A case of decompression sickness in a commercial pilot.

We report a case of decompression sickness (DCS) followed by pulmonary edema in a 47-year-old commercial pilot who operated a non-pressurized turboprop twin at flight level 290. He became unconscious and recovered after an emergency descent. The pilot collapsed and a pulmonary edema occurred 8 h after landing. The patient improved rapidly with fluid replacement and without hyperbaric therapy, which was not available at that time. This course of DCS is unusual because it is reported that fluid replacement without hyperbaric therapy normally cannot recover severe cases of DCS. The considerable increase in body weight of this pilot within the last 6 months may have been a predisposing factor for development of decompression sickness.

Relationship between neopterin and granulocyte elastase plasma levels and the severity of multiple organ failure.

In a series of 56 patients (24 uncomplicated postoperative and 32 septic patients), neopterin and elastase alpha 1 protease inhibitor complex (E-alpha 1 PI) plasma levels were measured daily. The clinical course of each patient was evaluated with the Multiple Organ Failure (MOF) score according to Goris. Neopterin could differentiate between septic and nonseptic patients (p less than .001), and E-alpha 1 PI between septic nonsurvivors and nonseptic patients only (p less than .01). In septic patients, acute pulmonary insufficiency was indicated by elevated E-alpha 1 PI values (greater than or equal to 400 micrograms/L) 1 day before mechanical ventilation was performed with a sensitivity of 81% and a specificity of 82%. Defining a patient with MOF whose score was greater than or equal to 5 as a high-risk septic patient, a comparison neopterin greater than or equal to 40 nmol/L and E-alpha 1 PI greater than or equal to 400 micrograms/L, measured 1 day before the evaluation of an MOF score of greater than or equal to 5 yielded a sensitivity of 91% and a specificity of 99% when patients fulfilled both criteria. We conclude that neopterin and E-alpha 1 PI might be useful parameters for the diagnosis of septicemia and monitoring of the clinical course in septic patients. Moreover, they might indicate the possible central role of macrophage and PMN activation in the development of MOF.

Application of a new radiometric system for identification of potentially useful drug combinations for treatment of human gastrointestinal adenocarcinoma.

As an alternative to empirical clinical evaluation of combined drug effects in human tumors, and in an attempt to establish whether the combination of mitoxantrone (DHAD) with other standard drugs would be of any benefit to the patient with advanced gastrointestinal cancer, we have examined the results of simultaneous single-agent testing in vitro in a panel of 8 human colorectal (HCC) and 5 gastric cancer (HGC) cell lines. Cytotoxic drug effects were measured by the use of a new semiautomated radiometric technique (Bactec system), and were quantitated with attention to potentially clinically relevant plasma concentrations. Among several different drug combinations tested, maximal synergistic cell kill was found for DHAD + 5-fluorouracil; continuous incubation of the cells at 1/100 of the peak plasma concentration achievable in humans yielded in vitro responses in 8/8 HCC and 5/5 HGC cell lines. With regard to our results of single-agent testing, our finding of a significant level of in vitro arabinoside-C activity, using prolonged exposure at an in vitro dose corresponding to a clinical high-dose regimen, may provide a rational basis for (re)evaluation of the compound in gastrointestinal cancer patients.

[Neurologic symptoms in inhalation poisoning with metallic mercury]. / Neurologische Symptome bei Inhalationsvergiftung mit metallischem Quecksilber.

Nineteen caisson workers had been exposed to metallic mercury vapours while digging tubes underneath the first district of Vienna (exposure between 470 and 2440 min; mean 1621 min). The blood mercury values on admission were between 29 and 166 micrograms/l (mean 75 +/- 34 micrograms/l). The main findings reported are clinical neurologic symptoms, psychic complaints, neurographic results and autonomic parameters (cardiovascular reflexes): 47% complained of headache and tiredness, 37% showed tremor and suffered from sleep disturbances, 26% showed hypersalivation, 16% changes in handwriting, and 11% slight dysarthria. The cardiovascular reflexes (autonomic parameters) were abnormal in 7 of 12 patients. On neurography the distal latency (median nerve) was pathologic in 47%, the distal latency (peroneal nerve) was pathologic in 26%, the antidromic sensory nerve conduction velocity (median nerve) was abnormal in 10%, the motor nerve conduction velocity, compound amplitude and vibratory threshold were normal.

The effect of sotalol on exercise-induced ventricular arrhythmias.

Sotalol is a non-selective beta-adrenergic blocking agent with class III antiarrhythmic properties. Our study was intended to assess the efficacy of sotalol on exercise-inducible arrhythmias by oral administration to out patients. Thirty patients with exercise-inducible arrhythmias (80% coronary artery disease, 20% congestive cardiomyopathy) were studied after two baseline bicycle ergometric stress tests performed in upright position. Twenty-five patients (including nine crossover cases of the lower dose protocol) were given sotalol in a daily dose of 320 mg (group 1) and 14 patients in a dose of 160 mg (group 2). After 2 and 8 weeks, respectively, group 1 showed a mean reduction of the total number of inducible ventricular premature beats (VPBs) of 50% (P = 0.0042) and 61% (P = 0.0107), respectively and a significantly improved Lown score (P = 0.0002 and 0.0006, respectively). A significant antiarrhythmic response was not demonstrable for group-2 patients. Because of inefficacy, nine patients were changed from group 2 to group 1. Reduction of arrhythmias on the higher dose was significant (P = 0.0147) in this group. There was the same significant reduction of the heart rate pressure product with the low and high dosage indicating that the beta-blocker effect is achieved with the lower dosage. We conclude that sotalol is a powerful drug for reducing the number and complexity of ventricular arrhythmias in a dose of 320 mg daily. As the beta-blocking effect in both groups was the same, we assume that the reduction of arrhythmias is mainly due to class III action.

Reliability of estimation of maximum performance capacity on the basis of submaximum ergometric stress tests in children 10-14 years old.

Thirty-three 10-year-old boys repeatedly performed six symptom-limited, spiroergometric exercise tests according to the vita maxima method over an observation period of 4 years. Submaximum and maximum performance parameters were assessed and their correlation was calculated. The correlation of the heart rate at 1, 2 and 3 watts/kg body weight with the values of maximum performance capacity (wattmax and VO2max) and with the body-weight-related, relative maximum values was statistically significant. The correlation factors for the relative values were about twice as high (r = 0.55) as the absolute values (r = 0.27). The heart rate at 1, 2 and 3 watts/kg therefore was more characteristic of the relative values, which represent the state of training, and less for the absolute performance capacity, which depends to a great extent on body weight. However, the statistically significant correlation factors were too low to estimate reliably the state of training in an individual case. The correlation of physical working capacity at an HR of 170/min (PWC 170) with the maximum ergometric Watt performance was r = 0.80 and therefore appears to be sufficient to estimate the maximum performance capacity in children. This is however only valid for children over the age of 11.

Circadian variation and age dependence of human atrial natriuretic peptide levels in hospitalized patients.

Circadian variation of plasma levels of human atrial natriuretic peptide (hANP) was studied in 8 patients less than or equal to 65 a of age (mean +/- SD = 43.8 +/- 13 a; 5 females, 3 males) and in 15 patients greater than 65 years of age (mean +/- SD = 81.4 +/- 5.7 a; 9 females, 6 males). Intraindividual variation was up to 40% relative to the day's mean level in both groups. A significant elevation of hormone levels in the evening was observed in patients greater than 65 years of age (P less than 0.002), no circadian rhythm could be detected in patients less than or equal to 65 years of age. All patients except the two eldest had average plasma levels of hANP within our normal range of 3-75 ng/l (N = 106; mean +/- SD = 29.9 +/- 15.3), found in healthy persons up to 65 years of age. We propose, that in the elderly hANP levels rise during the day by edema because of latent renal and/or cardial insufficiency. At rest, in the evening and during the night edema is eliminated by the well known nycturia, which might well be facilitated or at least partially caused by elevated levels of hANP.

Atrial natriuretic peptide release due to physical exercise in healthy persons and in cardiac patients.

Plasma levels of human atrial natriuretic peptide were determined during different stages of a symptom-limited bicycle ergometer stress test. Eight healthy persons and three patients suffering from well-defined cardiac disorders were examined. Measurements of the peptide were performed before the exercise, at 75 watts, at maximal work load, and 10 and 30 min after ceasing the exercise. In healthy persons plasma levels of the peptide increased from preexercise levels of 4-41 ng/l to 16-59 ng/l at maximal work load, but remained in the normal range (10-70 ng/l). In contrast, in the cardiac patients, levels of the peptide were up to 8-fold higher at maximal physical exertion (154-270 ng/l) than at rest (34-86 ng/l). Within a recovery period of 30 min hormone concentrations returned almost to preexercise levels.

[Comparison of the renal ultrasound-furosemide test with the isotope nephrogram. Possible clue to the retention phenomenon?]. / Vergleich des renalen Ultraschall-Furosemidtests mit dem Isotopennephrogramm. Möglicher Hinweis auf das Phänomen der Retention?

In 23 patients with essential hypertension renographic and sonographic examination of the kidneys was compared. No correlation could be observed for functional parameters and urinary excretion between the two different methods. Correlations have only been detected between renographic retentions and furosemide-conditioned swelling of the kidneys in sonography: patients with severe retention showed a statistically significant stronger response to furosemide. The increased retention in the renal pelvis could be responsible for alterations in sonographic findings. This study provides new data on the mechanisms of retention, whereby retention in the renal pelvis in some patients seems to be most probably caused by nephrosclerosis.

[Blood group isoagglutinins and immunoglobulins (IgG, IgM) in old age]. / Blutgruppenisoagglutinine und Immunglobuline (IgG, IgM) im hohen Alter.

Titres of blood-group isoagglutinins and the serum concentration of immunoglobulins M and G were investigated in 388 inmates (89.7% females) of an old-age home, ranging in age from 78 to 99 years [mean (+/- s) = 85.7 years +/- 4.1 years]. Concentrations of isoagglutinins were positively correlated to the concentrations of IgM (total concentration of IgM corr. to IgM anti-B (group A): p less than 0.0005, corr. to IgM anti-A (group B): p less than 0.01, corr. to IgM anti-B (group 0): p less than 0.025), but not to the concentration of IgG. The blood group A IgG red cell alloantibodies (IgG anti-B) indicated, in the low titre range, a positive correlation (p = 0.025) to the IgM isohaemagglutinins (IgM anti-B); the red cell alloantibodies (IgG, IgM) of the other blood groups did not correlate in this way. There was no age-dependent reduction or increase in isohaemagglutinin titres and/or total immunoglobulin levels. From these date we conclude that the lack of red cell alloantibodies in the serum of elderly patients in case of routine ABO blood grouping should not be accepted any more. There has to be an internal diagnosis available or, if missing, coinciding diagnostic tests should be performed.

[Direct Coombs' test in the aged]. / Direkter Coombs-Test im hohen Alter.

Blood samples from 431 persons (age: 78 to 99 years) were examined by the direct anti-human-globulin test (d. AHGT ) with polyspecific and monospecific antisera. Three antibody-mediated positive d. AHGT were found. There was no increase in non antibody-mediated positive complement Coombs reactions in healthy persons of high age.

[Anti-T in newborn infants]. / Anti-T beim Neugeborenen.

IgM (Immunoglobin M) antibodies to the antigen T (Thomsen-Friedenreich antigen, transformation antigen) were detected by normal agglutination technique in the serum of 7 out of 73 newborn children. Neither the mother's anti-T titre, nor the quantity of IgM and IgG (Immunoglobulin G) in the sera of mother and child was correlated with the anti-T in the newborn's serum. The significance of the newborn's anti-T for the serological diagnosis of a polyagglutinability caused by bacterial infection is discussed.