutem Kreislaufstillstand durch Asystolie oder Bradykardie führte in keinem von 8 Fällen zum Erfolg. Für die Früh- und Spätprognose sind bei adäquater Therapie in erster Linie Art und Schwere des Grundleidens sowie der morphologisch funktionelle Zustand lebenswichtiger Organe bei Einsetzen des plötzlichen Kreislaufstillstandes verantwortlich. Bei Kammerflimmern und Kammerflattern waren deutlich bessere Resultate zu erzielen, als beim akuten Kreislaufstillstand durch Asystolie. Von den 90 Patienten überlebten 12 länger als 4 Wochen (13%), 9 (10%) konnten entlassen werden und sind zum Zeitpunkt der Publikation ohne Nachwirkungen des akuten Kreislaufstillstandes. Es wird auf die Bedeutung einer lückenlosen Beobachtung Schwerstkranker und die Beachtung prämonitorischer Zeichen zur Verhütung des akuten Kreislaufstillstandes hingewiesen.

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Summary Criteria and therapeutic success of intensive therapy of cardiac arrests are evaluated in 115 episodes observed in 90 patients over a period of 2 1/22 years. While basic therapy with external cardiac massage, artificial ventilation, infusion of sodium bicarbonate and electrical defibrillation is generally agreed upon, the choice of further drugs is still problematic. It is shown in 10 cases that under certain conditions even in ventricular fibrillation and ventricular tachycardia beta-receptor stimulating drugs are indicated. Electrical stimulation of the heart by an external epicardial pacemaker was unsuccessful in all of eight cases with complete asystoly or bradycardia. Immediate and long term results of cardiac arrests with adequate treatment primarely depends on the extend of the underlying disease as well as on the condition of all vital organs at the time of onset of the arrest. Ventricular fibrillation and -flutter had a better prognosis than asystoly. Twelve out of the ninety patients lived longer than four weeks after the arrest (13%). Nine of these are still living at the time of publication with an observation time from three months to two years. The chance of improving therapeutic results with intensive care lie mainly in preventing rather than curing complications such as cardiac arrests.

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Professor Dr.H. E. Bock zum 65. Geburtstag.     

Kollagenfolien als temporärer Hautersatz. Klinische und patho-anatomische Untersuchungen

Zusammenfassung Im Kaninchenversuch wurde eine neue Kollagenfolie (COL 65–70, 65–71) im Vergleich mit Polypyrrolidonpulver, Teflonfilz und unbehandelten Kontrollen zur temporären Hautdeckung nach flächenhafter Hautverbrennung getestet. Bei der verwandten Kollagenfolie handelt es sich um gereinigtes tierisches Kollagen, das nach seiner Lösung wieder gefällt wurde. Nach einem patentierten Verfahren wurden hierbei die Moleküle wieder ausgerichtet, so daß eine gewisse physikalische Festigkeit gewährleistet ist. Ein Weichmacherzusatz bewirkt die Geschmeidigkeit. Zur Verhinderung der unerwünschten Austrocknung nach Auflage auf die Wundfläche wurde die Kollagen-Gelplatte mit einer härteren Kollagenfolie abgedeckt. Eine feingeweblich erfaßbare Abwehrreaktion des Wirtsorganismus gegen die Kollagenfolie bzw. eine entzündliche Demarkation konnte an unserem Versuchskollektiv nicht nachgewiesen werden.

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Summary Along with polypyrrolidon powder and teflon felt, a new collagen foil has been evaluated for the temporary closure of skin defects caused by experimental third degree burns in rabbits. A control serics remained untreated. The collagen foil applied was obtained from animal connective tissues the fibrils of which were regenerated after liquefaction. According to a patent procedure the collagen molecules were reconverted. By the addition of a weakener the flexibility of the foil could be changed. In order to avoid an undesired exsiccation after covering the burn wound the collagen foil was protected by a tanned collagen film layer. In the present material, no defensive reactions of the recipient organisms against the collagen foil nor any inflammatory demarcations could be noticed by means of microscopic examination.

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Herrn Prof. Dr. Drs. h. c. Dr. h. c.K. H. Bauer zum 75. Geburtstag in Verehrung und Dankbarkeit zugeeignet.