Changes in glycosylation alter the affinity of the human transferrin receptor for its ligand.

When transferrin receptors of human erythroleukemic cells were pulse-labeled with [35S]methionine and then chased in the absence of radioactive precursor, the first detectable immunoprecipitable form of the receptor had a molecular mass of 85 kDa. This form of the receptor was converted to the mature form of 93 kDa with a half-time of about 40-60 min. Both the immature (85 kDa) and mature (93 kDa) receptors associated as dimers, the native form of the receptor. The 85-kDa, as well as the 93-kDa, receptors bound to a monoclonal antibody raised against the transferrin receptor or to transferrin-Sepharose. In order to determine whether glycosylation was necessary for ligand binding, purified receptors were isolated from cells grown in the presence of tunicamycin. When K562 cells were grown in the presence of tunicamycin, an 80-kDa nonglycosylated form of the receptor was synthesized. This nonglycosylated receptor was also capable of dimer formation; however, much less of it reached the cell surface than the fully glycosylated form, although both untreated and tunicamycin-grown cells appeared to synthesize transferrin receptors at similar rates. Although the number of receptor molecules/cell was similar in control and tunicamycin-treated cells, the nonglycosylated receptors exhibited a much lower affinity for transferrin than those of untreated cells; in contrast, when receptors were purified by immunoprecipitation and digested with bacterial alkaline phosphatase, no difference was observed between the affinity of these receptors and undigested immunoprecipitated receptors. These results suggest that glycosylation is not necessary for specific binding of transferrin to its receptor, but the affinity of this binding can be influenced greatly by the presence or absence of carbohydrate residues.

[Problems in the refusal of blood transfusion]. / Probleme bei Verweigerung von Bluttransfusionen.

Three examples of refusal of blood transfusion by patients (Jehovah's witnesses) are presented to discuss the medicolegal and ethical problems anaesthetists may be faced with in daily clinical routine. For many cases deliberate hypotension is recommended. The primary aim has to be to comply with the patient's wish, but in case of acute and extraordinary bloodloss, there might develop a conflict from an ethical as well as a legal view between the patient's desire and the medical opinion.

[Correlation of psychological changes and spermiogram improvements following acupuncture]. / Korrelation psychischer Veränderungen und Spermiogrammverbesserungen nch Akupunktur.

The purpose of the study was to find the correlation between the effect of acupuncture on fertility and psychological effects. To investigate its influence on male subfertility, 28 patients received acupuncture treatment after informed consent. We evaluated subjective parameters by written psychological tests, while objective parameters consisted of measuring concentration, volume and motility in the spermiogram before and after acupuncture. There was a significant increase in sperm quality in all parameters but volume. The psychological test showed no change caused by acupuncture. Hence, we believe, that the effect of acupuncture on sperm quality is not caused by placebo-mechanisms.

[Comparison of the acetylcholine receptor antibody titer and clinical course in neonatal myasthenia]. / Vergleich von Acetylcholin-Rezeptor-Antiköpertiter und klinischem Verlauf bei "neonataler Myasthenie".

Ten to fifteen percent of infants of myasthenic mothers develop neonatal myasthenia independent of the severity of the maternal disease. The antiacetylcholin receptor-protein antibodytiter (AChR-AK) was followed through the first twelve months in a boy who's mother suffered from myasthenia gravis (M.G.) since twelve years. Only unspecific symptoms for an impaired neuromuscular transmission were found, the diagnosis however was confirmed by determination of AChR-AK (alpha-Bungarotoxin binding assay, Lindström 1979). Maternal AChR-AK did not change during the observation period: values were between 120 X 10(-9)mol/l and 140 X 10(-9)mol/l. The neonatal titer on day one was 100 X 10(-9) mol/l, somewhat below the corresponding maternal titer (120 X 10(-9)mol/l). By 7 months the AchR-AK had decreased to the reference value according to the half time for IgG (t/2 = 17 days). In contrast to Keesey and Donaldson we found no relationship between AChR-AK levels and clinical course.

[The circulatory effects of Org NC 45 (Norcuron) on three different anesthetic methods in patients with healthy hearts]. / Beeinflussung des Kreislaufverhaltens unter ORG NC 45 (Norcuron) bei drei verschiedenen Narkoseverfahren an kardial gesunden Patienten.

Patients under neurolept, halothane or enflurane anaesthesia received Org NC 45 for muscle relaxation. Systolic, diastolic, mean arterial pressure and heart rate were monitored throughout the study. All patients showed a fall in heart rate after Org NC 45, but this was significant (p less than 0,05) only during neurolept and enflurane anaesthesia. There was no significant change in blood pressure after Org NC 45.

[Modification of semen quality by acupuncture in subfertile males]. / Die Beeinflussbarkeit der Samenqualität durch Akupunktur bei subfertilen Männern.

Our first attempt in treating subfertility by acupuncture was carried out on 28 males. The results obtained from the experiences in veterinary medicine encouraged us to attempt this type of therapy. Each patient received a total of 10 treatments for a period of three weeks. Several spermiograms were made after diagnosis subfertility. We checked spermiograms and hormone levels before and after acupuncture. Total count, concentration and motility were evaluated. In all cases we observed a statistically significant improvement of sperm quality. Having obtained these good results in our first studies, we now intend to continue acupuncture therapy in subfertile males for insemination or intercourse at the time of the ovulation of their female partners.

[The RACZ-epidural catheter. First clinical experiences]. / Der RACZ-Epiduralkatheter. Erste klinische Erfahrungen.

We tested a new epidural catheter, which is made of a stainless steel spiral (similar to an anode endotracheal tube) covered with a fluorpolymer. This catheter was tested in 15 patients who were administered lumbar epidural anaesthesia for pain relief during labor. We also have information on the evaluation of this catheter in about 100 patients from the obstetric anesthesia service, Stanford-University Medical Center. The main advantage of this catheter is, that it does not kink. The disadvantages are: 1. catheter leakage either at the skin interface or just below the injection port particular after prolonged usage, 2. difficult or impossible injection if the catheter injection port is screwed on too tight which requires cutting the catheter (not recommended by the manufacturer), 3. a 17 gauge rather than a 18 gauge epidural needle is recommended and 4. the high price of the catheter.

[Intensive medicine--and what follows? Psychosocial follow-up study of former intensive care patients]. / Die Intensivmedizin--und was ist danach? Psychosoziale Nachuntersuchung ehemaliger Intensivpatienten.

Intensive care medicine enables the organic survival of many seriously ill patients; however, long continuing of disease and trauma itself and the addition of life supporting therapy can remain and make social readjustment difficult. In order to obtain data on the outcome of former intensive care patients we re-examined all patients for three consecutive years who had been discharged from a multidisciplinary ICU. The patients and relatives were interviewed to elucidate changes in personality, behaviour and handicaps. These data were tested on the basis of several hypotheses. 182 patients were tested. The death rate varied for the three different years between 27% up to 37% per reexamined year. 22%-32% of the former patients reported being seriously, 69%-78% reported being moderately disabled. The suicidal tendency is equal to the standard population, although dying and death become a central theme (39%). Due to the drug consumption the health status got worse in 35% of the former patients. Despite severe psychological and physical handicaps 97% were convinced of the necessity of an ICU.

[Problems of anesthesia for cesarean section in myasthenia gravis]. / Probleme der Sectionarkose bei Myasthenia gravis.

The case of a 27 year old female, being pregnant the second time and suffering from myasthenia gravis since 1974 is reported. The patient was admitted to the hospital for repeat caesarian section. Anaesthesia of the preoxygenated patient during caesarian section was induced with 0.5% halothane and ketamine (2 mg/kg b.w.) intravenously. Muscle relaxing drugs (competitive and depolarizing inhibitors) as well as morphine derivates (e.g. fentanyl) and barbiturates are contraindicated. Therefore anaesthesia was maintained with 0.2:N2O = 1:1 combined with 0.5% halothane up to the point of ligation of the umbilical cord, and up to 1.5% halothane thereafter. Intubation was performed without muscle relaxation. The postoperative somnolence frequently seen after the combined use of ketamine and halothane was antagonized with physostigmine salicylate. The newborn showed all signs of neonatal myasthenia.

[Premedication with flunitrazepam, lormetazepam or pethidine-promethazine. Psychometric study of subjective conditions]. / Praemedikation mit Flunitrazepam, Lormetazepam oder Pethidin-Promethazin. Psychometrische Untersuchung der subjektiven Befindlichkeit.

In the course of a clinical study oral administration of two different diazepine derivatives as well as i.m. injection of pethidine and promethazine have been explored with a view to their anxiolytic, sedating and hypnotic action. The study involved 128 patients, randomized into four groups. Group 1 received flunitrazepam 1,5-2 mg p.o. only the evening before operation to group 2 flunitrazepam 1,5-2 p.o. was administered the evening before and the morning of the operation, group 3 were given lormetazepam 2-2,5 mg p.o. at the same time as group 2, in group 4 nitrazepam, 5 mg p.o. the evening before operation and pethidine, 50-100 mg combined with promethazine, 25 mg was given i.m. 60 min before surgery. In group 1 anxiolytic and sedating effect of flunitrazepam were not persistent enough to provide the patient with adequate premedication until the onset of surgery. Intensive sedation and fatigue as well as minimum recollection were observed under medication 2, however, increase in anxiety and depression as well as deterioration of mood were not prevented. Under medication 3 patients felt less exhausted and fatigued than under medication 2, but likewise anxiety and depression increased in the course of the operating day. Group 4 emerged as the last effective premedication both with regard to sleep during the previous night and the conditions of the day of the operation itself.

[Unremovable epidural catheter due to a sling and a knot. A rare complication of epidural anesthesia in obstetrics]. / Festsitzender Epiduralkatheter durch Schlinge und Knoten. Eine seltene Komplikation der Epiduralanaesthesie in der Geburtshilfe.

An epidural catheter inserted at the height of L2/3 could not be removed after spontaneous delivery of a healthy boy, manual extraction of the placenta and fixing the episiotomy. X-rays (lumbar spine a-p and lateral) were taken in order to visualize the epidural catheter's site. The catheter could only be recognized on the a-p but not on the lateral film. It was possible to recognize a foreign body in the ultrasonic study. The exact site of the catheter could not be determined. Continuous pulling in various positions (bend over, stretch and lateral position) could not remove the catheter. A consultant neurosurgeon tried also in vain to remove the fixed catheter. In a final trial pulling hard the catheter broke. The indication for operative extraction was given. Finally the catheter fixed in the ligamentum flavum building a loop and a tight knot in the epidural space could be freed up and removed surgically.

[Head and brain injury in a patient with familial paroxysmal hypokalaemic paralysis (author's transl)]. / Schädel-Hirn-Trauma bei familiärer paroxysmaler hypokaliämischer Lähmung.

The case of severe skull and brain injury is reported in a patient with known familial paroxysmal hypokalaemic paralysis. Multiple cerebral contusions were seen in the brain trauma. The central nervous function could not be clearly determined since the patient had a hypokalaemic state at the time of admission to the hospital. Only electroencephalographic follow-up studies could reveal the central nervous function at that time.

[3-years' domiciliary respirator therapy in idiopathic hypoventilation syndrome (ondine's curse syndrome) (author's transl)]. / Drei Jahre Heimrespiratotortherapie bei idiopathischem Hypoventilationssyndrom *Undines Fluch-Syndrome).

A 67 years old patient with a tracheostomy and cribral cannula on account of severe idiopathic hypoventilation syndrome was discharged from the intensive care unit having been supplied with a respirator (MK 8-Bird) and compressor by his health insurance. The domiciliary respirator therapy was continued for more than 3 years. The disorder manifested itself initially in severe hypoventilation during sleep, acute hypoxaemia, hypercapnia and respiratory acidosis. The patient himself and his family took on the adjustment and maintenance of the respirator, having being appropriately trained before his discharge from hospital. The treatment succeeded for over 3 years in maintaining an acceptable quality of life for the patient.

[Physostigmine and reversal of anticholinergic effects of neurolept-anaesthesia (author's transl)]. / Physostigmin als Antagonist der anticholinergen Depression nach Neuroleptanästhesie.

After 486 gynaecological procedures performed under neuroleptanaesthesia 32 patients remained irresponsive despite naloxone reversal of possible fentanyl overdose and exclusion by peripheral nerve stimulation of prolonged neuromuscular blockade. By random selection 18 of these (group A) received physostigmine 2 mg, 14 patients (group B) served as controls. Groups were comparable concerning age, technique and duration of anaesthesia, total doses of anaesthetics and muscle relaxants. Patients in group A were fully responsive within 9 +/- 4,6 min. after physostigmine, patients without this drug (group B) however within 49 +/- 19 min. This difference was highly significant (P less than 0,001).

[Jet ventilation in laryngoscopy and microlaryngeal surgery under general anaesthesia (author's transl)]. / Injektbeatmung bei direkter Laryngoskopie und endolaryngealen mikrochirurgischen Eingriffen in Allgemeinanaesthesie.

This is a report on a technique which provides an unimpeded access to the operating field during laryngoscopy and laser microsurgery of the larynx. Under barbiturate-induced neuroleptanaesthesia and relaxation with alcuronium 18 patients were jet-ventilated with nitrous oxide and oxygen. The gas mixture was delivered via an automatic injection ventilator (Injection-Timer, Storz) connected to a short endotracheal tube (Injectoflex, Rüsch - a modified Carden tube). Arterial blood sampling was carried out during the whole procedure. In all patients the recommended technique provided adequate alveolar ventilation with minimal metabolic disturbances; the partial pressures of oxygen exceeded the standard values in all cases. Moderate circulatory alterations were observed. Clinical experience with the anaesthetic technique is presented and the advantages of the modified tube compared with the original Carden tube and former devices for jet ventilation during laryngoscopy are described.