Der Stoffwechsel bei vollständigem Fasten. Unterschiedliches Verhalten bei Männern und Frauen sowie bei Normalpersonen und Adipösen

Zusammenfassung Bei 24 idealgewichtigen und 24 adipösen Personen beiderlei Geschlechts wurden zirkulierende Substrate (Blutzucker, freie Fettsäuren, Ketonkörper) und Hormone (Insulin, Wachstumshormon, Pankreasglukagon) während sechstägigem Fasten bestimmt. Der Blutzucker sank bei Normalpersonen unter Nulldiät auf tiefere Werte als bei Adipösen. Der Konzentrationsanstieg der freien Fettsäuren und Ketonkörper erfolgte bei Normalgewichtigen rascher als bei Fettsüchtigen und bei Frauen rascher als bei Männern. Das Plasmainsulin fiel bei Adipösen stärker ab als bei Normalpersonen. Alle untersuchten Gruppen wiesen nach 1–3 Fastentagen einen signifikanten Anstieg des Pankreasglukagons auf, dieser erfolgte jedoch bei normalgewichtigen Frauen rascher als bei Männern. Wachstumshormon (GH) stieg bei normalgewichtigen Männern unter Nulldiät signifikant an, bei adipösen Männern jedoch nicht. Bei z.T. auffallend hohen Nüchternwerten zeigten normalgewichtige Frauen keinen signifikanten GH-Anstieg, jedoch signifikant höhere GH-Konzentrationen als adipöse Frauen nach 1–6 Fastentagen. Ausgehend von den allen untersuchten Gruppen gemeinsamen Stoffwechselveränderungen bei Nulldiät werden die diesbezüglichen Unterschiede zwischen männlichen und weiblichen sowie zwischen normalgesichtigen und adipösen Personen diskutiert.     

Recurrence of pulmonary embolism during anticoagulant treatment: a prospective study.

The risk of early recurrence of pulmonary embolism in patients with venous thromboembolic disease treated by anticoagulants is not well established. To determine the risk linked to contemporary proximal deep venous thrombosis, a prospective study was organised to give clinical and scintigraphic surveillance to 50 patients with angiographically proved pulmonary embolism plus phlebographically proved proximal deep vein thrombosis during the first 15 days of anticoagulant treatment. Perfusion lung scans were performed initially and on days 3, 7, and 15. Only two patients had a recurrence of pulmonary embolism during this period; both episodes were revealed by new symptoms, and one recurrence was fatal. The systematic performance of angiography in four patients found to have new scintigraphic defects led to the diagnosis of "spurious scintigraphic recurrence" in three of them. It is concluded that (a) adjusted anticoagulant treatment showed an effectiveness of 96% for preventing early recurrence of pulmonary embolism in this group of supposed high risk patients, and (b) in patients with recent pulmonary embolism new defects on systematic perfusion lung scans are not specific indicators of recurrent pulmonary embolism.     

Role of lipopolysaccharides in adherence of Actinobacillus pleuropneumoniae to porcine tracheal rings.

The ability of 17 Actinobacillus pleuropneumoniae isolates, representing serotypes 1, 2, 5, and 7, to adhere to tracheal rings maintained in culture was examined. Porcine tracheal rings were infected, and 8 h after inoculation, adherent bacterial cells were evaluated. A. pleuropneumoniae adhered to tracheal rings, and marked variations were observed between and even within serotypes, suggesting that adherence of this microorganism is not primarily related to the serotype of the isolate. No relationship was found between adherence to porcine tracheal rings and plasmid profiles, virulence in mice, hemagglutination, capsular material thickness, or whole-cell protein profiles. On the other hand, we observed that all isolates of serotypes 1 and 5 had a semirough-type lipopolysaccharide (LPS), whereas isolates of serotypes 2 and 7 had a smooth-type LPS (75%) or a semirough-type LPS (25%). Results showed that 83% of isolates with a smooth-type LPS adhered in large numbers to tracheal rings, whereas 80% of isolates with a semirough-type LPS adhered poorly (P less than 0.007). Our data indicated that the degree of adherence of A. pleuropneumoniae to porcine tracheal rings appeared to be related, at least in part, to LPS profiles. Furthermore, LPS seemed to be the adhesin of A. pleuropneumoniae, since purified LPS blocked adherence of this microorganism to porcine tracheal rings.     

Reversible tonsillar prolapse in vein of Galen aneurysmal malformations: report of eight cases and pathophysiological hypothesis

We report eight cases of vein of Galen aneurysmal malformation (VGAM) assoicated with a Chiari type I malformation. In four cases magnetic resonance imaging (MRI) or computed tomography performed in the neonatal period did not demonstrate the posterior fossa anomaly, which appeared on later scans. In the other cases the MRI was performed in infancy and the anomaly was already present. We compared the venous phases of the posterior fossa angiograms and the MRI in these patients. In all eight cases, the angiograms showed a reflux in the cerebellar veins, via the petrous vein, associated with a uni-or bilateral stenosis or thrombosis of the distal posterior dural sinuses. Furthermore, in two cases the posterior fossa returned to normal on MRI following endovascular treatment, while in three cases the herniation of the cerebellar tonsils decreased after the embolization. Tonsillar prolapse becomes irreversible when the venous outlet is incapable of taking the flow even when the VGAM has been treated adequately. In eight additional cases of VGAM for which MRI and angiogram studies were available and in which stenosis or thrombosis of posterior dural sinuses was present without tonsillar prolapse, no reflux into the cerebellar veins was shown. We suggest that the posterior fossa hydrovenous congestion is a result of inadequate venous drainage and that the tonsillar descent is reversible if adequate venous drainage is reconstituted following therapeutic embolization of the fistula. Tonsillar prolapse is not a consequence of mass or raised intraventricular pressure. Our observation suggests that in some other conditions, the Chiari I malformations may be secondary to early hydrovenous dysfunction of the posterior fossa.     

Detection of syphilitic hearing loss.

Syphilis can cause sensorineural hearing loss that is potentially treatable. To determine the incidence of positive serological findings in patients with sensorineural hearing loss, the rapid plasma reagin card test (RPRCT) and the FTA-ABS test were performed in a study group composed of patients with sensorineural hearing loss of obscure origin. Of the 306 patients with sensorineural hearing loss, 20 (6.5%) demonstrated a positive FTA-ABS as compared with two of 100 (2%) of the control group. Considerable variation was found in the rate of the false-negative and the biological false-positive RPRCT as performed by our hospital and state laboratories when compared with the results of the FTA-ABS test. Syphilis should be considered in any patient with sensorineural hearing loss of obscure origin, despite a negative history for syphilis. The FTA-ABS is the preferred test to exclude hearing loss of syphilitic origin.     

Congenital pulmonary atresia with ventricular septal defect: angiographic and surgical correlates

Of 181 patients with severe congenital pulmonary atresia and ventricular septal defect or "type IV truncus" (an obsolete term), all but 11% had true central pulmonary arteries. These arteries were demonstrable by large serial biplane angiograms using multiple selective injections into collateral vessels, frequent photographic subtraction, and occasional pulmonary vein-wedge angiograms. These techniques are extremely important for accurate diagnosis and in planning corrective or palliative surgery, which was done in 77% of patients with pulmonary arteries.