Soluble tumour necrosis factor receptors,tumour necrosis factor and interleukin-6 in serum in granulocytopenic patients with fever

Serum levels of TNF, IL-6 and soluble TNF receptors p55 and p75 (sTNFR-p55 and sTNFR-p75) were examined in 14 patients with acute myeloid leukaemia during 43 courses of chemotherapy. The patients experienced 30 episodes of fever which occurred during granulocytopenia (defined as granulocyte counts <0.2×10⁹/1) and six fever episodes when granulocyte counts were >1.0×10⁹/1. Febrile episodes were classified as microbiologically defined infection, clinically defined infection, and unexplained fever. Levels of bioactive IL-6 and immunoreactive TNF increased in response to fever during granulocytopenia, whereas bioactive TNF was not detected in any sample in this study. During granulocytopenia, both sTNFR rose significantly in microbiologically defined infection (P<0.01 for sTNFR-p55 and P<0.05 for sTNFR-p75), but not in the other two categories. The ratio of sTNFR-p55 to sTNFR-p75 was higher during febrile periods in granulocytopenia than in a non-granulocytopenic situation with granulocyte counts >1.0×10⁹/1 (P<0.01). We conclude that granulocytopenia affects release of the two sTNFR differently during febrile periods, and that release of sTNFR-p75 in response to fever is reduced during granulocytopenia, suggesting a role for the granulocytes in systemic release of sTNFR-p75.     

H2 receptor-mediated facilitation and H3 receptor-mediated inhibition of noradrenaline release in the guinea-pig brain

The effect of histamine and related drugs on the tritium overflow evoked electrically (0.3 Hz) or by introduction of Ca²⁺ ions into Ca²⁺-free K⁺-rich (25 mmol/l) medium containing tetrodotoxin was studied in superfused guinea-pig brain cortex, cerebellum, hippocampus or hypothalamus slices and in mouse brain cortex slices preincubated with ³H-noradrenaline. The electrically evoked tritium overflow in guinea-pig cortex slices was inhibited by histamine; the H₃ receptor antagonist clobenpropit reversed the effect of histamine to a slight facilitation. The facilitatory effect of histamine (obtained in the presence of clobenpropit) was not affected by the H₁ receptor antagonist mepyramine but abolished by the H₂ receptor antagonist ranitidine. In the absence of clobenpropit, ranitidine augmented the inhibitory effect of histamine. In slices superfused in the presence of ranitidine, the evoked overflow was inhibited by histamine and, more potently, by the H₃ receptor agonist R-α-methylhistamine in a concentration-dependent manner (maximum inhibitory effect obtained for both agonists 30–35%). The concentration-response curve of histamine was shifted to the right by the H₃ receptor antagonist thioperamide. R-α-Methylhistamine inhibited the electrically evoked tritium overflow also in guinea-pig cerebellar, hippocampal and hypothalamic slices. In cortex slices superfused in the presence of clobenpropit, the H₂ receptor agonists impromidine and, less potently, R-sopromidine facilitated the evoked overflow in a concentration-dependent manner. S-Sopromidine only tended to increase the evoked overflow. The effect of impromidine was counteracted by the H₂ receptor antagonists ranitidine and cimetidine. The extent of the maximum facilitatory effect of impromidine (by 15–20%) was about the same when (i) the Ca²⁺ concentration in the medium was reduced from 1.3 to 0.98 mmol/l, (ii) the time of exposure to impromidine was reduced from 28 to 8 min or (iii) cerebellar, hippocampal or hypothalamic slices were used instead of cortical slices. The Ca²⁺-induced tritium overflow in guinea-pig cortex slices was inhibited by histamine (in the presence of ranitidine); this effect was abolished by clobenpropit. In slices superfused in the presence of clobenpropit, impromidine failed to facilitate the Ca²⁺-evoked tritium overflow. The electrically evoked tritium overflow in mouse brain cortex slices was inhibited by histamine by about 60% (both in the absence or presence of ranitidine). The inhibitory effect of histamine was abolished (but not reversed) by clobenpropit. In conclusion, noradrenaline release in the guinea-pig brain cortex is inhibited via presynaptic H₃ receptors and facilitated via H₂ receptors not located presynaptically. In the mouse brain cortex, only inhibitory H₃ receptors occur. The extent of the H₃ receptor-mediated effect is more marked in the mouse than in the guinea-pig brain cortex. Received: 25 September 1997 / Accepted: 17 November 1997     

Consumption of pain medication by hospitalized patients with acute herpes zoster

Background The effect of acyclovir on inpatients with acute herpetic pain has been examined in only few studies. Aim To examine the effect of acyclovir on intensity and course of herpes zoster-associated neuralgia in hospitalized patients. Method Two groups of patients (50 each) hospitalized for acute herpes zoster in 1983/84 (before acyclovir was available) and in 1989/90 (when acyclovir was given for at least 5 days intravenously) were evaluated for pain and consumption of pain medication. Results The score for pain intensity did not differ significantly in acyclovir-related patients compared to patients who did not receive the drug. Conclusion This study fails to demonstrate a beneficial effect of acyclovir on acute herpetic neuralgia.     

Primäre Behandlung von offenen Strecksehnenverletzungen der Hand

OBJECTIVE: Reconstruction of extensor functions after extensor tendon injuries of the hand. INDICATIONS: Acute injuries of extensor mechanism with corresponding loss of function. CONTRAINDICATIONS: Complex injuries with loss of soft tissue. Limited possibility of extensor tendon reconstruction with combined injuries of the interphalangeal joints (in situations with irreparable joints: primary arthrodesis). SURGICAL TECHNIQUE: The treatment of extensor tendon injuries depends on the various levels of tendon laceration. Zones 1 and 2: in case of tendon disruption close to the base of the distal phalanx, refixation of tractus terminalis using a pull-out suture. In case of disruption more proximally, primary repair using mattress sutures. Temporary pinning of the distal interphalangeal joint in extension using a single transarticular Kirschner wire. Zone 3: mattress sutures of the tractus intermedius. Temporary pinning of the proximal interphalangeal joint in extension using a single transarticular Kirschner wire. Zone 4: reconstruction of the central slip and the lateral slip of extensor tendon using modified Becker sutures and mattress sutures. Temporary pinning of the proximal interphalangeal joint in extension using a single transarticular Kirschner wire. Zones 5 and 6: four-strand modified Becker sutures with additional epitendinous suture. Zones 7 and 8: core sutures using modified Kirchmayr techniques with additional epitendinous suture. POSTOPERATIVE MANAGEMENT: Zones 1-4: immobilization of the finger for 6 weeks with removal of the transarticular wire at 4 weeks. Zones 5-8: dynamic postoperative treatment in intrinsic-plus splint for 6 weeks. RESULTS: It is postulated that dynamic postoperative treatment leads to improved functional outcome after extensor tendon injuries. While for zones 1-4 no better final clinical results are observed using the dynamic postoperative protocol, early protected motion for zones 5-8 is superior to static post operative treatment.     

Prenatal radiographic diagnosis of alpha-fetoprotein positive malformations in early pregnancy

Early diagnosis of two malformed fetuses with positive alpha-fetoprotein test of the amniotic fluid with the aid of amniography is reported. Radiographic, diagnostic and prognostic aspects are discussed.     

FUNCTION OF THE RETICULOENDOTHELIAL SYSTEM : II. PARTICIPATION OF A SERUM FACTOR IN CARBON CLEARANCE

Reticuloendothelial clearance of carbon particles is inhibited by injection of heat-aggregated albumin. The possibility that this inhibition might involve a serum component has been explored. Evidence that such a serum factor does participate in carbon clearance inhibition by heat-aggregated albumin derives from the fact that prior treatment of the carbon with homologous serum eliminates the blockade; and also, if serum previously absorbed with carbon is mixed with the carbon particles no restoration of "blockade" by albumin occurs. A method for extracting the component from serum using barium sulfate adsorption is described which allows concentration of the factor and sensitive assay for its presence. It is concluded that while large or multiple carbon injections may bring about a saturation of the phagocytic cell, this saturation masks an underlying factor which protects against acute inhibition of carbon phagocytosis by denatured albumin when subsaturating carbon doses are used.     

DNA flow cytometry in human testicular cancer

DNA flow cytometry revealed aneuploid tumour stemlines in 19 of 20 primary testicular cancers without significant difference of the ploidy values between seminomas and non-seminomas. In 7 of 8 analyzable histograms the S-phase activity was 22-51%. A metastatic mature teratoma had 6% cells in S-phase. These results support the clinical observation that testicular cancer is usually a rapidly growing human tumour. The high percentage of aneuploidy in testicular cancer may be of clinical value in the diagnosis of this malignancy.