[Weight discordance of the second twin: effect on perinatal morbidity and mortality. An 8-year analysis of 213 twin deliveries]. / Gewichtsdiskordanz des zweiten Zwillings: Einfluss auf perinatale Morbidität und Mortalität. Eine 8-Jahres-Analyse von 213 Zwillingsgeburten.

In this retrospective eight-years-study we examine factors to be considered responsible for higher perinatal mortality in twins, especially in twins with discordant body weight. As a main risk factor for this we find vaginal delivery, i.e. from a non-vertex position. Other additional reasons for the higher perinatal mortality of twins are prematurity (less than 34 weeks of gestation) and birthweight lower than 1500 grams. Early hospitalisation has a positive influence on that risk. The perinatal mortality in the second twin (6.7%) is twice as high as in the first twin. The highest perinatal mortality (17.6%), however, is in twins with discordant growth whereas the second twin had a higher birthweight at delivery (15% more than the first twin). In twins with discordant body weight cesarean section gives advantage to the second twin versus vaginal delivery from breech presentation.

[Epidemiological indications for the etiology of proteinuria, hypertension in pregnancy and pre-eclampsia--a longitudinal cohort studies of all Swedish women giving birth between 1973 and 1981 to 3 singleton infants]. / Epidemiologische Hinweise auf die Atiologie von Proteinurie, Hypertonie in der Schwangerschaft und Präeklampsie--Eine longitudinale Kohortenstudie über alle schwedischen Frauen, die zwischen 1973 und 1981 dreimal Einlinge ausgetragen haben.

Based on centrally recorded data about all pregnancies that led to delivery in Sweden in the years from 1973 to 1981 this longitudinal study considers the course of pregnancies of all women who gave birth to their first three single babies during observation time especially regarding hypertension, proteinuria, pre-eclampsia and eclampsia-here subsumized under HP-disease. Incidence of HP-disease is shown to be 8.1% of all observed women, depending on the theoretical approach at a minimum of 34% and a maximum of 44% being due to primary, pregnancy-induced HP-disease. Some epidemiologic findings may give some hints on the etiology of HP-disease: In primary HP-disease mother's age is in the normal range, whereas infection of the urinary tract, diabetes mellitus, fetal deformity are found more frequently. Female fetus are over-represented with existence of HP-disease. The influence of HP-disease presence and parity on fetal development and fetal outcome are discussed.

Capillary versus arterial plasma catecholamines as markers for sympatho-adrenal activity in infants.

In this study, we investigated whether capillary plasma catecholamines can be used as a suitable substitute for arterial catecholamines. Analysis was done radioenzymatically. Catecholamine concentrations were not different in arterial and simultaneously collected "arterialized" (warmed foot) capillary plasma obtained by heel-prick from 18 neonatal intensive care patients as assessed by linear regression analysis (correlation coefficient: 0.966 for noradrenaline; 0.894 for adrenaline; p less than 0.05) and by a Wilcoxon test [noradrenaline: 2.13 (0.61-10.47) versus 2.41 (1.05-10.23); adrenaline: 0.75 (0.16-1.70) versus 0.72 (0.10-1.37) nmol/L, median (range)]. However, "arterialization" of capillary blood is important; when blood was obtained in nine neonates without warming their feet, capillary concentrations of noradrenaline were higher than arterial values (p less than 0.03) and those of adrenaline were not different from arterial values. Catecholamine concentrations in arterialized capillary plasma collected in healthy full-term infants at 1 h [n = 9; noradrenaline: 6.85 (3.09-8.88) nmol/L; adrenaline: 1.34 (0.86-2.85) nmol/L] and 5 d after birth [n = 27; noradrenaline: 1.58 (0.89-3.16) nmol/L; adrenaline: 0.59 (0.25-1.64) nmol/L] reflect the well-known fall (p less than 0.01) in catecholamine levels after delivery. With a highly sensitive analytical technique, catecholamine concentrations can reliably be assessed in minute samples (100-200 microL) of arterialized capillary blood, even when concentrations have dropped to low "resting" basal levels. Moreover, the capillary sampling procedure is simple and safe, can easily be applied to healthy infants, and does not have the practical and ethical limitations of arterial blood sampling.

[Exogenous allergic alveolitis (bird fancier's lung)]. / Exogen allergische Alveolitis (Vogelzüchterlunge).

A 13 year old boy was admitted to our clinic because of caugh, dyspnoe, tachypnoe and bilateral fine moist rales since more than 6 months. Pulmonary function studies showed a restrictive lung disease. Lung biopsy revealed an interstitial pneumonitis. These findings together with a hypergammaglobulinemia and precipitating antibodies were highly suggestive of an extrinsic allergic alveolitis i.e. pigeon breeder's disease. The patient was treated with corticosteroids and is well after 1 year without any therapy except prevention of further exposure.

[Juvenile nonspecific spondylodiscitis]. / Juvenile unspezifische Spondylodiscitis.

In the case of an 11-years old boy, diagnosis "Juvenile Spondylodiscitis" finally was established by MRI. X-Ray investigation was negative and bone scintigraphy was interpreted negative or not conclusive. In recently published studies using MRI for diagnosis of spondylodiscitis in children younger than six years, a typically MCR signal of involved disc and vertebral body was found at a stage of investigation when bone scintigraphy had already also been conclusive. In our case, the patient was a little bit older and may be because of this, scintigraphy was negative. The different vertebral blood perfusion situation of the older child seems to disadvantage scintigraphy to MRI in diagnosis of spondylodiscitis.

Antimicrobial chemotherapy in patients with cystic fibrosis.

The treatment of exacerbations of pulmonary infections due to Pseudomonas aeruginosa in patients with cystic fibrosis is unsatisfactory. Serum concentrations and urinary excretion of cephalexin, epicillin, azlocillin, ticarcillin, trimethoprim-sulfa and gentamicin useful in the treatment of these infections were investigated in cystic fibrosis patients suffering from pulmonary infections. The data were compared to those found in non-cystic fibrosis children treated with antibiotics for other reasons. Cephalexin and trimethoprim are absorbed at a slower rate; epicillin, azlocillin, ticarcillin sulfonamides were eliminated at a faster rate by the kidneys which was unique to patients with cystic fibrosis. Gentamicin is also eliminated faster. Further investigations disclosed that a considerable amount of drug is eliminated by tubular secretion in addition to the regular glomerular filtration in patients with cystic fibrosis. Creatinine clearance values were determined in these patients and found to be normal. By doubling the dose of gentamicin and administration as infusion over 90 min, higher serum and tissue concentrations were achieved without being in the toxic range. The clinical relevance of these investigations was determined in 36 patients and 48 episodes of infection with P. aeruginosa. Patients received gentamicin 4 mg/kg BW as i.v. infusion over 90 min q. 8 h and azlocillin or ticarcillin 120-160 mg/kg BW q. 8 h, applied 4 h later. In 14 patients respectively 27 episodes, pseudomonas was eradicated from the sputum for a minimum of three weeks, and in most of them for 12-24 weeks. No side effects were observed from the higher doses of aminoglycosides.

Breath holding in divers and non-divers--a reappraisal.

The two phases of breath holding, the voluntary inactive and involuntary active phases, were identified by non-invasive methods using the induction plethysmograph. Eight trained divers and 7 non-diving control subjects familiar with respiratory apparatus were studied. During breath holding from normocapnia and total lung capacity it was not possible to distinguish between the two groups in respect of the pattern or duration of breath holding or alveolar gas tensions at the breakpoint. Divers could, however, hold their breath much longer after hyperventilation (165 +/- 40.0 and 121 +/- 31.4 seconds; P less than 0.01). This was associated with a longer second phase than occurred in non-divers (78.0 +/- 29.7 and 17.6 +/- 13.1 seconds; P less than 0.01) and more severe alveolar hypoxia (percentage oxygen 7.6 +/- 1.8 and 10.9 +/- 1.7%; P less than 0.01). It is concluded that these divers had a hyperventilation-dependent attenuated hypoxic ventilatory response. Subjects could also be identified who have either a very short (less than 10 seconds) or very long (greater than 45 seconds) second phase. They were considered to be at risk of developing underwater hypoxia and unexpected loss of consciousness. It is further suggested that analysis of the phases of breath holding holds promise as a screening test of both novice and experienced divers.

Rheumatoid non-lymphoid synovial cells and the induction of mixed leukocyte reactions. Low-density preparations containing Ia+ macrophages and dendritic cells are less stimulatory than peripheral blood non-T cells.

Interactions of autologous or allogeneic T cells with non-lymphoid synovial cells were investigated to study the mechanisms of T-cell activation in rheumatoid arthritis. The synovial cell fraction obtained by Percoll gradients contained an average of 31% cells positive for monocyte antigens and 62% intensely Ia-positive cells. Tissue cultures demonstrated large numbers of cells with a dendritic morphology. Mixed leukocyte reaction (MLR) cultures between these synovial cell preparations and autologous or allogeneic peripheral blood T cells as responder cells revealed low T-cell responsiveness with an average of 3900 dpm or 17 800 dpm, respectively, in contrast to 16 900 dpm or 79 600 dpm, using rheumatoid peripheral blood non-T cells (P less than 0.01), despite equivalent amounts of Ia antigens on both stimulator populations, as determined by cell-sorter analysis. The addition of indomethacin to these synovial cell/T cell co-cultures resulted in an enhancement of T-cell responsiveness; however, this increase did not reach statistical significance due to large test variations. Co-cultures of non-lymphoid synovial cells and PHA-stimulated autologous T cells induced a marked inhibition of T-cell proliferation that could partially be reversed by the addition of indomethacin. The reduction of monocyte-antigen-positive cells by depletion of iron phagocytic cells did not result in a significant enhancement of T-cell responsiveness. These data demonstrate that the majority of non-lymphoid synovial cells, despite the presence of large amounts of Ia-antigens, are not potent inducers of T-cell proliferation and strong suppressing cells in polyclonal T-cell activation. These effects do not appear to reside in the macrophage fraction alone and can only partly be attributed to the action of prostaglandins.

Contractile proteins in human cancer cells. Immunofluorescent and electron microscopic study.

The presence of contractile proteins in human cancer cells has been studied by means of: a) immunofluorescent staining using specific antibodies, and b) electron microscopy in order to detect the presence of cytoplasmic filaments. The tissues examined were: normal human skin, basal cell carcinoma of the skin, squamous cell carcinomas (of skin, oral cavity, and larynx), normal nonlactating mammary gland, and infiltrating mammary carcinoma with or without fibrosis. Normal tissues were negative after immunnoflurosescent staining of contractile proteins and contained no or minimal amounts of microfilaments as judged by electron microscopy. Tumor cells were strongly positive after immunoflouorescent staining for actin, myosin, light and heavy meromyosin but were negative for tropomyosin. Moreover, they contained prominent microfilaments (40 to 80 A in diameter) with some filaments (100 to 120 A in diameter) scattered in between. It appears that malignant cells contain an increased amount of contractile proteins, organized in the form of a filamentous apparatus, when compared to their normal counterparts. The study of the presence of contractile proteins in tumor cells may be of potential importance in evaluating malignant growth.