Group Median Values Research Articles

Dilatation therapy for dysphagia in patients with upper esophageal sphincter dysfunction--manometric and symptomatic response.

Inability to maintain oral nutrition due to oropharyngeal dysphagia is common in patients with a variety of neurological and neuromuscular disorders and severely affects quality of life. Cricopharyngeal dilatation has been used as empiric therapy in these patients, but little data exist on symptom response and there is no data on the effect on the manometric characteristics of the upper esophageal sphincter (UES) and pharynx. We studied 10 patients with oropharyngeal dysphagia and either elevated upper esophageal sphincter resting pressure, or a high residual pressure or attenuated duration of relaxation on swallowing. Dilatation therapy was performed with an 18-20 mm Savary dilator and manometry was repeated after an average period of 4 weeks. Nine out of 10 patients had improvement in dysphagia and have maintained oral nutrition for a mean follow-up of 13 months. UES residual pressure decreased in nine out of 10 patients and the group median value decreased significantly from 10.8 mmHg pretreatment to 5.7 mmHg after therapy (P < 0.05). UES resting pressure decreased in eight out of 10 patients and the group median value decreased from 82 to 43 mmHg (P < 0.05). Duration of relaxation did not change significantly. Videoradiography was normal in five out of nine responders to therapy. For selected patients with oropharyngeal dysphagia and manometric signs of UES dysfunction, dilatation therapy may give excellent symptomatic relief, apparently by reducing UES resting pressure and/or increasing the duration and completeness of relaxation.

The effects of parturition and peripartum complications on the peritoneal fluid composition of mares

Abnormalities in peritoneal fluid are diagnostically useful for managing equine colic; however, their significance in post-dystocia mares is not known. This study was to determine what changes, if any, occurred following obstetrical manipulations. Peritoneal fluid samples were collected from 2 groups of foaling mares to establish control values, and from a third group that had developed clinical abnormalities (CAb,n = 14) or had made an uneventful recovery (CN,n = 36) following fetal extraction. In Group 1 mares, samples were collected before and after induced parturitions (n = 7), and although the total nucleated cell count was increased (P < 0.02) the median values for peritoneal fluid composition remained within the normal reference range. In Group 2 mares, samples were collected after unassisted foalings (n = 10) on postpartum Days 1, 3, 5 and 7, and the peritoneal fluid values remained within the normal reference range. In the Group 3 (CN) mares neither assisted vaginal delivery or fetotomy caused median peritoneal fluid values to rise above the normal reference range. Although remaining within normal limits, the total nucleated cell count was increased (P < 0.01) on Day 2. The median peritoneal fluid total protein value for Group 3 (CAb) mares was greater than the median value for Group 3 (CN) mares on Day 1 (P < 0.05) and Day 2 (P < 0.001). The peritoneal fluid total nucleated cell count in Group 3 (CAb) mares with a uterine tear, vaginal laceration involving the peritoneal cavity, or a ruptured mesocolon was greater than in Group 3 (CN) mares (P < 0.02). The median peritoneal fluid percentage of neutrophils value for Group 3 (CAb) mares was higher than for Group 3 (CN) mares on both Days 1 and 2 (P < 0.02). Elevation of a single peritoneal fluid value in the postpartum mare may be incidental; however, increases in 2 or more of these (total protein > 3.0 g/dl; total nucleated cell count > 15,000 cells/μl; percentage of neutrophils > 80%) is clinically significant.

Maternal plasma levels of vascular endothelial growth factor in normotensive pregnancies and in pregnancies complicated by pre-eclampsia.

We have measured the level of vascular endothelial growth factor (VEGF) in maternal plasma during normotensive pregnancy and in pregnancies complicated by pre-eclampsia. VEGF was measured using a competitive enzyme immunoassay. Plasma VEGF was significantly elevated (P < 0.0001) in the pre-eclamptic group (median value 32.7 ng mL-1, range 10.3-64.0), compared with the normotensive group (median value 11.7 ng mL-1, range 6.3-24.3). VEGF is a potent regulator of endothelial cell function. The increased level found in women with pre-eclampsia indicates that VEGF may be involved in the maternal endothelial cell dysfunction associated with this condition. An increase in VEGF, a potent regulator of microvascular permeability, may also contribute to the extravasation of plasma proteins and the subsequent development of proteinuria, both characteristic features of pre-eclampsia.

Procoagulant Properties of Intravenous Staphylokinase Versus Tissue-Type Plasminogen Activator

The fibrin-specificity and procoagulant effects of recombinant staphylokinase (Sak42D) were compared with those of recombinant tissue-type plasminogen activator (rt-PA) in patients with acute myocardial infarction. Plasma samples were obtained at baseline and at 25 and 90 min, from 24 patients who were randomly assigned to a double bolus (15 mg each, 30 min apart) administration of Sak42D or to accelerated weight-adjusted rt-PA (maximum of 100 mg over 90 min). Baseline levels of fibrinopeptide A (FPA), prothrombin fragment 1 + 2 and thrombin-antithrombin III complex (TAT) were comparable in the Sak42D and rt-PA groups (p > or = 0.6). In patients treated with Sak42D, plasma levels of FPA, prothrombin fragment 1 + 2 and TAT did not markedly increase during treatment (p = 0.06, p = 0.4 and p = 0.03, respectively). In contrast, during administration of rt-PA the levels of FPA, prothrombin fragment 1 + 2 and TAT increased significantly over baseline (p = 0.003, p < 0.0001 and p = 0.001, respectively). As a result, the levels of all three procoagulant parameters were significantly lower during treatment with Sak42D as compared to rt-PA. Thus, FPA levels in the Sak42D group (median values) were 40 ng/ml at 25 min and 11 ng/ml at 90 min, as compared to 88 ng/ml and 50 ng/ml in the rt-PA group (p = 0.0007 and p = 0.009, respectively). Prothrombin fragment 1 + 2 levels in the Sak42D group were 1.3 nM at 25 min and 1.2 nM at 20 min, as compared to 11 nM and 5.3 nM in the rt-PA group (both p < 0.0001). TAT levels were 4.7 ng/ml at 25 min and 6.2 ng/ml at 90 min in the Sak42D group, with corresponding values of 16 ng/ml and 9.6 ng/ml in the rt-PA group (p = 0.02 and p = 0.03, respectively). In the patients treated with Sak42D, no significant systemic fibrinolytic activation was observed, as revealed by unaltered levels of clottable fibrinogen, plasminogen and alpha 2-antiplasmin up to 90 min after the start of therapy. In contrast, the corresponding residual levels at 90 min in patients treated with rt-PA decreased to (mean +/- SEM; n = 12) 62 +/- 6%, 45 +/- 5% and 52 +/- 10%, respectively (all p < or = 0.01 versus the Sak42D group). These data confirm the high degree of fibrin-specificity of Sak42D and demonstrate that this is associated with significantly less generation of procoagulant activity in plasma after intravenous administration in patients with acute myocardial infarction.

Oxygenation of dog liver transplants as an early indicator of graft failure.

This study examines the potential value of liver oxygenation as a predictor of early graft function. pO2 measurements were performed on 10 pairs of beagle (donor) and foxhound (recipient) dogs during pentobarbital anesthesis. Two different explantation techniques were used: complete preparation and dissection before perfusion and explantation (group A) or rapid perfusion and explantation with detailed preparation of the liver and dissection of vessels ex situ after explantation (group B). In both groups, the technique of liver perfusion with 1,000 ml arterial and 500 ml portovenous application of ice-cold UW solution was equal. Local oxygen partial pressure values were obtained polarographically with miniaturized needle electrodes. The liver oxygenation directly after laparotomy was comparable in both groups (median values around 54 mm Hg). Prior to the infusion of UW solution, a reduction of the tissue oxygenation values to 24 mm Hg was observed in group A (p < 0.01 compared to postlaparotomy values). In group B, limited preexplantation surgical dissection resulted in a reduced pO2 decline to 42 mm Hg (n.s.). After transplantation, the reduced tissue oxygenation persisted in the livers of the dogs which were completely dissected in situ (group B) as compared to the preexplantation recipient and the donor liver before instrumentation (p < 0.01). In contrast, rapidly perfused livers again exhibited only an insignificant reduction of tissue oxygenation following transplantation. Survival correlated linearly with the liver oxygenation within the observation time after transplantation (p < 0.01). A significant survival advantage was found for the rapid perfusion technique (p < 0.05). We conclude that the tissue oxygenation might provide valuable information on early graft function.

PMN-related parameters for the monitoring of wound healing in traumatology

In the search for objective methods to monitor the course of wound healing, the proteinase PMN elastase (n=56 pat.), the lipid peroxidation product malondialdehyde (MDA) (n=18 pat.), and polymorphonuclear neutrophil granulocytes (PMN) migratory behaviour were measured [1, 6, 7, 11]. This "stimulated PMN-locomotion" was quantified by a new PMN migration filter assay (n=10 pat.) [2]. We determined the clinical course during "per primam (pp)" wound healing (group 1), "pp" wound healing with secondary inflammatory disease (group 2), manifestation of a bacterial wound infection during healing-"per secundam (ps)" (group 3) and manifest wound infection ("ps") at the time of admission (group 4).In group 1 PMN elastase returned to normal values on the 10th postsurgical day. Median values in group 3 reflected a highly significant difference (p<0,01) on day 4 and 5 compared with group 1. In group 2 and 4 medians reflected consistent high values without reaching normal ranges throughout. MDA did not exceed the normal range in group 1, in group 3 low levels persisted, and in group 4 a recurring increase was noticed.The total migration index median (TMI) in Group I, which quantifies the percentage of stimulated PMN, reflected its highest value immediately post-surgically and dropped to the lowest on the 13th postsurgical day (decrease by 54%). The mean invasion depth (T/2), a parameter of PMN distribution, showed only slight variation with time. In a group 3-patient, T/2 reflected a maximal migratory stimulation on day 6, 4 days before clinical infection signs could be noticed; then it dropped to the lowest on day 10. This decrease probably reflects a PMN behavioural change from migration to phagocytosis [9].

Soluble cytokine receptors and the low 3,5,3'-triiodothyronine syndrome in patients with nonthyroidal disease.

Cytokines have been implicated in the pathogenesis of the low T3 syndrome during illness. This is supported by our recent observation of a strong negative relationship between serum T3 and serum interleukin-6 (IL-6) in nonthyroidal illness (NTI). In the last few years, soluble cytokine receptors and cytokine receptor antagonists have been discovered in human serum. These proteins have the potential to further regulate cytokine activity. Therefore, we now studied the association between serum T3 and serum levels of soluble tumor necrosis factor-alpha (sTNF alpha R p55 and sTNF alpha R p75), soluble interleukin-2 receptor (sIL-2R), and the interleukin-1 receptor antagonist (IL-1RA) in 100 consecutive hospital admissions with a wide variety of nonthyroidal diseases. Patients were divided into group A (T3, > or = 1.30 nmol/L; T4, > or = 75 nmol/L; n = 41), group B (T3, < 1.30 nmol/L; T4, > or = 75 nmol/L; n = 46), and group C (T3, < 1.30 nmol/L; T4, < 75 nmol/L; n = 13). Serum sTNF alpha R p55, sTNF alpha R p75, sIL-2R, and IL-1RA were lower in group A than in groups B and C [median values; sTNF alpha R p55, 1.25, 2.25, and 3.55 ng/mL (P < 0.001); sTNF alpha R p75, 2.02, 4.56, and 7.00 ng/mL (P < 0.001); sIL-2R, 184, 259, and 272 U/mL (P = 0.0004), respectively]. Serum IL-1RA levels were not different in the three groups (median values, 122, 193, and 258 pg/mL, respectively). Taking all patients together, a significant negative relation was found among serum T3 and sTNF alpha p55 (r = -0.59; P < 0.0001), sTNF alpha R p75 (r = -0.55; P < 0.0001), sIL-2R (r = -0.54; P < 0.0001), IL-1RA (r = -0.38; P = 0.001), and IL-6 (r = -0.56; P < 0.0001). A remarkable high correlation (r = -0.70; P < 0.0001) was found between serum T3 and a newly designed total score based on the summation of serum levels of IL-6 and the four soluble cytokine receptor proteins. IL-6 and the four cytokine receptor proteins were all significantly related to each other. Stepwise multiple regression indicated IL-6 and sTNF alpha R p75 as independent determinants of T3 [serum T3 = 2.09-0.32ln (sTNF alpha R p75) -0.15ln (IL-6); r = 0.70]. The variability in serum T3 was accounted for 35% by changes in ln (sTNF alpha R p75) and 14% by changes in ln (IL-6).(ABSTRACT TRUNCATED AT 400 WORDS)

Use of bone mineral content determination by X-ray absorptiometry in the evaluation of osteodystrophy among workers exposed to aluminium powders

Within the framework of a cross-sectional study, we investigated 61 employees in an aluminium powder factory to see if aluminium had an influence on bone mineral content using the non-invasive method of bone density measurement. Thirty-two workers had been employed for, on average, 151 months in the area of aluminium powder production. Twenty-nine employees in the same factory, who had not been engaged in the production of aluminium powder, served as controls. The groups differed significantly in the concentrations of aluminium in urine and plasma. The bone mineral content, which was determined in the lumbar spine by means of photon absorptiometry showed no significant difference between the groups. The bone density value amounted to 1.00 g/cm2 for those exposed and 1.02 g/cm2 for the control group (median values). No correlation could be determined between the values obtained from the biological monitoring of the plasma or the duration of exposure and the bone density values. To summarise, using osteodensitometry as the method of investigation here, no influence could be detected for an occupational exposure to aluminium powders on the mineral salt content of the skeletal system in the area of the lumbar spine.

Relationship between trapezius load and the incidence of musculoskeletal illness in the neck and shoulder

A relationship between m. trapezius load measured by electromyography (EMG) and the incidence of musculoskeletal illness in the neck and shoulder regions, was investigated both for assembly workers and VDT operators. For assembly workers, the static trapezius load (probability 0.1 of the amplitude probability distribution function, APDF) was significantly reduced from 4.3% MVC (Maximum Voluntary Contraction) to 1.4% MVC as a group median value after an ergonomic adaptation of their work places. Musculoskeletal sickleave was significantly reduced from 22.9 days to 1.8 days as a medium duration per-man-labour year for the same group. Three groups of VDT operators were examined in terms of trapezius load and pain intensity and duration before and after an ergonomic intervention. All groups reported significant less intensity or duration of pain either in the neck or in the shoulder regions after the intervention. The trapezius load was reduced for all groups post vs. prior intervention. This reduction was measured in terms of a decrease in the static level of APDF and an increase in the number of periods per minute and total duration of muscle activity below 1% MVC. The results from this study indicate that the trapezius load may be a predictor for development of musculoskeletal illness in the neck and shoulder regions.

Calcium-dependent protein kinase-C activity in human adrenocortical neoplasms, hyperplastic adrenals, and normal adrenocortical tissue.

The calcium- and phospholipid-dependent protein kinase-C (PKC) is a critical enzyme of cellular signal transduction. In this report we studied calcium-dependent total PKC activity in eight adrenocortical carcinomas (group 1), nine adrenocortical adenomas (group 2), six hyperplasias (group 3), and five human normal adrenal tissues (group 4). The PKC activity assay was based on phosphorylation of a specific synthetic peptide from myelin basic protein. The specificity of the assay was confirmed by using an inhibitor peptide common to alpha-, beta-, and gamma-isoenzymes of PKC. The median value in group 1 was 1.15 pmol 32P/min.micrograms protein (range, 0.55-2.19), that in group 2 was 1.2 (range, 0.74-2.7), that in group 3 was 0.915 (range, 0.6-1.7), and that in group 4 was 1.22 (range, 0.6-3.95). The calcium-dependent total PKC activity was similar in the four groups studied. We did not find any correlation between urinary total cortisol, serum cortisol, testosterone, dehydroepiandrosterone, dehydroepiandrosterone sulfate, androstenedione, aldosterone, and estradiol concentrations and PKC activity. These findings suggest that the calcium-dependent PKC activity is not elevated in adrenocortical tumors and is not a useful marker of adrenocortical malignancy.

Inducing parturition

Abnormalities in peritoneal fluid are diagnostically useful for managing equine colic; however, their significance in post-dystocia mares is not known. This study was to determine what changes, if any, occurred following obstetrical manipulations. Peritoneal fluid samples were collected from 2 groups of foaling mares to establish control values, and from a third group that had developed clinical abnormalities (CAb,n = 14) or had made an uneventful recovery (CN,n = 36) following fetal extraction. In Group 1 mares, samples were collected before and after induced parturitions (n = 7), and although the total nucleated cell count was increased (P < 0.02) the median values for peritoneal fluid composition remained within the normal reference range. In Group 2 mares, samples were collected after unassisted foalings (n = 10) on postpartum Days 1, 3, 5 and 7, and the peritoneal fluid values remained within the normal reference range. In the Group 3 (CN) mares neither assisted vaginal delivery or fetotomy caused median peritoneal fluid values to rise above the normal reference range. Although remaining within normal limits, the total nucleated cell count was increased (P < 0.01) on Day 2. The median peritoneal fluid total protein value for Group 3 (CAb) mares was greater than the median value for Group 3 (CN) mares on Day 1 (P < 0.05) and Day 2 (P < 0.001). The peritoneal fluid total nucleated cell count in Group 3 (CAb) mares with a uterine tear, vaginal laceration involving the peritoneal cavity, or a ruptured mesocolon was greater than in Group 3 (CN) mares (P < 0.02). The median peritoneal fluid percentage of neutrophils value for Group 3 (CAb) mares was higher than for Group 3 (CN) mares on both Days 1 and 2 (P < 0.02). Elevation of a single peritoneal fluid value in the postpartum mare may be incidental; however, increases in 2 or more of these (total protein > 3.0 g/dl; total nucleated cell count > 15,000 cells/μl; percentage of neutrophils > 80%) is clinically significant.

Reduced serum lipoprotein(a) levels in patients with primary biliary cirrhosis

Lipoprotein(a) (Lp(a)) is a unique lipoprotein, elevated serum levels of which are independently associated with an increased risk of coronary heart disease (CHD). Primary billary cirrhosis (PBC) is often associated with high serum cholesterol, itself a risk factor for CHD. Despite this, patients with PBC are thought to have a lower than expected incidence of CHD. We hypothesised that this may be related to low serum levels of Lp(a) in PBC patients. This was investigated by collecting fasting blood samples from 42 patients with PBC, 39 age- and sex-matched subjects with non-PBC liver disease and 432 community control subjects. Serum was analysed for total cholesterol, triglycerides, high density lipoprotein (HDL) cholesterol and apolipoproteins Al and B (apo Al and apo B). Lp(a) was measured by an enzyme-liked immunosorbent assay (ELISA) technique. There was a significant reduction of Lp(a) concentrations in the PBC group compared with the healthy controls (median value 28.5 mg/l vs. 75.0 mg/l, P < 0.005) and between the non-PBC liver disease group (median value 52.0 mg/l) and control group ( P = 0.001). Within both the liver disease and PBC patient groups there were significant negative correlations between Lp(a) levels and bilirubin ( R = -0.564, P < 0.001 and R = -0.395, P = 0.010 respectively). This preliminary study has demonstrated reduced Lp(a) levels in PBC patients which may be a contributory factor to explain a possible cardioprotective effect in such patients, despite elevated LDL cholesterol levels.

Clinical stage B o or T1c prostate cancer: Nonpalpable disease identified by elevated serum prostate-specific antigen concentration

A retrospective study was performed to evaluate the clinical and pathologic characteristics of 60 patients with a palpably benign prostate gland, but with biopsy-proved prostate cancer. All patients underwent prostate biopsy because of elevated serum prostate-specific antigen (PSA) concentration, and subsequently underwent radical retropubic prostatectomy (RRP). Similar analysis was performed for a randomly selected group of 60 clinical Stage BI prostate cancers from the same period (control cohort). Patients with nonpalpable prostate cancers had a higher preoperative PSA level as compared with the clinical Stage BI group (median value: 12.3 ng/mL versus 4.6 ng/mL, p < 0.001). There was no significant difference between the two groups with regard to clinical parameters (voiding symptoms, hematuria, age). The nonpalpable prostate cancers exhibited a significant tumor volume (mean: 7.4 cc; range: 0.3–56 cc), and 18 (30 %) demonstrated capsular perforation to involve the periprostatic tissues. Of these, three (5 %) had seminal vesicle invasion, and one (2 %) had pelvic lymph node involvement. There was no difference between these pathologic characteristics and those of the clinical Stage B1 prostate cancers. These findings suggest that nonpalpable prostate cancers identified by an elevated serum PSA level can be of clinical significance and warrant therapeutic consideration. Although nonpalpable, these cancers are peripherally located and were clinically suspected prior to biopsy. Therefore, we propose that these cancers be classified as clinical Stage B o in the Whitmore-Jewett staging system; in the new TNM staging system, they are designated as clinical Stage T1c.

Serum Lp(a) as a discriminant marker of early atherosclerotic plaque at three extracoronary sites in hypercholesterolemic men. The PCVMETRA Group.

To investigate the role of lipoprotein (a) (Lp[a]) as an atherogenic condition related to hypercholesterolemia, we studied the serum concentration of Lp(a) as measured by immunonephelometry in relation to the presence of asymptomatic echographic plaques in the peripheral arteries of 103 untreated hypercholesterolemic, normotensive, middle-aged men. Plaque was found at carotid, aortic, and femoral sites in 36%, 51%, and 53% of subjects, respectively. The Lp(a) level was higher in the group with carotid plaques than in the group without (0.29 +/- 0.20 versus 0.17 +/- 0.14 g/l, p < 0.01), not significantly higher in the group with aortics plaque than in the group without (0.24 +/- 0.19 versus 0.19 +/- 0.16 g/l), and not different between groups with and without femoral plaques (0.21 +/- 0.18 versus 0.22 +/- 0.17 g/l). A logistic regression analysis confirmed that Lp(a) was associated with carotid plaques (p = 0.004), independent of other risk factors. However, in patients with low density lipoprotein cholesterol values above the group median value (4.7 mmol/l), Lp(a) was associated not only with carotid plaques (p < 0.01) but also with aortic plaques (p < 0.05), as well as with the number of diseased sites (p = 0.02). In contrast, in patients with low density lipoprotein cholesterol levels below or equal to 4.7 mmol/l, Lp(a) only remained associated with carotid plaques (p < 0.05). Thus, in symptom-free, hypercholesterolemic men, early atherosclerosis was influenced by serum Lp(a), particularly in the carotid arteries, as well as by the presence of a higher level of low density lipoprotein cholesterol.

Coronary stenting with polymer-coated and uncoated self-expanding endoprostheses in pigs

Background: Preliminary clinical reports suggest that metallic stents are thrombogenic during the first days to weeks after implantation but that restenosis rates after this period may be reduced. Methods: We investigated the angiographic patency and histologically measured neointimal hyperplasia of 48 uncoated self-expanding, stainless steel mesh stents (Wallstent, Schneider [Europe] AG, Bulach, Switzerland) placed in normal coronary arteries of three groups of eight pigs that received postprocedure aspirin (ASA, group B), acenocoumarol (group C), or no medication (group A). The results were compared with those obtained in a fourth group of eight pigs (group D) receiving 15 polymer-coated (BioGold, PlasmaCarb Inc., Bedford, NH, USA) Wallstent stents, which are designed to reduce thrombogenicity without additional medication. After 1, 4, and 12 weeks, angiography was repeated. After the last angiogram the coronary arteries were pressure-fixated followed by light microscopy, immunocytochemistry, and electron microscopic examination. Results: Group A showed a 38% thrombotic occlusion rate within 1 week, which was prevented by acenocoumarol or polymer coating, but not by ASA. Histologic analysis showed no difference in the thickness of neointimal hyperplasia between the groups (median values: 134, 101, 143 and 113 μm for groups A, B, C, and D, respectively). Polymer coating did not induce an inflammatory reaction. Conclusions: Acenocoumarol and the polymer coating protected against early thrombotic occlusion of stainless steel self-expanding stents, but neointimal hyperplasia was not affected by preventive measures against stent thrombosis.

Comparison of Two Preterm Formulas With or Without Addition of Medium‐Chain Triglycerides (MCTs). I

SummaryMedium‐chain triglycerides (MCTs) are included in the fat blend of several preterm formulas because of their complete absorption and rapid oxidation. The effects of two different fat blend compositions on nitrogen and fat balances and macronutrient oxidation were investigated in 28 healthy very‐low‐birth weight infants at 4 weeks of age. A preterm formula with a traditional corn oil/MCT blend containing 38% MCTs (MCT group) was compared to a new fat blend, designed to resemble human milk more, containing 6% MCTs (LCT group). There were no differences in nitrogen absorption or in excretion. Median nitrogen retention was 74% (MCT) vs. 71% (LCT) of intake. Fat absorption was higher (p &lt; 0.05) in the MCT group (88%) vs. 79% in the LCT group (median values). MCTs did not stimulate fat oxidation as measured by indirect calorimetry, so fat deposition was also higher on the MCT formula. As weight gain was not different between groups, the percentage of weight gain consisting of fat accretion was significantly (p &lt; 0.005) higher with the MCT formula (24% vs. 21%). On the other hand, there was no increase in percent protein accretion (both 15% of weight gain). We conclude that the existence of a slightly lower fat absorption in the healthy growing neonate fed a LCT formula compared with a MCT formula does not impair growth or nitrogen retention, but merely induces a slight decrease in the high relative fat accretion encountered in the preterm neonate.

Levels of selenium and antioxidative enzymes following occupational exposure to inorganic mercury

Levels of selenium and mercury in blood and urine were analysed in 37 male workers exposed to elemental mercury vapour in a chloralkali plant and in 39 unexposed controls of the same age. Mean urinary Hg was 223 nmol l −1 (15 nmol/mmol creatinine) in the exposed group and 26 nmol l −1 (2.0 nmol/mmol creatinine) in the controls. Mean blood and plasma Hg levels were 46 and 36 nmol l −1, respectively, in the exposed group, as compared with 17 and 7 nmol l −1 in the controls. The concentrations of Se in plasma and erythrocytes did not differ between the two groups. Urinary Se levels were, however, slightly but significantly lower in the exposed group (median values 23 vs 29 nmol/mmol creatinine), and there was a negative correlation between urinary Se and plasma Hg in the exposed group. This may be due to a retention of Se in the kidneys. In a subgroup of exposed workers and controls, glutathione peroxidase, superoxide dismutase and catalase were also analysed. No differences were found between the groups with respect to these antioxidative enzymes. The effect on Se status of moderate Hg exposure seems to be of minor clinical importance.

Intracervical 17β-oestradiol before induction of second-trimester abortion with a prostaglandin E 1 analogue

28 consecutive patients (17.5 weeks pregnant, range 15–21 weeks) referred for therapeutic termination of pregnancy were randomized for pretreatment overnight with either intracervical gel containing 50 mg 17β-oestradiol or placebo gel. The induction-abortion time with pessaries containing 16,16-dimethyl- trans- Δ 2-prostaglandin E 1 methyl ester was significantly reduced in the oestrogen group (median value of 11.5 versus 15 hours). The beneficial effect of oestradiol priming was primarily caused by a reduction of the number of women with high cervical resistance and prolonged induction-abortion time (90 percentiles of 15.5 and 34 hours). Thus, oestrogen pretreatment might reduce the cervical trauma due to the prostaglandins as well as the incidence of cervical incompetence in later pregnancies.

A longitudinal study of the hyaluronan level in the serum of patients with malignant mesothelioma under treatment. Hyaluronan as an indicator of progressive disease.

The serum hyaluronan levels of 37 patients with malignant mesothelioma were followed during the course of treatment (high doses of methotrexate were given to 32 of these patients). The patients could be divided into the following two groups: (1) those with progressive disease (n = 17) or (2) those showing improvement during therapy (complete remission [n = 2], partial remission, or no change [n = 18]). On admission to the hospital, the patients with progressive disease showed significantly higher initial serum hyaluronan levels (median value, 250 micrograms/l) than those in the second group (median value, 97 micrograms/l) (P less than 0.005, Wilcoxon). Serum hyaluronan as a predictor of progressive disease has a sensitivity of 65% and a specificity of 85%. There was a significant increase in serum hyaluronan levels during treatment in patients with progression (P less than 0.01). In three patients with initially high levels there was a clear decrease in parallel with the reduction in tumor burden. In the remaining patients of the responder group, the values were constantly low. There was no significant correlation between the hyaluronan level and any other laboratory test performed on blood samples. Pleural fluid was removed for medical reasons from 13 patients. Neither the presence of pleural fluid nor its hyaluronan level were correlated to the progression of the disease. However, there was an interesting negative correlation between serum and pleural hyaluronan levels, indicating that an elevated serum hyaluronan level does not reflect high production in the pleural cavity.

Application of geochemistry to the stratigraphic correlation of Appin and Argyll Group carbonate rocks from the Dalradian of northeast Scotland

240 samples from Appin and Argyll Group carbonate rock units of the Dalradian of northeast Scotland have been analysed for 10 major oxides and 14 to 19 trace elements in order to classify and correlate them using geochemistry. The carbonate rocks are chiefly limestones, with some dolostones. Rocks with 0.38 &gt; MgO/CaO &gt; 0.03 are classed as dolomitic limestones; those with MgO/CaO &gt; 0.38 are classed as dolostones. The data have approximately lognormal distributions at a high level of significance except for CaO, MgO and Sr. CaO and Sr have negatively skewed distributions. Median values for groups of sample analyses plotted on normalized multi-element variation diagrams and a nonlinear mapping (NLM) algorithm have been used to classify groups of samples. In the Appin Group, multi-element diagram patterns are distinctive for each unit, allowing correlations to be made. Though distinctive compositions do occur locally in Argyll Group carbonate rocks, correlation on a regional scale is not possible. The plot of NLM coordinates for suites of samples is consistent with the results from the spider diagrams; suites of Appin Group samples cluster closely whereas there is wide spread in samples from the Argyll Group. In several areas, most notably at Sandend Bay, the data have allowed reinterpretation of the stratigraphy. The data are consistent with other geological data in suggesting that crustal conditions were relatively stable during the deposition of the Appin Group, but not during the deposition of the Argyll Group.