[Implementation of the principle of supported employment in Germany : Position paper of a task force of the DGPPN]. / Umsetzung der Prinzipien des Supported Employment in Deutschland : Positionspapier einer Task-Force der DGPPN.

The effects of mental diseases on the employment and working situation can be substantial. They are one of the main reasons for inability to work and reduced earning capacity. Against this background the question arises about suitable occupational reintegration measures for people with severe mental illnesses. In recent years, the principle of supported employment has been internationally shown to be increasingly more successful. In this context mentally ill people are primarily placed at a position of the first employment market and supported on-site by a job coach. This concept is inclusive, individual and evidence based. Despite proven effectiveness, it has so far been insufficiently implemented in German-speaking regions. In the future it will be a matter of considering the individual needs for assistance of mentally ill people more intensively than previously and to respond with functional and in a best-case scenario, multiprofessional and flexible offers.

[Effect of surgery of pulmonary cysts related to immunoglobulin light chain deposits]. / Intérêt de la chirurgie de kystes pulmonaires liés à des dépôts de chaînes légères.

INTRODUCTION: Light chain deposition disease is a rare anatomo-clinical disorder, which rarely leads to cystic lung destruction. CASE REPORT: We report the case of a 62years old female patient with a history of a monoclonal gammopathy of unknown significance who developed progressive dyspnea. Thoracic CT-scan demonstrated a diffuse pulmonary cystic disorder with predominance in the right lower lobe. Thoracoscopic surgical resection of that lobe led to a diagnosis of non-amyloid kappa light chain deposits. Surgery also resulted in a lung volume reduction effect with clinical and functional benefits related to improved ventilation of adjacent segments. CONCLUSION: This report of pulmonary cystic disorder related to a light chain deposition disease highlights the potential clinical and functional benefits observed after lung volume reduction surgery.

[Thoracic impairment from familial Mediterranean fever: review of the literature and a case study]. / Atteintes thoraciques de la fièvre méditerranéenne familiale : revue de la littérature - à propos d'un cas.

Familial Mediterranean fever (FMF) is a recessive autosomal disease, predominantly affecting the population around the Mediterranean. The main clinical signs consist of attacks of fever associated with abdominal, articular and thoracic pain. Based on a case report, the authors describe the main thoracic forms of this illness comprising pleural pain, pleural effusion and pulmonary amyloidosis. The authors also discuss the association of mesothelioma and FMF. Colchicine is successfully used in the treatment of FMF.

[Thyroid metastasis of lung cancer and abnormal thyroid function--a case report]. / Métastase thyroïdienne d'un cancer bronchique et dysthyroïdie--à propos d'un cas.

The thyroid gland is a very rare location of metastasis and the metastatic involvement of the thyroid is mostly asymptomatic. The authors report one of the first cases of pulmonary adenocarcinoma associated with painful metastatic involvement of the thyroid gland. Temporary hyperthyroidism was noted, followed, two months later, by clinically and biologically proven hypothyroidism with positive antithyroglobulin antibodies. The suspect goiter was detected by diffuse hyperfixation on 18-FDG PET Scan and the ultrasonography revealed two hypoechogenic nodules. The fine needle biopsy confirmed the metastatic origin of these nodules. The evolution after five cycles of chemotherapy by cisplatine and docetaxel was marked by a complete regression of the thyroid metastasis and an improvement in the thyroid function.

[Psychopathology of Ganser's syndrome. Literature review and case report]. / Psychopathologie des Ganser-Syndroms. Literaturübersicht und Falldiskussion.

The key feature of Ganser's syndrome includes approximate answers to simple questions. The cause of this rare syndrome remains uncertain. Current classification systems categorise it as a dissociative disorder, the symptoms of which are judged as psychogenic in origin. Our review of the literature (n=151) demonstrates however that Ganser's syndrome is frequently associated with brain injury, although detailed imaging, neuropsychological, and neurological data of this for the most part do not exist. We describe a right-handed patient with Ganser's syndrome after a large left-hemispheric middle cerebral artery infarction. Detailed neuropsychological examination showed atypical lateralisation of cognitive functions with so-called crossed nonaphasia and pronounced frontal-executive dysfunctions. Regarding both psychiatric and neuropsychological aspects, we discuss how the key feature of approximate answers may be associated with frontal-executive cerebral dysfunctions.

[Cytomegalovirus infection in an immunocompetent patient complicated with pulmonary embolism and mimicking giant cell arteritis associated with polymyalgia rheumatica]. / Embolie pulmonaire compliquant une infection à cytomégalovirus, infection mimant une maladie de Horton associée à une pseudopolyarthrite rhizomélique chez un sujet immunocompétent.

Cytomegalovirus infection is generally asymptomatic in immunocompetent patients but can also provide a wide spectrum of clinical and biological signs. We report the case of a cytomegalovirus infection in an immunocompetent adult mimicking giant cell arteritis associated with polymyalgia rheumatica and complicated with pulmonary embolism. We review and discuss the venous prothrombic properties of CMV in immunocompetent patients.

[Possible genetic link between Darier's disease and depression. Review of the literature and case history]. / Morbus Darier und Depression - besteht eine genetische Verbindung? Ubersicht und klinischer Fall.

Darier's disease is a rare, inherited autosomal dominant skin disorder caused by a mutation in the sarcoendoplasmatic reticulum calcium transporter (SERCA)-2-gene. In a number of pedigrees, Darier's disease closely relates with affective disorder. The most likely hypothesis for this is a susceptibility gene for affective disorder near the SERCA-2-gene. A 6.5-megabase region could be identified as a susceptibility locus. This region constitutes a susceptability locus also in affective disorder without Darier's disease. The underlying gene has not yet been identified.

New erythromycin derivatives from Saccharopolyspora erythraea using sugar O-methyltransferases from the spinosyn biosynthetic gene cluster.

Using a previously developed expression system based on the erythromycin-producing strain of Saccharopolyspora erythraea, O-methyltransferases from the spinosyn biosynthetic gene cluster of Saccharopolyspora spinosa have been shown to modify a rhamnosyl sugar attached to a 14-membered polyketide macrolactone. The spnI, spnK and spnH methyltransferase genes were expressed individually in the S. erythraea mutant SGT2, which is blocked both in endogenous macrolide biosynthesis and in ery glycosyltransferases eryBV and eryCIII. Exogenous 3-O-rhamnosyl-erythronolide B was efficiently converted into 3-O-(2'-O-methylrhamnosyl)-erythronolide B by the S. erythraea SGT2 (spnI) strain only. When 3-O-(2'-O-methylrhamnosyl)-erythronolide B was, in turn, fed to a culture of S. erythraea SGT2 (spnK), 3-O-(2',3'-bis-O-methylrhamnosyl)-erythronolide B was identified in the culture supernatant, whereas S. erythraea SGT2 (spnH) was without effect. These results confirm the identity of the 2'- and 3'-O-methyltransferases, and the specific sequence in which they act, and they demonstrate that these methyltransferases may be used to methylate rhamnose units in other polyketide natural products with the same specificity as in the spinosyn pathway. In contrast, 3-O-(2',3'-bis-O-methylrhamnosyl)-erythronolide B was found not to be a substrate for the 4'-O-methyltransferase SpnH. Although rhamnosylerythromycins did not serve directly as substrates for the spinosyn methyltransferases, methylrhamnosyl-erythromycins were obtained by subsequent conversion of the corresponding methylrhamnosyl-erythronolide precursors using the S. erythraea strain SGT2 housing EryCIII, the desosaminyltransferase of the erythromycin pathway. 3-O-(2'-O-methylrhamnosyl)-erythromycin D was tested and found to be significantly active against a strain of erythromycin-sensitive Bacillus subtilis.

Expression pattern and localization of beta,beta-carotene 15,15'-dioxygenase in different tissues.

Beta,beta-carotene 15,15'-dioxygenase cleaves beta,beta-carotene into two molecules of retinal, and is the key enzyme in the metabolism of beta,beta-carotene to vitamin A. The enzyme has been known for more than 40 years, yet all attempts to purify the protein to homogeneity have failed. Recently, the successful cloning and sequencing of an enzyme with beta,beta-carotene 15,15'-dioxygenase activity from chicken, as well as from Drosophila, has been reported. Here, we describe in detail our attempt to enrich the chicken beta,beta-carotene 15,15'-dioxygenase to such an extent as to allow determination of partial amino acid sequences, which were then used to design degenerate oligonucleotides. Screening of a chicken duodenal expression library yielded a full-length clone containing a coding sequence of 1578 bp. Functional expression in Escherichia coli and in eukaryotic cell lines confirmed that we had cloned the first vertebrate dioxygenase that cleaves beta,beta-carotene at the central 15,15'-double bond. By performing a sequence homology search, the cDNA sequence of the mouse homologue was found as an expressed sequence tag (EST) in the gene bank. At the amino-acid level, the degree of homology between the chicken and mouse sequences is 81%. Thus beta,beta-carotene 15,15'-dioxygenase can be considered as being an enzyme that is evolutionarily rather well conserved. We established the expression pattern of beta,beta-carotene 15,15'-dioxygenase in chicken and mouse tissues with a combination of Northern blots and in situ hybridization. The mRNA for beta,beta-carotene 15,15'-dioxygenase was localized primarily in duodenal villi, as well as in liver and in tubular structures of lung and kidney. These new findings demonstrate that beta,beta-carotene 15,15'-dioxygenase is also expressed in epithelial structures, where it serves to provide the tissue-specific vitamin A supply.

Cloning and expression of beta,beta-carotene 15,15'-dioxygenase.

beta,beta-Carotene 15,15'-dioxygenase cleaves beta-carotene into two molecules of retinal and is therefore the key enzyme in beta-carotene metabolism to vitamin A. In the present study, it was possible to enrich the chicken beta,beta-carotene 15,15'-dioxygenase to such an extent that partial amino acid sequence information could be obtained to design degenerate oligonucleotides. With RT-PCR a cDNA fragment could be obtained and used subsequently in a radioactive screening of a chicken duodenal expression library. We cloned the first eukaryotic beta,beta-carotene 15,15'-dioxygenase which symmetrically cleaves beta-carotene at the 15,15'-double bond.

A defined system for hybrid macrolide biosynthesis in Saccharopolyspora erythraea.

The biological activity of polyketide antibiotics is often strongly dependent on the presence and type of deoxysugar residues attached to the aglycone core. A system is described here, based on the erythromycin-producing strain of Saccharopolyspora erythraea, for detection of hybrid glycoside formation, and this system has been used to demonstrate that an amino sugar characteristic of 14-membered macrolides (D-desosamine) can be efficiently attached to a 16-membered aglycone substrate. First, the S. erythraea mutant strain DM was created by deletion of both eryBV and eryCIII genes encoding the respective ery glycosyltransferase genes. The glycosyltransferase OleG2 from Streptomyces antibioticus, which transfers L-oleandrose, has recently been shown to transfer rhamnose to the oxygen at C-3 of erythronolide B and 6-deoxyerythronolide B. In full accordance with this finding, when oleG2 was expressed in S. erythraea DM, 3-O-rhamnosyl-erythronolide B and 3-O-rhamnosyl-6-deoxyerythronolide B were produced. Having thus validated the expression system, endogenous aglycone production was prevented by deletion of the polyketide synthase (eryA) genes from S. erythraea DM, creating the triple mutant SGT2. To examine the ability of the mycaminosyltransferase TylM2 from Streptomyces fradiae to utilise a different amino sugar, tylM2 was integrated into S. erythraea SGT2, and the resulting strain was fed with the 16-membered aglycone tylactone, the normal TylM2 substrate. A new hybrid glycoside was isolated in good yield and characterized as 5-O-desosaminyl-tylactone, indicating that TylM2 may be a useful glycosyltransferase for combinatorial biosynthesis. 5-O-glucosyl-tylactone was also obtained, showing that endogenous activated sugars and glycosyltransferases compete for aglycone in these cells.

Cultured trout liver cells: utilization of substrates and response to hormones.

The characterization of a recently established system for the short-term culture of rainbow trout (Oncorhynchus mykiss) liver cells in chemically defined medium has been extended to studies on the metabolic competence of the cells and the characterization of their response to hormones. Three areas of metabolism have been addressed: a) the utilization of the exogenously added substrates fructose, lactate, glucose, dihydroxyacetone, and glycerol for glucose and lactate formation; b) the effects of the pancreatic hormones insulin and glucagon on cellular glucose formation, lactate formation, and fatty acid synthesis; and c) the effects of insulin and dexamethasone on the estradiol-dependent production of vitellogenin. Incubation of trout liver cells with fructose, lactate, glucose, dihydroxyacetone, or glycerol resulted in enhanced rates of cellular glucose and lactate production. Substrate-induced effects usually were more clearly expressed after extended (20 h) than after acute (5 h) culture periods. Addition of the hormones insulin or glucagon caused dose-dependent alterations in the flux of substrates to glucose and lactate. Rates of de novo synthesis of fatty acids from [14C]acetate were stimulated by insulin and inhibited by glucagon during acute and extended incubation periods. Treatment of liver cells isolated from male trout for 72 h with estradiol induced vitellogenin production and secretion into the medium. However, the addition of insulin or dexamethasone drastically reduced this estrogen-induced vitellogenesis. These results indicate that trout liver cells cultured in defined medium maintain central metabolic pathways, including glycolysis, gluconeogenesis, lipogenesis, and vitellogenesis as well as their responsiveness to various hormones, for at least 72 h.(ABSTRACT TRUNCATED AT 250 WORDS)

Immunoelectron microscopy of rhodopsin and vitamin A in the pineal organ and lateral eye of the lamprey.

Rhodopsin- and vitamin A-immunoreactive sites were studied in the pineal organ of the larval and adult brook lamprey (Lampetra planeri Bloch), as well as in the retina of the larval lateral eye, at the electron microscopic level. In the pineal organ, several types of photoreceptor cells could be distinguished by their morphology and the immunoreactivity of their outer segments. The different kinds of photoreceptor cells were located at different levels of the pineal organ according to their distance from the "pineal window". The most superficial level, the so-called pellucida, appears to represent an exclusively "cone-type" area containing slender, rhodopsin-immunonegative (UV-blue-sensitive?) photoreceptors only. The second level, the pineal retina, contained predominantly rod-type photoreceptors, i.e., large, strongly rhodopsin-immunopositive (green-sensitive) photoreceptors medially, and few, small, weakly rhodopsin-immunopositive (blue-green-sensitive?) cells bilaterally. At the deepest level, the pineal atrium, there were both rod- and cone-type photoreceptor cells, the latter possibly representing red-sensitive elements. Vitamin A immunoreactivity was found in the outer segments of the pineal photoreceptor cells, in the cytoplasm and mitochondria of inner segments and perikarya, as well as in nuclear euchromatin and compact nucleoli. A similar gold labelling of organelles was observed in the ependyma and pineal neurons. The vitamin A immunoreaction of the outer segments suggests retinoids are present as chromophores of the photopigments. In the peripheral retina of the larval lateral eye, vitamin A immunoreactivity was found in some organelles of the undifferentiated photoreceptor cells, neurons, pigment epithelium and Müllerian cells. The localization of immunoreactive vitamin A in nuclei, nucleoli and cytoplasm including mitochondria appears to strengthen the case for an interaction of retinoids in the function of these organelles.

Immunocytochemical localization of vitamin A in the retina and pineal organ of the frog, Rana esculenta.

Vitamin A immunoreactive sites were studied in the retina and pineal organ of the frog, Rana esculenta, by the peroxidase antiperoxidase, avidin-biotinperoxidase and immunogold methods. In dark-adapted material, strong immunoreaction was found in the outer and inner segments of the photoreceptor cells of both retina and pineal organ, as well as in the pigment epithelium, retinal Müller cells and pineal ependymal cells. In light-adapted retina, cones and green (blue-sensitive) rods were immunopositive. At the electron microscopic level, immunogold particles were found on the membranes of the photoreceptor outer segments as well as on the membranes of the endoplasmic reticulum and mitochondria. Individual retinal photorecptor cells exhibited strong immunoreaction in the distal portion of the inner segment, the ciliary connecting piece and the electron-dense material covering the outer segment. In the pigment epithelium, the immunolabeling varied in intensity in the basal and apical cytoplasm and phagocytosed outer segments. The immunocytochemical results indicate that retinoids (retinal, retinol and possibly retinoic acid) are present not only in the photoreceptor cells of the retina but also in those of the pineal organ. The light-dependent differences in the immunoreactivity of vitamin A underlines its essential role in the visual cycle of the photopigments. Our results suggest that the pineal ependyma plays a role comparable to that of the Müller cells and pigment epithelium of the retina with regard to the transport and storage of vitamin A. The presence of a retinoid in nuclei, mitochondria and cytoplasmic membranes suggests an additional role of vitamin A in other metabolic processes.

[Indications and prognosis of preventive and simultaneous operations of the abdominal cavity]. / Indikation und Prognose prophylaktischer und simultaner Operationen in der Bauchhöhle.

The potential risk implied in prophylactic operations is just as high as that elective interventions. Indications must be subject to stringent deliminating criteria. Required are thorough elucidation and documentation as well as comprehensive substantiation. Operations of that kind may be performed even without elaborate advance planning, if indications are urgent. Simultaneous operations are accompanied by higher risk in cases of major surgery or if one of the interventions is septic. High risk factors were recordable from combined stomach and bile duct surgery, when performed simultaneously. Morbidity amounted to 13 per cent (pulmonary embolism and pneumonia) and lethality to 15 per cent. Simultaneous operations should be performed by an experienced surgeon who should be a fast worker.

The first component of complement as a constituent of human salivary sediment.

The sediment from human saliva is complement-reactive. Evidence presented shows that C1 (first component of complement) is a constituent of sediment from healthy human donors. Sediment (Sed) inactivated functionally pure C4 (fourth component of complement), and this action on C4 was inhibited by EDTA, phenylmethylsulphonylfluoride (PMSF, a serine-esterase inhibitor) and C1-inhibitor (C1-In). When Sed was incubated with 0.15 ionic strength buffer and separated by centrifugation, C1 haemolytic activity was found in the supernatant. By incubating Sed with EAC4 cells (sheep erythrocytes sensitized with rabbit antibody to which C4 has been fixed), transfer was shown of C1 from the Sed to the cells, resulting in the formation of EAC14; this transfer was inhibited by IgG directed against a subunit of C1 (anti-C1s).

Carbohydrate and protein contents of grain dusts in relation to dust morphology.

Grain dusts contain a variety of materials which are potentially hazardous to the health of workers in the grain industry. Because the characterization of grain dusts is incomplete, we are defining the botanical, chemical, and microbial contents of several grain dusts collected from grain elevators in the Duluth-Superior regions of the U.S. Here, we report certain of the carbohydrate and protein contents of dusts in relation to dust morphology. Examination of the gross morphologies of the dusts revealed that, except for corn, each dust contained either husk or pericarp (seed coat in the case of flax) fragments in addition to respirable particles. When viewed with the light microscope, the fragments appeared as elongated, pointed structures. The possibility that certain of the fragments within corn, settled, and spring wheat were derived from cell walls was suggested by the detection of pentoses following colorimetric assay of neutralized 2 N trifluoroacetic acid hydrolyzates of these dusts. The presence of pentoses together with the occurrence of proteins within water washings of grain dusts suggests that glycoproteins may be present within the dusts. With scanning electron microscopy, each dust was found to consist of a distinct assortment of particles in addition to respirable particles. Small husk fragments and "trichome-like" objects were common to all but corn dust.

Elemental analysis of airborne grain dusts.

The elemental composition of a group of airborne and settled grain dusts is reported. This survey was undertaken as part of a study to systematically describe the chemistry and morphology of these representative dusts. Our data show that airborne or settled grain dusts differ from each other with respect to elemental composition. Such fundamental differences may be related to previously observed differences in the biological activities of the dusts.

Interactions of complement with an extract of airborne spring wheat dust.

The inhalation, by grain elevator workers, of airborne grain dusts can lead to pulmonary problems. Complement, which is present in human airways, can interact with various grain dusts, producing activation products that have been shown to participate in the inflammatory reaction. Because of this apparent connection between grain-dust inhalation, complement activation, and respiratory difficulties, we are studying the reaction of an aqueous extract of spring wheat dust (swd) with human complement. The swd extract activates both the classical and alternative pathways; it acts on purified C2 to inhibit it, and it reacts with undiluted serum to consume C4 with kinetics significantly different from those shown by a "typical" antigen-antibody complex (sensitized sheep erythrocytes). Enzyme susceptibility experiments suggest that the alternative and classical pathway activators of swd extract are neither protein nor nucleic acid; periodate oxidation indicates these substances are carbohydrate, and gel filtration suggests they are macromolecular. Enzyme vulnerability also indicates that the C2 inhibitor of swd extract is ribonucleic acid. Although endotoxin is present in swd extract, a gel-filtration experiment showed that a major fraction of the complement reactivity was not associated with this substance.