Physiodiagnostische Indikatoren bei Spannungskopfschmerzen

Practitioners often rely on physiodiagnostic indicators to corroborate the hypothesis of a muscular origin of headache. Although these indicators have been widely applied, their reliability and validity have seldom been tested empirically in headache sufferers. In a controlled double blind study, two trained raters palpated muscle tension and latent and active myogeloses of the left and right trapezius and sternocleidomastoideus muscles and measured passive head rotation flexibility. There were 28 subjects in the study, 14 suffering from tension headache and 14 matched controls. In spite of the training, interrater reliability of ratings concerning degree of muscle tension and number of latent myogeloses proved to be too low to justify subsequent use of these indicators. In keeping with the hypothesis, the various parameters of active myogeloses very clearly differentiated between the experimental groups. The hypothesis turned out not to be true for the parameters of head rotation flexibility. In subjects suffering from tension headache, no correlations could be found between the number of myogeloses of the right trapezius muscle and parameters recorded in long-term EMGs of this muscle, and no correlations could be found between the total number of myogeloses and the chronicity of headache.     

Technische Entwicklung der spinalen Neurostimulation

The rationale for the use of spinal cord stimulation (SCS) in the treatment of chronic pain arose from Melzack and Wall's gate theory of the control of pain (1965). Originally electrodes were placed directly on the spinal cord via open operation, while now they are placed by means of direct puncture the epidural space. In most cases, one of two different systems is used: (1) semi-implants, consisting of an implantable electrode, connection cable and receiver, and externally worn stimulator with antenna; (2) full implants, consisting of an implantable electrode, connection cable and a stimulator, which is also implanted. The implantation of an SCS system is a surgical procedure, which requires the highest standards in asepsis. The operation and its complications and ways of avoiding them are described.     

The insulin receptor: signalling mechanism and contribution to the pathogenesis of insulin resistance

Summary The insulin receptor is a heterotetrameric structure consisting of two -subunits of M_r135 kilodalton on the outside of the plasma membrane connected by disulphide bonds to -subunits of M_r95 kilodalton which are transmembrane proteins. Insulin binding to the -subunit induces conformational changes which are transduced to the -subunit. This leads to the activation of a tyrosine kinase activity which is intrinsic to the cytoplasmatic domains of the -subunit. Activation of the tyrosine kinase activity of the insulin receptor represents an essential step in the transduction of an insulin signal across the plasma membrane of target cells. Signal transduction on the post-kinase level is not yet understood in detail, possible mechanisms involve phosphorylation of substrate proteins at tyrosine residues, activation of serine kinases, the interaction with G-proteins, phospholipases and phosphatidylinositol kinases. Studies in multiple insulin-resistant cell models have demonstrated that an impaired response of the tyrosine kinase to insulin stimulation is one potential mechanism causing insulin resistance. An impairment of the insulin effect on tyrosine kinase activation in all major target tissues of insulin, in particular the skeletal muscle was demonstrated in Type 2 (non-insulin-dependent) diabetic patients. There is no evidence that the impaired tyrosine kinase response in the skeletal muscle is a primary defect, however, it is likely that this abnormality of insulin signal transduction contributes significantly to the pathogenesis of the insulin-resistant state in Type 2 diabetes.Given as the Minkowski Lecture, EASD Meeting, Lisbon, Portugal 1989.     

Prognostic value of galactose elimination capacity,aminopyrine breath test,and ICG clearance in patients with cirrhosis

Seventy-eight patients with cirrhosis were prospectively followed for up to 20 months, on the average. At entry into the study, galactose elimination capacity, aminopyrine breath test, and ICG clearance were measured. At the end of the study, 27 patients had died. Univariate analysis using the Kaplan-Meier method showed that both quantitative liver function tests (galactose elimination capacity:P<0.025; aminopyrine breath test:P<0.001; ICG clearance:P<0.005) and common clinical and biochemical data (encephalopathy:P<0.001; ascites:P<0.001; serum bilirubin:P<0.005; serum albumin:P<0.001; prothrombin index:P<0.05) were significant predictors of survival. To investigate whether quantitative liver function tests could contribute to a better definition of the prognosis, once Pugh score had already been taken into account, a multiple regression analysis according to the Cox model was performed. Pugh score and galactose elimination capacity resulted in the only independent prognostic covariates. From them a prognostic index was calculated, and the model was validated in an additional sample of 70 patients investigated according to the same protocol. The contribution GEC gave to the assessment of overall prognosis over that obtained using the Pugh score was slight, as estimated by the statistical parameters of the Cox's model, but was significant as assessed by a ROC curve analysis (P=0.05). These data show that all quantitative liver function tests were predictors of survival in cirrhosis, and that the galactose elimination capacity added some new prognostic information to those already available using the Child-Turcotte-Pugh classification.This study was supported in part by a grant from the Italian Ministry of Education (National Project Liver Cirrhosis). Part of this study was presented at the 22nd Meeting of the European Society for Clinical Investigation, Graz, Austria, April 20–23, 1988.     

Characterization of rat hyperplastic bile ductular epithelial cells in culture andin vivo

A novel intrahepatic biliary cell culture/in vivo transplantation system has been developed with an essentially pure population of bile ductular epithelial cells isolated from rat liver 6–12 weeks after bile duct ligation. In primary culture, these cells retain staining strongly for -glutamyltranspeptidase and glutathione S-transferase P. The cytoplasm of cultured bile ductular cells reacts with an anti-laminin antibody, but loses immunoreactivity with a monoclonal anti-cytokeratin 19 antibody. Semiconservative DNA synthesis in the cultured cells was dependent upon the continued presence of 10% fetal calf serum in the medium. Replicating bile ductular cells could be subcultured for a finite number of passages. In addition, freshly isolated bile ductular epithelial cells gave rise to well differentiated bile ductular structures when transplanted into the interscapular fat pads of syngeneic recipient rats.Presented at the Proceedings of the International Meeting on Normal and Neoplastic Growth in Hepatology, Bari, Italy, June 1989.This work was supported by USPHS Grant RO1 CA39225 to Dr. Sirica by the National Cancer Institute, Department of Health and Human Services.     

Current prevalence of hepatitis B,A and C in a healthy Spanish population. A seroepidemiological study

Summary A seroepidemiological study was carried out in order to determine the prevalence of markers of viral hepatitis infection in employees of five health-care companies and their cohabiting family members. Each participating family unit was required to fill out a questionnaire, in which, among other data, the employee was requested to indicate his or her job category. Markers of hepatitis B infection (anti-HBs, anti-HBc or HBsAg) were observed in 11.7% (58/497) of all subjects. When employees and family members were analysed according to the employee's job category, significant differences were found between staff (3%) and administrative personnel (13.3%; p<0.01) or factory workers (16.9%; p<0.01). Of 489 individuals tested for the presence of anti-HAV and anti- HCV, 59.1% and 0.6% respectively, were positive. There was a correlation between the prevalence of anti-HAV and age; a large proportion of the subjects under the age of 30 years had no evidence of prior HAV infection.

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Prävalenz der Hepatitis B, A und C in einer gesunden spanischen Bevölkerungsgruppe. Aktuelle seroepidemiologische Studie

Zusammenfassung Um die Prävalenz von Virus-Hepatitis-Markern zu ermitteln, wurde eine seroepidemiologische Studie durchgeführt, in die Beschäftigte von fünf pharmazeutischen Firmen und Familienmitglieder der Wohngemeinschaft aufgenommen wurden. Fragebogen, die alle teilnehmenden Familien auszufüllen hatten, enthielten unter anderem Daten zur Berufsbezeichnung. 58 von 497 untersuchten Seren (11,7%) wiesen Marker einer Hepatitis B Virus-Infektion auf (anti-HBs, anti-HBc oder HBsAg). Nach Berufskategorie aufgeschlüsselt, fanden sich zwischen Beschäftigten und Familienmitgliedern signifikante Unterschiede: Personen, die zum Staff gehörten, waren in 3% der Fälle positiv, Verwaltungspersonal in 13,3% (p<0,01), Fabrikarbeiter in 16,9% (p<0,01). Von den 489 auf anti- HAV getesteten Personen waren 59,1 % positiv, anti-HCV-Antikörper wiesen in derselben Gruppe 0,6% der Getesteten auf. Die Prävalenz von anti-HAV zeigte eine Altersabhängigkeit; ein großer Anteil der unter 30jährigen hatte keine Marker für eine durchgemachte HAV-Infektion.

     

Prediction of survival and recurrence in bladder carcinoma

Summary We have followed a large population of patients receiving radiation treatment for bladder carcinoma with respect to survival and recurrence-free survival. Bivariate and multivariate life table analyses have been performed using a set of independent variables. The most important were T class, grade (G), urinary carcinoembryonic antigen (U-CEA) taken before treatment and cytological analysis 4 months after treatment. We compared the usual way of classifying a patient (T+G) with the combination of U-CEA and cytology since the latter two variables seemed to have great prognostic importance. The analyses show that T+G gives the best significance for survival (P=0.0003) while U-CEA and cytology is better for recurrence-free survival (=0.0002). 0.0002).     

Creatine kinase isoenzyme (CK-BB) in combination to prostatic acid phosphatase measured by RIA in the diagnosis of prostatic cancer

Summary Creatine kinase isoenzyme (CK-BB) measured by mass was used to determine its value in the early diagnosis of prostatic cancer. Sera of patients with prostatic carcinoma of various stages (treated and untreated) were compared to normal male sera and sera of patients with benign hyperplasia of the prostate (BPH) with respect to CK-BB. The sera were simultaneously tested for PAP content. The sensitivity of the CK-BB-RIA was 1.63+/-0.08 g/l and reproducibility in the higher and lower concentration range 7.6% and 10.5%, respectively. CK-BB alone or in combination with PAP is no marker for early detection of prostatic cancer. In individual cases changes occurred similar to those found with a malignant growth of the prostate.     

Correlations of pseudouridine in 8-hour and 24-hour urinary samples determined by high-performance liquid chromatography

Summary The correlations of Pseudouridine () values in 8 h and 24 h urinary samples from 23 healthy persons were determined. Pseudouridine in the 8 h urinary samples was measured by high-performance liquid chromatography and the 24 h excretion was calculated from the results of three 8 h determinations. Simultaneous determinations of urinary creatinine were performed by Jaffe's reaction. Based on the 8 h values of urinary Pseudouridine the results demonstrated a constant excretion of Pseudouridine in the 24 h periods, if the values were related to the urinary creatinine. The precision in using this ratio as an indicator for normal 24 h excretion of Pseudouridine was 90.5% for males and 92.5% for females.     

Stoffwechseluntersuchungen unter ergometrischer Belastung bei total duodenopankreatektomierten Patienten

Zusammenfassung Ein Jahr nach totaler Duodenopankmatektomie wurde bei 6 Patienten die exokrine Pankreainsuffizienz geprüft. Diese kann durch orale Gabe von wenigstens 10 g Pankreatin kompensiert werden. Gegenüber 7 Normalpersonen und 6 Typ 1-Diabetikern hatten die Duodenopankreatektomierten unter körperlicher Belastung höhere arterielle Spiegel von Lactat und freiem Glycerin als Ausdruck einer gestörten hepatischen Gluconeogenese bei fehlendem pankreatischem Glucagon. Ihre körperliche Leistungsfähigkeit war auffallend schlecht. Catecholamine stiegen unter körperlicher Belastung nur gering an, Wachstumshormone gar nicht. Diese Resultate sprechen gegen die totale Duodenopankreatektomie als Therapie der chronischen Pankreatitis.

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Metabolic investigations under ergometric strain in patients with total duodenopancreatectomy

Summary One year after total duodenopancreatectomy a clinical and laboratory evaluation including exhaustive bicycle ergometry was performed in 6 male patients. The insufficiency of the exocrine pancreas can be compensated by at least 10 g pankreatin per day. During physical exercise patients had higher arterial values of lactate and free glycerol after duodenopancreatectomy than 7 healthy individuals and 6 diabetic patients type 1. This metabolic overreaction was due to a deficiency of pancreatic glucagon and resulted in an impaired hepatic gluconeogenesis. There was no detectable increase in growth hormones and only a small one in catecholamines. The physical condition of patients after duodenopancreatectomy was clearly worse.

Diese Arbeit ist Herrn Prof. Dr. Dr. h.c. Hans Erhard Bock zum Geburtstag gewidmet