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Every physician providing care to diabetics will at some time be asked whether driving is allowed. The answer is often determined by the type of sequela that may develop, in particular diabetic retinopathy. Among the metabolic conditions, hypoglycemia is important. But the fitness of a diabetic to drive may be impaired more by such associated conditions as CHD or hypertension than by the diabetes as possible to drive, near-normal glucose levels and intensive counseling are necessary, to ensure not only that the patient can carry out the required control measures, and self-medicate, but also is able to recognize threatening hypoglycemia in good time. Good documentation of the physician's surveillance is the basis for the determination of fitness to drive by an independent expert.

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Mutation of Saccharomyces cerevisiae leads to an alteration of the size and surface structure of the mutant cell. These phenomena are correlated with change in the lipid composition and hence membrane fluidity of the plasma membranes. Such alterations are in the fatty acyl constituents of phospholipids and glycolipids and include changes in the saturation or length of fatty acyl chains. Simultaneously, the "melting point" of phospholipid fractions, i.e. the temperature of the ordered-disordered phase transition and mixing behavior, changed. Consequently calorimetry on isolated phospholipid fractions extracted from plasma membranes is a useful analytical method to demonstrate directly such phase transitions and change in the mixing behavior of the cellular lipid fractions in connection with mutation. A correlation between the alteration of the lipid composition in the plasma membrane of strains of S. cerevisiae S 288 and its mutant VY 1160 is discussed.

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A 36-year-old woman presented with multiple shadows, up to 1 cm in diameter, in both lungs revealed by routine chest radiography. Right thoracotomy showed numerous firm nodules in the middle and lower lobes. Histological examination of the wedge biopsy disclosed an epithelioid haemangioendothelioma of the lung (positive immunohistochemical reaction for factor VIII-associated antigen). Eight years later the patient remains symptom-free without treatment and the radiological picture is almost unaltered. Another woman, 22 years old, had a skin nodule near the right external malleolus. It was removed and found to be a semi-malignant haemangioendothelioma. Five years later a chest radiograph showed finely nodular shadowing in both lungs which roused suspicion of sarcoidosis. She had steroid therapy for one year, but the radiological findings remained unchanged. After a further 10 years a round lesion, some 3 cm in diameter with partial calcification, was found in the right lower lobe. Histological examination revealed an epithelioid haemangioendothelioma with a positive immunohistochemical reaction for factor VIII-associated antigen. She subsequently complained of severe pain in the left shoulder (with histologically demonstrated bone involvement by the neoplasm) together with rapidly increasing dyspnoea. Seventeen years after the original diagnosis she died of rapidly progressive diffuse lymphangiomatosis carcinomatosa. Post mortem secondary deposits were found in the liver as well.

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A 20-year-old woman developed multifocal bone pain. Diagnostic radiology revealed thickened periosteum, and syphilis serology was positive (T. pallidum haemagglutination test 1:5120). She also had discrete signs of congenital syphilis, with retinitis pigmentosa and Hutchinson's incisors. Skeletal scintigraphy demonstrated increased uptake even in radiologically unremarkable bones. The bone pain decreased after four-week administration of 1 M units of penicillin G daily. Scintigraphy one year later showed regression of the increased uptake, skeletal radiology did not reveal significant changes. This case shows that late manifestations of congenital syphilis still occur today. The stigmata of such an infection can be minute and easily missed. Skeletal scintigraphy is better for demonstrating active bone involvement than conventional radiology.

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The miscibility properties of branched phosphatidylcholines in mixtures of aqueous dispersions were studied by means of differential scanning calorimetry. The phase diagrams of four pseudo-binary systems from mixing type unbranched phosphatidylcholine/branched phosphatidylcholine/water (50 wt. % water) were investigated and discussed. The unbranched dipalmitoylphosphatidylcholine acts as a reference component of the mixtures. The phase diagrams of these four pseudo-binary phosphatidylcholine systems showed some connections between chain structure of the branched phosphatidylcholines and miscibility of the components. A change of the phase diagram type has been observed according to the branching and/or chain length differences of the phosphatidylcholines: complete miscibility and peritectic mixing behaviour. Generally we observed complete miscibility in the high-temperature phase (La-phase) and demixing in the low-temperature phases (gel phase). This is dependent on the branching and chain length differences of the mixing components.

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A 39-year-old woman was admitted to hospital with severe pain in the left shoulder due to an endothelial bone tumor. The tumor showed the same histologic signs as an intravascular sclerosing bronchioloalveolar tumor of the lung (IVBAT) which had been enucleated 2 years previously. This combination is uncommon. It is discussed whether the IVBAT is a malignant tumor with metastases or a benign tumor with coincidental tumors in other organs of the same endothelial vascular origin. We consider this to be an epitheloid angiosarcoma of the lung with, in our case, bone metastases; this is in agreement with some most recent reports on the disease.

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The detailed miscibility analysis of binary phospholipid monolayers requires the application of a variety of spreading and surface techniques which often yield complementary results. Testing the equilibrium state of the binary monolayer by long-time experiments is also of great importance. Studies of the compression and spreading behavior of binary monomolecular systems form a basis for the determination of binary monomolecular phase diagrams. Within these plots different phase regions occur which permit clear statements regarding the miscibility state. Additional knowledge of the miscibility properties (phase diagrams) of the binary bulk systems is required. From the analogy of the properties of the bulk systems, the miscibility state of the monolayers is also determined by the temperature, and we can classify the monolayers of binary lecithin and cephalin systems into systems of complete miscibility, partial miscibility and complete immiscibility. In addition to the differences in the chemical structure of the mixing components, the film states in the monolayer and the miscibility behavior of the bulk systems are also influencing factors. If one of the components does not produce a spreading pressure, miscibility gaps occur in the phase diagram of the phospholipid monolayer. The miscibility gap, expressed by a constant spreading pressure, indicates complete immiscibility within this concentration range. If both components produce spreading pressures, and condensed and liquid-expanded film states within the considered temperature range, partial miscibility of the components becomes probable. The most effective parameter is then the difference in the chemical structure of the components. When both components produce spreading pressures and condensed films, the chemical structure of the mixing phospholipid compounds within their hydrophilic and hydrophobic parts is of essential importance. Depending on the differences in the chemical structures of their chains and their head groups in the case of binary phospholipid monolayers, the following possibilities result: complete miscibility, partial miscibility and complete immiscibility of the lecithins and the cephalins. Complete miscibility within the binary phospholipid monolayer takes place in the case of identical head-group structure and where there are only small differences in the chain length of the fatty acid groups. With increasing hydrocarbon chain length differences, partial miscibility or even complete immiscibility can occur within the monolayer. Chemical differences in the head-group structure of the mixing components have a similar influence. In the case of binary lecithin/cephalin mixtures, the differences in the head-group structure affect the miscibility behavior more than the chain length differences do in the case of lecithin/lecithin and cephalin/cephalin mixtures.(ABSTRACT TRUNCATED AT 400 WORDS)

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The angiomyolipoma of the kidney is composed by blood vessels, smooth muscle tissue, and fat. It is important to differentiate this benign tumor from a malignant one. Two cases demonstrate the diagnostic value of the different imaging procedures. In 'typical' cases computed tomography shows the density of fat; histological examination is not necessary and follow up control with ultrasonography is sufficient. In other cases with a low part of fat histological examination cannot be missed. Angiography is not helpful for the differentiation from a malignant tumor.

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A 62-year-old man with histological confirmed relapsing polychondritis showed chondritis of ears and nose, arthritis, keratitis and a hemolytic anemia. The bronchoalveolar lavage, computed tomography of the thorax and pulmonary function tests disclosed findings compatible with fibrosing alveolar disease. IgG antibodies to alveolar pneumocytes type II and bronchiolar Clara cells were detected by indirect immunofluorescence of human lung tissue. To our knowledge this is the first report of fibrosing alveolar disease in relapsing polychondritis and detection of antibodies to human pneumocytes type II and Clara cells.

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A 31-year-old woman with chronic myeloid leukemia developed bullous skin changes not responding to antibiotic therapy. A biopsy showed a sterile predominantly neutrophilic infiltrate consistent with Sweet's syndrome. These skin changes responded well to methylprednisolon. Seven months later the patient died in a blast crisis.

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The miscibility properties of homologous cephalines (PEs) were studied by means of differential scanning calorimetry (DSC). The phase diagrams of 5 pseudo-binary cephaline/cephaline/water systems (50% water) are discussed. In the high temperature L alpha-phase, all the homologous cephalines of fatty acid chain length from C = 12 to C = 18 were completely miscible. On the other hand in the low temperature L beta-phase, a miscibility gap occurred in dependence on the differences of the acyl chain lengths. Further, a distinct succession of the phase diagram types was observed according to increasing chain length differences of the PEs: complete miscibility (systems di-(C12:O)-PE/di-(C14:O)-PE/H2O; di-(C14:O)-PE/di-C(16:O)-PE/H2O)----peritectic mixing behaviour (systems di-(C12:O)-PE/di-(C16:O)-PE/H2O; di-(C14:O)-PE/di-(C18:O)-PE/H2O)----eutectic mixing behaviour (system di-(C12:O)-PE/di-(C18:O)-PE/H2O). The change in the type of phase diagram from azeotropic to semi-azeotropic and from semi-azeotropic to eutectic is interpreted by means of the Landau theory.

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A 29-year-old woman with HIV-infection developed disseminated abscesses of the skin, identified as an infection with Actinomyces israelii. To our knowledge, actinomycosis associated with HIV-infection (AIDS-related complex) has been reported only once previously.

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Three male patients with the acquired immunodeficiency syndrome revealed perforations of the intestine (jejunum-ileum; colon ascendens; coecum). The cause was necrosis due to cytomegalovirus infection. The characteristic findings were cytomegalic inclusion bodies in endothelial cells of the capillaries. These lesions caused alterations of the microcirculation. Therefore it seems reasonable to conclude that in these cases necrosis and perforation were due to ischemia. Cytomegalovirus infection must be taken into consideration in any patient with the acquired immunodeficiency syndrome and gastrointestinal ulcerations.

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A 42-year-old man had a 4 year history of sarcoidosis stage II (lung). In biopsied specimens of the antrum we found epithelioid granulomas caused by gastric involvement in sarcoidosis. Coincidentally we found a gastric ulcer which was later the source of gastric bleeding. The granulomas were located around this ulcer and also under intact mucosa. Therefore, in our opinion it was not the case that granulomatous gastritis caused the ulceration in a direct way. We saw a connection between hypercalcemia--often found in patients with sarcoidosis, as in our patient--and the gastric ulcer. Therapy was thus aimed at lowering the blood calcium concentration. Steroids were avoided at this time. The ulceration healed, although granulomatous gastritis continued.

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Lecithins with branched fatty acid chains were synthesized and characterized by differential scanning calorimetry and X-ray diffraction. The influence of three chemical alterations on the phase transition parameters were investigated: length of the branches in 2-position of the acyl chains, position of the branches in the acyl chains, and position of the branched fatty acid chains in the glycerol backbone. The results show that the branched phosphatidylcholines (PCs) have a reduced gel-to-liquid-crystalline phase transition temperature (Tm) compared to the corresponding straight-chain PCs. Depending on both the length of the branches in 2-position of the acyl chains and the position of the branches in the acyl chains, the Tm-values pass through a minimum. The systematic change of the main-transition temperatures Tm is connected with a modified structural polymorphism. If the length of the branches increases three types of polymorphism were observed.

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