Stoffwechseluntersuchungen bei Zuführung Eines Neuen Eiweisspräparates

Ohne ZusammenfassungFERDINAND FLURY zum 60. Geburtstag gewidmet.     

A clinical study assessing the tolerability and biological effects of infliximab, a TNF-alpha inhibitor, in patients with advanced cancer

BACKGROUND: Tumour necrosis factor-alpha (TNF-alpha) is an important regulator of the chronic inflammation contributing to tumour progression. Infliximab, an anti-TNF-alpha monoclonal antibody was investigated in this trial of patients with advanced cancer. The primary objectives were to determine the safety profile and biological response of infliximab in a cancer population. Clinical response was a secondary objective. PATIENTS AND METHODS: Forty-one patients received infliximab at 5 mg/kg (n = 21) or 10 mg/kg (n = 20) i.v. at 0 and 2 weeks and then every 4 weeks. Post-treatment samples were measured for changes in plasma and serum TNF-alpha, CCL2, IL-6 and C-reactive protein (CRP). RESULTS: Infliximab was well tolerated with no dose-limiting toxic effects. At both doses of infliximab, neutralisation of serum TNF-alpha was observed after 1 h while plasma CCL2, IL-6 and serum CRP were decreased 24 and 48 h following infliximab administration. Seven patients experienced disease stablisation (range 10-50+ weeks). There was no evidence of disease acceleration in any patient. CONCLUSIONS: Infliximab treatment was safe and well tolerated in patients with advanced cancer. There was evidence of biological activity with baseline TNF-alpha and CCL2 being correlated with infliximab response.     

Darmbrand (Enteritis necroticans) Eine historische und aktuelle übersicht

Zusammenfassung In den Jahren 1946 bis 1948 trat in Lübeck und anderen Städten Norddeutschlands eine epidemisch verlaufende Infektion auf, die bis dahin nicht bekannt war. Die Erkrankung wurde aufgrund ihrer Morphologie als Darmbrand (Enteritis necroticans) bezeichnet. Untersuchungen ergaben, dass es sich bei dem Infektionserreger um Clostridium perfringens Typ C handelte. In der Folge konnten die Pathogenese der Enteritis necroticans und eine krankheitsauslösende Bedeutung des #-Toxins von Clostridium perfringens Typ C gesichert werden. Entsprechend konnte durch die Immunisierung gegen dieses Toxin die Inzidenz der Enteritis necroticans in Papua-Neuguinea, einem Land, in dem die Erkrankung in bestimmten Regionen noch heute endemisch ist, deutlich gesenkt werden. Wenngleich der Darmbrand in Europa eine kaum noch auftretende Erkrankung ist, so ist mit seinem epidemischen Auftreten besonders in Notstandsgebieten zu rechnen. Die vorliegende Arbeit soll an die in Lübeck aufgetretene Darmbrandepidemie erinnern, eine Darstellung der Epidemiologie, Pathogenese und Therapie der Erkrankung unter Berücksichtigung inzwischen gewonnener Erkenntnisse geben und andere durch Clostridium perfringens induzierte Erkrankungen abgrenzen. Abstract Enteritis necroticans, locally called "Darmbrand", is a severe and life threatening infectious disease which was epidemic in Northern Germany after World War II. Darmbrand had a limited appearance, occurring only for a few years. In Lübeck many cases were diagnosed in 1946/1948 and the book "Darmbrand, Enteritis necroticans" was published in 1949 by clinicians and pathologists. Enteritis necroticans is also known as a tropical cause of bloody diarrhea and is caused by Clostridium perfringens Type C (type #-toxin). The disease is related to pig feasts in Papua New Guinea. Although necrotizing enterocolitis is now a rather rare disease we must be aware of the appearance of this fulminant entity. This paper represents a review on the historic and current aspects of enteritis necroticans and discusses the epidemiology, pathogenesis and treatment of this disease.     

Changes of body image and body awareness in eating-disorder and non eating-disorder patients after inpatient-therapy

Altered body image and body awareness have significant clinical implications not only for patients with eating disorders. We evaluated therapy-outcome including distortions in body image in 61 inpatients using two instruments assessing body image (FKB-20 Clement and L?we, and FBeK Strauss and Richter-Appelt ). Eating disorder subjects, as expected, showed the most severely disturbed body image with negative attitudes towards their own body and restricted body dynamics. While body image improved over all diagnostic groups after treatment, anorectic patients improved less than others. This finding confirms the clinical observation of the limited therapeutic influence on body image distortions in anorectic patients. Our results show, that the body image questionnaire FKB-20 discriminates well between healthy and psychosomatically diseased patients and is a suitable instrument for process- and outcome-evaluation.     

Geographic variation in groundwater iodine and iodine deficiency in Israel, The West Bank and Gaza

BACKGROUND: Iodine deficiency during pregnancy and infancy is the world's most common preventable cause of mental retardation. Previous studies have shown a high incidence of goiter and low groundwater iodine concentrations in northern Israel. OBJECTIVE: We examined the relationship between low groundwater iodine and iodine deficiency in pregnant women and schoolchildren. SUBJECTS AND METHODS: We measured the urinary iodine excretion of school-children in the West Bank and Gaza and rural and urban pregnant women in Western Galilee (an area known to have low groundwater iodine concentrations). We also measured iodine concentrations in groundwater in various locations in the West Bank and Gaza. RESULTS: Lower urinary iodine excretion was found among pregnant Arab women living in rural Western Galilee (101+/-7 microg iodine/g creatinine). 20% of them excreted <50 microg I/g creatinine. This is relatively less than found among pregnant Jewish women living in cities in the same area (154+/-13 microg I/g creatinine). Low iodine concentrations (<5 microg/l) were found in groundwater in the Nablus, Ramallah, Bethlehem highlands, as compared to normal concentrations in the lowland districts of the West Bank and Gaza. In a cohort of 728 schoolchildren aged 8-10, 10% (range 8-13%) of children from areas of low groundwater iodine had low levels of urinary iodine excretion, as compared to only <5% of those from districts with groundwater iodine concentrations >10 microg/l. CONCLUSIONS: Lower concentrations of groundwater iodine are related to low urinary iodine excretion in Israel, the West Bank and Gaza.     

The diurnal variation in plasma homovanillic acid level persists but the variation in 3-methoxy-4-hydroxyphenylglycol level is abolished under constant conditions

Plasma concentrations of homovanillic acid (HVA) and 3-methoxy-4-hydroxyphenylglycol (MHPG) were determined every two hours for two consecutive days in seven depressed patients and seven matched normal controls. On the first day subjects followed their regular ward routine. On the second day they were placed on a regimen in which activity, posture, diet, and wakefulness were held constant. There were significant diurnal variations in both MHPG and HVA concentrations on the baseline day, whereas on the constant routine, a diurnal variation was present only in HVA. We conclude that diurnal variations in plasma MHPG are evoked by changes in physical activity, posture, or other factors controlled on the constant routine, and that a major component of the diurnal variation in plasma HVA concentrations is regulated by a circadian oscillator that is independent of sleep or activity.     

The effect of thyroxine and corticosteroids upon amniotic fluid fluorescence polarization: a randomized controlled study.

The efficacy of glucocorticoid and intra amniotic thyroxine therapy on fetal lung maturity were compared in a randomized prospective clinical trial. Eighty two patients received either intra amniotic thyroxine (n = 36), or intra muscular Dexamethasone (n = 46). The Fluorescence Polarization (FP) of amniotic fluid measured prior to and one week following treatment were similar in the two groups. The rate of decrease in FP value per unit of time (dFP/dt) was identical in the T4 and corticosteroid treated patients and the proportion of immature FP values obtained was similar in the two groups. The effect of thyroxine therapy was more pronounced in pregnancies above 33 weeks gestation. Intra amniotic thyroxine therapy appeared to be as effective as glucocorticoids for the enhancement of fetal lung maturity. This therapeutic modality may be of particular use on pregnant subjects in whom a relative contra indication for the administration of steroids exists.