PMID- 2664022 TI - Immunohistochemical detection of carcinoembryonic antigen (CEA) in non-cancerous and cancerous gastric mucosa. AB - Carcinoembryonic antigen (CEA) was stained by the PAP immunoperoxidase method in cancerous and non-cancerous gastric mucosa of 40 patients (25 non-cancerous dyspeptic patients and 15 patients with gastric carcinoma). The pattern of CEA localization was apical or membranous-cytoplasmic and immuno-reactivity was mild (+), moderate (++) or intensive ( ). No CEA immunoreactivity was detected in normal gastric mucosa whereas it was marked in gastric mucosa of non-cancerous dyspeptic patients with chronic atrophic gastritis and dysplasia (intense). In patients with superficial gastritis and epithelial hyperplasia it was mild or absent. The CEA localization pattern was also apical in non-cancerous dyspeptic patients with microscopic changes, e.g. superficial or chronic atrophic gastritis, epithelial hyperplasia and dysplasia, and in non-cancerous mucosa and cancerous tissue of patients with well (G1) and moderately (G2) differentiated adenocarcinoma. PMID- 2664023 TI - Bacterial infection is not necessary for lethal necrotizing pancreatitis in mice. AB - Sepsis is the most common cause of late death in pancreatitis. The presence of early bacterial infection has been correlated with the severity of the disease. A choline-deficient ethionine-supplemented (CDE) diet given to young female mice produces severe necrotizing pancreatitis that has morphologic and biochemical similarities to the human disease. We therefore searched for bacterial pancreatic infection in female CD-1 mice given the CDE diet. The mortality rate was 47.5% in mice fed the CDE diet. All of these mice had severe pancreatitis with inflammation, edema, and necrosis on histologic examination. Bacterial infection was present in 1/12 pancreatica among nonsurvivors and in 1/32 pancreatica in surviving animals (p not significant). Histologic examination showed edema to be more pronounced in surviving mice, although the overall severity of morphologic changes was not significantly different between survivors and nonsurvivors. We conclude that bacterial infection is not a determinant of the severity or lethality of experimental pancreatitis induced by the CDE diet. PMID- 2664024 TI - Noninvasive microwave phased arrays for local hyperthermia: a review. AB - Microwave energy has proven useful for treating superficial tumours in the head, neck and chest regions. Currently, multi-element phased arrays are being proposed to upgrade clinical capabilities for localized microwave hyperthermia. When compared with a single radiating element, phased array applicators are expected to provide deeper tissue penetration, reduce undesired heating of normal tissues between the applicator and tumour, and improve local control of the tumour temperature distribution. This paper surveys recent developments in the design and characterization of phased arrays, identifies anatomical and physiological factors that complicate successful clinical treatment and discusses the current state of phased array hardware development for hyperthermia. PMID- 2664025 TI - [Proteasomes--20S ring-shaped particles with multiple proteolytic active sites]. PMID- 2664026 TI - [Oncogenic alterations of glycosphingolipids and their monoclonal antibodies]. PMID- 2664027 TI - [Protein engineering on subtilisin]. PMID- 2664028 TI - [Two distinct ferredoxins in plants]. PMID- 2664029 TI - [Two polymorphic repetitive sequences: evolution and genetic instability]. PMID- 2664030 TI - [On the regulation of ribosome synthesis in eukaryotic cells]. PMID- 2664031 TI - [Identification of proteins which are preferentially synthesized in the presence of polyamines]. PMID- 2664032 TI - Modulation of myelopoiesis by prostaglandin E2: demonstration of a novel mechanism of action in vivo. PMID- 2664033 TI - Preclinical and clinical studies with the hematopoietic colony-stimulating factors and related interleukins. PMID- 2664034 TI - Regulation of colony-stimulating factor production by normal and leukemic human cells. AB - Considerable progress has been made over the last 5 years in defining the exact factors which make up 'colony-stimulating activity', the cells that produce individual CSFs, and determining some of the stimuli that lead to secretion of specific CSFs. There is much to learn however about the mechanisms of CSF action, and also much to learn about the role these factors play in hematopoietic regulation in vivo. The role, if any, of marrow stromal cells in the production of CSFs is particularly important and needs much clearer definition. Much of our understanding of CSF activity has been previously dependent on in vitro bioassays which were sensitive but frequently imprecise. The availability of purified recombinant protein has alleviated the reliance on conditioned media. Previously used conditioned media frequently contained multiple growth factors and inhibitory factors. The cloning of the CSFs has revealed both structural homology and diversity. The conserved genomic structural schema between the majority of the CSFs suggest a common ancestral gene. However, M-CSF diverges from this schema. Conserved also is the 3' untranslated motif of AUUUA in the majority of CSFs. M-CSF is again divergent in this respect. However, where regulation of the mRNA transcript level has been characterized carefully, normal cells appear to regulate CSF mRNAs primarily in a post transcriptional manner. The regulation of CSF transcription in leukemia is complex. In retrovirally mediated leukemia, CSF production is due to increased transcription mediated by the retrovirus. In the few cases of human leukemias making CSFs which have been studied, evidence for both post-transcriptional regulation and structural rearrangements in the CSF genes has been presented. Due to the extreme rarity of normal hematopoietic progenitor cells that correspond to the same state of differentiation as that of the leukemic blast forms, several questions remain. Do normal progenitor cells also make CSFs at some stages of differentiation? What role, if any, do CSFs play in leukemogenesis? The rapid development of our understanding of CSFs over the past several years has led to a much better understanding of hematopoiesis. As we understand more of normal hematopoiesis we also begin to understand the complexities involved in the abnormal regulation as in myelogenous leukemias. With the powerful tools currently available we can be much more precise in our understanding of the intricacies involved. PMID- 2664035 TI - Regulation of hemopoietic cell development by interleukins 4, 5 and 6. PMID- 2664036 TI - Recent studies of the hematopoietic microenvironment in long-term bone marrow cultures. PMID- 2664038 TI - [Development of a system for ultrasonic three-dimensional reconstruction of fetus]. AB - We have developed a system for ultrasonic three-dimensional (3-D) fetus reconstruction using computers. Either a real-time linear array probe or a convex array probe of an ultrasonic scanner was mounted on a position sensor arm of a manual compound scanner in order to detect the position of the probe. A microcomputer was used to convert the position information to what could be recorded on a video tape as an image. This image was superimposed on the ultrasonic tomographic image simultaneously with a superimposer and recorded on a video tape. Fetuses in utero were scanned in seven cases. More than forty ultrasonic section image on the video tape were fed into a minicomputer. The shape of the fetus was displayed three-dimensionally by means of computer graphics. The computer-generated display produced a 3-D image of the fetus and showed the usefulness and accuracy of this system. Since it took only a few seconds for data collection by ultrasonic inspection, fetal movement did not adversely affect the results. Data input took about ten minutes for 40 slices, and 3-D reconstruction and display took about two minutes. The system made it possible to observe and record the 3-D image of the fetus in utero non-invasively and therefore is expected to make it much easier to obtain a 3-D picture of the fetus in utero. PMID- 2664037 TI - Mechanism of GM-CSF stimulation of neutrophils. PMID- 2664039 TI - [An attempt at in vitro reconstruction of the human endometrium by serum-free collagen gel culture of glandular epithelial cells and stromal cells]. AB - Normal human endometrial epithelial cells were obtained from premenopausal women at the time of necessary hysterectomy. The cells were cultured in, or on, collagen gels in a serum-free medium, and were also co-cultured with endometrial stromal cells in order to reconstruct an in vitro model of the endometrium. They were observed morphologically and effects of estrogen (E) and progesterone (P) on the cultured cells were assessed. The epithelial cells and the stromal cells were separated by collagenase digestion and filtration through stainless steel sieves. The floating collagen gel method was used. The epithelial cells on the gels formed a monolayer sheet of columnar or cuboidal cells, and those in the gels grew three-dimensionally to form round or oval glands. The stromal cells co cultured with the epithelial cells formed cell masses just under the epithelial cell layer quite similar to those of the endometrium in vivo. The epithelial cells on the gels did not migrate into the gels, nor did the stromal cells in the gels proliferate outside of the epithelial cell layer. The epithelial cells did proliferate, showing mitotic activity, but there was no evidence of their responding to E and/or P. The endometrial stromal cells themselves did not decidualize following the addition of E and/or P to the medium. PMID- 2664040 TI - [The significance of serum specific IgA antibody to Chlamydia trachomatis in the diagnosis and treatment of chlamydial infection in female genital tract]. AB - Chlamydia trachomatis IgA and IgG antibody titers were determined by indirect immunoperoxidase assay in sera of 88 female patients with C. trachomatis-positive cervicitis and 55 C. trachomatis negative healthy controls. Serial serum samples obtained until 66 weeks after treatment were also studied for IgA and IgG antibodies in 28 of the 88 patients with chlamydial cervicitis. In the 88 patients, the presence (94.3%) of antibody (titer greater than or equal to 16) was comparable to that (100%) of IgG antibody (titer greater than or equal to 32), but in healthy controls the presence (5.4%) of IgA antibody was lower than that (30.6%) of IgG antibody. Serum IgA antibody decreased gradually and was undetectable (titer less than or equal to 8) at 20 weeks after treatment in 78.6% of the 28 patients. Serum IgG antibody persisted at stable levels within the same period. These data suggest that the presence of serum IgA antibody to C. trachomatis is correlated with active C. trachomatis infection of the female genital tract. PMID- 2664041 TI - The evaluation of transrectal radial ultrasonography on parametrial infiltration in untreated cervical carcinoma for more accurate staging. AB - To assess the diagnostic criteria of transrectal radial ultrasonography to differentiate a cervical carcinoma confined to the cervix from a lesion that invades the parametria, data on 41 patients with newly diagnosed, untreated cervical carcinoma were studied following transrectal ultrasonography (TRU). TRU findings associated with parametrial tumor invasion were: (1) Irregular margin of the cervix, (2) Parametrial thickness, (3) High dense echo, (4) Massive echo pattern. We prepared the TRU score with regard to characteristic findings. The TRU findings for eighty-two parametria in 41 patients with cervical carcinoma were compared with CT findings, surgical and/or clinical findings. Discrepancies were found between FIGO stages and the extent of the disease, in those in stage IIb. Among 32 parametria in the clinical stage IIb, only 17 parametria (53%) were correctly staged. Our diagnostic criteria for a high TRU score (more than 5) were the high significance of true parametrial infiltration in comparison with CT staging and clinical FIGO staging (Sensitivity was 83%, specificity 97%, positive predictive value 89% and negative predictive value 95%). PMID- 2664042 TI - Results of a modified WHO regimen in highly bacilliferous BL/LL patients. AB - A regimen consisting of 600 mg of rifampin once a month, 100 mg of clofazimine on alternate days, and 100 mg of dapsone daily was used in 56 untreated, highly bacillated borderline lepromatous/lepromatous (BL/LL) patients with an average bacterial index (BI) of 4.45. Treatment was continued until skin-smear negativity. After 2 years of therapy, none of the patients had become smear negative and the average BI was 2.56. There was no growth on inoculation of skin tissue biopsies in the normal mouse foot pad after 6 months of therapy. Bacillemia was still detectable in 11/50 patients, and significant ATP levels were detected in Mycobacterium leprae from skin-tissue biopsies in 16% of the cases. After 3 years of therapy, three patients had become smear negative. The average BI was 1.30. None of the patients had detectable bacillemia, and 5% of the cases showed detectable ATP levels in M. leprae from tissue biopsies. After 4 years of therapy, 41.7% of the patients had become smear negative. The average BI was 0.66, and no ATP was detected in any of the purified bacillary suspensions. The fall in BI was accelerated, and more patients on continued treatment became negative earlier compared to those having treatment for a limited duration, as reported by others. PMID- 2664043 TI - Reactive oxygen intermediates inactivate Mycobacterium leprae in the phagocytes from human peripheral blood. AB - Reactive oxygen intermediates such as hydrogen peroxide, superoxide, and hydroxyl radicals are important microbicidal components, and they could also play a role in an infection with Mycobacterium leprae. A comparative study of the level of hydrogen peroxide and superoxide produced by peripheral blood phagocytes from normal healthy individuals and lepromatous leprosy patients showed a deficiency in superoxide production in the patients. In the phagocytes from normal healthy individuals, there was good release of superoxide ions, and this mediated the killing of M. leprae. The lack of superoxide production allowed the viability of M. leprae inside the macrophages from leprosy patients. This deficiency could be rectified by the use of an immunomodulator, the delipidified cell wall of M. leprae. This modulation resulted in the ability of the patients' phagocytes to respond to M. leprae, to produce reactive oxygen intermediates such as superoxide, and also to kill the bacteria. These observations indicate that delipidified cell wall could have significant potential to positively modulate the immune-deficient cells of leprosy patients. PMID- 2664044 TI - An electron microscopic study of lymphatics in the dermal lesions of human leprosy. AB - The dermal lymphatic vessels in lepromatous and tuberculoid leprosy lesions were studied by light- and electron-microscopy. In the lepromatous patient, lymphatic vessels were seen in both intra- and peri-granulomatous areas. The lymphatic lining cells contained lipid droplets, lysosomes, and numerous pinocytotic vesicles. Cells bearing bacilli were only occasionally seen. In the tuberculoid cases, lymphatic vessels were seen only along the edges of the granulomas and the lining cells were less prominent. Inflammatory cells, both lymphocytes and histiocytes, were found traversing the walls of lymphatic vessels in both groups of patients. The results of the study confirm the continued and increased functioning of the lymphatic drainage system in dermal leprosy lesions, and indicates that it may be a major route for the clearance of lipids from the lipid rich bacilliferous lesions in the lepromatous patient. The lymphatic pathway appears to be a minor pathway for the dissemination of Mycobacterium leprae in comparison with the blood vascular system. PMID- 2664045 TI - The macrophage in leprosy: a review on the current status. PMID- 2664046 TI - Relapse or late reversal reaction? PMID- 2664047 TI - Controlled clinical trial for evaluation of antimicrobial drug activity against M. leprae. PMID- 2664048 TI - Operational aspects of multidrug therapy. PMID- 2664049 TI - HLA-DQ molecules may be products of an immune suppression gene responsible for Mycobacterium leprae-specific nonresponsiveness. PMID- 2664050 TI - [Clinical features of acquired idiopathic generalized anhidrosis]. PMID- 2664051 TI - [Chronic myelocytic leukemia detected through the associated multiple liver abscess. A case report]. PMID- 2664052 TI - [A case of malignant lymphoma presenting with pleuropericardial effusion]. PMID- 2664053 TI - [Titanium, a target for progress in dental casting]. PMID- 2664054 TI - Upper limb surgery in tetraplegia. PMID- 2664055 TI - Pseudarthrosis of the radius treated by free vascularised bone graft. AB - We report a case of pseudarthrosis of the radius successfully treated by free vascularised bone grafting. After a comprehensive review of the literature, we recommend this as the treatment of choice in this condition. We also report the use of callus distraction of an incorporated vascularised bone graft to achieve bone lengthening. PMID- 2664056 TI - En bloc excision and reconstruction with a fibular autograft of giant-cell tumour of the metacarpal--a case report. AB - A giant-cell tumour involving the diaphysis of the third metacarpal is reported. The unusual site, age, radiographic atypicality and therapeutic options are reviewed. PMID- 2664057 TI - Flexor tendon repair: significant gain in strength from the Halsted peripheral suture technique. AB - A biomechanical study in vitro has evaluated a new modification of the core and peripheral suture technique for flexor tendon repair. Groups of repairs were conducted in cadaver tendons, using a core suture alone, a core suture with a simple running surface suture and a new modification involving a 'Halsted' horizontal mattress technique for the peripheral stitch. The Halsted modification increased the load at which a visible gap formed by 93%, the load at which a 2 mm gap formed by 77%, and the maximum strength by 89%. This increase was due to the technique; it did not depend on the suture material used. The bulk of the tendon repair was not significantly greater with the Halsted modification. PMID- 2664058 TI - Inflammatory bowel disease and cancer. PMID- 2664060 TI - An International Committee of Chiropractic Journal Editors. PMID- 2664061 TI - Cybernetic model of psychophysiologic pathways: II. Consciousness of tension and kinesthesia. AB - This paper describes a series of experiments directed toward the following questions: a) do signals from musculotendinous receptors reach consciousness?, and b) does feed-forward information of muscular force and expected extent of voluntary movement exist? To answer these questions, data from voluntary compression of springs and strain-gauge have been analyzed in healthy young subjects. By successive elimination of information from other sources, it was possible to verify that receptors in muscles and tendons do signal movement magnitude and muscular tension to the cerebral cortex, and that this information does reach consciousness. There also exists a feed-forward mechanism signalling parameters of voluntary contraction. However, it is unclear whether peripheral, subcortical or intracortical loops are directly involved. PMID- 2664062 TI - Plain film assessment of spinal stenosis: method comparison with lumbar CT. AB - Methods to determine the sagittal diameter of spinal canal on plain film radiographs have been previously proposed by Eisenstein in 1975 and Buehler in 1978. The purpose of this study was to determine the accuracy of these methods as compared to computed tomography (CT) and to compare the accuracy of each method. The AP diameter of the lumbar canal was evaluated at the L3 through L5 levels. Results indicate that the Buehler method was significantly (p less than or equal to 0.05) more accurate than Eisenstein method at the L3 level. At L4 and L5, there were no significant (p less than or equal to 0.01 p less than or equal to 0.20, respectively) differences between either of the plain film measurements and the mean value of the corresponding CT scans. The standard deviation (SD) showed less dispersity of the measurements with the Buehler method at all three levels examined. PMID- 2664059 TI - Inflammatory intermediaries in inflammatory bowel disease. PMID- 2664063 TI - Osteoporosis: exercise therapy, pre- and postdiagnosis. AB - The idiopathic, accelerated phase of bone loss associated with postmenopausal and surgically induced menopausal women is rapidly becoming a large public health problem due to the great expense involved in caring for those with vertebral, hip and distal radial fractures. The method of therapy with the least incidence of ill effects is physical exercise. This is a valid, appropriate alternative, but is, however, the most overlooked and unappreciated form of treatment. Studies have shown that bone mineral content can be increased, not just maintained as with the other forms of therapy. The question may then be asked: what about exercise therapy for women already clinically diagnosed? Would exercise increase their risk of fracture, and if not, what forms of exercise would be the most effective? Although osteoporosis prevention and treatment is a multifactorial process, it appears that extension exercises are one form of physical activity necessary to prevent further fracture once it has occurred. A review of the literature will address this conservative noninvasive approach to preventive and ongoing treatment of involutional osteoporosis. PMID- 2664064 TI - Effects of chiropractic treatment on blood pressure and anxiety: a randomized, controlled trial. PMID- 2664065 TI - Mortality in the Stockholm heart disease secondary prevention study. PMID- 2664066 TI - Regulation of T lymphocyte proliferation. Interleukin 2-mediated induction of c myb gene expression is dependent on T lymphocyte activation state. AB - We previously reported that with time, after antigenic stimulation of antigen regulated murine T lymphocyte clones, total IL-2-R expression decayed 10-50-fold, commensurate with a decline in the ability of the cells to proliferate to IL-2. However, late after antigenic stimulation, when the cells were refractory to the IL-2-proliferative stimulus, high levels of high affinity IL-2-R remained. In this report we further explore the basis of unresponsiveness to IL-2 in the quiescent clones. We show that the proto-oncogene c-myc is induced in the late cell population by IL-2 to comparable levels observed early after antigen stimulation. IL-2-dependent c-myb induction, however, is seen only early after activation but not in the late-activated population. Analysis of the IL-2 dependent expression of c-myb mRNA with time after antigenic stimulation showed that steadystate c-myb expression declines dramatically with kinetics closely paralleling a decay in IL-2-dependent proliferative ability. In contrast, steadystate c-myc expression remains high throughout this period. Expression of c myb is critical for proliferation of these cells since antisense oligodeoxy nucleotide to c-myb can inhibit their IL-2-dependent proliferation. We present evidence for a pathway of c-myb induction via the TCR that is independent of the IL-2/IL-2-R interaction. In addition, the inhibition of IL-2-R-induced c-myb expression by 2-aminopurine and enhanced induction of c-myb via the TCR demonstrate that TCR activation and IL-2-R activation lead to induction of c-myb by different mechanisms. PMID- 2664067 TI - Tumor necrosis factor alpha stimulates the growth of the clonogenic cells of acute myeloblastic leukemia in synergy with granulocyte/macrophage colony stimulating factor. AB - TNF-alpha has been shown to antagonize the proliferative effects of growth factors present in crude conditioned media from PHA-stimulated leukocytes or cell lines on the clonogenic cells of acute myeloblastic leukemia (AML) (19,21). In the present study, we investigated the responses of AML blasts to TNF-alpha in the presence of defined growth factors (recombinant granulocyte/macrophage-CSF [rGM-CSF], recombinant granulocyte-CSF [rG-CSF], rIL-3, and rIL-1) and under conditions described for autocrine stimulation (32). While TNF-alpha antagonized the stimulatory effects of G-CSF and IL-3 on blast progenitors, TNF-alpha did not affect blast colony formation in the presence of IL-1. Unexpectedly, TNF-alpha significantly enhanced blast proliferation in the presence of GM-CSF. Further, TNF-alpha also acted synergistically with an endogenous source of growth stimulatory signal to promote proliferation of blast clonogenic cells. Thus, on human leukemic cells, TNF-alpha appears to be a molecule that is at least bifunctional, having the ability to either support or inhibit cell proliferation, depending on the other growth factors present. It is postulated that the proliferative response of blast progenitors to TNF-alpha under conditions that favor autocrine stimulation may represent one property that allows the cells to escape from negative regulation and proliferate in AML. PMID- 2664069 TI - [What can psychiatry expect from genetics?]. PMID- 2664068 TI - Identification of a subset of murine natural killer cells that mediates rejection of Hh-1d but not Hh-1b bone marrow grafts. AB - NK cells demonstrate many immune functions both in vitro and in vivo, including the lysis of tumor or virus-infected cells and the rejection of bone marrow allografts. However it remains unclear whether or not all NK cells can mediate these various functions or if NK cells exist in functionally distinct subsets. We have developed a new NK-specific mAb, SW5E6, which binds to approximately 50% of murine NK cells. The 5E6 antigen identifies a distinct and stable subset of NK cells and is expressed on about one-half of fresh or rIL-2-activated murine NK cells. Both 5E6+ and 5E6- NK cells are capable of lysing YAC-1 tumor cells in vitro and in vivo. By treating animals with SW5E6, we demonstrate that the 5E6+ subset is necessary for the rejection of H-2d/Hh-1d but not H-2b/Hh-1b bone marrow cells. Thus NK cells exist as functionally separable subsets in vivo. PMID- 2664070 TI - Alzheimer's disease: overview and progression. PMID- 2664071 TI - Psychopharmacology and Alzheimer's disease. PMID- 2664072 TI - Pharmacotherapeutic interventions for cocaine abuse. Matching patients to treatments. AB - Cocaine abuse treatment has begun to use a variety of adjunctive pharmacotherapies. These medications have been used for both acute crash symptoms and long-term prevention of relapse. A phasic model of recovery was integrated with a patient typology to formulate guidelines for using these rapidly evolving pharmacotherapies. The phases are crash, with-drawal, and extinction, and the patient typology includes psychiatric vulnerability and severity of cocaine abuse as contributors to the neuroadaptation that requires pharmacological amelioration. These guidelines address five issues: whom to treat, when to treat, what treatments are available, where to initiate and maintain treatment, and how to match patients to treatment options. PMID- 2664073 TI - Cultural relativism and psychiatric illness. AB - Psychiatry has had a long-standing association with sociology and, especially, cultural anthropology. These social sciences have been influential in developing the concept of cultural relativism and applying it to psychiatry, sometimes in a challenging way and with much detriment. The concept has been used by some antipsychiatrists in attempts to discredit psychiatric practice. Contemporary psychiatrists endorsing a form of biological determinism have tended to either disregard the concept or judge it as trivial if not nonsensical. This study describes the concept of cultural relativism, reviews its applications to illness, and analyzes its implications from a historical and theoretical point of view. Its varied aspects, power, and limitations are discussed. PMID- 2664074 TI - Fly photoreceptor synapses: their development, evolution, and plasticity. AB - Recent studies are reviewed on the synapses of photoreceptor terminals in the first optic neuropile of the flies, Musca and Drosophila. Afferent synaptic contacts are of uniform dimensions; they have a postsynaptic tetrad with a membrane organization of P-face particles, resembling other inhibitory synapses. A distributed population of such contact sites forms progressively during synaptogenesis by the selective, sequential accretion of identified postsynaptic elements at the receptor terminal. The comparative anatomy of this synapse indicates that elements have also been added during its phylogeny from an ancestral dyad. All cells are homologs of those in other species of Diptera. The number of synaptic sites is regulated by both pre- and postsynaptic cells, in proportion to their cell surfaces; an independent size increase in the receptor terminals (procured in the Drosophila mutant gigas) produces an increase in their synaptic population. The number of sites declines with age, however, accompanied by an increase in size of those synaptic sites remaining; this occurs for both afferent and feedback photoreceptor synapses. Lastly, the number of sites changes with visual experience; the frequency of feedback synapses is larger following dark rearing during early adult life than following visual experience. PMID- 2664075 TI - Neuronal plasticity in the adult invertebrate nervous system. AB - This essay provides a brief overview of neuronal plasticity in adult invertebrate nervous systems. Our discussion focuses on the factors which influence sprouting by adult neurons, i.e., (1) the nature of the neuron itself, (2) axon integrity, (3) the presence of targets, (4) diffusible factors, and (5) ageing. Evidence that the neurites of some adult neurons exhibit a dynamic equilibrium of expansion and retraction is presented, a topic which prompted us to speculate on the significance of such plasticity in altered behavioral states. We conclude with some suggestions as to specific questions that need to be addressed by future studies in this challenging area. PMID- 2664076 TI - Parallel processing and selection of the responses to serotonin during reinnervation of an identified leech neuron. AB - In an attempt to define the mechanism of synaptic specificity, we have been studying pairs of identified leech neurons isolated in tissue culture. The cultured neurons reform specific synapses when paired with appropriate partners in the absence of other cell types. In recent studies, we have examined in detail the reformation of a serotoninergic synapse between the Retzius cell and one of its targets, the pressure sensitive (P) cell. The P cell in vivo and its soma in vitro have two types of responses to serotonin (5-HT). From voltage clamp analysis of cultured P cells, we demonstrated the parallel activation of chloride (gCls) and monovalent cation (gCations) channels coupled to distinct receptor subtypes and gated by separate second messengers. Only gCls was activated by 5-HT released from the presynaptic Retzius cell both in vivo and in vitro. This demonstrates the remarkable specificity of the reformation of this synapse in culture since only the correct 5-HT receptor subtype is activated. An 80% reduction of gCations was observed in P cells that had failed to be innervated by Retzius cells in culture, suggesting that gCations may be lost prior to synapse formation. Retzius cells depleted of 5-HT also reduced gCations in the paired P cells and incubating single P cells in 5-HT did not reduce gCations. In addition, aldehyde-fixed Retzius cells were able to selectively reduce gCations when paired with P cells. We conclude that the loss of gCations was due to contact between the neurons. The early clearing of counter-effective receptor subtypes may be a prelude to synapse formation. PMID- 2664077 TI - The refinement of invertebrate synapses during development. AB - Evidence is provided that during invertebrate development synapses undergo a period of refinement during which there are changes in synaptic connectivity and specific synaptic properties. It appears that extrinsic cues such as competition and neural activity are involved in guiding these synaptic changes in invertebrates. Comparisons are made with findings in the vertebrate literature. PMID- 2664078 TI - Structural plasticity at identified synapses during long-term memory in Aplysia. AB - We have used the gill- and siphon-withdrawal reflex of Aplysia californica to determine the morphological basis of the prolonged changes in synaptic effectiveness that underlie long-term habituation and sensitization. We have found that clear structural changes accompany behavioral modification and have demonstrated that these can be detected at the level of identified sensory neuron synapses, a critical site of plasticity for the short-term forms of both types of learning. These alterations occur at two different levels of synaptic organization and include (1) changes in focal regions of synaptic membrane specialization--the number, size and vesicle complement of sensory neuron active zones are larger in sensitized animals and smaller in habituated animals compared with controls--and (2) a parallel but more dramatic and global trend involving modulation of the total number of presynaptic varicosities per sensory neuron. Quantitative analysis of the time course over which these structural alterations occur during sensitization has further demonstrated that changes in the number of varicosities and active zones persist in parallel with the behavioral retention of the memory. This increase in the number of sensory neuron synapses during long term sensitization in Aplysia is similar to changes in the number of synapses in the mammalian brain following various forms of environmental manipulations and learning (Greenough, 1984). Therefore learning may involve a form of neuronal growth across a broad segment of the animal kingdom, thereby suggesting a role for structural synaptic plasticity during long-term behavioral modifications. PMID- 2664079 TI - Rapid introduction of long-lasting synaptic changes at crustacean neuromuscular junctions. AB - In this review we present recent evidence implicating second-messenger systems in two forms of long-lasting synaptic change seen at crustacean neuromuscular junctions. Crustacean motor axons are endowed with numerous terminals, each possessing many individual synapses. Some synapses appear to be quiescent or impotent, but can be recruited in response to imposed functional demands. Supernormal impulse activity leads to long-term facilitation (LTF) which persists for many hours. During the persistent phase, additional synapses are physiologically effective, and morphological changes in synapses are seen at the ultrastructural level. Pulsatile application of serotonin, a neuromodulator, also enhances synaptic transmission, but this enhancement declines more rapidly than LTF. Elevation of intraterminal Ca2+ is neither necessary nor sufficient for long lasting enhancement of transmission, but activation of A-kinase is necessary. LTF is set in motion by an unknown depolarization-dependent mechanism leading to A kinase activation, whereas serotonin facilitation depends for its initiation on the phosphatidylinositol system. The initial phase of serotonin facilitation may be accounted for by production of inositol triphosphate, whereas the secondary long-lasting phase appears to require participation of both C kinase and A kinase. Neither LTF nor serotonin facilitation requires an intact neuron; both are presynaptic phenomena expressed by the nerve terminals. Brief comparison is made with long-lasting synaptic changes in other systems. PMID- 2664080 TI - Synaptic plasticity at the crayfish opener neuromuscular preparation. AB - The crayfish opener neuromuscular preparation exhibits most of the plasticities yet described for any synapse, including facilitation, long-term potentiation, presynaptic inhibition, and modulation. Since the presynaptic terminals and postsynaptic muscle fibers can both be intracellularly penetrated, one can now more easily examine the cellular/molecular bases for these plasticities. Data from such studies suggest that facilitation may be influenced by something other than residual free calcium and that presynaptic inhibition is produced by a conductance increase to chloride in the terminals of the excitor axon. Several drugs (ethanol, pentobarbital) have significant effects on these synaptic plasticities over concentration ranges which produce obvious behavioral effects in crayfish and mammals. Hence, this preparation should be a useful model system to determine cellular/molecular bases for various synaptic plasticities and the effects of drugs on these plasticities. PMID- 2664081 TI - Structural plasticity at crustacean neuromuscular synapses. AB - Crustacean motor axons innervate muscle fibers via a multiplicity of synaptic terminals which release small but variable amounts of transmitter. Differences in release performance appear to be correlated with the size of synaptic contacts and presynaptic dense bars (active zones). These structural parameters proliferate via sprouting from existing synaptic terminals and relocate to ever more distal sites during development and growth of an identified axon. Moreover, alterations in number of synaptic contacts and active zones occur in adults following stimulation or decentralization, demonstrating structural plasticity of crustacean neuromuscular synapses. PMID- 2664082 TI - Common and specific inhibition in leg muscles of decapods: sharpened distinctions. AB - Crustaceans are characteristically parsimonious in their neuromuscular innervation. In extreme instances, a single efferent axon, excitatory or inhibitory, may innervate two or more muscles that have totally different actions. In particular, the inhibitory axons of the reptantian decapod leg have been reported, in various studies within four different infraorders, to innervate anywhere from one to all seven of the leg's distal muscles and to vary in number from two to four. These axons' often inexplicable combinations of target muscles have in many cases precluded interpretation of their behavioral significance. Recent findings reviewed in this paper suggest that in fact all reptants share the same three inhibitory axons: one is a universal common inhibitor, making synaptic connections within all leg muscles; the other two are specific (single target) inhibitors of the opener and stretcher muscles, respectively (muscles which share a single excitatory axon as their sole source of activation even though they act on different joints). The literature suggests two distinct roles in the control of limb movement for these two classes of inhibitors. PMID- 2664083 TI - Premotor neurons in the feeding system of Aplysia californica. AB - Central pattern generator (CPG) circuits control cyclic motor output underlying rhythmic behaviors. Although there have been extensive behavioral and cellular studies of food-induced feeding arousal as well as satiation in Aplysia, very little is known about the neuronal circuits controlling rhythmic consummatory feeding behavior. However, recent studies have identified premotor neurons that initiate and maintain buccal motor programs underlying ingestion and egestion in Aplysia. Other newly identified neurons receive synaptic input from feeding CPGs and in turn synapse with and control the output of buccal motor neurons. Some of these neurons and their effects within the buccal system are modulated by endogenous neuropeptides. With this information we can begin to understand how neuronal networks control buccal motor output and how their activity is modulated to produce flexibility in observed feeding behavior. PMID- 2664084 TI - Detection of a novel serotonin receptor subtype (5-HT1E) in human brain: interaction with a GTP-binding protein. AB - [3H]Serotonin (5-hydroxytryptamine, [3H]5-HT) was used as a radioligand probe of brain 5-HT receptors in homogenates of human cortical tissue. Two binding sites were detected in the presence of 1 microM pindolol (to block 5-HT1A and 5-HT1B receptors), and 100 nM mesulergine (to block 5-HT1C and 5-HT2 receptors). One of these sites demonstrated high affinity for 5-carboxyamidotryptamine (5-CT) and ergotamine, consistent with the known pharmacology of the 5-HT1D receptor; the second site demonstrated low affinity for 5-CT and ergotamine. Computer-assisted analyses indicated that both drugs displayed high affinities (Ki values of 1.1 nM and 0.3 nM for 5-CT and ergotamine, respectively) for 55% of the sites and low affinities (Ki values of 910 nM and 155 nM for 5-CT and ergotamine, respectively) for 45% of the sites. To investigate the non-5-HT1D component of the binding, 100 nM 5-CT (to block 5-HT1A, 5-HT1B, and 5-HT1D receptors) was coincubated with [3H]5-HT, membranes, and mesulergine. The remaining [3H]5-HT binding (hereafter referred to as "5-HT1E") displayed high affinity and saturability (KD, 5.3 nM; Bmax, 83 fmol/mg) in human cortical tissue. Competition studies with nonradioactive drugs indicated that, of the drugs tested, 5-CT and ergotamine displayed the highest selectivity for the 5-HT1D site versus the 5-HT1E site.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 2664085 TI - Molecular interaction of S-100 proteins with microtubule proteins in vitro. AB - Several procedures were employed to examine the in vitro interaction between S 100 proteins and microtubule proteins. Binding of S-100 to tau factors was observed under all experimental conditions. S-100 binding to microtubule associated protein 2 (MAP2) was best detected by exposing nitrocellulose immobilized MAP2 or MAPs to either 125I-labeled S-100 or biotinylated S-100. S 100 binding to tubulin was detected when the two protein fractions were first incubated with each other followed by exposure to the bifunctional cross-linker disuccinimidylsuberate, and then separated by sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) and transfered onto nitrocellulose paper. By this procedure, complex formation between S-100 and tubulin, as well as between S-100 and a relatively low-molecular-weight MAP, was evidenced by immunoblotting using an anti-S-100 antiserum. Alternatively, complex formation between biotinylated S-100 and either tubulin or MAPs was visualized by means of avidin-peroxidase, after SDS-PAGE of the complex mixtures and transfer of the separated proteins onto nitrocellulose. The interaction between S-100 and tubulin was strictly Ca2+ dependent, and resistant to high concentrations of KCl, colchicine, or vinblastine. PMID- 2664086 TI - Autogenous bone grafting for severe angular deformity in total knee arthroplasty. AB - Fourteen patients with severe angular knee deformities (range, 30 degrees varus to 35 degrees valgus) had total knee arthroplasty using autogenous bone graft to the tibia. Twelve knees had osteoarthritis, one rheumatoid arthritis, and one gouty arthritis. The preoperative knee motion averaged -5 degrees of extension to 80 degrees of flexion and the average motion arc was 70 degrees. All tibial defects were greater than 25% of the tibial component support surface and more than 10 mm deep. Twelve knees were reconstructed with Insall-Burstein posterior stabilized total condylar knee implants and two knees, with severe preoperative ligamentous instability, with the constrained Total Condylar III implant. Postoperative rehabilitation was routine, and weight bearing was begun, on average, on the third postoperative day. The follow-up period averaged 4.1 years (range, 2-7.3 years). Radiographic analysis revealed no change in knee or component alignment compared with immediate postoperative position. All grafts consolidated without evidence of collapse, resorption, or prosthetic subsidence. All patients had good or excellent clinical results (Hospital for Special Surgery Knee Rating Scale). The average postoperative arc of motion was 90 degrees. There were no infections and no need for implant removal. The technique developed by the senior author (T.P.S.) utilizes bone resected from the distal femur during knee arthroplasty. An oblique planar cancellous surface is created on the recipient side, and coaptation of cancellous distal femoral graft surface to this recipient bed is ensured by vitallium screw fixation. The proximal tibia is reconstituted by the graft, and subchondral femoral bone after shaping of the graft forms the tibial periphery. PMID- 2664087 TI - Recommended minimum data to be collected in research studies on Alzheimer's disease. The MRC (UK) Alzheimer's Disease Workshop Steering Committee. AB - In order to be able to compare the results of research work carried out in different centres on Alzheimer's disease and dementia, it is necessary for there to be standardised assessment methods. The Medical Research Council organised a workshop in order to see whether workers in Britain in the field of dementia research could agree on such standardised assessment methods. The workshop agreed guidelines for the minimum data which should be collected, in clinical and pathological studies, on patients with presumed Alzheimer's disease and dementia. These recommendations are compared with other approaches based on research diagnostic criteria. PMID- 2664088 TI - Major depression in Parkinson's disease and the mood response to intravenous methylphenidate: possible role of the "hedonic" dopamine synapse. AB - The euphoric response to equivalent doses of intravenous methylphenidate (MTP) was assessed in a group of 13 Parkinsonian patients affected by major depression, in a group of 11 nondepressed Parkinsonians, in a group of 14 nonparkinsonian subjects suffering from major depression, and finally in a group of 12 controls with no CNS or psychiatric disease. Subjects of all four groups were matched for age, sex and other main characteristics. Depressed and nondepressed Parkinsonians were also matched for duration and severity of illness, and for the type of antiparkinsonian treatment. The response to MTP was evaluated in the context of a double-blind, placebo-controlled study. Parkinsonian patients with major depression exhibited a significant lack of sensitivity to the euphoriant effects of MTP, in comparison with the other three groups. Euphoria produced by central stimulants has been shown to depend on the activity of a dopamine synapse in humans, which is thought to be situated at the limbic terminals of dopamine neurons located in the ventral tegmental area. Degeneration of this system may have predisposed our Parkinsonian patients to major depression. PMID- 2664090 TI - No viral antigens detected in brain tissue from a case of acute encephalitis lethargica and another case of post-encephalitic parkinsonism. PMID- 2664089 TI - A randomised controlled study of bromocriptine versus levodopa in previously untreated Parkinsonian patients: a 3 year follow-up. AB - The long term effects of a de novo treatment with levodopa versus bromocriptine were compared in respectively 13 and 15 previously untreated patients with Parkinson's disease in a prospective randomised trial. Thirteen patients were treated with levodopa alone (mean dose 444, SEM 63 mg daily) whereas 15 others received bromocriptine alone (mean dose 50, SEM 6 mg daily) during 37, SEM 4 and 32, SEM 4 months respectively. For a similar decrease in the Columbia rating scale, the nature of long term side effects was different in the two groups: three patients on levodopa developed peak-dose dyskinesias and one other dystonia. With bromocriptine, one patient developed a severe psychosis whereas 3 others suffered from primary lack of efficacy (1 case) or late decrease in efficacy (2 cases). These results demonstrate the potential of D2 dopamine agonists (like bromocriptine) in the de novo treatment of Parkinson's disease; however, their use is limited by their lack of efficacy and/or the occurrence of neuropsychiatric side effects. PMID- 2664091 TI - Cyclosporin neurotoxicity in cardiac transplant recipient. PMID- 2664092 TI - Demyelination in spinal cord injury. AB - Morphological and physiological studies demonstrate that demyelination constitutes a significant component of the pathology in compressive spinal cord injury. In many cases of spinal cord injury, a rim of demyelinated axons surrounds a central core of hemorrhagic necrosis. This provides a pathophysiological basis for "discomplete" spinal cord injuries, characterized by apparently complete transection as judged by clinical criteria, but with neurophysiological evidence of conduction through the level of damage. Recovery of conduction in demyelinated axons may permit recovery of function, and can be mediated by several mechanisms, including remyelination by oligodendrocytes or Schwann cells. Alternatively, conduction of action potentials can occur in the absence of remyelination, but this requires plasticity of the demyelinated axon. The biophysics of conduction favors recovery of electrogenesis after demyelination of small diameter axons. This may account, in part, for the observation that functional recovery is more common after demyelination of visual, compared to spinal, axons. Restoration or modification of conduction in demyelinated fibers represents an important strategy for promoting functional recovery in spinal cord injury. PMID- 2664093 TI - Dystrophin immunostaining and freeze-fracture studies of muscles of patients with early stage amyotrophic lateral sclerosis and Duchenne muscular dystrophy. AB - We used polyclonal antibodies against dystrophin for the immunohistochemical localization of this protein in human skeletal muscle. Dystrophin was localized in the sarcolemma of the myofibers in 8 infantile and 11 adult normal control muscles and in 10 early stage patient muscles with amyotrophic lateral sclerosis (ALS). The protein was absent or markedly decreased in 8 early stage patients with Duchenne muscular dystrophy (DMD). Moreover the densities of sarcolemmal plasma membrane assemblies, orthogonal arrays and their pits were estimated by freeze-fracture electron microscopy studies in the same number of muscle samples in each disease and control case. The group median densities of orthogonal arrays and their pits in the ALS group and adult control group were 4.8 with a midrange of 1.1-13.5 (25-75%) and 7.5 with a midrange of 2.3-12.9, respectively (P greater than 0.1, Wilcoxon rank-sum test), whereas those of the DMD group and child control group were 0 with a midrange of 0-1.1 and 10.8 with a midrange of 5.4 16.7 respectively (P less than 0.01). The skeletal muscles of mdx mice and their controls were also investigated by the same techniques. In mdx mice, the absence or marked deficiency of dystrophin was also noted; however, the decrease of orthogonal arrays was not as severe as in DMD, which might relate to the milder clinical features in mdx mice as compared with those in DMD. PMID- 2664094 TI - Hyperthermic modulation of tumor necrosis factor-dependent monocyte/macrophage tumor cytotoxicity in vitro. AB - Tumor necrosis factor (TNF) production by human peripheral blood monocytes and murine bacillus Calmette-Guerin-activated peritoneal macrophages was strongly influenced by acute hyperthermia. If hyperthermia was administered simultaneously with or preceding lipopolysaccharide triggering, production was severely ablated by 42 degrees and 43 degrees C treatments; however, if triggering preceded heating by at least 90 min, production was either unaffected or markedly enhanced. A somewhat similar pattern was reflected with chronic heating. TNF production by murine macrophages was inhibited with 39 degrees C heating and completely blocked by 40.5 degrees C treatment, if triggering coincided with the initiation of hyperthermia. However, augmentation of production occurred with either of these temperatures if triggering preceded hyperthermia by as little as 90 min. Human monocytes demonstrated greater resistance to the deleterious effects of coincident triggering and heating with respect to TNF secretion than the rodent effectors, but the response was otherwise very similar. The TNF sensitive phenotype of the L929 cell could be augmented by chronic or acute hyperthermia, markedly so with a 43 degrees C treatment. The TNF-resistant phenotype of the EMT-6 cell could be reversed by chronic heating at 40.5 degrees C, or by acute heating at 43 degrees C, but only if the latter followed TNF treatment. These results reflect important regulatory controls of TNF production and responses in tumor cells which are susceptible to hyperthermia manipulation. PMID- 2664095 TI - Transcranial Doppler study of intracranial circulatory arrest. AB - To investigate the hemodynamics of intracranial circulatory arrest, the authors correlated the findings of noninvasive transcranial Doppler ultrasonography (TCD) with those of transfemoral four-vessel angiography in 65 patients following brain death and intracranial circulatory arrest due to severe intracranial hypertension. The three TCD stages of intracranial circulatory arrest, which have been described previously, corresponded with different levels of extracerebral angiographic cessation of flow. With TCD progression from the first stage (oscillating flow) to the third stage (no flow), the level where the dye stopped descended caudad from subarachnoid to cervical levels. The study shows that, in progressing intracranial hypertension, arterial circulatory standstill within the cranial cavity develops in a distal-to-proximal direction. The basal cerebral arteries remain patent in the early stages of intracranial circulatory arrest. Experimental evidence from the literature, together with the findings of the present investigation, points to the capillary bed as the initial site of the flow obstruction in progressing intracranial hypertension. PMID- 2664096 TI - Immunomagnetic separation of infiltrating T lymphocytes from brain tumors. AB - Tumor-infiltrating lymphocytes (TIL's) were isolated from human glioma biopsy specimens by immunomagnetic separation using T cell-specific monoclonal antibodies coupled to paramagnetic beads, and were expanded in culture with feeder cells and interleukin-2 (IL-2). The infiltrating cells from five of seven patients proliferated in culture. When tested after 2 to 3 weeks of culture, virtually all of the cells stained with antibodies against the CD2 and CD3 antigens. Most cells also expressed human leukocyte antigen class II molecules, while varying percentages of cells stained with antibodies against the IL-2 receptor and the CD4 and CD8 antigens. The cytotoxicity of the cultured TIL's against autologous and allogeneic glioma cells and the K562 and Daudi cell lines was measured and compared with that of lymphokine-activated killer (LAK) cells from the same patients. None of the TIL's showed significant cytotoxicity against these targets, whereas LAK cells lysed all of the targets. PMID- 2664097 TI - Laser-assisted nerve repair in primates. AB - Studies on the peripheral nerves in rats and other species have helped in the development of laser-assisted nerve anastomosis (LANA), but offer little in evaluating the efficacy of this technique in primates. The authors present a study of LANA in the peripheral nerves of rhesus monkeys. Twelve adult rhesus monkeys underwent bilateral resection of a portion of the peroneal nerve followed by placement of autogenous sural nerve interposition fascicular grafts. The grafts were completed with conventional microsurgical suture technique on one side and with LANA on the other. At 5, 8, 10, and 12 months, the grafted nerves were evaluated for continuity, nerve conduction, and histology (both light and electron microscopy). No significant difference in continuity, conduction velocity, nerve degeneration, nerve regeneration, axon fiber number, or axon fiber density was found in any animal between grafts performed by conventional microsuture and LANA grafts. There was no difference in distal or proximal myelinated fiber density between the LANA grafts and the conventional microsuture grafts. It was concluded that LANA is as effective as microsurgical suture nerve anastomosis in a primate model of nerve repair and grafting. PMID- 2664098 TI - Neural mechanisms in the control of blood glucose concentration. AB - Recent studies of sensory signals from the visceral areas have enhanced our understanding of mechanisms that control blood glucose levels. The activity of efferent fibers to the pancreas, liver, and adrenal medulla is modulated by both central glucose-responsive neurons and peripheral (gustatory, intestinal and hepatic) glucose sensors. It is well known that induction of hyperglycemia facilitates efferent activity of the pancreatic and hepatic branches of the vagus nerve. This in turn increases insulin secretion from the pancreas and glycogen synthesis in the liver. Hypoglycemia activates efferent activity of the pancreatic, hepatic and adrenal branches of the splanchnic nerve, and this results in increased glucagon secretion from the pancreas, release of glucose from the liver and secretion of catecholamines from the adrenal medulla. Glucose responsive neurons in the hypothalamus and medulla oblongata may be involved in the modulation of this autonomic efferent activity. PMID- 2664099 TI - Copper deficiency during perinatal development: effects on the immune response of mice. AB - Dietary copper (Cu) was restricted in Swiss albino mice during five discrete intervals over a 9-wk period of perinatal development: gestation only (G), lactation only (L), 3 wk postlactation (PL), 1 wk after birth through postlactation (2/3L + PL), and lactation plus postlactation (L + PL). Biochemical and immunological status of mice in copper-deficient (-Cu) treatment groups in models G and L did not differ from that of copper-adequate (+Cu) controls. Signs of severe copper deficiency, such as low liver copper levels, and significant reductions in activity of plasma ceruloplasmin and splenocyte Cu-Zn superoxide dismutase were most evident in 6-wk-old mice from two groups, -Cu 2/3L + PL and Cu L + PL. Mice in these groups were anemic and had small thymuses and enlarged spleens compared to controls receiving +Cu treatment. The -Cu mice demonstrated impaired antibody (plaque-forming cells, PFC) response to sheep erythrocytes, and the attenuation was proportional to copper deficiency, as judged by liver copper levels. Total plasma IgM levels were not greatly altered by -Cu treatment except in model L + PL. Total IgG levels were markedly reduced in this group and in the Cu 2/3L + PL group. The PFC response of mice in the -Cu PL group was normal even though signs of copper deficiency were evident; however, the PFC response was reduced when -Cu treatment was extended to 5 wk and was reversible by switching to +Cu treatment. Splenocyte reactivity to B- and T-cell mitogens was not greatly different between groups. Incorporation of thymidine into DNA in the absence of mitogen was higher in -Cu mice. It is evident that severity of copper deficiency is related to degree of impaired immunity. Furthermore, severity of copper deficiency is dependent on duration and time of initiation of dietary copper restriction. PMID- 2664100 TI - Tobacco, alcohol, and caffeine use during pregnancy. AB - Research on the effects of smoking, alcohol, and caffeine on the outcomes of pregnancy is reviewed. The strength of the evidence on the effects of these substances is varied, ranging from some clear and consistent findings for smoking to inconsistent findings for caffeine. Evidence regarding alcohol is strong in some areas and less consistent in others. The implications for clinical practice, particularly that effects vary with both the timing and the amount of the substances used, are discussed. PMID- 2664101 TI - Fundamentals of obstetric, gynecologic, and neonatal nursing research: Part II. AB - This is part two of a three-part series on the basics of obstetric, gynecologic, and neonatal nursing research. Research designs and data collection methods are the main focus. Examples of published maternal-newborn nursing research illustrate both of these steps of the research process. PMID- 2664102 TI - The return of stereotaxic surgery. AB - Stereotaxic surgery, which declined with the advent of dopaminergic treatment of Parkinson's disease, has found new life and new uses with unknown limits. PMID- 2664103 TI - Image guided stereotaxic surgery. AB - Computerized tomographic (CT) scanning and magnetic resonance imaging (MRI) can demonstrate areas of abnormal tissue within the brain, sometimes smaller than can be safely found and biopsied by open surgery or free-hand needle techniques. Image guided stereotaxic surgery can accurately and reproducibly place a needle in the brain based upon data from high resolution images. Tissue biopsy, abscess or cyst drainage, placement of radioactive seeds, or removal of a parenchymal hematoma can be done with less patient morbidity and in-hospital time. PMID- 2664104 TI - Multicenter follow-up study of the transmandibular implant. AB - The purpose of this multicenter study was to review the results of treatment and identify complications in edentulous patients who were treated with the transmandibular implant. A total of 190 patients were treated in four university departments. These patients presented for treatment with mandibular bone heights that ranged from 4 to 18 mm (mean, 10 mm). After postoperative periods that ranged from 3 months to 5 years, 182 of the 190 implants (95.8%) were stable and functional. Three implants were removed due to perioperative fractures in mandibles with 4 to 6 mm of bone height. Five were removed due to infection which occurred within the first 3 months after surgery. Reversible complications that developed in 22.2% of the patients were treated successfully. The 182 implants in function demonstrated no mobility and no infrabony pockets around any of the transmucosal posts. The results of this study demonstrate that the transmandibular implant has acceptable predictability and reliability for reconstruction of patients with severe atrophy of the mandibular alveolar process. PMID- 2664105 TI - An unusual anesthetic course in a patient susceptible to malignant hyperthermia. PMID- 2664106 TI - Traumatic asphyxia: report of a case. PMID- 2664107 TI - Recurrent keratocysts in basal cell nevus syndrome: review of the literature and report of a case. PMID- 2664108 TI - Traumatic emphysema of the head, neck, and mediastinum associated with maxillofacial trauma: case report and review. PMID- 2664109 TI - Electromyographic studies of craniomandibular disorders: a review of the literature. AB - Craniomandibular disorders have been investigated from many points of view, structurally and functionally. To evaluate the behaviour of the masticatory muscles, electromyography (EMG) has been widely used and the studies have emanated from many different paradigms. The purpose of this paper is to review articles in which EMG has been used to study symptomatic subjects. Findings from sleep studies and basic laboratory studies seem to support the hypothesis of a correlation between masticatory muscle hyperactivity and symptoms. Experimentally induced stress studies consistently show an increased activity in symptomatic subjects. Investigations of motor pauses, the often lengthened silent period, are summarized and discussed. Several different treatment strategies, particularly splints and biofeedback, have been evaluated using EMG, indicating a normalization, but controlled outcome studies are sparse. The use of EMG has thus substantially increased our knowledge of dysfunction of the masticatory system. PMID- 2664110 TI - Oral pathology and prostheses--are they related? Investigations in an elderly population. AB - A survey of 233 elderly subjects living in the district served by the Halton Health Authority (Cheshire, England) investigated the relationship between the age of dentures, their need for replacement and the presence of any oral pathological lesions. The retention, stability, occlusion and cleanliness of the dentures were all found to be worse in the older appliances; perceived need for denture replacement was found to increase from 40% in 5-year-old dentures to 84% in dentures over 31 years old. While 41% of the sample had an oral pathological lesion, no significant relationship was found between denture age and pathology or place of residence. People resident in the community with no assistance had the highest incidence of oral pathology and those living in long-stay hospitals the least. The absence of a relationship between denture age and oral pathology is considered to be a powerful indicator of the need for regular oral examination of the edentulous population. PMID- 2664111 TI - A comparative study of the bond strengths of amalgam and alloy-glass ionomer cores. AB - The purpose of this study was to compare the bond strengths of dental amalgam cores and dental alloy-glass ionomer cores that were luted to cast gold crowns with glass ionomer cement. Seventy-two human extracted molars were sectioned horizontally and four regular thread mate system pins were inserted into a flat pulpal floor. The teeth were restored with amalgam or alloy-glass ionomer admixture and prepared for crown preparations. Castings were produced with type III gold and cemented to the cores with Fuji type I glass ionomer cement. Thirty six of the specimens were subjected to thermal fatigue by cycling between 4 and 50 degrees C for periods of 1, 5 and 10 weeks. The remainder of the specimens were retained in deionized water at 37 degrees C. Bond strengths of the cores, in tension, were measured with a universal testing machine. The alloy-glass ionomer cores exhibited higher bond strengths than the amalgam cores for virtually all time periods, particularly the thermocycled samples. The alloy-glass ionomer cores exclusively displayed core fractures and pin/tooth insufficiencies while the amalgam cores failed because of a deterioration of the glass ionomer luting cement. PMID- 2664112 TI - A Candida albicans mutant conditionally defective in sterol 14 alpha demethylation. AB - A conditional sterol 14 alpha-demethylation mutant of Candida albicans was isolated whose defect was dependent both on the growth temperature and on the culture medium used. Under restrictive conditions, this mutant showed a deficiency in hyphal growth and an increased susceptibility to diverse chemicals, in accordance with the phenotypes of the already known non-conditional mutants of 14 alpha-demethylation. In addition, the mutant was shown to have a conditional defect in respiration. The impaired respiration was also seen in the non conditional mutants. PMID- 2664113 TI - Development of an ultrasonic system for three-dimensional reconstruction of the fetus. AB - The ultrasonic diagnostic devices available at present can only represent one section of the fetus. We have developed a system for three-dimensional reconstruction of the ultrasonic fetal image in order to facilitate the understanding of the 3-D structure of the fetus and also to make 3-D recordings of this image. Either a real-time linear array probe or a convex array probe of the ultrasonic scanner was mounted on a position sensing arm of a manual compound scanner in order to detect the position of the probe. A microcomputer was used to convert the positional information to a recording of a visual image of videotape. This image was superimposed onto the ultrasonic tomographic image simultaneously using a superimposer and was recorded on the video tape, thereafter, being recalled by the image processing minicomputer. The minicomputer VAX11/780 (DEC) system was used for 3-D reconstruction and 3-D display. In the memory system the image of the anterior uterine wall was identified and subsequently excluded in order to visualise the fetus more clearly. The threshold of brightness was set to a high level so that the fetus could be separated from the amniotic fluid. The fetus was displayed three-dimensionally using computer graphics. Using this system, we have made it possible to observe the whole image of the fetus in utero non-invasively. This system offers a method for easier understanding of the 3-D structure of the fetus in utero and also makes 3-D recording possible. In the future, we confidently expect that this system will be used for screening for fetal anomalies and abnormalities of fetal growth. PMID- 2664114 TI - Determination of the minimum number of cardiac cycles necessary to ensure representative blood flow velocity measurements. AB - The aim of this study was to determine the minimum number of cardiac cycles necessary over which blood flow velocity representative of the situation (and not unduly influenced by sporadic irregularities). Blood flow was measured by Doppler ultrasound in the adult a. carotis communis, a. femoralis and fetal a. umbilicalis. The coefficients of variation (CV) for the Pulsatility Index (PI), Resistance Index (RI) and Time Average of Space Average Velocities (TASAV) from 10 averaged cycles were compared with the CVs of the respective indices from 2, 3, 4 up to 9 averaged cycles. The number of averaged cycles where the difference between the coefficients of variability became insignificant (Wilcoxon signed rank test) was taken to be the point at which representative values of PI, RI or, respectively, TASAV are assured. For PI evaluation for the a. carotis communis with either the 7 mx or 15 mx calculation program one needs to average over 7 cardiac cycles. Manually determining the maximum frequency curve envelope, 5 cycles are sufficient. Using these same calculation programs for the a. femoralis, 5, 6 and, respectively, 6, cycles are sufficient for representative PI indices; for the umbilical artery, 6, 8 and, respectively, 7 cycles are necessary. For RI, 5 cycles are sufficient in both the a. carotis communis and a. umbilicalis by manual evaluation. For TASAV, a minimum of 3 cycles for the a. carotis communis and of 7 for the a. femoralis are necessary. Thus the number of cardiac cycles which should be averaged is dependent on the vessel being examined, the index being calculated, and the program being used. PMID- 2664115 TI - Documentation of paradoxical umbilical blood supply of an acardiac twin in the antepartum state. AB - In a case with one acardiac twin, color Doppler examination revealed retrograde umbilical circulation to this fetus. This pulsatile flow in the umbilical vessel of the acardiac fetus was supported by the cardiac function of the co-existing healthy twin. PMID- 2664116 TI - Fiber optic probe augmented sonic scaling versus conventional sonic scaling. AB - Several factors, including access and visualization problems, make total deposit removal during scaling and root planing procedures extremely difficult. This study examined the effectiveness of a mode of therapy designed to improve access and visualization for sonic scaling compared to closed sonic instrumentation. Teeth with moderate to deep probing depths in six patients scheduled to receive immediate dentures were divided into three experimental groups: Group I, sonic scaling with access augmented by interdental papilla reflection and fiber optic illumination/transillumination (34 surfaces); Group II, closed sonic scaling (34 surfaces); and Group III, untreated controls (35 surfaces). Immediately after treatment the experimental teeth were extracted, stained with toluidine blue, and interproximal areas evaluated for remaining accretions with a microscope digitizing pad-computer system. Group I had a significantly lower percentage (P less than 0.01) of remaining subgingival accretion coverage than Group II (1.30 +/- 0.25% vs 6.35 +/- 1.08%), and both Group I and II demonstrated significantly (P less than 0.01) fewer deposits than the control surfaces (46.61 +/- 4.32%). These findings suggest that minimal tissue reflection and fiber optic illumination/transillumination are beneficial adjuncts to deposit removal in moderate to deep periodontal pockets. PMID- 2664117 TI - Deleterious effects of complement activation on the lungs during extracorporeal circulation and its inhibition by FUT-175. AB - The purpose of this paper is to review the deleterious effects of complement activation during extracorporeal circulation on the lungs and to discuss the feasibility of FUT-175, a new synthetic protease inhibitor, as a complement activation inhibitor. Complement activation causes leukocyte aggregation and aggregated leukocytes behave as microemboli in the pulmonary vessels. Anaphylatoxins produced by complement activation have potent vasoactive properties and many chemical mediators are also released from leukocytes. FUT-175 might be effective to inhibit complement activation during cardiopulmonary bypass (CPB). Although deleterious effects of CPB on the lungs are multifactorial, we hypothesize that complement activation may play a major role in lung injury during CPB. PMID- 2664118 TI - [Studies on biological damage by active oxygens. III. Generation of hydroxyl radical and inhibition of insulin release in hypoxanthine-xanthine oxidase system in the presence of pancreatic islet cells]. AB - The hydroxyl radicals (HO.) spin adduct of 5,5'-dimethyl-1-pyrroline-N-oxide (DMPO) was obtained in the hypoxanthine-xanthine oxidase (HX-X.O.) system in the presence of isolated islet cells by using electron spin resonance spectroscopy. There was a significant increase in the concentration of DMPO-OH spin adduct dependent on the increase in a number of islet cells. In the absence of islet cell, the DMPO-OOH spin adduct formed by superoxide together with a small amount of DMPO-OH spin adduct was detected in HX-X.O. system. These results suggest that HO. is greatly produced in the HX-X.O. system in the presence of islet cells. The generation of HO. was partially inhibited by the addition of superoxide dismutase or catalase and completely by the combined use of both enzymes. Iron-chelator, diethylenetriaminepentaacetic acid and iron-binding protein, apotransferrin also inhibited the generation of HO., suggesting a possible participation of a trace iron in the islet cells. The inhibition of insulin release from islet cell, as well as the amount of DMPO-OH spin adduct, was dependent on the concentration of X.O. These results indicate that the HO. is produced by the site-specific action with islet cells in HX-X.O. system, suggesting a possible involvement of HO. in the oxygen damages of islet cells. PMID- 2664119 TI - Effect of protonophore on growth of Escherichia coli. AB - When 20 microM of carbonyl cyanide-m-chlorophenyl hydrazone (CCCP) were added to a M medium containing glucose as an energy source at pH 7.6, the Escherichia coli K12 strain 3301 was able to grow, whereas on the medium containing NaCl above 200 mM, the growth was remarkably suppressed by the addition of 20 microM CCCP. Furthermore, when glucose was replaced by either glycerol or lactate as an energy source, no growth occurred in the presence of 20 microM of CCCP. When glycerol was used as a substrate, O2 consumption by whole cells was observed in the presence of 20 microM of CCCP, but not in the case of lactate. We found that 14C lactate uptake was completely inhibited by the addition of 20 microM of CCCP. The cells, which were incubated for 24 h on a M medium containing glucose in the presence of 20 microM of CCCP produced many more organic acids (mainly, acetate and lactate) than was the case in its absence. It appears that the influx process of external lactate when this was added as an energy source, was completely inhibited by addition of CCCP (20 microM), but the efflux process of lactate that was produced by glycolysis, was not influenced by this protonophore. On the other hand, it is suggested that on the hyposalts medium, a proton motive force (pmf) is not necessary for the growth of the strain 3301, whereas pmf is necessary for growth to occur. PMID- 2664120 TI - [A fermenter dialysis cultivation technic for encapsulated pathogenic bacteria. II. Group B streptococci]. AB - For mass cultivation of group B streptococci (B-III and B-variant streptococci), a fermenter dialysis culture technique is described and compared to conventional shaking culture and fermenter batch culture techniques. The influence of two kinds of cultivation media on the bacterial yield is demonstrated. The growth rate of the bacteria and the yield of the microbes is higher in modified POPE medium than that observed with Nahrbouillon I. The type-specific polysaccharide of B-III-streptococci prepared by phenol-water extraction followed by gel chromatography can be used as a screening antigen for the production of monoclonal antibodies against B-III-streptococci. PMID- 2664121 TI - [Chemical characterization of Escherichia coli K 1 capsular polysaccharide]. AB - The exact chemical characterization of the prepared Escherichia coli K 1 capsule polysaccharide is necessary and a prerequisite for using this antigen as a screening antigen in the production of monoclonal anti-K 1-antibodies. The K 1 antigen, prepared by phenol-water-extraction, was analyzed by protein, RNA, and neuraminic acid determination. An addition, the antigen was subjected to elementary analysis, infrared- and 13C-NMR-spectroscopy, and gelchromatography. After testing the serological specificity, the K 1-antigen was identified as a high molecular polyneuraminic acid. PMID- 2664122 TI - Iontophoretic (transdermal) delivery of drugs: overview of historical development. PMID- 2664123 TI - Iontophoretic drug delivery: effects of physicochemical factors on the skin uptake of nonpeptide drugs. PMID- 2664124 TI - Iontophoretic delivery of nonpeptide drugs: formulation optimization for maximum skin permeability. AB - Although the technique of transdermal iontophoretic drug delivery has been known for many years, its use has been limited clinically to those applications for which a brief drug delivery period is adequate (e.g., delivery of pilocarpine in the diagnosis of cystic fibrosis). For most therapeutic applications, however, it is necessary to have an extended, if not continuous, drug delivery regimen. The use of iontophoresis has been limited in these applications by side effects, primarily skin trauma, associated both with the current density and the total amount of current passed. A mechanism for these side effects will be proposed and techniques to mitigate them will be presented. Many of these techniques involve ways in which the drug formulation can be designed to maximize the fraction of current carried by the drug species. These methods include the following: control of the pH in the bulk solution and in the boundary layer without using conventional buffers; taking advantage of polarization effects; and enhancing the permselectivity of skin. In this way, the therapeutic dose or optimal infusion rate of drug can be achieved with the minimum current and, therefore, the minimum number of side effects. PMID- 2664125 TI - Transdermal iontophoretic drug delivery: mechanistic analysis and application to polypeptide delivery. AB - Three factors are of primary importance in determining the iontophoretic flux of a charged solute: the electrochemical potential gradient across the skin, an increase in skin permeability to passive transport due to iontophoresis (loosely defined as skin damage), and a current-induced water flux. The latter two factors can also affect the transport of uncharged solutes during iontophoresis. A method of correcting for the skin damage effect is introduced. The contributions of the water transport effect relative to that of the applied voltage drop for charged solutes is estimated. It is shown that the water transport contribution is generally lower than the contribution due to the applied voltage drop. The observed iontophonetic flux of the enhancement factors due to the applied voltage drop alone are compared with the theoretical predictions based on the constant field assumption. It is shown that the theoretical predictions are higher than the experimental observations. This work also examines, for the first time, a synergism of iontophoresis and pretreatment with a chemical penetration enhancer as a means for delivering high molecular weight polypeptides. It is shown that a 2-h pretreatment with absolute ethanol followed by iontophoresis dramatically increases the permeability coefficient of insulin through human skin. PMID- 2664126 TI - Direct current iontophoretic transdermal delivery of peptide and protein drugs. PMID- 2664127 TI - Charcot foot. AB - Successful management of the Charcot foot is one of the most challenging undertakings faced by physicians. However, many times such patients undergo prolonged and attentive care only to develop further deformity, and in many cases succumb to amputation. Research in the past few years has yielded a new understanding of the Charcot process that should serve as the basis for improved therapeutic measures. The authors discuss these more recent developments and how this knowledge may be applied to better serve the patient. In addition, surgical reconstruction of the diabetic Charcot foot is introduced and discussed. PMID- 2664128 TI - Lyme disease. A review and case report with pedal symptoms. PMID- 2664129 TI - Forensic methods and the podiatric physician. AB - This is an introductory study of forensic podiatry. To elevate forensic podiatry to the level of forensic odontology and forensic anthropology, the podiatric medical profession must begin educational programs and research. A system for monitoring the activities of podiatrists involved in forensic medicine must be established to ensure that the high degree of integrity to which the profession is committed is maintained. By following these guidelines, the author believes that sometime in the future a podiatrist will be on the staff of every major police department in the country. At that point, the podiatric medical profession will have achieved unsurpassed status, recognition, and prestige. PMID- 2664130 TI - Podiatric pathology of lupus erythematosus. AB - Lupus erythematosus is an enigmatic disease. Its podiatric manifestations are largely cutaneous, but vasculitic involvements may produce complications. The authors review much of the histopathology of lupus erythematosus that is relevant to the podiatric physician and surgeon. Awareness of the serious systemic implications of lupus erythematosus and the internal medications used in treatment is part of the physician's responsibility in understanding the whole patient. PMID- 2664131 TI - Recurrent aphthous stomatitis: current concepts of etiology, pathogenesis and management. AB - Recurrent aphthous stomatitis (RAS) is a common oral disorder, however, despite detailed clinical, immunologic, hematologic and microbiologic investigation, the etiology of RAS remains unknown. At present, topical steroids and antimicrobial mouth rinses are the mainstays of treatment, but there is still no means of preventing recurrence of the oral ulceration. PMID- 2664132 TI - Familial pemphigus vulgaris with oral manifestations affecting two Greek families. AB - Two families of Greek origin with oral pemphigus vulgaris are reported. Both are fully documented cases of familial pemphigus in Greek Mediterranean patients. In the first family, a sister and a brother developed oral mucosal pemphigus lesions within a 5-year period, and a cousin had died from the disease 20 years earlier. In the second family, a daughter, a son and their mother developed the disease 2, 4 and 6 years apart. HLA typing has been performed and disclosed striking associations and similarities between the members of each family. Review of the fully documented cases of familial pemphigus vulgaris is also presented in a tabular form. PMID- 2664133 TI - Sampling of jugulo-digastric lymph nodes in oral cancer. AB - A modified method of histologic sampling involving multiple blocks has been applied to 37 jugulo-digastric nodes dissected from freshly submitted neck dissection specimens from patients with oral squamous cell carcinoma (SCC). Seventeen of these nodes had been found to be free from tumor following standard sampling. The method was also applied to a further 29 jugulo-digastric nodes that had been previously reported as being free from metastatic tumor. Only one of the 46 nodes previously reported as negative was found to contain secondary tumor following more extensive sampling. PMID- 2664135 TI - Your CE topic (No. 39). Pain: its assessment and treatment. PMID- 2664134 TI - Localization of H-ras mRNA in oral squamous cell carcinomas. AB - Expression of the H-ras oncogene was examined in 5 SCC of the oral cavity. The presence of oncogene mRNA was detected and localized in the tumor tissue by in situ hybridization. Tumor tissues were also examined for the presence of the oncogene product, p21, by immunohistochemical techniques. H-ras mRNA and p21 were detected in all 5 tumors in cells that were also positive for both keratin mRNA and keratin protein. The distribution of the mRNA was not uniform throughout the tumor tissue. Distinct spatial localizations of the H-ras mRNA were present in regions of the tumors with both higher proliferative and invasive potential. The results suggest that the distribution of the oncogene mRNA may be related to the pattern of development and progression of oral SCC. PMID- 2664136 TI - Your CE topic (No. 40). Obesity: its etiology and management (Part 1). PMID- 2664137 TI - Comparison of the marginal fit of various ceramic crown systems. AB - This study evaluated the marginal fit of four ceramic crown systems, (1) metal ceramic crowns with a metal margin, (2) metal ceramic crowns with a porcelain facial margin, (3) Cerestore crowns, and (4) Dicor crowns. Measurements of the marginal adaptation were recorded from the facial and lingual margins by using a video-enhanced microscope with digital micrometer and image intensification in a high resolution television screen. Results indicate that all four crown systems yielded comparable and acceptable marginal fit. PMID- 2664138 TI - A new device to directly examine parallelism of abutment teeth. AB - The path of insertion is essential for the successful seating of fixed partial dentures. A new device is described that directly examines the parallelism of the axial walls of the abutment teeth. It can also be used to create guiding planes for abutment teeth of removable partial dentures and determine the path of insertion of a Maryland Bridge fixed partial denture. The various parts of this device, its principle of operation, the results of its use, and advantages in relation to similar devices are presented. PMID- 2664139 TI - Photoelastic analysis of stress transfer by endodontically treated teeth to the supporting structure using different restorative techniques. AB - A photoelastic model was used to examine the influence of different types of restorations placed following endodontic therapy, emphasizing the way in which forces applied to the occlusal surface were dispersed to the supporting structures of the teeth. Stresses were photographed in the polarized light field. Findings indicate that distribution and patterns of stresses vary depending on the direction of the loads and the nature of the involved restorative procedures. PMID- 2664140 TI - Veterans Administration Cooperative Studies Project No. 147. Part VIII: Plaque accumulation on metal ceramic restorations cast from noble and nickel-based alloys. A five-year report. AB - In 1980, the Veterans Administration Cooperative Studies Program No. 147 initiated a multicentered, multidisciplinary clinical study to evaluate the use of alternative alloys for porcelain-fused-to-metal restorations. This segment of the study compares the accumulation of dental plaque, over time, on restorations made from either Olympia or one of several alternative alloys, including W-1, Ceramalloy II, Micro-Bond N/P2, or Ticon in comparison to: (1) an unrestored tooth, which served as the periodontal control, (2) Olympia, the alloy control, and (3) among the alternative alloys. The restoration of approximately 800 teeth with fixed partial dentures/crowns was not found to contribute to plaque accumulation when measured by using the Loe and Silness plaque index. Statistically, more plaque was exhibited by the unrestored periodontal control tooth than by any of the restored teeth. No differences in plaque accumulation were observed between Olympia and the alternative alloys or among the alternative alloys themselves after 36 months of clinical use. PMID- 2664141 TI - Orthodontic extrusion of premolar teeth: an improved technique. AB - Traditional methods of tooth restoration may be impossible because of insufficient crown length. This article describes a method to orthodontically extrude "nonrestorable" premolar teeth. More than 100 patients who required premolar extrusion before prosthetic restoration have been treated with this procedure. Clinical records of a typical patient are shown to demonstrate the effects of the application of this technique, and a method of bracket placement on a severely broken down "nonrestorable" tooth is described. The advantages of the technique recommended in this article are described. PMID- 2664142 TI - Improving the fit of crowns with die spacers. AB - This investigation studied the dependence of seating crowns on the thickness of layers of spacers applied to dies. Extracted molars were prepared to designated taper angles. Artificial stone dies were prepared in polyether impressions of tooth preparations and covered with one to five layers of new or old spacer material in a predetermined manner. Wax patterns were invested to obtain a uniform and low expansion. Crowns were cast, luted to the teeth, invested in acrylic resin, ground parallel to the axes of the teeth, and inspected microscopically. The average thickness of layers of new and old spacer material was determined. The application of spacers up to the shoulder margins of dies decreased the elevation of the casting above the margin of the tooth preparation until an average minimum elevation above the shoulder of the preparation was obtained. A further increase in the spacer thickness did not affect the elevation, but increased the cement thickness at the axial walls. The average minimum elevation results mainly from individual protrusions on the casting surface. The optimum thickness of the spacer results in the minimum elevation at the margin together with a low cement thickness at the axial walls. Leaving the cervical part of the axial walls near the margin uncovered with spacer negates the effect of a thick spacer on the remaining die surface almost completely and is therefore contraindicated. PMID- 2664143 TI - Treatment of the mandibular compromised ridge: a literature review. AB - Restoration of the mandibular compromised ridge requires various treatment modalities. The simplest approach often is to extend the denture base adequately for proper use of all available supporting tissues. If the patient is incapable of wearing a conventional denture, the surgical approach becomes necessary. Surgical avenues include vestibular extension procedures that increase vestibular depth and augmentation procedures, which include (1) overlay grafts of rib or the crest of the ilium, (2) osteotomy grafts to include the visor osteotomy and the interpositional bone graft, (3) alloplastic grafts of which hydroxyapatite augmentation is the most common, and (4) various types of implants to restore the compromised ridge. The ultimate goal, regardless of the treatment modality chosen, is to restore the patient to a level of masticatory function. PMID- 2664144 TI - The effectiveness of two disinfectants on denture base acrylic resin with an organic load. AB - This study compared the biocidal effectiveness of chlorine dioxide and 5.25% sodium hypochlorite (diluted 1:10) on acrylic resin strips inoculated with Staphylococcus aureus, Candida albicans, or Escherichia coli in the presence of an organic load. Sterile acrylic resin strips were immersed in a solution containing 10% horse serum and 10(5) to 10(7) organisms/ml for each type of organism, then disinfected in chlorine dioxide, sodium hypochlorite, or 0.9 sterile saline for 30 seconds or 1, 2, or 4 minutes. After disinfection, the strips were neutralized and incubated for 72 hours. The results showed a difference between the ability of chlorine dioxide and sodium hypochlorite to kill the test organisms on acrylic resin strips when organic matter is present. Chlorine dioxide achieved complete disinfection of all three organisms within 2 minutes. Sodium hypochlorite achieved complete disinfection of all three organisms within 4 minutes. PMID- 2664145 TI - A photoelastic study of stress induced by framework design in a maxillary resection. AB - Support of a framework and obturator in a patient with an acquired maxillary defect is diminished by the removal of a portion of the palate and alveolar bone. The intent of this study was to investigate, by three-dimensional photoelastic analysis, the stress transmission that occurs with four commonly used retentive systems. The individual designs were facial cast circumferential retention with palatal plating, swing-lock design with palatal plating, facial cast circumferential retention and palatal cast circumferential clasp reciprocation, and facial cast circumferential reciprocation with palatal I-bar retention. Stresses were observed and compared on the palate and around the teeth of the four models. PMID- 2664146 TI - Submerged alumina dental root implants in humans: five-year evaluation. AB - This article describes the placement, success rate, and evaluation of an experimental alumina (Al2O3) ceramic dental implant at a mean placement time of 5 years. The study compared the longevity of a submerged implant of the same root design and a refined surgical technique with previously reported studies of the implant exposed to the human oral environment during initial healing. A 54% success rate was achieved for 29 implants placed in the maxillae and mandible, all restored with cast gold dental crowns. A significant difference (p = 0.05) appeared between success and failures at 7.8 months following placement. Crown/root ratio slopes were an earlier and more sensitive indicator of potential success or failure than the bone height slopes. Computer analysis revealed no apparent correlation between implant mobility and/or pocket depths and implant longevity. Delayed implant root fractures and a cast post fracture occurred in 20% of the implants that survived. PMID- 2664147 TI - Implant transfer coping verification jig. AB - Osseointegrated implants provide a treatment modality that should be considered for the edentulous and partially edentulous patient because of the high predictability of success. This technique article describes the fabrication of a verification jig that holds the transfer copings together in the same spatial relationship. The transfer copings can be splinted on the working cast and returned to the mouth to confirm the accuracy of the working cast. PMID- 2664148 TI - Basic biomechanics of dental implants in prosthetic dentistry. AB - A discussion of loads applied to implants must include the clinical consideration that not only rigid implant types are used, such as the Tubingen immediate implant and the TPS screw implant without shock absorber, but also systems with inherent resilience integrated in the implant design, such as the IMC and Flexiroot implants. The common goal of all of these implant systems is to achieve a stable anchorage of the implant body in the bone tissue, that is, contact osteogenesis or osteointegration. In the implant-to-bone interface region there is an implant mobility resulting from the elasticity of the bone. The question of whether additional implant-integrated elastic elements are necessary to simulate the periodontal attachment is controversial. PMID- 2664149 TI - Tooth crazing associated with threaded pins: a three-dimensional model. AB - A model for observing the three-dimensional pattern of cracking associated with placement of self-threading retentive pins was developed. Four sizes of self threading pins were placed in extracted posterior tooth samples. The pins were subsequently removed and the samples coated with butyl acetate lacquer except for the pin channel orifice. Samples were immersed in dye solution followed by a demineralization and dehydration process. Samples were placed in methyl salicylate until cleared. Cleared samples were examined for dye penetration into the pin channel and communication with the pulp chamber. Comparisons were made of the patterns created by the four sizes of retentive pins. Results showed that more extensive cracks occurred with the larger size pins and that crack communication with the pulp chamber occurred more frequently with the larger pins. PMID- 2664150 TI - Laboratory procedures for the one-clasp removable partial denture. AB - The lateral rotational path of insertion for removable partial dentures in the Kennedy class II category is generally limited to situations where the dentulous side has been restored with fixed restorations that provide a lingual undercut. The rigid lingual plate is first inserted horizontally into the undercut, followed by a lateral rotation to seat the edentulous side. No alterations of properly designed fixed restorations are necessary. This article discusses the technical procedures in detail. PMID- 2664151 TI - Evaluation of primers used for bonding silicone to denture base material. AB - Three primers were evaluated to determine their effect on the strength of the bond when Silastic 891 is cured to poly(methylmethacrylate). Silastic cured directly to the poly(methylmethacrylate) without a primer was used as a control. All primers increased the bond strength but one of the primers was definitely superior to the others. PMID- 2664152 TI - Simplified shielding of a metallic restoration during radiation therapy. PMID- 2664153 TI - Evaluation of bond strength of six porcelain repair systems. AB - The shear bond strength of six porcelain repair systems was evaluated in vitro at 48 hours and 3 months. Water storage and thermocycling significantly lowered the mean shear bond strength for all kits tested. However, at the end of 3 months Scotchprime resin had the highest mean bond strength. With current products, porcelain repair remains an interim clinical procedure. PMID- 2664154 TI - Mechanical undercuts as a means of decreasing shrinkage in the postpalatal seal region of the maxillary denture. AB - A basic experiment compared two different alterations (modified postpalatal strap and the "Ristau post-dam") of maxillary casts before flasking and processing with a control (unaltered maxillary casts). This experiment evaluated whether the alterations of the maxillary cast and its subsequent flasking procedures can alter the palatal separation in the postpalatal seal region between the master cast and the simulated denture. Ten trials each were performed for the modified postpalatal strap, the Ristau post-dam, and the unaltered maxillary casts (control). Subsequent to the flasking and processing, measurements were made to evaluate the palatal separation in the postpalatal seal region. After two statistical analyses, improvements (decreased palatal separation) were noted with the use of the modified postpalatal strap (with the mechanical undercuts) technique. In addition, measurements were made to compare results before and after 72 hours of hydration. PMID- 2664155 TI - A simplified technique for intraoral undercut blockout before impression procedures. PMID- 2664156 TI - Comparison of two functional impression techniques for distal-extension removable partial dentures. PMID- 2664157 TI - Tensile strength of three bonding agents for resin-bonded prostheses. AB - A chemically cured enamel bonding agent and two dentin bonding agents were used in conjunction with a composite resin luting cement to determine whether a difference in bonding strengths would exist when each was subjected to a tensile force. PMID- 2664158 TI - Palladium-silver alloys: a review of the literature. AB - Since their introduction in 1973, the use of palladium-silver alloys has increased significantly and they now comprise a substantial part of the noble metal ceramic alloy sales in North America. Literature regarding various properties of this alloy system is presented with particular emphasis on castability, fit, and porcelain discoloration. PMID- 2664159 TI - Metal-porcelain bonding to a magnetizable alloy. AB - The bond strength of porcelain to a magnetizable Pd-Co alloy was compared with that of a precious and nonprecious ceramic alloy by using the four-point flexure test and a direct shear test. The test procedure consisted of continuous loading until a bond failure occurred. The fractured surfaces were then examined with a scanning electron microscope. A good strength of the magnetizable Pd-Co alloy comparable to that of two specific ceramic alloys and intermediate between precious and nonprecious alloys was observed. Most of the failures of the precious alloy occurred at the oxide-porcelain interface. The preferential fracture paths were observed for the nonprecious alloy between the metal fracture and the oxide layer. The fractures of the magnetizable alloy occurred at the oxide-porcelain interface and in the bulk of the porcelain, clearly pointing out the possibility of using magnetizable Pd-Co alloy for metal ceramic abutment crowns. PMID- 2664160 TI - Patient response to variations in denture technique. Part VII: Twenty-year patient status. AB - Sixty-four patients were originally treated with complete dentures. Two different techniques, complex and standard, were used with 32 patients assigned to each group. Patients were recalled for their 20th year recall and 34 of the original 64 patients returned. Of those 34 patients, 26 patients were still wearing their original dentures. All 26 patients were judged by three project clinicians to have clinically acceptable dentures. In addition, all but two stated that their dentures were clinically acceptable. Neither of these patients were unhappy with fit, but with the esthetics. One patient had worn his denture teeth by pipe smoking and the other had bleached the pink out of her denture bases. The remaining eight patients who still participate in the project have had modifications in their original dentures or have had new dentures constructed. PMID- 2664161 TI - A modified edentulous maxillary custom tray to help prevent gagging. AB - The gag reflex can be a normal, healthy defense mechanism to prevent foreign objects from entering the trachea. During certain dental procedures, however, gagging can greatly complicate the final result, especially during the maxillary complete denture final impression. A modification can be made to the maxillary custom acrylic resin tray to aid in securing a clinically acceptable elastomeric final impression. This modification involves forming a vacuum chamber at the posterior extent of the custom tray to which a saliva ejector tip is embedded. When the saliva ejector is connected to the low-volume evacuation hose, the chamber will trap any excess impression material that might extrude from the posterior border of the loaded tray. This results in a reduced chance of eliciting the patient's gag reflex. PMID- 2664162 TI - Design and construction of pediatric interim obturators. AB - Interim obturator prostheses of acrylic resin are used during the healing period following loss of portions of the maxillae in pediatric patients. Retention is provided by undercuts in the vestibule. The step-by-step technique for making retentive prostheses is described. PMID- 2664163 TI - Report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry. AB - Dental research continued to grow during 1988. Unfortunately the quality does not always parallel the quantity of publications. This report obviously does not encompass all of the literature but focuses on studies that are related to trends and to matters that are considered controversial. Likewise the particular interests of the members of the American Academy of Restorative Dentistry were taken into consideration. The subjects covered include periodontics, preventive dentistry, bulp biology, craniomandibular disorders, ceramics, color in restorative dentistry, and dental materials. PMID- 2664164 TI - Acute calcific tendinitis of the hand and wrist: a report of 12 cases and a review of the literature. AB - Acute calcific tendinitis is a frequently unrecognized cause of hand and wrist tenderness and swelling. We report 12 cases seen over an 8-year period. Roentgenograms showed deposits in various peritendinous sites especially near the pisiform. Special views may be required for visualization. A correct diagnosis was made in 5/12 cases; other etiologies considered included closed-space infections. In most cases, treatment consisted of immobilization plus nonsteroidal antiinflammatory drugs or local steroid injections. Results were uniformly good. Seven of 7 patients demonstrated resolution of calcium deposits on subsequent roentgenograms. Failure to recognize this entity may cause unnecessary investigation and therapy. PMID- 2664165 TI - Salmonella septic arthritis in systemic lupus erythematosus. The importance of chronic carrier state. AB - Salmonella bacteremia is more frequently seen in hospitalized patients with systemic lupus erythematosus (SLE) than in hospitalized patients with other diseases. In our experience. Salmonella enteritidis septic arthritis is more common in SLE than in patients with others connective tissue diseases. We report that 4 of 7 patients with SLE with glomerulonephritis and history of Salmonella enteritidis septic arthritis were chronic carriers of this bacteria, since positive cultures were obtained from feces, bone marrow and bile fluid from 20 84 months after Salmonella arthritis developed. In contrast, none of 24 patients with SLE without a history of Salmonella arthritis were chronic carriers and only one of 12 patients with rheumatoid arthritis had positive bile culture to S. typhi while otherwise being asymptomatic. From our study we conclude that patients with active SLE who have gomerulonephritis are at increased risk of becoming chronic carriers of Salmonella enteritidis and of developing Salmonella arthritis once combined prednisone cyclophosphamide treatment has begun. A chronic Salmonella carrier state must be ruled out in patients with active SLE living in endemic zones, before initiating immunosuppressive therapy. PMID- 2664166 TI - Polyarticular Salmonella bacterial arthritis in a patient with systemic lupus erythematosus. AB - Patients with systemic lupus erythematosus (SLE) are at increased risk for infections. Insufficiency of the reticuloendothelial system caused either by immunosuppressive therapy or inadequate opsonisation are mechanisms by which Salmonella infections in particular appear in these patients. Salmonella infections can provoke a polyarticular reactive arthritis while Salmonella bacterial arthritis usually is monarticular. We report on the seriousness of a Salmonella infection (enteritis complicated by polyarticular bacterial arthritis) in a patient with SLE. PMID- 2664167 TI - Meta-analysis of injectable gold in rheumatoid arthritis. AB - A pooled estimate of the magnitude of the benefit and side effects of injectable gold salts in rheumatoid arthritis was computed using meta-analysis based upon available evidence in the literature. Active joint count, grip strength, functional capacity, hemoglobin concentration and erythrocyte sedimentation rate (ESR) were pooled. The change in percentage in favor of gold (adjusted for placebo) was as follows: active joint count 30.1%, (p less than 0.00001), grip strength 13.7% (p less than 0.013), functional capacity 13% (p less than 0.0005), hemoglobin concentration 5.3% (p less than 0.02), and ESR 19.6% (p less than 0.02). Pooling of side effects gave the following results: side effect withdrawals were 11% (p less than 0.01), dermatitis occurred in 15% and proteinuria in 0.7% more patients than in the placebo group. PMID- 2664168 TI - A clinical and biochemical assessment of prinomide in patients with rheumatoid arthritis. AB - Prinomide (CGS-10787B), a potential disease modifying drug, was evaluated clinically and biochemically in 15 patients with active rheumatoid arthritis. The single group study design included monthly assessments of 7 clinical measures and 22 laboratory measures. Twelve patients completed 24 weeks' therapy with prinomide 1.2 g/day. All clinical variables showed improvement which consistently reached statistical significance for articular index from Week 8 (p less than 0.01), for summated change score from Week 12 (p less than 0.01) and for pain score from Week 16 (p less than 0.05). Sustained significant improvement in laboratory variables was seen by Week 2 for erythrocyte sedimentation rate and platelet count (both p less than 0.05), and by Week 4 for plasma viscosity (p less than 0.01), IgG, IgA, IgM (all p less than 0.05). PMID- 2664169 TI - Pharmacokinetic interactions of penicillamine in rheumatoid arthritis. AB - The pharmacokinetic effect of the combined treatment of penicillamine with indomethacin and chloroquine was investigated in patients with rheumatoid arthritis. The mean plasma penicillamine concentration increased by 26% during indomethacin and 34% during chloroquine treatment. This new pharmacokinetic interaction may have important clinical implications. PMID- 2664170 TI - Lupus pneumonitis and anti-SSA(Ro) antibodies. AB - Interstitial pneumonitis has previously been thought to be an uncommon feature in systemic lupus erythematosus (SLE). A review of 63 patients with SLE from 1984 to 1987 at Tulane University revealed a frequency of 25.4% (N = 16) of lupus pneumonitis. Serologic testing for antibodies to SSA(Ro) revealed that 81% (13 of the 16) of the patients with lupus pneumonitis have anti-SSA(Ro) antibodies, compared to a frequency of 38% (24 of the 63) for the entire group with SLE (p less 0.001). The association of lupus pneumonitis and anti-SSA(Ro) antibodies is discussed in light of a speculative immunopathogenic role for the antibody to SSA(Ro) antigen. PMID- 2664171 TI - Uveitis and arthritis induced by adjuvant: clinical, immunologic and histologic characteristics. AB - The intradermal administration of complete Freund's adjuvant (CFA) containing Mycobacterium butyricum to Sprague-Dawley (SD) and Lewis strain rats results in polyarthritis and uveitis. Over 90% of the eyes examined from the SD rats given CFA had histologic evidence of anterior uveitis, clinically evident in only 20 to 28%. Many rats developed arthritis without clinical uveitis, but uveitis was rare in the absence of arthritis. Histologically, the ocular inflammation was characterized by a polymorphonuclear, and later, a lymphocytic infiltration of the iris and ciliary body with cells and fibrinous exudate in the anterior chamber and cells in the vitreous. Antibodies and cellular immunity to ocular (S antigen, alpha crystallin), articular (type II collagen, proteoglycan) and bacterial components (MDP), were demonstrated in some rats, but positive tests did not correlate with either articular or ocular disease. Ten percent of rats given type II collagen in incomplete Freund's adjuvant developed uveitis. Thus, the pathogenesis of the arthritis and uveitis in the adjuvant model may be mediated by lymphocytes which exhibit crossreactivity with antigens in these structures, although the specificity of such antigens has not been identified in our studies. PMID- 2664172 TI - Skin hypersensitivity to streptococcal antigens and the induction of systemic symptoms by the antigens in Behcet's disease--a multicenter study. The Behcet's Disease Research Committee of Japan. AB - Twenty-four different antigens from 6 strains of streptococcus were prepared for skin testing and delayed hypersensitivity testing. The induction of Behcet's disease symptoms by these antigens was studied. Delayed skin reactions to whole cells and cell walls of streptococci were frequently observed in Behcet's disease, but only a few skin reactions were observed in other diseases and healthy controls. The skin reactions to the other bacteria were also strong in Behcet's disease, but the differences between Behcet's disease and the other diseases were not significant. Interestingly, the induction of systemic Behcet's disease symptoms was observed after the streptococcus skin test in 15 of 85 cases tested, but no case of induction by the other bacteria was observed. Our study supports the possible pathogenetic role of certain streptococcal antigens in Behcet's disease. PMID- 2664173 TI - Short term effects of ibuprofen in primary fibromyalgia syndrome: a double blind, placebo controlled trial. AB - Therapeutic effects of ibuprofen were evaluated in 46 patients with primary fibromyalgia syndrome in a double blind, placebo controlled study for 3 weeks and in an open trial for another 3 weeks. Several features of primary fibromyalgia syndrome, including number of pain sites, fatigue, swelling feeling, and tender points significantly improved over time in both groups. However, no significant differences were found between the ibuprofen and placebo groups. Improvements in fibromyalgia features might have occurred as a result of physician or study interactions (i.e., an intervention effect). An important observation in our blinded study was that tender point sites among patients with fibromyalgia were significantly (p less than 0.001) consistent at 3 as well as 6 weeks when compared with the baseline. PMID- 2664174 TI - Antinuclear antibodies in patients with habitual abortion. PMID- 2664175 TI - NSAID usage patterns by rheumatologists in the treatment of SLE. PMID- 2664176 TI - Search for a common DNA fragment in B27+ AS+ lymphocytes and an E. coli strain from a patient with AS. PMID- 2664177 TI - A possible human homologue for the mouse mutant disorganisation. AB - The mouse mutant disorganisation (Ds) is a semidominant gene with variable penetrance in heterozygotes and lethality in homozygotes; 67% of heterozygotes have multiple defects and the rest have single defects. Fifty-three percent have cranioschisis and execephaly, 40% have hamartomas represented by papillae of variable size and shape protruding from the body, sometimes containing cartilage, and 33% have limb abnormalities. A child is presented with defects similar to those seen in mice heterozygous for Ds. He had shortening of the upper and lower segments of the right leg with a popliteal web and nine toes on the same side. A finger-like structure arose from the abdomen and one kidney was absent. The homology between this infant and Ds mice is discussed and published reports of human cases with similar abnormalities are reviewed. PMID- 2664178 TI - Sibs lacking characteristic features of duplication of distal 17q. AB - Two brothers with karyotype 46,XY,-16,+der(16),t(16;17)(q24.3;q25.1)pat are presented. It is commonly thought that duplication of distal 17q results in a clinically recognisable syndrome. Although our cases had several features often seen in patients with autosomal chromosome aberrations, they did not have any of the specific features found in other patients with this duplication. PMID- 2664179 TI - The SHORT syndrome: further delineation and natural history. PMID- 2664180 TI - Plaque-related infections. PMID- 2664181 TI - Inhibitory effects of human neutrophil granules and oxygen radicals on adherence of Candida albicans. AB - The adherence of Candida albicans to dacron fibre microcolumns was significantly suppressed after interaction with human neutrophils. The adherence-inhibiting properties of neutrophils were shown to reside in their cytoplasmic granules and granular enzymes. Oxygen-derived free radicals produced by the respiratory burst may also be responsible, as shown by experiments in which oxygen radicals were generated by the cell-free hypoxanthine-xanthine oxidase system. Dose-response studies with H2O2 and beta-glucoronidase demonstrated that lower concentrations of these agents inhibited adherence without affecting viability of C. albicans. These results suggest that interference with adherence mechanisms may be an effective means of host defence by neutrophils against the colonisation of mucosal surfaces by C. albicans. PMID- 2664182 TI - Coagglutination (COA) test for the rapid diagnosis of cryptococcal meningitis. AB - Cryptococcus coagglutination (COA) test reagent was prepared locally and showed no cross reactions with different species of bacteria or yeasts or with 75 control sera including 25 that gave positive results for RA factor. We used the COA test to detect cryptococcus antigen in the CSF and we could confirm the diagnosis of 11 out of 115 suspected cases of fungal meningitis; the titre varied from 4 to 128. A four-fold rise in titre confirmed the diagnostic value and a steady fall in titre in three patients on therapy indicated the prognostic value of the test. The earliest confirmation was in a renal transplant patient on the eighth day after onset of symptoms. The COA test was negative with the CSF of 118 patients with chronic meningitis. Cryptococcal colony forming units (cfu) in CSF varied from 100 to greater than 100,000/ml and correlated well with microscopy and with the COA antigen titre in CSF. Four out of the 11 patients who had cryptococcaemia, had 50,000-100,000 cfu/ml in the CSF. Cryptococcus antigen was detected by COA in the serum of all 11 patients, even in those with only 100 cfu/ml in CSF. In the three post-renal transplant patients, who were being monitored regularly, the diagnosis was made early and all three recovered on antifungal therapy with no relapse to date (1-2 years). All the others, including the two primary CNS infections, succumbed to the disease because they presented late for diagnosis and therapy. The cryptococcus COA test is a simple and specific test that can be used as a rapid test to confirm early diagnosis and permit prompt therapy, which should improve the prognosis in CNS and other forms of systemic cryptococcosis. Moreover, it is reproducible and cost-effective, particularly in countries where the latex and other expensive test reagents are not generally available. PMID- 2664183 TI - Biotyping of Campylobacter pylori. AB - Ninety-one biochemical tests were done on each of 50 strains of Campylobacter pylori isolated from the gastric mucosa of patients with gastritis and peptic ulcers in Singapore. The API ZYM system distinguished three biotypes of C. pylori. The organism was found to be biochemically different from C. jejuni and C. coli. We propose a biochemical identification kit that would be of use in identifying and differentiating biotypes of C. pylori, and would distinguish them from C. jejuni and C. coli. PMID- 2664184 TI - Interactions of the 4-quinolones with other antibacterials. AB - The effect of sub-inhibitory concentrations of 16 antibacterials on the bactericidal activity of the 4-quinolones nalidixic acid, ciprofloxacin and ofloxacin against Escherichia coli KL16 in nutrient broth was investigated. Sub inhibitory concentrations of rifampicin, clindamycin, chloramphenicol, erythromycin or tetracycline antagonised the bactericidal activity of the 4 quinolones. Conversely, all seven aminoglycosides tested enhanced the bactericidal activity of the 4-quinolones whereas the cell wall antagonists, azlocillin, mezlocillin, ceftazidime and vancomycin had no effect on the bactericidal activity of the 4-quinolones. PMID- 2664185 TI - Detection of anti-vascular endothelial cell antibodies with microcytotoxicity testing. AB - Antivascular endothelial cell antibodies (anti-VEC) were detected in 20 out of 20 serum samples from post renal transplant nephrectomy patients using a microcytotoxicity (MET) test, but in only 1 of 100 healthy blood donors. Cytotoxicity to VEC could occur in the absence of lymphocytotoxic antibodies. In this paper factors influencing the specificity and sensitivity of microcytotoxicity on vascular endothelial cell (VEC) were studied, including improvements in the preparation of VEC from an umbilical cord vein to get 95% and more of purity and viability; adequate dilution of rabbit sera to reduce its nonspecific VEC cytotoxic effect; and results read by exactly adjusted phase contrast microscopy to reduce the percentage of false negative. The original titers of allotypic and monoclonal antibodies against VEC have been shown to be reproducible in repeated testing during the past two years. The recognition of the weak cytotoxic effects of anti-HLA on VEC makes possible direct application of microcytotoxicity on VEC, to detect anti-VEC and to study VEC antigen classification (through a comparison of the cytotoxic effects of tested sera on VEC and concordant lymphocytes). PMID- 2664186 TI - Analysis of actin and tropomyosin in hearts of cardiac mutant axolotls by two dimensional gel electrophoresis, western blots, and immunofluorescent microscopy. AB - When homozygous, recessive mutant gene c in Ambystoma mexicanum results in a failure of embryonic heart function. This failure is apparently due to abnormal inductive influences from the anterior endoderm resulting in an absence of normal sarcomeric myofibril formation. Biochemical and immunofluorescent studies were undertaken to evaluate the contractile proteins actin and tropomyosin in normal and mutant hearts. For the immunofluorescent studies, cardiac tissues were fixed in periodate-lysine-paraformaldehyde, frozen sectioned, and immunostained by an indirect method with monospecific polyclonal antibodies produced against highly purified chicken heart actin and tropomyosin. In normal hearts, both antiactin and antitropomyosin stained the myofibrillar I-bands intensely. In mutant hearts, intensity of staining with antiactin antibody was similar to normal, although sarcomeric patterns were not observed. Staining intensity for tropomyosin with antitropomyosin antibody was significantly reduced in mutant hearts when compared to normal. Biochemical studies were used to evaluate antibody specificity, antigenic variability, and relative protein concentrations of actin and tropomyosin in normal and mutant cardiac tissues. Tissue homogenates were electrophoresed in two dimensions, and second-dimension slab gels were either Coomassie Blue silver-stained or transblotted onto nitrocellulose and the proteins stained with antibodies. Stained gels and immunoblots of cardiac proteins reveal that the amounts of actin isoforms are identical in normal and mutant hearts. However, these methods demonstrate a significantly reduced amount of tropomyosin in mutant tissue. This confirms earlier studies suggesting reduced amounts of tropomyosin in mutant hearts based upon immunological assays. Thus, failure of normal myofibrillogenesis in gene c mutant hearts does not appear to result from a change in actin isoform composition but may be related to a deficiency in tropomyosin. PMID- 2664187 TI - Major ocular glands (harderian gland and lacrimal gland) of the musk shrew (Suncus murinus) with a review on the comparative anatomy and histology of the mammalian lacrimal glands. AB - The Harderian gland of the musk shrew Suncus murinus is elongated anteroposteriorly from in front of the eye to behind the ear. The gland is divided into two portions: an anterior portion (A portion) and a posterior portion (P portion). The single secretory duct of the gland emerges from the anterior end of the P portion, receives several secretory ducts of the A portion during the course along it, runs around the ventral aspect of the eyeball, and finally opens into the anterior corner of conjunctival sacs. The two portions of the gland show a fundamentally similar histological structure, having a poorly developed intraglandular duct system and wide tubular alveoli. The quantity of lipid vacuoles and stromal connective tissue in the A portion is greater than in the P portion. The lipid vacuoles in both portions are surrounded by unit membranes, but their contents appear different. The lacrimal gland of the musk shrew is located along the ventral side of the P portion of the Harderian gland. The lacrimal duct emerges from its anterior end, runs around the ventral and anterior aspects of the ear, crosses the A portion of the Harderian gland, and finally opens at the posterior corner of conjunctival sacs. The lobules of the lacrimal gland comprise a branched duct system and terminal acini with two types of secretory cells: 1) acidic cells positive both for the periodic acid-Schiff reaction (PAS) and for Alcian blue (AB) and 2) neutral cells positive for PAS and negative for AB. Both cell types tend to make separate acini, but when present in the same acinus, the acidic cells occupy relatively peripheral positions in the acinus. Both cell types lack intercellular canaliculi. On the basis of the present study as well as previous descriptions in the literature, the author suggests that the mammalian lacrimal glands can be divided into two sets: 1) a Glandula lacrimalis superior with multiple secretory ducts associated with the upper eyelid and 2) a Glandula lacrimalis inferior with a single secretory duct opening into the lateral corner of the conjunctival sacs. These glands have a fundamentally similar histological structure; but in the rabbit, which possesses both sets of lacrimal glands, they are different. On the other hand, the secretory cells of lacrimal glands generally have no intercellular secretory canaliculi, which are characteristically present between the serous secretory cells of the salivary glands. PMID- 2664188 TI - Formation of the primitive myo- and endocardial tubes in the chicken embryo. AB - The morphogenesis of the mesenchymal cardiogenic plate, the formation of the bilateral heart primordia leading to the primitive heart tube, and also the genesis of the endocardial tube, have been studied in 1 to 13 somite chick embryos. The morphological data were compared with those obtained in electrophysiological studies of the development of the cardiac action potentials (Fujii et al., 1981a). The primordia of the consecutive heart chambers are definable before the appearance of myosin-type filaments and primitive Z bands, which occurs simultaneously with the first spontaneous action potentials in the 7 somite embryo. At the 8 to 9 somite stage, fusion of the lateral heart primordia proceeds to include the outflow tract and atrial primordia; the pacemaker site migrates into the atrial wall and subsequently into the sinus venosus, this process occurring simultaneously with the progressive transformation of mesenchymal cells into cardiomyocytes. Proendocardial cells are first detected detaching individually or in small groups from the cardiogenic plate to become attached by fine filamentous material to the basal surface of the foregut endoderm, on which they "stream", establishing an anastomosing V-shaped array with respect to the ventral mesoderm. This array coalesces first at the atrioventricular groove to form double endocardial tubes, which in turn fuse into a single tube with the establishment of the single myocardial tube. Evidence suggests a key role for the ventral mesocardium and its transient attachment zone with the foregut, in providing a line focus for migration of proendocardial cells and primitive capillaries from the lateral splanchnic mesoderm, from which they derive. PMID- 2664189 TI - A rapid cross-sectioning and freeze-clamping device for the beating canine heart. AB - A new sampling method of cross-sectioning the canine heart in situ was developed. A mechanical device, driven by spring power, enabled cross-sectioning of a short axis plane of the beating canine heart (4 mm thick) with high speed rotating blades, at a pre-determined phase of the cardiac cycle, and instantaneous freeze clamping (2.4 mm thick) with pre-cooled aluminum blocks, all within 120 ms. By this method, the anatomical structures of the sample were well preserved. Transmural metabolism and flow distribution were instantaneously fixed and high resolution of the two-dimensional redox state was obtained by application of NADH fluorescence photography. Micro-samplings from the desired portion of the cross sectional slice were possible at -190 degrees C. NADH fluorescence of the samples did not increase from the surface to 1.2 mm in depth, confirming that there was no ischemic artifact. With the present technique, a heart sample in which transmural metabolism, and the redox state, are fixed and visualized is attainable, thus providing a new tool for the study of myocardial ischemia. PMID- 2664190 TI - Inhibition of post-ischemic ventricular recovery by low concentrations of prostacyclin in isolated working rat hearts: dependency on concentration, ischemia duration, calcium and relationship to myocardial energy metabolism. AB - The objective of this study was to characterize the effect of prostacyclin (PGI2) on ventricular function following total global ischemia in isolated working rat hearts and to investigate the mechanism of its action. Ischemia was initiated for 10, 15, 20 or 25 min with or without treatment with PGI2. Increasing durations of ischemia resulted in a progressive decline in high energy phosphate (HEP) stores, an elevation in tissue lactate, and incomplete recovery of function with reperfusion. Prostacyclin at either 1 or 10 ng/ml had no effect on HEP levels or total adenine nucleotides, and tissue lactate was not significantly affected by PGI2 in hearts made ischemic for 10 to 20 min, but both PGI2 concentrations significantly elevated lactate levels after 25 min ischemia. Reperfusion recovery of left ventricular function was complete following 10 and 15 min ischemia, but incomplete recovery was evident following 20 min ischemia (77% of pre-ischemic function); and although PGI2 had no direct effect on the function of aerobically perfused hearts, recovery of aortic flow with 1 ng/ml PGI2 after 20 min of ischemia was reduced to approximately 20% (P less than 0.01). This depression in recovery was associated with significantly increased lactate levels during reperfusion. At a concentration of 10 ng/ml PGI2 did not depress ventricular recovery or elevate lactate content after 20 min ischemia. When hearts made ischemic for 20 min were analyzed, a significant negative correlation was found between ventricular recovery (aortic flow rate) and lactate concentration; however, no correlation existed between recovery and ATP levels. After 25 min of ischemia, five of eight (62.5%) untreated hearts demonstrated some degree of ventricular recovery, however, only two of ten hearts studied demonstrated any measurable functional recovery with either PGI2 concentration. This effect of PGI2 to reduce or prevent recovery of ventricular function following either 20 or 25 min of ischemia as well as the corresponding elevation in lactate levels was prevented by treatment with the calcium channel blocker verapamil. This study therefore shows that PGI2 at critical low concentrations can depress left ventricular recovery following total ischemia. This effect of PGI2 becomes more pronounced as ischemia duration is prolonged and is associated with elevated tissue lactate levels. The studies with verapamil suggest that PGI2 may be acting via the slow calcium channel to increase lactate levels and depress ventricular recovery following prolonged periods of ischemia. PMID- 2664191 TI - 4-Ipomeanol: a novel investigational new drug for lung cancer. AB - 4-Ipomeanol (IPO) is the first agent to undergo preclinical development at the National Cancer Institute (NCI) based principally on a specific biochemical biological rationale for clinical investigation as an antineoplastic agent targeted against lung cancer. This disease-specific development of IPO was initially stimulated by observations that the compound was activated by metabolism, preferentially within the mammalian lung, specifically within bronchiolar Clara cells, and that its predominant toxicity was to the lung in most species. IPO is inactive or only minimally active against most conventional antitumor test systems. However, some human lung cancer cell lines, as well as a variety of fresh human lung tumor biopsy specimens, have been shown to be capable of mediating the in situ biotransformation of IPO to a potentially cytotoxic intermediate. In this report, the biochemistry, metabolism, preclinical pharmacology, and toxicology of IPO are reviewed and the clinical development plans for this unique and challenging new agent are presented. PMID- 2664192 TI - Deletion of histo-blood group A and B antigens and expression of incompatible A antigen in ovarian cancer. AB - Expression of histo-blood group ABH antigens in 53 cases of ovarian cancer was examined by immunoperoxidase staining of Formalin-fixed as well as frozen histological sections with various monoclonal antibodies, including those defining type 1, 2, 3, and 4 chain A. Findings of major interest were (a) deletion of A and B determinants in tumors from histo-blood group A and B individuals, and a high incidence of H antigen deletion in tumors from group O individuals were observed and (b) strong expression of incompatible A antigen in two of 10 samples from group B patients and in two of nine samples from group O patients was demonstrated. A antigen expression was defined by monoclonal antibody AH21, which reacts with monofucosyl type 1 chain A (ALed), but not by other types of anti-A antibodies directed to difucosyl type 1 chain A (ALeb), mono- or difucosyl type 2 chain A, or type 3 or type 4 chain A. The reactivity of monoclonal antibody AH21 was abolished by alpha-N-acetylgalactosaminidase from chicken liver. These findings clearly identified the specific expression of incompatible A antigen with the structure monofucosyl type 1 chain A (ALed) in tumors from histo-blood group B and O individuals. PMID- 2664193 TI - Dietary management of the patient with atherosclerosis: are the new National Cholesterol Education Panel recommendations enough? AB - The black patient has a poorer prognosis with arteriosclerotic heart disease than does a white patient and needs a more aggressive approach to reduce cholesterol and other risk factors. The new National Cholesterol Education Panel recommendations are similar to those used in the Multiple Risk Factor Intervention Trial study which lowered cholesterol levels only by 5% to 7% over a seven-year period. We recommend a more aggressive dietary approach introducing the postinfarction patient to a less than 10% fat and 50 mg cholesterol vegetarian diet while recovering in the hospital. PMID- 2664194 TI - Prednisone when used as treatment for rejection correlates with poor outcome. AB - Since January 1974, 195 of 202 (95%) renal transplants have been performed on blacks at the Howard University Hospital Transplant Center. Hypertension is the most common cause of end-stage renal disease (ESRD) at this center (57%). The immunosuppressive regimens utilized were divided into four eras. The first era (1974-1980) consisted of the prophylactic administration of prednisone, Imuran (AZA), and Minnesota antilymphocyte globulin (MAG) with high prednisone dosage used to treat rejection. One-year, two-year, and five-year patient survival rates were 59% 54%, and 41%, respectively. Graft survival rates for the same period were 53%, 47%, and 36%. In the second era (1980-1983), the same immunoprophylaxis was used but only MAG was used to reverse rejection. One-year and two-year patient survival rates were 90% and 84%. Graft survival rates for the same period were 72% and 64%. When era 1 is compared with era 2, statistically significant improvement in patient survival is evident (P less than 0.005). Graft survival rates are statistically significant for one-year graft survival (P less than 0.05). In the third era (1983-1986), cyclosporine was the principal immunosuppressive agent used along with prednisone. Rejection in this era was treated by adjusting the cyclosporine dose to keep the level between 100 ng to 150 ng per mL and in addition to high prednisone. One-year patient survival and graft survival rates were 83% and 55%, respectively. The fourth era began April 1986 and was initiated because of previous bad experiences with high doses of prednisone to treat rejection in era 1.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 2664195 TI - Investigational drugs for treatment use: an avenue of hope for minority populations. AB - The Food and Drug Administration in its efforts to facilitate the drug approval process so that promising treatments may be offered to seriously ill or dying patients has established an innovative regulation, commonly known as the Treatment Investigational New Drugs (TIND). The benefits of this new policy should prove to be particularly appealing to black Americans. Traditionally blacks, due to numerous social, political, economic, and cultural factors, have had the poorest health status of any other population in the United States. The implementation of strategies to eradicate such factors will ultimately provide considerable improvement of the health status of blacks. Until then, the utilization of the TIND may prove to be one of the most significant influences in the advancement of our health care. Barriers to the use of the TIND regulation in the black community must be addressed as well. PMID- 2664197 TI - Ectopic pregnancy: the surgical epidemic. AB - Ectopic pregnancy has become a major health problem in terms of its morbidity and its impact on health care resources. In a case-control study involving 40 black patients, the odds ratio of developing ectopic pregnancy in current and former intrauterine device users is 11.7, which is statistically significant. The odds ratio for patients with a history of pelvic inflammatory disease is 4.4, which is statistically insignificant. A review of the current literature indicates Chlamydia salpingitis as the major cause of the ectopic epidemic. Prompt and effective treatment of this venereal disease may curtail health care expenses and prevent suffering of thousands of women each year. PMID- 2664196 TI - Bone marrow transplantation: a review. AB - Bone marrow transplantation represents the technical application of basic immunologic principles to the treatment of a variety of neoplastic and allied disorders that originate in the bone marrow. The results have improved during the past 15 years, being most striking for the treatment of the acute and chronic leukemias. The promise of autologous bone marrow transplantation for the treatment of leukemias and solid tumors is awaiting the perfection of techniques for the effective removal of residual neoplastic cells as well as more effective therapy. The use of this technique at its present stage of development for the treatment of benign hematologic disorders, which cause severe morbidity (ie, thalassemia or sickle cell anemia), is controversial, raises serious ethical issues, and cannot be recommended routinely at this time. Complications of bone marrow transplantation such as graft rejection, graft-versus-host disease, and opportunistic infections are discussed. PMID- 2664198 TI - Coronary artery disease in black Americans 1920-1960: the shaping of medical opinion. AB - Current opinions regarding the prevalence of coronary artery disease in black Americans are conflicting. Some physicians believe that the prevalence of coronary artery disease in black Americans is less than that in the general population; some find no difference; still others argue that the high prevalence of risk factors, such as hypertension, should result in a higher prevalence of coronary artery disease in black Americans. This article will not attempt to resolve these conflicts but instead will review some of the medical literature that may have influenced prevailing opinions. PMID- 2664199 TI - Impaired black physicians: a methodology for detection and rehabilitation. AB - The author contends that the great majority of black physicians lead happy and productive lives. Regrettably, black physicians must not only cope with stress related to marriage, finances, parenting, and other daily problems, but they must also cope with institutional racism. Consequently, some black physicians become impaired. This article discusses issues related to the problem of impairment in black physicians and suggests a methodology for detection and rehabilitation. It is the author's belief that future intervention should be culturally compatible and that black physicians themselves must bolster the effort to prevent impairment. At an empirical level, the author brings together the sparse amount of epidemiological and cultural data related to the subject. PMID- 2664200 TI - Role of anaerobic bacteria in intra-abdominal septic abscesses in mediating septic control of skeletal muscle glucose oxidation and lactic acidemia. AB - Altered glucose metabolism and lactic acidemia are features of Gram-negative polymicrobial abscesses, but the relationship between carbohydrate metabolism and the aerobic or anaerobic organisms is unclear. Since reductions in the % active pyruvate dehydrogenase complex (PDHa) limits glucose oxidation in sepsis, the effect of a 7-day monoclonal (E. coli or B. fragilis) vs. biclonal (E. coli + B. fragilis) intra-abdominal abscess (IA) on PDHa and lactate concentrations in skeletal muscle (SM) and plasma was studied in rats. A chronic IA was created by the intraperitoneal introduction of a sterile rat fecal-agar pellet (1.5 ml) inoculated with a known bacterial flora [sterile (S); E. coli 10(6) CFU/ml (EC); B. fragilis 10(8) CFU/ml (BF); E. coli 10(3) CFU/ml + B. fragilis 10(4) CFU/ml (ECLBF); E. coli 10(3) CFU/ml + B. fragilis 10(8) CFU/ml (ECHBF)]. Neither SM PDHa nor SM nor plasma lactate were altered from control in animals with either sterile (S) or E. coli (EC) monoclonal IA, but SM PDHa was significantly (p less than 0.001) reduced and SM lactate increased (p less than 0.05) in rats with B. fragilis 10(8)/ml (BF) monoclonal IA. In biclonal IA, the effect of sepsis on SM PDHa depended on the concentration of B. fragilis in the IA fluid (ECLBF = 10(4) CFU/ml vs. ECHBF = 10(8) CFU/ml) since the E. coli were constant (10(3) CFU/ml). At the lower B. fragilis IA concentration (ECLBF), the SM PDHa was not different from control. However, when the IA B. fragilis concentration was increased to 10(8) CFU/ml (ECHBF), the SM PDHa was significantly (p less than 0.001) decreased relative to control. A decreased muscle PDHa was always associated with elevated SM and plasma lactate concentrations. These results suggest that IA which permit a threshold of relatively nonlethal (BF = 0% mortality) anaerobic B. fragilis (greater than or equal to 10(8) CFU/ml) to enter the circulation are more important in altering metabolic control of skeletal muscle glucose oxidation and in producing lactic acidemia than are IA with only aerobic E. coli. However, in biclonal intra-abdominal abscesses, B. fragilis potentiated the early mortality from E. coli (EC = 6% vs. ECHBF = 37% mortality), suggesting that the metabolic effect of the B. fragilis-induced lactic acidemia is synergistic with the direct toxic effects of the E. coli. PMID- 2664201 TI - The immunosuppressive effects of the in vivo administration of endotoxin as influenced by macrophages. AB - It is well documented that endotoxin can have immunosuppressive effects on lymphocytes and induce the production and secretion of monokines which act on the lymphocytes. To delineate the interaction between macrophages and lymphocytes more clearly, 0.15 mg of lipopolysaccharide (LPS) (E. coli 0111:B4) was injected into Hartley guinea pigs intraperitoneally twice a day for 7 days (saline for control group). Seven days after the last injection, spleens were taken and lymphocyte proliferation was determined in the presence and absence of macrophages. When macrophages were present, there was a significant suppression of lymphocyte proliferation when PHA and PWM were used as mitogens. There was no suppression of proliferation when the macrophages were removed. Splenic macrophages were also cultured in the presence and absence of LPS and their supernatants analyzed for PGE2 and TXB2. There was no significant difference between the endotoxin and control groups for PGE2 or TXB2 production in the presence and absence of LPS. However, the endotoxin group had significant decreases in serum levels of C3 postinjection of endotoxin which could indicate C3 degradation by LPS. Taken together these results give further evidence that macrophage products in addition to PGE2 can inhibit lymphocyte proliferation. C3 degradation products could possibly stimulate macrophages to produce inhibitors of lymphocyte proliferation or induce suppressor cells. PMID- 2664202 TI - 1988 Fitts lecture: heart rate changes after haemorrhage and injury--a reappraisal. PMID- 2664203 TI - Hypoxia and endotoxin induce macrophage-mediated suppression of fibroblast proliferation. AB - Cellular mechanisms and environmental factors contributing to wound failure following shock and wound contamination are unclear. The activation of macrophages by exposure to hypoxia (pO2 less than 20) and/or lipopolysaccharide (10 micrograms/ml) in vitro was investigated for its effect on macrophage regulation of fibroblast proliferation. The effect on fibroblast proliferation of conditioned medium from activated murine macrophages or co-culture with activated macrophages was tested by measuring 3T3 fibroblast incorporation of 3H-thymidine and culture DNA content. Unstimulated macrophages produced growth factors that increase fibroblast proliferation (proliferation index (PI) = 1.4 +/- 0.15, p less than 0.05 vs. control). Activation by hypoxia alone had little effect on macrophage regulation of fibroplasia (PI = 1.55 +/- 0.28, N.S. vs. unstimulated macrophages). LPS activated macrophages suppressed fibroplasia and the combination of hypoxia with LPS augmented the suppression (PI = 0.5 +/- 0.11, LPS alone, p less than 0.05 and 0.25 +/- 0.05, LPS + hypoxia, p less than 0.01). In addition, hypoxia + LPS treated co-cultures had reduced DNA contents, suggesting reduced cell numbers (12.5 +/- 2.6 micrograms vs. 8.2 +/- 2.0 micrograms). We screened several macrophage cytokines for their direct effect on 3T3 proliferation and found that mr-Tumor Necrosis Factor-alpha (150 units) also suppressed proliferation. Conditioned supernatants from LPS activated macrophages contained 12 +/- 2 units of mrTNF as measured by L929 cytolysis; however, this was significantly less than required to induce suppression of proliferation by direct addition. The regulatory role of the macrophage appears to be dependent on its level of activation. Activation by hypoxia and LPS altered macrophage regulation of fibroblast proliferation from stimulation to suppression.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 2664204 TI - Clonidine transdermal patches for use in outpatient opiate withdrawal. AB - We conducted a study to assess the clinical usefulness of transdermal clonidine for heroin detoxification in an outpatient drug treatment clinic. Twenty-two young otherwise healthy heroin addicts participated. Outcome was assessed on the basis of (a) hypotension and other side effects of clonidine; (b) patient retention; (c) concomitant drug use; (d) subjective symptoms of withdrawal; and (e) objective signs of withdrawal. Side effects were present but in no case necessitated discontinuation of treatment. Drop-out rates were equal to conventional treatment offered at the clinic. The availability of clonidine broadens the therapeutic options available to patients and clinicians in treating the opiate-addicted patient. Transdermal clonidine offers several advantages over the oral form: patches can be applied weekly, fewer supplemental medications are required, and patches supply an even blood level of medication. A protocol for use is recommended. PMID- 2664205 TI - Pulmonary vascularity in pediatric heart disease. AB - In children, analysis of pulmonary vascularity can provide useful information about cardiac and noncardiac abnormalities. The abnormal vascular patterns encountered in children with heart disease include (1) active engorgement, (2) passive congestion, (3) diminished pulmonary blood flow, (4) cephalad redistribution, and (5) unequal blood flow. Familiarity with these various patterns enables the clinician to produce relevant differential diagnoses for each. With additional study of the cardiac chambers, great vessels, and other radiographic findings, a specific diagnosis may often be suggested. PMID- 2664206 TI - The post-cardiac surgery chest radiograph: a clinically integrated approach. AB - The post-cardiac surgery chest radiograph is often read without full knowledge of the patient's pathophysiology or of the specific surgical approach employed. This lack of clinical integration severely limits the effectiveness of the radiologic consultation. This article synthesizes a pathophysiologic foundation for interpretation, drawing on (1) the preoperative physiology and radiographic findings, (2) the events of surgery, cardiopulmonary bypass, and hypothermia, and (3) a detailed survey of the postoperative occurrences and their radiographic presentations including the various appliances, disturbances in fluid balance and ventilation, and complications encountered in the immediate postoperative period. The objective is to define the perioperative events and their radiographic correlations more accurately so that effective radiologic consultation will result. PMID- 2664207 TI - The Fleischner lecture: computed tomography of diffuse pulmonary disease. AB - The current level of computed tomography (CT) scanner resolution is such that CT is possibly the best radiographic procedure available for viewing gross pulmonary anatomy and pathology. CT densitometry, in contrast, is of limited value in assessing diffuse lung disease because of partial volume errors created by the wide range of intrathoracic tissue densities. Anteroposterior density gradients and total mean lung density can be used advantageously in a select group of patients with suspected high-density disease. The morphologic patterns of diffuse high-density lung disease as viewed on conventional roentgenograms correlate closely with those depicted on CT images. Density measurements in normal and abnormal patients suggest that the medulla of the lung may be a reservoir zone that accommodates increased blood flow via distention and recruitment of vessels under appropriate conditions. Pulmonary diseases that cause oligemia can be identified and distinguished by their combined CT densitometric and morphologic characteristics. Combined high- and low-density disease may need total integration of plain radiographs, isotopic scans, and CT scans for proper interpretation. PMID- 2664208 TI - The radiology of right heart dysfunction: chest roentgenogram and computed tomography. AB - Alterations in the right heart silhouette resulting from chamber enlargement, pericardial disease, and juxtacardiac masses can be diagnosed by plain-film radiography. On the other hand, plain films rarely reveal intracardiac masses or right ventricular hypertrophy, and to suggest these disorders it may be necessary to rely on secondary signs such as pulmonary artery enlargement. In contrast, computed tomography will show both right ventricular hypertrophy and intracardiac masses and is therefore an important adjunct in evaluating right heart abnormalities. PMID- 2664209 TI - Endoscopic ultrasonography of gastric myogenic tumor. A comparative study between histology and ultrasonography. AB - In order to find a correspondence between the sonographic findings of endoscopic ultrasonography (EUS) and the histology of gastric myogenic tumors, histologic specimens (24 cases) and preoperative ultrasonograms (10 cases) were examined. Histologically, the incidence of necrosis within the tumor was more frequent and the area of necrosis was larger in leiomyosarcoma than in leiomyoma. Liquefaction necrosis was observed only in leiomyosarcoma. By EUS, myogenic tumors originating from the proper muscle were delineated as clearly demarcated hypoechoic tumors arising from the fourth layer. Irregularly shaped sonolucent areas within the tumor corresponded to liquefaction necrosis. Thus, sonolucent areas may be indicative of leiomyosarcoma. PMID- 2664210 TI - Sonographic features of focal orchitis. AB - High-resolution sonography is a very sensitive imaging modality for detecting intratesticular pathology and is an accurate means of distinguishing intratesticular lesions (usually malignant) from extratesticular ones (usually benign). Unfortunately, there are no reliable sonographic criteria to distinguish testicular neoplasms from focal benign intratesticular lesions such as infarction, hemorrhage, or infection. We describe three cases of focal orchitis in which the sonographic features did allow a confident diagnosis of intratesticular infection. In each case a focal peripheral hypoechoic intratesticular abnormality was seen that was poorly defined or crescent-shaped, adjacent to an enlarged epididymis. The specific sonographic features suggest the diagnosis of focal orchitis and orchiectomy can be prevented. Rapid improvement (2 to 4 weeks) should be seen sonographically and in all cases the intratesticular lesions should be followed to complete resolution. PMID- 2664211 TI - Sonography of the distal cystic duct. AB - This prospective study of 139 patients was performed for evaluation of the normal and abnormal distal cystic duct and cystic duct remnant after cholecystectomy. The normal distal cystic duct could be demonstrated in 51% of the patients with normal common bile duct and normal gallbladder. The average diameter of the normal distal cystic duct was 1.8 mm. In 95% of the patients, the distal cystic duct was located posterior to the common bile duct and, in 5% of the patients, anterior to the common duct. Echoes produced by cystic duct insertion into the common bile duct occasionally can be mistaken for stones in the common bile duct. These echoes, however, are not associated with acoustic shadowing. Sludge and stones could be demonstrated in the distal cystic duct as well as in the cystic duct remnant after cholecystectomy. PMID- 2664212 TI - Umbilical artery Doppler blood velocity waveforms in normal and abnormal gestations. AB - Blood velocity patterns in peripheral arteries reflect hemodynamic characteristics, particularly systemic vascular resistance. Doppler blood velocity waveforms in umbilical arteries (UA) indirectly assess placental vascular resistance (P1VR) and therefore an abnormal waveform value may serve as an index of placental insufficiency associated with elevated P1VR. We prospectively studied the ratio of peak-systolic to end-diastolic velocities (A/B ratio) in the UA of 113 normal fetuses on 121 occasions over a period of 4 years. A range-gated, pulsed Doppler, duplex, two-dimensional, real-time echocardiogram (ECHO) allowed placement of the sample volume in the UA by direct vision; hard copy of the tracing was later analyzed. Hand calipers allowed measurement of the fetal cardiac cycle length (RR) and A/B ratio, which were compared with gestational age (EGA), echo-derived total cardiac dimension (TCD), and aortic root size (AO). Normative data were analyzed by least squares linear regression and compared to data in several high-risk groups. In the normal fetus, there was an orderly pattern with advancing gestational age of linearly decreasing A/B ratio and increasing TCD, AO, and RR. The A/B ratio varied inversely with TCD and AO, but was independent of RR. In a group of 20 hypertensive patients, 6 had elevated A/B ratios; of 18 diabetic pregnancies, 4 had elevated A/B ratios. In other high-risk groups, 4 of 21 patients were abnormal: sickle-cell disease (1 case), systemic lupus erythematosus (1 case), and intrauterine growth retardation (2 cases). In conclusion, Doppler A/B ratios in the UA of normal patients, like cardiac size, show an orderly pattern of change with EGA independent of RR.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 2664213 TI - Sonographic appearance of primary retroperitoneal cysts. AB - The sonographic findings observed in four patients with primary retroperitoneal cysts were reviewed. All lesions presented as fluid-filled masses with anechoic content and regular margins; all increased through transmission. Preoperative location of the cysts within the retroperitoneal space was possible in all cases by either real-time ultrasound (US) analysis of the different relationships of the kidneys and the cysts during respiratory movements or the anterior displacement of surrounding structures. A differential diagnosis among retroperitoneal lesions containing fluid is difficult and cannot be obtained with imaging methods alone. However, preoperative knowledge of both the retroperitoneal location of the disease process and its fluid content may help to narrow the diagnostic possibilities, thus allowing the surgeon to more accurately plan the therapeutic approach to the patient. PMID- 2664214 TI - Linear array test tool. AB - A new linear array test tool is presented. It is easily used to directly measure an image acquisition parameter: the transmit/receive aperture. The aperture measurement gives important information concerning the functioning of the real time multielement transducer and the equipment's signal-processing hardware and software. A feasibility test of the new test tool demonstrated that it can be easily used by clinical personnel to (1) determine the variation of the transmit/receive aperture with image depth; (2) document the operation of the equipment in each of the operator selectable focusing schemes; (3) perform quick checks of equipment performance when in doubt; and (4) test for and document the existence of nonfunctioning elements in linear, curved linear (convex), and phased arrays. PMID- 2664215 TI - Intra-amniotic hemorrhage secondary to placenta circumvallate. PMID- 2664216 TI - Bladder puncture from Fletcher-Suit tandem applicator. Diagnosis by pelvic ultrasound. PMID- 2664217 TI - Fetal heart rates. PMID- 2664218 TI - Two nuclear oncogenic proteins, P135gag-myb-ets and p61/63myc, cooperate to induce transformation of chicken neuroretina cells. AB - Several studies have shown that full transformation of primary rodent fibroblasts can be achieved in vitro through the cooperation of two oncogenes (usually one nuclear and one cytoplasmic) classified on the basis of different complementation groups. We have shown previously that cooperation between v-mil (cytoplasmic, serine-threonine kinase product), and v-myc (nuclear, DNA-binding product) is required to transform 7-day-old chicken neuroretina cells, which in usual culture medium do not rapidly proliferate. v-mil induces sustained growth of chicken neuroretina cells without transformation; v-myc fails to stimulate the proliferation of chicken neuroretina cells but is required to achieve transformation of the proliferating cells. Here, we present results indicating that the P135gag-myb-ets nuclear protein of avian erythroblastosis virus E26 is able to induce proliferation but not transformation of chicken neuroretina cells. v-myc is required in addition to P135gag-myb-ets to achieve chicken neuroretina cell transformation. In contrast, we found that the P135gag-myb-ets and P100gag mil proteins are not able to cooperate in this system. PMID- 2664219 TI - Invasion of the peripheral nervous systems of adult mice by the CVS strain of rabies virus and its avirulent derivative AvO1. AB - The penetration of the CVS strain of rabies virus and its avirulent derivative AvO1 into peripheral neurons was investigated after intramuscular inoculation into the forelimbs of adult mice. It was found that CVS directly penetrates both the sensitive and motor routes with equal efficiency, without prior multiplication in muscle cells. Infected neurons became detectable 18 h after infection. The second cycle of infection occurred within 2 days, and at day 3 there was a massive invasion of the spinal cord and sensory ganglia. In sensory ganglia, where it was possible to identify cell outlines, it was evident that the infection did not proceed directly from cell body to cell body. The avirulent strain AvO1 penetrated motor and sensory neurons with the same efficiency as CVS. Restriction of viral propagation was observed from the second and third cycles onwards. No further development of the infection could be seen after day 3, and by that time the lysis of primarily infected neurons seemed to occur. PMID- 2664220 TI - Orthotopic renal transplant and results in 139 consecutive cases. AB - Although a commonly performed technique, heterotopic renal transplantation may be a cause of late graft failure owing to ureteral stenosis, urinary fistula and vesicoureteral reflux secondary to the immune response. The new retroperitoneal lumbar approach to the splenic vessels has allowed the orthotopic technique to be developed using the splenic artery or aorta, the renal vein and a pyelo-pyelic anastomosis. In this manner the renal graft is located in an anatomical position that is well protected, and with the recipient urinary tract the normal physiology is preserved with comparatively low complication and mortality rates. A third transplant attempt also is simplified. This method is the only alternative in some cases. Transplant ureter pathology symptoms are not observed. The results of 139 consecutive cases are presented. PMID- 2664221 TI - Clinical and urodynamic features of a new intestinal urinary sphincter for continent urinary diversion. AB - We describe a new sphincter mechanism and its clinical application in 11 patients requiring continent diversion. The sphincter, composed of 2 short segments of ileum, is urodynamically responsive and actually increases its resistance to leakage when reservoir pressure or volume increases. Because of this dynamic continence control and its ease of construction, it appears to be a useful addition to the reconstructive urological armamentarium. PMID- 2664222 TI - Value of sonography in true complete diphallia. AB - A case of true complete diphallia associated with multiple malformations is presented. Complete radiological evaluation should include sonography of both penes preoperatively to classify the penile duplication correctly. PMID- 2664223 TI - Hyperammonemic encephalopathy: a complication associated with the prune belly syndrome. AB - Hyperammonemic encephalopathy in the urological patient is a rare but grave condition. In the pediatric urological population it has been associated with massively dilated upper tracts and urinary infection with urea-splitting organisms. We report 2 cases of hyperammonemic encephalopathy in association with the prune belly syndrome. Both patients presented comatose with markedly elevated serum ammonia levels and Proteus mirabilis urinary tract infection. Intravenous antibiotics and catheter drainage resulted in dramatic reversal of the encephalopathy. The pathophysiology of hyperammonemic encephalopathy in association with the prune belly syndrome and a review of the literature are presented. PMID- 2664224 TI - Conservative treatment of renal allograft rupture with polyglactin 910 mesh and gelatin resorcin formaldehyde glue. AB - Renal-sparing treatment of spontaneous renal allograft rupture remains a surgical challenge, since profuse hemorrhage may result from these friable kidneys during surgical repair. A technique is proposed to achieve control of local bleeding with a synthetic glue (gelatin, resorcin and formaldehyde) and external compression with a polyglactin 910 absorbable mesh. We report 4 cases of spontaneous allograft rupture associated with rejection and bleeding was controlled in all 4. Three grafts were preserved with more than 1 year of followup. The other graft had to be removed for uncontrolled vascular rejection despite satisfactory control of renal fractures. Renal wrapping with external compression is proposed to improve results of conservative management of renal allograft rupture. PMID- 2664225 TI - Scrotal incarceration of the ureter with crossed renal ectopia: case report and literature review. AB - To our knowledge only 18 cases of ureteral herniation into the groin have been reported in the literature. We encountered a patient with crossed renal ectopia and ureteral incarceration into a right indirect inguinal hernia. Based on analysis of the presentation and management of our patient combined with a review of the literature we conclude that patients with urinary symptoms and a groin hernia should undergo preoperative urological evaluation, all hernias containing a ureter should be repaired and ureteral resection rarely is necessary during the hernia repair. PMID- 2664226 TI - Pediatric Urology Medal. J. Herbert Johnston tribute. PMID- 2664227 TI - Sonographic evaluation and conservative management of newborns with myelomeningocele and hydronephrosis. AB - Hydronephrosis has been reported in 7 to 60 per cent of all newborns with myelomeningocele. However, most of these reports have been based upon x-ray findings obtained after closure of the myelomeningocele. To determine whether the radiographic abnormalities might be secondary to the neurosurgical procedure in a manner analogous to spinal shock, a prospective study of 34 newborns with myelomeningoceles was done during a 5-year period. Renal and bladder sonography was done on day 1 of life before surgical intervention and for varying periods thereafter. A total of 31 infants (91 per cent) had normal renal sonograms preoperatively but 6 of these had bilateral hydronephrosis and distended bladders postoperatively. Three patients had urinary retention before postoperative sonography could be obtained. For these 9 patients intermittent catheterization was required for 4 to 14 days until bladder tone recovered. Urinary retention in the infant with myelomeningocele may be a transient consequence of the myelomeningocele repair and should be treated conservatively for at least 2 weeks before surgical intervention is considered seriously. PMID- 2664228 TI - Role of superoxide dismutase in the pathogenesis of pyelonephritis: immunological localization of superoxide dismutase in human renal tissues. AB - The enzyme superoxide dismutase affords a protective effect from renal scarring secondary to acute pyelonephritis in primates. To investigate the relationship between renal superoxide dismutase content and age we selected formalin-fixed normal human renal tissue from subjects of varying age, ranging from premature infant to adult, for immunostaining with human anti-superoxide dismutase antibody using the peroxidase-antiperoxidase technique. Sections that demonstrated acute pyelonephritis were immunostained for comparison. Immunostaining for superoxide dismutase was detected consistently in the proximal tubular cell cytoplasm in all specimens regardless of subject age. Superoxide dismutase was not detected in other segments of the nephron. In kidneys that demonstrated acute pyelonephritis we detected enhanced immunostaining in the proximal tubules, as well as increased background staining related to the inflammatory cells present. These results in conjunction with recent demonstrations of proximal tubular cell endocytosis of bacteria suggest that superoxide dismutase has an important role in mediating the initial events of pyelonephritis within the proximal tubular cell. PMID- 2664229 TI - Modified meatal advancement and glanuloplasty (Arap hypospadias repair): experience in 31 patients. AB - We used the Arap hypospadias repair in 31 patients with distal hypospadias with considerable success, achieving an excellent result in 93 per cent of our patients. Improved cosmesis, extension of the scope of the problems that can be addressed with this repair (including treatment of a distal urethrocutaneous fistula) and the ease with which the Arap procedure can be performed are the advantages that this operation has over other 1-stage distal hypospadias repairs. PMID- 2664230 TI - Laser welding of pedicled flap skin tubes. AB - The efficacy of the carbon dioxide laser used at high power levels for tissue destruction is well established. This laser at lower power levels has been used to incise and anastomose blood vessels, tendons, nerves, dura, bowel, fallopian tube, vasa deferentia, ureters and skin. Laser welding is faster, reduces surgical manipulation and introduces less foreign material into the wound than conventional suturing techniques. We tested the feasibility of laser welding of pedicled flap skin tubes to determine if there is a potential application in reconstruction, particularly for hypospadias repair. PMID- 2664231 TI - Changing concepts in management of primary obstructive megaureter. AB - The management of neonatal urinary tract dilatations represents one of the most challenging dilemmas in pediatric urology today. We have been confronted with 44 renal units in 35 neonates diagnosed as having primary obstructive megaureter during the last 6 years. Of these units 23 in 17 infants were diagnosed antenatally and 20 (87 per cent) have been managed without surgical intervention. Notably, 16 renal units were graded as moderate to severe megaureters by an excretory urogram. The decision to manage conservatively was based on the initial extraction of the 99mdiethylenetriaminepentaacetic acid renal scan (the extraction factor). This estimate of absolute renal function has been used to differentiate dilatations with obstructive implications for the renal parenchyma from those without. Significantly, expectant treatment has resulted in improvement of dilatation on sequential excretory urograms in 15 megaureters and none has shown a deterioration of function by renal scan. Similar diagnostic criterion also has resulted in conservative management for 12 of 21 additional neonatal megaureters seen during this period with symptoms or they were discovered serendipitously. Only 2 of these 12 megaureters required surgical correction. The neonatal primary megaureter appears in many cases to represent a different entity than those that commonly presented before the advent of antenatal and perinatal diagnosis. PMID- 2664232 TI - The fate of infant kidneys with fetal hydronephrosis but initially normal postnatal sonography. AB - Antenatal hydronephrosis involving 49 renal units in 35 infants seen since 1984 was studied. Postnatal sonography performed in the first few days after birth confirmed upper tract dilatation in 39 kidneys (80 per cent) in 29 neonates and it was normal in 10 kidneys (20 per cent) in 6 neonates. Of the 6 neonates with a normal postnatal sonogram 5 underwent repeat renal sonography at an average of 2 months after birth, all showing moderate hydronephrosis (7 kidneys). Furosemide enhanced diethylenetriaminepentaacetic acid renography was performed in 4 infants (5 kidneys) with ureteropelvic junction or megaureter obstruction, of whom 2 had persistent unilateral obstruction and underwent successful reconstructive surgery (1 pyeloplasty and 1 megaureter reimplantation). Two infants (3 kidneys) with nonobstructive dilatation are being followed while 1 infant with bilateral vesicoureteral reflux is being managed medically on long-term antimicrobial prophylaxis. Thus, 50 per cent of neonates with antenatal hydronephrosis and a normal postnatal sonogram performed during the first few days of life subsequently were found to have either significant obstruction (2 requiring surgery) or reflux. This study underscores the absolute necessity of followup sonography in all newborns with antenatal hydronephrosis that is not confirmed on the initial postnatal ultrasound. PMID- 2664233 TI - About heparin, or ... whatever happened to Jay McLean? PMID- 2664234 TI - Competition and hospital costs. PMID- 2664235 TI - Chemical and biological warfare. Should defenses be researched and deployed? AB - The threat of chemical and biological weapons of mass destruction has intensified because of improved delivery systems and advances in chemistry, genetics, and other sciences. Possible US responses to this threat include deterrence, defenses, and/or disarmament, including a reaffirmation of the Biological and Toxin Weapons Convention of 1972, which is now in jeopardy. This article discusses the history of chemical and biological warfare, existing and potential weapons, the proliferation of weapons and delivery systems, ways to prevent the use of these weapons, and ways to protect populations from their effects. PMID- 2664236 TI - Progress in medical defense against nerve agents. AB - For nearly 50 years, nerve agents have constituted a serious threat that has stimulated extensive efforts to develop effective medical countermeasures. Recent progress in producing pharmacologic defenses suggests that humans can be largely protected from the lethal and prolonged incapacitating effects of these compounds on a chemical battlefield. Current research on new approaches to binding and inactivating nerve agents may further decrease their potential as a threat against protected persons. PMID- 2664237 TI - The controversy over radiation safety. A historical overview. AB - The hazards of ionizing radiation have aroused concern since a short time after the discovery of x-rays and natural radioactivity in the 1890s. Misuse of x-rays and radium prompted efforts to encourage radiation safety and to set limits on exposure, culminating in the first recommended "tolerance doses" in 1934. After World War II, the problems of radiation protection became more complex because of the growing number of people subjected to radiation injury and the creation of radioactive elements that had never existed before the achievement of atomic fission. Judging the hazards of radiation became a matter of spirited controversy. Major public debates over the dangers of radioactive fallout from atmospheric bomb testing in the 1950s and early 1960s and the risks of nuclear power generation in later periods focused attention on the uncertainties about the consequences of exposure to low-level radiation and the difficulties of resolving them. PMID- 2664238 TI - Low-level radioactive wastes. Council on Scientific Affairs. AB - Under a federal law, each state by January 1, 1993, must provide for safe disposal of its low-level radioactive wastes. Most of the wastes are from using nuclear power to produce electricity, but 25% to 30% are from medical diagnosis, therapy, and research. Exposures to radioactivity from the wastes are much smaller than those from natural sources, and federal standards limit public exposure. Currently operating disposal facilities are in Beatty, Nev, Barnwell, SC, and Richland, Wash. National policy encourages the development of regional facilities. Planning a regional facility, selecting a site, and building, monitoring, and closing the facility will be a complex project lasting decades that involves legislation, public participation, local and state governments, financing, quality control, and surveillance. The facilities will utilize geological factors, structural designs, packaging, and other approaches to isolate the wastes. Those providing medical care can reduce wastes by storing them until they are less radioactive, substituting nonradioactive compounds, reducing volumes, and incinerating. Physicians have an important role in informing and advising the public and public officials about risks involved with the wastes and about effective methods of dealing with them. PMID- 2664239 TI - Biological defense research: charting a safer course. PMID- 2664240 TI - The 1987 US hospital AIDS survey. AB - In 1987, the National Public Health and Hospital Institute conducted a national survey of 623 acute-care hospitals to obtain information relating to inpatient and outpatient care for persons with acquired immunodeficiency syndrome (AIDS). Two hundred seventy-six hospitals reported treating persons with AIDS; the average length of stay was 16.8 days. Average costs and revenues per inpatient day were $681 and $545, respectively, with a cost per patient per year of $17,910. Estimated cost for AIDS inpatient care during 1987 was $486 million; Medicaid represented the primary payer. Regional and ownership comparisons for this year and between 1985 and 1987 indicated significant differences in utilization, payer source, and financing. Results suggest major differences in reimbursement and losses related to payer source or lack of insurance, with many hospitals that serve large numbers of low-income persons with AIDS encountering moderate to severe financial shortfalls. We conclude that increasing concentrations of persons with AIDS in relatively few hospitals in large cities may make it more difficult to secure the broader political base necessary to obtain adequate support for treatment. PMID- 2664241 TI - Academic medicine as a public trust. AB - Academic medicine is entrusted by society with the responsibility to undertake several important social missions toward improving the health of the public, including education, patient care, and research. This trust is given implicit authority by generous public funding and considerable autonomy. Medical academia can take pride in its successes, manifested by a premier scientific establishment, the development and use of sophisticated medical technologies and drugs, and the recent dramatic declines in death rates from heart disease and stroke. Academic medicine, however, has been relatively unresponsive to a number of vexing public problems, including skyrocketing expenditures for medical care, substandard indexes of population health, uneven quality of care, an unfavorable geographic and specialty mix of physicians, and widespread disability from long term medical and psychiatric problems. Although there are many cogent reasons why academic medicine has chosen to define its task relatively narrowly (the nature of its funding successes, the intractability of the social problems, and the attractiveness of the biomedical model), the central issue is how well academic medicine is fulfilling its responsibilities to the public. To the degree that academic medicine defines its central mission narrowly, it may violate its implicit social contract and jeopardize its primary source of financial support. Alternatively, in recognition of its public responsibilities, academic medicine can choose to expand its current activities to be more responsive to the health concerns of the general population. PMID- 2664242 TI - Calcium entry blockers in the treatment of hypertension. Current status and future prospects. AB - Calcium entry blockers will be increasingly used for the treatment of hypertension. The currently available calcium entry blockers are similar in antihypertensive efficacy but differ in their effects on the atrioventricular node and the degree of peripheral vasodilatory action. The new generation of dihydropyridine calcium entry blockers exhibits more specific vasodilatory actions with a less negative inotropic effect, which may affect their use in patients with congestive heart failure. The responsiveness to these drugs is little affected by race or age. Because of their mild natriuretic action, the concomitant use of dietary sodium restriction or diuretics may be less necessary. Short-term administration of calcium entry blockers preserves or improves renal function; however, their long-term effect has not been documented. Calcium entry blockers have not exhibited protection against coronary heart disease, but experimental evidence supports the continued search for cardioprotection. Calcium entry blockers are important drugs for the treatment of hypertension; the second generation may provide additional benefits because of its more specific pharmacologic actions. PMID- 2664243 TI - Dermatology, 50 years ago. PMID- 2664244 TI - A comparative study of two different methods for detecting late potentials in patients with and without ventricular tachycardia. AB - To compare the clinical utility of 2 methods in detecting late potentials (LPs), our method (K-method) and Simson's method (S-method) were used in 96 patients with or without ventricular tachycardia(VT). Indices of LPs were LP duration (LPd) in K-method, and mean voltage of the filtered vector magnitude for the last 40 ms of the QRS complex (V40) in S-method. For patients with underlying cardiac disease (UD), LPd in patients with sustained VT (s-VT; 39.4 +/- 20.1 ms) was significantly longer than that in patients with nonsustained VT (ns-VT; 16.1 +/- 6.6 ms) or without VT (non-VT; 13.3 +/- 5.2 ms) (p less than 0.01), while V40 in patients with s-VT, ns-VT, and non-VT were 24.7 +/- 26.4 microV, 56.5 +/- 31.7 microV, and 98.1 +/- 75.3 microV, respectively (p less than 0.05). Patients without UD had less apparent LPs in both methods. There was a significant reciprocal correlation between LPd and V40; LPd = (378/V40) + 6.66 (r = 0.89, p less than 0.001). The sensitivity and specificity with the highest predictive accuracy for s-VT in K-method were 50% and 100% and those in S-method were 50% and 97% respectively. In conclusion, despite many differences in these 2 methods, sensitivity and specificity were nearly equal and they were both useful to identify patients with s-VT. PMID- 2664245 TI - Predictability of left heart dysfunction from right heart performance--cardiac index-venous pressure plots and cardiac index-mean pulmonary artery wedge pressure plots at rest and their shift during dynamic exercise. AB - In an attempt to examine the extent to which the right heart performance can predict the left heart performance in heart diseases primarily affecting the left heart, we recorded cardiac index-venous pressure (CI-VP) plot and cardiac index mean pulmonary artery wedge pressure (CI-PAW) plot at rest and investigated the shift of CI-VP plot and CI-PAW plot that occurred during mild dynamic exercise of the lower limbs. Six patients had normal heart function and 20 patients had heart diseases primarily affecting the left heart. The sensitivity, specificity, positive predictive value and negative predictive value in the estimation of the left heart function with delta CI/delta VP were 80%, 100%, 89% and 100%, respectively, when delta CI/delta PAW was regarded as the golden standard for the estimation of the left heart function. The sensitivity, specificity, positive predictive value and negative predictive value in estimating the left heart function with delta CI/delta RA were 86%, 93%, 92% and 86%, respectively. When the left heart function was estimated by delta VP alone without measuring delta CI, the sensitivity, specificity positive predictive value and negative predictive value were 40%, 100%, 73% and 100%, respectively. In short, it was possible to predict the left heart dysfunction with delta CI/delta VP or delta CI/delta RA, in the presence of the right heart dysfunction. It was also possible to predict a steep heart slope from normal delta CI/delta VP with error of 2/18 (11%), when steep left heart slope was predicted, based on the presence of steep right heart slope. In comparison, delta VP alone was a less sensitive index of the performance of the left heart. PMID- 2664246 TI - Occupational exposures in petroleum refining; crude oil and major petroleum fuels. IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. PMID- 2664247 TI - [New antimicrobial agents series XXXIV: isepamicin]. PMID- 2664248 TI - [Clinical experience of chemotherapy with cefmetazole for severe infections accompanying malignant hematological disorders]. AB - We made an attempt to treat with cefmetazole (CMZ) 25 patients who developed severe infectious diseases while suffering with granulocytopenia associated with the treatment of malignant hematological disorders. 1. Determination of bacteriological efficacy While 20 strains were isolated and identified from 15 patients, no significant bacteria were detected in 9 patients. Isolates obtained were: 5 strains of Enterococcus faecalis, 3 strains of Haemophilus influenzae, 2 strains of Staphylococcus epidermidis, 2 strains of Klebsiella oxytoca, 2 strains of Staphylococcus aureus, and 1 strain each of Neisseria sp., Pseudomonas maltophilia, Enterobacter sp., alpha-Streptococcus, beta-Streptococcus and Gram positive cocci. Causative organisms were eradicated or markedly in 7 of the 15 patients from whom bacteria were isolated. Clinical findings, including fever, revealed that none of the patients, in whom bacteriological efficacy was determined to be poor, exhibited sufficient clinical response. E. faecalis was isolated from 4 of 6 patients bacteriologically determined to have no response. 2. As for 23 patients, who were found to be evaluable among the 25 patients, 8 (34.8%), 4 (17.4%), 4 (17.4%), and 7 (30.4%) demonstrated excellent, good, fair and poor responses, respectively, showing a 69.6% efficacy rate which indicates a sum of percentages of patients with excellent, good and fair responses. 3. While an efficacy rate of 100% was obtained for 3 patients with number of peripheral neutrophils less than 500/mm3 before the beginning of CMZ administration, only an efficacy rate of 66.7% was obtained for 15 patients with neutrophils more than 500/mm3.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 2664249 TI - [Clinical studies on sulbactam/ampicillin in the field of pediatrics]. AB - During 8 months from October 1986 to May 1987, the clinical efficacy of sulbactam/ampicillin (SBT/ABPC) was evaluated in 63 pediatric inpatients with various infections. Clinical efficacies were evaluable in 58 patients among them (consisting of 2 patients with sepsis, 3 with tonsillitis, 12 with bronchitis, 6 with bronchopneumonia, 24 with pneumonia, 1 with phlegmon, 2 with lymphadenitis, 1 with impetigo and 7 with urinary tract infection) and were excellent in 40 patients and good in 17 with an overall efficacy rate of 98.3%. Bacteriological efficacies were assessed in 25 patients and 27 strains of organisms (consisting of 3 strains of Staphylococcus aureus, 2 Streptococcus pneumoniae, 1 Streptococcus pyogenes, 2 beta-Streptococcus, 1 Gram-positive cocci, 5 Escherichia coli, 1 Enterobacter aerogenes, 7 Haemophilus influenzae, 2 Haemophilus parainfluenzae, 1 Branhamella catarrhalis, 1 Proteus mirabilis and 1 Salmonella subgenus I). Bacteriological eradication rates were 88.9% for Gram positive organisms, 66.7% for Gram-negative organisms and 74.1% overall. No superinfection was observed in any of patients treated. Side effects and clinical laboratory parameter abnormalities observed consisted of diarrhea in 7 (11.1%) of the 63 patients, eosinophilia in 2 (3.3%) of 61 tested, thrombocytosis in 3 (5.5%) of 55, elevation of direct bilirubin in 1 (3.3%) of 30, elevation of total bilirubin in 1 (3.1%) of 32, elevation of GOT in 4 (6.8%) of 59 and elevation of GPT in 1 (1.7%) of 59 patients tested. As an effect on the hemostatic mechanism of this drug, PIVKA II was detected in 1 patient (4.2%) of 24 tested, but findings of other coagulation tests were normal and none of patients showed bleeding tendency or inhibition of platelet aggregation. From the above results, it appears that SBT/ABPC is an efficacious and safe drug in the treatment of bacterial infections of pediatric patients. PMID- 2664250 TI - [Studies on sulbactam/ampicillin in the field of pediatrics]. AB - Pharmacokinetic and clinical studies on sulbactam/ampicillin (SBT/ABPC) were carried out in the field of pediatrics. 1. Absorption and excretion Serum levels and urinary excretion of SBT/ABPC were studied in 4 children with ages 6 to 8 years. The mean serum concentration of SBT at 15 minutes following a single intravenous injection of 30 mg/kg of SBT/ABPC was 27.4 +/- 2.2 micrograms/ml and that of ABPC was 42.8 +/- 3.9 micrograms/ml, and their concentrations declined with mean half-lives of 1.06 +/- 0.15 hours and 0.84 +/- 0.05 hour, respectively, and at 6 hours were 0.3 +/- 0.2 microgram/ml and 0.2 +/- 0.1 microgram/ml on the average, respectively. The urinary recovery rates of SBT and ABPC at 6 hours after the injection were 59.0 +/- 22.4% and 58.4 +/- 25.3% on the average, respectively. 2. Clinical study SBT/ABPC was used for the treatment of a total of 36 pediatric patients with ages ranging 2 months to 11 years and it's clinical effectiveness, bacteriological efficacy and adverse effects were evaluated. Clinical efficacies in 5 patients with acute purulent tonsillitis, 26 with acute pneumonia and 1 with acute pyelonephritis were judged to be excellent in 27 cases and good in 5 cases with an overall efficacy ratio of 100.0%. Clinical efficacies in 6 patients whose infections were caused by beta-lactamase producing strains were judged to be excellent in all cases. Bacteriological efficacies of SBT/ABPC were assessed on 1 strain of Staphylococcus aureus (beta-lactamase producing strain), 2 strains of Streptococcus pneumoniae, 16 strains of Haemophilus influenzae (5 beta-lactamase producing strains and 11 non-beta-lactamase producing strains), 1 non-beta-lactamase strain of Haemophilus parainfluenzae and 2 strains of Escherichia coli (non-beta-lactamase producing strains). All strains except 1 strain of H. influenzae (beta-lactamase producing strain) which decreased in number were eradicated with a bacteriological eradication rate of 95.5%. Only 1 patient complained of diarrhea which was suspected to be related to the drug. No other side effect was reported. Elevations of GOT and GPT were observed in only 1 patient. The above results suggested that SBT/ABPC was a useful drug with preferable safety profile in the treatment for pediatric patients with infectious disease caused by beta-lactamase producing strains as well as those by non-beta-lactamase producing strains. PMID- 2664251 TI - [Clinical evaluation of sulbactam/ampicillin in children]. AB - Sulbactam/Ampicillin (SBT/ABPC), a combination at a fixed ratio of ABPC and SBT which is an irreversible inhibitor of beta-lactamase in a 2:1 ratio, was clinically evaluated for its efficacy and safety in 24 patients with ages from 5 month-old to 12 years old with bacterial infection. The results obtained are summarized as follows. 1. A pharmacokinetic study following 30 mg/kg SBT/ABPC administration by 30 minutes drip infusion or intravenous bolus injection showed that mean half-lives of SBT and ABPC were 48.9 minutes and 40.2 minutes, respectively, and mean urinary excretion rates of SBT and ABPC in the first 6 hours were 67.1% and 48.3%, respectively. 2. SBT/ABPC was administered to 14 patients with bronchopneumonia, 4 patients with tonsillitis, a patient each with acute upper respiratory infection, with submandibular lymphadenitis, with phlegmon, with enterocolitis, with pyelonephritis and with cystitis at a daily dosage of 88.2-133.3 mg/kg, divided into 3 or 4, by intravenous bolus injection or by 30 minutes drip infusion. Clinical responses of the 24 patients were as follows: excellent: 17 patients, good: 7 patients. The efficacy rate was 100%. 3. Neither clinical adverse reactions nor abnormal laboratory test values, except slight eosinophilia in a patient and an elevation of GOT, GPT in another were observed. 4. MICs of SBT/ABPC against 7 strong beta-lactamase producing strains isolated from some of the patients were as follows. MIC against a strain of Staphylococcus aureus was 3.13 micrograms/ml, MICs against 2 out of 5 strains of Branhamella catarrhalis were 0.10 microgram/ml and those of the remaining 3 strains were 0.20 microgram/ml. MIC against a strain of Haemophilus parainfluenzae was 3.13 micrograms/ml. 5. These data described above show that SBT/ABPC has excellent bactericidal capacity against beta-lactamase producing bacteria as well as beta-lactamase non-producing Gram-positive and negative bacteria and suggest that SBT/ABPC is a very useful antibiotic for pediatric patients. PMID- 2664252 TI - [Pharmacokinetic, bacteriological and clinical studies of sulbactam/ampicillin in pediatric patients]. AB - Plasma and urine concentrations of sulbactam (SBT) and ampicillin (ABPC) were determined following bolus administration of injectable SBT/ABPC combined in a fixed ratio of 1:2 to 6 pediatric patients, 3 at a dose of 30 mg/kg and the other 3 at 60 mg/kg. Clinical and bacteriological efficacies of SBT/ABPC were evaluated in a total of 65 patients composed of 45 cases with pneumonia, 3 cases each with bronchitis, urinary tract infections, staphylococcal scalded skin syndrome, purulent lymphadenitis, 2 cases each with tonsillitis, pleuropneumonia, phlegmon and 1 case each with pyothorax, submaxillitis. The dosage used was 101.2 mg/kg daily given in 3 or 4 divided doses (t.i.d. in 24 patients and q.i.d. in 41 patients) by bolus intravenous injection for 7 days on an average. Side effects and effects on clinical laboratory parameters were monitored in the 65 patients. The results of these evaluations are summarized as follows. 1. Mean serum concentrations of SBT and ABPC in 3 children each given an intravenous bolus injection of 30 mg/kg and other 3 each given 60 mg/kg reached peak levels at 5 minutes after administration with values of 49.8 and 90.3 micrograms/ml, respectively, for SBT and 99.8 and 189.7 micrograms/ml, respectively, for ABPC. The latter values were about twice as high as SBT, and both were dose-related. Mean half-lives were 0.889 hour for SBT and 0.857 hour for ABPC in the 30 mg/kg group and 0.882 hour for SBT and 0.834 hour of ABPC in the 60 mg/kg group, showing similarities between the 2 dosage groups as well as between SBT and ABPC. 2. Mean urine concentrations in the 2 groups mentioned above were the highest for both SBT and ABPC during the first 2 hours after administration, with values of 1,677 micrograms/ml for SBT and 2,730 micrograms/ml for ABPC in the 30 mg/kg group and 2,693 micrograms/ml and 3,623 micrograms/ml, respectively, in the 60 mg/kg group. Mean recovery rates in urine in the first 6 hours were 72.4% for SBT and 56.8% for ABPC in the low dosage group and 72.7% and 52.0%, respectively, in the high dosage group. In the 2 groups, the amounts of ABPC recovered were less than those of SBT. 3. Clinical efficacies of SBT/ABPC in 65 patients with various bacterial infections were excellent or good in 62 (95.4%) patients. 4. The bacteriological efficacy was evaluable with 10 patients. The pathogenic bacteria were eradicated in 9 patients and the efficacy rate was 90%.(ABSTRACT TRUNCATED AT 400 WORDS) PMID- 2664253 TI - [Therapeutic effects of imipenem/cilastatin sodium against severe infections in patients with hematopoietic disorders. Hanshin Infection Study Group]. AB - One hundred ninety-eight patients with severe infections associated with hematopoietic disorders were treated with imipenem/cilastatin sodium (IPM/CS), and the efficacy and safety of the drug were evaluated. The results obtained are summarized below. 1. Out of 182 patients in whom efficacies are evaluable, responses were excellent in 50 patients, good in 52, fair in 21 and poor in 59, and the efficacy rating was 56.0%. 2. The efficacy rating in 87 patients who had failed to respond to prior treatment with other antibiotics was 58.6%. 3. There were significant differences in efficacy ratings when patients were grouped according to differences the number of neutrophils after treatment, less than 100, 101 approximately 500 and over 501/mm3. 4. The eradication rate in 38 patients from whom causative organisms were isolated was 75.8%. 5. Out of 197 patients in whom the safety was evaluable, side effects were observed in 19 patients (9.6%) and abnormal laboratory test values in 15 (7.6%). PMID- 2664254 TI - [Pharmacokinetic and clinical evaluations of imipenem/cilastatin sodium in neonates and premature infants]. AB - Pharmacokinetic and clinical studies on imipenem/cilastatin sodium (IPM/CS), a beta-lactam antibiotic of the carbapenem class and its renal dehydropeptidase-I inhibitor in a 1:1 ratio, were performed in neonates, premature infants and an infant. IPM/CS was administered intravenously to 4 neonates and 5 premature infants at a dose level of 10 mg/kg. Plasma levels and urinary excretion of IPM and CS were determined in 2 neonates and 2 premature infants after 30-minute infusion, and in 2 neonates and 3 premature infants after 1-hour infusion. Plasma and cerebrospinal fluid (CSF) concentrations of IPM and CS were determined in 2 cases with purulent meningitis with ages of 2 and 26 days and 1 with purulent meningitis/bacteremia with an age of 4 days. The drug was administered to a total of 31 patients with ages between 0 and 30 days, consisting of neonates, premature infants and an infant (24 suffering with various bacterial infections, 5 treated for prophylaxis of infections and 2 treated for aseptic meningitis diagnosed at the completion of therapy) by intravenous drip infusion in a mean daily dose level of 50.1 mg/kg in 2 to 4 divided doses for 9 days on the average. Clinical efficacy, prophylactic effectiveness and bacteriological response of IPM/CS were evaluated in 29 cases. Adverse effects and abnormal laboratory test results were examined in 31 cases including 2 drop-out cases. The results obtained are summarized as follows. 1. Plasma concentrations of IPM and CS after 30-minute infusion of the drug reached their peaks at the end of administration, and obtained values were 22.4 to 29.0 micrograms/ml for IPM and 26.3 to 34.6 micrograms/ml for CS, thus peak plasma levels of CS were a little higher than IPM. Plasma half-lives of IPM were 1.05 to 2.43 hours, and those of CS were 1.24 to 4.76 hours, and the half-life of CS tended to be longer than that of IPM. Drug concentrations in plasma after 1-hour infusion of IPM/CS reached their peaks at the end of administration and the levels of CS (25.7 to 32.0 micrograms/ml) were a little higher than those of IPM (20.8 to 23.9 micrograms/ml). Plasma half-lives of IPM were 1.40 to 1.63 hours, whereas those of CS were 1.51 to 2.90 hours. The half-life of CS tended to be longer than IPM. 2.(ABSTRACT TRUNCATED AT 400 WORDS) PMID- 2664255 TI - [Susceptibilities of clinical isolates to antibacterial agents. A study mainly focused on ofloxacin (the second report). Reported by the Research Group for Testing ofloxacin Susceptibility on Clinical Isolates]. AB - Susceptibilities of various clinical isolates to ofloxacin (OFLX) and other antibacterial drugs were examined at 128 hospital laboratories in 36 prefectures throughout Japan between April, 1986 and March, 1987. The results were totalized with an emphasis mainly on OFLX and were compared with data obtained in the previous year. In this study, identification and susceptibility tests of the isolates were carried out at each hospital laboratory and the tests were performed according to the 1-dilution or 3-dilution disc method in which susceptibilities are classified into 4 grades: , ++, +, and -. Similarly to the study performed in the previous year, species showing susceptibilities to OFLX included Staphylococcus aureus (4,205 strains), Staphylococcus epidermidis (2,009 strains), Entercoccus faecalis (1,697 strains), Streptococcus pneumoniae (702 strains), Escherichia coli (4,097 strains), Klebsiella pneumoniae (1,375 strains), Enterobacter cloacae (762 strains), Enterobacter aerogenes (296 strains), Citrobacter freundii (406 strains), Proteus mirabilis (613 strains), Morganella morganii (320 strains), Serratia marcescens (869 strains), Haemophilus influenzae (1,282 strains), Pseudomonas aeruginosa (4,206 strains), Acinetobacter calcoaceticus (351 strains), Acinetobacter sp. (415 strains), and Campylobacter jejuni (151 strains). Neisseria gonorrhoeae (26 strains) were exceptional due to their smaller number this time than that of the previous year and only the susceptibility to OFLX was investigated with this species. As results, OFLX showed strong antibacterial activities (similar to the previous year) against S. aureus, S. epidermidis, N. gonorrhoeae, E. coli, K. pneumoniae, E. cloacae, E. aerogenes, C. freundii, P. mirabilis, M. morganii, H. influenzae, A. calcoaceticus, Acinetobacter sp., and C. jejuni. However, when these susceptibilities shown in the present study were compared to those obtained in the previous year, many species showed decreases in the occurrence of or increases in -, though they were rather small changes. The following species were not totalized in the previous year due to their low numbers but were summarized in combination with those examined in this study: Streptococcus pyogenes (944 strains), Streptococcus agalactiae (815 strains), Enterococcus faecium (146 strains), Branhamella catarrhalis (135 strains), Citrobacter diversus (128 strains), Klebsiella oxytoca (873 strains), Proteus vulgaris (438 strains), Serratia liquefaciens (266 strains), Pseudomonas cepacia (433 strains), Pseudomonas putida (154 strains), Xanthomonas maltophilia (272 strains), Vibrio parahaemolyticus (120 strains), Bacteroides fragilis (98 strains), PMID- 2664256 TI - [Pharmacokinetic and clinical studies on cefodizime in the pediatric field. Pediatric Study Group of Cefodizime]. AB - A multi-center open study was conducted to investigate cefodizime (CDZM), a newly developed cephem antibiotic, from pharmacokinetic, bacteriological and clinical aspects, in the pediatric field with the participation of 17 institutions and their related facilities. The results are summarized as follows: 1. Serum concentrations and urinary excretion: The pharmacokinetics in pediatric patients was investigated with a dose of 20 mg/kg, via a bolus intravenous injection or intravenous drip infusion over 30 or 60 minutes. The results were nearly the same as those in adult patients. Mean serum concentrations 5 minutes after a bolus intravenous injections were: 105.5, 264.0 and 461.7 micrograms/ml with 10, 20 and 40 mg/kg, respectively, and T 1/2 (beta)'s for the 3 dosages were 1.75, 1.92 and 1.88 hours, respectively. With 30-minute intravenous drip infusion, mean serum concentrations at the end of infusion were: 90.5 micrograms/ml with a dose level of 10 mg/kg, 178.3 micrograms/ml with 20 mg/kg, and 322.8 micrograms/ml with 40 mg/kg, and T 1/2 (beta)'s for these dosages were 1.90, 2.15 and 1.93 hours, respectively. With 60-minute intravenous drip infusion, mean serum concentrations at the end of infusion were: 66.3 micrograms/ml with a dose level of 10 mg/kg, 136.0 micrograms/ml with 20 mg/kg and 259.2 micrograms/ml with 40 mg/kg, and T 1/2 (beta)'s for these dosages were 1.43, 2.05 and 1.46 hours, respectively. In 8 hours after administration of CDZM, urinary excretion rates were 82.1, 77.7 and 76.5% for bolus intravenous injections of 10 mg/kg, 20 mg/kg and 40 mg/kg, respectively, and 83.3, 71.3 and 68.1% for 30-minute intravenous drip infusions of 10 mg/kg, 20 mg/kg and 40 mg/kg, and 84.4 and 84.3% for 60-minute intravenous drip infusions of 20 mg/kg and 40 mg/kg, respectively. 2. Concentrations in cerebrospinal fluid: Penetrations into cerebrospinal fluid in patients with purulent meningitis reached levels of 1.96-9.48 micrograms/ml with administration of CDZM at 50 mg/kg in acute cases within 6 days after onset. The penetration rates of CDZM were about a median range among injectable beta-lactam agents. 3. CLINICAL RESULTS: Of 457 cases treated with CDZM, 53 cases were excluded from the clinical evaluation. Clinical efficacies were evaluated as "excellent" in 126 and "good" in 78 out of 221 case from which causative agents were isolated, with an efficacy rate of 92.3%. Efficacies were "excellent" in 97 and "good" in 69 out of 183 cases from which pathogens were not isolated giving an efficacy rate of 90.7%.(ABSTRACT TRUNCATED AT 400 WORDS) PMID- 2664257 TI - [Clinical effectiveness of cefoperazone for respiratory infections of elderly patients, focusing on its safety on renal function]. AB - Clinical effectiveness of cefoperazone (CPZ) was studied for 46 elderly patients with respiratory infections. 1. Clinical efficacy rate of CPZ was 80.6% (29/36). 2. Adverse reactions occurred in 2 patients as systemic rush and fever. Laboratory abnormalities were observed in 5 patients. These included elevation of transaminase value. 3. The serum concentration of CPZ at 12 hours after administration of 2 g CPZ was not reflected in creatinine clearance and total bilirubin, and those 2 values appeared to have little effects on CPZ excretion. 4. The administration of CPZ at 4 g/day for less than 3 weeks had no effects on the renal function. As a result of this study, CPZ was found to have little undesirable effect on renal functions and to be a useful drug for the treatment of respiratory infections in elderly patients. PMID- 2664258 TI - [Clinical evaluation of roxithromycin in odontogenic infection]. AB - The clinical effectiveness and safety of roxithromycin (RU 28965, RU), a new macrolide antibiotic, were compared with those of josamycin (JM) using a double blind method in the treatment of orofacial odontogenic infections. The diseases covered in this study were periodontal infections, pericoronal infections and osteitis of jaws. Drugs were administered for 3 to 7 days at daily doses of 300 mg (RU) and 1,200 mg (JM). A total of 270 cases was evaluated in this study. Results obtained are summarized as follows: 1. The clinical efficacy was evaluated through the judgement of doctors in charge of 247 cases (128 in the RU group and 119 in the JM group) and by a committee on the 3rd day of treatment in 243 cases (126 in the RU group and 117 in the JM group). Clinical efficacy rates according to the committee judgement were 78.6% for the RU group and 82.1% for the JM group. As for the evaluation through the doctors' judgement, they were 79.7% for the RU group and 73.1% for the JM group. There was no significant difference in clinical effectiveness between 2 groups according to these 2 methods of judgement. 2. Some side effects were observed in 4 cases (2.9% out of 136) treated with RU and in 3 cases (2.4% out of 126) treated with JM. No severe symptoms were observed. Abnormal changes in laboratory test values were noted among 7.9% in the RU group and 4.0% in the JM group. There were no significant differences in their safety between the 2 groups. 3. In terms of clinical usefulness, there were no significant differences between the 2 groups as well. From these results, it has been concluded that RU (daily dose 300 mg) is as effective as JM (daily dose 1,200 mg) in the treatment of orofacial odontogenic infections. PMID- 2664259 TI - [Studies on lipid A, the active center of endotoxin--structure-activity relationship]. PMID- 2664260 TI - [A case of superficial esophageal cancer with an intramural metastasis to the gastric wall]. AB - Reported is a case of 61-year-old man with a superficial esophageal cancer that was associated with an intramural metastasis to the stomach. Examination of the upper G.I. tract revealed a slightly elevated lesion with an irregular surface at the left wall of the lower esophagus, and a large submucosal tumor with an ulcerous formation that had developed and had increased rapidly within a month. Thus a resection of the lower esophagus and a total gastrectomy were performed. Histopathologically, the tumor of the lower esophagus was determined as being a moderately differentiated squamous cell carcinoma with a deep invasion to the submucosal tissue. The submucosal tumor of the stomach also was found to be a moderately differentiated squamous carcinoma. Neither provided evidence, however, of a direct involvement of the gastric serosa may have metastasized from the neighboring lymph nodes or from other organs, nor of any continuous mucosal metastasis between the primary lesion of the esophagus and the submucosal tumor of the stomach. Judging from these findings, the case was diagnosed as an esophageal cancer with an intramural metastasis to the stomach. PMID- 2664261 TI - [Prolonged thrombocytopenia after autologous bone marrow transplantation]. AB - Thirty two patients with hematologic malignancies and solid tumors were treated with intensive therapy and autologous bone marrow transplantation. In nine out of 32 patients, it took more than 50 days to achieve a sustained platelet count of 50,000/microliter or greater. Significant associations with poor platelet recovery were found for patient age, diseases, period of cryopreservation, the kinds of eradicative therapy and in vitro purging. But most of these factors overlapped each other in the same patients. No correlation was found between platelet recovery and number of cells or CFU-GM infused. PMID- 2664262 TI - [Aggressive natural killer cell leukemia/lymphoma--possible existence of a new clinical entity originating from the third lineage of lymphoid cells]. AB - The morphologic, immunologic, genotypic, and functional properties of peripheral blood and bone marrow cells or cultured cells from two patients with a clinically aggressive non T, non B natural killer cell lymphoma/leukemia (ANKL/L) were described. The leukemic cells possessed medium to large granules in the cytoplasm, antigens against CD 38, CD 2, OKIal, and NKH-1 (N 901) monoclonal antibodies on their cell-surface, and also showed a high natural killer (NK) activity. In addition, these ANKL/L belonged to neither T-nor B-cell lineage, proved by studying clonal gene rearrangement for the T beta and T gamma receptor, and immunoglobulin. After we compared and investigated them with 9 cases of ANKL/L reported in other institutions, concerning immunophenotype, genotype and function, we reached the conclusion that the existence of ANKL/L originating from the third lineage in lymphoid cells is an obvious fact, suggesting this new clinical entity. It is important that all patients who have this type of a clinical disorder be diagnosed that there is no effective form of therapy at present. PMID- 2664263 TI - [Spontaneous transient remission in adult acute myeloid leukemia]. AB - A spontaneous complete remission for one month duration was observed in a 54-year old female with acute myeloid leukemia. She had no documentation of apparent infection and blood transfusions, although they were ordinarily associated with spontaneous remission. PMID- 2664264 TI - [An autopsy case of primary cutaneous plasmacytoma]. AB - An autopsy case of primary cutaneous plasmacytoma with very unusual extensive skin involvement resulting in death 9 months later, was reported. A 75-year-old female was admitted to our hospital in November, 1985 because of an enlarging skin nodule on the right neck of 5 month's duration. The nodule was a 5 x 7 x 4 cm, firm and mobile mass. Light- and electron-microscopic studies of its biopsy specimen revealed a cutaneous plasmacytoma which was composed of dense aggregates of plasma cells. Cytogenic study on the biopsy specimen revealed hypotetraploid and structural abnormalities such as 7q+, 11q+ and 20q+. After radiotherapy, the right neck nodule became smaller, but subcutaneous indurations with erosions extended to the surrounding skin. The biopsy specimen of these skin lesions microscopically revealed massive infiltrations of plasma cells in the dermis. The PAP method revealed a definite evidence of monoclonal kappa light chain production by these cells. 3H-thymidine were incorporated in 5.6% of the plasma cells. The skin lesions were refractory to chemotherapy and gradually extended. The clinical course showed a progressive one leading to persistent deterioration and she died in August, 1986. Repeated examinations including immunoelectrophoresis of serum and concentrated urine, bone marrow aspirations and skeletal x-ray films, excluded the diagnosis of myeloma. At autopsy, massive infiltrations of plasma cells in the skin of chest wall and neck, small metastatic tumors in the liver and bilateral axillary lymph nodes were found, but there was no evidence of bone marrow involvement. PMID- 2664265 TI - [Prostanoid metabolism and its regulatory mechanisms in platelets and endothelial cells]. PMID- 2664266 TI - [Molecular marker for hemostasis and thrombosis]. PMID- 2664267 TI - [Thromboxane synthetase inhibitor and prostacyclin analogue]. PMID- 2664268 TI - [Cytokines with suppressive function on immune responses]. PMID- 2664269 TI - [Diagnostic ability of ultrasonography for very small cancer]. PMID- 2664270 TI - [Gene diagnosis of early-stage cancers]. PMID- 2664271 TI - [Recent advances in endoscopic diagnosis and treatment of early gastric cancer]. PMID- 2664272 TI - [Definition, diagnosis and treatment of early pancreatic cancer]. PMID- 2664273 TI - [Definition, diagnosis and treatment of breast cancers]. PMID- 2664274 TI - [Detection and diagnosis of bladder cancer in the early stage]. PMID- 2664275 TI - [Definition, diagnosis and treatment of prostatic carcinomas at an early stage]. PMID- 2664276 TI - [Definition, diagnosis and treatment of preleukemic syndrome]. PMID- 2664277 TI - [Trends in research and development of drug delivery systems]. PMID- 2664278 TI - [Imaging diagnosis of early cancer: prospect and problems of present investigation]. PMID- 2664279 TI - [Molecular markers of hemostatic mechanisms--fibrinopeptide B beta 1-42]. PMID- 2664280 TI - [Molecular markers of hemostatic mechanisms--FDP-D Dimer]. PMID- 2664281 TI - [Molecular markers of hemostatic mechanisms--thrombin-antithrombin III complex]. PMID- 2664282 TI - [Retrospective glance on our studies made in clinical chemistry for the past 40 years]. PMID- 2664283 TI - [Evaluation of the confirmatory test by western blotting assay (WB) for the detection of antibodies to adult T-cell leukemia virus type I. Analysis of the discrepancy between indirect immunofluorescence assay (IF), enzyme immunoassay (EIA) and gelatin particle agglutination assay (PA)]. PMID- 2664284 TI - [The history of radiotherapy of breast cancer]. AB - Radiotherapy has come to be an important resource in the treatment of breast cancer. After the discovery of X-ray in 1985, postoperative irradiation has been important in selected patients who have undergone mastectomy and locoregional irradiation for postoperative recurrence has proved to be beneficial. Although histology of the breast cancer is adenocarcinoma, it is radiosensitive. The role of radiotherapy has shifted from surgical adjuvant therapy to definitive management in an effort to preserve esthetics and function. PMID- 2664285 TI - [Present situation and research trends of morphological diagnosis of colorectal cancer]. PMID- 2664286 TI - [Diagnosis of the infiltrating depth of the colonic cancer by endoscopic ultrasonography (EUS)]. AB - Endoscopic ultrasonography (EUS) is the latest procedure in the field of gastroenterology and is highly evaulating now because of its unique diagnosing method. For the example, the intra- and extra-mural informations of the GI tract can be known through this technique. In this paper, we reported on the usefulness of EUS in the diagnosis of the depth invasion of the colonic cancer and introduced the new and exclusive instrument for the colon. Namely, we could obtain the accurate diagnosis in 18 out of 20 cases with the rectal or the sigmoid colon cancer. One of causes of misdiagnosis in 2 cases of early cancer was due to the ghost echo. Another cause was the cancer cells infiltration to the deeper tissue which could be recognized only by a microscope. Then, we tried to examine the entire colon in 2 cases using the new instrument and succeeded to insert the endoscope to the cecum in a short time. In conclusion, we were convinced that EUS would develop the new aspect in the diagnosis of the colonic diseases including cancer. PMID- 2664287 TI - [Studies of diagnosis of rectal cancer using MRI, CT and intrarectal ultrasonography]. AB - Examination using MRI, CT and Intrarectal Ultrasonography (US) were performed in 186 patients with primary rectal cancer and 127 postoperative cases, in order to diagnose the depth of invasion, lymph node metastases and local recurrence. In the diagnosis of depth of invasion, intrarectal US was superior to MRI and CT for detailed diagnosis, and MRI was the best examination modality for detecting infiltration of other organs. Also, these were available for the diagnosis of lymph node metastases, and intrarectal US was superior to MRI and CT for detecting small lymph nodes. In the detection of local recurrence, MRI, CT guided biopsy and intrarectal US were useful, especially MRI was the best examination for the decision of re-resection. PMID- 2664288 TI - [Ultrasonic evaluation of two cases of primary lymphoma of the intestine]. AB - Two cases of primary malignant lymphoma of the intestine were examined by ultrasonography. In the first case, the lymphoma originated from the terminal ileum and caused intussusception. The tumor was significantly hypoechoic. In the second case, the tumor showed pseudokidney sign. The echo level of the tumor was low and the size of the tumor was over 10 cm. PMID- 2664289 TI - [Successful treatment of autoimmune bullous diseases with a combination therapy of ciclosporin and corticosteroid]. AB - Three patients with autoimmune bullous diseases, pemphigus vulgaris, pemphigus foliaceus and bullous pemphigoid, were treated with a combination therapy of ciclosporin and corticosteroid. These patients responded to systemic low-dose prednisolone (or dexamethasone) and low-dose ciclosporin therapy; the result was prolonged complete remission. The addition of low-dose ciclosporin may produce enhanced clinical effects of steroid therapy without increasing any significant side effects. PMID- 2664290 TI - [Immunohistochemical analysis of extracellular components on the glomerular sclerosis in patients with glomerulonephritis and diabetic nephropathy]. AB - Immunofluorescence and immunoperoxidase staining were carried out to determine the correlations between the progression of glomerular sclerosis and changes in the amount and distribution of glomerular extracellular components, such as Type I, III, IV, V, VI collagen, laminin (LN) and fibronectin (FN) in patients with various types of glomerulonephritis and diabetic nephropathy. Six patients with IgA nephropathy, four patients with membrano-proliferative glomerulonephritis, four patients with rapidly progressive glomerulonephritis and six patients with diabetic nephropathy were examined. The intensity and distribution of Type IV collagen, LN and FN were similar between the glomeruli from normal individuals and patients with mild stages of glomerulonephritis and diabetic nephropathy. However, staining of Type I, III or V collagen was not observed in the glomeruli from normal individuals and such patients. In more advanced stages of glomerulonephritis and diabetic nephropathy, the amounts of Types IV and VI collagen, LN and FN were increased markedly in the mesangium, and their distribution extended along the glomerular capillary walls. The intensity of Type IV collagen, LN or FN in the nodular sclerotic lesions of glomeruli was decreased significantly in patients with glomerulonephritis and diabetic nephropathy. On the other hand, staining of Types I, III and V collagen was observed focally in the sclerotic or hyalinotic glomeruli and around such glomeruli in these patients. In light microscopic examinations, the patients who had marked staining of Type I, III or V collagen by immunofluorescence showed severe damage of the basement membrane in Bowman's capsules. It is concluded that hyperproduction and/or infiltration of interstitial collagens, i.e. Types I, III and V collagen, is closely linked to the progression of glomerular sclerosis and hyalinosis in patients with various types of glomerulonephritis and diabetic nephropathy. PMID- 2664291 TI - [Profile of a nurse. Ms. Kimiko Suzuki, who established a nursing scholarship for the promotion of nursing research in China]. PMID- 2664292 TI - [Hemagglutinating activity of Escherichia coli isolated from the respiratory tract in comparison with those isolated from urine feces and blood]. AB - Various bacteria with pili are able to agglutinate human and animal red blood cells. Hemagglutinating activity of 131 strains of Escherichia coli isolated from respiratory tract (24 strains), urine (64 strains), feces (36 strains) and blood (7 strains) were tested using human type A, guinea pig, bovine and chicken erythrocytes. Concerning the hemagglutination activity for erythrocytes from at least one of four species (human, guinea pig, bovine, chicken), the strains isolated from respiratory tract showed a higher level than those isolated from feces (p less than 0.01) or those isolated from blood (p less than 0.1). Agglutination of human erythrocytes: Of 131 strains, mannose-sensitive agglutination was observed in 31 strains, mannose-resistant agglutination in 40 strains and non-agglutination in 60 strains. More agglutinated strains were isolated from the respiratory tract than those isolated from blood but not with statistical significance (p less than 0.1). Agglutination of guinea pig erythrocytes: Of 131 strains, mannose-sensitive agglutination was observed in 56 strains, mannose-resistant agglutination in 10 strains and non-agglutination in 65 strains. More agglutinated strains were isolated from the respiratory tract than from urine, feces and blood (p less than 0.01), and of those, 89% were mannose-sensitive agglutination. Agglutination of bovine erythrocytes: Of the 131 strains, mannose-sensitive agglutination was observed in 4 strains, mannose resistant agglutination in 6 strains and non-agglutination in 121 strains. Therefore, only a few agglutinated strains were seen.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 2664293 TI - [Cancer of the urinary bladder: current concepts and future]. AB - Recent research trends on carcinoma of the bladder with special references to the current concepts of its pathogenesis, the basic problems on its diagnosis and treatment were reviewed and discussed. 1) The transitional epithelium as the origin of transitional cell carcinoma (TCC) is understandable as an intermediate of squamous and glandular epithelium and the biology on the basal cells is seemed to be the most interesting. 2) Multistage carcinogenesis theory is adapted in the carcinoma of the urinary bladder and the research will be directed to clarify mechanisms to maintain the dormant cell in the state and to develop new technology for quantitative analysis of its promoters and antipromoters. 3) Grading of TCC by the conventional histology is not adequate in the future that new objective criteria to evaluate the structural atypia is expected other than the current DNA analysis by flow cytometry. 4) Endoscopy for diagnosis of the bladder carcinoma should be available to observe whole urinary system and the recorded images should be analyzed by the objective method developed by new technology. 5) New direction of the treatment of the bladder carcinoma will be headed to find a BRM as an antipromoters in the short range strategy. PMID- 2664294 TI - [Infectious diseases in kidney transplant recipients treated with cyclosporin]. AB - Cyclosporin (CYA) is now recognized as an effective immunosuppressant to lead to a marked improvement in graft survival in organ transplant recipients. Although the incidence of infection in the CYA group has been decreased compared with that in the azathioprine group, infectious diseases in 400 kidney transplant recipients treated with CYA were noted in our single center. Treatment strategy for infectious diseases: Antibiotics and/or gamma-Globulin were administered to all recipients with bacterial infections. Aciclovir was added in recipients with herpes simplex virus (HSV) infection or varicella zoster virus (VZV) infection. Human interferon-beta (HuIFN-beta) was used in recipients who had life threatening viral infection, especially cytomegalovirus (CMV) pneumonitis. Glycyrrhizin was used for acute hemorrhagic cystitis and nephropathy due to adenovirus (AV). Trimethoprim sulfamethoxazole and/or pentamidine were added in recipients complicated with Pneumocystis carinii (Pc) pneumonitis or in order to prevent Pc pneumonitis. Infectious diseases: One hundred and six recipients had infectious diseases 129 times in this series, seventy-six percent of all infections occurred during the first 4 months after the transplantation. Urinary tract infection (UTI), herpes zoster and pulmonary infection were the most common infectious diseases, occurring in 28.7%, 24.0% and 23.2%, respectively. Septicemia or bacteremia developed in 9 recipients, secondary to UTI in 8 and to surgical wound infection in one. Sixty-one symptomatic viral infections occurred in 57 recipients. A total of 5 recipients (1.3%) died of interstitial pneumonitis. Infectious organisms: Viral and bacterial infections were most common, occurring in 47.3% and 41.9%, respectively. Viral species detected in these recipients with the frequency were HSV 14 times, CMV 9 times, VZV 31 times and AV 7 times. 1) The incidence of viral infections in kidney transplant recipients treated with CYA is relatively high compared to bacterial infections. 2) HuIFN-beta therapy is effective in the treatment of serious opportunistic herpes virus infections, especially CMV pneumonitis. 3) Glycyrrhizin therapy is effective in the treatment of acute hemorrhagic cystitis and nephropathy due to AV and hepatic dysfunction. 4) Aerosolised pentamidine therapy is very useful for prophylaxis of Pc pneumonitis. PMID- 2664295 TI - [Emphysematous pyelonephritis a case report and review of the literature- comparative study with Japan and other countries]. AB - A 36-year-old woman with diabetes mellitus complained of left flank pain and high fever. Drip infusion pyelogram (DIP) did not visualize the left kidney, but revealed crescent-shaped gas formation within the left renal shadow. Abdominal computerized tomography showed a subcapsular shadow in the left kidney. Because her symptoms was aggravated, left nephrectomy was performed under the diagnosis of emphysematous pyelonephritis. There was no manifestation of her prior symptoms after the operation, and she was discharged on the 19th postoperative day. In Japan, 43 cases of emphysematous pyelonephritis have been reported in the literature. These 43 cases were studied clinically and in comparison to the cases reported in Western countries. The male-to-female ratio was approximately 4 to 1, in contrast to the Western ratio of female preponderance. The age of the patients showed its peak at the 50-60's, the mean age being not significantly different from that of Western patients. 37% of the patients had the affected side on the right, 56% on the left, and 7% bilaterally. This was comparable to the results of Western countries. 93% of the subjects suffered from diabetes mellitus as the basal malady, which was comparable to that in Western studies. However, patients afflicted with urinary passage impairment accounted for 14%. This incidence was lower than that reported in Western studies.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 2664296 TI - [Study on nephrotoxicity in rats receiving cis-diammine-1,1-cyclobutane dicarboxylate platinum II--special reference to morphological changes]. AB - Nephrotoxic effects of cis-Diammine-1,1-cyclobutane dicarboxylate platinum II (CBDCA) were investigated in male 6 weeks old Wistar rats. The animals were divided into 4 groups: Group I (each received a single intraperitoneal injection of CBDCA 80, 120 mg/kg); Group II (a single intraperitoneal injection of CBDCA 80, 120 mg/kg after withdrawal of food and water for 2 days); Group III (intravenous administration of CBDCA 15, 30 mg/kg for 7 consecutive days after withdrawal of food and water for 2 days); Group IV (controls). Rats from each group were sacrificed at 3, 7, 10 and 14 days following the start of the experiment. Serum levels of BUN and creatinine were then measured and renal histopathological examination was conducted by light and electron microscopy. In addition, the total platinum concentration in the serum was measured in Group I, and X-ray microanalysis was performed after intraperitoneal administration of CBDCA (100 mg/kg) and cis-Diamminedichloroplatinum (II) (CDDP) (6 mg/kg) for 2 consecutive days (Group V). The results showed increased levels of BUN in each group due to catabolism. No significant increase in serum creatinine was observed and there appeared to be no evidence of renal dysfunction. For all groups, localized vacuolar degeneration in the epithelial cells of the tubules was predominantly apparent. Electron microscopy revealed only degeneration of the epithelium mainly in the proximal tubules and also showed reabsorption of platinum from the lumen of the tubules.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 2664297 TI - [Case report of primary carcinoma in situ in upper urinary tract and review of the Japanese literature]. AB - A case of carcinoma in situ (CIS) in the right renal pelvis in a 71-year-old women is reported. The patient was admitted because of macroscopic hematuria. Drip infusion pyelography showed a filling defect (coagulum) in the right renal pelvis. Other abnormal findings were not made. Malignancy was suspected by cytology examination in both voiding urine and that obtained by catheter from the right pelvis. A right total nephroureterectomy was performed. Macroscopic abnormal findings were only of the coagulum in the renal pelvis. Pathologic examination showed CIS in the renal pelvis. We studied the features, pattern of recurrence, and prognosis of 19 cases of primary CIS in the upper urinary tract in the Japanese literature. A slight higher frequency was reported for women than for men. When the CIS was in the ureter, abnormal roentgenological findings, such as stenosis, filling defects, or a dilated ureter, were common (77%), contrary to expectation. But when the CIS was in the pelvis, such findings were rare. Urine cytology examination was positive in 95% of the patients. In four of the 19 patients, a recurrence was found. In all four patients, the first recurrence was in the bladder within 2 years of surgery. The kind of recurrent bladder tumors varied with the patients. The prognosis with recurrence was poor. If signs of recurrence were not recognized within 2 years of surgery, the prognosis was good. PMID- 2664299 TI - Writing for the Journal: it's not who you know, but what you know. PMID- 2664298 TI - [Treatment of suture-thread stones in the kidney by percutaneous nephrolithotripsy. Report of a case]. AB - Percutaneous nephrolithotripsy was performed successfully to the stones in the left kidney, in which pyelolithotomy had been done three years earlier. There were foreign body stones with silk sutures used in the previous surgery as the nuclei. All the stones were removed, and a stricture in the renal pelvis was liberated endoscopically. No reports of endoscopic management to foreign body stones in a kidney are found in the Japanese literature. A few ways of the treatment are discussed. PMID- 2664300 TI - Emergency nursing interventions with battered women. PMID- 2664301 TI - A comparison of teaching methods for ED discharge instruction after head injury. AB - Combined teaching methods may improve recall and comprehension of discharge instructions. It is not clear from the study whether improved recall and comprehension resulted in better compliance. However, complications from head injuries, although rare, can be life threatening. Therefore it is recommended that emergency nurses present all instructions to the patient (or person accompanying the patient) by reviewing and explaining all medical terms and directions that the person must understand and follow. If additional time is available or the person does not appear to understand the instructions, reinforcement of content should be provided. It also is recommended that discharge instructions be written at a fifth-grade reading level, avoiding technical and medical terms. With research, emergency nurses can develop and evaluate effective and efficient teaching/learning strategies. PMID- 2664302 TI - Current trends in ED nursing shortage: 1988 ENA survey results. PMID- 2664303 TI - COBRA legislation: complying with ED provisions. Consolidated Omnibus Budget Reconciliation Act of 1985. AB - With the passage of the COBRA transfer provisions, Congress has put hospitals on notice that patient dumping will no longer be tolerated. It is incumbent on hospitals to provide thorough guidelines of the COBRA requirements to its medical and nursing staff. The wise hospital administrator will ensure that comprehensive transfer procedures will be put into effect that are in accord with the COBRA provisions. Financial triage of patients in the emergency department could prove to be a costly problem for the hospital that misses an emergency condition. PMID- 2664304 TI - Noninvasive monitoring of oxygenation with pulse oximetry. PMID- 2664305 TI - Moving forward with vision and unity. PMID- 2664306 TI - Common ocular injuries and disorders. Part I: Acute loss of vision. PMID- 2664308 TI - California EMSC project establishes guidelines for rural pediatric emergency care. PMID- 2664307 TI - Common ocular injuries and disorders. Part II: Red eye. PMID- 2664309 TI - Battered women handout and referral card. PMID- 2664311 TI - Red ribbons in Texas. PMID- 2664312 TI - Opposite sex stand-in nurses. PMID- 2664310 TI - Evaluation of an ATLS track for nurses. PMID- 2664313 TI - Emergency nursing in Oman. PMID- 2664314 TI - Common errors in emergency management of patients transferred for replantation. PMID- 2664315 TI - Sleeping beauty: a case of pickwickian syndrome. AB - The patient arriving at the emergency department with somnolence must be evaluated quickly, efficiently, and with a definite goal in mind. Head and neck trauma should always be suspected and protective steps taken in the unconscious patient. The coma mnemonic, AEIOU TIPS, (alcohol, epilepsy, insulin, overdose, uremia, trauma, infection, psychiatric, stroke) provides an excellent memory tool for the evaluation of decreased level of consciousness in the emergency setting. Interventions that provide diagnostic and therapeutic results (naloxone and 50% dextrose) should be initiated immediately while blood samples are drawn for pretreatment documentation. Each of the possible causes of lethargy or somnolence needs to be evaluated with the understanding that a multitude of factors may be present in the patient whose condition precludes a thorough history; the depressed diabetic may have taken an overdose of medications in addition to his insulin. Social preconceptions may also effect the outcome. The intoxicated patient described herein was allowed to "sleep it off" in the emergency department under the watchful eyes (and ears) of a nursing staff who faithfully recorded vital signs and pupil reactivity as the patient's blood gas values deteriorated. PMID- 2664316 TI - Venomous snake bites in Kansas. PMID- 2664317 TI - [Sudden and unexpected infant death]. AB - SIDS is a topical problem in pediatrics. The cause of SIDS is still unknown. The paper considers different possible pathomechanisms and on the basis of different observations a variety of hypotheses: There is the apnoe hypothesis, the sleep hypothesis, the QT-hypothesis, the arousal hypothesis and the functional deficit primarily concerning the reticular formation of the brainstem. Therefore there is an urgent need for screening programms to find out children at risk of SIDS. Finally, aspects of prophylaxis and treatment in case of recognized risk are discussed. PMID- 2664318 TI - [Contribution of the pediatrician in the early diagnosis of eye diseases]. AB - In the 1st part, the conditions for the coordinated use of both eyes are described. Strabism continues to be the major reason for disorders of binocular vision. Particularly, causes, simple diagnostic procedures and therapy of infantile squint (soncomitant strabismus) and of paretic squint are reported in detail. Further, ocular nystagmus as ocular symptom of diverse motor and sensorial disturbances is classified and described. Finally, the most important forms of congenital, myogenic, senile, traumatic and neurological ptosis are presented and the time of therapeutic approach is fixed. PMID- 2664319 TI - [Sonography in the diagnosis of Hodgkin's disease in childhood and adolescence]. AB - We are reporting about the results of the staging by ultrasound in 11 children with Hodgkin's disease. Sonography stands the test as a method that reliably predicts abdominal involvement in patients with Hodgkin lymphoma. Only in a few cases an indication for an additional computerized tomography is given. A demonstration of typical ultrasonic findings takes place. PMID- 2664320 TI - [Physiologic principles of studying visual functions]. AB - The retinal coding system for visual information comprises three important steps: 1) hyper- and depolarization of the sensory cells as the active basis for perception of light and dark; 2) reaction solely to changes in the bipolar cell on/off system, as a consequence of the action of the horizontal cells with the receptive fields, as a basis for adaptation to brightness and glare; and 3), under the influence of the amacrine cells, important time-space functions as a basis for visual perception of movement. The signal form, which changes over from analog to digital in the ganglion cell system, also results from this last step. therefore, both latencies and amplitudes (VEP) are important criteria for long signal response paths. Taking the examples of "statistical perimetry", visual acuity testing, and examination of contrast sensitivity, clinically relevant methodological problems from signal detection theory are illustrated: there are no "certain" measured values. This uncertainty and the age-dependence of normal values make it difficult to identify pathologic conditions, though trend analyses can help. As the sizes of the retinal areas examined by these methods differ so widely, correlations between the various examination methods are theoretically possible; but one method can never be substituted by another. In routine practice, to detect pathology early, one will sometimes deviate from the prescribed examination method (vision tests with low contrast for visual acuity). PMID- 2664321 TI - [Principles of modern determination of refraction]. AB - Electronic data processing systems are being used increasingly to support traditional ophthalmological and optical examination methods. Although the accuracy of the instruments has not increased substantially as a result, measurements have become far easier to perform and examination times have been reduced. The patient is thus subjected to a minimum of stress. The time saved should be used, e.g., for a personal conversation with the patient. PMID- 2664322 TI - [Examination of central vision. Visual acuity, contrast sensitivity, color vision]. AB - In the neurophysiological organization of the visual system, form, color, movement, and depth perception are processed separately. Therefore, sensorial examination methods should test each of these basic functions separately, since they may be affected individually or to different extents by pathologic processes. For diagnosis the limit of visual acuity, i.e., the capacity for discrimination must be searched for, using Paliaga's "limits method". Visual acuity can also be tested in infants by the preferential looking method. Contrast sensitivity is tested using sinusoidal grid patterns of varying contrast and spatial frequency. In routine practice, however, this is usually achieved more easily with acuity cards on which contrast is reduced in several stages. The "two equation method" is a colorimetric test combining two metameric matches, red + green = yellow, and blue + green = cyan, for testing color vision. The test requires an anomaloscope or anomalometer with four light channels. With this method it is possible to test the "red", "green", and "blue" cones and the "red green" and "blue-yellow" opponents. The test provides a qualitative and quantitative evaluation of color vision disorders. If no colorimeter is available, classic printed test can be used. However, they might never achieve the same qualitative and quantitative precision. PMID- 2664323 TI - [Indications for electrophysiologic studies of the eye]. AB - The phenomena of light-evoked electrical activity of the retinal pigment epithelium, retina, and visual cortex can be used for specific diagnostic testing. The EOG, with standing potential and light peak, reflects the functional state of the pigment epithelium; the ERG reflects the function of the photoreceptors (a-wave) and inner nuclear layer (b-wave), and the visual evoked response (VER) provides information on signal conduction along the entire visual pathway. The indications for electroretinography are discussed in detail, resulting in a broad spectrum including degenerative, metabolic, inflammatory and toxic changes of the retina. In addition, a condensed table of diagnoses that can hardly be established without ERG is proposed. The value of ERG recordings is extended by the possibility to document rate of progression and relative involvement of the rod- and/or the cone system of the retina. VER procedures are mainly directed towards demyelinating diseases of the CNS. We attempt to interpret results of electrophysiologic testing synoptically with subjective complaints and clinical observations. PMID- 2664324 TI - [Bacteriologic and serologic studies]. AB - With many infectious eye diseases, the practising ophthalmologist is faced by the question as to whether a serologic or microbiologic work-up pays off in terms of greater diagnostic or therapeutic efficiency. A critical appraisal indicates that on average, they are relatively insignificant, and so some time and money could probably be saved. Important exceptions to the rule are discussed separately. PMID- 2664325 TI - [Transitory disorders of visual function: diagnostic procedure]. AB - Transient disorders of visual function are a phenomenon commonly encountered in neuro-ophthalmological practice. Differential diagnosis is discussed on the basis of the general appearance of these functional changes. PMID- 2664326 TI - [Examination strategies in the diagnosis of drug-induced retinal damage]. AB - The large number of potentially retinotoxic drugs and their effects at multiple structural sites, from pigment epithelium to retina and optic nerve, imply complex diagnostic procedures rather than a single test. Early diagnosis of retinotoxicity, however, can be established by through history, ophthalmoscopy and routine (simple) functional tests carried out by the responsible ophthalmologist. In case of suspected damage of the retina or of the optic nerve electrophysiology, angiography, selective perimetry and color vision tests are recommended. In this outline chloroquine retinopathy is discussed in detail. PMID- 2664327 TI - [Sense and nonsense of examinations in hematogenous and exogenous intra-ocular infections]. AB - Diagnosis of intraocular inflammations can be difficult, particularly if the patient is suffering from immunodeficiency. Among the endogenous inflammations this applies mainly to cases of hyaloretinitis caused by Candida or other fungi, often presenting as an acute hyalitis with sudden onset; the various ocular complications of AIDS, especially those due to toxoplasmosis (rare) and cytomegalovirus, and lyme disease, which can occasionally cause chronic panuveitis. Among the exogenous cases it applies to postoperative and posttraumatic endophthalmitis. In all these cases the diagnosis has to be established clinically if possible, since, as a consequence of the immunodeficiency, serology is hardly helpful, and only biopsy (of the vitreous) may provide additional information. Rapid diagnosis is very important because of the urgent need for therapy. PMID- 2664329 TI - [Importance of ocular biopsies in the etiologic diagnosis of uveitis]. AB - In many uveitis cases a biopsy of ocular tissues can enable an exact diagnosis to be established, unnecessary additional examinations to be avoided, and an appropriate therapeutic regimen to be selected. In general, follicle biopsy is performed where sarcoidosis is suspected, keratocentesis in viral uveitis and toxoplasmosis, and vitreous biopsy in tentatively diagnosed primary intraocular lymphoma (reticulosarcoma) and bacterial or mycotic endophthalmitis. PMID- 2664328 TI - [Serologic and immunologic evaluation in uveitis]. AB - Following a brief discussion of the various general immunologic examinations useful in uveitis, the author goes on to stress the need for a goal of serologic examinations, taking the clinical picture and clinical context into account. In conclusion, a schematic approach is proposed which should be adhered to in paraclinical investigations. PMID- 2664330 TI - [Intraocular inflammations. Anamnesis and clinical study]. AB - Extensive laboratory work-ups are often called for to establish the diagnosis in uveitis cases. In order to interpret the results, however, the degree of validity of the tests must be known. As the number of laboratory tests increases there is a considerable increase in the probability of false-positive results. Demographic peculiarities help in interpreting the results and findings. The information value of laboratory results can be increased by establishing a clear differential diagnosis and compiling a list of precise questions, on the basis of a meticulous clinical examination and a detailed history. The clinical examination remains the key to uveitis diagnosis. If the clinical diagnosis is obvious, contradictory laboratory results should be disregarded. PMID- 2664331 TI - The adult respiratory distress syndrome. AB - The adult respiratory distress syndrome is a condition of life-threatening organ failure triggered by blood-borne factors and challenges which arrive via the airways. Vascular damage is a necessary, but often not sufficient criterion for ARDS, which is observed in an acute and chronic form. There is a consensus that neutrophils and their products contribute to the pathogenesis of the syndrome, and that lung vascular tone regulation and endothelial and epithelial cell permeability are affected in ARDS. Whereas the precise roles of individual mediators for the development of ARDS are still ill-defined, a synergism between lipid mediators and other injurious principles is recognized. Chronic ARDS is a proliferative disorder which may require different treatment strategies than acute ARDS. Specific treatment modalities which inhibit the interaction between activated neutrophils and the lung endothelium, and surfactant replacement might have a future as early therapy approaches. PMID- 2664332 TI - Multiple nodular foci in the liver associated with chronic hepatic porphyria after previous treatment of breast cancer. AB - More than 7 years after the diagnosis and treatment of breast cancer (T1N1aM0), multiple nodular foci were observed in the liver of a 40-year-old woman at ultrasonographic examination. The lesions were confirmed by CT scan, but CT guided liver biopsy revealed only non-specific alterations. At subsequent peritoneoscopic examination, bluish-brown foci were indeed visible on the liver surface, but guided liver biopsies again failed to corroborate the suspected metastases. Instead, histology showed mild portal fibrosis, moderate steatosis and siderosis of hepatocytes, as before. Only the intense red fluorescence of part of the biopsy material under Wood's light suggested the diagnosis of chronic hepatic porphyria or porphyria cutanea tarda, here presumably as a consequence of prolonged alcohol consumption. Subsequent porphyrin studies in urine, faeces and plasma yielded the typical constellation of latent porphyria cutanea tarda (chronic hepatic porphyria type C). The activity of erythrocyte uroporphyrinogen decarboxylase was normal, which argued against a genetic predisposition. After 1 year of strict alcohol abstinence and low-dose chloroquine treatment the "nodular foci" in the liver were no longer visible on ultrasonogram and CT scan; only proton-weighted NMR imaging (SE 1500/30) still showed ill-defined areas of higher signal intensity. The renal excretion of porphyrins had decreased considerably. The levels are now consistent with the diagnosis of subclinical chronic hepatic porphyria type A. Modern non-invasive imaging techniques are tremendously useful, but they have their pitfalls. Focal liver lesions may present serious diagnostic problems, especially when they are found in a patient with a history of carcinoma at an extrahepatic primary site. A rare example is described.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 2664333 TI - [Treatment of peptic ulcer with milide (proglumide)]. PMID- 2664334 TI - [N.I. Pirogov and social medicine]. PMID- 2664335 TI - [M.P. Konchalovskii--a scientist, teacher and physician]. PMID- 2664336 TI - [A.P. Chekhov's comments on cardiac hypertrophy]. PMID- 2664337 TI - [Free radicals and diseases of the digestive organs (a review of the foreign literature)]. PMID- 2664338 TI - [Current problems of early diagnosis and treatment in medical practice]. PMID- 2664339 TI - [Effect of calcium channel blockers on the functional and morphologic conditions of the stomach and duodenum]. PMID- 2664340 TI - [Effectiveness of the Russian drug prazosin in patients with arterial hypertension (Working Group for the Cooperative Study of New Drugs in the Prevention of Arterial Hypertension (CSDPAH)]. AB - The results of a comparative study of the action of a new Soviet agent prazosin in arterial hypertension patients have shown that it does not differ in its pharmacokinetic characteristics from its Finnish analogue and is an effective hypotensive agent. A short course of prazosin treatment caused hypotensive effect in 85.8 per cent of the patients. The clinical effectiveness and tolerance of both agents is the same. PMID- 2664341 TI - [Various computer programs for the diagnosis of ischemic heart disease and neurocirculatory asthenia]. PMID- 2664342 TI - [Treatment of supraventricular paroxysmal tachycardia by intravenous administration of ATP]. AB - The results of treatment of supraventricular paroxysmal tachycardia by the intravenous administration of ATP in a dose of 10-30 mg make it possible to consider ATP as an agent of choice for relieving supraventricular paroxysmal tachycardia under conditions of emergency medical aid. PMID- 2664343 TI - [Lausanne at the start of the century--education and health]. PMID- 2664344 TI - [Health of children in the school environment. Prevention of school stress: sleep and relaxation]. PMID- 2664345 TI - [Of what use is sonography in orthopedics?]. PMID- 2664346 TI - Ultrastructure of eosinophils and basophils stimulated to develop in human cord blood mononuclear cell cultures containing recombinant human interleukin-5 or interleukin-3. AB - We used recombinant human interleukins (IL) and cultured human cord mononuclear cells to determine the cell lineages supported by the inclusion of the individual interleukins-5, -3, or -4 in the cultured media. Cultures were examined by electron microscopy at 2-, 3-, and 5-week culture intervals. We found that IL-5 primarily supported the eosinophilic lineage with lesser numbers of basophils, that IL-3 initially supported all granulocyte lineages but eventually supported the eosinophilic lineage with lesser numbers of basophils, and that IL-4 did not support the development of granulocyte lineages in these cultures. At early culture intervals in either IL-5 or IL-3, eosinophilic and basophilic myelocytes were seen in variable proportions. Mature cells of these lineages developed later. Both mature eosinophils and basophils showed morphologic evidence of activation similar to those described for tissue eosinophils and basophils in various disorders. Mast cells were absent in all cultures. Recognition of the variable morphologies associated with maturation and activation of human eosinophils and basophils is important for the correct identification of cell lineages that develop in cultures containing human recombinant interleukins. PMID- 2664348 TI - Early medical journalism in South Carolina. PMID- 2664347 TI - HLA class II polymorphism: implications for genetic susceptibility to autoimmune disease. AB - Our understanding of HLA class II polymorphism has undergone a rapid evolution in the last few years. As in so many areas of modern biology, this progress has depended largely on the application of recombinant DNA techniques to the study of this gene family. In particular, the recent development of methods of gene amplification by means of the polymerase chain reaction has allowed for the rapid assessment of polymorphism in the human population. In addition, the elucidation by x-ray crystallographic analysis of the three-dimensional structure of an HLA molecule has been a major step. These areas of progress have now begun to converge to allow a more detailed approach to the problem of class II polymorphism and disease susceptibility. As discussed in this review, the data so far indicate that a few amino acid substitutions in class II molecules may exert a critical influence on susceptibility to autoimmune diseases such as RA and IDDM. The mechanism by which these class II polymorphisms predispose to autoimmune disease is still unknown. It is tempting to speculate that differences in the binding affinity of HLA molecules for autoantigens might be involved; however, as yet no specific autoantigen has been identified for either RA or IDDM. Intriguingly, sequence similarities have been observed between some viral proteins and class II molecules, raising the possibility that these infectious agents might induce autoimmunity by "molecular mimicry." Examples include the human cytomegalovirus protein, IE2 as well as the Epstein Barr virus gp110 protein. Other possible mechanisms involve more complex immunoregulatory effects, such as the absence of suppressor functions that appear to be under the influence of the HLA genes. To some extent, the persistent ignorance about the cause of autoimmunity reflects a general lack of knowledge concerning exactly how HLA polymorphisms exert immunoregulatory effects. For example, in addition to influencing antigen presentation, MHC molecules also affect the overall T cell repertoire during thymic selection. The relative importance of HLA class II polymorphism in exerting immunoregulatory effects by means of thymic selection of the T cell repertoire is unknown. For autoimmune diseases such as RA and IDDM, there is a need to identify a specific functional abnormality that is causing the disease before the etiological significance of the emerging associations with class II polymorphisms become clear.(ABSTRACT TRUNCATED AT 400 WORDS) PMID- 2664349 TI - The use of a hand-held gamma detector improves the safety of isolated limb perfusion. AB - We used two hand-held gamma-detecting probes (GDP) (Neoprobe 1000 system) capable of detecting small gamma emissions to monitor leakage in patients undergoing hyperthermic isolated limb perfusion (HILP) who received 800 microCi Technetium 99m pentetate through the perfusate. The percentage of gamma-ray leakage was calculated by a simultaneous reading of two probes at 1-minute intervals (one over the precordial area and one over the thigh) and this was compared to results of simultaneous blood sampling from the perfusate and systemic circulation at 15 minute intervals for gamma well counting (GWC). The percentage of leakage recorded by the GDPs was essentially identical to that detected by the GWC (7.3% and 8.2%, respectively at the conclusion of the perfusion). The GDP gives an immediate and accurate indication of the percentage of leakage during HILP, making it a safer procedure. PMID- 2664350 TI - Splenic rupture in leukemia. AB - We present a review of the incidence, differential diagnoses, mechanism of rupture, laboratory findings, and signs and symptoms of splenic rupture in leukemia. The types of leukemia most often associated with ruptured spleen are described. The treatment of splenic rupture in leukemia is splenectomy, with careful evaluation of the need for transfusion with appropriate blood products. The issue of whether such cases should be referred to as "pathologic" or "spontaneous" is discussed. Indications for prophylactic splenectomy in leukemia are also addressed. PMID- 2664351 TI - A general outlook on ethnopharmacology. PMID- 2664352 TI - Methods for ethnopharmacological field work. AB - This paper describes the interdisciplinary methods used in the recording and collecting of ethnopharmacological field data. General considerations of procedure and interviewing, the collection of botanical and pharmacological specimens, procedures of data collection in field studies of medicinal plants, and the field screening of drug plants are discussed. PMID- 2664353 TI - Mechanisms of hypoglycemic activity of aconitan A, a glycan from Aconitum carmichaeli roots. AB - Aconitan A did not affect plasma insulin levels in normal, glucose-loaded and alloxan-induced hyperglycemic mice and gave no influence on insulin binding to isolated adipocytes. Aconitan A exerted no effect on the activities of hepatic hexokinase, glucokinase, glucose-6-phosphatase and glucose-6-phosphate dehydrogenase, whereas it significantly increased hepatic phosphofructokinase activity. Although the activity of hepatic glycogen synthetase showed a tendency to increase, the activity of liver phosphorylase and glycogen content were unchanged by aconitan A. Aconitan A did not change the total cholesterol and triglyceride contents of plasma and liver. PMID- 2664354 TI - [Anti-infective phytotherapies of the tree-savannah, Senegal (occidental Africa). III: A review of phytochemical substances and the antimicrobial activity of 43 species]. AB - A review has been made of the ethnobotanical and pharmacological data of 43 medicinal plants of the tree-savannah used by the Diola against infectious diseases. The traditional use of ten plants can be explained by pharmacologically active principles: Adansonia digitata, Azadirachta indica, Carica papaya, Cassia tora, Fagara leprieurii, Guiera senegalensis, Khaya senegalensis, Mangifera indica, Psidium guajava and Voacanga africana. Four of these herbs are recommended for use in Primary Health Care. The therapeutic value of the other plants discussed is not absolutely clear. It is, however, obvious that herbal medicine has a large potential, which is still insufficiently explored, for utilization in Primary Health Care. PMID- 2664355 TI - Plants used in traditional medicine in eastern Tanzania. II. Angiosperms (Capparidaceae to Ebenaceae). AB - Sixty-nine plants are listed, which are used by traditional healers in five regions of Eastern Tanzania, Coast, Dar es Salaam, Kilimanjaro, Morogoro and Tanga. For each species the botanical name, vernacular name, collection number, locality, habit, distribution and medicinal uses are given. Results of a literature survey on medicinal uses, isolated constituents, and pharmacological effects are also provided. PMID- 2664356 TI - Medicinal plants with hypoglycemic activity. AB - This review summarises the literature on the antidiabetic activity of 343 medicinal plants reputed in the indigenous system of medicine or in which the pharmacological activity has been scientifically demonstrated. The data are presented in tabular form. The table reflects the plant parts involved, the nature of the extracts used and the names of the active principles with their structures where known. The pharmacological activities of some of the extracts or of the active principles isolated from these plants are also described. PMID- 2664357 TI - Ethnopharmacologic analysis of medicinal plants used by Laotian Hmong refugees in Minnesota. AB - Laotian Hmong refugees in the Twin Cities of Minneapolis and St. Paul, Minnesota, cultivate many plants and employ them as a first line of defense against illness and disease. Thirty-seven medicinal plants have been identified, phytochemical components catalogued through literature research, and potential pharmacological activities correlated with Hmong medicinal uses. Using western biomedical criteria of efficacy, 92% of the medicinal plants being cultivated were found to be potentially efficacious. The frequent use of these plants in diet (81%) suggests that they have served to mediate against illness and disease states in the cultural and natural environment in which the practices evolved. A listing of 37 plants with Hmong names, uses and potentially active constituents is provided. PMID- 2664358 TI - Mechanisms of drug resistance in acute leukaemia. AB - The development of resistance to chemotherapeutic agents is a frequent cause of treatment failure in acute myeloid and lymphocytic leukaemia. The mechanisms by which resistance develops in these patients are poorly understood, although a framework for their investigation has been provided by a range of studies using animal and human cell lines as model systems. In this review the basic concepts of drug resistance mechanisms are outlined, with special emphasis on studies using cells obtained from patients with resistant forms of leukaemia. PMID- 2664360 TI - Nicolas-Louis Vauquelin--discoverer of chromium. PMID- 2664359 TI - Stiff-man syndrome updated. AB - Stiff-man syndrome, a rare disorder characterized by intermittent spasms and stiffness of the axial muscles, is associated with an electromyographic pattern of continuous motor unit activity in affected muscles. Since the initial description in 1956, the stiff-man syndrome has been reported to occur in various clinical and neurologic settings. In this study, we reviewed the current state of knowledge about this syndrome, defined diagnostic criteria, provided a long-term follow-up of the disorder, and assessed rehabilitative attempts in affected patients. Use of rigorous criteria that identify patients who have the stiff-man syndrome is important because the initial clinical manifestations are similar to those of other neuromuscular diseases. Analysis of 13 patients with stiff-man syndrome examined at the Mayo Clinic during the past 30 years revealed that treatment with diazepam decreased the muscle spasms. Because some muscle spasms usually persist, rehabilitation is an important adjunct that may further improve function when it is centered on the treatment of low-back pain and hyperlordosis, mobility problems, gait abnormalities, and muscular stiffness. PMID- 2664361 TI - Obstructive sleep apnea syndrome in patients with class II malocclusion. AB - This study was designed to analyze the effect of class II malocclusion as a factor in the development of obstructive sleep apnea syndrome. Although mandibular retrusion has been reported coincidentally with obstructive sleep apnea syndrome many times, no causal relationship has been established. No previous study has analyzed the occurrence of obstructive sleep apnea syndrome in patients with class II malocclusion without sleep complaints. In this study, we selected 12 patients with class II malocclusion who required surgical mandibular lengthening or repositioning procedures. These patients were surveyed for sleep habits or sleep complaints and then studied with overnight polysomnography for sleeping or breathing abnormalities. None of these patients had obstructive sleep apnea syndrome. From this sample population, an incidence of obstructive sleep apnea syndrome of no more than 26.5% in the surgical population of patients with class II malocclusion can be extrapolated. PMID- 2664362 TI - Cognitive and psychiatric abnormalities in multiple sclerosis. AB - In multiple sclerosis, behavioral changes, including alterations in cognitive functions and psychiatric abnormalities, have been recognized with increasing frequency in recent years. Multiple sclerosis formerly was thought to be primarily a disorder of the brain stem and spinal cord; however, functional changes that can be attributed, at least in part, to cerebral dysfunction are being recognized. Certain cognitive functions such as memory and conceptual processes seem to be preferentially impaired. The degrees of impairment of other functions such as attention and visuospatial skills are now being evaluated. Psychiatrically, affective disorders seem to be the most common diagnoses, and debate exists about whether these abnormalities are a function of the demyelinating process itself or are a reaction to the disability produced by the disorder. PMID- 2664363 TI - Classification and terminology of hepatic allograft rejection: whither bound? AB - The current classification of hepatic allograft rejection recognizes "acute rejection" and "chronic rejection." Although these terms convey duration, implicitly they have been defined on the basis of their morphologic manifestations. This usage causes contradictions in reports and publications because features of "chronic rejection" may occur acutely and vice versa. In the future, biopsy reports, clinical communications, and, in particular, evaluation of treatment might benefit from use of a classification and terminology that more clearly distinguish clinical and morphologic findings and that reserve "acute" and "chronic" for describing the duration of episodes of rejection and terms such as "cellular rejection" or "arteriopathic rejection" for biopsy reporting. Severity should be graded independently for clinical, laboratory, and morphologic findings, inasmuch as an overall grading is not always meaningful--for example, severe cellular rejection may be mild in terms of prognosis, whereas histologically mild rejection may prove incurable. For an overall evaluation of graft rejection, adjectives such as "mild" or "severe" should be replaced or at least supplemented by terms that describe results of treatment and thus prognosis, and a designation should be added for duration and histology--for instance, "acute rejection, cellular, corticosteroid-responsive." Use of such a well-defined clinicopathologic classification of rejection and precise terminology might improve documentation and communication; it might even become a prerequisite for the evaluation of treatment trials. PMID- 2664364 TI - Role of the nurse in the multidisciplinary team approach to care of liver transplant patients. AB - Nursing plays an important contributory role in the multidisciplinary team approach to patient care. The nurse who is responsible for the care of liver transplant patients requires special preparation to meet the patient's needs during the critical phases of the liver transplant process. In the hospital setting, a primary nursing-care delivery system enhances the nurse's role in supporting the goal of patient recovery. Primary nursing places the accountability and responsibility for planning, administering, and evaluating the care of the liver transplant patient with the primary nurse. The transplant nurse acts as a key link in the communication network within the multidisciplinary team, and effective communication is essential in the care of the liver transplant patient. For achievement of a life-style of independence after transplantation, the patient is assisted by the nurse, who provides instruction in such areas as diet, medications, monitoring of vital signs, and record keeping. Although the nurse is only one member contributing to the care of liver transplant patients, the nurse's role in the success of treatment is vital. PMID- 2664365 TI - Application of the Mayo primary biliary cirrhosis survival model to Mayo liver transplant patients. AB - Liver transplantation is considered lifesaving for selected patients with end stage primary biliary cirrhosis (PBC). A mathematical model to predict survival in the patient with PBC who has not undergone transplantation would be valuable for improving selection of patients for and timing of transplantation and for providing control information for assessment of the efficacy of transplantation. The Cox regression method and data from 312 Mayo Clinic patients with PBC were used to develop a model based on age, total serum bilirubin, serum albumin, prothrombin time, and severity of edema. When cross-validated on an independent set of 106 Mayo patients, the model accurately predicted their survival. It was similar to two other published survival models in terms of risk measurement but had the advantage of not necessitating liver biopsy. The model was used to assess the efficacy of liver transplantation by comparing the Kaplan-Meier survival of 32 Mayo patients after transplantation with the average model prediction of survival without transplantation. Beyond 3 months after transplantation, Kaplan Meier survival probabilities were significantly greater than control survival predicted by the model (P less than 0.001). Examples of using the model for aiding in selection of patients for and timing of transplantation are provided. PMID- 2664366 TI - Organ donation--are we moving in the right direction? PMID- 2664367 TI - Positron emission tomography of the heart: mapping flow and metabolism in vivo. PMID- 2664368 TI - Positron emission tomography--the promise of metabolic imaging. PMID- 2664369 TI - Growth of brain tissue grafts is dependent upon host age. AB - Growth of grafts of cortex cerebri, hippocampus, septum and cerebellum in oculo were significantly reduced in 16--17-month-old hosts as compared to growth in 3 month-old and 1.5-month-old rat hosts. (Host age is given as the age of the recipients at the time of grafting.) This growth difference was less pronounced in locus coeruleus grafts. The vascular network (as observed with laminin immunofluorescence) in cortex cerebri, hippocampus, cerebellum and septum grafts in 16--17-month-old hosts was abnormal with few thick-walled vessels in clusters as compared to the more 'normal' vascularization found in 1.5-month-old hosts with a high number of thin-walled blood vessels evenly distributed throughout the grafts. Grafts in the oldests hosts were markedly more gliotic than grafts in 1.5 and 3-month-old hosts as evaluated using immunofluorescence with antibodies against glial fibrillary acidic protein. Neurofilament immunoreactivity in the grafts seemed not to be influenced by host age. When a second cortex cerebri or hippocampus graft was placed into contact with a previously grafted locus coeruleus graft, the second graft grew less well in 16--17-month-old hosts as compared to 1.5-month-old hosts. When cortex cerebri was added to a previously grafted cortex cerebri graft, the second graft in both 16--17- and 3-month-old hosts grew to larger sizes than the corresponding single cortex grafts, although the growth differences between the two groups of hosts described above were still maintained. Thus, cortex grafts in 16--17-month-old hosts still have the ability to become trophically stimulated. The vascularization of the second graft in both groups was almost normalized and the gliotic reaction was less pronounced in the second grafts in both groups as compared to the single cortex grafts. In conclusion, the present results indicate that host age affects growth and morphology of intraocular single grafts from several brain regions. Using double grafts of cortex cerebri it was shown that grafts in 16-17-month-old hosts still had the capacity to become trophically stimulated. Data on brain transplants in older hosts are important in view of clinical possibilities to use transplantation strategies to counteract the symptoms of neurodegenerative diseases, which usually occur in old patients. PMID- 2664370 TI - Combined grafting of bone marrow and thymus, and sequential multiple thymus graftings in various strains of mice. The effect on immune functions and life span. AB - The combined grafting of young bone marrow and newborn thymus performed in old mice was effective in restoring the impaired immune functions, but the same treatment performed in middle-aged adult mice had no effect on the life span of C3H/MTV female mice. Sequential multiple newborn thymus graftings starting at young adult age were effective in enhancing immunological functions, delaying the onset of tumor and extending the survival rate to certain degree in the first half of the experimental course in both C3H/MTV as well as C57BL/6 mice, but these effects were not observed in the latter half of the experimental course. It was suggested that multiple newborn thymuses sequentially implanted into the peritoneal cavity underwent atrophy and these atrophic thymuses had a suppressive effect on the host immune system. In autoimmune prone B/WF1 mice, however, the combined grafting of young bone marrow and newborn thymus resulted in suppression of antibody formation to SRBC, and single grafting of either young bone marrow or newborn thymus resulted in a trend of increase in the antibody formation to SRBC. The sequential multiple newborn thymus graftings in B/WF1 mice brought about aggravation of kidney diseases and shortening of the mean life span. On the contrary, administration of thymosin in B/WF1 mice resulted in amelioration of kidney disease and elongation of the mean life span. PMID- 2664371 TI - Aneuploidy as a prognostic factor in breast cancer. AB - The predictive value of nuclear DNA content in mammary carcinoma is still under debate in spite of several reports indicating a relationship between DNA ploidy and prognosis. The impact of differences in methodology on the evaluation of DNA data is discussed, and a recent study demonstrating DNA ploidy as a statistically significant prognostic variable on a prospective material of breast cancer patients is presented. PMID- 2664373 TI - [Is Creutzfeldt-Jakob disease the first evidence demonstrating a biological heterodoxy?]. PMID- 2664372 TI - An EORTC gastrointestinal (GI) group randomized evaluation of the toxicity of sequential high dose methotrexate and 5-fluorouracil combined with adriamycin (FAMTX) vs 5-fluorouracil, adriamycin and mitomycin (FAM) in advanced gastric cancer. AB - Until now advanced gastric cancer has been generally treated with the FAM chemotherapy protocol. Due to the relatively low response rates with this protocol we decided to start a randomized prospective phase II trial comparing the FAM with the FAMTX protocol. The primary aim of our trial was to compare the toxicity in both protocols. The FAMTX protocol has been demonstrated to be fully comparable with the toxicity of the FAM protocol. The trial has been extended to a phase III study. With respect to response rates and survival times it is too early for evaluation. PMID- 2664374 TI - [Autoimmune oophoritis and anti-ovarian antibodies]. PMID- 2664375 TI - [The importance of a biological study of venous thromboembolism]. PMID- 2664376 TI - [Progressive multifocal leukoencephalopathy]. PMID- 2664377 TI - [Engraftment markers in allogenic bone marrow graft]. PMID- 2664378 TI - [Bone marrow transplantation in hereditary diseases: benefits and risks]. PMID- 2664379 TI - [Sudden cardiac death]. PMID- 2664381 TI - [Current indications for magnetic resonance in non-neurological pathology (II)]. PMID- 2664380 TI - [Design and implementation of a multicenter case-control study on bladder cancer in Spain]. AB - The aim of a case-control design is to make a measurement of the highest possible accuracy, reducing to a minimum the possible selection, information and confusion biases. The design, methods and procedures of a multicentric study carried out in 14 hospitals from 4 autonomous communities in Spain are discussed. Overall 254 incident cases, 243 prevalent cases, 583 hospital controls and 530 population controls were included. The proportion of nonresponders was somewhat higher in population controls, particularly in large cities. Statistically significant differences between cases and controls were not found for socioeconomic levels, educational level, number of jobs, degree of response, duration of the interview, and errors of transcription and codification of information. Also, significant differences were not found between the population and hospital controls regarding diet habits and cigarette smoking. It is considered that a non-biased measurement of the association can be obtained from cases and hospital controls. The collected information was satisfactory. In spite of the lack of adequate facilities for research in hospitals, the development of multicentric etiologic studies is feasible. PMID- 2664382 TI - [The man behind the syndrome: Antonin Marfan. He introduced the discovery of congenital connective tissue diseases]. PMID- 2664383 TI - [Dr. Andreas Andree--a well-known figure in the 19th century in Visby]. PMID- 2664384 TI - [A new instrument for locating an intrauterine device in the uterus]. PMID- 2664385 TI - [Intensive research on antiviral agents--a review]. PMID- 2664386 TI - [Suicide as communication--psychological analysis of Antigone's suicide]. PMID- 2664387 TI - Repair of orbital floor fractures with Marlex mesh. AB - The best method for reconstructing the acutely fractured orbital floor is controversial. In this review, the outcome of 81 patients with an operatively confirmed pure orbital blow-out fracture is evaluated with respect to postoperative enophthalmos, diplopia, infection, and extrusion. A Marlex mesh implant was used to repair 58 of the fractures, with minimal resultant complications. We believe that Marlex mesh is an ideal implant for use in repairing the early blow-out fracture. PMID- 2664388 TI - Reconstruction of circumferential defect of the hypopharynx: experimental studies and clinical application of a new method. AB - Reconstruction of circumferential defect of the hypopharynx is a challenging problem in head and neck surgery. Reconstruction with a totally tubed pectoralis major myocutaneous flap (PMMCF) has been advocated in recent years, but this procedure has the disadvantage of excessive bulkiness. In order to solve this problem, the author experimented with a partially tubed platysma myocutaneous flap and an inner surface of apron skin flap of the anterior neck in the reconstruction of the circumferential defect of the hypopharynx in ten dogs. Subsequently, the same surgical technique using PMMCF instead of the platysma myocutaneous flap was used for reconstruction following total laryngopharyngectomy in eight patients. The new partially tubed flap was successful in solving the problem of excessive bulkiness of the totally tubed PMMCF. PMID- 2664389 TI - Reconstruction of full-thickness cheek defects with combined cervicopectoral and pectoralis major myocutaneous flaps. PMID- 2664390 TI - [Prenatal diagnosis of hereditary epidermolysis bullosa using ultrasonically guided biopsy of the fetal skin]. AB - Ultrasonically guided fetal skin biopsy was performed in 5 patients who were at risk having a baby affected by epidermolysis bullosa hereditaria. Samples of the fetal skin were taken by means of Tru-cut biopsy needle that was introduced transabdominally into the amniotic cavity under continuous ultrasound control. Samples of the skin were obtained in all cases and were adequate for histopathological analysis. There were no significant clinical complications that may be related to the procedure. Prenatal diagnosis of the disease was made in 2 cases. In both cases pregnancies were interrupted. In 3 cases with normal histologic findings pregnancies resulted in term deliveries of normal babies. The authors suggest that fetal skin biopsy can be successfully performed under sonographic guidance. This diagnostic procedure may be considered the method of choice for prenatal diagnosis of hereditary skin disease. PMID- 2664391 TI - What is the relationship between the endothelium derived relaxant factor and nitric oxide? AB - Nitric oxide gas in solution (NO) relaxes blood vessels with similar actions and pharmacodynamics as the endothelium derived relaxant factor (EDRF) and has been proposed to be a component of the materials released from stimulated endothelial cells. Certain data however suggest that EDRF and NO may not be identical. In some non-vascular smooth muscles, NO and EDRF exhibit markedly different pharmacologic profiles. Furthermore the interaction of EDRF and NO with anion exchange resins differ. The hypothesis that EDRF is identical to nitric oxide gas in solution or a nitrogen oxide containing compound is discussed. PMID- 2664392 TI - Additive stimulation of hepatic putrescine production by glucagon and insulin after partial hepatectomy in rats. AB - When rats received glucagon or insulin every 2 h after partial hepatectomy (Hx), hepatic putrescine content was increased above control levels at 6 and 12 h, respectively. When the two hormones were combined, the increased levels were additive. Hepatic ornithine decarboxylase activity was above control levels at 12 h after insulin treatment. Hepatic spermidine N1-acetyltransferase activity was enhanced at 6 h only when glucagon was dosed. Putrescine administration from 0 to 4 h or from 6 to 10 h increased hepatic DNA synthesis to similar levels 22 h after Hx. These results suggest that glucagon and insulin additively stimulate hepatic putrescine production after Hx. This may explain the cooperative stimulation of liver regeneration by both hormones. PMID- 2664393 TI - Effect of sodium glycocholate and polyoxyethylene-9-lauryl ether on the hydrolysis of varying concentrations of insulin in the nasal homogenates of the albino rabbit. AB - Protease inhibition has been postulated to be one of the several mechanisms by which penetration enhancers promote the mucosal absorption of peptide and protein drugs. The objective of this study was to determine whether protease inhibition by Na glycocholate and polyoxyethylene-9-lauryl ether, two extensively studied enhancers, led to suppression of insulin proteolysis over a range of insulin concentrations. To this end, the rate of insulin proteolysis in nasal tissue supernatants of the albino rabbit was determined in the presence of 0.1-2% Na glycocholate and polyoxyethylene-9-lauryl ether and at insulin concentrations ranging from 5 to 100 microM. Partly due to self-association, insulin was self stabilizing against nasal proteolysis as its concentration was raised from 5 to 100 microM. At insulin concentrations lower than 50 microM, both Na glycocholate and polyoxyethylene-9-lauryl ether reduced the rate of insulin proteolysis. By contrast, at 100 microM insulin concentration, both enhancers accelerated insulin proteolysis. Such an effect was attributed to the deaggregation of insulin by the enhancers, increasing the proportion of monomers available for nasal proteolysis. The incorporation of 0.1 mM PCMPS, a potent inhibitor of insulin proteolysis, partly overcame the accelerating effect of Na glycocholate on insulin proteolysis. PMID- 2664394 TI - A rapid method for the in vivo measurement of liver volume. AB - A method is described to calculate liver volume at US using real-time equipment. The method is based on the measurement of the 3 maximum diameters of the liver. Equations were derived by correlation vs CT volume measurement using the 3 diameters (multiple regression) or their product (simple regression) as independent variables in 20 subjects with and without liver disease. It is suggested that liver volume may be estimated as: y = -2364 + 89.2.(C-C) + 119.9.(A-P) + 59.6.(L-L) or y = 133.2 + 0.422.(C-C.A-P.L-L) where y is the volume (in ml), and C-C, A-P, and L-L are the 3 diameters (in cm). The two equations were validated in a second set of 22 subjects. US volume estimated according to Eq. 2 explained approximately 82% of the variance of the actual liver volume. The method is reproducible (interobserver variations less than 8%), rapid and easy-to repeat. These features make it potentially useful in prospective longitudinal studies. PMID- 2664395 TI - Aggressive and disruptive behavior. PMID- 2664396 TI - Community-referenced research on self-stimulation. PMID- 2664397 TI - Behavioral parent training. A view of the past and suggestions for the future. PMID- 2664398 TI - Treating aberrant behavior through effective staff management. A developing technology. PMID- 2664399 TI - Self-management approaches. PMID- 2664400 TI - The use of token economies with individuals who have developmental disabilities. PMID- 2664401 TI - Punishment for people with developmental disabilities. PMID- 2664402 TI - Religion and medicine: an ancient relationship. PMID- 2664403 TI - Immunization of asymptomatic HIV-infected children with measles vaccine: assessment of risks and benefits. AB - Because HIV infection is associated with immunologic abnormalities, concerns have been expressed about the safety and efficacy of vaccination of infected children with live virus vaccines. The authors used decision analysis to assess the likely impacts of four alternative policies for immunization of asymptomatic HIV infected children with measles vaccine. Probabilities for vaccine efficacy, vaccine-related adverse events, and measles complications in HIV-infected children and the prevalence of HIV infection in the birth cohort were obtained from a modified Delphi survey. Using median estimates from the Delphi survey, there were no major differences in outcomes under any proposed policy. Using the most extreme estimates, serologic testing and exclusion of seropositive children from vaccination or exclusion of all high-risk children decreased vaccine associated adverse events without greatly increasing measles complications, primarily because of the current low incidence of measles. Under conditions assumed to exist in the United States today, alternate immunization policies have only minor differences in societal impact although costs would certainly differ. PMID- 2664404 TI - Revision of diagnostic logic using a clinical database. AB - Statistical pattern-recognition techniques have been frequently applied to the problem of medical diagnosis. Sequential Bayesian approaches are appealing because of the possibility of generating the underlying sensitivities, specificities, and prevalence statistics from the estimates of medical experts. The accuracy of these estimates and the consequences of inaccuracies carry implications for the future development of this type of system. In an effort to explore these subjects, the authors used statistics derived from a clinical database to revise the diagnostic logic in a Bayesian system for generating a differential diagnostic list. Substantial changes in estimated a priori probabilities, sensitivities, and specificities were made to correct for significant under- and overestimations of these values by a group of medical experts. The system based on the derived values appears to perform better than the original system. It is concluded that the statistics used in a Bayesian diagnostic system should be derived from a database representative of the patient population for which the system is designed. PMID- 2664406 TI - Fallen fontanelle in the American Southwest: its origin, epidemiology, and possible organic causes. PMID- 2664405 TI - Threshold analysis using diagnostic tests with multiple results. AB - Clinical problems represented by decision trees can be analyzed in terms of the probability threshold model, which provides management recommendations based on the prior probability of disease, the test threshold, and the test-treatment threshold. As originally proposed, the threshold model assumes that diagnostic tests provide information about a single event that is relevant to the decision. For some problems, however, a diagnostic test may provide information about more than one such event (e.g., a computed tomography [CT] scan gives information about both mediastinal and hilar metastases in lung cancer). The authors extend the probability threshold model to cases in which a single test provides information about two events that are relevant to the decision. They derive four thresholds that determine the best strategy for any combination of test results. The approach is illustrated for the decision to use a CT scan to stage lung cancer. The analysis reveals that: 1) the range of prior probabilities for which testing is optimal increases; 2) for some prior probabilities only test results about one event are important; 3) for some prior probabilities test results about both events are important; and 4) failure to account fully for information provided by a test can lead to erroneous test and treatment recommendations. PMID- 2664407 TI - The limitations of medical ecology: the concept of adaptation in the context of social stratification and social transformation. PMID- 2664408 TI - Fitness to plead and psychiatric reports. AB - The role of the psychiatrist in the determination of fitness to plead is reviewed by reference to 77 pre-trial psychiatric reports prepared on 31 Special Hospital patients detained under the provision of Section 5(1)(c) (Unfit to Plead) of the Criminal Procedure (Insanity) Act 1964. Each psychiatric report was analysed using a standardized checklist which addressed the legal criteria used to determine fitness to plead, the nature of the alleged offence and the clinical diagnosis. The results showed that almost 40% of the reports made no mention of fitness to plead at all and that only one-third of the reports made a statement about fitness to plead which was supported by reference to standard legal criteria. The results of this study support earlier work which has suggested that psychiatrists have a poor understanding of the issues surrounding fitness to plead and criminal responsibility. These findings are discussed in relation to recommendations made by the Report of the Committee on Mentally Abnormal Offenders, 1975 (Butler Report) and legislative changes introduced by the Mental Health Act 1983. PMID- 2664409 TI - Medico-legal issues in detecting and proving the sexual abuse of children. AB - In this article the author reviews the scope and magnitude of the problem currently faced by medical and investigative personnel in detecting and proving the sexual molestation of children. The legal effects of poor medical records are discussed in detail. Various medical and legal issues that may present pitfalls for the unwary examining physician are identified and discussed. The admissibility of various portions of the medical examination and medical report as evidence in courts of law is reviewed as well as newly emerging forensic tests and techniques for collecting medical evidence. The author provides a comprehensive and detailed summary of steps to be followed in the physical examination of a child sex abuse victim, emphasizing the importance of a strict, thorough procedure for protecting the interests of the patient, the physician and society. PMID- 2664410 TI - Serum strontium estimation as a medico-legal diagnostic indicator of drowning. AB - In order to corroborate the medico-legal diagnosis of vital submersion we reviewed the appropriate literature and tested Icard's initial hypothesis, already expressed in 1932, that Strontium might be a good indicator of sea-water drowning. Therefore, we examined all the bodies found either in fresh or in sea water, and also non-drowned control cases. Strontium concentrations in both cardiac cavities and in a peripheral blood-vessel were determined by flameless atomic absorption spectrophotometry. The statistical evaluation of the results is hereby presented. We come to the conclusion that this determination can be a valuable additional proof for sea-water drowning diagnosis, whilst freshwater drowning would be more difficult to assess. Further investigations are being undertaken. PMID- 2664411 TI - Inhalational injury in fires. PMID- 2664412 TI - Meetings: twelve tips for chairing a new committee. PMID- 2664413 TI - The change process and medical education. AB - Successful innovators in medical education accurately diagnose institutional barriers to innovation and employ effective strategies for overcoming these barriers. These institutional barriers and successful strategies are described with illustrative vignettes. They are generic to medical schools all over the world. PMID- 2664414 TI - [Technical characteristics and principles of operation of an insulin pump in the treatment of diabetes mellitus]. PMID- 2664415 TI - [Use of the PFK-01 psychophysiologic unit in the diagnosis of alcoholic patients]. AB - Alcoholic patients were tested on production of short time intervals by means of psychophysiological computer-controlled unit PFK-01 after the dedicated software was completed. Subjective time rate was related to the emotional state of patients. A tendency towards hypoproduction, i.e. towards acceleration of subjective time rate, was associated with the state of anxiety. PMID- 2664416 TI - [Personality structure in depression]. AB - A catamnestic study has been carried out on 45 patients, who had presented "major affective disturbances" according to the DSM III classification, for the purpose of evaluating various features of depressive disease. It is deduced that the depressed personality is not without changes even in the interval period: these are partly attributable to a residual syndrome, in part they are practically constant constituents of the personality of the endogenous depressed. PMID- 2664417 TI - [Euthanasia]. AB - After examining the question of euthanasia from various viewpoints, the paper concludes that the socioeconomic factor is one of the most significant. It also shows that the greatest responsibility falls on the physician who has no decalogue or rulebook to guide him apart from his own conscience. PMID- 2664418 TI - Molecular and mutational analysis of three genes preceding pyrE on the Escherichia coli chromosome. AB - The nucleotide sequence of two kilobase pairs (kb) 5' to the orfE-pyrE operon has been determined. The sequence revealed two open reading frames, orfX and orfY, consisting of 286 and 274 codons, respectively, and having a transcriptional orientation opposite that of the orfE-pyrE operon. Analysis of transcription initiations showed that the promoters of orfE and orfX constitute a pair of divergent promoters with overlapping -35 regions and that orfY is transcribed from an independent promoter. Translational analysis indicated that the orfs are expressed in Escherichia coli. The orfE, orfX, and orfY genes were inactivated on the bacterial chromosome by deletion-insertion mutagenesis using a kanamycin resistance cassette. The mutants were all viable. However, the orfE deletion caused a dramatic reduction in the level of pyrE expression and a partial pyrimidine requirement, because this mutation prevented transcription of pyrE. the orfE protein seemed without significance for pyr-gene expression in E. coli, and the mutations in orfX and orfY were without detectable phenotypes. PMID- 2664419 TI - virG of Agrobacterium tumefaciens plasmid pTiC58 encodes a DNA-binding protein. AB - Virulence genes of the Agrobacterium tumefaciens Ti plasmid are positively regulated by the products of virA and virG. To study the DNA-binding properties of the VirG protein, a translational fusion between virG and the trpE gene of Escherichia coli was constructed, and antiserum was raised against the encoded fusion protein. Using this antiserum, a protein of Mr congruent to 29,000, a size similar to that calculated from the virG nucleotide sequence, was detected in an E. coli strain harbouring a virG expression vector. Both the virG protein and the fusion protein were found, by filter-binding and gel retardation analyses, to bind DNA nonspecifically. These data support an existing model for the two component regulatory systems of bacteria. PMID- 2664420 TI - Integration of the Serratia marcescens haemolysin into human erythrocyte membranes. AB - The haemolytic activity of Serratia marcescens is determined by two proteins, ShlA and ShlB. ShlA integrates into the erythrocyte membrane and causes osmotic lysis through channel formation. The conformation of ShlA and its interaction with erythrocyte membranes were studied by determining the cleavage of ShlA by added trypsin. Our results suggest that the conformation of inactive ShlA (from an ShlB- strain) differs from the active ShlA, and that in a hydrophobic environment (detergent or membrane) active ShlA assumes a conformation distinct from that in buffer. Only active haemolysin adsorbed to erythrocytes. ShlA was firmly integrated into the erythrocyte membrane since it was only released under conditions which also dissolved the integral erythrocyte membrane proteins. Moreover, ShlA integrated into 'ghosts' remained there and was not haemolytic when incubated with erythrocytes. From the trypsin cleavage pattern obtained with haemolysin and C-terminally truncated, but still active, haemolysin derivatives integrated into erythrocytes, and sealed and unsealed erythrocyte 'ghosts', we conclude that ShlA is preferentially cleaved by trypsin at a few sites but only from the inside of the erythrocyte. Haemolysin in the erythrocyte membrane forms a water-filled channel and is resistant to trypsin and other proteases. PMID- 2664421 TI - Nucleoprotein structures at positively regulated bacterial promoters: homology with replication origins and some hypotheses on the quaternary structure of the activator proteins in these complexes. AB - The quaternary structure of regulatory proteins undoubtedly plays an important role in the initiation of transcription and DNA replication. To date, the best characterized regulatory proteins are oligomers in which promoters are bound together by isologous interactions. From the examples presented in this article, it appears that the formation of certain nucleoprotein complexes implicated in transcription initiation might involve heterologous rather than isologous interactions, allowing differentiation between two classes of transcription activators. Nucleoprotein structures present at the oriC replication origin and at malB promoters show striking homologies. PMID- 2664422 TI - Construction of chimaeric promoter regions by exchange of the upstream regulatory sequences from fdhF and nif genes. AB - Hybrid 5' regulatory regions were constructed in which the upstream activator sequence (UAS) and promoter of various nif genes were exchanged with the upstream regulatory sequence (URS) of the fdhF gene from Escherichia coli. They were analysed for their regulatory response under different growth conditions with the aid of fdhF'-'lacZ or nif'-'lacZ fusions. Placement of the UAS from the Bradyrhizobium japonicum nifH gene in front of the spacer (DNA region between URS and promoter) plus promoter from fdhF renders fdhF expression activatable by the Klebsiella pneumoniae NIFA protein, both under aerobic and anaerobic conditions. This excludes the possibility that the spacer of the fdhF5' flanking region contains a site recognized by a putative oxygen- or nitrate-responsive repressor. There was also considerable activation by NIFA of fdhF expression in a construct lacking the nifH UAS but containing the fdhF spacer plus promoter. Further experimental evidence suggests that this reflects a direct interaction between NIFA and RNA polymerase at the ntrA-dependent promoter. A second set of hybrid constructs in which the URS from fdhF (E. coli) was placed in front of the nifD spacer plus promoter from B. japonicum or in front of the K. pneumoniae nifH, nifU, nifB spacers and promoters, delivered inactive constructs in the case of the nifD, nifU and nifB genes. However, a nifH'-'lacZ fusion preceded by its own spacer and promoter plus the foreign fdhF URS displayed all the regulatory characteristics of fdhF expression, i.e. anaerobic induction with formate and repression by oxygen and nitrate. Although it is not known why only one out of the four nif promoters could be activated by the fdhF URS, this result nevertheless demonstrates that the various regulatory stimuli affecting expression of fdhF in E. coli have their target at the upstream regulatory sequence. PMID- 2664423 TI - The proline transport protein of Aspergillus nidulans is very similar to amino acid transporters of Saccharomyces cerevisiae. AB - In Aspergillus nidulans, the gene prnB encoding the major proline transport system is one of a cluster of four genes necessary and sufficient for the utilization of proline as sole nitrogen and/or carbon source. The prn cluster has been cloned and the sequence and transcript map of the prnB gene are presented in this paper. The predicted translated sequence consists of 570 amino acids, resulting in a molecular weight of 63,028 Daltons. Its hydropathy profile shows 10 hydrophobic segments typical of integral membrane proteins. No N-terminal hydrophobic signal peptide is present, the N-terminal and C-terminal ends of the protein being hydrophilic. Similar results were previously found for the arginine and histidine transporters of Saccharomyces cerevisiae, with which the prnB transporter shares regions of highly conserved amino acid sequences. Using S1 mapping and Northern blot analyses, we confirm the presence of a unique inducible prnB transcript of 1.9 kb. PMID- 2664424 TI - Immunity protein is not required for the bactericidal activity of colicin E3. AB - Plasmid pLAX3, carrying the colicin E3 gene, was used to direct the in vitro synthesis of a colicin E3* molecule totally devoid of its immunity protein. We established that this molecule is able to kill sensitive Escherichia coli cells in the total absence of immunity protein. Therefore, all of the information required for colicin E3 action is located on the colicin polypeptide itself. Furthermore, our studies indicated that immunity protein protects the C-terminal enzymatic part of native colicin E3 protein against proteolytic degradation before or during its translocation across the cell envelope. These results are discussed in relation to the mode of entry of colicin E3 into bacterial cells. PMID- 2664425 TI - The Azorhizobium caulinodans nitrogen-fixation regulatory gene, nifA, is controlled by the cellular nitrogen and oxygen status. AB - The nucleotide sequence of the Azorhizobium caulinodans ORS571 nifA locus was determined and the deduced NifA amino acid sequence compared with that of NifA from other nitrogen-fixing species. Highly conserved domains, including helix turn-helix and ATP-binding motifs, and specific conserved residues, such as a cluster of cysteines, were identified. The nifA 5' upstream region was found to contain DNA sequence motifs highly homologous to promoter elements involved in nifA/ntr-mediated control and a consensus element found in the 5' upstream region of the Bradyrhizobium japonicum 5-aminolevulinic acid synthase (hemA) gene and of Escherichia coli genes activated during anaerobiosis via the fnr (fumarate nitrate reduction) control system. A nifA-lac fusion was constructed using miniMu lac and its activity measured in different genetic backgrounds and under various physiological conditions (in culture and in planta). NifA expression was found to be negatively autoregulated, repressed by rich nitrogen sources and high oxygen concentrations, and controlled (partially) by the ntrC gene, both in culture and in planta. DNA supercoiling was also implicated in nifA regulation, since DNA gyrase inhibitors severely repressed nifA-lac expression. PMID- 2664426 TI - The ribonucleoside diphosphate reductase gene (nrdA) of Escherichia coli carries a repetitive extragenic palindromic (REP) sequence in its 3' structural terminus. AB - A computer search for repeated sequences led us to identify five REP (repetitive extragenic palindromic) sequences in the 3'-terminal region of the Escherichia coli ribonucleoside diphosphate reductase gene (nrdA). These REP sequences are located within a putative duplicated DNA region, the first of them being part of the carboxy-terminal coding region of the nrdA gene. This is the first report of a REP sequence within a structural gene and also the first example of a REP sequence apparently generated by DNA duplication. PMID- 2664427 TI - Passive smoking in perspective. PMID- 2664428 TI - Acute arthropod envenomation. Incidence, clinical features and management. AB - Black widow spider (Latrodectus mactans) envenomation is found throughout both the temperate and tropical latitudes, and is one of the leading causes of death from arthropod envenomations worldwide. The venom is highly neurotoxic, affecting the presynaptic motor endplate to allow massive noradrenaline (norepinephrine) and acetylcholine release into synapses causing excessive stimulation and fatigue of the motor end plate and muscle. Clinically, patients develop a bite site lesion and pain, abdominal pain and tenderness, and lower extremity pain and weakness within minutes to hours of envenomation. Symptoms progress over several hours, then subside over 2 to 3 days. The recommended treatment of 'common' envenomation is calcium gluconate 10% intravenously, titrated to relief of symptoms; antivenin, although effective, may cause hypersensitivity and serum sickness reactions, and should be restricted to life-threatening envenomations only. Brown recluse spider (Loxosceles reclusa) envenomations are seen in the Americas and in Europe, and are endemic to the south and central United States. The venom contains at least 8 enzymes, consisting of various lysins (facilitating venom spread) and sphingomyelinase D, which causes cell membrane injury and lysis, thrombosis, local ischaemia, and chemotaxis. Local envenomations begin as pain and itching that progresses to vesiculation with violaceous necrosis and surrounding erythema, and ultimately ulcer formation. Systemic envenomations may be life threatening, and present with fever, constitutional symptoms, petechial eruptions, thrombocytopenia, and haemolysis with haemoglobinuric renal failure. Treatment of local envenomations is conservative (local wound care, cryotherapy, elevation, tetanus prophylaxis, and close follow-up); systemic envenomation requires supportive care and treatment of arising complications, corticosteroids to stabilise red blood cell membranes, and support of renal function. Dapsone 100mg daily has emerged as a promising therapeutic agent in both animal studies and clinical trials. Over 650 species of scorpions are known to cause envenomation (mostly in children under 10 years); they are endemic mostly in arid and tropical areas. Different venoms and clinical presentations are seen across the different species. Most commonly, an inflammatory local reaction occurs with envenomation, which is treated with wound debridement and cleaning, tetanus prophylaxis, and antihistamines. Occasionally the venom is allergenic, and the resultant allergic reaction is treated in a standard fashion.(ABSTRACT TRUNCATED AT 400 WORDS) PMID- 2664429 TI - Clinical toxicology of cocaine. AB - Recent widespread abuse of cocaine has resulted in an alarming increase in emergency department admissions for acute treatment of this toxic drug. Highly publicized cocaine-associated deaths of prominent athletes have awakened both the medical community and the general public to the possible devastating effects of this so-called 'champagne of drugs'. A potent central nervous system stimulant, cocaine produces symptoms that include changes in activity, mood, blood pressure, cardiac rhythm, respiration and body temperature. The adverse effects of cocaine, which may progress rapidly to death, include cerebrovascular accidents, myocardial infarction, sudden cardiac arrhythmias, pneumomediastinum, rhabdomyolysis with myoglobinuric renal failure and intestinal ischaemia. In addition, cocaine has been implicated in obstetric and neonatal complications. Because of the exceedingly rapid progression of the 'cocaine reaction' to a fatal outcome, it is imperative that clinicians know how to recognise and manage the symptoms of cocaine overdose. PMID- 2664430 TI - Drug-induced acute pancreatitis. A critical review. AB - Acute pancreatitis has a high morbidity and significant mortality. Among its many causes ethanol is pre-eminent, but many other drugs have also been incriminated. This article begins with a definition of the mechanisms, pathogenesis and clinical features of acute pancreatitis; it then critically reviews the evidence for drugs, excluding ethanol, as being causative. The drugs which have been implicated are considered under 3 headings: definite associations, probable associations and unlikely associations. A brief outline of possible treatment, strategies and prognosis associated with acute pancreatitis concludes the article. PMID- 2664431 TI - Photochemical labeling of apolar phase of membranes. PMID- 2664432 TI - Comparison of an enzyme immunoassay (IDEIA) with tissue culture isolation for detection of Chlamydia trachomatis using a single swab. AB - We directly compared a monoclonal antibody-based enzyme immunoassay (IDEIA) with isolation of Chlamydia trachomatis in cell culture (Buffalo Green Monkey cells) by changing the transport medium used for the IDEIA test so as to allow use of a single swab for both tests of the two techniques. We also modified the IDEIA test to exclude any possibility of false positive results caused by non-specific interference by Staphylococcus aureus. The observed sensitivity of the IDEIA compared to cell culture was rather low, 80.3% (57/71). However the IDEIA test's specificity was excellent, 99.7% (566/564) giving a positive predictive value of 96.6% and a negative predictive value of 97.9% (isolation rate by cell culture = 11%). PMID- 2664433 TI - Possible role of phospholipase C in the regulation of cell division in normal and neoplastic cells. AB - It is proposed that a phosphatidylinositol-specific phospholipase C (PLC) enzyme may be present in abnormally high concentrations in certain cancer cells, and that the elevated activity may explain many, if not all, of the neoplastic characteristics of the cancer cells. There have thus far, been two reports in which PLC activity has been found to be elevated several fold in neoplastic cells. The products of the action of PLC on the phosphoinositides, including diglycerides and inositol phosphates, have been shown to activate the process of cell division by elevating the intracellular concentration of calcium ions and by stimulating the activity of protein kinase C. An elevated content of PLC in at least certain neoplastic cells could thus explain uncontrolled proliferative processes in those cells. PMID- 2664434 TI - Does oxygen free radical increased formation explain long term complications of diabetes mellitus? AB - Oxygen free radicals (OFR) can form by reaction of glycated proteins with molecular oxygen. We hypothesize that this mechanism operates in tissues of diabetic patients when their content of glycated proteins is significantly increased. OFR are harmful to polyunsaturated fatty acids of lipid membranes, proteins, sugars and DNA. The most significant complications of diabetes, for example polyneuritis, retinopathy, microangiopathy, perforating ulcers, impaired healing, may depend on the excessive production of OFR by glycated proteins. Clues to these effects may be deduced from the decrease of glutathione stores in red blood cells, and the increases of lipid peroxidation and malondialdehyde formation, all of which have been documented to occur in the course of diabetes mellitus. PMID- 2664435 TI - Etiology of alcoholism: relevance of prenatal hormonal influences on the brain, anomalous dominance, and neurochemical and pharmacological brain asymmetry. AB - Because of possible prenatal hormonal influences on the brain, leading to anomalous dominance, pharmacological and neurochemical asymmetry, and consequent antisocial personality and phobic anxiety, the subject ingests ethanol for its tension-reducing properties via endorphinergic activation and the dopaminergic reward system. Due to presence of stress, and effects of anomalous dominance on ethanol metabolizing enzymes, ethanol-oxidizing systems are activated leading to high rates of ethanol elimination from the blood, and thus the decreased intensity of reaction to ethanol, leading to tolerance. Since stress can cause a decrease in the number of opiate receptors, a vicious cycle of ingesting more and more ethanol may be instituted. PMID- 2664436 TI - Chemotherapy of malignant tumors--a self-defeating form of immunotherapy? AB - Chemotherapy of malignant diseases was introduced into clinical practice during the 1940's. The initial response rate to this type of therapy is high in patients with a variety of cancers but the survival rate is affected in only a few patients, mainly in women with choriocarcinoma. Despite intensive research, the percentage of survivors following chemotherapy, for example in patients with small-cell bronchogenic cancer, has remained almost constant during the last 2 decades. The objective of the present paper is to consider the likelihood of immune mechanisms being active both in the regression and again in the later progression of tumor growth observed during treatment with cytotoxic drugs. Such a dual role for immunity appears to be possible. In contrast to most malignant cells in solid tumors, the leucocytes and leukemia cells are highly sensitive to anti-cancer agents. Thereby the drugs become immunosuppressive at a level in serum lower than that required for a direct interference with the proliferative capacity of the cells in a solid tumor. Furthermore, the cytotoxic drugs selectively influence the immune system. In the first phase of treatment the drugs enhance the effect of T-killer cells relatively by reducing blocking activity in serum; the net result being a regression in the tumor volume. However, continued chemotherapy is inconvenient for cancer patients.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 2664437 TI - Assessment of biological and colony hybridization assays for detection of the aerobactin system in Escherichia coli from urinary tract infections. AB - A total of 466 E. coli strains from urinary tract infections (UTI) were screened for the presence and expression of the aerobactin system by a colony hybridization test and a bioassay. A probe carrying part of the genes for aerobactin synthesis was used. A total of 43.1% (201) of the strains were positive in the probe test and undoubtedly positive in the bioassay. When doubtfully positive bioassays were included, this figure rose to 49.8% (232). An additional 4.9% (23) of the strains were positive in the colony hybridization test only while 44% (205) of the strains were negative in both tests. Doubtfully positive bioassays were probably due either to a false positive reaction or to a weak expression of the aerobactin system. 01:K1:H- strains were characteristically probe positive and doubtfully positive in the bioassay. The incidence of isolates positive by both methods or by only one of them was significantly higher among isolates from cases of pyelonephritis (Py) than among those from asymptomatic bacteriuria (ABU) and normal feces (FN) (P less than 0.01). PMID- 2664438 TI - Hydatid disease: analysis of parasite antigens in circulating immune complexes and in preformed hydatid antigen-antibody complexes. AB - Fifty-three sera from 29 patients with hydatid disease, all but one positive for specific anti-parasite antibodies and all negative for specific circulating antigens, were studied for the presence of circulating immune complexes (CIC) by conglutinin binding-assay (KgBA). Fourteen serum samples (26%) from eight patients (27%) were positive. These positive sera were pooled for each patient and the eight samples were PEG-precipitated and analysed for the presence of specific Echinococcus granulosus antigens in the CIC using a human anti-human hydatid cyst fluid antiserum capable of recognizing the major antigenic systems of the parasite namely, antigens 4 and 5. The assays utilized for detecting antigen in CIC were: (a) blotting on nitrocellulose paper after sodium dodecil sulphate polyacrylamide gel electrophoresis (SDS-PAGE) and specific immunological detection; (b) ultracentrifugation in acid buffer and subsequent detection of antigens by a sandwich-radioimmuno assay (RIA); (c) protein separation by isoelectric focusing (IEF) and specific immunological recognition. In addition, all positive sera were analysed for the presence of antigen in the CIC by a modified KgBA and by polyethylenglicol (PEG)-precipitation in acid buffer followed by immunological recognition of antigen. All tests gave negative results with the patients' samples, but were positive with preformed in vitro complexes between parasite antigens and corresponding antibodies. Failure to detect antigen in the CIC could be due to: 1) insufficient sensitivity of the assays used to detect hydatid antigens in CIC; 2) rapid clearance of antigen or CIC from the circulation; 3) presence of parasite antigen not recognized by the antiserum employed; 4) production of CIC as a result of polyclonal B-cell activation. This last hypothesis is supported by the demonstration of IgM-rheumatoid factor (RF) and anti-F(ab')2 antibodies respectively in 11 (44%) and 13 (52%) out of 25 patients. PMID- 2664439 TI - ColV increases the virulence of Escherichia coli K1 strains in animal models of neonatal meningitis and urinary infection. AB - Isogenic Escherichia coli strains, differing in their expression of K1 antigen and ColV plasmid, were studied for their ability to produce disease. Newborn rats were used to test the ability of these strains to colonize the intestine and to produce bacteremia and meningitis; adult rats were used to test their ability to produce urinary tract infection. Colonization of intestine and bladder by K1+ ColV+ E. coli was associated with rapid induction of bacteremia and higher mortalities compared with colonization with K1+ ColV- strains. These findings suggest that the ColV plasmid could play a role in the pathogenesis of human infections. PMID- 2664440 TI - Patients', parents', and oncologists' perceptions of informed consent for bone marrow transplantation. AB - Bone marrow transplantation (BMT) is gaining increasing acceptance as a therapeutic treatment modality and is being offered to patients even in the early stages of disease in the presence of minimal debilitating symptoms. Despite this, little is known regarding patients' and physicians' perceptions of the process in which informed consent for this controversial and potentially lethal procedure is obtained. Thirty-nine adult BMT patients and the parents of 61 children undergoing BMT and each of their physicians completed a questionnaire concerning their perceptions of the discussion in which consent for BMT was obtained and their evaluation of the consent document. In addition, the factors influencing patients' and parents' decision to accept BMT and the nature and amount of BMT information retained by patients and parents were assessed. The results indicate that on the whole patients and parents evaluated the BMT consultation and consent document favorably, were motivated by their trust in the physician and their belief in BMT as a cure, retained information regarding major points of informed consent from both the consent document and physician discussion, and had considerable difficulty with recall of the specific toxic side effects associated with BMT. Physicians' perceptions, on the other hand, reflected a less positive view of the extent to which patients and parents were actively involved in the consent process and the readability of the consent document. Perceptions of the informed consent process on the part of oncologist-investigators and patients which could impede the goals of informed consent and implications for facilitating the process are discussed. PMID- 2664442 TI - Liposarcoma of hepatic hilum in childhood: report of a case and review of the literature. AB - Liposarcoma in childhood has seldom been documented. The rare occurrence of this tumor has resulted in a lack of information about its natural history, prognosis, and management. The differential diagnosis with lipoblastomatosis is obligatory. A 2 year 4 month-old white male child presented at the Hospital das Clinicas of Medical School of Ribeirao Preto, University of Sao Paulo, with fever, jaundice, and coluria secondary to a tumoral mass of the hepatic hilum causing obstruction of the biliary tree. Histologic and immunohistochemical study at autopsy disclosed a liposarcoma. A literature review found 64 other reported cases. Special attention was given to age, sex, anatomic localization, and histologic aspects of the literature cases. Liposarcoma involving the hepatic hilum and causing obstruction of the biliary tree in childhood was not previously reported in the literature. PMID- 2664441 TI - Is androgen substitution necessary in hypogonadal patients when they are treated with chemotherapy for malignant diseases? AB - A patient with hypogonadotropic hypogonadism owing to endogenous gonadotropin releasing hormone deficiency, who developed Hodgkin's disease is described. Chemotherapy administration caused prolonged and life-threatening myelosuppression; androgen substitution seemed to reverse bone marrow function and to maintain normal peripheral blood counts. Whether or not androgens are a necessary substitution in hypogonadal patients suffering from cancer and undergoing chemotherapy is discussed. PMID- 2664443 TI - [Comparative evaluation of echography and C.A.T. in diagnosing retinoblastoma]. AB - The comparative efficiency of sonography and computerised axial tomography on the diagnosis of retinoblastoma was assessed in 8 consecutive cases. Ocular echography revealed a 100% sensitivity whereas CT scans gave false negatives in 2 out of the 8 cases (80% sensitivity). The value of ultrasound scanning as the diagnostic test of first choice for suspected retinoblastoma is therefore emphasised. PMID- 2664445 TI - [Analysis of ultrasound B-mode histogram in thyroid tumors]. AB - B-mode histograms of preoperative ultrasound texture were correlated to final pathological diagnoses and findings in 50 thyroid tumors (18 follicular adenomas, 6 follicular carcinomas and 26 papillary carcinomas) and 10 cases without any thyroid disease. Histograms were taken in the region of interest (ROI) and in the control area of the normal thyroid tissue. The following parameters, after subtracting the statistics of the control region from that of ROI, were evaluated; the difference of mean (D1), of standard deviation (D2), of skewness (D3), and of krutosis (D4). Likewise, Maharanobis distance (MD) was also studied. D1 was lower in papillary carcinomas than in follicular adenomas, and diminished by the relative proportion of some pathological findings, D2 and D3 of papillary carcinomas was higher than those of follicular adenomas. MD, having a significant correlation to D1 (r = -.8), revealed similar relationship with pathology as that of D1. No significant difference was observed between normal thyroid tissue and follicular adenoma, nor between follicular adenoma and follicular carcinoma in any parameter. MD showed the best correlation to malignancy. The criterion which judges the the tumor with D1 less than -2.5, or D2 more than 1 to be malignant, was expected to have sensitivity of 83% and specificity of 88%. PMID- 2664444 TI - [Preventive effect of OP-41483-alpha-CD on cyclosporine A-induced renal tubular and arterial damages]. AB - The aim of this study is to test whether a stable analogue prostaglandin I2 (OP 41483-alpha-CD) (OP) is effective to prevent Cyclosporine A (CsA)-induced nephrotoxicity. Male Lewis rats were administrated with CsA (50 or 100 mg/kg/day, per os) and treated with OP (25 micrograms/kg/day, subcutaneously). For the quantitativeness of qualitative changes, percent area of tubular vacuolization and the grade of renal arteriolar changes were evaluated at light microscopic level, then further examined under electron microscopy. CsA trough levels in the whole blood were also analyzed with HPLC and prostaglandin I2 was assayed by radioimmunoassay of its stable degeneration product 6-keto-PGF1-alpha. As a result, 1) ultrastructurally, perinuclear vacuoles in arteriolar media consisted of cellular intervaginated cytoplasmic processes of neighboring cells, suggesting spastic vasoconstriction induced by CsA, 2) survival rate of OP-treated rats were significantly high compared to that of rats with CsA alone, 3) pathologically, tubular and arterial damages were reduced in OP-treated models, 4) pharmacokinetic studies revealed that CsA trough levels were not different from those of CsA-received alone and OP-treated models, and 5) mean blood 6-keto-PGF1 alpha excretion in rats given CsA was higher than in normal rats. PMID- 2664446 TI - [Adrenal cyst: report of a case]. AB - This is a case report of an adrenal pseudocyst which developed in a 46-year-old man. The patient experienced dull headache, vertigo and palpitation. The diagnosis of the right adrenal cyst was established by echography and CT scan. The fluid of the cyst obtained preoperatively by percutaneous needle aspiration under ultrasonic guidance was 30 ml of a white, cloudy fluid and contained higher concentrations of cortisol and aldosterone than those in the plasma. The adrenal cyst was removed surgically: it measured 4 x 4 x 4 cm and contained yellow and serous fluid. Histological study revealed that the wall of the cyst consisted of thick collagen fibrous tissue without endothelial cell lining and so this adrenal cyst was classified to pseudocyst of the adrenal grand. The percutaneous needle aspiration under ultrasonic guidance is useful in the diagnosis and treatment of adrenal cyst. This is the 81st case of adrenal cyst reported in the Japanese literature. PMID- 2664447 TI - Multiple genes are transcribed in Hordeum vulgare and Zea mays that carry the DNA binding domain of the myb oncoproteins. AB - cDNA clones were isolated from tissue specific cDNA libraries of barley and maize using as a probe the cDNA of the maize gene C1, a regulator of anthocyanin gene expression. C1-related homology for all of the four cDNAs characterized by sequence analysis is restricted to the N-terminal 120 amino acids of the putative proteins. This region shows striking homology to the N-proximal domain of the myb oncoproteins from vertebrates and invertebrates. Within the myb proto-oncogene family this part of the respective gene products functions as a DNA binding domain. Acidic domains are present in the C-proximal protein segments. Conservation of these sequences, together with the genetically defined regulator function of the C1 gene product, suggest that myb-related plant genes code for trans-acting factors which regulate gene expression in a given biosynthetic pathway. PMID- 2664448 TI - An Escherichia coli cis-acting antiterminator sequence: the dnaG nut site. AB - The Escherichia coli rpsU-dnaG-rpoD operon contains an internal transcription terminator T1 located in the intergenic region between the rpsU and dnaG genes (Smiley et al. 1982). By cloning T1 as a small 127 bp fragment into the terminator probe plasmid pDR720 between the trp operator promoter and the assayable galK gene, it was shown that T1 acts as a strong transcription terminator, comparable in strength to the 3' operon terminator T2. However, an operon sequence that occurs 5' to T1 within the coding region of the rpsU gene and which has homology with the lambda nut site, (Lupski et al. 1983) when placed 5' to T1 in the pDR720 plasmid construct, modifies transcription through T1 allowing expression of the galK gene. This sequence, called the dnaG nut site also modifies the termination activity of the external operon terminator T2. It is proposed that the dnaG nut site is a cis-acting element of an antitermination system in E. coli. PMID- 2664449 TI - Cloning of histidine genes of Azospirillum brasilense: organization of the ABFH gene cluster and nucleotide sequence of the hisB gene. AB - A cluster of four Azospirillum brasilense histidine biosynthetic genes, hisA, hisB, hisF and hisH, was identified on a 4.5 kb DNA fragment and its organization studied by complementation analysis of Escherichia coli mutations and nucleotide sequence. The nucleotide sequence of a 1.3 kb fragment that complemented the E. coli hisB mutation was determined and an ORF of 624 nucleotides which can code for a protein of 207 amino acids was identified. A significant base sequence homology with the carboxy-terminal moiety of the E. coli hisB gene (0.53) and the Saccharomyces cerevisiae HIS3 gene (0.44), coding for an imidazole glycerolphosphate dehydratase activity was found. The amino acid sequence and composition, the hydropathic profile and the predicted secondary structures of the yeast, E. coli and A. brasilense proteins were compared. The significance of the data presented is discussed. PMID- 2664450 TI - Export and activity of hybrid FhuA'-'Iut receptor proteins and of truncated FhuA' proteins of the outer membrane of Escherichia coli. AB - The FhuA protein in the outer membrane of Escherichia coli serves as a multifunctional receptor for the phages T5, T1, phi 80, for colicin M, for ferrichrome (Fe3+-siderophore) and for the structurally related antibiotic, albomycin. To determine structural domains required for these receptor functions and for export, a fusion protein between FhuA and Iut (receptor for Fe3+ aerobactin and cloacin DF13) was constructed. In the FhuA'-'Iut hybrid protein, 24 amino acids of FhuA were replaced by 19 amino acids, 18 of which were from Iut. The number of plaque forming units of phage T5 and T1 on cells expressing FhuA'-'Iut was nearly as high as on cells expressing plasmid-encoded wild-type FhuA. However, 10(7)-fold higher concentrations of phage phi 80 and 10(3) times more colicin M were required to obtain a zone of growth inhibition. Truncated FhuA' proteins in which the last 24 amino acids at the carboxy-terminus were replaced by 16 (FhuA'2) or 3 (FhuA'T) amino acids could hardly be detected on polyacrylamide electrophoretograms of outer membrane proteins, due to proteolytic degradation. Sensitivity of cells expressing FhuA'2 to phage T5 and T1 was reduced by several orders of magnitude and sensitivity to phage phi 80 and colicin M was totally abolished. In contrast, cells expressing FhuA'T were nearly as sensitive to pahge T5, T1, and phi 80 and to colicin M as cells containing FhuA'-'Iut. None of the constructs could grow on ferrichrome as sole iron source and none was sensitive to albomycin.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 2664451 TI - Localization of proteins L4, L5, L20 and L25 on the ribosomal surface by immuno electron microscopy. AB - Ribosomal proteins L4, L5, L20 and L25 have been localized on the surface of the 50S ribosomal subunit of Escherichia coli by immuno-electron microscopy. The two 5S RNA binding proteins L5 and L25 were both located at the central protuberance extending towards its base, at the interface side of the 50S particle. L5 was localized on the side of the central protuberance that faces the L1 protuberance, whereas L25 was localized on the side that faces the L7/L12 stalk. Proteins L4 and L20 were both located at the back of the 50S subunit; L4 was located in the vicinity of proteins L23 and L29, and protein L20 was localized between proteins L17 and L10 and is thus located below the origin of the L7/L12 stalk. PMID- 2664452 TI - Three rpoBC mutations that suppress the termination defects of rho mutants also affect the functions of nusA mutants. AB - We have mapped three Escherichia coli RNA polymerase mutations selected by Guarente (1979) to suppress the termination defects of rho201. We find that two of the mutations are located in the 3' half of the rpoB gene encoding the beta subunit. The third mutation is in the rpoC gene, encoding the beta' subunit. All three RNA polymerase mutations affect termination efficiency, even in rho+ strains, suggesting that the C-terminal end of the beta as well as the beta' subunit participates in termination. In addition we find that all three rpoBC alleles inhibit lambda N-mediated antitermination at 30 degrees C in a strain containing the nusA1 allele. It may be significant that the three other RNA polymerase mutations known to revert the termination defect of mutant rho alleles also affect N-mediated antitermination in nusA1 strains. The correlation of these two phenotypes suggests that both phenotypes may arise from the same functional defect in RNA polymerase. PMID- 2664453 TI - A functional analysis of the repeated methionine initiator tRNA genes (IMT) in yeast. AB - Standard laboratory yeast strains have from four to five genes encoding the methionine initiator tRNA (IMT). Strain S288C has four IMT genes with identical coding sequences that are colinear with the RNA sequence of tRNA(IMet). Each of the four IMT genes from strain S288C is located on a different chromosome. A fifth IMT gene with the same coding sequence is present in strain A364A but not in S288C. By making combinations of null alleles in strain S288C, we show that each of the four IMT genes is functional and that tRNA(IMet) is not limiting in yeast strains with three or more intact genes. Strains containing a single IMT2, 3 or 4 gene grow only after amplification of the remaining IMT gene. Strains with only the IMT1 gene intact are viable but grow extremely slow; normal growth is restored by the addition of another IMT gene by transformation, providing a direct test for IMT function. PMID- 2664454 TI - Heme-deficient mutants of Salmonella typhimurium: two genes required for ALA synthesis. AB - The first step in heme biosynthesis is the formation of 5-aminolevulinic acid (ALA). We have isolated, mapped and characterized a large number of Salmonella typhimurium mutants auxotrophic for ALA. These mutants carry defects in either one of two genes, both required for ALA synthesis. The previously identified hemA gene maps at 35 min, and the hemL gene maps at 5 min on the S. typhimurium genetic map. Mutants in hemA and hemL are defective for aerobic and anaerobic respiration, and appear to be oxygen sensitive. The Hem- phenotype of hemL mutants is less severe than that of hemA mutants. Although hemA and hemL mutants are deficient in heme synthesis, genetic tests indicate that they still synthesize two minor products of the heme pathway, siroheme and cobalamin (vitamin B12), under anaerobic conditions. In contrast, hemB, hemC and cysG mutants, blocked after ALA synthesis, make neither siroheme nor vitamin B12. Double mutants defective in both hemA and hemL also make siroheme. We suggest that hemA and hemL are required for one route of ALA synthesis and that a second, minor route of ALA synthesis may operate in S. typhimurium; this second pathway would be independent of the hemA and hemL functions. PMID- 2664455 TI - Isolation and nucleotide sequence of the hemA gene of Escherichia coli K12. AB - The hemA gene of Escherichia coli K12 was cloned by complementation of a hemA mutant of this organism. Subcloning of the initial 6.0 kb HindIII fragment allowed the isolation of a 1.5 kb NheI-AvaI fragment which retained the ability to complement the hemA mutant. DNA sequencing by the dideoxy chain terminator method of Sanger showed the presence of an open reading frame (ORF) of 1254 nucleotides, which ends 6 nucleotides beyond the AvaI site. Primer extension experiments showed the existence of a putative transcription initiation site for the hemA gene, located at position 130. A possible promoter sequence was identified upstream from this transcription initiation site, and its functional activity was confirmed by the use of the pK01 promoter-probe vector. Protein synthesis in an in vitro coupled transcription-translation system showed a 46 kDa protein, which corresponds to the mol. wt. of the hemA protein, as deduced from the nucleotide sequence of the gene. No homology was found between the amino acid sequence of the hemA protein of E. coli K12 and known sequences of other delta aminolevulinic acid synthases (delta-ALAS), suggesting that this protein is different from other delta-ALAS enzymes. PMID- 2664456 TI - Cell surface proteins of a group A streptococcus type M4: the IgA receptor and a receptor related to M proteins are coded for by closely linked genes. AB - Two genes coding for cell surface proteins were cloned from a group A streptococcus type M4: the gene for an IgA binding protein and the gene for a fibrinogen binding protein. Both proteins were purified and partially characterized after expression in Escherichia coli. There was no immunological cross-reaction between the two proteins. The IgA binding protein, called protein Arp4, is similar to an IgA receptor previously purified from another strain of group A streptococci, but the proteins are not identical. Characterization of many independent clones showed that the two proteins described here are coded for by closely linked genes. Bacterial mutants have been found which have simultaneously lost the ability to express both genes, and a simple method to isolate such mutants is described. The existence of these variants indicates that expression of the two cell surface proteins may be coordinately regulated. Binding of fibrinogen is a characteristic property of streptococcal M proteins, and the available evidence suggests that the fibrinogen binding protein is indeed an M protein. PMID- 2664457 TI - Identification of a second polypeptide required for McrB restriction of 5 methylcytosine-containing DNA in Escherichia coli K12. AB - The McrB restriction system in Escherichia coli K12 causes sequence-specific recognition and inactivation of DNA containing 5-methylcytosine residues. We have previously located the mcrB gene near hsdS at 99 min on the E. coli chromosome and demonstrated that it encodes a 51 kDa polypeptide required for restriction of M.AluI methylated (A-G-5mC-T) DNA. We show here, by analysis of maxicell protein synthesis of various cloned fragments from the mcrB region, that a second protein of approximately 39 kDa is also required for McrB-directed restriction. The new gene, designated mcrC, is adjacent to mcrB and located distally to hsdS. The McrB phenotype has been correlated previously with restriction of 5-hydroxy-methyl cytosine (HMC)-containing T-even phage DNA that lacks the normal glucose modification of HMC, formally designated RglB (for restriction of glucoseless phage). This report reveals a difference between the previously correlated McrB and RglB restriction systems: while both require the mcrB gene product only the McrB system requires the newly identified mcrC-encoded 39-kDa polypeptide. PMID- 2664458 TI - Heat shock response in Escherichia coli promotes assembly of plasmid encoded RNA polymerase beta-subunit into RNA polymerase. AB - Escherichia coli cells, carrying a rifampicin sensitive RNA polymerase beta subunit gene in the chromosome and a rifampicin resistant beta-subunit gene placed under the control of a strong promoter in a multicopy plasmid, are unable to grow in the presence of rifampicin, despite the accumulation of large quantities of the resistant subunit. A major portion of the overproduced subunit is found in an insoluble form. Conditions known to induce the heat shock proteins (hsps), e.g. elevated temperature or the presence of ethanol in the growth medium, increase the amount of the plasmid-borne beta-subunit which apparently assembles into active RNA polymerase and makes the plasmid bearing cells rifampicin resistant. Alternatively, plasmid-borne subunits assemble into RNA polymerase with low efficiency in rpoH mutant cells known to have reduced level of hsps. We suggest that the plasmid-borne subunit is poorly assembled into RNA polymerase and that hsps promote the assembly by interfering with beta-subunit aggregation. PMID- 2664459 TI - Identification of the recR locus of Escherichia coli K-12 and analysis of its role in recombination and DNA repair. AB - A new recombination gene called recR has been identified and located near dnaZ at minute 11 on the current linkage map of Escherichia coli. The gene was detected after transposon mutagenesis of a recB sbcB strain and screening for insertion mutants that had a reduced efficiency of recombination in Hfr crosses. The recR insertions obtained conferred a recombination deficient and extremely UV sensitive phenotype in both recB recC sbcA and recB recC sbcB sbcC genetic backgrounds. recR derivatives of recBC+ sbc+ strains were proficient in conjugational and transductional recombination but deficient in plasmid recombination and sensitive to UV light. Strains carrying recR insertions combined with mutations in uvrA and other rec genes revealed that the gene is involved in a recombinational process of DNA repair that relies also on recF and recO, and possibly recJ, but which is independent of recB, recC and recD. The properties of two other insertions, one located near pyrE and the other near guaA, are discussed in relation to their proximity to recG and xse (the gene for exonuclease VII), respectively. PMID- 2664460 TI - The naturally occurring silent invertase structural gene suc2 zero contains an amber stop codon that is occasionally read through. AB - The yeast invertase structural gene SUC2 has two naturally occurring alleles, the active one and a silent allele called suc2 zero. Strains carrying suc2 zero are unable to ferment sucrose and do not show detectable invertase activity. We have isolated suc2 zero and found an amber codon at position 232 of 532 amino acids. However, transformants carrying suc2 zero on a multicopy plasmid were able to ferment sucrose and showed detectable invertase activity. Full-length invertase was found in gels stained for active invertase and in immunoblots. Therefore we concluded that the amber codon is occasionally read as an amino acid. The calculated frequency of read-through is about 4% of all translation events. PMID- 2664462 TI - Stable maintenance of a 35-base-pair yeast mitochondrial genome. AB - Small deletion variants ([rho-] mutants) derived from the wild-type ([ rho+]) Saccharomyces cerevisiae mitochondrial genome were isolated and characterized. The mutant mitochondrial DNAs (mtDNAs) examined retained as little as 35 base pairs of one section of intergenic DNA, were composed entirely of A.T base pairs, and were stably maintained. These simple mtDNAs existed in tandemly repeated arrays at an amplified level that made up approximately 15% of the total cellular DNA and, as judged by fluorescence microscopy, had a nearly normal mitochondrial arrangement throughout the cell cytoplasm. The simple nature of these [rho-] genomes indicates that the sequences required to maintain mtDNA must be extremely simple. PMID- 2664461 TI - Cloning and sequence analysis of the Saccharomyces cerevisiae RAD9 gene and further evidence that its product is required for cell cycle arrest induced by DNA damage. AB - Procaryotic and eucaryotic cells possess mechanisms for arresting cell division in response to DNA damage. Eucaryotic cells arrest division in the G2 stage of the cell cycle, and various observations suggest that this arrest is necessary to ensure the completion of repair of damaged DNA before the entry of cells into mitosis. Here, we provide evidence that the Saccharomyces cerevisiae RAD9 gene, mutations of which confer sensitivity to DNA-damaging agents, is necessary for the cell cycle arrest phenomenon. Our studies with the rad9 delta mutation show that RAD9 plays a role in the cell cycle arrest of methyl methanesulfonate treated cells and is absolutely required for the cell cycle arrest in the temperature-sensitive cdc9 mutant, which is defective in DNA ligase. At the restrictive temperature, cell cycle progression of cdc9 cells is blocked sometime after the DNA chain elongation step, whereas cdc9 rad9 delta cells do not arrest at this point and undergo one or two additional divisions. Upon transfer from the restrictive to the permissive temperature, a larger proportion of the cdc9 cells than of the cdc9 rad9 delta cells forms viable colonies, indicating that RAD9 mediated cell cycle arrest allows for proper ligation of DNA breaks before the entry of cells into mitosis. The rad9 delta mutation does not affect the frequency of spontaneous or UV-induced mutation and recombination, suggesting that RAD9 is not directly involved in mutagenic or recombinational repair processes. The RAD9 gene encodes a transcript of approximately 4.2 kilobases and a protein of 1,309 amino acids of Mr 148,412. We suggest that RAD9 may be involved in regulating the expression of genes required for the transition from G2 to mitosis. PMID- 2664463 TI - Regulation of the mRNA for monocyte-derived neutrophil-activating peptide in differentiating HL60 promyelocytes. AB - A cDNA library was constructed from HL60 human promyelocyte poly(A)+ RNA harvested 3 h after induction of macrophage differentiation with 12-O tetradecanoyl phorbol-13-acetate in the presence of cycloheximide. We isolated from this library a 1.6-kilobase full-length clone designated b4 whose corresponding mRNA was greatly increased in abundance in cytoplasmic RNA under these conditions. Dideoxy sequencing revealed that this mRNA encoded MONAP (monocyte-derived neutrophil-activating peptide), a 10-kilodalton monokine with neutrophil-specific chemotactic and enzyme-releasing activities. The 3' untranslated region of this mRNA was found to be 1.2 kilobases long and possessed nine copies of the AUUUA sequence known to be associated with regulation of mRNA stability. Actinomycin D chase experiments yielded evidence that cytoplasmic stabilization was one of the means of regulation of MONAP expression. Analysis of cytoplasmic poly(A)- RNA revealed the presence of several discrete truncated species that shared a common 5' end and appeared to be intermediates of degradation. S1 mapping showed that the 3' ends of these molecules were distributed throughout the 3' untranslated region, preferentially in A + U-rich regions, broadly correlating with the distribution of AUUUA sites. Nuclear run-on experiments indicated that transcriptional induction accounted for less than 15% of the accumulation of MONAP mRNA. This mRNA was induced in HL60 cells by treatment with several differentiation-inducing agents: 12-O-tetradecanoyl phorbol-13-myristate alone, sodium butyrate, vitamin D3, and dimethyl sulfoxide. It was also induced in quiescent diploid lung fibroblasts stimulated to divide by serum, and it was constitutively overexpressed by some human tumor lines. PMID- 2664464 TI - Autocrine induction of major histocompatibility complex class I antigen expression results from induction of beta interferon in oncogene-transformed BALB/c-3T3 cells. AB - By varying growth conditions, we identified a novel mechanism of autocrine regulation of major histocompatibility complex (MHC) class I gene expression by induction of beta interferon gene expression in transformed BALB/c-3T3 cells. Low serum conditions enhanced MHC class I antigen expression in v-rasKi- and v-mos transformed BALB/c-3T3 cells but not in untransformed BALB/c-3T3 cells. Transformed and untransformed cells grown under standard serum conditions (10% bovine calf serum) expressed similar cell surface levels of MHC class I antigens. However, low-serum conditions (0.5% bovine calf serum) induced four- to ninefold increases in cell surface levels of MHC class I antigens in both v-rasKi- and v mos-transformed cells but not in untransformed cells. These increases in MHC class I gene expression were seen at both the mRNA and cell surface protein levels and involved not only the heavy-chain component of the class I antigens but also beta 2 microglobulin. Beta 1 interferon mRNA and beta interferon inducible 2',5'-oligoadenylate synthetase mRNA were induced by growth under low serum conditions in transformed BALB/c-3T3 cells, and antibodies to beta interferon blocked the induction of MHC class I antigen expression by serum deprivation in these cells. These results demonstrate that growth under low-serum conditions leads to induction of beta interferon expression in oncogene transformed cells which then directly mediates autocrine enhancement of MHC class I gene expression. PMID- 2664465 TI - Synthesis of an enzymatically active FLP recombinase in vitro: search for a DNA binding domain. AB - We have used an in vitro transcription and translation system to synthesize an enzymatically active FLP protein. The FLP mRNA synthesized in vitro by SP6 polymerase is translated efficiently in a rabbit reticulocyte lysate to produce enzymatically active FLP. Using this system, we assessed the effect of deletions and tetrapeptide insertions on the ability of the respective variant proteins synthesized in vitro to bind to the FLP recognition target site and to carry out excisive recombination. Deletions of as few as six amino acids from either the carboxy- or amino-terminal region of FLP resulted in loss of binding activity. Likewise, insertions at amino acid positions 79, 203, and 286 abolished DNA binding activity. On the other hand, a protein with an insertion at amino acid 364 retained significant DNA-binding activity but had no detectable recombination activity. Also, an insertion at amino acid 115 had no measurable effect on DNA binding, but recombination was reduced by 95%. In addition, an insertion at amino acid 411 had no effect on DNA binding and recombination. On the basis of these results, we conclude that this approach fails to define a discrete DNA-binding domain. The possible reasons for this result are discussed. PMID- 2664466 TI - Identification of a 150-kilodalton polypeptide that copurifies with yeast TFIIIC and binds specifically to tRNA genes. AB - The transcription in vitro of eucaryotic tRNA genes by RNA polymerase III requires two transcription factors, designated TFIIIB and TFIIIC. One of the critical functions of TFIIIC in the transcription of tRNA genes is that it interacts directly and specifically with the two internal promoter elements of these genes. We have partially purified Saccharomyces cerevisiae TFIIIC by chromatography on Bio-Rex 70, DEAE-cellulose, and phosphocellulose resins. A 150 kilodalton (kDa) DNA-binding polypeptide copurified with TFIIIC activity. This 150-kDa protein coeluted with the DNA-binding activity of TFIIIC after rechromatography of TFIIIC on phosphocellulose and its elution with a linear salt gradient. The stable and high-affinity interaction of this protein with tRNA genes was demonstrated by the maintenance of a protein-DNA complex under conditions of high ionic strength. Finally, we showed by two criteria that the interaction of this protein with tRNA genes was specific. First, the protein-DNA complex was competed with only by DNA-containing tRNA genes; second, the protein preferentially bound to DNA fragments containing a tRNA gene. These results strongly suggest that the DNA-binding domain of the yeast TFIIIC is contained within this 150-kDa polypeptide. PMID- 2664467 TI - Positive and negative regulation of basal expression of a yeast HSP70 gene. AB - The SSA1 gene, one of the heat-inducible HSP70 genes in the yeast Saccharomyces cerevisiae, also displays a basal level of expression during logarithmic growth. Multiple sites related to the heat shock element (HSE) consensus sequence are present in the SSA1 promoter region (Slater and Craig, Mol. Cell. Biol. 7:1906 1916, 1987). One of the HSEs, HSE2, is important in the basal expression of SSA1 as well as in heat-inducible expression. A promoter containing a mutant HSE2 showed a fivefold-lower level of basal expression and altered kinetics of expression after heat shock. A series of deletion and point mutations led to identification of an upstream repression sequence (URS) which overlapped HSE2. A promoter containing a mutation in the URS showed an increased level of basal expression. A URS-binding activity was detected in yeast whole-cell extracts by a gel electrophoresis DNA-binding assay. The results reported in this paper indicate that basal expression of the SSA1 promoter is determined by both positive and negative elements and imply that the positively acting yeast heat shock factor HSF is responsible, at least in part, for the basal level of expression of SSA1. PMID- 2664468 TI - The Saccharomyces cerevisiae CKS1 gene, a homolog of the Schizosaccharomyces pombe suc1+ gene, encodes a subunit of the Cdc28 protein kinase complex. AB - The Saccharomyces cerevisiae gene CDC28 encodes a protein kinase required for cell cycle initiation. In an attempt to identify genes encoding proteins that interact with the Cdc28 protein kinase, high-copy plasmid suppressors of a temperature-sensitive cdc28 mutation were isolated. One such suppressor, CKS1, was found to encode an 18-kilodalton protein that shared a high degree of homology with the suc1+ protein (p13) of Schizosaccharomyces pombe (67% amino acid sequence identity). Disruption of the chromosomal CKS1 gene conferred a G1 arrest phenotype similar to that of cdc28 mutants. The presence of the 18 kilodalton Cks1 protein in yeast lysates was demonstrated by using Cks-1 specific antiserum. Furthermore, the Cks1 protein was shown to be physically associated with active forms of the Cdc28 protein kinase. These data suggest that Cks1 is an essential component of the Cdc28 protein kinase complex. PMID- 2664469 TI - The two positively acting regulatory proteins PHO2 and PHO4 physically interact with PHO5 upstream activation regions. AB - The repressible acid phosphatase gene PHO5 of Saccharomyces cerevisiae requires the two positively acting regulatory proteins PHO2 and PHO4 for expression. pho2 or pho4 mutants are not able to derepress the PHO5 gene under low-Pi conditions. Here we show that both PHO2 and PHO4 bind specifically to the PHO5 promoter in vitro. Gel retardation assays using promoter deletions revealed two regions involved in PHO4 binding. Further characterization by DNase I footprinting showed two protected areas, one located at -347 to -373 (relative to the ATG initiator codon) (UASp1) and the other located at -239 to -262 (UASp2). Exonuclease III footprint experiments revealed stops at -349 and -368 (UASp1) as well as at -245 and -260 (UASp2). Gel retardation assays with the PHO2 protein revealed a binding region that lay between the two PHO4-binding sites. DNase I footprint analysis suggested a PHO2-binding site covering the region between -277 and -296. PMID- 2664470 TI - A transcriptional cascade governs entry into meiosis in Saccharomyces cerevisiae. AB - Two signals activate meiosis in yeast: starvation and expression of the a1 and alpha 2 products of the mating-type locus. Prior studies suggest that these signals stimulate expression of an activator of meiosis, the IME1 (inducer of meiosis) product. We have cloned a gene, IME2, with properties similar to those of IME1: both genes are required for meiosis, and both RNAs are induced in meiotic cells. Elevated dosage of IME1 or IME2 stimulates the meiotic recombination pathway without starvation; thus, the IME products may be part of the switch that activates meiosis. IME1 was found to be required for IME2 expression, and a multicopy IME2 plasmid permitted meiosis in an ime1 deletion mutant. Accordingly, we propose that the IME1 product stimulates meiosis mainly through activation of IME2 expression. PMID- 2664471 TI - Characterization of the human p53 gene promoter. AB - Transcriptional deregulation of the p53 gene may play an important part in the genesis of some tumors. We report here an accurate determination of the transcriptional start sites of the human p53 gene and show that the majority of p53 mRNA molecules do not contain a postulated stem-loop structure at their 5' ends. Recombinant plasmids of the human p53 promoter-leader region fused to the bacterial chloramphenicol acetyltransferase gene (cat) were constructed. After transfection into rodent or human cells, a 350-base-pair fragment spanning the promoter region conferred 4% of the CAT activity mediated by the simian virus 40 early promoter/enhancer. We monitored the efficiency with which 15 3' and 5' promoter deletion constructs initiated transcription. Our results show that an 85 base-pair fragment, previously thought to have resided in exon 1, is all that is required for full promoter activity. PMID- 2664472 TI - Kluyveromyces lactis maintains Saccharomyces cerevisiae intron-encoded splicing signals. AB - The actin (ACT) gene from the budding yeast Kluyveromyces lactis was cloned, and the nucleotide sequence was determined. The gene had a single intron 778 nucleotides in length which possessed the highly conserved splicing signals found in Saccharomyces cerevisiae introns. We demonstrated splicing of heterologous ACT transcripts in both K. lactis and S. cerevisiae. PMID- 2664473 TI - Resistance to oncogenic transformation in revertant R1 of human ras-transformed NIH 3T3 cells. AB - A flat revertant, R1, was isolated from human activated c-Ha-ras-1 (hu-ac-Ha-ras) gene-transformed NIH 3T3 cells (EJ-NIH 3T3) treated with mutagens. R1 contained unchanged transfected hu-ac-Ha-ras DNA and expressed high levels of hu-ac-Ha-ras specific mRNA and p21 protein. Transfection experiments revealed that NIH 3T3 cells could be transformed by DNA from R1 cells but R1 cells could not be retransformed by Kirsten sarcoma virus, DNA from EJ-NIH 3T3 cells, hu-ac-Ha-ras, v-src, v-mos, simian virus 40 large T antigen, or polyomavirus middle T antigen. Somatic cell hybridization studies showed that R1 was not retransformed by fusion with NIH 3T3 cells and suppressed anchorage independence of EJ-NIH 3T3 and hu-ac Ha-ras gene-transformed rat W31 cells in soft agar. These results suggest that the reversion and resistance to several oncogenes in R1 is due not to cellular defects in the production of the transformed phenotype but rather to enhancement of cellular mechanisms that suppress oncogenic transformation. PMID- 2664474 TI - Thyrotropin increases malic enzyme messenger ribonucleic acid levels in rat FRTL 5 thyroid cells. AB - The addition of TSH to FRTL-5 thyroid cells induces a 7- to 8-fold increase in the steady state level of malic enzyme [L-malate-NADP+ oxidoreductase (decarboxylating); EC 1.1.1.40] mRNA, but does not alter beta-actin mRNA levels. Insulin alone or together with TSH has no effect on malic enzyme mRNA. The effect of TSH is not the result of thyroid hormone formation, since the addition of T3 in the presence or in the absence of TSH and the addition of 5% serum (which includes T3 and T4) have no effect. Forskolin (10(-6) M) reproduces the TSH effect, suggesting that cAMP is involved. PMID- 2664475 TI - Regulation of cathepsin-D and pS2 gene expression by growth factors in MCF7 human breast cancer cells. AB - In MCF7 human breast cancer cells, cathepsin-D and pS2 mRNAs are specifically and directly induced by estrogens at the transcriptional level. We studied the regulation of expression of these two genes by growth factors that are also mitogenic in this cell line. We show that pS2 mRNA, like cathepsin-D mRNA, is rapidly induced 2- to 4-fold by epidermal growth factor. The effect of epidermal growth factor on these two mRNAs was dependent upon de novo protein synthesis, indicating a different mechanism of regulation than with estradiol. Other peptide growth factors, such as insulin, insulin-like growth factor I, and basic fibroblast growth factor, also increased up to 3-fold the steady state levels of the two mRNAs in MCF7 cells. The pS2 mRNA, but not cathepsin-D mRNA, was also induced up to 8-fold by protein kinase-C activation with 12-O tetradecanoylphorbol-13-acetate, suggesting the possible involvement of this transduction pathway in pS2 mRNA induction. The effect of 12-O tetradecanoylphorbol-13-acetate was time and dose dependent and required protein synthesis. In addition, treatment by agents elevating cAMP increased pS2 mRNA accumulation 4-fold, whereas it had no effect on cathepsin-D mRNA levels. These results demonstrate that cathepsin-D and pS2 genes are under complex regulation in MCF7 cells, since growth factors stimulate their expression via indirect mechanisms contrasting with the primary transcriptional effects of estrogens. PMID- 2664476 TI - Expression of insulin-like growth factor I in cultured rat hepatocytes: effects of insulin and growth hormone. AB - The effects of GH and insulin the accumulation of insulin-like growth factor I (IGF-I) RNA transcripts and the secretion of immunoreactive IGF-I protein were studied in rat liver hepatocytes cultured in serum-free medium. GH at concentrations of 10 ng/ml or greater stimulated the accumulation of IGF-I RNA transcripts relative to actin transcripts in poly(A)+ RNA isolated from cultured hepatocytes. The time course of IGF-I transcript accumulation in response to GH appeared to be biphasic. The transcript levels rose dramatically during the first 2 h after exposure of the cultures to GH, declined between 3 and 6 h, but reaccumulated by 24 h after exposure to GH. The presence of insulin did not influence the effect of GH on the accumulation of IGF-I RNA transcripts, although insulin did elevate IGF-I transcript levels in the absence of GH. Analysis of RNA pulse-labeled with thiouridine followed by purification of the thiol-labeled RNA using mercurated agarose indicated that GH probably acts by increasing IGF-I transcription. Insulin also affected the release of immunoreactive IGF-I into the culture medium. In the presence of insulin, immunoreactive IGF-I accumulated in the culture medium to approximately the same extent over a 24-h period regardless of whether GH was also present. In the absence of insulin, immunoreactive IGF-I accumulated in the medium only if GH was present. The results suggest that insulin may play an important role in both IGF-I transcript accumulation and the secretion of IGF-I from cultured hepatocytes. PMID- 2664477 TI - Insulin receptor expression in the Burkitt lymphoma cells Daudi and Raji. AB - The specific binding of insulin to either intact or Triton-solubilized Daudi cells (a Burkitt lymphoma cell line) was reduced by over 95% compared to that to control IM-9 lymphocytes due to a decrease in receptor number without a change in affinity. Analysis by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and autoradiography revealed that 125I-labeled Daudi cells had reduced amounts (approximately 1/20th) of immunoprecipitable binding (alpha) subunit [mol wt (Mr), 130,000] of the receptor and a relatively abundant 210,000 Mr form not seen in IM-9 cells. The transmembranous (beta) subunit (Mr, 90,000) of the receptor, although not detected by 125I surface labeling, could be phosphorylated and, together with the 210,000 Mr form, exhibited the same 2-fold stimulation of phosphorylation by insulin as that in IM-9 cells. Northern blot hybridization revealed a decrease in Daudi cells of all four major species of insulin receptor mRNA. The Raji cell, another Burkitt lymphoma cell line, also exhibited reduced protein and genetic expression of the insulin receptor, indicating that reduced insulin receptor expression may be representative of other Burkitt lymphoma cell lines. PMID- 2664478 TI - [Fixation of tissue specimens. II]. AB - As a routine fixative calcium-acetate-formol is recommended causing no tissue shrinkage, haemolysis, formaldehyde pigments and having an almost neutral pH. Due to the formation of insoluble calcium salts it preserves fatty acids and water soluble urates and makes them withstanding to paraffin embedding. If completed with methylene blue this solution is also suitable for an improved fixation of acidic glycosaminoglycans. PMID- 2664479 TI - [Immunohistochemical, immunocytochemical and electron microscope studies in experimental E. coli pyelonephritis]. AB - Authors have studied in apostematous pyelonephritis induced by the ligation of the ureter and the intravenous injection of E coli bacteria the localization and elimination with time of the pathogen. The pathogen was demonstrated by light and electron microscopy, its parietel antigen was localized with the light microscopic peroxidase antiperoxidase and post-embedding electron microscopic immunogold techniques. Two days after inoculation the suppurative inflammation of tubulo-interstitial foci was observed; in the capillaries, interstitium, and tubuli, free and phagocyted bacteria were encountered. In the interstitium, in the proximal tubuli and in the capillary space of some glomeruli bacterial groups were observed. Intracapillary bacteria were attached by their outer wall to the surface of endothelial cells. In the tubuli this adherence occurred with pili or with the outer layer of bacterial wall. From the seventh day after inoculation macrophages containing PAS-positive globuli appeared in the interstitium. Under the electron microscope these globuli proved to be features composed of myelin figures of phagolysosomal origin. Globuli and the myelin figures possessed an E. coli antigenicity. Thirteen weeks after inoculation E. coli antigen positivity was found in the cytoplasm of inflammatory cells in the tubular walls and in the suppurative cylinders, The organism was apparently unable to eliminate the materials derived from the pathogenic microorganisms. PMID- 2664481 TI - Computerized tomography and magnetic resonance imaging in a case of spinal dysraphism. PMID- 2664480 TI - Functioning lipoadenoma of the parathyroid: case report and literature review. AB - Lipoadenoma of the parathyroid gland is a rare histologic variant of parathyroid adenoma that is usually functional and associated with clinical hyperparathyroidism. We report a case in which a radiolabeled thallium scan failed to demonstrate evidence of an adenoma, presumably because of the tumor's high fat content. The literature concerning this entity is reviewed. To our knowledge there are no other reported cases in which parathyroid scanning was used in diagnostic studies of parathyroid lipoadenoma. PMID- 2664482 TI - An overview of fluoxetine, a new serotonin-specific antidepressant. AB - Fluoxetine is a new, chemically unique antidepressant. In contrast with antidepressants already on the market, its only significant neurophysiologic effect is inhibition of serotonin reuptake. Double-blind comparisons show it is as effective in the treatment of major depression as tricyclic antidepressants. It is free of most of the troubling side effects of currently available antidepressants, including anticholinergic effects and weight gain. In fact, it is commonly associated with weight loss which is independent of nausea, the most commonly reported adverse effect. The recommended dose is 20 mg per day, given in the morning or early in the day. Fluoxetine deserves consideration for depressed patients for whom the clinician wishes to avoid anticholinergic effects, sedation, and weight gain. It may be especially effective in patients with pronounced obsessive-compulsive symptoms, weight gain with depression or from antidepressants, and in patients who have not responded to tricyclic therapy. PMID- 2664483 TI - Assessment of synthetic media for in vitro fertilization. PMID- 2664484 TI - Aortic graft-enteric fistula and paraprosthetic-enteric fistula: a review. AB - AGEF/PPEFs are infrequent, life-threatening complications of aortic reconstructive surgery. Early diagnosis requires a high index of suspicion. Whenever a patient with an aortic prosthesis develops gastrointestinal bleeding or manifestations of sepsis, the presence of a fistulous complex should be assumed until proven otherwise. In the vast majority of cases, adequate surgical management requires graft excision with extraanatomic bypass. Widespread retroperitoneal infection precludes any attempt at local revascularization. PMID- 2664485 TI - The history of responses to epidemic disease in the United States since the 18th century. AB - History offers some guidance for understanding social and policy responses to the AIDS epidemic. Pertinent themes in the history of responses to epidemic disease in the United States in the past two hundred years include an initial underestimation of the severity of the epidemic; the prevalence of fear and anxiety; flight, denial, and scape-goating as a result of fear; efforts to quarantine and isolate carriers and the sick; the assertion of rational policies by coalitions of business, government, and medical leaders; the recruitment of a special cadre of physicians to treat the sick; the similarity of responses to both epidemic and endemic infectious diseases; and the high cost of epidemics, which is shared by government, philanthropy, and private individuals. However, until more is known about the natural history of AIDS, generalizations about past epidemics must be cautiously applied to our present circumstances. PMID- 2664486 TI - [The use of the plasmid pTH10 for isolating the donor strains of Pseudomonas mallei]. AB - The plasmid pTH10 was transfered by conjugation into the Pseudomonas mallei strains. An attempt to construct the donor strains using the widely known technique employing the homology between the plasmid and chromosome due to the transposon Tn1 carried by the plasmid was unsuccessful. Among the clones resistant to bacteriophage PRD1 the variants were selected with the supposed integration of the plasmid into the chromosome. The latter clones required the ability to transfer the auxotrophic chromosomal markers in conjugation after the repeated conjugational transfer of the plasmid pTH10 into them. PMID- 2664487 TI - [Structural-functional analysis of the par-region of ColE1 plasmid]. AB - The DNA fragment identical to the right shoulder of the inverted repeat from the par-region of ColE1 plasmid has been synthesized chemically. It is shown to participate in the plasmid multimers resolution and to define the stable inheritance of the plasmid pKS1 containing the fragment in Escherichia coli C600 cells as well as in the multirecombinogenic strain Escherichia coli JC8679. The efficiency of the fragments functioning in Escherichia coli JC8679 is not enough for resolution of all forms of oligomeric pKS1 DNA. The site for recombinase action is found to be located in the synthesized oligonucleotide. However, some extra sequences of DNA located within the region of inverted repeat are necessary for maximally efficient functioning of the recombinase, the enzyme participating in plasmid multimers resolution. PMID- 2664488 TI - [Synthesis of heat-shock proteins in Saccharomyces cerevisiae protoplasts]. AB - The effect of cellular capsule elimination in Saccharomyces cerevisiae yeasts (protoplast formation) on the heat-shock protein synthesis and the synthesis of the proteins in protoplasts were studied. The methods of mono- and dimeric electrophoresis have demonstrated that (1) about 18 heat-shock proteins with the molecular masses 26-98 Kd are synthesized in cells at 41 degrees C; (2) protoplast formation per se does not induce the synthesis of heat-shock proteins, but the induction of these proteins in protoplasts at 41 degrees C is similar to the one in intact cells. The protoplast formation induces the synthesis of specific proteins different from heat-shock proteins and the synthesis is inhibited by the heat-shock. The heat-shock induces modification of 88 and 86 Kd heat-shock proteins. It inhibits the synthesis of a number of peptides (15-50 Kd) in cells and protoplasts. PMID- 2664489 TI - [Cloning and study of the function of recA-like gene of Yersinia pestis in Escherichia coli cells]. AB - A 2 kb fragment of Yersinia pestis genome cloned in Escherichia coli cells of the strain HB101 contains a gene able to complement the recA-dependent deficiency of E. coli cells in UV-resistance, resistance to alkylating agents, UV- and MNNG induced mutability. Cellular capability for homologous recombination in crosses with HfrH donor, derepressed synthesis of bacteriocins (colicin E1 and pesticin 1) is also complemented by the fragment in E. coli recA-strains. The obtained data suggest the functional homology of the cloned recA-like gene product with the product of E. coli recA-gene. PMID- 2664490 TI - Screening for possible human carcinogens and mutagens: a symposium report. PMID- 2664491 TI - Mutagens as carcinogens: development of current concepts. AB - The earliest work on reactions of mutagenic carcinogens with DNA, in which the author participated, is recalled in a personal reminiscence. Some significant consequences of this approach for studies of the mode of action of mutagenic carcinogens are briefly discussed, with regard to the types of mutation induced, and to current concepts of the involvement of somatic mutation in experimental cancer and in the aetiology of human cancer. PMID- 2664492 TI - Genetic toxicology of 1,2-dibromo-3-chloropropane (DBCP). AB - 1,2-Dibromo-3-chloropropane (DBCP) is a nematocide, which has been used extensively as a soil fumigant in agriculture. Since sterility was found among male workers involved in the manufacture of DBCP, great concern has been focused on the genetic hazards of DBCP. DBCP gave positive results in many tests such as microbial, in vitro cytogenetics, and Drosophila studies. In mammalian test systems, DBCP caused chromosomal aberrations in the bone marrow cells and dominant-lethal mutations in germ cells in rats. In mice, there were no signs of DBCP-induced heritable mutation in germ cells, although point mutations were detected in somatic cells. The occurrence of Y-chromosomal non-disjunction was indicated in DBCP-exposed male workers by an increased number of sperm containing 2 Y-chromosomes. PMID- 2664493 TI - Genetic toxicology of 1,1,2-trichloroethylene. AB - 1,1,2-Trichloroethylene (TCE) is a widely used halogenated solvent, produced in hundreds of millions of kg each year for industrial purposes. Occupational and environmental exposure of human populations to TCE has been reported in industrialized areas. Long-term carcinogenicity studies in rodents demonstrate that exposure to high doses of TCE results in the induction of liver and lung tumors in the mouse, and tumors of the kidney and the testis in the rat. An indirect mechanism, based on the stimulation of liver peroxisome proliferation by TCE metabolites, was proposed to explain species differences in TCE hepatocarcinogenicity. Mutagenicity studies indicate that TCE is weakly active both in vitro, where liver microsomes produce electrophilic TCE metabolites, and also in vivo in mouse bone marrow, where high rates of micronuclei, but no structural chromosome aberrations, are found. Among TCE metabolites, trichloroacetic acid was reported to be carcinogenic to mouse liver. Furthermore, both trichloroacetic acid and chloral hydrate were found to be genotoxic in vivo, inducing structural and numerical chromosome abnormalities, respectively. PMID- 2664494 TI - Constitutional chromosome instability and cancer risk. AB - Acquired, clonal chromosome abnormalities are thought to be of pathogenetic importance in human cancer; at the cellular level, neoplasia is best viewed as a genetic disease. It is therefore logical to suggest that cancer risk must somehow be related to individual variations in genomic stability. Those persons whose chromosomes are less stable will, on average, be the ones who are most likely to develop cancer. The testing of this hypothesis shows that, apart from the autosomal recessive chromosome breakage syndromes, only patients with adenomatosis of the colon and rectum have, consistently and by different groups, been found to display elevated spontaneous and clastogen-induced chromosome breakage frequencies. Some evidence indicates a similar tendency in patients with dysplastic nevus syndrome, basal cell carcinoma, cervix cancer, and Kaposi's sarcoma. For several other cancers the data strongly argue against any inherent genomic instability. Although most results thus fail to support constitutional chromosome fragility as a factor of importance in tumorigenesis, conclusive falsification of the hypothesis cannot be said to have been obtained. The possibility remains that variations in chromosome stability and clastogen sensitivity between different cell types, and also difficulties in selecting the most appropriate carcinogens in clastogen-exposure tests, may have masked systematic constitutional differences between patients and controls in the breakage assays. PMID- 2664495 TI - International Commission for Protection Against Environmental Mutagens and Carcinogens. ICPEMC publication No. 17. Can a mechanistic rationale be provided for non-genotoxic carcinogens identified in rodent bioassays? AB - In a recent survey of the results of the National Cancer Institute/National Toxicology Program's Carcinogenesis Bioassay Program, Ashby and Tennant (1988) drew attention to the high proportion of carcinogens that were non-genotoxic insofar as their response to the Salmonella-microsome test was concerned. The present review contrasts these findings with what is known mechanistically about non-genotoxic carcinogens that affect the tissues which are considered to be particularly prone to non-genotoxic tumor induction. Excessive and often thresholded increases in cellular proliferation in the affected tissues appear to be one common feature in tumor induction by these agents, which act either through cytotoxicity followed by regeneration or through hormone-mimetic action. It is suggested that a weight of the evidence approach on a chemical by chemical basis is necessary to decide the relevance of these agents to the human situation. PMID- 2664496 TI - Non-mutability by ultraviolet light in uvrD recB derivatives of Escherichia coli WP2 uvrA is due to inhibition of RecA protein activation. AB - The deficiency in UV mutagenesis in uvrD3 recB21 strains of E. coli is almost completely overcome by constitutive activation of RecA protein and expression of the SOS system (by recA730 or 43 degrees C treated recA441 lexA71). When SOS was expressed but RecA protein not self-activated (recA441 lexA71 at 30 degrees C), uvrD3 recB21 still reduced UV mutagenesis at low doses. The uvrD3 recB21 combination is therefore inhibiting activation of RecA protein. It is suggested that the DNA unwinding activity of the products of the uvrD and recB genes may be involved in generating single-stranded DNA needed to activate RecA protein both for the cleavage of LexA repressor and for a further role in UV mutagenesis. PMID- 2664497 TI - Methyl methanesulphonate (MMS) is clearly mutagenic in S. typhimurium strain TA1535; a comparison with strain TA100. AB - No mutagenicity or an uncertain mutagenic response has been reported in the literature for methyl methanesulphonate (MMS) in S. typhimurium strain TA1535 when using the plate assay. In our studies we found a reproducible mutagenic activity of 62 revertants/mumole and plate for MMS in strain TA1535 when using the preincubation assay. A dose-dependent increase in revertants was, however, observed only at fairly high doses (exceeding 4 mumole). Two different slopes were observed in the dose-response curve when testing MMS with strain TA100. Slope A is dependent on the error-prone response, possible only in strain TA100 due to the pKm101 plasmid (R factor) but not possible in strain TA1535 due to its umuDC deficiency. Slope B observed at higher doses (as in strain TA1535) could be explained through a GC----AT transition initiated by the O6-methylation of guanine. Our findings demonstrate that MMS induces back mutation in S. typhimurium strains carrying the hisG46 missense mutation due to the formation of O6-methylguanine. In the case of strain TA100 the pKm101 plasmid-mediated error prone mechanism is, however, the predominant process in MMS mutagenesis which leads to a higher mutagenic response at much lower doses than the GT----AT transition in strain TA1535. PMID- 2664498 TI - Mutagenicity on chlorination of products formed by ozonation of naphthoresorcinol in water. AB - The mutagenicity of products formed by chlorination after ozonation of naphthoresorcinol in aqueous solution was assayed with Salmonella typhimurium strains TA98 and TA100 in the presence and absence of S9 mix from phenobarbital- and 5,6-benzoflavone-induced rat liver. Ozonated and subsequently chlorinated naphthoresorcinol was directly mutagenic, as was ozonated naphthoresorcinol, in both strains tested. The mutagenic activity at chlorination with 8 equivalents of chlorine per mole of naphthoresorcinol after ozonation was markedly higher than that at only ozonation. Of the identified ozonation products of naphthoresorcinol, muconic acid, after chlorination with 2 or 4 equivalents of chlorine per mole of the compound, induced direct mutagenicity against TA98 and TA100. The chlorination of glyoxal with 0.5 and 1 chlorine equivalents per mole of the compound was shown to produce direct mutagenicity toward TA98. The identification of the chlorination products of these compounds is also discussed. PMID- 2664499 TI - 7-Amino-2,4,6-trimethylquinoline as a mutagenic pyrolysate compound of polyurethane foam. AB - Commercial polyurethane foam was pyrolyzed by gas burners at 600-700 degrees C for 2 h with introduction of air (200 ml/min). Gaseous pyrolysate was trapped in water and 10% hydrochloric acid. Basic and neutral pyrolysates have a mutagenic activity (447 revertants/10 micrograms) in Salmonella typhimurium TA98 in the presence of a mammalian metabolic activation system. These pyrolysates contained 12.32 mg of amino compounds as diaminotoluene per g polyurethane foam, amounts which are 120 times higher than those in unpyrolysed polyurethane foam. Basic and neutral pyrolysates were subjected to silica gel column chromatography, and 6 fractions having mutagenic potency were obtained. The colorless needles (m.p. 200.5-202 degrees C) were separated from fraction 4. These needles have the most potent mutagenicity (678 revertants/2 micrograms) in basic and neutral pyrolysates in Salmonella typhimurium TA98 with 10% S9 mix. From the physicochemical data, the structure of the compound was estimated to be an aminoquinoline derivative, and was identified using synthesized 7-amino-2,4,6 trimethylquinoline by mixed melting point, thin-layer co-chromatography and gas chromatography-mass spectrometry. PMID- 2664500 TI - Simple method for precise determination of chemical lethality in the L-arabinose resistance test of Salmonella typhimurium. AB - A simple method is described for the determination of the lethal effects of chemicals assayed with the L-arabinose resistance test of Salmonella typhimurium. The method uses a mixed culture of 2 isogenic bacterial strains which are distinguished on the basis of their different nutritional requirements: sensitivity or resistance to L-arabinose, auxotrophy or prototrophy to histidine and leucine. BA13 (the mutation indicator strain) is the strain for routine screening of mutagens and allows the selection of forward mutation from L arabinose sensitivity to L-arabinose resistance. BAL13 (the survival indicator strain) is a derivative of BA13. Both bacterial strains are found to be equally sensitive to the lethal effects of mutagens. The method described permits the measurement of cell survival at the same high cell concentration as used in the measurement of the mutant yield and in the same type of minimal medium with L arabinose and glycerol, except for the histidine supplement in the mutant plates or the leucine in the survival plates. PMID- 2664501 TI - Mutagenicity of 2,6-dinitrotoluene and its metabolites, and their related compounds in Salmonella typhimurium. AB - The mutagenic activities of 2,6-dinitrotoluene (2,6-DNT) and its 6 metabolites, and their 8 related compounds were examined using Salmonella typhimurium strains TA98 and TA100 in the absence or presence of S9 mix. 2,6-DNT itself showed no mutagenicity toward either strain, but 2,6-dinitrobenzaldehyde (2,6-DNBAl), one of the metabolites of 2,6-DNT, showed the highest mutagenic activity in strain TA100. 2,6-DNBAl was a direct-acting mutagen, not requiring metabolic activation. The other compounds containing nitro groups showed weak or no mutagenic activity. This result suggests that the direct-acting mutagenicity of 2,6-DNBAl is mainly due to the aldehyde group of the 2,6-DNBAl molecule. PMID- 2664502 TI - Reduction of the translation fidelity by kanamycin: effects on growth and mutant frequency in S. typhimurium TA102. AB - Kanamycin reduces the translation fidelity in prokaryotes. By read-through of the ochre stop codon (hisG428) of S. typhimurium TA102 enough functional enzyme is produced to allow the his- cells to form a dense background growth on the minimal agar plates. The influence on the revertant colony numbers is similar to the effect of histidine supplementation. PMID- 2664503 TI - Myosin heavy chain composition of muscle fibers in spinal muscular atrophy. AB - Muscle biopsies from 20 cases of spinal muscular atrophy (SMA), mostly diagnosed as Werdnig-Hoffmann (W-H) disease, were examined for myosin heavy chain (HC) composition. The fetal, fast, and slow heavy chains were characterized in the isolated muscle myosin, and in myosin of single, chemically skinned fibers, by electrophoresis in SDS-6% polyacrylamide gels and by immunoblot techniques, using specific antibodies directed to each main type of myosin HC. The fiber distribution of myosin HC isozymes was further investigated on muscle cryostat sections by an indirect immunofluorescent technique. Fetal myosin HC was found to be expressed in a subpopulation of severely atrophic fibers, alone or together with the slow form of myosin HC. Triangulated fibers of intermediate size contained fetal and fast myosin or fast myosin alone. The hypertrophic fibers were characterized by the predominant expression of slow myosin HC; but in some of these fibers, also low amounts of HC fetal were found to be expressed. These findings are discussed in relation to developmental transitions of myosin heavy chains in human muscle. PMID- 2664504 TI - Effect of hypertonic solutes upon the polysaccharide capsule in Cryptococcus neoformans. AB - The polysaccharide capsule is a characteristic virulence factor in the yeast pathogen, Cryptococcus neoformans. Growth in hypertonic growth media results in yeast cells with visibly smaller capsules. We investigated this suppression quantitatively, using a chemical assay for cell-bound and dissolved capsular polysaccharide. Molar NaCl suppressed production of cell-bound polysaccharide by a factor of 2.5- to 5-fold. The possibility of salt-induced physico-chemical contraction of capsular gel was tested by dialysis of fixed cells from hypotonic medium against medium containing 1 M NaCl and against the original medium again, while capsular thickness, packed cell volume and cell-bound polysaccharide were followed. We detected a physical contraction of gel following dialysis against medium containing 1 M NaCl. Mutants which gave mucoid colonies on hypertonic agar were isolated. One of these gave twice as much polysaccharide as the wild type when cultivated in medium containing 1 M NaCl. The hypercapsular trait was passed through serial outcrosses to the wild type and segregated as a chromosomal gene. This mutant may represent a gene which regulates production of capsular polysaccharide. PMID- 2664505 TI - Mitochondrial kinetics during mitosis in Cryptococcus neoformans--an ultrastructural study. AB - Mitochondrial kinetics during mitosis in Cryptococcus neoformans was examined with ultrathin serial sections using a computer-aided three-dimensional reconstruction technique. The number of mitochondria varied during mitosis: there was an increase in prophase to telophase cells and a decrease in interphase cells. No appreciable differences in the form and number of mitochondria were found between the cells in the logarithmic growth phase and stationary phase. Fluctuations in the ratio of mitochondrial volume/total cytoplasmic volume were minimum during mitosis. However, the ratio was affected by the growth condition of the cells; that is, the ratio in the logarithmic growth cells was significantly higher than that in stationary cells. A giant mitochondrion, which is composed of a coalescence of all the mitochondria in a cell, was not found in this study. PMID- 2664506 TI - Differential recognition of two cloned Brugia malayi antigens by antibody class. AB - The humoral and cellular immune response to filarial parasites is complex. Numerous studies have shown that antibodies to a large number of protein and non protein antigens may be produced over the course of infection and that immune recognition of any given antigen may vary by disease manifestation and by immunoglobulin class. We have used the techniques of molecular cloning to attempt to dissect this complex interaction, and describe here two clones, isolated from an expression library constructed from Brugia malayi genomic DNA, whose products are recognized by distinct immunoglobulin classes. A lambda gt11 fusion protein containing part of the B. malayi myosin tail region is recognized by antibodies of the IgG class from a high percentage of bancroftian filariasis patients. A fusion protein containing a collagen-like sequence is less frequently and weakly recognized under the same experimental conditions, but is almost universally recognized when the developing reagent is specific for IgE. We thus identify specific filarial proteins against which the infected human host responds preferentially with antibodies of a specific immunoglobulin class. PMID- 2664507 TI - A surface antigen of Trypanosoma cruzi involved in cell invasion (Tc-85) is heterogeneous in expression and molecular constitution. AB - A monoclonal antibody (McAb), H1A10, causes 46-96% inhibition of the invasion of tissue culture cells by trypomastigotes from different strains and clones of Trypanosoma cruzi. Higher inhibition was observed when axenic medium-derived metacyclic trypomastigotes (72-96%) were employed instead of tissue culture derived trypomastigotes (46-60%). In contrast to the metacyclic population, in which all individuals reacted with the McAb, part of the tissue-cultured trypomastigote population did not bind the antibody. The molecular masses and isoelectric points of the glycoproteins recognized by the H1A10 McAb differed when tissue culture trypomastigotes of the Y strain and YuYu strain were analyzed. Variability between the strains was also observed when the antigens were metabolically labelled in the presence of tunicamycin. These results suggest that the differences described are probably not due solely to the carbohydrate portion of the molecule. PMID- 2664508 TI - Filarial parasites exhibit unusually high levels of choline acetyltransferase activity. AB - The presence of unusually high levels of choline acetyltransferase (ChAT, EC 2.3.1.6) in human and animal filarial parasites has been demonstrated. The levels of ChAT were highest in male worms of Brugia malayi and Brugia pahangi, with specific activities in crude extracts of about 2.27 and 1.26 mumol min-1 (mg protein)-1, respectively. The enzyme levels in these worms were over 10-20 times higher than in male worms of Litomosoides carinii. The ChAT levels were about 2-5 times higher in male than in female worms. The enzyme was also present in appreciably high levels in microfilariae of Brugia species, L. carinii and Wuchereria bancrofti. The levels of ChAT in male worms of Brugia species were several thousand-fold higher than in the intestinal nematodes Trichuris muris and Necator americanus, and were over three orders of magnitude higher than in mammalian brain. Unlike the mammalian ChAT, the parasite enzyme was extremely stable. The parasite enzyme was not inhibited by any of the antifilarial agents except suramin. The filarial ChAT was strongly inhibited by sulphydryl reagents and diethylpyrocarbonate. Ethacrynic acid (EA), a diuretic and a sulphydryl reagent, irreversibly inhibited the filarial ChAT activity at low concentrations. In contrast, EA inhibited the activity of mammalian brain ChAT at much higher concentrations. The motility of adult worms and microfilariae was irreversibly inhibited by low concentrations of EA. Furthermore, the inhibition of motility was paralleled by the inactivation of ChAT in these parasites. These studies indicate that ChAT activity appears to be vital for parasite's survival and that acetylcholine might play a key role in the control of worm motility. PMID- 2664509 TI - Final report on the aspirin component of the ongoing Physicians' Health Study. AB - The Physicians' Health Study is a randomized, double-blind, placebo-controlled trial designed to determine whether low-dose aspirin (325 mg every other day) decreases cardiovascular mortality and whether beta carotene reduces the incidence of cancer. The aspirin component was terminated earlier than scheduled, and the preliminary findings were published. We now present detailed analyses of the cardiovascular component for 22,071 participants, at an average follow-up time of 60.2 months. There was a 44 percent reduction in the risk of myocardial infarction (relative risk, 0.56; 95 percent confidence interval, 0.45 to 0.70; P less than 0.00001) in the aspirin group (254.8 per 100,000 per year as compared with 439.7 in the placebo group). A slightly increased risk of stroke among those taking aspirin was not statistically significant; this trend was observed primarily in the subgroup with hemorrhagic stroke (relative risk, 2.14; 95 percent confidence interval, 0.96 to 4.77; P = 0.06). No reduction in mortality from all cardiovascular causes was associated with aspirin (relative risk, 0.96; 95 percent confidence interval, 0.60 to 1.54). Further analyses showed that the reduction in the risk of myocardial infarction was apparent only among those who were 50 years of age and older. The benefit was present at all levels of cholesterol, but appeared greatest at low levels. The relative risk of ulcer in the aspirin group was 1.22 (169 in the aspirin group as compared with 138 in the placebo group; 95 percent confidence interval, 0.98 to 1.53; P = 0.08), and the relative risk of requiring a blood transfusion was 1.71. This trial of aspirin for the primary prevention of cardiovascular disease demonstrates a conclusive reduction in the risk of myocardial infarction, but the evidence concerning stroke and total cardiovascular deaths remains inconclusive because of the inadequate numbers of physicians with these end points. PMID- 2664510 TI - Serum erythropoietin levels after renal transplantation. AB - We measured serum erythropoietin levels serially in 31 renal-transplant recipients treated with cyclosporine, using the recently developed recombinant human erythropoietin-based radioimmunoassay. The mean (+/- SEM) serum erythropoietin concentration in these patients before transplantation (14 +/- 2 U per liter) was similar to that in normal subjects who did not have anemia. A transient postoperative 9-fold increase (range, 0- to 74-fold) in the serum erythropoietin levels was followed by a smaller (3-fold) and sustained (28 +/- 3 days) second elevation. The initial increase occurred in the absence of graft function and was not accompanied by an erythropoietic response, whereas the second increase was associated with graft recovery and the complete resolution of the anemia. Serum erythropoietin levels returned to normal as the hematocrit rose above 0.32. Thereafter, the hematocrit continued to rise toward normal, while the serum erythropoietin levels remained normal. The patients in whom erythrocytosis or iron-deficiency anemia developed had persistently elevated serum erythropoietin levels. We conclude that in patients who have undergone renal transplantation, slight increases in endogenous erythropoietin levels induce erythropoiesis to the same extent as do large doses of exogenous erythropoietin in patients with uremia. Moreover, once initiated, erythropoiesis in renal transplant recipients may be sustained by normal serum erythropoietin levels. These results suggest that the restoration of renal function improves the erythropoietic response to erythropoietin. PMID- 2664511 TI - The debate over physician ownership of health care facilities. PMID- 2664512 TI - Bone marrow transplantation after the Chernobyl nuclear accident. AB - On April 26, 1986, an accident at the Chernobyl nuclear power station in the Soviet Union exposed about 200 people to large doses of total-body radiation. Thirteen persons exposed to estimated total-body doses of 5.6 to 13.4 Gy received bone marrow transplants. Two transplant recipients, who received estimated doses of radiation of 5.6 and 8.7 Gy, are alive more than three years after the accident. The others died of various causes, including burns (the cause of death in five), interstitial pneumonitis (three), graft-versus-host disease (two), and acute renal failure and adult respiratory distress syndrome (one). There was hematopoietic (granulocytic) recovery in nine transplant recipients who could be evaluated, six of whom had transient partial engraftment before the recovery of their own marrow. Graft-versus-host disease was diagnosed clinically in four persons and suspected in two others. Although the recovery of endogenous hematopoiesis may occur after exposure to radiation doses of 5.6 to 13.4 Gy, we do not know whether it is more likely after the transient engraftment of transplanted stem cells. Because large doses of radiation affect multiple systems, bone marrow recovery does not necessarily ensure survival. Furthermore, the risk of graft-versus-host disease must be considered when the benefits of this treatment are being weighed. PMID- 2664513 TI - An outbreak of shigellosis associated with the consumption of raw oysters. AB - We describe an outbreak of Shigella sonnei infection among 24 persons who had eaten raw oysters in restaurants in southeastern Texas within five days before the onset of symptoms. The oysters in all eight restaurants were supplied by the same dealer, but examination of a routine water sample collected six days before the probable time of contamination showed the waters where the oysters were harvested to be free of fecal contamination, making widespread sewage contamination unlikely. The suspect oysters were traced to a single boat. Stool swabs from that boat's oyster harvesters allowed the identification of one asymptomatic carrier who had a strain of S. sonnei (determined by colicin typing, plasmid analysis, and testing for susceptibility to antibiotics) that was similar to or the same as that infecting the patients. Although the source of this man's infection was unknown, he reported having eaten no oysters. Investigation revealed that 5-gallon (19-liter) pails were used as toilets aboard the oyster boats. Sewage collected in these pails was often dumped overboard into the harvesting area. We conclude that this outbreak of S. sonnei resulted from poor sanitary procedures that probably allowed stool from a carrier to contaminate oysters either just before or after they were taken aboard the boat. PMID- 2664514 TI - Recent developments in the understanding of the pathogenesis and treatment of anaerobic infections (2). PMID- 2664515 TI - On the date of the first use of ether in surgery. PMID- 2664516 TI - The cardiovascular response of normal humans to the administration of endotoxin. AB - Marked abnormalities in cardiovascular function accompany septic shock, and bacterial endotoxin is believed to be one of the principal mediators of these abnormalities. To evaluate the cardiovascular effects of endotoxemia in humans, we measured hemodynamic variables in nine normal subjects given an intravenous bolus dose of endotoxin (Escherichia coli, 4 ng per kilogram of body weight) and in six normal subjects given a bolus dose of saline, before and three hours after administration. All the subjects then underwent volume loading with normal saline (mean, 2217 ml) during the fourth and fifth hours after administration of the bolus, and the measurements were repeated. Three hours after the administration of endotoxin and before volume loading, the cardiac index had increased by 53 percent and the heart rate by 36 percent (both changes were significant; P less than or equal to 0.008), and the systemic vascular-resistance index had decreased by 46 percent (P = 0.004). After volume loading (five hours after the administration of endotoxin), the left ventricular ejection fraction decreased by 1 percent of the base-line value in the subjects given endotoxin, but increased by 14 percent in the controls (P = 0.008). The left ventricular end-diastolic and end-systolic volume indexes increased by 18 percent (P = 0.07) and 24 percent (P = 0.042), respectively. Left ventricular performance, as measured by the ratio of the peak systolic pressure to the end-systolic volume index, was depressed (a decrease of 0.90 in the subjects given endotoxin vs. an increase of 0.76 in the controls; P = 0.024). We conclude that the administration of endotoxin to normal subjects causes a depression of left ventricular function that is independent of changes in left ventricular volume or vascular resistance. The changes in function are similar to those observed in septic shock and suggest that endotoxin is a major mediator of the cardiovascular dysfunction in this condition. PMID- 2664517 TI - Cyclosporine-induced hyperuricemia and gout. AB - To evaluate the frequency and the pathogenesis of hyperuricemia and gout during cyclosporine therapy, we studied renal-transplant recipients who were treated with either cyclosporine and prednisone (n = 129) or azathioprine and prednisone (n = 168). Among the patients with stable allograft function and serum creatinine concentrations below 265 mumol per liter, hyperuricemia was more common in the cyclosporine group than in the azathioprine group (84 percent vs. 30 percent; P = 0.0001). Gout developed in nine patients (7 percent) in the cyclosporine group, but no episodes occurred in the azathioprine group. Serum urate levels became elevated in 90 percent of the patients in the cyclosporine group who were treated with diuretics, as compared with 60 percent of those not treated with diuretics (P = 0.001); in the azathioprine group, the corresponding values were 47 percent and 15 percent (P = 0.0001). Serum urate levels did not correlate with trough blood cyclosporine levels in a selected subgroup (n = 40) of patients from the cyclosporine group, who were studied from 4 to 96 weeks after transplantation. Detailed studies of urate metabolism in six cyclosporine-treated patients revealed normal turnover rates for urate and decreases in creatinine and urate clearance, as compared with seven control subjects. We conclude that hyperuricemia is a common complication of cyclosporine therapy and is caused by decreased renal urate clearance. Gouty arthritis is the cause of considerable morbidity among renal-transplant recipients who receive cyclosporine. PMID- 2664518 TI - Recent developments in the understanding of the pathogenesis and treatment of anaerobic infections (2). PMID- 2664519 TI - Management of drug therapy in the elderly. PMID- 2664520 TI - Early metabolic defects in persons at increased risk for non-insulin-dependent diabetes mellitus. AB - To identify early metabolic abnormalities in non-insulin-dependent diabetes mellitus (NIDDM), we measured sensitivity to insulin and insulin secretion in 26 first-degree relatives of patients with NIDDM and compared these subjects both with 14 healthy control subjects with no family history of NIDDM and with 19 patients with NIDDM. The euglycemic insulin-clamp technique, indirect calorimetry, and infusion of [3-3H]glucose were used to assess insulin sensitivity. Total-body glucose metabolism was impaired in the first-degree relatives as compared with the controls (P less than 0.01). The defect in glucose metabolism was almost completely accounted for by a defect in nonoxidative glucose metabolism (primarily the storage of glucose as glycogen). The relatives with normal rates of metabolism (mean +/- SEM, 1.81 +/- 0.27 mg per kilogram of body weight per minute) and impaired rates (1.40 +/- 0.22 mg per kilogram per minute) in oral glucose-tolerance tests had the same degree of impairment in glucose storage as compared with healthy control subjects (3.76 +/- 0.55 mg per kilogram per minute; P less than 0.01 for both comparisons). During hyperglycemic clamping, first-phase insulin secretion was lacking in patients with NIDDM (P less than 0.01) and severely impaired in their relatives with impaired glucose tolerance (P less than 0.05) as compared with control subjects; insulin secretion was normal in the relatives with normal glucose tolerance. We conclude that impaired glucose metabolism is common in the first-degree relatives of patients with NIDDM, despite their normal results on oral glucose-tolerance tests. Both insulin resistance and impaired insulin secretion are necessary for the development of impaired glucose tolerance in these subjects. PMID- 2664521 TI - Experience with anencephalic infants as prospective organ donors. AB - Recent advances have made organ transplantation in newborns feasible, but the paucity of organs small enough for this age group remains a major limitation. Because anencephalic infants can survive for no more than a few weeks, they have been considered as possible organ donors for other infants. Under current law, however, they cannot be used as donors until their brain-stem activity ceases and the criteria for total brain death are thereby met. If anencephalic infants receive customary care, their solid organs usually undergo irreversible hypoxic injury during the process of dying and become unsuitable for donation by the time of death. We modified the medical care of 12 live-born anencephalic infants for one week to determine whether organ viability could be maintained and whether the criteria of total brain death could be met. Six received intensive care from birth, and six only when signs of imminent death developed. Only two infants met the criteria for total brain death within one week, and no solid organs were procured. Most organs were suitable for transplantation at birth. When intensive care was provided from birth, organ function was maintained; however, brain-stem activity ceased in only one infant within the first week. When intensive care was delayed until death was imminent, most organs were damaged to an extent that made them no longer suitable for transplantation. Our findings suggest that it is usually not feasible, with the restrictions of current law, to procure solid organs for transplantation from anencephalic infants. PMID- 2664522 TI - The use of aspirin to prevent pregnancy-induced hypertension and lower the ratio of thromboxane A2 to prostacyclin in relatively high risk pregnancies. AB - We carried out a prospective, randomized, double-blind, placebo-controlled study to investigate the capacity of aspirin to prevent pregnancy-induced hypertension and to alter prostaglandin metabolism. A total of 791 pregnant women with various risk factors for pre-eclamptic toxemia were screened with use of the rollover test (a comparison of blood pressure before and after the woman rolls from her left side to her back) during week 28 or 29 of gestation. Of 69 women with abnormal results (an increase in blood pressure during the rollover test), 65 entered the study and were treated with a daily dose of either aspirin (100 mg; 34 women) or placebo (31 women) during the third trimester of pregnancy. The number of women in whom pregnancy-induced hypertension developed was significantly lower among the aspirin-treated than among the placebo-treated women (4 [11.8 percent] vs. 11 [35.5 percent]; P = 0.024); the same was true for the incidence of preeclamptic toxemia (1 [2.9 percent] vs 7 [22.6 percent]; P = 0.019). The mean ratio of serum levels of thromboxane A2 to serum levels of prostacyclin metabolites after three weeks of treatment decreased by 34.7 percent in the aspirin-treated group but increased by 51.2 percent in the placebo-treated group. No serious maternal or neonatal side effects of treatment occurred in either group. We conclude that low daily doses of aspirin taken during the third trimester of pregnancy significantly reduce the incidence of pregnancy-induced hypertension and pre-eclamptic toxemia in women at high risk for these disorders, possibly through the correction of an imbalance between levels of thromboxane and prostacyclin. PMID- 2664523 TI - Effect of low-dose aspirin on fetal and maternal generation of thromboxane by platelets in women at risk for pregnancy-induced hypertension. AB - There is evidence that aspirin in low doses favorably influences the course of pregnancy-induced hypertension, but the mechanism, although assumed to involve suppression of the production of thromboxane by platelets, has not been established. We performed a randomized study of the effect of the long-term daily administration of 60 mg of aspirin (n = 17) or placebo (n = 16) on platelet thromboxane A2 and vascular prostacyclin in women at risk for pregnancy-induced hypertension. Low doses of aspirin were associated with a longer pregnancy and increased weight of newborns. Serum levels of thromboxane B2, a stable product of thromboxane A2, were almost completely (greater than 90 percent) inhibited by low doses of aspirin. The urinary excretion of immunoreactive thromboxane B2 was significantly reduced without changes in the level of 6-keto-prostaglandin F1 alpha, a product of prostacyclin. Mass spectrometric analysis showed that aspirin reduced the excretion of the 2,3-dinor-thromboxane B2 metabolite--mainly of platelet origin--by 81 percent and of thromboxane B2, probably chiefly of renal origin, by 59 percent. The urinary excretion of 6-keto-prostaglandin F1 alpha and of its metabolite 2,3-dinor-6-keto-prostaglandin F1 alpha was not affected. Low doses of aspirin only partially (63 percent) reduced neonatal serum thromboxane B2. No hemorrhagic complications were observed in the newborns. Thus, in women at risk for pregnancy-induced hypertension, low doses of aspirin selectively suppressed maternal platelet thromboxane B2 while sparing vascular prostacyclin, but only partially suppressed neonatal platelet thromboxane B2, allowing hemostatic competence in the fetus and newborn. PMID- 2664524 TI - The physiologic replacement of insulin. An elusive goal. PMID- 2664525 TI - Dystrophin and Duchenne's muscular dystrophy. PMID- 2664526 TI - Reversal of hyperglobulinemia after orthotopic liver transplantation. PMID- 2664527 TI - Hepatotoxic mushroom poisoning: diagnosis and management. AB - Hepatotoxic mushroom poisoning (due to Amanita, Lepiota and Galerina species) may be considered as a real medical emergency, since an early diagnosis and immediate treatment are required for a successful outcome. In this review the physio pathological features and the clinical picture of amatoxin poisonings are described as the basis for diagnosis and therapeutic decisions. The treatment schedule proposed is analyzed in some points: Symptomatic and supportive measures, toxin removal and extraction procedures, and the possibility of using antidotes. Some parameters with prognostic significance are commented on. Finally, the mortality rate and its evolution throughout the present century is also considered. PMID- 2664528 TI - AIDS. US patent for Montagnier. PMID- 2664529 TI - [Quantification of chemical genetic risk]. AB - Associated with technical advances of our civilization is the possibility of an increase of radiation- and chemically induced germ-cell mutations in man. This would result in an increase in the frequency of genetic diseases and would be detrimental to future generations. It is the duty of our generation to keep this risk as low as possible. In order to achieve this goal it is necessary to identify, evaluate and quantify the genetic risk of chemical mutagens. The possibilities and the shortcomings of the quantification of radiation- and chemically induced mutations are discussed. The discrepancy between the high safety standards for radiation protection and the low level of knowledge for the toxicological evaluation of chemicals is emphasized. PMID- 2664530 TI - [Synthesis and biochemical actions of idebenone and related compounds. Ubiquinone and related compounds, XL]. AB - Syntheses of some metabolites of ubiquinone and of related compounds are described. Idebenone (QSA-10), a methyl-dimethoxy-benzoquinone bearing an omega hydroxydecyl side chain in 3-position, restored the oxidation of succinate and of NADH in ubiquinone-depleted mitochondrial preparations and showed a stabilizing effect on lysosomal membranes and an inhibitory effect on cAMP-phosphodiesterase. It inhibited lipid peroxidation in canine brain mitochondria and in microsomes from canine brain and rat liver. Administered orally to rats, it increased the respiratory control index for glutamate and succinate oxidation but had no effect on the ADP/O2 ratio. Pharmacological effects of idebenon are also briefly discussed. PMID- 2664531 TI - [Blue blood: structure and evolution of hemocyanin]. AB - Hemocyanins are the oxygen-transporting proteins in arthropods and molluscs, the oxygen is bound by two copper atoms. Spectroscopic studies on the active site show similarities to the active site of a further group of copper-containing proteins, the tyrosinases. Arthropodan and molluscan hemocyanins form high molecular aggregates which are markedly different in size and quaternary structure. There is only one tertiary structure of an arthropodan hemocyanin available, but from comparison of all amino acid sequences known so far from arthropodan hemocyanins, a common tertiary structure for all arthropodan hemocyanins can be deduced. Again, sequence comparison allows the construction of an evolutionary tree for some oxygen-binding copper proteins. PMID- 2664533 TI - [Control of diabetes mellitus with the insulin pen. Adequately managed?]. AB - An insulin pen is often preferred to conventional injection material. It implies the use of 100 IU insulin/ml and the patient may not be aware of the change from 40 IU/ml. Moreover the handling of the insulin pen materials is not well known to home care workers called in when the patient is unable to help him/herself. General change over to insulin concentrations of 100 IU/ml is desirable. PMID- 2664532 TI - Neuropeptides--occurrence and functions in insects. PMID- 2664534 TI - [Current developments in the surgical treatment of supraventricular arrhythmias]. PMID- 2664536 TI - [The anhedonia concept in schizophrenia research]. PMID- 2664537 TI - [Changes in the paradigms of psychopathology]. PMID- 2664535 TI - [Combined alpha and beta thalassemia in a Chinese family in The Netherlands]. AB - In a Chinese family living in The Netherlands alpha 0- and beta-thalassaemia occur singly and in combined form. All members of the family are moderately anaemic and show the characteristic haematological abnormalities of thalassaemia carriers. The nature of the alpha 0-thalassaemia defect was shown at the molecular level to be a deletion of the South East Asian type, which removes about 20 kb of DNA spanning both alpha genes in cis. The chromosome carrying the beta-thalassaemia mutation was identified using RFLPs (restriction enzyme fragment length polymorphisms). The combined heterozygosity for alpha 0- and beta thalassaemia results in a phenotype virtually indistinguishable from heterozygous beta-thalassaemia, except for the almost balanced globin chain synthesis. PMID- 2664538 TI - [Alois Alzheimer 1864-1915. An overview of his life and work on the occasion of his 125th birthday]. PMID- 2664539 TI - [Suicide attempts in diabetic patients with insulin and their neuropsychiatric sequelae]. PMID- 2664540 TI - Growth hormone response to apomorphine, a dopamine receptor agonist, in normal aging and in dementia of the Alzheimer type. AB - The growth hormone (GH) response to the dopamine (DA) receptor agonist, apomorphine HCl (Apo) (0.5 mg SC) was studied in young and elderly normal subjects as well as in patients with dementia of the Alzheimer type (DAT) and controls matched for age, gender and Quetelet index. The GH response was significantly decreased in normal elderly men (mean age 67.3 years; N = 16) compared with young men (mean age 21.2 years; N = 12) and in elderly women (mean age 65.4 years; N = 9) compared with young women (mean age 25.5 years; N = 6) in the luteal phase but not in the early follicular phase. Young men had a significantly greater GH response than young women in either phase of the menstrual cycle. The decline in GH response with normal aging may be related to a decrease in sex steroid activity. There was no significant difference in GH response between DAT patients (N = 15) and paired controls. This suggests that hypothalamic D2 receptor function regulating GH secretion is not altered in DAT. PMID- 2664541 TI - Vasopressin in aged rats: longitudinal studies of vasopressin excretion in Sprague-Dawley and Fischer 344 strains. AB - In order to provide physiological baseline values for future experimental procedures, indices of vasopressin secretion were assessed in male Sprague-Dawley (SD) and Fischer 344 (F344) rats at 3 and 20 months of age. Daily water intake, urine volume, urine osmolality, and urinary vasopressin excretion were monitored in SD rats for 30 days, and in F344 rats for 60 days. In the SD strain, daily water and urine volumes, expressed as ml/24 hr/100 g b.wt., were consistently lower in aged animals, as was a calculation of water balance (water intake-urine output volumes/24 hr). Although mean VP concentration in urine appeared higher in aged rats (33.9 +/- 20.4 pg/ml) than in young (16.3 +/- 7.7 pg/ml), total daily VP excretion was comparable for both ages when expressed as a function of body weight [80.6 +/- 37.3 pg for 3 months old (m.o.) and 81.9 +/- 47.2 pg/24 hr/100 g b.wt. for 3 and 20 m.o. respectively]. Young and old F344 males showed comparable daily drinking and urine volumes, and water balance, during two months of monitoring, but VP excretion was lower (p less than 0.025) in aged rats (83.8 +/- 19.0 pg/24 hr/100 g b.wt.) than in 3 m.o. rats (213.0 +/- 48.1 pg/24 hr/100 g b.wt.). Urine VP concentration was comparable (69.6 +/- 20.6 for 3 m.o.; 59.8 +/- 25.6 pg/ml for 20 m.o.). Mean urine osmolality was not significantly different among groups. Urine osmolality and daily urine volumes showed a significant correlation with daily VP excretion among young, but not aged, rats of both strains.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 2664542 TI - Circadian rhythms of activity in healthy young and elderly humans. AB - Patterns of activity of healthy adult humans were monitored in a controlled environment for several days using a wrist-mounted ambulatory activity meter. Subjects were 15 young males, 14 young females, 17 elderly males and 23 elderly females. Substantial differences in the absolute levels and patterns of daily rest and activity across age groups were observed. The elderly subjects were somewhat more active than the young subjects overall, especially in the early morning. Consistent with their increased levels of daytime activity the elderly subjects reported less sleepiness, especially in the morning, than the young volunteers. The age groups also differed significantly on all circadian parameters. The mean acrophase (peak of a sinusoid fitted to the activity rhythms) of the elderly group occurred at 1326 hr, significantly earlier than in the young group (1513 hr). The amplitude and the mesor (mean level) of the rhythms were both greater in the elderly group. It is uncertain whether these differences reflect changes in behavior that occur as a consequence of the aging process, previously-established differences in the life styles of the different populations studied, or some other factor. These findings suggest that levels and rhythms of daily activity in healthy elderly people are often well preserved and may not deteriorate as readily as had been assumed. PMID- 2664543 TI - Bombesin produces hypothermia in insulin treated rats. AB - Previous studies have shown that central injection of bombesin produces hypothermia in food-deprived, but not food satiated rats at normal ambient temperatures. The present study evaluated the effects of bombesin on core body temperature (Tb) and feeding behavior in rats pretreated with insulin. Administration of bombesin (0.25, 0.5, and 1.0 microgram) into the lateral cerebral ventricle produced hypothermia in rats injected with insulin (10 U/kg; i.m.). No significant change in core temperature was observed in control rats following bombesin. Insulin treatments significantly stimulated feeding behavior and the highest dose of bombesin significantly reduced feeding behavior. The results demonstrate bombesin-induced hypothermia under metabolic conditions similar to acute starvation. These findings are consistent with the hypothesis that bombesin-induced hypothermia in food-deprived rats is directly related to the fasting state. PMID- 2664544 TI - Results of stereotactic aspiration in 175 cases of putaminal hemorrhage. AB - Believing that improved therapeutic results in cases of intracerebral hematoma might be obtained by minimal invasion of the brain, we used computed tomographic guided stereotactic aspiration in 175 of 241 patients with putaminal hemorrhage. These patients, who were treated 6 or more hours after onset, had hematomas larger than 8 ml and were unable to raise an arm and/or leg on the affected side. Craniotomy was performed in 15 other patients, most of whom were brought to the hospital with large hematomas within 6 hours of onset. The remaining patients either had mild deficits of consciousness (33 patients) or severe deficits and/or were elderly (18 patients) and were treated conservatively. Thirteen patients (7.4%) showed rebleeding after stereotactic aspiration (6 instances of major and 7 instances of minor rebleeding). Craniotomy and removal of the hematoma were required in three of these patients. Aspiration should be avoided in patients who have a tendency for bleeding, even if mild, because rebleeding occurred in 6 of 23 such patients (26%) in these study. The consciousness level improved in 66 patients (38%), was unchanged in 103 patients (59%), and was worse in 6 patients (3%) 1 week postoperatively. Motor function of the arm improved in 55 patients (31%) and was worse in 23 patients (14%). Six months after surgery, the results for the 175 patients who underwent stereotactic aspiration were: 19% excellent, 32% good, 35% fair, 7% poor, 6% dead, and 1% unknown. For the entire series of 241 patients, the results were: 24% excellent, 26% good, 31% fair, 7% poor, 11% dead, and 1% unknown.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 2664545 TI - Linear accelerator radiosurgery of cerebral arteriovenous malformations. AB - A technique for linear accelerator radiosurgery has been used in clinical practice since 1982. The technique is based on multiple intersecting arc irradiations focused on a stereotactic target. From November 1984 to October 1988, 97 patients with cerebral arteriovenous malformations have been treated. Seventy-nine patients suffered one or more than one hemorrhage. Four patients had progressive neurological symptoms. In 14 patients, epilepsy was the principal complaint. Stereotactic localization was performed by stereotactic angiography. Lesion dimensions varied from 4 to 40 mm in diameter. Doses from 18.7 to 40 Gy were delivered in one or two sessions. Mean follow-up is 17.1 months (from 1 to 49). Four instances of minor rebleeding were observed after treatment; 3 patients complained of transient neurological deterioration. Of 56 patients who were followed longer than 1 year, 50 underwent 12-month follow-up angiography. In 26 patients complete obliteration of the malformation was demonstrated (52%), in 12 patients subtotal obliteration was obtained (24%), in 11 patients the obliteration was evident but not significant (22%), and in 1 patient the AVM was unchanged. Other angiographic features in incompletely obliterated cases were a significant reduction of flow velocity through the malformation together with a reduction in diameter of both feeding arteries and draining veins. PMID- 2664546 TI - Stereotactic heavy-charged-particle Bragg peak radiosurgery for the treatment of intracranial arteriovenous malformations in childhood and adolescence. AB - Forty patients aged 6 to 18 years have now been treated for inoperable intracranial arteriovenous malformations (AVMs) using stereotactic heavy-charged particle Bragg peak radiosurgery at the Lawrence Berkeley Laboratory 184-inch Synchrocyclotron at the University of California, Berkeley. This paper describes the procedures for selection of patients, the treatment protocol, and the neurological and neuroradiological responses to stereotactic radiosurgery in this age group. The volumes of the treated AVMs ranged from 265 mm3 to 60,000 mm3. The results are favorable: thus far, 20 of 25 patients have experienced greater than or equal to 50% obliteration of their AVMs within 1 year after treatment, and 14 of 18 patients have experienced total obliteration of the AVM by 2 years after treatment. Two patients hemorrhaged from radiosurgically treated AVMs within 12 months after treatment, but none thereafter. Complications include vasogenic edema and arterial occlusion; three patients have had neurological worsening as definite or possible sequelae of treatment. The strengths and limitations of the method are discussed. PMID- 2664547 TI - Positive end-expiratory pressure in supine and sitting positions: its effects on intrathoracic and intracranial pressures. AB - The effects of positive end-expiratory pressure (PEEP) on central venous and intracranial (ICP) pressures were evaluated in 10 patients with posterior fossa tumors, in both supine and sitting positions. With patients in the supine position, intrathoracic PEEP-dependent venous hypertension was clearly transmitted to the intracranial compartment but without intracranial hypertension. On the contrary, with patients in the sitting position PEEP had no influence in almost half of our patients. In patients with radiological or clinical signs of increased ICP, however, the combination of head flexion and rotation with institution of PEEP caused a dangerous increase in ICP, even when the patients were in the sitting position. The need for early withdrawal of cerebrospinal fluid in these patients is stressed. PMID- 2664548 TI - The Johns Hopkins medical centennial. 1889-1989: a century of neurosurgery. PMID- 2664549 TI - Reference: nimodipine in cerebral vasospasm. PMID- 2664550 TI - State of the brain as a systemic neurophysiological mechanism of the conditioned reflex. PMID- 2664551 TI - Compression spectral analysis of the EEG in patients with occlusive lesions of the carotid and vertebral arteries. PMID- 2664552 TI - Psychotropic properties of ovarian estrogens (review). PMID- 2664554 TI - Acute neck pain due to tendonitis of the longus colli: CT and MRI findings. AB - Calcific retropharyngeal tendonitis is an under-recognized cause of acute cervical pain produced by inflammation of the longus colli muscle. Although the clinical presentation may mimic more serious disorders, the diagnosis can be established radiographically by identification of prevertebral soft tissue calcification and swelling. Six patients with typical signs and symptoms of retropharyngeal tendonitis are presented. All were evaluated with plain films, four with CT and one with MRI. The pathognomonic finding of amorphous calcification anterior to C1-2 with associated asymmetric soft tissue swelling was clearly demonstrated by CT. Diffuse swelling of the longus colli muscle was shown as prominent high signal in the prevertebral region by T2 weighted MRI. PMID- 2664553 TI - Aneurysms of the vein of Galen: embryonic considerations and anatomical features relating to the pathogenesis of the malformation. AB - Vein of Galen aneurysms may be defined as direct arteriovenous fistulas between choroidal and/or quadrigeminal arteries and an overlying single median venous sac. Anatomic analysis of 23 cases of vein of Galen aneurysm and correlation with known embryologic data indicate that the venous sac most probably represents persistence of the embryonic median prosencephalic vein of Markowski, not the vein of Galen, per se. The frequent concurrent venous abnormalities are easily understood as (a) retention of fetal anatomical features and (b) frequent occlusions of the dural sinuses of the posterior fossa, especially the sigmoid sinuses. PMID- 2664555 TI - Interactions between the amygdala and ventral striatum in stimulus-reward associations: studies using a second-order schedule of sexual reinforcement. AB - Bilateral, N-methyl-D-aspartate-induced lesions of the basolateral region of the amygdaloid complex in male rats resulted in a marked decrease in instrumental responses maintained by a visual conditioned reinforcer in a paradigm in which sexual reinforcement was presented under a second-order schedule. There were no effects of lesions of the amygdala on the unconditioned sexual behaviour of the males, i.e. on behaviour elicited by primary reinforcers. Infusion of D amphetamine bilaterally into the nucleus accumbens region of the ventral striatum resulted in a dose-dependent amelioration of the decrease in instrumental behaviour maintained by a conditioned reinforcer which followed lesions of the amygdala. This effect of D-amphetamine critically depended upon the presentation of the conditioned reinforcer (a previously neutral light which had gained reinforcing properties through its prior association with sexual interaction). The results indicate that the basolateral region of the amygdala may interact with dopamine-dependent processes in the ventral striatum in mediating the control by conditioned reinforcers over instrumental behaviour. PMID- 2664556 TI - Involvement of the amygdala in stimulus-reward associations: interaction with the ventral striatum. AB - The involvement of the amygdala in the potentiation of responding for conditioned reinforcers following intra-accumbens amphetamine injections has been studied. Thirsty rats were trained to associate a light-noise compound stimulus with water and then implanted with guide cannulae in the nucleus accumbens. Half of these rats received excitotoxic lesions of the basolateral region of the amygdala by accumbens. Half of these rats received excitotoxic lesions of the basolateral region of the amygdala by infusing N-methyl-D-aspartate, whereas the other half received infusions of the vehicle. In the test phase, water was no longer presented but responding on one of two novel levers produced the light-noise compound (the conditioned reinforcer) whereas responding on the other lever had no effect. The two groups received four counterbalanced intra-accumbens infusions of amphetamine (3, 10 and 30 micrograms /microliter) or vehicle over four test days. Intra-accumbens amphetamine infusions dose-dependently increased responding on the lever providing a conditioned reinforcer but had no significant effect on responding on the lever which did not produce the conditioned reinforcer. Compared with controls, the lesioned group exhibited a significant, selective reduction in responding on the lever providing a conditioned reinforcer, with no change on the lever on which responding had no consequence, irrespective of drug or control treatment. Control experiments showed that the amygdala lesioned animals were not hypodipsic and exhibited similar levels of hyperactivity following intra-accumbens infusions of D-amphetamine. Furthermore, the capacity to discriminate the conditioned stimulus as well as to acquire a new motor task was not altered by the lesion. These results indicate a role for the amygdala in mediating the effects of stimulus-reward associations on behaviour, via an action on dopamine-dependent mechanisms of the ventral striatum. PMID- 2664557 TI - Primary intracerebral malignant lymphoma presenting with ophthalmological symptoms: bioptical and autoptical case study. AB - A case of primary malignant lymphoma of the brain with preceding first unilateral, then bilateral uveitis and retinochorioiditis is presented. The diagnosis was established on brain biopsy material using immuno-histochemical methods. The autopsy disclosed a polymorphous immunocytoma with bilateral brain involvement including structures of the posterior optic pathways. Clinical and pathogenetic implications regarding this "oculo-cerebral type" of malignant lymphoma, which has been only seldom reported in the literature are discussed. PMID- 2664558 TI - [Giovanni Alfonso Borelli (1608-1679). An ingenious precursor of a mathematical model of myocardial dynamics]. PMID- 2664559 TI - [Serum ionized calcium, parathormone and plasma renin activity in essential arterial hypertension]. AB - Given the significance of the calcium ion in the pathogenesis of essential arterial hypertension, blood levels of total and ionised calcium, phosphorus, parathormone, blood renin activity as well as urinary calcium and phosphorus were assayed in a group of hypertensives and a comparable control group with normal blood pressure. The results showed reduced ionised calcium in the blood of the hypertensives together with hyperparathyroidism and increased calciuria. In addition, the link between parathormone and mean blood pressure levels suggests that parathormone itself play a primary role in the genesis of high blood pressure. Finally the connection between renin activity in the plasma and ionised calcium in the serum suggests that the two hormone systems are closely linked and may interact via the calcium ion. PMID- 2664560 TI - [Experimental study of colonic anastomoses. Comparison of different suture methods in the rat]. AB - A comparative experimental study was conducted on three different suture techniques for end-to-end colonic anastomoses. The development of stenosis, perivisceral adhesions and resistance to endoluminal pressure were assessed. The results show that the one layer all-coat interrupted stitch anastomosis displays less resistance to endoluminal pressure during the first seven days but is followed by fewer complications. PMID- 2664561 TI - [Biliary ileus. Review of the literature and report of 22 further cases]. AB - A critical review of the world literature of the main authors in the past twenty years (871 cases) and the personal series (1975-1987: 22 cases) shows that biliary ileus is a rare, serious pathology with an emergency surgical indication. The numerical data collected confirm the need for a conservative surgical attitude, limited to the removal of the obstructing cause. Some authors have maintained that it is possible to treat the occlusion and the bilio-digestive fistula and carry out the cholecystectomy contemporaneously. Personally it is considered that the latter possibility can be confined to carefully selected patients who are not too elderly, do not present associated pathologies and for whom the diagnostic opinion is one of preoperative biliary ileus. Cholecystectomy is therefore programmed and this is followed at a later stage by repair of the biliary fistula, the occlusive pathology being corrected immediately so as to eliminate as far as possible the immediate risks of prolonged emergency surgery on the bile ways and digestive tract at the same time. PMID- 2664563 TI - [Aneurysm of the innominate artery: pathology simulating pulmonary neoplasm]. AB - A chance case of aneurysm of the brachiocephalic trunk suggested a review of the literature on this rare pathology. Stress is laid on the possible asymptomaticity of the lesion and on its frequent chance observation in chest X-rays; the diagnostic procedure, at times particularly complex, may not lead to decisive results but the possibility of aneurysm of the brachiocephalic trunk must be borne in mind in any case so as to avoid gross diagnostic and therapeutic errors. PMID- 2664562 TI - [Evaluation of plasma carnitine levels after orthotopic transplantation of the liver]. AB - Variations in plasma levels of total carnitine (TC), free carnitine (FC), and acyl-carnitine (AC) were studied in 10 patients undergoing orthotopic liver transplantation. The postoperative values were higher than the preoperative ones and positively related to time flow. As exogenous carnitine was not supplied during the study, these data suggested a better biosynthetic activity in the transplanted liver, in spite of standard blood tests results. No positive correlation between carnitine levels and variations in serum transaminases, bilirubin, cholestasis related enzymes, pre-albumin and albumin supply was found. Carnitine plasma levels were not influenced either by nutritional caloric input or by methionine and lysine inputs. Our results show that variations in carnitine plasma levels are a specific and responsive index of functional recovery in the transplanted liver. PMID- 2664564 TI - [Complete cervical rib. Possible neurovascular implications of the upper limb]. AB - The thoracic outlet syndrome (TOS) is caused by compression of the brachial plexus or subclavian artery or vein in the region of the neck and shoulder girdle. The neurovascular bundle may be compressed at multiple sites: costoclavicular space, interscalene triangle, insertion of the pectoralis minor into the coracoid process. More than 90% of the patients present with neurologic symptoms: pain, paraesthesias or arm and hand weakness and 10% also have vascular problems. The diagnosis of TOS is always difficult and depends on careful clinical study of patients. For the neurological type of TOS, electromyograms, arteriograms and venograms are not helpful. The value of Doppler study and of arteriography is demonstrated in the present case of a woman with a five month history of pain and paraesthesias of the arm and hand, who shoved sudden occlusion of left humeral artery. Roentgenograms showed the presence of a well developed left cervical rib. Doppler study and arteriography showed the compression of subclavian artery with the arm abduction manoeuver. After first rib resection and humeral artery thrombectomy there was a complete return of humeral artery flow and of all neurologic functions. Thus the role of first cervical rib or other bone and muscular structures must be emphasyzed both in the brachial and in the subclavian artery or vein compression. Embolization of the axillary or humeral artery should be corrected as soon as possible when the cervical rib is corrected. PMID- 2664565 TI - [A rare case of aneurysm of the superficial femoral artery with dysplasic etiology]. AB - The most frequent localisation of fibrous dysplasia of the arteries is at the renal arteries. Other localisations are rarer and those at the femoral as in the case described are exceptional. The case was observed in a 21-year-old woman who, in the absence of any previous traumatism and septic state, noticed the onset of a pulsating tumefaction at thigh level. Echography and arteriography showed the tumefaction to be an aneurysm of a collateral of the superficial femoral artery at the lower IIIrd of the thigh with the dimensions of a pigeon's egg. The aneurysm was successfully removed without the need for grafts and subsequent histological examination showed it was secondary to fibrous dysplasia. The rarity of such a clinical case is stressed. PMID- 2664566 TI - Recurrent inguinal hernia repaired with mesh (Teflon). PMID- 2664567 TI - A tanned, sheep dermal collagen graft as a dressing for split-skin graft donor sites. PMID- 2664568 TI - Pitfalls in diagnosis and treatment of cystic neoplasms of the pancreas. PMID- 2664569 TI - A patient with a duodenocolic fistula. PMID- 2664570 TI - [A preliminary communication on the possibility of the differential diagnosis of breast nodules by Doppler ultrasonography]. AB - The diagnostic possibilities of Doppler velocimetry with spectral analysis have been assessed in the diagnosis of benign and malignant breast cancers. The study considers 18 patients with mammary nodules. The data obtained with Doppler velocimetry are compared with those of mammographic, cytological and histopathological studies. Although statistically insignificant owing to the small series examined, the results suggest that the technique is highly reliable. PMID- 2664571 TI - [Defibrotide versus heparin in antithrombotic prophylaxis in gynecological surgery]. AB - Deep venous thrombosis (DVT) can be a significant complication of the postoperative course in gynaecological surgery, because of traumatism and compression to which the vascular pelvic structures are subjected. A protocol was therefore designed to evaluate the effectiveness and tolerability of defibrotide, a new antithrombotic and profibrinolytic drug, compared with low-dose heparin. The study was conducted on 102 women, undergoing major gynaecological surgery for benign and malignant affections, randomly assigned to the following two treatment groups. A) defibrotide (400 mg i.v./i.m. b.i.d., starting the day before the surgery for 8 days); B) calcium heparin (5000 IU s.c. b.i.d., starting on the day of surgery, for/days). Clinical, haematological and instrumental (Doppler ultrasound) parameters were assessed and no major events were noted in either of the two treatment groups though in the calcium heparin group, 2 patients showed clinical signs of DVT (not confirmed by Doppler ultrasound) and no side effects were noticed, except for a cutaneous rash in one defibrotide patient and an episode of bleeding on the third postoperative day in a patient treated with calcium heparin. Defibrotide proved as effective as calcium heparin in the prevention of DVT in gynaecological surgery. PMID- 2664572 TI - [Assessment of the estrogen and progesterone receptor status of meningiomas. A preliminary study of 10 cases]. AB - Ten cases of intracranial meningiomas in patient who differed by age, sex and histological characteristics of the lesion have been considered for the purpose of evaluating the lesion's receptor capacity and the changes in it with the above variations. Receptors were found and they varied with age and histological features. PMID- 2664573 TI - [Hemobilia. The echographic findings in a dialyzed patient]. AB - A case of gall bladder haematoma observed echographically in a dialysed patient is reported. The observation was probably related to the administration of anticoagulants during dialysis. PMID- 2664574 TI - [Risk factors and sensitivity to certain antibiotics in hospital urinary infections]. AB - Urinary infections contracted in hospital are one of the most important health problems. The present paper looks at 549 hospitalised patients and 548 subjects referred to the laboratory for routine tests over a period of 6 months. The results showed a higher number of hospital infections in the Medicine Department and this number was directly proportional to certain risk factors such as the presence of a catheter at home, the greater age of patients and a poorer physical condition. The strains most frequently isolated were E. coli and Pseudomonas spp although percentages were different between out-patients and hospitalised patients. The infections in question might be reduced and, at least partially, controlled by means of stricter hygiene on the part of personnel and by a moderate use of vesical catheterism. PMID- 2664575 TI - [Antihypertensive efficacy and effects on quality of life of captopril in mild-to moderate arterial hypertension]. AB - The anti-hypertensive effectiveness and effect on the "quality of life" of captopril administered for 90 days to 17 patients suffering from mild-to-moderate arterial hypertension and already under anti-hypertensive treatment have been assessed. At the end of treatment with captopril, 76% of the patients attained normal pressure values. A diuretic was added in 7 patients. Average A.P. fell from 183 +/- 24/110 +/- 9 mmHg to 147 +/- 11/92 +/- 5 mmHg (p less than 0.001) without significant changes in heart rate. "Quality of life" was assessed on the basis of a questionnaire at the start and finish of treatment and it was reported improved after treatment with captopril compared to the previous pharmacological treatment. This improvement was particularly felt with respect to sense of wellbeing and capacity to perform working and recreation activity, and there was a reduction in physical disturbances. PMID- 2664576 TI - [Paroxysmal nocturnal hemoglobinuria with multiple venous thrombosis and acute renal insufficiency. Description of a case]. AB - Oral anticoagulants were administered to a young woman suffering from P.N.H. after the development of portal vein thrombosis. She interrupted the treatment and developed multiple splanchnic thromboses followed by acute renal failure, from which she recovered four weeks later. Although the pathogenetic mechanism could include renal vascular microthrombosis, the possibility of renal ischemic damage due to massive blood pooling within the splanchnic district is discussed. PMID- 2664577 TI - [Thymopentin in the treatment of recurrent condylomata acuminata]. AB - Twelve patients who had been suffering from genital and/or perianal recurrent condyloma acuminatum for a minimum of 5 to a maximum of 24 months, in spite of treatment, were studied from the immunological viewpoint and treated with 50 mg s.c. Thymopentin three times a week for 4 or 6 weeks. Six of the patients were cured at the end of treatment, five after 5 months, and one was not cured. Analysis of the clinico-laboratory data shows a significant agreement between the course of clinical signs and the immunological picture. The various cure stages are probably attributable to the basic immune arrangement which was more impaired in the 5 patients who were cured more slowly and in the non-cured case. In the latter too, however, Thymopentin permitted correcting the balance of the relationship between the various lymphocyte subpopulations. PMID- 2664578 TI - [Ultrasonic criteria for the evaluation of placentation in twin pregnancies]. AB - Ultrasound assessment of septum thickness is useful in twin pregnancies for predicting the type of placentation. In fact, its greater or lesser acoustic resonance distinguishes monochorionic or dichorionic pregnancies. This makes adoption of therapeutic measures more secure in the event of pathology involving only one of the two fetuses. PMID- 2664579 TI - [Role of the ultrasonic examination in the diagnosis of pelvic pathology]. AB - The diagnostic accuracy of sonography in pelvic pathology is assessed in the case in which the operator is aware of the clinical report. Results attribute in absolute terms more effectiveness to sonography than to the clinical examination but it must, in any case, be considered as an extension of the gynaecological examination and not a replacement of the anamnestic history and physical examination. PMID- 2664580 TI - Two brain nuclei controlling circadian rhythms are identified by GFAP immunoreactivity in hamsters and rats. AB - The intergeniculate leaflet (IGL) of the lateral geniculate complex is marked by the presence of neuro-peptide Y-containing neurons that project to the suprachiasmatic nuclei (SCN) of the hypothalamus. In the present study, we demonstrate that both the IGL and SCN in the hamster and rat are specifically delineated by the presence of glial fibrillary acidic protein-like immunoreactivity. This is significantly greater than in most other diencephalic regions and is particularly dense in the hamster brain. These observations suggest that glial-neuronal interactions may participate in circadian rhythm generation and regulation. PMID- 2664582 TI - Aseptic synovitis. AB - We report the first case of aseptic synovitis that occurred after a titanium knee prosthesis failed. This complication should be considered when a patient with a titanium prosthesis develops tenderness, erythema, and swelling of that joint. PMID- 2664583 TI - The use of n.m.r. spectroscopy in the structure determination of natural products: two-dimensional methods. PMID- 2664581 TI - Bradykinin enhances excitability in cultured rat sensory neurones by a GTP dependent mechanism. AB - The excitatory action of bradykinin (Bk; 0.1-1.0 microM) on cultured rat dorsal root ganglion neurones (DRGs) was studied using the whole cell clamp technique. In a subpopulation of DRGs, a 1 s depolarising voltage pulse from -70 to +20 mV evoked more than one inward current. In these neurones, local application of Bk increased the inward current frequency from 7.0 +/- 0.7 s-1 to 14.9 +/- 1.0 s-1 (mean +/- S.E.M., n = 53). Intracellular application of the GTP analogue, guanosine 5'O-3-thiotriphosphate (GTP gamma S) mimicked this excitatory action of Bk: the frequency of inward currents increased from 5.0 +/- 0.8 s-1, 30 s after the start of recording to 6.9 +/- 1.1 s-1 at 5 min to a maximum of 18.5 +/- 2.2 s 1 at 15 min (n = 16). In control cells, the frequency decreased from 4.6 +/- 0.8 s-1 to 2.5 +/- 0.5 s-1 at 5 min (n = 12). Bk also increased excitability in 4/11 Herpes Simplex Virus I (HSV-I)-infected DRGs. Thus, we demonstrate an excitatory action of Bk in DRGs, which may involve G-protein activation. PMID- 2664584 TI - The biosynthesis of porphyrins, chlorophylls, and vitamin B12. PMID- 2664585 TI - The polyether and macrolide antibiotics: biogenetic analysis and structural correlations. PMID- 2664586 TI - The Harvey Lectures, Series XLIII, 1946-1947: Physiological information gained from studies on the life raft ration. PMID- 2664587 TI - Severe acquired hypocholesterolemia: two case reports. AB - We present two case reports from different institutions that emphasize two distinct aspects of severe acquired hypocholesterolemia. The first case report discusses the issue of malabsorption in a man with systemic lupus erythematosus and bacterial overgrowth of the small bowel. The second case report examines the data on metabolic abnormalities associated with severe illness that appear to be independent of digestion and absorption. These two cases serve to alert the physician that severe hypocholesterolemia is a portentous finding that may be associated both with a wide variety of diseases and with a high mortality rate. Successful therapy of the underlying diseases may lead to correction of the hypocholesterolemia. PMID- 2664588 TI - Unrecognized cobalamin-responsive neuropsychiatric disorders. AB - Neuropsychiatric disorders due to cobalamin deficiency occur in the absence of anemia or significant macrocytosis and may be overlooked because usual clinical laboratory tests are unreliable for diagnosis of cobalamin deficiency. Serum methylmalonic acid and homocysteine levels appear to be sensitive and accurate markers of cobalamin deficiency. PMID- 2664589 TI - Fish oils reduce postprandial lipemia. AB - The presence of fish oils in a background diet appears to reduce postprandial triglyceridemia from a fatty test meal. PMID- 2664590 TI - Glutamine transport in muscle protein economy. AB - The regulatory properties of a principal glutamine transport system of skeletal muscle may control the balance between muscle protein synthesis and breakdown. PMID- 2664591 TI - Ascorbic acid and ferritin catabolism. AB - Ascorbic acid blocks the degradation of cytoplasmic ferritin by reducing lysosomal autophagy of the protein. PMID- 2664592 TI - Hepatic zonation of carbohydrate metabolism. AB - Periportal cells synthesize twice as much glucose from lactate than do cells from the perivenous zone. PMID- 2664593 TI - Triacylglycerols: influence of structure on metabolism in the rat. AB - The location of long-chain saturated fatty acids and a trans-unsaturated fatty acid in triacylglycerols of chylomicrons can modulate metabolism of these particles. PMID- 2664594 TI - Orthopedic assessment of young children: developmental variations. AB - Parents often seek orthopedic evaluation of their young children because of apparent abnormalities. However, many of these are simply developmental variations that are part of normal growth and development. Pes planus, or flat foot, is one of the earliest and most common concerns. Torsional variations are also often seen; the presenting complaint may be intoeing (metatarsus adductus, tibial torsion and increased femoral anteversion) or out-toeing (pes calcaneovalgus and external rotation contractures of the hips). Angular variations (genu varum and genu valgum) are also seen frequently in young children. In assessing each finding, consideration must be given to the age at which the finding may be considered within normal limits, methods of examination and documentation, the expected course, findings that may signify abnormality, and appropriate follow-up and referral. An understanding of these common developmental variations in the orthopedic assessment of young children will enable the health care provider to respond to parents' concerns with accurate information and counseling. PMID- 2664595 TI - Urinary tract infections in the pediatric patient. AB - Urinary tract infections (UTIs) can be difficult to diagnose positively in the pediatric patient. The patient with such an infection, however, is at risk for subsequent morbidity such as recurrence, renal damage and hypertension. Accurate diagnosis in the very young child may require multiple urine specimens involving repeating bag specimens, catheterization, or suprapubic aspiration. Septic children and those with pyelonephritis must be hospitalized. Children younger than 6 years old need follow-up with radiographic studies to rule out reflux and congenital anomalies. The clinician plays a significant role in detecting possible UTIs, and providing patient education and support. PMID- 2664596 TI - Direct-reimbursement proposal may not live. PMID- 2664597 TI - Management of the psychiatric emergency. AB - This article provides concrete, practical information designed to increase the knowledge base of the health care provider who works with psychiatric emergencies. Psychiatric emergency intervention is differentiated from crisis intervention. Numerous treatment aspects are addressed, including assessment of psychiatric emergencies and intervention principles. The specialized emergency situations of environmental disasters, families of dying patients, and psychiatric emergencies with children are discussed. The article includes a discussion of frequently used psychiatric emergency medications and their effects and side effects. Legal issues integral to psychiatric emergency care, including confidentiality and involuntary commitment, are addressed. PMID- 2664598 TI - The state of food production and nutrition in the developing countries. AB - The genesis of the problem of food production and nutrition of African, Asian and Central and South American countries can be traced back to the beginning of 'inter-continental trade' and the emergence of colonialism. Indigenous food patterns and social and economic orders that had evolved to befit the inhabitants and the environment were destroyed. A nutritional framework and an agricultural and economic policy designed to benefit the colonising nations were fostered. At present, millions of people in the developing countries suffer from endemic undernutrition and associated diseases. Famine is always present under the surface claiming families and individual hamlets and breaks through when the semblance of equilibrium between minimal food requirement for survival and supply is disturbed by natural or man-made disaster. Landlessness, an uneven distribution of wealth, overemphasis on cash-crop production, neglect of peasant agriculture in favour of unnecessary expenditure on military hardware and other misguided projects, and crop specialisation are some of the factors responsible for food shortage and undernutrition. Moreover, most of the staple foods of the developing countries are of low energy density and deficient in some essential nutrients. The cycle of undernutrition, hunger, disease and death can only be broken by instituting a well planned, peasant-orientated, integrated development programme based on self-reliance and self-sufficiency. PMID- 2664599 TI - Food sensitivities and psychological disturbance: a review. AB - The literature dealing with the relationship between food sensitivities and psychological disturbance is reviewed. Numerous theorists and researchers believe the problems of persons presenting with adverse reactions to foods are psychological when immunological techniques fail to confirm an allergic basis. However, there is mounting evidence that adverse reactions to foods can most likely be caused by a variety of mechanisms, and that food sensitivities may indeed cause or exacerbate symptoms of a psychological nature. PMID- 2664600 TI - The swinging door: reflections on fifty-three years from graduation to retirement (continued). AB - In the first part of this article, Brigadier Fuller described the involvement in dentistry and subsequent distinguished military career of Lieutenant General Lord Freyberg VC. Describing his own association with the General, commencing in 1940 when Director of Dental Services with the New Zealand Expeditionary Force in Egypt, Brigadier Fuller outlined his own career up to and including the War. He concluded with his repatriation home because of illness in 1945, where he found his Masterton practice severely damaged in the 1942 earthquake. PMID- 2664601 TI - The problem of occlusal caries and its current management. AB - Occlusal caries has become relatively more important, due to the changing pattern of dental caries that has occurred in the developed countries of the world. Accurate diagnosis of the activity of a carious lesion is important, because arrest and remineralization are possible. Diagnosis of occlusal caries is difficult due to the morphology of the occlusal surface. Unfortunately, topical action of fluorides is thought to be making diagnosis increasingly difficult. The literature suggests that we should be examining for caries under good lighting and a dry field, the use of a blunt probe being reserved for gently removing debris from fissures to enable good visualisation. Bitewing radiography is valuable in the detection of occlusal as well as approximal caries, but good radiographic technique and careful viewing are essential. Electronic caries detection may well prove useful in the future. The traditional restorative approach to occlusal caries resulted in inconsistent treatment decisions, poor durability of restorations, and the unfortunate consequences of replacement restorations. It seems logical to take a more conservative, preventive approach in the management of dental caries. Fissure sealants should be used preventively for the caries-prone patient, and therapeutically for the suspect or early carious lesion. Where the caries has spread into dentine, as shown radiographically, then the sealant restoration may be more suitable. These techniques have been shown to be safe and effective, although careful case selection, appropriate manipulation of materials, recall, and maintenance are essential to long-term success.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 2664602 TI - The amalgam overhang dilemma: a review of causes and effects, prevention, and removal. AB - Overhanging margins of restorations are common, and much iatrogenic periodontal disease is caused by plaque stagnation associated with overhangs. Greater awareness of the causes of overhangs--the clinical skills and judgment of the operator, the properties of the restorative materials, and the morphological features of the dentition--may help to reduce the number of overhangs placed and subsequently ignored. Thorough examination for overhangs, using both clinical and radiographic assessments, is the most reliable way of diagnosing overhanging margins. Neither clinical assessment nor radiographic examination alone is accurate. Failure to recognise and eliminate overhanging margins of restorations occur frequently and may constitute professional negligence. Once overhangs are recognised, they should not be ignored as they predispose to, and increase the severity of periodontal disease. Small overhangs are more easily removed than large ones, and the latter may necessitate replacement of the restoration. A variety of instruments may be used to remove overhanging margins, but such instruments need to be used carefully to avoid damaging adjacent dental tissues. Consequently, appropriate skills should be gained during the undergraduate course so that future generations of dentists are better able to cope with overhanging margins. The dental profession has an ethical obligation to recognise the need for improvement. PMID- 2664603 TI - Eugenic racism from "The Church and Racism"--document of the Pontifical Commission "Iustitia et Pax". PMID- 2664604 TI - Diagnosis of periodontal diseases. Changing concepts. A challenge for the future. AB - Dental researchers have made great advances in our understanding of the progression and diagnosis of human periodontal disease. Standardized electronic probes promise to improve accuracy in measuring probing attachment levels and one such probe is being marketed to the dental profession. Improved techniques for radiographs such as subtraction radiography will continue to aid in the diagnosis of small changes in attachment. The isolation of an enzymatic diagnostic marker may allow for an in-office diagnostic kit for predicting site specific periodontal disease activity before it occurs. These trends portend well for the practice of periodontics and the management of our patients. PMID- 2664605 TI - Periodontal regeneration. A clinical possibility. PMID- 2664606 TI - Chemotherapeutics in periodontics. PMID- 2664607 TI - Clinical attempts at periodontal regeneration. PMID- 2664608 TI - Against Medicare expansion. PMID- 2664609 TI - Effectiveness of the cavity-rim cervical cap: results of a large clinical study. AB - From 1981-1988, 3433 women were fitted with a cavity-rim cervical cap in a Food and Drug Administration-approved study. The estimated first-year pregnancy risk was 11.3% (95% confidence limits 10.0-12.8), with risks of 8.3 and 3.8% for user and method failures, respectively. Women who were younger, less educated, and more sexually active, and who intended to have children in the future, had higher pregnancy risks. "Near-perfect" users, ie, individuals who wore the cap for a maximum of 72 hours, used spermicide 100% of the time, and did not report unprotected sexual intercourse, had half the first-year pregnancy risk of others (6.1 versus 11.9%). There were no serious medical or gynecologic complications associated with cap use, although over 20% of users reported problems with cap dislodgment during or after intercourse, cap malodor, or partner discomfort. PMID- 2664610 TI - The morbidity and benefits of concurrent gracilis myocutaneous graft with pelvic exenteration. AB - This study was undertaken to evaluate the morbidity and potential benefits of concurrent gracilis myocutaneous graft with exenteration. All patients undergoing exenteration from 1962-1986 were reviewed, of whom 24 had concurrent grafts. The mean operative time, blood loss, and hospital stay were not different in patients with versus without grafts. The rate of fistula formation in the hospital was less in the graft group (P = .004) but was not different when compared with contemporary patients only. The total infection rate (wound and pelvic) was decreased in the graft group (P = .04) when graft infections were excluded. The major problem with the graft was significant necrosis of the flap(s) in nine of the 24 patients. There were no life-threatening complications attributed to concurrent placement of gracilis myocutaneous flaps. Experience with the technique is improving the cosmetic and functional outcome of the neovagina formed with the graft. Patients most likely to benefit from this procedure include those requiring immediate reconstruction or those with potentially poor healing due to high-dose pelvic radiation, including intraoperative radiation. PMID- 2664611 TI - Long-term prognosis of pregnancies in women with intrauterine hematomas. AB - To evaluate the long-term significance of intrauterine hematomas in patients with threatened abortion, 380 women with a living fetus of more than 8 weeks were studied. On ultrasound, intrauterine hematomas, defined as an echo-poor subchorionic collection, were found in 86 women. Two hundred ninety-four patients without hematomas served as controls. The rate of miscarriage was significantly increased in the study group (22.1 versus 8.2%; P less than .05). Patients discharged from the initial hospitalization without aborting still had a higher abortion risk than controls (16.3 versus 5.6%; P less than .05). Second-trimester debut of symptoms was followed more often by preterm delivery. Thus, patients with intrauterine hematomas continue to be a high-risk group for the remainder of their pregnancies. PMID- 2664612 TI - Closed intravenous administration of gonadotropin-releasing hormone: safety of extended peripheral intravenous catheterization. AB - The use of pulsatile gonadotropin-releasing hormone is an effective means of inducing ovulation, but requires prolonged intravenous (IV) or subcutaneous administration. We hypothesized that the use of self-contained infusion pumps using fluids maintained in a closed system would permit safe peripheral IV administration of gonadotropin-releasing hormone, and possibly other hormones, over prolonged intervals. Thirty-eight female patients undergoing pulsatile IV gonadotropin-releasing hormone therapy were followed for 1958 catheter days (230 catheters). Catheters were removed for signs of local inflammation, at the completion of a treatment episode or, initially, at routine intervals of 7-10 days. There were no episodes of fever (temperature over 37.5C) and three episodes of local inflammation. The incidence of significant catheter-tip cultures was 11%, and none were associated with local inflammation. There were four positive blood cultures (2%), none associated with local or systemic signs of infection. We conclude that the use of a closed system of prolonged peripheral IV cannulation is relatively safe when combined with fastidious care of the catheter site and careful outpatient monitoring for long-term administration of pulsatile gonadotropin-releasing hormone. PMID- 2664613 TI - Doppler recording of fetal movement: clinical correlation with real-time ultrasound. AB - Processed Doppler signals can be used to detect fetal movements during antepartum fetal heart rate (FHR) testing. The purpose of this project was to evaluate the ability of a commercially available Doppler system, the Toitu Fetal Actocardiograph MT-320, to detect and discriminate various fetal activities during routine antepartum FHR testing. Simultaneous visualization with real-time ultrasound allowed correlation of isolated and complex fetal activities with the processed actograph signals. This apparatus was able to detect 95.9% of all major fetal movements observed, 94.3% of isolated fetal movements, 95.6% of isolated spinal flexion-extension, 97.1% of isolated rolling movements, and 100% of all multiple (P less than .001) fetal movements. Based on the amplitude (P less than .0001) and duration of the isolated actograph signals, it was possible to discriminate among fetal limb movements (mean amplitude 87.3 units, mean duration less than 2.0 seconds), spinal flexion-extension movements (66.3 units, 14.8 seconds), and rolling movements (43.8 units, 22.1 seconds). The routine detection of fetal breathing, hand movements, and rapid eye movements appears to be beyond the sensitivity of this particular apparatus. The ability to evaluate fetal activity reliably may be clinically useful during routine antepartum FHR testing. PMID- 2664614 TI - Etiology of endometriosis. AB - The likelihood of developing endometriosis can thus be viewed as a quantitative phenomenon--that is, the probability of having large amounts of endometrium delivered to the peritoneal cavity and the inherent ability of the pelvic tissues to support transplantation, or a combination of the two. What part immunologic, genetic, and menstrual factors contribute to an individual woman's susceptibility to develop the disease has yet to be explored in detail. A substantial amount of research will be required to evaluate these areas to devise methods of preventing the development of endometriosis. PMID- 2664615 TI - Embryologic theory of histogenesis of endometriosis in peritoneal pockets. AB - A novel presentation of endometriosis is described in which the lesion is identified within the brim or floor of peritoneal pockets located within a crescentic band in the posterior pelvis. The predictability of these peritoneal pockets and their strong association with other anomalies of the Mullerian and urinary tracts raises the possibility of a congenital origin. PMID- 2664616 TI - Combination medical and surgical therapy for infertile patients with endometriosis. AB - Endometriosis is a difficult problem for practicing gynecologists and is commonly associated with infertility. The diagnosis of endometriosis should only be made at the time of laparoscopy or laparotomy and should be confirmed with biopsy if possible. Once the diagnosis is made, it should be classified according to the revised AFS system. The treatment of infertility associated with endometriosis is controversial and usually consists of either medical therapy with hormonal manipulation designed to suppress the disease, surgical therapy designed to debulk the disease and repair anatomic distortion, or a combination of both. Despite an abundance of research on the treatment of endometriosis, the pregnancy rate for patients with endometriosis remains lower than that of the normal population. The reasons for this are obscure. Endometriosis does not respond to hormonal changes the same way that normal endometrium does and has been shown to persist despite extensive medical therapy. The recurrence rate of the disease is impressively high after either medical or surgical therapy. Interestingly, expectant management of minimal or mild disease is associated with pregnancy rates equal to those of any other type of therapy. Only when the disease is more extensive does aggressive treatment appear to show improvement in pregnancy rates. Whether combination therapy of endometriosis is better than single agent therapy remains open to debate. Some of the best-designed studies using combination therapy have shown no difference in pregnancy rates. Yet, when taken as a whole, it would appear that if combination medical and surgical therapy is chosen, the medical therapy should be given preoperatively. The literature abounds with a wide variety of classification systems, methods of calculating pregnancy rates, and inclusion of control groups. Because of this disparity between studies, reliable conclusions cannot be drawn. PMID- 2664617 TI - The role of the new reproductive technologies including IVF and GIFT in endometriosis. AB - In the context of the pathophysiology of endometriosis, the technology of IVF-ET and GIFT appears to offer a promising alternative for infertility associated with endometriosis in situations refractory to conventional medical or surgical therapy. The success rate of IVF with respect to follicular response, oocyte recovery, fertilization rate, and pregnancy rate in mild-to-moderate (stages I to II) disease is comparable to patients with tubal disease. However, compromise of oocyte recovery and fertilization appears to be present in severe-extensive cases (stages III to IV) implying an impairment of reproductive potential in advanced disease. In all stages of endometriosis, prior therapy, either medical or surgical, offers the best prognosis for an IVF or GIFT attempt. Surgical therapy with operative endoscopy at the time of oocyte retrieval offers a reasonable prognosis for treatment-independent pregnancy in cases of active endometriosis. The GIFT procedure bypasses an unfavorable peritoneal environment in stages I to II endometriosis without anatomic distortion or compromise of fallopian tube function. Pretreatment with GnRH analogues prior to ovulation induction is valuable in suppression of active disease as well as in inducing improved homogeneity of follicular response in IVF or GIFT cycles. PMID- 2664618 TI - Extrapelvic endometriosis. AB - Extrapelvic endometriosis has been reported in nearly every organ system of the human female body. The etiology of this disease may well be due to one or more factors. Though less common than pelvic disease, extrapelvic endometriosis is often difficult to diagnose and more difficult to treat. Our experience combined with a review of world literature is presented focusing on diagnosis and management. PMID- 2664619 TI - Adenomyosis: current perspectives. AB - Adenomyosis frequently involves gravid and nongravid uteri, remaining asymptomatic in up to one half of all cases. The symptoms of adenomyosis, particularly menorrhagia and dysmenorrhea, correlated with the depth of myometrial involvement, and consequently with the patient's age. Adenomyosis is most frequent in parous women in their middle to late forties. There is a high frequency of associated pathology, including leiomyomas, endometriosis, endometrial hyperplasia, and carcinoma. This relationship may suggest a common underlying disorder, such as hyperestrogenemia. Adenomyosis is a frequent finding in pregnancy, and obstetric or surgical complications are rare. Approximately 30 to 50 per cent of adenomyotic foci respond to progesterone, particularly to the high serum levels in pregnancy. The preoperative diagnosis of adenomyosis remains poor. Radiologic procedures and serum levels of CA-125 are of limited diagnostic value. Only a high degree of clinical suspicion will aid in the diagnosis of this histopathologic entity. Hysterectomy remains the mainstay of treatment and diagnosis. PMID- 2664620 TI - CA-125 in women with endometriosis. AB - The serum CA-125 level is elevated in most women with endometriosis. Although tests are readily available to measure the marker, simple modifications of the present assays are required to improve and standardize the quality of the measurements. The serum test has low sensitivity and would not be appropriate for general screening purposes, but in clinical situations that have a relatively high prevalence of endometriosis, CA-125 determinations have acceptable sensitivities and very high specificities. The concentrations of CA-125 correlate with both the severity and the clinical course of the disease. In women with diagnosed endometriosis, use of serial CA-125 determinations to monitor the course of the disease shows much promise in early studies. The changes in the CA 125 levels can offer additional information to the clinician about the status of the endometriosis, but how much this information will assist in the management and improve the outcome of treatment must await the results of prospective studies. PMID- 2664621 TI - Clinical presentation and diagnosis of endometriosis. AB - Endometriosis is one of the most common conditions encountered in gynecology and the field of infertility. The clinical presentation depends on the location and the extent of disease, but the severity of symptoms does not correlate directly with the extent of disease. Symptoms of genital endometriosis may be categorized as menstrual dysfunction, ovulatory dysfunction, and reproductive dysfunction. With menstrual dysfunction, the frequent clinical symptoms are cyclic pelvic pain, dysmenorrhea, and dyspareunia. Endometriosis is commonly found to be the cause in younger patients with pain and dysmenorrhea, particularly when the clinician is aware of the appearance of atypical lesions. Types of ovulatory dysfunction reported to be associated with endometriosis include anovulation, premenstrual spotting, luteal phase defects, and LUF syndrome. The data are not sufficient to determine the prevalence of endometriosis, luteal phase defects, and hyperprolactinemia. With LUF syndrome, there are data to support an association, but more data on the frequency of LUF in consecutive normal cycles compared to consecutive cycles in women with endometriosis would be beneficial. A higher rate of infertility is reported in couples with endometriosis. Two approaches are used to evaluate spontaneous abortions and endometriosis. In retrospective studies, the abortion rates are higher in couples with endometriosis; however, when the pregnancy outcomes in untreated couples are studied, there is less evidence to support the association of a higher spontaneous abortion rate. Formerly, the diagnosis of endometriosis depended on the appearance of typical lesions. With the recognition of early or atypical lesions the histologic confirmation of glands and stroma is assuming a more prominent role. Noninvasive techniques such as assays of endometrial antibodies or CA-125 have certain limitations in terms of producing false-positive results and lacking predictability in early stages of disease. Ultrasonography and MRI give additional and confirmatory information. Most noninvasive techniques are ancillary in diagnosis and management. It still needs to be determined whether their routine use will give enough added information to justify their cost. Currently, the diagnosis of endometriosis is best made by histologic evidence of glands and stroma. PMID- 2664622 TI - Clinical epidemiology of endometriosis and infertility. AB - Evidence from clinical epidemiologic research is reviewed in relation to the prevalence of endometriosis, characteristics associated with its development, the association between endometriosis and infertility, and the efficacy of treatment. PMID- 2664623 TI - Classification of endometriosis. AB - The classification of endometriosis has evolved during this century under the influence of many factors. Although classifications initially paralleled the staging of pelvic malignancies, more modern systems follow the natural progression of this pathologic process. The diagnosis of endometriosis at earlier stages has been limited by the technology of the era. Previously, only patients with more severe disease or symptoms were evaluated and treated. Earlier therapies were more radical and centered on pain relief achieved with removal of the internal genitalia. The objectives of classification were to provide standardized documentation of the disease and--it was hoped--define those patients amenable to less radical therapy. As our diagnostic and therapeutic capabilities grew, so did our interest in infertile women with endometriosis and the treatment of such patients. The diagnosis of endometriosis was often made at an earlier stage of involvement, and therapy stressed repair rather than removal. Description of pelvic involvement, has become more detailed and accurate, and the stage of disease has become prognostic of future fertility. The basic tenet of the R-AFS classification system is to provide an objective and universal method for describing the severity of disease visualized at laparotomy or laparoscopy. Stage of disease will aid the physician in choosing the therapy most suited for the individual patient. If reparative surgery is undertaken, the stage of disease will reflect the extent of pelvic reconstruction required. Quantifying disease severity will, it is hoped, make it predictive of success in conception and prognostic of the need for future medical or surgical treatment. It will also serve to stratify patients with a similar degree and distribution of disease into somewhat homogeneous groups. This will permit reasonable comparisons of effectiveness of different therapies and investigators' methods. Refinement of this type of classification scheme will depend on critical analysis of the system's prognostic capabilities. Further studies will help elucidate the relative importance of individual variables on the potential for success in achieving pregnancy. PMID- 2664624 TI - Endometriosis as a cause of infertility. AB - Although association between moderate or severe endometriosis and infertility is fairly well established, the link between lesser disease stages and infertility is more tenuous. The proposed mechanisms underlying this association are reviewed. These include mechanical factors, changes in the peritoneal fluid environment, activation of local or systemic immune response, and abnormalities of ovulation, fertilization, and early pregnancy. PMID- 2664625 TI - Immunologic aspects of endometriosis. AB - Endometriosis appears to be a systemic disease with alterations in both humoral and cell-mediated immunity. An immune defect may allow ectopic implantation of the endometrial cells with subsequent development of autoantibodies. PMID- 2664626 TI - Problems associated with penetrating keratoplasty for corneal edema in congenital glaucoma. AB - Corneal edema from congenital glaucoma is a rare indication for penetrating keratoplasty. We report the complications and problems associated with eight consecutive penetrating keratoplasties performed in adult eyes with a history of congenital glaucoma. Only 25% of the eyes achieved 20/40 or better vision after surgery. These generally poor results can be attributed to previous glaucomatous optic nerve damage, to complications related to previous surgery, and possibly to amblyopia. The most common surgical complication was postoperative elevation of intraocular pressure, which occurred in all the cases (8/8 eyes), and required permanent augmentation of glaucoma medications in seven eyes (88%), and glaucoma surgery in four eyes (50%). Two eyes (25%) developed corneal graft failure, one from immune rejection and the other from severe postoperative glaucoma necessitating cyclocryotherapy. In view of these complications and the multiple impediments to good postoperative vision, we advise that penetrating keratoplasty be reserved for patients with severe visual disability whose preoperative glaucoma is well controlled. PMID- 2664627 TI - Communicating intravitreal cysticercosis. AB - A viable intravitreal cysticercus cellulosae communicating with subretinal space was identified in a 45-year-old man. The cyst was removed in toto via the direct scleral approach without incident. To our knowledge this is the first report of intravitreal cysticercus with subretinal extension removed successfully by the direct route. The role of careful ultrasonic scanning in cases of intravitreal cysticercosis is emphasized. PMID- 2664628 TI - Levobunolol. A four-year study of efficacy and safety in glaucoma treatment. The Levobunolol Study Group. AB - In a 4-year, double-masked, parallel, multicenter study comparing the efficacy and safety of levobunolol and timolol, 391 patients with open-angle glaucoma or ocular hypertension were randomly assigned to receive masked 0.5% or 1% levobunolol, or 0.5% timolol, twice daily. Mean decreases in intraocular pressure (IOP) over 4 years of therapy were 7.1, 7.2, and 7.0 mmHg for 0.5% levobunolol, 1% levobunolol, or 0.5% timolol, respectively. Little attenuation of ocular hypotensive efficacy occurred. The 4-year efficacy failure rate for the three groups, which did not differ from each other, was approximately 30%. Adverse experiences requiring cessation of therapy occurred in an additional 10% of patients. The vast majority of efficacy failures (79/95) and of adverse events (33/37) requiring removal from the study occurred during the first 2 years. Overall mean decreases in heart rate for the 4 years ranged from 3 to 6 beats per minute for all treatment groups; overall mean decreases in systolic and diastolic blood pressure ranged between 1 and 2 mmHg. The authors concluded that levobunolol is relatively effective and relatively safe for the long-term (4 year) treatment of elevated IOP. PMID- 2664629 TI - Angle-closure glaucoma complicating ciliochoroidal detachment. AB - Acute angle-closure glaucoma complicating ciliochoroidal detachment developed in eight eyes of six patients. The clinical presentation was uniform: extremely shallow central anterior chamber depth, flat peripheral anterior chamber, closed angle, and elevated intraocular pressure (IOP). There were three patients with uveal effusion syndrome, two with posterior scleritis, and one with an arteriovenous malformation. Cycloplegia, along with aqueous suppressants and corticosteroids, successfully resolved the acute glaucoma in all eyes. This rare, secondary glaucoma must be differentiated from primary angle-closure glaucoma, because the treatment is markedly different. Although primary angle-closure glaucoma is treated with miotics and peripheral iridectomy, such therapy may worsen the glaucoma in eyes with angle-closure glaucoma due to a ciliochoridal detachment. PMID- 2664630 TI - Radial keratotomy for myopia. American Academy of Ophthalmology. PMID- 2664631 TI - Corneal astigmatism after penetrating keratoplasty. The role of suture technique. AB - A randomized clinical trial was conducted to contrast two techniques of suturing in penetrating keratoplasty (PK) surgery: double running 10-0 and 11-0 sutures (DR), and a combination of 12 interrupted 10-0 sutures with a single running 11-0 suture (IR), followed by selective suture removal. The primary outcome evaluated in the 60 patients within each group was keratometric astigmatism. A decreasing trend in astigmatism over postoperative year 1 was observed only in the IR group (from 4.00 diopters [D] at 3 months to 2.50 D at 12 months). The difference in median astigmatism at 1 year (IR, 2.50 D; DR, 4.00 D) approached statistical significance (P = 0.06, Mann-Whitney U test). Both groups showed comparable steepening of almost 1 D during postoperative year 1. Assessment of the rate of visual rehabilitation was limited by a greater proportion of IR patients showing cystoid macular edema (CME) after surgery. These results, while favorable toward the IR/selective suture removal technique, must be substantiated by a final assessment after all sutures have been removed. PMID- 2664632 TI - Postoperative active-specific immunotherapy of lymph node micrometastasis in a guinea pig tumor model. AB - Strain 2 guinea pigs bearing the transplanted intradermally growing line 10 tumor underwent surgical tumor excision at a time when the tumor had already metastasized to the first draining lymph node. Postoperative active-specific immunotherapy (ASI) consisted of two vaccinations with either Newcastle disease virus (NDV) modified or BCG-admixed line 10 tumor cells. 32% of the animals were cured of residual lymphatic micrometastasis by ASI with NDV-modified tumor cells while ASI with BCG was successful in 45%. No synergistic effect was observed when both ASI procedures were combined. Vaccine preparations with mitomycin C inactivated tumor cells proved to be less (NDV) or noneffective (BCG) compared to those with irradiated tumor cells. PMID- 2664633 TI - Acoustic trauma-induced Meniere's syndrome. AB - Eight male patients suffering from Meniere's syndrome are presented. All patients sustained sudden or prolonged exposure to severe noise levels and suffer from acoustic trauma. The incidence of Meniere's syndrome in our group of patients is significantly higher than in series reported in the normal population. Our presentation supports the implication of acoustic trauma as a possible cause of Meniere's syndrome. PMID- 2664634 TI - Ramsay-Hunt syndrome in a preschool infant. AB - The Ramsay-Hunt syndrome affects mostly adults. The recovery of facial nerve function, according to recent literature, seems better than has been generally accepted. A small number of children with herpes zoster oticus have been reported. We describe a case of Ramsay-Hunt syndrome in a healthy 3 1/2-year-old girl. She still had an obvious facial palsy after 12 months. Three out of 6 reported children with herpes zoster oticus have had a slow recovery of the facial nerve function. This suggests a less favorable prognosis in children than in adults. Although not successful in this case, acyclovir should be tried early in the course of the disease. PMID- 2664635 TI - [Current views on bed rest in pediatrics]. AB - The author reviews the method of laying and bed rest that has been used for several centuries, describes the aim and assumed advantages of this therapeutic precautions. The criticism concerning the inflexible prescriptions are dealt with. Some disease groups where concerning laying and bed rest new viewpoints were brought up and discussed in the literature are dealt with in details. Studying the literature the author advises to weight the assumed positive effect of bed rest against the not always favourable effect that a "confinement to bed" means for a child. The author is of the opinion that the sometimes inflexible principles learned and applied in connection with laying and bed rest should be reconsidered and reassessed and if necessary changed. PMID- 2664636 TI - [Significance of low osmolarity contrast media in state of the art roentgen diagnosis]. AB - The authors used low-osmolality contrast material intravascularly in 546 patients, in 371 cases ioxaglate, in 80 patients iopamidol and in 95 iohexol. On each occasion good detail-rich pictures were obtained. Sensation of heat was indicated only by 1 patient (iopamidol), pain by 7 patients (ioxaglate 4, iohexol 2, iopamidol 1). The blood pressure, pulse rate and the UN, SGOT and SeBiru values showed no significant changes. The experiments were carried out on 101 dog kidneys. Selective renal angiography was done with the aforementioned materials and compared with the conventional, high-osmolality materials (iodamide, metrizoate). The histological changes were only slight, of small extent, and reversible when the new materials were used. Use of the new, low-osmolality contrast materials is justified whenever they must be given intravascularly, but it is imperative in the examination of children, patients of high risk groups and sensitive organs (nervous system, kidney, coronary vessels). PMID- 2664637 TI - [The significance of Campylobacter pylori infection in gastroenterologic and diabetic practice]. AB - The presence of Campylobacter pylori was investigated in gastric antral biopsy specimens. In 50 consecutive patients undergoing upper gastrointestinal tract endoscopy microbiological cultures, histological examination and rapid urease test were parallel performed, and a 92 per cent sensitivity and 100 per cent specificity of rapid and cheap urease test were determined. Afterwards--in a prospective study--311 patients were examined for C. p. by the rapid urease test only. C. p. was detected in 92 per cent of duodenal ulcer patients, in 52 per cent of patients with gastric ulcer, in 67 per cent of non-ulcer dyspepsia, in 62 per cent of mixed diabetic patient material, and in 21 per cent only of asymptomatic volunteers. It has been found by the authors, that the rate of C. p. infection increased parallel with the continuance of diabetes and did not follow the increasing with age as in the general population. This is the first observation in the world literature concerning the correlation between C. p. and diabetes mellitus. Very close, significant correlation has been found between C. p. infection and chronic active gastritis. C. p. may play an important role in the recurrences of duodenal ulcer and in the pathogenesis of non-ulcer and diabetic dyspepsia. Further studies are planned to the correct evaluation of pathogeneity of Campylobacter pylori. PMID- 2664638 TI - [Intracystic instillation of yttrium 90 silicate colloid in cystic craniopharyngioma]. AB - The authors evaluate the intracavital treatment with 90 Yttrium silicate colloid given in 31 occasion in 26 patients of cystic craniopharyngioma. The method has been applied since 1975 in the National Institute of Neurosurgery Budapest, using practically the same method as described by Backlund et al. (1972). Although the intracavital treatment was only one among several applied forms of treatment (resection, aspiration, shunting etc.) the effectiveness of the internal irradiation is obvious. The main effect is shrinkage of the cyst. At the 26 patients there was an average of more than 70% volume decrease of the cysts. In 5 cases the cysts totally disappeared and only on two occasions the volume has remained unchanged. Neuroophtalmological data: Preoperatively visual field defects or an impairment of visual activity have been observed in 24 out of the 26 patients studied. After the 90-Yttrium treatment the ophtalmological state of the patients improved 4, worsened in 2 cases. There was no change in 18 cases. The neuroophtalmological prognosis was good only when a relatively intact optic disc was seen; when the disc was atrophic the visual deterioration proved to be irreversible. Pathologically, the fibrotic tissue is responsible for the shrinkage of the cyst. PMID- 2664639 TI - [The role of intraoperative ultrasonic studies in abdominal surgery]. AB - Intraoperative echography is a new field of application of the ultrasound diagnostics. With a special intraoperative examination head the parenchymal abdominal organs may be examined directly in the course of the operation. The intraoperative echo-examination of the tumors and cysts of the liver and pancreas as well as of nephroliths and gallstones is routinely applied in several institutions abroad. The authors report on their initial experiences with intraoperative ultrasonography of different abdominal organs. PMID- 2664640 TI - ["The clan system in science"]. PMID- 2664641 TI - [Systemic lupus erythematosus and pregnancy]. AB - The authors report on the successful outcome of pregnancy of a young woman with systemic lupus erythematosus. Her disease presented with severe renal involvement. The delivery was followed by lasting, complete remission. Even at the time of the report both the mother and her child are in a good health. On the occasion of this case-history the authors attempts, to summarize the present knowledge of pregnancy in systemic lupus erythematosus. PMID- 2664642 TI - [Ultrasonic diagnosis of agenesis of the corpus callosum]. AB - Agenesis of the corpus callosum may be diagnosed successfully in vivo when sonograms demonstrate absence of corpus callosum, absence of pericallosal and cingulate sulci, wide interhemispheric fissure, small laterally positioned frontal horns with concave lateral borders. Two cases of corpus callosum agenesis were diagnosed in early infancy by ultrasound. Ultrasonographic anatomy of the corpus callosum and characteristic ultrasound features and neurological findings of agenesis are described. PMID- 2664643 TI - [Fulminating course of Wegener's granulomatosis associated with gastrointestinal bleeding]. AB - Foudroyant generalizated Wegener's granulomatosis of 57 years old man is reported. The diagnosis was proved on basis of characteristic clinical picture, the bronchial laesions and histology. The disease improved in consequence of high dose immunsupressant therapy. The massive letal haemorrhage origined from the intestinal manifestation of Wegener's granulomatosis merits particular attention. Only one similar case has been reported for this time. The clinical features and the therapeutic possibilities of Wegener's granulomatosis is reviewed. PMID- 2664644 TI - [Surgical treatment of ventral compression of the dorsal spine: retrospective study of advances in the course of the past decades]. PMID- 2664645 TI - [Commemorating Mor Kaposi on postage stamps]. PMID- 2664646 TI - [Direct and indirect immunofluorescence studies in congestive myocardial diseases]. AB - Immunfluorescence examinations were made on 118 patients with congestive cardiomyopathy. Standard techniques of direct immunfluorescence (DIF) were employed on myocardial biopsy material in 61 cases, and of indirect immunfluorescence (IIF) on the serum in 89 cases. On the basis of the assumed aetiologies, the patients were classified into 6 groups: definitely alcoholic, presumably alcoholic, familial, peripartum, chronic myocarditic and idiopathic; studies were then made of the frequencies of pathological immunological processes in the individual groups. The highest incidences of DIF-positive cases were observed in the familial, peripartum, chronic myocarditic and idiopathic groups (67-87%). In the presumably alcoholic group the corresponding incidence was 37%, and in the definitely alcoholic group it was 25%, in contrast with expectations. Interestingly, very strong IIF-positive reactions too were observed in these alcoholic groups. It is possible that, besides the effect of alcohol, the fact that the immune background becomes pathological is also a significant factor in the emergence of the congestive cardiomyopathy in the alcoholic groups. PMID- 2664647 TI - [The role of radical abdominal hysterectomy and lymphadenectomy (Wertheim's operation) in contemporary gynecology]. AB - During a 20-year period between January 1964 and December 1983, 317 radical hysterectomies and pelvic lymphadenectomies were performed for stage IB, IIA and IIB carcinoma of the cervix at the Department of Obstetrics and Gynaecology, University Medical School of Debrecen. The 5-year survival rate for Stage IB patients is 88.3 per cent, in Stage IIA 82.7%, in Stage IIB 68.0% and the major prognostic factor clearly being the status of the pelvic lymph nodes. In comparison with the literary data their results seem to suggest that routine pre- and postoperative radiotherapy reduces pelvic metastases and improves survival in patients with positive pelvic lymph nodes. It was noted that closed retroperitoneal suction drainage after radical operation effectively removes fluid from the pelvis and probably prevents some of the postoperative complications. Evidence seems to suggest that properly performed radical pelvic surgery with radiation therapy is successful in treating early cervical carcinoma. There does not appear to be any contraindication to operation in this group of patient as long as the condition is deemed medically operable. PMID- 2664648 TI - [Centenary of the death of Ferenc Schwartzer]. PMID- 2664649 TI - [Once more about the two (three?) Gomorys]. PMID- 2664650 TI - [In memory of Ardnold Winternitz]. PMID- 2664651 TI - The problem of nasal obstruction. PMID- 2664652 TI - Objective assessment of nasal obstruction. AB - Attempts to find objective tests to assess nasal obstruction have a long history. The physiologic and pathologic fluctuations that occur within the nose over short periods of time have hampered these efforts, and all presently available techniques have significant drawbacks. The most commonly used is active rhinomanometry, and relatively recent standardization has led to the popularization of the anterior method. Posterior active and passive rhinomanometry are also available; other methods include plethysmography, peak expiratory flow rate, rhinohygrometry, thermography, oscillometry, echorhinometry, audiometric rhinomanometry, and rhinostereometry. A reliable technique would have many applications, particularly in pre- and post-therapeutic evaluation. At present, however, no method enjoys routine clinical usage, although there is considerable interest in future development. PMID- 2664653 TI - Nasal obstruction. The nasal septum and concha bullosa. AB - Nasal septal defects impair nasal physiology, leading to progressively more severe rhinosinusitis and the development of chronic disease. Anatomy and physiology are described. Treatment for the deviated nasal septum is discussed. PMID- 2664654 TI - Rhinitis and nasal obstruction. AB - Inflammation of the nasal mucosa is a common cause of nasal obstruction. The multitude of causes are discussed, and treatment protocols are detailed. PMID- 2664655 TI - Nasal septal perforations and nasal obstruction. AB - Nasal septal perforations cause a wide range of symptoms that vary from mild discomfort and nasal obstruction to life-threatening epistaxis. The differential diagnosis, pathophysiology, and treatment of this disorder are reviewed. PMID- 2664656 TI - Nasal obstruction due to benign and malignant neoplasms. AB - Nasal obstruction can be the first symptom of an obstructing neoplasm originating in the paranasal sinuses, nasopharynx, nasal skin, or nasal chamber. Several standard approaches permit access to these lesions for surgical removal, and these are outlined here. PMID- 2664657 TI - Nasopharyngeal obstruction. AB - The causes of nasopharyngeal obstruction are described. The diagnosis and treatment of each type of nasopharyngeal obstruction are presented in detail. PMID- 2664658 TI - Nasal obstruction in children. AB - Acute nasopharyngitis and adenoidal hypertrophy, common causes of nasal obstruction in children, are reviewed. The less common, but equally important, congenital and neoplastic lesions that result in blocked nasal airways in children are discussed in detail. PMID- 2664659 TI - Influence of nasal obstruction on smell function. AB - This article has reviewed studies that document a relationship between loss of smell function and disturbances in nasal airflow function. In some cases (for example, hypertrophied adenoids and nasal sinus disease), medical or surgical intervention appears to be useful in restoring some, if not all, of the smell loss associated with the disorder. In other cases (for example, septoplasty), empirical evidence of such efficacy is wanting. Given the current research interest on these topics, however, a clear understanding of both the positive and negative influences of surgical and medical interventions in most cases of obstructive nasal disease or malformities will be forthcoming. PMID- 2664660 TI - Nasorespiratory function and orofacial development. AB - The controversy over whether altered development of orofacial structures arises purely from expression of genetic potential or is influenced by environmental factors is reviewed. Resolving this controversy will determine the need for early intervention to permit nasal respiration and for orthodontic treatment. PMID- 2664661 TI - Nasal obstruction and human communication. AB - Nasal obstruction may cause a variety of communication disorders, particularly in children. The effects of nasal obstruction on hearing, speech, language, and voice are examined. Methods for assessing the effects of nasal obstruction are delineated, and recommendations for therapeutic interventions are described. PMID- 2664662 TI - The systemic effects of nasal obstruction. AB - Nasal obstruction has profound effects on the body as a whole. Occasionally, these effects dominate the patient's symptoms and complaints and should be recognized as part of the nasal obstruction syndrome. A thorough understanding of their relationship with nasal obstruction will provide reassurance to the patient and allow for their resolution. PMID- 2664663 TI - Human pain responsivity in a tonic pain model: psychological determinants. AB - Human pain responsivity was defined as the subject's behavioral pain endurance time (PET) to the 1 +/- 0.3 degrees C cold-pressor test, a naturalistic and clinical analogue tonic pain model. Over the past 2 years, we have consistently observed a behavioral dichotomy of pain responsivity in each of our 6 studies (all at P less than 0.000001 effect level), totaling 205 subjects. Overall, the pain-tolerant (PT) subjects could endure the whole 5 min (note that 3 min was the ceiling criterion in the last study) of cold-pressor test, while the pain sensitive (PS) subjects could merely tolerate the test for an overall mean of 60 sec, 20% of PET in the PT group. No overlapping of distribution was observed between these 2 populations. Further, we observed that the percentage of subjects in each of these 2 groups varied substantially across studies. The mean pain perception (Visual Analogue Scale) of tonic pain ranged from 60-70 for both aversiveness and intensity scales. The characteristics of this tonic pain, assessed by the McGill Pain Questionnaire (MPQ), showed similar patterns across each study with a high degree of consistency. Although ratings of pain aversiveness did not differ in the PT vs. PS subjects, ratings of pain intensity did differ, with the PT subject reporting less pain. It was found that state anxiety correlated with MPQ scores for PS, but not PT, subjects. Additionally, psychological tests (Tellegen Absorbance Scale, Kleinknecht Fear, Spielberger Trait-Anxiety) were positively correlated with certain MPQ measures for PS, but not PT subjects. Multivariate regression analyses indicated, in the PS but not the PT group, that 36% of variance in pain score (MPQ-T) could be predicted by the psychological trait factors. The general level of fear contributed singularly as the major predictor variable in the pain-sensitive individuals. We consider this tonic pain model indeed offers a succinct empirical paradigm to study human pain responsivity in general. The psychological/physiological etiology of such drastic human pain responsivity requires intense systematic investigations. This report discusses the results in: (a) individual differences in pain responsivity, (b) characterization of the cold-pressor test as a model for tonic pain, (c) contrast between PS and PT groups of pain perception and state anxiety, and (d) psychological determinants of measures for cognitive, perceptual and affective domains. Discussion was also focused on the experimental tonic pain model and its generality for clinical pain, as well as the basic model of the cold-pressor test for human tonic pain responsivity. PMID- 2664664 TI - Single doses of the serotonin agonists buspirone and m-chlorophenylpiperazine do not relieve neuropathic pain. AB - A large body of evidence links serotonin with analgesia in animal models, but the lack of serotonin agonists suitable for clinical use has delayed study of serotonin's relevance to pain relief in humans. In a randomized, double-blind crossover study, we compared single doses of two 5-HT1 agonists, buspirone and m chlorophenylpiperazine, to placebo in 20 patients with post-herpetic neuralgia or painful neuropathy. No analgesia was observed after either drug, at doses high enough to produce frequent central nervous system side effects. These results suggest that acute stimulation of 5-HT1 receptors is not sufficient to produce analgesia in patients with these neuropathic pain syndromes. PMID- 2664665 TI - Expansion of receptive fields of spinal lamina I projection neurons in rats with unilateral adjuvant-induced inflammation: the contribution of dorsal horn mechanisms. AB - We have physiologically characterized the receptive field properties of lamina I projection neurons with cutaneous input in the lumbar spinal cords of control rats and rats with unilateral adjuvant-induced inflammation of the hindlimb. The majority of cells recorded in rats with inflamed limbs demonstrated properties uncharacteristic of this cell population in control rats, including large receptive fields, discontinuous receptive fields, responsiveness to deep as well as cutaneous tissues and ongoing or bursting spontaneous activity. Cells with complex receptive fields were encountered from less than 6 h to 5 days after induction of inflammation. This time course correlates with the occurrence of hyperalgesia to thermal stimuli. The contributions of nociceptive afferent sensitization and alterations in the physical environment of peripheral receptors to the observed enlargement of receptive fields were examined by testing the responses of cells to localized electrical and thermal stimuli in the absence and presence of local anesthesia. Nociceptive primary afferents did not demonstrate enlarged receptive fields in this model of inflammation. The results imply that the enlargement of receptive fields cannot be accounted for by peripheral sensitization of peripheral nociceptors or physical changes in the environment of peripheral receptors and must therefore involve changes within the central nervous system. PMID- 2664666 TI - [History of the geographic ranges and migration routes of ticks in the genus Dermacentor Koch, 1844 (Ixodidae)]. AB - The mutually checking parasitological and zoogeographic criteria for the issue in question made it possible to express the viewpoint and present supporting data on the origin and spread of Dermacentor ticks. Their origin was dated back to Oligocene (38 mln years ago). Having appeared in Angar Mainland, the ticks spread by land in Europe, North America (Miocene, 25 mln years ago) and Africa (Pliocene, 5 mln years ago). The list of species according to zoogeographic regions is given. PMID- 2664667 TI - [The behavior of the causative agents of blood and transmissible infections during the preparatory period for a change in host. A review]. AB - The author has reviewed the available literature on the changes in the physiological state and behaviour of hosts of vector-borne diseases agents during the before-host-changing and during host-changing periods. For vertebrates the effect of the agent is reflected in the rise of body temperature, reduction of locomotor activity and protective reactions, thrombocytopenia and vasodilation, accompanied by periodical concentration of the agent in the peripheral part of the vascular system. All this provides a successful search for a host, a source of infection, and obtaining the agent by blood-sucking vector. For arthropods the effect of the agent is reflected in changes in the vector behaviour as during the host-searching period so in an attempt for bloodsucking. Alimentary tract obstruction with an agent blocking, phagoreceptors block (eructation type of infection), inhibition of saliva ferments activity (saliva type of transmission) result in the prolongation of the feeding period and rise of agent hit probability. The last three types of effect on the feeding mechanism increase the possibility of death of an infected individual and decrease the chance of progeny preservation. PMID- 2664668 TI - The spinal pedicle screw: techniques and systems. AB - New spine instrumentation systems are being developed that incorporate pedicle screws for purchase. This review article outlines techniques for the safe insertion of these devices. A description of the various screw-rod and screw plate systems currently available is presented. PMID- 2664669 TI - Tumoral calcinosis. Case report with treatment failure. AB - Periarticular calcifications are the hallmark of a rare entity: tumoral calcinosis. We have followed for 90 months a nine-year-old black girl with involvement of both shoulders. Seven initial local excisions of the mass on the right shoulder were attempted without complete removal and prompt recurrence after each attempt. The entire lesion on the right side, including a cutaneous ulceration, was managed by en masse surgical excision. Preoperative inpatient medical management in the form of low calcium and low phosphorus diet was unsuccessful. Postoperatively, she has remained free of ulceration; however, after two and a half years, the right mass has again increased in size with compression of the brachial plexus. This recurrence occurred despite strict dietary control starting immediately postoperatively. Although there are many advocates of surgical excision of these lesions and, more recently, several cases reported of successful medical management, we find that often a combination approach is necessary to effectively treat tumoral calcinosis and reduce the rate of recurrence. PMID- 2664670 TI - Comparison of intraoperative versus 24 hour antibiotic prophylaxis in total joint replacement. A controlled prospective study. AB - One hundred and ninety-six consecutive total joint recipients, including unilateral and bilateral procedures, were studied. Patients were randomly assigned to receive one of two prophylactic protocols. Group A (98 patients) received two intraoperative doses of cefuroxime (1500 mg and 750 mg) intravenously and continued cefuroxime for 24 hours postoperatively (750 mg every eight hours intravenous piggy back). Group B (98 patients) received two intraoperative intravenous doses of cefuroxime (1500 mg and 750 mg) and no postoperative doses. The opening or closing surgical culture was positive for five patients in Group A and 10 patients in Group B. None of these patients had a postoperative infection. Patients were followed for a minimum of one year after surgery. No deep wound infection was reported for either group. PMID- 2664671 TI - Myoelectric prosthetic replacement in the upper-extremity amputee. AB - Myoelectric upper-extremity prostheses, which have opened up a new world of freedom and function for upper-extremity amputees, are examined in terms of patient acceptance, ease of use, and durability of the unit. PMID- 2664672 TI - Infected uncemented hip arthroplasty. Preserving the femoral stem with a two stage revision procedure. AB - Revision of an infected uncemented hip arthroplasty can be significantly complicated by the presence of extensive bony ingrowth. Although removal of the prosthesis is desirable, technical difficulties in extracting a well anchored prosthesis can be extreme. Femoral windowing or splitting may be necessary. In these cases, treatment alternatives that avoid destruction of the femoral cortex are desirable. A 47-year-old man presented with a deep infection of a virtually fully coated porous implant two years postoperatively. Radiographs revealed extensive bony ingrowth and an arthrogram revealed no dye tracking down the femoral canal. The infecting organism was Staphylococcus epidermis. In order to avoid the possible complications of extraction of this fully coated stem, treatment was carried out initially with removal of the bipolar head, joint debridement, and placement of antibiotic impregnated beads. After seven weeks of intravenous antibiotic therapy with the patient in tibial pin traction, a revision was undertaken and the acetabulum was revised with a threaded uncemented acetabular component. The patient recovered and at 18 month follow-up is without evidence of infection and back to full function. Revision with a two-stage femoral stem preserving procedure is presented as an alternative in the management of infected uncemented hip arthroplasty. PMID- 2664673 TI - Team physician #7. A comparative study of functional bracing in the anterior cruciate deficient knee. AB - We evaluated the ability of three functional knee braces, (CTI, OTI, and TS7) to control anterolateral rotary instability of the knee. Fourteen subjects, none of elite athletic status, with arthroscopically proven anterior cruciate deficient knees were selected. The subjects evaluated each brace after one-month periods, and then underwent testing with physical examinations, KT-1000 arthrometry, and timed running events. All braces reduced subjective symptoms of knee instability. Different subjects preferred different braces. KT-1000 testing showed a reduction in anterior tibial displacement for all braces; however, this reduction did not increase as forces increased. A timed figure-of-eight running event did not show any functional advantage of bracing. Five subluxation events occurred in four subjects while braced. Functional braces appear to have a role in the anterior cruciate deficient knee, but only in conjunction with activity modification. PMID- 2664674 TI - [Anatomo-pathologic findings in 25 autopsy cases of AIDS]. AB - Pathologic findings in 25 autopsies of AIDS. The common and severe changes of the central nervous system, lungs, adrenals, heart, kidneys and gonads are reviewed in a series of autopsies of AIDS. In the brain, HIV infection induces directly inflammatory infiltrates including the typical multinucleated giant cells described by Sharer. In addition, primary lymphomas are seen as well as reactive and inflammatory lesions that are caused by opportunistic infections, such as those of poliomavirus, Cytomegalovirus and Toxoplasma gondii. In the lung, interstitial inflammation prevails, which may be related to direct HIV infection and include rare multinucleated giant cells like the ones described by Sharer. Opportunistic infections are often associated, and are commonly sustained by Cytomegalovirus and Pneumocystis carinii. A peculiar findings is the evolution from septal inflammation to fine fibrosis and hyaline degeneration, either focal or diffuse. We believe that the severe respiratory insufficiency that is commonly seen in the advanced stages of AIDS could be related to the interstitial damage. In the adrenal gland, the most common change is Cytomegalovirus infection affecting both the cortex and the medulla, and inducing massive necrosis in the cortex with little or no reaction. Again, adrenal involvement should be related to adrenal functional insufficiency, which may be over-looked clinically because of the preponderant lesions of other sites. In the heart, myocarditis is often discrete, and may be complicated by perivascular fibrosis and rare foci of myocytolysis; in some cases primary lymphomas may also develop. In the kidney, several histological lesions are found, including glomerular damage with segmental necrosis, cortical areas of hyporeactive necrosis, and mild interstitial inflammation. In the gonads, the changes are partly induced by drug abuse, and consist of atrophy with secondary hypoplasia of the germ cells and interstitial fibrosis. In conclusion, the most important abnormalities consist of opportunistic infections, hyporeactive necrosis, fibrotic evolution of the inflammatory infiltrates and neoplasias (Kaposi's sarcoma and lymphomas). In this work, the changes of the lymphoid organs are only mentioned, for they have been widely reviewed elsewhere. PMID- 2664675 TI - [Gastric carcinoma probably of hamartomatous origin. Presentation of a case and review of the literature]. AB - Gastric carcinoma of hamartomatous histogenesis. Case report and review of the literature. A rare case of adenocarcinoma arising in adenomyomatous hamartoma of the pyloric wall is presented and the literature reviewed. PMID- 2664676 TI - Chest wall deformities in children. AB - Pectus excavatum and pectus carinatum deformities are not uncommon. Pectus excavatum is associated with definite demonstrable adverse physiologic effects. The psychologic impact of these deformities on the patient can be truly devastating. The clinician must realize the impact and importance of the advice given to patients and their families. Although correction of these deformities is a major surgical undertaking, it is well tolerated, safe, and usually produces a satisfactory result. PMID- 2664677 TI - The acute abdomen in childhood. PMID- 2664678 TI - Common lumps and bumps of the head and neck in infants and children. AB - The majority of lesions in the neck of children will prove to be benign and of congenital origin arising from such structures as the thyroglossal duct and the branchial clefts in addition to hemangiomas and lymphangiomas. However, it is essential that lymphadenopathy be proven infectious and any asymptomatic lymph node enlargement must be considered Hodgkin's disease until proven otherwise. The occasional neuroblastoma or rhabdomyosarcoma presenting in the neck can usually be identified as solid by sonography, leading to early investigation and biopsy. Because of the abundance of important structures that course through the neck, surgery should be conducted in an operating suite with sophisticated, modern anesthetic techniques and with a surgeon experienced in dealing with the full array of lesions that occur. PMID- 2664679 TI - Gastroesophageal reflux in childhood: implications for surgical treatment. AB - Gastroesophageal reflux is a frequent occurrence in infancy and childhood. When appropriate symptoms are present, accurate diagnosis and treatment assessment can be obtained by a variety of diagnostic studies, most accurately by esophageal pH monitoring. Medical, nonoperative treatment usually is indicated initially if no established complication or life-threatening symptoms exist. When medical treatment is insufficient, operative treatment with fundoplication can be performed with an acceptable complication rate and a high expectation of success. PMID- 2664680 TI - The pediatric acute scrotum. AB - The pediatric acute scrotum can be a diagnostic dilemma. The history, physical examination, and appropriate tests are important. The correct diagnosis will be arrived at if the systematic approach is remembered (Figure 14). In cases where testicular torsion cannot be ruled out (such as an epididymitis or torsion of the appendix testis where torsion of the testis is mimicked), the patient will need scrotal exploration. It is hoped that with further availability of scanning and expertise by pediatric surgeons the false negative exploration will decrease in number. Remember, occasionally a patient will require scrotal exploration with biopsy of the epididymis to delineate the underlying cause. In most cases of epididymitis, effort should be made to identify the cause by culture of urine, urethral discharge, or appropriate fluid from the epididymis. Urological evaluation will be necessary in the younger boys, particularly those with recurrent episodes, to rule out congenital anomalies. Only by following this systematic approach can clinicians hope to preserve gonadal function and achieve best care of their patients. PMID- 2664681 TI - Circumcision. AB - There are no absolutes regarding circumcision, and the decision to circumcise a child as a newborn or otherwise must be made after carefully weighing the alternatives to, and risks and benefits of, this common surgical procedure. These alternatives, risks, and benefits must be fully explained to parents considering circumcision, and informed consent must be obtained. In well-trained, experienced hands, circumcision is a safe procedure that effectively eliminates proven problems such as cancer of the penis, and may eliminate the problems of increased risk of urinary tract infection and sexually transmitted diseases. PMID- 2664682 TI - Behavior during middle childhood: developmental themes and clinical issues. PMID- 2664683 TI - The development of thinking skills in school age children. PMID- 2664684 TI - Attention and memory: progression and variation during the elementary school years. PMID- 2664685 TI - Language development from six to twelve. AB - This article has shown that the elementary school years are vital for the growth of linguistic skills. During this period children go from a relatively rudimentary understanding of syntax and grammar to a very sophisticated appreciation of the complexities of language. Syntactic skills also are increasing during these years, particularly the ability to understand factitive verbs and complicated prepositions and conjunctions. Additionally, the child is developing a greater awareness of what language is and how to manipulate and use it. This allows the youngster greater flexibility in dealing with metaphors, poetry, and linguistic interpretation. A child's expressive skills improve during the elementary years; both the ability to narrate events and to provide appropriate information is increasing dramatically. The child progresses from learning to write sentences to producing long term papers and sophisticated reports. Also, it has been shown that children who have problems in these areas are at risk for academic failure and social isolation. Pediatricians play a significant role in identifying children with such problems. Often children are not discovered by teachers who are overwhelmed by large classes or encumbered with a complicated curriculum. Fortunately, physicians come in contact with children regularly and, by asking the right questions and inquiring about school progress, they can often determine if a child needs further assessment. In addition, instruments have been specifically designed to enable physicians to assess the age-appropriateness of a child's linguistic skills. By using specific subtests physicians can quickly determine whether a child's receptive, expressive, or syntactical skills are intact.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 2664686 TI - Social development in middle childhood. PMID- 2664687 TI - Pulmonary manifestations of immune deficiency diseases. PMID- 2664688 TI - Ultrasonic features of pyogenic and amoebic hepatic abscesses. AB - Pyogenic liver abscesses are not infrequent in some developing countries. Amoebic abscesses may also occur in endemic areas and differentiation may be difficult. The ultrasonic data of proven cases of both conditions were compared and we are now more more confident in predicting the aetiology of these lesions. PMID- 2664689 TI - Duplex Doppler ultrasound evaluation of calcified inferior vena cava thrombosis. AB - We describe the use of duplex Doppler ultrasound in the noninvasive assessment of inferior vena cava patency and abdominal venous flow dynamics in a four month old infant with calcified inferior vena cava thrombosis. PMID- 2664690 TI - Allergy, respiratory tract infections and bronchial hyperreactivity. PMID- 2664691 TI - Use of aminoglycosides during cyclosporine A immunosuppression after liver transplantation in children. AB - To determine the frequency of renal dysfunction associated with the use of aminoglycosides with cyclosporine A (CyA) in children, the records of 26 consecutive children receiving CyA after liver transplantation were reviewed. Fourteen patients with normal baseline serum creatinine concentrations received an aminoglycoside postoperatively. These children received CyA and an aminoglycoside for 249 days (average, 17.8 days/patient). Forty of the 249 days included treatment with vancomycin or amphotericin B. Twelve children (86%) showed no evidence of renal dysfunction after aminoglycoside therapy. Two children developed renal dysfunction and eventually succumbed. In neither case could aminoglycoside nephrotoxicity be identified as the main cause of renal dysfunction. Multiple other factors, including ischemia and high CyA concentrations, probably contributed to renal deterioration. We conclude that aminoglycosides can be used safely in children receiving CyA following liver transplantation, provided serum CyA concentrations are followed closely and other risk factors for renal dysfunction are minimized. PMID- 2664692 TI - Nontyphoidal Salmonella enteric infections and bacteremia. AB - Antimicrobial treatment of nontyphoidal Salmonella gastroenteritis is usually advocated for infants younger than 3 months of age based on published data showing that infants in this age group are more prone to have bacteremia and develop extraintestinal focal infections. A review of nontyphoidal Salmonella isolates from our institution from January, 1981, through March, 1988, was undertaken to assess the role of age and specific serovar on the incidence of bacteremia. Two hundred twenty isolates were identified: one cerebrospinal fluid, 14 blood and 205 stool. The mean age of patients with bacteremia was 182 months, not significantly different from the mean age of 142 months for patients with stool isolates. Salmonella weltevreden was the most frequent isolate accounting for 23% of all isolates and all isolates of this organism were from stool cultures. Patients with S. weltevreden infections had mean and median ages of 50 and 2.5 months and were younger than patients with stool isolates from other serovars who had mean and median ages of 174 and 38 months. Infants younger than 3 or 6 months of age with positive stool cultures in whom blood cultures were obtained did not demonstrate a higher incidence of bacteremia than did older patients. We conclude that the incidence of bacteremia in patients with nontyphoidal Salmonella gastroenteritis is highly related to the invasiveness of the infecting specific Salmonella serovar. PMID- 2664693 TI - Typhoid vaccines come of age. PMID- 2664694 TI - Enhancement of neutrophil function for treatment of neonatal infections. AB - Newborn infants are at increased risk of morbidity and mortality from infection despite the continued development of new antibiotics. Because impairment of such host defense mechanisms as PMN function is thought to be largely responsible for this problem, correction of these defects in neonates offers a new and potentially important therapy against infection. Further studies are necessary to determine whether transfusion of either adult PMNs, antibody or fresh frozen plasma; administration of immunomodulating drugs; or some combination of these will provide maximum therapeutic benefit for the newborn infant with infection. PMID- 2664695 TI - Amphotericin B in the treatment of Candida cholecystitis. PMID- 2664696 TI - Symptomatic mitral valve prolapse in children and adolescents: catecholamines, anxiety, and biofeedback. AB - It has been proposed that symptomatic mitral valve prolapse may be associated with a hyperadrenergic state and/or increased anxiety. To test this hypothesis, Spielberger State-Trait Anxiety (STAI) scores and 24-hour urinary catecholamine collections were gathered from 11 children and adolescents without mitral valve prolapse, 6 with asymptomatic mitral valve prolapse, and 14 who had chest pain (some with additional symptoms of shortness of breath, palpitations, and fatigue). STAI scores and catecholamine excretion values were not significantly different between groups. Ten symptomatic patients were randomly assigned to either eight sessions of skin temperature biofeedback with daily home practice of relaxation-mental imagery techniques or an attention-placebo condition. Change in 24-hour urinary catecholamine excretion values and STAI scores from baseline to end of treatment did not differ significantly between treatment and placebo conditions. Although not evident at the end of treatment, a significant decrease in chest pain was found in the biofeedback group at 6-month follow-up evaluation. In summary, results of this study did not show evidence of increased sympathetic tone or levels of anxiety in symptomatic pediatric patients with mitral valve prolapse. A behavioral treatment program using biofeedback and relaxation-mental imagery techniques was associated with decreased chest pain at 6-month follow-up. PMID- 2664698 TI - Contributions to the history of psychology: LVI. J.E. Purkinje (1787-1869), "the phenomenon" and beyond. AB - Light-adaptation and dark-adaptation are complementary (not "identical") processes. Both came to be covered by the term "Purkinje phenomenon." While the phenomenology remains unaffected by the advances of science, our understanding of the histological details and the molecular events has increased dramatically. At the same time we are still in the dark as to who coined the term "Purkinje phenomenon" and what relevant observations preceded Purkinje's report of 1825. A comprehensive account of Purkinje's involvement in psychology and its significance is lacking. PMID- 2664697 TI - American Academy of Pediatrics: Report of the Task Force on Circumcision. AB - Properly performed newborn circumcision prevents phimosis, paraphimosis, and balanoposthitis and has been shown to decrease the incidence of cancer of the penis among US men. It may result in a decreased incidence of urinary tract infection. However, in the absence of well-designed prospective studies, conclusions regarding the relationship of urinary tract infection to circumcision are tentative. An increased incidence of cancer of the cervix has been found in sexual partners of uncircumcised men infected with human papillomavirus. Evidence concerning the association of sexually transmitted diseases and circumcision is conflicting. Newborn circumcision is a rapid and generally safe procedure when performed by an experienced operator. It is an elective procedure to be performed only if an infant is stable and healthy. Infants respond to the procedure with transient behavioral and physiologic changes. Local anesthesia (dorsal penile nerve block) may reduce the observed physiologic response to newborn circumcision. It also has its own inherent risks. However, reports of extensive experience or follow-up with the technique in newborns are lacking. Newborn circumcision has potential medical benefits and advantages as well as disadvantages and risks. When circumcision is being considered, the benefits and risks should be explained to the parents and informed consent obtained. PMID- 2664699 TI - Contributions to the history of psychology: LV. Purkinje phenomenon: original account and later definitions. AB - Although Purkinje observed the eponymous phenomenon at dawn, it is identical to what happens in the dark-adapting eye. It is shown that most modern definitions of the phenomenon couch it in terms of dark adaptation and that the author's definition of it in similar terms is justified in spite of Brozek's objection. PMID- 2664701 TI - Expert clinical teaching. PMID- 2664700 TI - Contributions to the history of psychology: LVII. Terman-Binet communication. AB - An attempt is made to reconcile some views on possible communication between Alfred Binet and Lewis M. Terman on the basis of a letter from Terman's papers. PMID- 2664702 TI - Strategic planning. PMID- 2664703 TI - Program evaluation. AB - In this chapter, evaluation was defined as a decision-making process that leads to suggestions for action to maintain and/or improve effectiveness and efficiency of programs and participants. Purposes for evaluating nursing programs in education and service were explained. The principles that govern evaluation in nursing, which are the same as those that govern the evaluation of any programmatic endeavor, were presented. The unique and specific character of nursing and its settings, which must be taken into account when strategies and techniques for implementing these principles are designed and/or selected, were discussed. Of major concern was the selection of an approach to evaluating nursing programs. Models for evaluating programs that have served as prototypes for evaluation in a variety of settings and fields were presented. More specifically, the views addressed included: Tyler's Objective-Based Evaluation, Accreditation/Certification Evaluation, Stake's Client-Centered Evaluation, Stufflebeam's Decision-Oriented Evaluation, Taba's Experimental-Research Evaluation, and Scriven's Consumer-Oriented Evaluation. Also discussed was the Utilization-Focused Approach to Evaluation. However, while all prototypes contribute in some manner to the conditions necessary for conducting a comprehensive evaluation of nursing programs, none are complete or sufficient in this regard. An eclectic approach to evaluating nursing programs developed by Waltz in an attempt to incorporate the strengths of existing models, minimize limitations, and expand thinking to include additional components and concerns with particular relevance to nursing was discussed. Attention was given to definition of terms, purposes for the evaluation, what the focus of the evaluation is, how the evaluation should proceed, when evaluation should occur, and major audiences. Specific considerations that increase the likelihood that an evaluation will be comprehensive but cost-efficient were elaborated. PMID- 2664704 TI - Implementing strategic planning. PMID- 2664705 TI - Marketing in nursing organizations. AB - The purpose of chapter 3 is to provide a conceptual framework for understanding marketing. Although it is often considered to be, marketing is not really a new activity for nursing organizations. What is perhaps new to most nursing organizations is the conduct of marketing activities as a series of interrelated events that are part of a strategic marketing process. The increasingly volatile nursing environment requires a comprehensive approach to marketing. This chapter presents definitions of marketing, the marketing mix, the characteristics of nonprofit marketing, the relationship of strategic planning and strategic marketing, portfolio analysis, and a detailed description of the strategic marketing process. While this chapter focuses on marketing concepts, essential components, and presentation of the strategic marketing process, chapter 4 presents specific methods and techniques for implementing the strategic marketing process. PMID- 2664706 TI - Operationalizing strategic marketing. AB - The strategic marketing process, like any administrative practice, is far simpler to conceptualize than operationalize within an organization. It is for this reason that this chapter focused on providing practical techniques and strategies for implementing the strategic marketing process. First and foremost, the marketing effort needs to be marketed to the various publics of the organization. This chapter advocated the need to organize the marketing analysis into organizational, competitive, and market phases, and it provided examples of possible designs of the phases. The importance and techniques for exhausting secondary data sources and conducting efficient primary data collection methods were explained and illustrated. Strategies for determining marketing opportunities and threats, as well as segmenting markets, were detailed. The chapter provided techniques for developing marketing strategies, including considering the five patterns of coverage available; determining competitor's position and the marketing mix; examining the stage of the product life cycle; and employing a consumer decision model. The importance of developing explicit objectives, goals, and detailed action plans was emphasized. Finally, helpful hints for operationalizing the communication variable and evaluating marketing programs were provided. PMID- 2664707 TI - Practical nursing programs accredited by the NLN 1989. PMID- 2664708 TI - Differential repair of UV damage in Saccharomyces cerevisiae. AB - Preferential repair of UV-induced damage is a phenomenon by which mammalian cells might enhance their survival. This paper presents the first evidence that preferential repair occurs in the lower eukaryote Saccharomyces cerevisiae. Moreover an unique approach is reported to compare identical sequences present on the same chromosome and only differing in expression. We determined the removal of pyrimidine dimers from two identical alpha-mating type loci and we were able to show that the active MAT alpha locus is repaired preferentially to the inactive HML alpha locus. In a sir-3 mutant, in which both loci are active this preference is not observed. PMID- 2664709 TI - Human telomeres contain at least three types of G-rich repeat distributed non randomly. AB - Using a combination of different oligonucleotides and restriction enzymes we have examined the gross organisation of repeats within the most distal region of human chromosomes. We demonstrate here that human telomeres do not contain a pure uniform 6 base pair repeat unit but that there are at least three types of repeat. These three types of repeat are present at the ends of most or all human chromosomes. The distribution of each type of repeat appears to be non-random. Each human telomere has a similar arrangement of these repeats relative to the ends of the chromosome. This could reflect differences in the functions that they perform, or might result from the mutation and correction processes occurring at human telomeres. The number of repeat units, the repeat types and arrangement differs at mouse telomeres. Analysing the change in length of the telomeric repeat region between an individuals blood and germline DNA reveals that this is due to variable amounts of the TTAGGG repeat and not the other repeat types. This organization of repeat units at human telomeres will only be confirmed upon the isolation and sequencing of full length (10-15 kb), intact human telomeres. PMID- 2664710 TI - A novel method for promoter search enhanced by function-specific subgrouping of promoters--developed and tested on E.coli system. AB - A new method for evaluating some complex characteristics of the primary structure of E.coli promoters is proposed. The method, of nonparametric statistical significance, selects important conserved single-base positions in combination with 2-base coupling relations of identity and complementarity. The extended consensus of promoter characteristics thus obtained was used to scan unknown sequences for similarity with E.coli promoters. In terms of this method, a complete set of 244 E.coli promoters was shown to be structurally inconsistent. The set was then broken down into functionally homogeneous subsets of promoters to enhance the selectivity of the search for E.coli-specific promoter sequences, with a high significance level being attained. PMID- 2664711 TI - The nucleotide sequence of Escherichia coli genes for L-fucose dissimilation. PMID- 2664712 TI - Sequence of the yeast mitochondrial OX13/OL12 promoter region. PMID- 2664713 TI - Nucleotide sequence for the htpR gene from Citrobacter freundii. PMID- 2664714 TI - The SSB1 heat shock cognate gene of the yeast Saccharomyces cerevisiae. PMID- 2664715 TI - A rapid procedure for the transformation of Saccharomyces cerevisiae by plasmids extracted from yeasts. PMID- 2664716 TI - Frame-shift mutation in the lacZ gene of certain commercially available pUC18 plasmids. PMID- 2664717 TI - Rare c-Ha-ras-1 alleles in human leukaemia. PMID- 2664719 TI - Fit for nursing. Relax with a tape. PMID- 2664718 TI - The effects of relaxation training on clinical symptoms: a meta-analysis. AB - Forty-eight experimental studies of nonmechanically assisted relaxation techniques used to control a variety of clinical symptoms were synthesized using meta-analysis. Effect sizes for three types of comparisons, experimental-control, experimental-placebo, and pre-post, ranged from .43 to .66, demonstrating that treatment of any type included in the analysis moved the client from the 50th to the 67th percentile of an untreated group at minimum and from the 50th to the 75th percentile at maximum. All treatments included in the analysis except Benson's relaxation technique demonstrated evidence of effectiveness, particularly for nonsurgical samples with chronic problems such as hypertension, headache, and insomnia. PMID- 2664720 TI - Choosing the right anti-emetic. PMID- 2664721 TI - History and current application of intravenous therapy in children. AB - More than 36,000,000 individuals in the United States were hospitalized in 1985, and, on the average, 25% of hospitalized patients have insertion of an intravenous catheter (IVC). Considering those 9,000,000 IVC placements in 1985, it may be surprising to learn that "modern" intravenous (IV) therapy has a lifetime that is barely 40 years old. For the pediatrician, IV access holds particular importance, since its acquisition is often the rate-limiting step in initiation of a therapeutic plan, particularly in the setting of cardiopulmonary resuscitation. This article is a review of the nearly 500-year history of IV therapy and an overview of the IV techniques and products currently available for use in pediatric patients. PMID- 2664722 TI - TAC: a review. PMID- 2664723 TI - Scoring systems in emergency pediatrics: "one cannot see the forest for the trees". PMID- 2664724 TI - Intraosseous drug administration: successful resuscitation from asystole. AB - The case of a seven-month-old infant presenting in full cardiac arrest and resuscitated utilizing a right tibial intraosseous access line is presented. The child who presented in asystole appears to be the first reported case of the successful use of the intraosseous route as the sole source of drug administration. Flow time from tibia to clinical cardiac response was noted to be less than three minutes, similar to those in animal arrest models. PMID- 2664725 TI - Delta sleep-inducing peptide (DSIP)-like immunoreactivity in gut: coexistence with known peptide hormones. AB - Delta sleep-inducing peptide-like immunoreactivity (DSIP-LI) has previously been demonstrated in brain neurons and in endocrine cells of the pituitary and the adrenal medulla. By means of three different antisera against synthetic DSIP we now describe the occurrence and distribution of DSIP-LI in several gut endocrine cells. The human gut was the richest source, where DSIP-LI was located in gastrin/CCK, secretin and PYY/glicentin cells. The rat and pig gut harbour a moderate number of immunoreactive cells in the antral mucosa but in the intestines DSIP-LI-containing cells were very few. By radioimmunoassay, the concentration of DSIP-LI was determined in extracts of various gut regions from man, pig and rat. The highest concentrations were found in all human specimens compared with corresponding samples in the pig and rat. In all three species, high-performance liquid chromatography revealed a single peak of DSIP-like material with approximately the same retention time as DSIP 3-9. Taken together, the present results provide evidence for the presence of DSIP-LI in gut endocrine cells in man, pig and rat; the human gut seems to be the richest source of DSIP like peptides. PMID- 2664726 TI - Endogenous opiates: 1987. AB - This paper is the tenth installment of our annual review of the research during the past year involving the endogenous opiate system. It covers the nonanalgesia and behavioral studies of the opiate peptides published in 1987. The specific topics this year include stress; tolerance and dependence; eating; drinking; gastrointestinal and renal activity; learning, memory, and reward; cardiovascular responses; respiration and thermoregulation; seizures and other neurological disorders; electrical activity; locomotor activity; sex, pregnancy, and development; immunology and cancer; and other behavior. PMID- 2664727 TI - Hemodynamic actions of endothelin in conscious and anesthetized dogs. AB - The newly described endogenous peptide, endothelin, was administered to five chronically instrumented conditioned dogs. Endothelin produced significant and simultaneous increases in both heart rate (HR) and mean arterial pressure (MAP) in conscious dogs. Endothelin also produced significant increases in MAP in anesthetized animals. Ganglionic suppression induced by hexamethonium (10 mg/kg) and atropine (0.1 mg/kg) blocked HR responses and markedly inhibited the pressor responses to endothelin in conscious animals. These results suggest that endothelin in part acts to elevate blood pressure and heart rate through modification of autonomic nervous system tone. When endothelin and angiotensin II were administered in mole equivalent doses, angiotensin II produced a pressor response of greater magnitude than did endothelin in conscious animals. PMID- 2664728 TI - Meclofenomate inhibition of UV-induced erythema--a randomized, placebo controlled, double-blind study. AB - Systemic intradermal and topical inhibitors of eicosanoid synthesis have been shown to decrease the intensity delay the onset of erythema produced with a single exposure to ultraviolet (UV) light. We studied the effect of single and multiple doses of meclofenomate on erythema induced by single and multiple doses of UV light. Thirty Caucasian subjects took either meclofenomate 100 mg t.i.d. or matching placebo for 5 days, crossing over to the alternative for 5 more days after a 2-day washout period. A statistical analysis was made of erythema response immediately prior to the study and then on 8 successive days during the study. Analysis of single and multiple exposure data revealed a statistically significant inhibition of erythema from meclofenomate therapy as compared with placebo. PMID- 2664729 TI - Late onset of skin cancers in 2 xeroderma pigmentosum group F siblings and a review of 30 Japanese xeroderma pigmentosum patients in groups D, E and F. AB - Sib patients with xeroderma pigmentosum (XP), XP90TO (42 years old, male) and XP92TO (40 years old, female, were assigned to group F by the complementation analysis in hybridized heterodikaryons. The XP90TO and XP92TO fibroblasts exhibited the typical XPF characteristics of a threefold higher sensitivity to the lethal effect of 254 nm UV and a reduced level of 12% unscheduled DNA synthesis (UDS) compared with normal cells. Clinically, both patients manifested moderate to severe acute sun sensitivity by age 8, pigmented freckles by age 10 and skin malignancies at higher ages (6 basaliomas at 42 years in XP90TO; 1 basalioma at 41 years in XP92TO). Despite the still currently sun-sensitive state, the patients showed normal minimal erythema dose (MED) at monochromatic wavelengths of 290, 300 and 305 nm but abnormally delayed peaking of erythema reaction at 48 h after exposure. After irradiation with more than 3 MED, XP92TO showed a long persistence of induced erythema for at least 7 days. A review of the 16 reported XPF patients indicated mild skin manifestations, no neurological abnormalities, and more delayed skin carcinogenesis at a lower frequency than that in XPA patients. In addition, we have collected clinical information from Japanese XP patients in rare complementation groups D and E and reviewed their clinical and photobiological characteristics. PMID- 2664730 TI - Group psychotherapy for victims of incest. AB - Group psychotherapy is a recommended part of treatment for victims of incest- male and female--in childhood or adulthood. Self-help groups, treatment groups, individual treatment, family therapy, and other modalities may be used concurrently or sequentially. Special techniques include art therapy, play therapy, psychodrama, bibliotherapy, wilderness encounters, and educational techniques. PMID- 2664731 TI - Hypnosis in the treatment of victims of sexual abuse. AB - The relevance of hypnosis to the treatment of sexual assault derives from two sources: the fact that hypnotic phenomena are mobilized spontaneously as defenses during assault, becoming part of the syndrome of posttraumatic stress disorder (PTSD) and the usefulness of formal hypnosis in treating PTSD. The role of dissociative defenses during and after traumatic experiences is reviewed; an analogy between the major elements of formally-induced hypnosis--absorption, dissociation, and suggestibility, and the major elements of PTSD--is drawn. Special problems relevant to sexual assault in childhood are discussed, including extreme self-blame and a profound sense of personality fragmentation. Uses of hypnosis in the treatment of sexual assault victims are reviewed, with an emphasis on helping such patients restructure their memories of the experience, both by reviewing them with greater control over their physical sense of comfort and safety and by balancing painful memories with recognition of their efforts to protect themselves or someone else who was endangered. The use of a split-screen technique in hypnosis is described with a clinical example. Special considerations in such treatment, including the traumatic transference and forensic complications of such psychotherapeutic work, are enumerated. PMID- 2664732 TI - The compulsion to repeat the trauma. Re-enactment, revictimization, and masochism. AB - Trauma can be repeated on behavioral, emotional, physiologic, and neuroendocrinologic levels. Repetition on these different levels causes a large variety of individual and social suffering. Anger directed against the self or others is always a central problem in the lives of people who have been violated and this is itself a repetitive re-enactment of real events from the past. People need a "safe base" for normal social and biologic development. Traumatization occurs when both internal and external resources are inadequate to cope with external threat. Uncontrollable disruptions or distortions of attachment bonds precede the development of post-traumatic stress syndromes. People seek increased attachment in the face of external danger. Adults, as well as children, may develop strong emotional ties with people who intermittently harass, beat, and threaten them. The persistence of these attachment bonds leads to confusion of pain and love. Assaults lead to hyperarousal states for which the memory can be state-dependent or dissociated, and this memory only returns fully during renewed terror. This interferes with good judgment about these relationships and allows longing for attachment to overcome realistic fears. All primates subjected to early abuse and deprivation are vulnerable to engage in violent relationships with peers as adults. Males tend to be hyperaggressive, and females fail to protect themselves and their offspring against danger. Chronic physiologic hyperarousal persists, particularly to stimuli reminiscent of the trauma. Later stresses tend to be experienced as somatic states, rather than as specific events that require specific means of coping. Thus, victims of trauma may respond to contemporary stimuli as a return of the trauma, without conscious awareness that past injury rather than current stress is the basis of their physiologic emergency responses. Hyperarousal interferes with the ability to make rational assessments and prevents resolution and integration of the trauma. Disturbances in the catecholamine, serotonin, and endogenous opioid systems have been implicated in this persistence of all-or-none responses. People who have been exposed to highly stressful stimuli develop long-term potentiation of memory tracts that are reactivated at times of subsequent arousal. This activation explains how current stress is experienced as a return of the trauma; it causes a return to earlier behavior patterns. Ordinarily, people will choose the most pleasant of two alternatives. High arousal causes people to engage in familiar behavior, regardless of the rewards. As novel stimuli are anxiety provoking, under stress, previously traumatized people tend return to familiar patterns, even if they cause pain.(ABSTRACT TRUNCATED AT 400 WORDS) PMID- 2664733 TI - The centrality of victimization. Regaining the focal point of recovery for survivors of child sexual abuse. AB - Psychiatrists have tended to be reluctant followers rather than leaders in the proliferation of concern for child abuse that has developed over the past 25 years. By discounting the relevance of child sexual trauma, psychiatric clinicians and theoreticians overlook not only the therapeutic needs of many survivors but the opportunity to reconceptualize the role of trauma in the etiology and treatment of conditions presumed to be incurable. Present controversies over child sexual abuse are mirrors of past misadventures with uncovering. Since 1860, child abuse has been discovered and then discredited every 35 years by the most visionary clinicians of the day, each faced with the alternative of denouncing the discovery or succumbing to scorn and disgrace. The history of child sexual abuse, whether viewed by parent via child, therapist via patient, or adult survivor via the child within, is one of unimaginable pain and betrayal masked by adult distancing, disavowal, victim blame, and identification with the aggressor. The lurid emotional imperatives of the trauma itself have no place in a just and fair society, and they resist translation into the rational, objective language and concepts of behavioral science. The subject of child sexual abuse is itself so passionate and so paradoxical that it provokes polarized dichotomies at every level, leaving indifference and avoidance as the only hope for serenity. The active nesciance, the determined insistence on not knowing, that pervades every aspect of child sexual abuse encourages the most authoritative scholars to be the most repressive of radical discovery, especially if authority has been achieved as a reaction against youthful vulnerability. Every clinician facing a survivor of childhood sexual trauma faces an assault on personal comfort and authority, just as each patient in that encounter risks intimidation and disgrace. The connections between childhood assault and adult adjustment will be missed unless the therapist can find an unprejudiced path toward mutual acceptance. The promise of genuine understanding and radical resolution of the effects of child sexual abuse is dimmed on both sides by a history of abandonment in the face of scornful, punishing authority. Freud's concept of the unconscious as the arena for successful psychotherapy, his sense of the patient as a normal, healthy individual incapacitated by the effects of buried trauma and his initial optimism for radical recovery from post-traumatic handicaps were soundly derived from his clinical confrontations with child sexual abuse, as were Ferenczi's parallel contributions 35 years later.(ABSTRACT TRUNCATED AT 400 WORDS) PMID- 2664734 TI - 25 years of the European Society of Pathology. The 25th Silver Jubilee Congress of Porto (September 3-9, 1989), Portugal. A pre-congress message from the President of the European Society of Pathology. PMID- 2664735 TI - Detection by immunogold techniques of HIV antigens in Lowicryl ultrathin sections of infected cells. AB - A post-embedding technique for immunocytochemical analysis at the ultrastructural level was used to detect and localize HIV antigens on ultrathin sections of Lowicryl K4M-embedded HIV-infected cells. With serum from an AIDS patient, specific immunogold labelling was obtained exclusively on mature viral extracellular structures. The more intense reactivity was obtained with core antigens. The present immunoelectron microscopy method provides several advantages - high sensitivity of immunodetection, good preservation of cellular morphology, easy preparation procedure - which could lead to the use of this method for HIV-infected human tissues. PMID- 2664736 TI - Intermediate filament expression and the progression of prostatic cancer as studied in the Dunning R-3327 rat prostatic carcinoma system. AB - To evaluate if there is any consistent relationship between the expression of intermediate filament proteins (IFP), particularly keratins, and the degree of malignancy of prostatic cancer cells, a series of nine Dunning rat prostatic cancer sublines that span the entire spectrum of progression of prostatic cancer were studied immunocytochemically by the use of a variety of antibodies specific for keratins, vimentin, or desmin. For the keratin studies, monoclonal antibodies with either a general reactivity to several keratins or highly specific for either luminal or basal epithelial cells of the normal rat prostate were used. By use of an antibody specific for luminal cell keratin 18, the luminal tumor cells of the well-differentiated, slow-growing H and HI-S sublines were positively stained. In most of the sublines with a more advanced state of progression (i.e., the moderately differentiated, moderately fast growing HI-M; the poorly differentiated, faster growing HI-F; and the anaplastic, very fast growing AT-1, AT-2, and MAT-Lu tumors), however, no expression of keratin specific for luminal cells was detected. In addition, several of the most advanced sublines (i.e., AT 1, AT-2, and MAT-Lu) were negative using any of the keratin antibodies. In contrast, several of the other sublines with the most advanced degree of progression (i.e., the anaplastic, very fast growing MAT-LyLu tumor derived from the AT-1 subline; and the anaplastic, very fast growing AT-3 tumor, derived from the HI-F subline), however, were positively stained with the keratin antibody specific for the luminal cells. By use of the keratin antibody specific for the basal cells of the normal rat prostate, the basal tumor cells of the well differentiated slow-growing H and HI-S tumor were positively stained. This positive staining for basal cell keratin was also found in the HI-M and HI-F tumors, while the AT-1, AT-2, MAT-Lu, MAT-LyLu, and AT-3 were negative with this antibody. Thus, a loss in staining for basal cell keratin was consistently associated with the most advanced state of tumor progression. Vimentin-positive staining was demonstrated either alone or with keratin-positive staining in part of the epithelial cancer cells of all the sublines. An increase in the positive staining for vimentin was consistently associated with a more advanced state of tumor progression. Desmin-positive staining was found only in smooth cells present within the various tumor sublines.(ABSTRACT TRUNCATED AT 400 WORDS) PMID- 2664737 TI - Immunohistochemical localization of metallothionein in the rat prostate gland during postnatal development. AB - Immunocytochemical and electrophoretic techniques were used to investigate the presence of metallothionein, a metal-binding protein, in the dorsolateral and ventral lobes of the developing rat prostate. Male rats aged 7 and 14 days were injected subcutaneously with 6 and 20 mg/kg body weight of cadmium and zinc, respectively, or with saline for controls, 24 h prior to tissue sampling. Immunohistochemical localization of metallothionein was observed in the epithelial tissues of the dorsolateral prostate from 7 and 14 day-old animals and in 1 day-old untreated rats. This staining pattern did not appear to be significantly affected by cadmium or zinc treatment. In contrast, metallothionein localization in the ventral prostate decreased with age but demonstrated a slight response to metal-ion treatment in the 7 day-old animals. Electrophoretic and immunoblot analysis confirmed the presence of metallothionein in the control and metal-induced prostate samples from neonatal rats. Lobe-specific differences in localization suggest a functional significance for metallothionein, independent of inducible protein. PMID- 2664738 TI - Estrogen therapy and liver function--metabolic effects of oral and parenteral administration. AB - Oral estrogen therapy for prostatic cancer is clinically effective but also accompanied by severe cardiovascular side effects. Hypertension, venous thromboembolism, and other cardiovascular disorders are associated with alterations in liver metabolism. The impact of exogenous estrogens on the liver is dependent on the route of administration and the type and dose of estrogen. Oral administration of synthetic estrogens has profound effects on liver-derived plasma proteins, coagulation factors, lipoproteins, and triglycerides, whereas parenteral administration of native estradiol has very little influence on these aspects of liver function. PMID- 2664739 TI - Poikiloderma of Theresa Kindler: report of a case with ultrastructural study, and review of the literature. AB - Kindler's syndrome occurred in a 13-year-old boy with parental consanguinity. The patient had acral congenital blistering and photosensitivity, both regressive, at 12 years of age, together with diffuse progressive poikiloderma, marked cutaneous atrophy, mild hyperkeratosis of the palms, gingival hypertrophy and fragility, and anal stenosis. The ultrastructural study of bullae induced by rubbing showed clefts in three levels of the dermoepidermal junction zone. A review of 14 cases in the literature consistent with Kindler's syndrome showed this to be a definite clinical entity among the other bullous hereditary poikilodermas. In two cases, ultrastructural studies showed intraepidermal, junctional, and dermal cleavage. This syndrome must be differentiated from congenital epidermolysis bullosa, Weary's syndrome, and the other bullous hereditary poikilodermas. PMID- 2664740 TI - Kindler syndrome: report of two cases and review of the literature. AB - We evaluated two patients with hereditary bullous poikiloderma. Both had acral bullae, generalized poikiloderma with prominent atrophy, and acral keratoses. One patient, with sporadic disease, had, in addition, urethral and subglottic stenoses, webbing of digits, and poor dentition. The other patient, whose disease was dominantly inherited, had koilonychia. The results of cutaneous histopathology, electron microscopy, and immunofluorescence mapping studies are presented. It is possible that Kindler syndrome and Weary's hereditary acrokeratotic poikiloderma are variants of the same disease. PMID- 2664741 TI - Neonatal hepatitis--a viral disease? PMID- 2664742 TI - Arteriotracheal fistula in patients treated for lymphoma. AB - Exsanguinating hemorrhage is an unusual cause of death in patients who are being treated for neoplasms. We report two cases of adolescents with mediastinal non Hodgkin's lymphoma who each developed a fistula between the right brachiocephalic trunk and the trachea following mediastinal irradiation and systemic chemotherapy. During the hospital course, the patients had each suffered a respiratory arrest and undergone difficult endotracheal intubation. The tracheal ulcerations at the fistula sites were unsuspected prior to autopsy. PMID- 2664743 TI - The Goldston syndrome: report of a case. AB - We present a case of the Goldston syndrome--that is, cystic renal dysplasia and the Dandy-Walker malformation. The condition was diagnosed by ultrasound in a 635 g fetus in the seventeenth week of gestation. Ultrasound studies showed the fetal head to be somewhat enlarged with slight dilatation of the lateral ventricles and marked dilatation of the fourth ventricle. The kidneys were symmetrically enlarged and multicystic. Autopsy revealed evidence of the oligohydramnios syndrome. The kidneys were typical of the Goldston syndrome as were the microscopic lesions in the liver. To our knowledge this is the first reported case in which this diagnosis was made during intrauterine life. PMID- 2664744 TI - The use of acetylcholinesterase (AChE) in the diagnosis of Hirschsprung's disease and intestinal neuronal dysplasia. PMID- 2664745 TI - Society for Pediatric Pathology Presidential Awards, 1988. PMID- 2664746 TI - Hypothyroidism in the newborn. PMID- 2664747 TI - Nephrolithiasis in children. PMID- 2664748 TI - Acute diarrhea in children. AB - Acute diarrhea is a common problem in children. Understanding the different pathologic processes that cause diarrhea, and the agents that are associated with those processes, can aid the clinician in predicting the etiology of the diarrhea in an individual patient. Small bowel involvement, most commonly caused by Rotavirus, produces a high incidence of vomiting, often before the onset of diarrhea, and large, watery, and relatively infrequent stools. Large bowel involvement, usually due to Campylobacter, Salmonella, or Shigella produces frequent, often bloody stools containing leukocytes. Treatment of diarrhea should be focused on correcting dehydration, principally with oral rehydration solutions containing appropriate concentrations of electrolytes and carbohydrates. Early refeeding, avoiding foods containing lactose, should be considered for most pediatric patients with acute diarrhea. Antimicrobial therapy should be reserved primarily for parasitic infectious, pseudomembranous enterocolitis, and the early stages of a Campylobacter dysentery. The etiology of acute pediatric diarrhea can be predicted in most patients and early, appropriate treatment can be instituted. PMID- 2664749 TI - Histological study on seminal plasma absorption and spermiophagy in the epididymal region of domestic fowl. AB - Absorption of seminal plasma and spermiophagy in the fowl epididymal region were studied ultrastructurally and histochemically. Epithelial cells of the rete testis had sparse coated vesicles and rarely showed spermiophagy. Many macrophages in the lumen of the rete testis actively phagocytosed spermatozoa. Nonciliated cells in the proximal efferent ductules had well-developed microvilli, coated vesicles, numerous tubular structures, and lysosomes in their apical cytoplasm. They rarely contained fragments of spermatozoa. Intense alkaline phosphatase activity was observed at the luminal borders of these cells. Ciliated cells had no features indicating active absorption of seminal plasma. Epithelial cells of the connecting ductules and epididymal duct had numerous microvilli, a few vesicles, and small lysosomes. They did not contain spermatozoa. Intense acid phosphatase activity was observed on the luminal and lateral surfaces of the epithelial cells of the connecting ductules and epididymal duct. After injection of horseradish peroxidase into the excurrent ducts, a large amount of reaction product was detected in the vesicles and tubular structures of the nonciliated cells of the proximal efferent ductules. These results suggest that the absorption of seminal plasma occurred mainly in the efferent ductules, and that spermiophagy by macrophages occurred in the rete testis in the fowl epididymal region. PMID- 2664750 TI - Newer agents for coronary thrombolysis. Perspectives from clinical studies. AB - Myocardial infarction (MI) is a major cause of morbidity and mortality in western countries and the formation of intracoronary thrombi is recognized as a critical determinant of this ischaemic event. Since streptokinase and urokinase cause in vitro lysis of clots, it was though that these drugs were also effective in vivo in dissolving coronary thrombi. Clinical studies supported this concept. However, the beneficial effects of these drugs were, to some extent, offset by their inherent adverse reactions. Therefore new thrombolytic agents were developed, and for three of them (APSAC, tPA and proUK) there are enough clinical studies to allow for a comparison with 'old' agents. The data show that none of the new agents is safer or better than old agents with respect to easy handling, incidence of reperfusion of occluded coronary arteries, frequency of reocclusions, thrombus specificity, and bleeding complications. Thus, several directions are currently pursued to develop newer thrombolytic drugs with risk/benefit ratios better than those of 'old' agents. In this respect, it has been shown recently that the combination of aspirin with streptokinase is significantly better than streptokinase alone as far as mortality and incidence of rethrombosis is concerned. These data suggest that thrombolytic approaches safer and better than those currently available are possible and indicate that some of such new strategies are already available to enter the 'thrombolytic era' of acute MI. PMID- 2664751 TI - Renal function studies with cadralazine in conscious dogs: a comparison with hydralazine. AB - The effect of the antihypertensive vasodilator, cadralazine, on renal function in the conscious dog was compared to that of hydralazine using inulin and para aminohippurate clearances. Both drugs were administered as intravenous bolus, at the dose of 1 mg/kg. As expected, hydralazine rapidly decreased mean blood pressure (from 110 to 89 mmHg), significantly increased heart rate (from 109 to 190 beats/min), markedly decreased urine volume (from 0.90 to 0.47 ml/min) and sodium excretion (from 101 to 45 microEq/min), and increased potassium excretion (from 28 to 53 microEq/min). Cadralazine displayed a similar activity on blood pressure and on heart rate, but differently from hydralazine, these effects appeared more slowly and were not accompanied by sodium and water retention. Hydralazine, but not cadralazine, caused a quick and transient decrease in glomerular filtration rate (from 55 to 40 ml/min), whereas both compounds increased renal plasma flow and reduced renal vascular resistance, renal extraction of para-aminohippurate and filtration fraction. Moreover, cadralazine increased plasma renin activity to a lesser extent than hydralazine, and this could explain the different effect on water and sodium excretion after acute administration of the two drugs. PMID- 2664752 TI - Eicosanoid metabolism by lymphocytes: do all human nucleated cells generate eicosanoids? PMID- 2664753 TI - Idiosyncratic drug reactions: possible role of reactive metabolites generated by leukocytes. AB - Idiosyncratic drug reactions represent a poorly understood problem with serious medical implications. Many idiosyncratic drug reactions appear to be hypersensitivity reactions that involve an immune mechanism. The initiating step appears to involve the formation of a chemically reactive metabolite which can act as a hapten. Although the major site of drug metabolism is the liver, we have found that leukocytes, which contain myeloperoxidase and can generate hydrogen peroxide when stimulated, can also generate reactive metabolites. This has obvious implications for such idiosyncratic reactions as agranulocytosis. Furthermore, because of the importance of monocytes in the processing of antigen and the presentation of antigen to T lymphocytes in the initiation of an immunological reaction, formation of reactive metabolites by monocytes may also have implications for other idiosyncratic reactions such as drug-induced lupus and generalized idiosyncratic reactions. PMID- 2664754 TI - Drug delivery by phonophoresis. AB - Phonophoresis is defined as the migration of drug molecules, contained in a contact agent, through the skin under the influence of ultrasound. Several drugs have been introduced into the body by this technique. The design of a phonophoretic drug delivery system is in developmental stages in various research laboratories. Parameters affecting the delivery of drugs by this technique and devices available for drug delivery purposes are discussed in this review. PMID- 2664755 TI - Prenatal diagnosis of 45,X/46,XY mosaicism--a review and update. AB - A total of 54 cases with prenatal diagnosis of 45,X/46,XY mosaicism was reviewed. Of 47 cases with information on phenotypic outcome, 42 cases (89.4 per cent) were reported to be associated with a grossly normal male phenotype. Three cases (6.4 per cent) were diagnosed as having mixed gonadal dysgenesis with internal asymmetrical gonads. Two other cases were questionably abnormal. In 40 cases with successful cytogenetic confirmatory studies, the overall rate of cytogenetic confirmation of 45,X/46,XY from tissues derived from fetus/liveborn/placenta was 70.0 per cent. This review shows a major difference in the phenotypic outcome between postnatal diagnosis and prenatal diagnosis. Due to the ascertainment bias, almost all known patients with postnatal diagnosis of 45,X/46,XY mosaicism are phenotypically abnormal. Therefore, caution must be used in translating information derived from postnatal diagnosis to prenatal diagnosis. This review calls for collection of more data on 45,X/46,XY mosaicism diagnosed prenatally, more long-term follow-up of liveborn infants, and pathological studies of all abortuses. Emphasis is placed also on the importance of genetic counselling, ultrasound examination, and cytogenetic confirmation. PMID- 2664756 TI - The application of automated metaphase scanning to direct preparations of chorionic villi. AB - In order to increase the speed of analysis of metaphases from chorionic villi direct preparations, we have investigated the use of two automatic scanning devices, the Magiscan II and a version of Metafip (the research laboratory precursor of Cytoscan). The speed, efficiency, and ranking system have been compared to manual scanning. Results show that both machines detect approximately 80 per cent of the total analysable metaphases detected by a trained cytogeneticist. There appears to be reasonable agreement in ranking between methods. PMID- 2664757 TI - Gelatin embedding and diagnostic ultrasound in the examination of the fetal and neonatal brain. AB - We describe a new method for the post-mortem examination of the fetal central nervous system. The brain is immobilized in gelatin prior to ultrasonic examination. Correlation with prenatal ultrasound is excellent and subsequent pathological examination is enhanced and facilitated. PMID- 2664758 TI - [Clinical aspects of disseminated nonspecific pneumonia]. AB - Characteristic features of the clinicoroentgenological picture of extended nonspecific pneumonia are described. The frequency of difficulties with the differential diagnosis and the sources of the diagnostic mistakes (exceeding 70 per cent by the materials of the authors) are analyzed. The basic diagnostic criteria are indicated and the possibilities for test therapy and computer diagnosis are defined. This will decrease the periods for the disease diagnosis. PMID- 2664759 TI - [Significance of ultrasonic examination in the diagnosis of genital tuberculosis in women]. AB - Ultrasonic examination was applied to 149 female patients with active genital tuberculosis, late aftereffects of clinically cured tuberculosis and different nonspecific diseases of the internal genitalia. In all the three groups the ultrasonic examination revealed fibromyomas, adenomyosis, hypoplasia of the womb body, tubo-ovarian inflammations, cysts and cystic degeneration of the ovary. The examination made it possible to detect small fibromyomas, small ovary cysts and hydrosalpinx in the three groups. This extended the diagnostic possibilities. PMID- 2664760 TI - Circularly permuted proteins. PMID- 2664761 TI - Can a simple function for the dielectric response model electrostatic effects in globular proteins? AB - The relationship between the effective dielectric constant that models the electrostatic effect from a charged side chain in a protein was evaluated both experimentally and theoretically. Experimental values were obtained from the shifts in pKa that resulted from point mutations of side chains in subtilisin. Theoretical values were obtained from an iterative solution to Poisson's equation that considers the dielectric response of the protein and the solvent together with charge positions. There is no simple relationship between the effective dielectric constant and the distance from the charge responsible for the interactions. For some charge positions a linear but not a direct proportional relationship of the effective dielectric with distance of separation was observed. Thus, simple models such as a linear distance-dependence for the dielectric response are not suitable to evaluate electrostatic effects in proteins. PMID- 2664762 TI - The structure of signal peptides from bacterial lipoproteins. AB - Statistical analysis of lipoprotein and non-lipoprotein signal peptides reveals that the two classes differ significantly only in the region close to the signal peptidase cleavage site. This region is apolar and has the consensus sequence LA(G,A) decreases C in the lipoproteins, but is polar and has small, uncharged residues in positions -3 and -1 in the non-lipoproteins. A simple search for matches to the lipoprotein consensus cleavage site suffices to discriminate between the two groups with close to 100% reliability. PMID- 2664763 TI - The Q-linker: a class of interdomain sequences found in bacterial multidomain regulatory proteins. AB - Evidence is presented that establishes a novel class of interdomain linkers, named Q-linkers, as a defined element of protein structure. Q-linkers occur at the boundaries of functionally distinct domains in a widespread set of bacterial regulatory and sensory transduction proteins, typified by the nitrogen regulatory proteins, NtrB, NtrC, NifA and NifL. Q-linkers are not strongly conserved in sequence in otherwise homologous proteins, are approximately 15-25 residues long and relatively rich in glutamine, arginine, glutamate, serine and proline, and are assigned as 'coil', with a very low probability of alpha or beta structure, by eight secondary structure prediction methods. Hydrophobic amino acids are spaced with a periodicity of approximately 4-5 residues in the C-terminal 15 residues of these sequences. A pattern discriminator is presented that incorporates these properties and is used to predict segments resembling Q linkers in sequence databases. Insertions of four and eight amino acids, constructed in the Q-linker sequences of NtrC and NifA, were found to have no effect on the function of the proteins in signal transduction and transcriptional activation. However, when NtrC was expressed as two separate polypeptides, consisting of the domains normally joined by the Q-linker, the construct failed to function. These results suggest that the Q-linker serves a simple but essential role in tethering the structurally-distinct but interacting domains of the protein. Q-linkers are therefore potentially applicable as domain fusion junctions for engineered chimaeric multidomain proteins expressed in enteric bacterial systems. PMID- 2664764 TI - Thermitase, a thermostable subtilisin: comparison of predicted and experimental structures and the molecular cause of thermostability. AB - The subtilisin family of proteases has four members of known sequence and structure: subtilisin Carlsberg, subtilisin novo, proteinase K, and thermitase. Using thermitase as a test case, we ask two questions. How good are methods for model building a three-dimensional structure of a protein based on sequence homology to a known structure? And what are the molecular causes of thermostability? First, we compare predicted models of thermitase, refined by energy minimization and varied by molecular dynamics, with the preliminary crystal structure. The predictions work best in the conserved structural core and less well in seven loop regions involving insertions and deletions relative to subtilisin. Here, variation of loop regions by molecular dynamics simulation in vacuo followed by energy minimization does not improve the prediction since we find no correlation between in vacuo energy and correctness of structure when comparing local energy minima. Second, in order to identify the molecular cause of thermostability we confront hypotheses derived by calculation of the details of interatomic interactions and estimates of hydrophobic interactions with inactivation experiments. As a result, we can exclude salt bridges and hydrophobic interactions as main causes of thermostability. Based on a combination of theoretical and experimental evidence, the unusually tight binding of calcium by thermitase emerges as the most likely single influence responsible for its increased thermostability. PMID- 2664765 TI - Electrostatic interactions in the assembly of Escherichia coli aspartate transcarbamylase. AB - Although ionizable groups are known to play important roles in the assembly, catalytic, and regulatory mechanisms of Escherichia coli aspartate transcarbamylase, these groups have not been characterized in detail. We report the application of static accessibility modified Tanford-Kirkwood theory to model electrostatic effects associated with the assembly of pairs of chains, subunits, and the holoenzyme. All of the interchain interfaces except R1-R6 are stabilized by electrostatic interactions by -2 to -4 kcal-m-1 at pH 8. The pH dependence of the electrostatic component of the free energy of stabilization of intrasubunit contacts (C1-C2 and R1-R6) is qualitatively different from that of intersubunit contacts (C1-C4, C1-R1, and C1-R4). This difference may allow the transmission of information across subunit interfaces to be selectively regulated. Groups whose calculated pK or charge changes as a result of protein-protein interactions have been identified and the results correlated with available information about their function. Both the 240s loop of the c chain and the region near the Zn(II) ion of the r chain contain clusters of ionizable groups whose calculated pK values change by relatively large amounts upon assembly. These pK changes in turn extend to regions of the protein remote from the interface. The possibility that networks of ionizable groups are involved in transmitting information between binding sites is suggested. PMID- 2664766 TI - Treatment of electrostatic effects in macromolecular modeling. PMID- 2664767 TI - Folding of bovine growth hormone is consistent with the molten globule hypothesis. AB - Previous results from equilibrium and kinetic studies of the folding of bovine growth hormone (bGH) have demonstrated that bGH does not follow a simple two-step folding mechanism. These results are summarized and interpreted according to the "molten globule" model. The molten globule state of bGH is characterized as a folding intermediate which is largely alpha-helical, retains a compact hydrodynamic radius, has packing of the aromatic side chains that is similar to the unfolded state, and possesses a solvent-exposed hydrophobic surface along helix 106-127 that readily leads to association. PMID- 2664768 TI - Structural principles of alpha/beta barrel proteins: the packing of the interior of the sheet. AB - Alpha/beta barrel structures very similar to that first observed in triose phosphate isomerase are now known to occur in 14 enzymes. To understand the origin of this fold, we analyzed in three of these proteins the geometry of the eight-stranded beta-sheets and the packing of the residues at the center of the barrel. The packing in this region is seen in its simplest form in glycolate oxidase. It consists of 12 residues arranged in three layers. Each layer contains four side chains. The packing of RubisCO and TIM can be understood in terms of distortions of this simple pattern, caused by residues with small side chains at some of the positions inside the barrel. Two classes of packing are found. In one class, to which RubisCO and TIM belong, the central layer is formed by a residue from the first, third, fifth, and seventh strands; the upper and lower layers are formed by residues from the second, fourth, sixth, and eighth strands. In the second class, to which GAO belongs, this is reversed: it is side chains from the even-numbered strands that form the central layer, and side chains from the odd numbered strands that form the outer layers. Our results suggest that not all proteins with this fold are related by evolution, but that they represent a common favorable solution to the structural problems involved in the creation of a closed beta barrel. PMID- 2664769 TI - Lymphocyte activation in oral lichen planus. AB - The current study analyses the ultramorphology, lymphocyte activation marker expression, DNA synthesis, and gamma-interferon and immunoglobulin production of inflammatory cells in oral lichen planus (OLP) lesions. According to these four different aspects of lymphocyte activation, only a minor fraction, 5% at the most, of all T cells in situ were activated. However, it is this minor fraction, and not the resting T cells without signs of activation, which may prove decisive for the outcome of the local immune-inflammatory process in OLP. We also studied both spontaneous and phytohaemagglutinin (PHA) stimulated peripheral blood T cell function. 3H-thymidine incorporation and gamma-interferon secretion were determined. Interleukin-2 (IL-2) receptor and major histocompatibility complex (MHC) locus II coded la antigen were stained with monoclonal antibodies. The peripheral blood T cell subsets and spontaneous MHC locus II antigen expression were similar in OLP patients and healthy controls, whereas spontaneous lymphocyte proliferation was lower in OLP patients (p less than 0.01). The PHA induced expression of IL-2 receptor and T cell proliferation were similar in both groups. Gamma-interferon secretion and MHC locus II antigen expression were low in OLP patients compared with the controls (p less than 0.01). The results suggest a defect in OLP T cell activation disclosed by in vitro PHA stimulation and occurring between IL-2 receptor ligand binding and gamma-interferon secretion. The findings of our peripheral blood mononuclear studies do not, however, provide an easy or straightforward explanation of the changes observed in the disease itself, particularly with respect to local pathogenesis. PMID- 2664770 TI - Basement membrane changes in oral lichen planus. AB - In recent years ultrastructural morphological alterations in the basement membrane have been observed in a number of mucocutaneous diseases. Varying degrees of fragmentation and branching are seen, but such changes are not specific to any disease. In this respect, oral lichen planus has been studied extensively and clear correlations observed between the clinical type of lesion and type of basement membrane change. The nature of these changes has been studied using different immunohistochemical methods, including immunoelectron microscopy, and immunoreactivity to various basement membrane components has been noted even in the branches of the subbasal basement membrane. Thus these changes probably reflect various proliferative or degenerative changes in basal cells. Using the same technique the topographical distribution of T cell subsets and their relationship to the basement membrane pathology have been studied. Inflammation topography, analysis of lymphocyte differentiation markers, signs of CD8+ cell activation and association of CD8+ cells with mononuclear phagocytes all suggest that the local inflammatory cells are active participants in the local pathogenetic process. PMID- 2664771 TI - Mast cells and their mediators. AB - Mast cells (MC) are the most important cells in hypersensitivity reactions. Their functions in other pathological conditions are, however, not completely understood. At least two different MC subtypes have been isolated and it seems that due to environmental changes further differences in the morphology and functions of MC:s exist. The activation of MC:s can be both due to immunological and non-immunological factors and results in a release of different mediators and production of so called newly generated MC mediators. The functions following mediator release are complicated and several other inflammatory cells are involved in these reactions. Due to the more slowly effect of the newly generated mediators and the interaction of different cell types the effects of these reactions are often spread over a long time. It seems that MC:s may play an important part not only in hypersensitivity reactions but also in other pathological conditions as in inflammatory disorders. PMID- 2664772 TI - Introduction to immunocytochemistry. AB - Immunocytochemistry has opened a new era in research and diagnosis. The development of immunocytochemical methods has made it possible to identify in situ normal and pathological tissue constituents, which it has not been possible to detect using ordinary histological methods. However, immunocytochemical techniques involve several pitfalls, which without proper control protocols can easily lead to incorrect findings. When interpreting the results obtained, account must always be taken of the morphological findings from routine histological sections. In other words, it is essential to understand the principles of these methods as well as to have enough basic knowledge in the field of research interest for making correct conclusions of the immunocytochemical findings. PMID- 2664773 TI - Circulating antibodies and immune complexes in oral mucosal diseases. AB - This paper reviews the use of measurement of circulating auto-antibodies and antibodies to food proteins, and of circulating immune complexes (CIC) for diagnosis of various systemic diseases with oral involvement. Results of a study of 29 patients suffering from chronic oral mucosal disease, in which such methods were applied are reported. Auto-antibodies against epithelial intercellular substance (AICSA) were found in three patients, two of whom had pemphigus. Only one of the two patients diagnosed as having pemphigoid had circulating antibodies to basement membrane zone (ABMZA). Auto-antibodies to reticulin (IgA-ARA) were found in one patient in whom a diagnosis of coeliac disease (CD) was confirmed by intestinal biopsy. In addition to the patient with CD, another patient had IgA class antibodies against gliadin (IgA-AGA). IgG-AGA were found in five other patients, in one of whom dermatitis herpetiformis (DH) was diagnosed. Antibodies to cow's milk (ACMA) were detected in 10 patients and CIC in 4 patients. Case reports are given to illustrate the important role of antibody determination coupled with histopathological and immunofluorescence examination of tissue biopsy material in the diagnosis of serious oral disease. PMID- 2664774 TI - Recombinant DNA techniques. Basic concepts and practical applications in oral biology. AB - Advances in molecular biology and recombinant DNA technology, in particular, have provided researchers and diagnostic laboratories with powerful new tools enhancing understanding of biological events and aiding clinical laboratory diagnosis of many diseases (both genetic and those caused by infectious agents). The main applications of recombinant DNA technology at the moment include diagnosis of genetic disorders and microbiological infections, assessment of normal cell differentiation, and the molecular biology of tumours. In future, extensive correlation analyses of gene structure and expression with tissue morphology, clinical presentation and prognosis will also improve abilities to diagnose diseases of the oral cavity. PMID- 2664775 TI - Cellular and molecular aspects of inflammation. AB - Cellular host reaction to noxious agents and damaging events consists of inflammatory, immune and repair responses. These are usually involved in different phases of the host reaction in a well co-ordinated manner, contributing to the well-being of the host. However, when they are excessive, uncontrolled or occur in a vulnerable anatomic location, they can contribute greatly to injury. In general, the effects of the initiating stimulus are much enhanced by secondary involvement of amplification loops, leading to recruitment of nonspecific cells. The number of initially stimulated and/or actively involved cell is, therefore, usually low but of crucial importance for the outcome of the process. As important as understanding of the mechanisms responsible for initiation and amplification of the host response is knowledge of the negative feedback loops responsible for down-regulation of the whole process. PMID- 2664776 TI - Physical association of the 2,6-diamino-4-hydroxy-5N-formamidopyrimidine-DNA glycosylase of Escherichia coli and an activity nicking DNA at apurinic/apyrimidinic sites. AB - The 2,6-diamino-4-hydroxy-5N-formamidopyrimidine (Fapy)-DNA glycosylase of Escherichia coli, which is coded for by the fpg gene, excises purine bases with ring-opened imidazoles. In addition to the DNA glycosylase activity, we report that the Fapy-DNA glycosylase of E. coli has an associated activity, resistant to EDTA, that nicks DNA at apurinic/apyrimidinic (AP) sites. The levels of Fapy-DNA glycosylase and AP-nicking activity were parallel in crude lysates of E. coli HB101 harboring different plasmids constructed from the fpg gene. The fpg gene is different from the xth, nth, and nfo genes of E. coli, whose gene products also cleave DNA at AP sites. The Fapy-DNA glycosylase was purified to electrophoretic homogeneity. During this purification, the Fapy-DNA glycosylase copurified with an AP-nicking activity using chromatographic separations based on ion-exchange, molecular weight exclusion, and hydrophobicity. The cleavage at AP sites by the Fapy-DNA glycosylase left a 5'-phosphomonoester nucleotide at one terminus. In addition, DNA containing reduced AP sites was not nicked by the Fapy-DNA glycosylase. These data suggest that the mechanism of cleavage involved beta elimination. Therefore, this activity of the Fapy-DNA glycosylase nicking DNA at AP sites should be referred to as an AP lyase. The 3' terminus did not prime nick translation by E. coli DNA polymerase I. However, the 3' terminus becomes a substrate for nick-translation if first allowed to react with calf intestine phosphatase or the E. coli exonuclease III. These data suggest that the repair of the Fapy lesion at least to some extent results in the formation of both 5'- and 3'-phosphomonoester nucleotides and the release of the deoxyribose. PMID- 2664777 TI - Labeling the peptidyltransferase center of the Escherichia coli ribosome with photoreactive tRNA(Phe) derivatives containing azidoadenosine at the 3' end of the acceptor arm: a model of the tRNA-ribosome complex. AB - Photoreactive derivatives of yeast tRNA(Phe) containing 2-azidoadenosine (2N3A) at position 73 or 76 have been crosslinked to the peptidyl site of Escherichia coli ribosomes. Covalent tRNA-ribosome attachment was dependent upon the replacement of adenosine by 2N3A in the tRNA, irradiation with 300-nm light, and the presence of poly(U). In all cases, the modified tRNAs became crosslinked exclusively to 50S ribosomal subunits. While the tRNA derivative containing 2N3A at position 73 labeled only protein L27, that containing 2N3A at position 76 labeled proteins L15, L16, and L27 as well as a segment of the 23S rRNA. The site of crosslinking in the rRNA was identified as guanosine-1945, which lies within a highly conserved sequence adjacent to a number of modified bases and has not until now been identified at the peptidyltransferase center. On the basis of these results, and previously reported crosslinks from tRNA containing 8 azidoadenosine in the 3'-terminal -A-C-C-A sequence [Wower, J., Hixson, S. S. & Zimmermann, R. A. (1988) Biochemistry 27, 8114-8121], we propose a model for the arrangement of tRNA molecules at the peptidyl and aminoacyl sites that is consistent with most of the information available about the location of the peptidyltransferase center and the decoding domain of the E. coli ribosome. PMID- 2664778 TI - Cooperative activation of a eukaryotic transcription factor: interaction between Cu(I) and yeast ACE1 protein. AB - Cu ions activate yeast metallothionein gene transcription by altering the conformation and DNA-binding activity of the ACE1 transcription factor. We show that this conformational switch occurs in an all-or-none highly cooperative fashion (Hill coefficient = 4). Analysis of the subunit composition of ACE1 bound to DNA indicates that cooperativity results from the binding of multiple Cu(I) ions to the cysteine-rich DNA-binding domain. Surprisingly, DNA has little effect on the interaction between Cu(I) and ACE1 as assayed by partial proteolysis; this suggests that the effect of the metal on DNA binding is primarily kinetic rather than thermodynamic. Although Ag(I) also activates ACE1, it acts less cooperatively than the smaller Cu(I) ion and the resulting metalloprotein has a reduced affinity for DNA. The cooperative interaction between Cu and ACE1 allows the cell to respond to a small change in metal concentration by a large change in gene expression. PMID- 2664779 TI - Calf thymus histone H1 is a recombinase that catalyzes ATP-independent DNA strand transfer. AB - An activity that catalyzes the strand transfer from linear double-stranded tetracycline-resistance gene (tetr) DNA to circular M13mp8-tetr viral DNA was detected in a crude extract from calf thymus. This activity was purified to near, if not complete, homogeneity as judged by NaDodSO4/polyacrylamide gel electrophoresis. We have tentatively named this protein calf thymus strand transfer protein 1 (CTST1). The apparent molecular mass of the protein was 35 kDa by gel electrophoresis. Its sedimentation coefficient was approximately 1.5 S in glycerol gradient centrifugation. These values led us to examine the possibility that CTST1 is histone H1. Western blot analysis of CTST1 with anti-rat liver histone H1 antiserum showed that CTST1 crossreacts with the serum, indicating that CTST1 is histone H1. The mobility of CTST1 was identical to one of the subtypes of calf thymus histone H1 by NaDodSO4/polyacrylamide gel and acetic acid/urea/polyacrylamide gel electrophoreses. We have also confirmed the above conclusion by showing that calf thymus histone H1 has a strand-transfer activity with a specific activity comparable to that of CTST1. The reaction required homologous substrates, but neither Mg2+ nor ATP. The reaction also required stoichiometric amounts of protein. The purified CTST1 fraction lacked detectable exo- and endonuclease activities and also lacked a DNA helicase activity. PMID- 2664780 TI - Escherichia coli SecB protein associates with exported protein precursors in vivo. AB - The product of the Escherichia coli secB gene is required for efficient export of proteins across the cytoplasmic membrane. The studies described in this report show that in wild-type growing cells, SecB protein associates with precursor forms of exported proteins, such as the periplasmic maltose-binding protein (MBP) and the outer-membrane proteins LamB and OmpA. In contrast, the cytoplasmic protein beta-galactosidase was not found in association with SecB. Pulse-chase analysis showed that the SecB-precursor MBP complex was short lived, as expected for a complex that represents an intermediate in the protein-export pathway. The results support the hypothesis that SecB protein associates with exported protein precursors in the cytoplasm and dissociates prior to or during translocation of precursors across the cell membrane. PMID- 2664781 TI - Electrostatic fields in the active sites of lysozymes. AB - Considerable experimental evidence is in support of several aspects of the mechanism that has been proposed for the catalytic activity of lysozyme. However, the enzymatically catalyzed hydrolysis of polysaccharides proceeds over 5 orders of magnitude faster than that of model compounds that mimic the configuration of the substrate in the active site of the enzyme. Although several possible explanations for this rate enhancement have been discussed elsewhere, a definitive mechanism has not emerged. Here we report striking results obtained by classical electrodynamics, which suggest that bond breakage and the consequent separation of charge in lysozyme is promoted by a large electrostatic field across the active site cleft, produced in part by a very asymmetric distribution of charged residues on the enzyme surface. Lysozymes unrelated in amino acid sequence have similar distributions of charged residues and electric fields. The results reported here suggest that the electrostatic component of the rate enhancement is greater than 9 kcal.mol-1. Thus, electrostatic interactions may play a more important role in the enzymatic mechanism than has generally been appreciated. PMID- 2664782 TI - Drosophila ninaA gene encodes an eye-specific cyclophilin (cyclosporine A binding protein). AB - Mutations in the ninaA gene of Drosophila severely reduce the amount of rhodopsin specifically in R1-6 photoreceptors. Isolation of the ninaA gene by chromosomal walking revealed that it is expressed only in the eye and encodes a 237-amino acid polypeptide that shows strong sequence similarity to cyclophilin, a putative molecular target for cyclosporine A, a potent immunosuppressant used in human organ transplantations. Unlike most cyclophilins characterized to date, the ninaA encoded protein has a putative signal sequence and a transmembrane domain. Each of the three ehtyl methanesulfonate-induced ninaA mutant alleles analyzed shows a single nucleotide change in the mRNA coding region leading to either a nonsense or a missense mutation. We find no evidence that the ninaA-encoded protein is directly involved in phototransduction. The only detectable mutant phenotype that correlates with the severity of molecular defects in the three mutants is the amount of depletion of R1-6 rhodopsin. The above results and the recent findings that cyclophilin is a peptidylprolyl cis-trans-isomerase suggest that the ninaA encoded protein may be required for proper folding and stability of R1-6 rhodopsin. PMID- 2664783 TI - Regulated expression of foreign genes in mammalian cells under the control of coliphage T3 RNA polymerase and lac repressor. AB - Systems that stringently regulate the expression of individual genes within a complex genetic background have contributed greatly to the analysis of gene function. In this report the development of a highly regulated expression system in mammalian cells is described in which transcription of a foreign gene is mediated by the bacteriophage T3 RNA polymerase under the control of the Escherichia coli lac repressor. Rabbit kidney cell lines have been established that constitutively express the phage RNA polymerase and lac repressor. The two bacterial proteins regulate the transcription of the coding sequence of the firefly luciferase, which has been placed under the control of a T3 promoter/lac operator fusion. In the presence of the inducer isopropyl beta-D-thiogalactoside, efficient T3 polymerase-dependent transcription is observed, which is tightly repressed in the absence of inducer. Translation of the T3 transcripts can be mediated by vaccinia virus functions. The demonstration that a specific transcription activity can be regulated over a range of several orders of magnitude in higher eukaryotic cells by using a highly specific and nontoxic inducer has broad implications for a variety of studies. PMID- 2664784 TI - Identification of a vitamin D-responsive protein on the surface of human osteosarcoma cells. AB - Monoclonal antibodies were elicited to membrane constituents of the osteoblastic human osteosarcoma cell line Saos-2. Two types of antibody reactivities were characterized: one group of antibodies identified fibroblastic and osteoblastic cultured cells, whereas the other group was specific for the parent cell line, Saos-2. Primary endothelial cells and hepatoma cells were not recognized by either group of antibodies. Through indirect immunofluorescent microscopy, the Saos-2-specific antigen was demonstrated to reside on the surface of these osteosarcoma cells. Metabolic radiolabeling of cultured Saos-2 cells and subsequent immunoprecipitation, electrophoretic separation, and autoradiography revealed this protein to have a Mr of 80,000. Similar experiments in the presence of hormones showed that the expression of this cell surface protein was influenced in an opposing fashion by the bone-regulating hormones parathyroid hormone and vitamin D. Vitamin D stimulated expression by 300%, whereas parathyroid hormone depressed expression by 50%. Thus, Saos-2 human osteoblastic cells demonstrate hormonal regulation through an apparently specific membrane protein. PMID- 2664785 TI - UV induction of coliphage 186: prophage induction as an SOS function. AB - Our results show that UV induction of the 186 prophage depends upon the phage function Tum, with the mutant phenotype of turbid plaques on mitomycin plates and the expression of which is controlled by the host LexA protein. Tum function, encoded near the right-hand end of the coliphage 186 chromosome, is under the control of promoter p95. This promoter is overlapped by a sequence closely related to the consensus sequence of the LexA-binding site. It is proposed that inactivation of LexA after UV irradiation (or by genetic means) leads to prophage induction by permitting expression of Tum which, by unknown means, induces prophage. This mechanism is basically different from that seen with the UV inducible lambdoid coliphages, which are not regulated by LexA. PMID- 2664786 TI - Human homologue of mouse lymph node homing receptor: evolutionary conservation at tandem cell interaction domains. AB - A cDNA clone homologous to the mouse lymph node homing receptor core protein (mLHRc) was isolated from a cDNA library derived from stimulated human peripheral blood lymphocytes. Human RNA blot analysis shows a tissue and cell-line distribution of transcript expression generally parallel to that seen in the mouse, with expression confined to lymphoid tissues and some cell lines. Genomic DNA analysis suggests a low-copy gene under high-stringency conditions. The complete nucleotide sequence predicts a mature protein of 334 amino acids, identical in length to mLHRc. The protein shows striking conservation globally between human and mouse sequences. In particular, all three genre of protein interaction domains identified in the mouse--an animal lectin domain, an epidermal growth factor (EGF)-like domain, and two homologous repeat units preserving the motif of complement regulatory proteins (CRP)--are present in the human protein (hLHRc), and maintain the same tandem arrangement. The lectin and EGF-like regions are the most homologous, while the CRP domains are less conserved between species. The two CRP units in hLHRc are distinct from those in mLHRc in that they are homologous to one another rather than identical, suggesting strong pressure for maintenance of two repeats in this molecule. hLHRc is distinct from other kinds of lymphocyte adhesion molecules represented by VLA 4 (integrin) or CD44/gp90Hermes and, together with mLHRc and two other recently described molecules having a similar domain motif, defines a novel class of adhesion molecules exhibiting distinct evolutionary features. We propose that hLHRc likely represents the protein core of the human homologue of mLHRc functionally as well as structurally. PMID- 2664787 TI - Adrenalectomy decreases nerve growth factor in young adult rat hippocampus. AB - The effect of adrenalectomy on the level of nerve growth factor (NGF) in the hippocampus and on the distribution of choline acetyltransferase immunoreactivity in forebrain cholinergic neurons of developing rats was studied. Biological and immunohistochemical determinations indicated that in 40-day-old rats, adrenalectomy reduced the NGF level in the hippocampus and the choline acetyltransferase immunoreactivity in the septal lateral bands. Furthermore, autoradiographic studies showed that adrenalectomy causes changes in the distribution and expression of NGF receptors in the hippocampus. These results suggest that adrenal hormones are involved in the regulation of the NGF level in the hippocampus and of NGF receptors in the septum. PMID- 2664789 TI - Bone metastases. PMID- 2664788 TI - Early assessment of pressure sore risk. AB - If they are to prevent at-risk patients developing pressure sores, and ensure optimum healing time for those already existing, it is vital that nurses understand the aetiology of pressure sores and employ a system of risk assessment. PMID- 2664790 TI - A terminal case? Burnout in palliative care. AB - Nursing terminally ill patients is stressful and can lead to burnout. However, with proper support systems palliative care can be rewarding and satisfying. PMID- 2664791 TI - A cry for help? Management of postoperative pain and discomfort in neonates. PMID- 2664792 TI - Cells and tissues: a three-dimensional approach by modern techniques in microscopy. A celebrative symposium: the "Opera Omnia" of Marcello Malpighi. Proceedings of the VIIIth International Symposium on Morphological Sciences. Rome, Italy, July 10-15, 1988. PMID- 2664793 TI - Shape changes in kidney glomerular podocytes: mechanisms and possible functional significance. PMID- 2664794 TI - Human developing metanephric nephrons. Morphological, immunohistochemical and histochemical studies. PMID- 2664795 TI - Marcello Malpighi and the foundation of microscopic anatomy. PMID- 2664796 TI - A new approach for the TEM visualization of the 3-D organization of filamentous structures in cells and tissues. PMID- 2664797 TI - The endocrine heart. PMID- 2664798 TI - Statistical, morphometric and stereological basics in the morphological sciences and their possible applications in corrosion cast studies. PMID- 2664799 TI - Scanning electron microscopy in ophthalmology. PMID- 2664800 TI - Application of optical diffractometry in the analysis of cytological and histological images. PMID- 2664801 TI - Review of scanning tunneling microscopy--new biological frontier? PMID- 2664802 TI - Scanning electron microscopy in clinics. PMID- 2664803 TI - Three dimensional microarchitecture of organs reconstructed on the basis of modern histological observation methods. PMID- 2664804 TI - Brief survey of Malpighi's life. PMID- 2664805 TI - Relevance of in vitro transformation systems to skin carcinogenesis in vivo. PMID- 2664806 TI - Consequences of exposure to initiating levels of carcinogens in vitro and in vivo: altered differentiation and growth, mutations, and transformation. PMID- 2664807 TI - Initiation of skin carcinogenesis can occur by induction of carcinogen-specific point mutations in the Harvey-ras gene. PMID- 2664808 TI - Metabolism of polycyclic aromatic hydrocarbons and phorbol esters by mouse skin: relevance to mechanism of action and trans-species/strain carcinogenesis. AB - Mouse epidermal cells are a useful model system for studying chemical carcinogenesis in epithelial tissues. The available data suggest that some aspects of the metabolic activation and covalent binding of PAH carcinogens are similar in mouse and in human epidermis, whereas notable differences include conjugation pathways and wide interindividual differences, especially in adduct formation. Further work is necessary to determine the role of these differences in susceptibility to PAH carcinogenesis. Clearly, future in vitro assay systems for species extrapolation of epidermal carcinogenesis data must take into account the differentiation state of the cells, among other factors. We showed that the differentiation state of keratinocytes may profoundly influence the metabolic activation of PAHs. Also needed are in vivo assay systems in which quantitative data such as specific DNA adduct levels can be related to the biologic end point of cellular transformation. Several systems were discussed that may fulfill this need. With regard to skin tumor promoters, much less is known about the role of metabolism in mediating species and strain differences in responsiveness. The data available for phorbol esters indicate that differences in the metabolic inactivation of TPA cannot explain the marked species differences in sensitivity to this class of promoters. Much less is known about other chemical classes of promoters, which also require further investigation. PMID- 2664809 TI - Role of free radicals in tumor promotion and progression. PMID- 2664810 TI - Short-term assays to detect tumor-promoting activity of environmental chemicals. PMID- 2664811 TI - Mouse skin tumors as predictors of human lung cancer for complex emissions: an overview. PMID- 2664812 TI - Skin carcinogenicity bioassays of petroleum refinery streams: issues of interpretation. PMID- 2664813 TI - Application of short-term assays by the petroleum industry to identify skin carcinogens. PMID- 2664814 TI - Morphological evaluation of the effects of carcinogens and promoters. PMID- 2664815 TI - Epidermal tumor promotion by damage in the skin of mice. PMID- 2664816 TI - Amoxycillin/clavulanic acid ('Augmentin') compared with a combination of aminopenicillin, aminoglycoside and metronidazole in the treatment of pelvic inflammatory disease. AB - A randomized, multi-centre trial was carried out in 152 hospitalized women with pelvic inflammatory disease to evaluate the efficacy and tolerability of amoxycillin/clavulanic acid compared with that of a standard regimen using three antimicrobial agents (aminopenicillin, an aminoglycoside and metronidazole). Seventy patients initially received 3 to 4 intravenous doses per day of 1 g amoxycillin/200 mg clavulanic acid (mean 7.7 days) and then 4 to 6 tablets per day of 500 mg amoxycillin/125 mg clavulanic acid (mean 11.2 days). The other group of 82 patients initially received parenteral therapy daily (mean 7.7 days) with a combination of 3 to 4 g amoxycillin or ampicillin, 160 mg gentamicin (or 150 mg dibekacin or tobramycin) and 1.5 g metronidazole, and then oral therapy with 2 to 3 g amoxycillin or ampicillin and 1 to 1.5 g metronidazole daily (11.1 days). Clinical results, assessed at discharge from hospital (mean 10 days in both groups), were comparable in both groups, with 96% complete or partial response and no failures in the amoxycillin/clavulanic acid group, and 90% complete or partial successes and 5 failures with the triple therapy regimen. Both treatments were well tolerated and very few side-effects were reported. PMID- 2664817 TI - [Treatment and surgery of abdominal septic states: comparison of two antibiotic therapies]. AB - A prospective, randomized controlled study was carried out in 104 patients to compare clavulanate-potentiated amoxycillin ('Augmentin') with a combination of cephalosporins (cefazoline and cefadroxil) supplemented with metronidazole in the treatment of abdominal septic states, suspected or proven after surgical intervention. Patients on 'Augmentin' received 1.2 g (1 g amoxycillin plus 200 mg clavulanic acid) intravenously 3-times daily for a mean of 6.6 days, then 375 mg (250 amoxycillin plus 125 mg clavulanic acid) orally for a further 6.4 days. Patients on the standard therapy received 1 g cefazoline intravenously 4-times daily plus 500 mg metronidazole intravenously 3-times daily for 7 days, then 500 mg cefadroxil orally 4-times daily for a mean of 6.6 days. Evaluation of the patients' condition was undertaken after 24 hours, 3 days and 7 days. The results showed a significantly better response to treatment in the 'Augmentin' group, as judged by the amelioration of clinical symptoms, bacteriological findings, and tolerance. All the patients treated with 'Augmentin' showed an excellent or satisfactory overall response at Day 7 compared with 76% of those receiving the standard therapy. PMID- 2664818 TI - [The application of insulin-agar embedding in suppositories for controlled hormone liberation and dose lowering]. AB - By embedding of insulin in agar a significant retardation as well as a protective effect for the hormone is obtained. As demonstrated on in vivo animal experiments, this embedding method in dependence on the insulin concentration and particle size of the polymeric matrix allows to prepare rectal insulin applications with remarkable depot effects. Alternatively in combination with resorption promoting tensides it permits to lower the administered hormone doses to a order of magnitude reaching those used for parenteral insulin applications. PMID- 2664819 TI - Development of new beta-lactam antibiotics derived from natural and synthetic sources. PMID- 2664821 TI - N-acetyltransferase. PMID- 2664820 TI - Some aspects of controlled release dosage forms. PMID- 2664823 TI - Hyperthermic oncology: current biology, physics and clinical results. PMID- 2664822 TI - Metabolism of endogenous and xenobiotic substances by pulmonary vascular endothelial cells. PMID- 2664824 TI - Measurement of pressure ulcer volume using dental impression materials: suggestion from the field. AB - Understanding of the healing rates of deep pressure ulcers may be enhanced in future studies by relating changes in wound volume to changes in WSA. In this report, a type of dental impression material, vinyl polysiloxane, was used to produce a model of the internal topography of a pressure ulcer. This model was used to obtain volumetric measurements of the wound cavity. A permanent replica (cast) of the wound was also fabricated. Further clinical trials investigating the reliability of this method for measuring the volume of deep pressure ulcers are indicated. PMID- 2664825 TI - Neurophysiology of the suprachiasmatic circadian pacemaker in rodents. PMID- 2664826 TI - Functional specialization of different hepatocyte populations. AB - Hepatocytes from the periportal (afferent) and perivenous (efferent) zones of the liver parenchyma differ in their enzyme content and subcellular structures and thus have different metabolic capacities. Therefore the model of metabolic zonation proposes a functional specialization for the two zones: 1) oxidative energy metabolism with beta-oxidation, amino acid catabolism, ureagenesis, gluconeogenesis for the synthesis of both glucose and glycogen, cholesterol synthesis, bile formation, and protective metabolism are predominantly located in the periportal zone; 2) glycolysis, glycogen synthesis from glucose, liponeogenesis, ketogenesis, glutamine formation, and xenobiotic metabolism are preferentially situated in the perivenous zone. The input of humoral and nervous signals into the two zones is different. During passage of blood through the liver acinus, concentration gradients of oxygen, substrates, and hormones are established; the nerve densities in the two zones seem to be different. The different expression of the genome in upstream and downstream hepatocytes can be caused among other factors by the zonal gradients in oxygen and hormone concentrations. The functional specialization of the different hepatocyte populations is especially well documented for carbohydrate, amino acid, ammonia, and xenobiotic metabolism as well as for bile formation by a number of different approaches. Zonal flux differences were calculated from enzyme and metabolite distributions measured in vivo. They were observed in periportal- and perivenous like hepatocytes in cell culture and in hepatocyte populations enriched in periportal and perivenous cells. They were detected also during ortho-and retrograde liver perfusion and finally by noninvasive techniques, using surface micro-light guides and miniature oxygen electrodes. The peculiar zonal hepatotoxicity of many xenobiotics can be explained at least in part by the enzymatic and fine-structural hepatocellular heterogeneity. PMID- 2664827 TI - Oncogenes and cellular signal transduction. PMID- 2664828 TI - Osteocalcin and matrix Gla protein: vitamin K-dependent proteins in bone. PMID- 2664829 TI - Ellagitannins as active constituents of medicinal plants. AB - Isolation and structure determination, accompanied by measurement of various biological activities of each isolated tannin, particularly of ellagitannins, have brought about a marked change in the concept of tannins as active constituents of medicinal plants. Their biological activities should now be discussed on the basis of the structural differences among each tannin, in a way similar to that of the other types of natural organic compounds. The anti-tumor activity exclusively exhibited by several oligomeric ellagitannins, and their anti-HIV activities are examples of such biological activities. The inhibitory activity against lipid peroxidation, which is different in the strength among tannins of various structures, is exhibited in general more strongly by ellagitannins than by the other types of tannins of similar structures. The radical-scavenging activities of tannins as the mechanism of their inhibition, which is regarded to participate in several biological activities of tannins, have been supported by the ESR spectral measurements. Other biological activities, i.e., inhibition of mutagenicity of carcinogens, inhibition of tumor promotion, etc., have been found for tannins including ellagitannins. PMID- 2664830 TI - Functional mandibular reconstruction: prevention of the oral invalid. AB - Composite mandibulectomy for carcinoma can create an "oral invalid," with difficulty in mastication. Functional reconstruction has fallen short of ideal. Three patients were seen with significant anatomic deficits and functional debilitations resulting from large composite mandibulectomies for oral carcinoma. Each patient underwent reestablishment of the mandibular arch with a vascularized iliac crest bone graft. Following complete healing, the dental arch was replaced with a fixed prosthesis by the technique of osseointegration. The creation of a fixed osseodental unit has allowed each of these individuals to return to a state of anatomic, functional, psychological, and social good health. Follow-up has been from 6 months to 2 years. PMID- 2664831 TI - Enhanced survival of full-thickness skin grafts following the application of DC electrical fields. AB - The present study was undertaken to determine if uses of exogenous electrical fields could improve the posttraumatic quality of dermis and epidermis in isolated grafts in the rat. In blinded procedures, a full-thickness area of skin was removed and reattached to the original site. A galvanic device delivering 4.5 microA of direct current was applied using three electrode orientations: (1) anode above graft (AT; N = 8), (2) cathode above graft (CT; N = 7), and (3) no current (NC; N = 7). Current delivery was discontinued 4 days postoperatively. Quantitative assessment at 7 days postoperatively indicated the presence of necrotic skin over 80 to 90 percent of the graft surface area in NC and CT animals. In contrast, only 50 percent of the graft area was necrotic in AT rats. Histologic examinations indicated a significantly thickened dermis in the AT (versus NC and CT) rats, accompanied by patches of multilayered intact epidermis, which was virtually absent from the other experimental groups. Results are consistent with the hypothesis that direct-current stimulation can affect skin graft survival and repair. PMID- 2664832 TI - Direct monitoring of nutritive blood flow in a failing skin flap: the hairless mouse ear skin-flap model. AB - A new experimental skin-flap model is presented in which direct observations of blood flow in individual capillaries can be made from the time of flap creation throughout the entire evolution of the establishment of necrosis. After flap creation, one observes through the microscope that at 1 hour a large area of tissue is nonperfused as a result of the surgical trauma. This is followed by vasodilatation at 6 hours, resulting in an increase in the area of perfused tissue. At 24 hours, the vasodilatation persists, and the red cells that have entered the tissue during the vasodilatation (6 hours) accumulate in the capillaries, this being reflected by an increased area of nonperfused tissue. This increase continues to 72 hours, at which time the perfusion-nonperfusion interface becomes well defined and remains so throughout the 5-day experiment. Analyses of the relationship between early postoperative capillary perfusion and eventual necrosis are presented. Advantages and disadvantages of this model are listed. PMID- 2664833 TI - Health maintenance. AB - "Health maintenance" includes screening procedures, risk assessment, early intervention, and prevention--primary, secondary, and anticipatory. Guidelines for health maintenance in some age groups are quite well established, especially for children. Although recommendations for older adults may lack complete consensus, there are many activities that are widely accepted and can be employed in every primary care physician's practice. In the words of Anne Somers: "Postponement of dependency and promotion of vitality may be the most important public health challenges of the next two decades." Primary care physicians have the greatest opportunity to meet this challenge through the implementation of specific strategies for health maintenance with patients at every stage of life. PMID- 2664834 TI - Comprehensive functional assessment of the elderly. AB - The addition of function assessment in a formalized way into the primary care delivery for elderly patients can be viewed as an extension of the traditional concerns of primary care physicians when asking patients how they are doing. Functional assessment strategies simply provide a format for doing this in a reproducible, recordable, and reliable fashion. Although the complexity of functional assessment instruments can be intimidating to clinicians, the principles behind instruments of functional assessment are quite familiar. Physicians already are doing a significant amount of this performance assessment, though frequently it is not labeled as such. Table 8 provides a summary of these performance functional assessments that are easily accomplished in an ambulatory setting and applicable to the hospital or long-term care setting. The direct observation of these elements, combined with the selection of an appropriate assessment instrument for functional assessment, should allow for enhanced patient assessment and better application of the biopsychosocial model of medical care into practice to benefit the future care of our geriatric patients. PMID- 2664835 TI - Mental status assessment in the elderly. AB - Mental status testing is an essential element of evaluating elderly patients. A structured examination often helps identify the etiology of symptoms that are responsible for changes in patient behavior, that lead to family stress, but that are otherwise not indicative of cognitive dysfunction. A structured mental status examination is also helpful in distinguishing cognitive changes caused by dementia, delirium, and depression. This article examines the steps in mental status assessment and the commonly used assessment instruments. The experience of a family medicine ambulatory multidisciplinary evaluation service in mental status testing is discussed. PMID- 2664836 TI - Evaluation of acute confusion (delirium). AB - Acute confusion in the elderly is a problem that has high prevalence with significant morbidity and mortality, and that may lead to institutional placement. It is imperative that delirium be recognized promptly and its underlying cause(s) identified and treated. Management requires a multifaceted approach that addresses the precipitating cause(s), maintenance and support of vital functions, management of behaviors with use of nursing staff and family, attention to the environment, and sometimes the use of appropriate psychotropic medication. Prompt treatment is likely to result in a return to normalcy. PMID- 2664837 TI - The medical evaluation of the elderly preoperative patient. AB - Improvements in anesthesia and surgical techniques have greatly reduced the perioperative mortality and morbidity of elderly patients. Mortality is more closely correlated with pathology, type of surgery, and duration of anesthesia rather than with age. Particular attention should be directed toward cardiac and pulmonary status, because operative mortality and morbidity is related, for the most part, to cardiovascular and pulmonary complications. Postoperatively, the occurrence of pulmonary emboli and painless myocardial infarctions is more common in this age group. Elderly patients are more often confused postoperatively owing to the residual effect of anesthetics, analgesics, fever, and electrolyte disturbances. The stress of surgery and unfamiliar surroundings are also frequent precipitating causes. Orthostatic blood pressure and pulse readings should be checked before ambulating elderly patients who have been at bed rest for more than 2 to 3 days because of the frequent occurrence of orthostatic hypotension. Pressure sores, incontinence, and aspiration pneumonia may also occur owing to immobility. The elderly patient's functional status and mental status may be enhanced by simple encouragement, early mobilization, and by social interaction. It is not possible to precisely define the risks of proposed procedure, nor can the physician eliminate all risks from a surgical procedure. The risks a particular patient is subjected to depend on the complex interplay of the preoperative medical condition of the patient, the type of surgery proposed, and the skill and expertise of the anesthesiologist and surgeon. We must strive to achieve the goal of bringing our patient to the operating room in the best possible condition in the time available. PMID- 2664838 TI - Falls in the aged. AB - A fall is a major problem for the elderly person. Finding that a patient has a history of falls should lead to an aggressive investigation to search for treatable causes. The investigation should be based on a functional approach that emphasizes the underlying medical problems that contribute to falling, the psychologic reactions of the patient to having fallen, and the hazards of the patient's environment. Functionally oriented interventions may decrease further falls even when specific causes are elusive. PMID- 2664839 TI - Antihypertensive therapy in the elderly. AB - Control of hypertension in the elderly has been shown to reduce cardiovascular morbidity. Although it is not known if this is also true for isolated systolic hypertension, drug treatment should be considered for systolic pressures over 170 mm Hg that cannot be controlled with nondrug therapy. The diuretics, calcium channel blockers, and the ACE inhibitors are very effective and generally well tolerated therapy for the elderly. It may be necessary to combine two of these agents for some patients. Beta blockers are particularly useful for patients with ischemic heart disease or prior myocardial infarction. Beta blockers are the only agents which have been shown to be cardioprotective. For all antihypertensive agents, the elderly should be started on low doses. The drugs should then be titrated slowly if necessary. It is common for the elderly to respond to lower dosages than younger patients, and they should be monitored carefully for adverse reactions to medications. Antihypertensives should be administered once or twice daily whenever possible. If these principles are considered, most patients can be effectively controlled with a minimum of side effects. PMID- 2664840 TI - Alcoholism and other drug dependencies. AB - The disease of addiction is upon us and it is obvious that the elderly are not immune. There is every reason to believe from early reports that the elderly respond favorably to treatment, perhaps more so than their younger counterparts. It is believed that treating chemical dependency as a primary disease rather than as a symptom of something else has been a great boon in terms of improving recovery rates. Furthermore, group therapy is the main component of treatment in rehabilitation, as it affords the greatest opportunity to shift the dependence on chemical to a dependence on human beings. The physician is in a key position to help the elderly, because so many elderly need and use medical care. Intervention is highly recommended if the doctor is knowledgeable and skilled in this area and is willing to kindly confront the patient with a somewhat undesirable diagnosis. Rehabilitation regimens are becoming more plentiful throughout the country. If services are unavailable, however, there is always AA to fall back on or to recommend initially. Remember, fully one third of all AA members are older than 50 and that it is a source of acceptance, support, and an opportunity to depend on human beings instead of psychoactive chemicals. Remember too that few patients with addiction recover by themselves. It is worth remembering that this is an incurable disease in that once addicted, it is unlikely that anyone can ever use socially psychoactive chemical substances again. Use of psychoactive chemicals is fraught with danger for the physician and the patient and indeed may place the physician at risk for malpractice. There is great satisfaction to be gained from helping those afflicted with alcoholism and other drug dependencies. The gratitude displayed by those receiving help for this affliction is truly remarkable and one that will leave the clinician with a sense of "a job well done." PMID- 2664841 TI - Management of depression in the elderly. AB - Primary care physicians have a vital role to play in identifying depression in their elderly patients. Diagnosis may be difficult, because symptoms are atypical and frequently include psychomotor agitation, somatic symptoms, and complaints of memory loss. Patients with medical illnesses, such as cancer, postmyocardial infarction, stroke, Parkinson's disease, and early Alzheimer's disease are particularly vulnerable to depression. Drugs that may cause depressive symptoms are digitalis at toxic levels, beta-blockers, centrally acting antihypertensives, immunosuppressants, and nonsteroidal anti-inflammatory agents. Cyclic antidepressants are the drugs of first choice. Selection depends on the patient's physical health and current medications and the side effect profile of the drug. Side effects are more pronounced in old age because of drug accumulation owing to slowed clearance. Troublesome side effects are anticholinergic effects, orthostatic hypotension, sedation, cardiotoxicity, and weight gain. The most useful antidepressants for geriatric patients are the secondary amines, desipramine and nortriptyline. The second-generation drug trazodone has the advantage of causing the least anticholinergic effects, but it is very sedating. Before treatment, the patient should have an electrocardiogram, liver function tests, tonometry, sitting and standing blood pressures, evaluation of urinary symptoms for outflow obstruction, review of current medications, and estimation of suicide risk. Cyclic antidepressants are contraindicated during recovery from myocardial infarction, in heart disease when there is severe impairment of myocardial performance, in seizure disorders, and in the presence of glaucoma or a large prostate. Drug interactions that may cause trouble can occur with epinephrine, MAO inhibitors, thyroid hormone, cimetidine, and centrally acting antihypertensives. Dosage should start low, increasing usually by 25 mg every 4 to 5 days until a therapeutic level is reached. Failure of a noradrenergic antidepressant after 4 to 5 weeks can be followed by a trial of a serotonergic drug. Drug serum level monitoring is useful for imipramine, desipramine, and nortriptyline. Monoamine oxidase inhibitors are effective in many elderly patients who are resistant to TCAs. Sympathomimetic drugs must be avoided with MAOIs. Elderly patients are at high risk of toxicity and drug interactions with lithium. Electroconvulsive therapy is useful for patients who do not respond to drug treatment, but medical complications, particularly cardiovascular, often occur in patients 75 or older. Many patients relapse after ECT. Psychotherapy together with pharmacotherapy may be the optimal treatment for elderly depressives. Older patients are more likely to become chronically depressed than younger patients. The risk of suicide in depressed elderly males is high, particularly in those with psychosocial problems, and depression rises with age. PMID- 2664842 TI - Sleep disorders in the elderly. AB - Many elderly complain of serious difficulty getting to sleep or staying asleep. Sleep physiology changes with age. Furthermore, medical conditions that may affect sleep and serious pathologic sleep disorders are more prevalent among the elderly. Treatment should be directed toward any identified underlying condition after thorough evaluation by history, examination, and in certain instances, referral to a sleep disorders center. PMID- 2664843 TI - Nutrition for the elderly. AB - Nutrition in the older person is complex because of changing physiology, changes caused by multiple chronic diseases, changes induced by pharmacologic agents, and commonly, failing protein/caloric intake. This article is designed to explain the mechanisms of these processes and to suggest pragmatic and practical responses in the management of the older patient. PMID- 2664844 TI - Fever of unknown origin in the elderly. AB - Fever is a prominent sign of an acute-phase response induced by microbial invasion, tissue injury, immunologic reactions, or inflammatory processes. This generalized host response is produced by a multiplicity of localized or systemic diseases and characterized by acute, subacute, or chronic changes in metabolic, endocrinologic, neurologic, and immunologic functions. The fundamental event is an initiation of the acute-phase response by the production of a mediated molecule called IL-1. This polypeptide is produced primarily from phagocytic cells such as blood monocytes, phagocytic lining cells of the liver and spleen, and other tissue macrophages. IL-1 produces a local reaction but also enters the circulation, acting as a hormone to mediate distant organ system responses to infection, immunologic reaction, and inflammatory processes. Fever is the result when IL-1 initiates the synthesis of prostaglandins, notably prostaglandin E2 in the thermoregulatory center located in the anterior hypothalamus. The thermostatic set point is then raised and mechanisms to conserve heat (vasoconstriction) and to produce heat (shivering) are initiated. The result is a sudden rise in body temperature. The same basic mechanisms are involved in FUO. Many of the biologic and biochemical changes that are seen in FUO are also evidence of an acute-phase response. The elevated erythrocyte sedimentation rate is partly due to increased synthesis of hepatic proteins, including compliment components, ceruloplasmin, fibrinogen, and C-reactive protein. IL-1 acts directly on the bone marrow to increase absolute numbers and immaturity of circulating neutrophils. Anemia is produced by many mechanisms, including the reduction of circulating serum iron. Although fever production in the elderly maybe delayed or of less intensity, it is still a marker of significant disease.(ABSTRACT TRUNCATED AT 400 WORDS) PMID- 2664845 TI - Urinary incontinence in the elderly. AB - Although often unreported, urinary incontinence is a common problem confronting primary care physicians caring for the elderly. Most patients with urinary incontinence can be cured or improved through proper diagnosis and management. Many incontinent patients can be treated based on history, physical examination, and simple laboratory and bedside testing. Efforts are currently underway to determine the best method for selecting patients who require referral for urologic evaluation and urodynamic testing. Behavioral therapy, drugs, and surgery, alone or in combination, will result in marked improvement for many patients. For others, careful attention to environmental support may minimize the impact of incontinence. An optimistic and enthusiastic attitude on the part of the treating physician is important in improving patient compliance with long term therapy. PMID- 2664846 TI - Development of a screening questionnaire to study attrition in weight-control programs. PMID- 2664847 TI - Geophysical variables and behavior: LVII. Seasonal affective disorder and phototherapy. AB - Seasonal affective disorder, depressive symptoms that recur in fall and winter and abate in spring-summer, for many patients in the United States and Europe, have been alleviated by exposure to bright, full spectrum light for several hours daily (phototherapy). The characteristics of these patients, the procedures used, the theoretical explanations of the mechanisms, and the potential of phototherapy are reviewed. PMID- 2664848 TI - Psychologists and children of alcoholic parents. AB - Clinical evidence has pictured children of alcoholic parents as vulnerable physically, emotionally, socially, academically, and at risk for alcoholism. Review of research indicated that some of these clinical insights have been validated, but much more is needed to fill out an accurate picture for psychologists who will be asked to work with them. PMID- 2664849 TI - Suicide and the stress of residency training: a case report and review of the literature. AB - Suicide rates among physicians have been reported to be twice that of the general adult population. Few data are available, however, regarding suicide among resident physicians. A case study of the suicide of a male intern is discussed. The literature is reviewed to elucidate potential contributory factors including reported causes and manifestations of stress among resident physicians, suicide rates among physicians including house staff with considerations of sex, and common personality characteristics of physicians and medical students. Recommendations are extended which may assist in early recognition and treatment of individuals at risk of impairment and suicide. PMID- 2664850 TI - Lying by children: why children say one thing, do another? AB - Lying constitutes a problematic behavior for parents and other social agents involved in children's development of effective behaviors. This analysis suggests that lying is, in part, the name for a lack of correspondence between saying and doing, and that effective correspondence training procedures can be designed to teach truthfulness in children through the teaching of either promise-then-do correspondence or do-then-report correspondence. This paper proposes a relational definition of lying and shows its applications in the area of correspondence training. The generalization and maintenance of truthfulness, advantages and disadvantages of correspondence training in the management of lying are also considered. PMID- 2664851 TI - [Early psychoanalytic concepts of pain]. AB - It is amazing how small a proportion of the very extensive psychoanalytic literature is devoted to the psychoanalytic understanding of pain and how much less to a pain-theory. Reviewing the history of psychoanalytically orientated pain-concepts up to 1933--mostly concerning "psychogenic" pain--Sigmund Freuds remarks are reaching from autobiographical notices up to his case histories ("Studien uber Hysterie"), in which pain is one of the dominating conversionsymptoms. Psychoanalytic observations on pain are also made by Sandor Ferenczi, Wilhelm Stekel, Edoardo Weiss, Anna Freud and Ernst Simmel--one of the pioneers in psychosomatic research--who developed an unknown theory of an earliest postnatal intestinal libido for a better understanding of somatogenic pain. PMID- 2664852 TI - [The patient with psychogenic and psychosomatic pain. Outline of psychoanalytically oriented nosology]. AB - Starting with the contribution of G. L. Engel (1959) a systematization of the psychodynamic conceptions of pain and pain disorder is given. Four different explanations for the genesis and maintenance of pain states are worked out: (1) The narcissistic mechanism (substitution), (2) the conversion mechanism (symbolization), introduced by S. Freud himself, (3) the psychovegative mechanism (resomatization), and (4) learning principles. These four conceptions are presented. Finally concern is expressed as the conceptual range of three of these explanatory principles is thought to cover a relevant range by far not reached by other pain theories more en vogue. PMID- 2664853 TI - [Psychogenic pain as a representation of the maternal object]. AB - Since Freud, psychoanalysis has approached psychogenic pain from two points of view: conversion, and narcissistic hurt through loss of an object (pain of separation). In an early developmental phase concerning the first differentiation of self, body-self and external objects, representatives of physical and psychical pain as well as representatives of frustrating experiences with external objects (emotional deprivation, overstimulation) are able to take the place of each other reciprocally. This means, as Deutsch (1959) has elaborated, the extension of the concept of conversion to pregenital stages and its connection with object-relation-theories. The author suggests an idea of a two phase conversion, by which the primarily acquired defence of conversion is followed by later traumatization, which introduces subsequent conflicts of later developmental stages, for example oedipal ones. In the case of psychogenic pain, where physical and sexual abuse as well as the inherent guilt dynamics are frequently found, they can be integrated by using this hypothetical model. The relation to the conceptualizations of archaic hysterization (McDougall) and secondary hysterization (Mentzos) respectively symbolization (Engel) is discussed; case studies are illustrating the theoretical conception. PMID- 2664854 TI - Physiological changes in skeletal muscle as a result of strength training. AB - The picture of training that emerges is of a process that can be divided into a number of phases. In the first phase there is a rapid improvement in the ability to perform the training exercise such as lifting weights which is the result of a learning process in which the correct sequence of muscle contractions is laid down as a motor pattern in the central nervous system. This phase is associated with little or no increase in the size or strength of individual muscles. The learning process appears to be very specific in that lifting weights makes better weight lifters but not better sprinters. The second phase is an increase in the strength of individual muscles which occurs without a matching increase in the anatomical cross-section. The mechanism for this is not clear but could be a result of increased neural activation or some change in the fibre arrangement or connective tissue content. The third phase starts at a point where scientific studies usually end, at about 12 weeks when non-athletic subjects are beginning to tire of the repeated training and testing. After this point, if training continues, there is probably a slow but steady increase in both size and strength of the exercised muscles. The stimulus for these changes remains enigmatic but almost certainly involves high forces in the muscle, probably to induce some form of damage that promotes division of satellite cells and their incorporation into existing muscle fibres. Our information on the effect of long-term training comes primarily from observations on elite athletes whose physique may well be the result of genetic endowment or the use or abuse of drugs. For the athlete or patient hoping to increase muscle size by weight training the best combination of intensity, frequency and type of exercise still remains a matter of individual choice rather than a scientific certainty. PMID- 2664855 TI - One selectionist's perspective. AB - Following introductory comments expressing doubts about the validity of genetic load and Haldane's "cost of natural selection," the role of selection (expressed as the average number of adult daughters per female) on gene frequencies in populations has been partitioned into population and time arenas. The population arena (a geometric plane) deals with the fitnesses of different genotypes under the many situations encountered by individual members of the population in a single generation; average fitnesses of carriers of various genotypes are obtained by calculating across these many situations. The population arena includes the point signifying that, on the average, each mother leaves one daughter as her replacement within the population. It is the plane within which evolutionarily significant norms of reaction exist. The time arena is also a (geometric) plane, one that is composed of the edge-on limit (average fitness) of each successive population arena. It does not include the effects of individual situations on relative fitnesses within each population arena; it encompasses only the temporal sequence of average relative fitnesses. Amino acid substitutions in proteins and base-pair substitutions in DNA are events of concern in the time arena; within the population arena, however, gene action (not merely gene structure) is a matter of considerable concern. Thus, the discussions of the 1950s and 1960s regarding genetic variation which were reasonable within the population arena seem less so within the time arena where structural, rather than functional, variation is stressed. The function-structure dichotomy is entangled with the neutralist-selectionist controversy. PMID- 2664856 TI - Protein and protein-bound water dynamics studied by Rayleigh scattering of Mossbauer radiation (RSMR). PMID- 2664857 TI - [Prognosis and therapy of malignant non-Hodgkin's lymphoma]. AB - Rarely low malignant Non-Hodgkin-lymphomas (NHL) can be attended curatively. An alternative to hitherto applied chemotherapy in advanced stages is the retarded therapeutic proceeding in the so-called "indolent" NHL. However, the optimal therapeutic regimen is unknown. High malignant NHL can be attended curatively to a high percentage. With protocols of therapy in 2. and 3. generation the total remission rate could be increased and the rate of relapses could be decreased compared with the CHOP-scheme. The application of radiotherapy is not defined sufficiently in high malignant NHL yet. PMID- 2664858 TI - Imaging of renal trauma. AB - Because of complex variables and unsettled treatment issues, a standardized prescription for imaging the acutely traumatized kidney cannot be written. Imaging considerations are based on treatment considerations and will vary from place to place, from patient to patient, from physician to physician, and even from time to time in the same institution. The condition of the patient, the availability of resources and personnel, and (especially) whether existing treatment policy is conservative or aggressive will govern the selection of studies. Above all, since the kidney may be only one of several organs requiring immediate investigation, it is always the totality of the situation that sets the tone for the imaging process. A synthesis of prevailing thought is depicted diagrammatically in Figure 2 and is summarized as follows: CT is the most informative radiologic study in renal trauma and is the examination of choice in patients suspected of having serious renal injuries or associated injuries amenable to CT evaluation. CT is wasteful, however, in the stable, asymptomatic patient who is perceived to have only a minor, exclusively renal injury. Here, excretory urography is an acceptable alternative. Most of these patients will have normal findings at urography, all but ruling out significant renal damage. The vast majority of patients will fall into this category but for those whose urograms do not provide adequate information for management, CT is performed next. Sonography and radionuclide imaging, while advocated in some quarters, do not enjoy wide acceptance in the United States as first-line triage studies. They are usually reserved for selected situations, mainly for follow-up. Arteriography still has a place, primarily in preoperative road mapping, and for therapeutic interventions such as embolization of bleeding vessels and arteriovenous fistulas. The role of MR imaging has yet to be defined. The choice of imaging in renal trauma requires discretion, judgement, and common sense. Standard protocols are useful, but there is a place for flexibility and the customizing of individual approaches. PMID- 2664859 TI - Recommendations for obstetric sonography in the evaluation of the fetal cranium. PMID- 2664860 TI - Level 1, level 2, level 3 obstetric sonography: I'll see your level and raise you one. PMID- 2664861 TI - Gianturco expandable metallic biliary stents: results of a European clinical trial. AB - Eleven patients with benign strictures (after choledochojejunostomy, n = 10; chronic pancreatitis, n = 1) and 16 with malignant biliary strictures (cancer of the pancreas, n = 7; cholangiocarcinoma, n = 5) were treated with a self expanding metallic biliary stent. The patients with benign disease had failed treatment with surgical reconstruction and transhepatic balloon dilation. All patients had immediate relief of jaundice and cholangitis. In a follow-up period of 6-21 months, nine of the 11 patients with benign disease had no difficulties with infection, pruritus, or recurrent jaundice. In patients with malignant strictures, the stent produced relief of biliary obstruction unless recurrent tumor invaded the bile ducts. With careful patient selection, this stent appears to be useful in the management of biliary obstruction, particularly in benign disease. PMID- 2664862 TI - Brain death in infants: evaluation with Doppler US. AB - In a preliminary study, nine infants with a clinically determined diagnosis of brain death were examined with duplex pulsed Doppler ultrasonography (US) through the anterior fontanelle. Flow velocity measurements were made in the intracranial internal carotid artery and anterior cerebral artery. Resistive index (RI) was calculated in each patient and used as an indicator of diastolic flow. Eight of nine infants showed markedly elevated RI (100%-191%) with reversal of diastolic flow. One infant had low RI (42%-58%) with preserved systolic and diastolic flow until death. The authors believe that the elevation of RI with diastolic flow reversal seen in these patients is a reflection of increased intracranial pressure and is a sign of poor prognosis when present on serial examinations. Cranial duplex pulsed Doppler US is a useful, noninvasive tool in the diagnosis of brain death in infants but must be carefully correlated with clinical examination and other diagnostic tests. PMID- 2664863 TI - Intraabdominal adhesions: intraoperative US. AB - Intraoperative ultrasound (US) was used to help locate the bowel, liver, and spleen in dense abdominal adhesions in 30 patients who were undergoing repeated laparotomy and had undergone previous surgery for various conditions. US helped determine the correct location of these organs in 49 abdominal adhesions. The authors conclude that in patients who have undergone previous surgery, intraoperative US can aid the distinction of tissue planes that can then be safely transected from vital abdominal organs. PMID- 2664864 TI - Detection of fetal central nervous system anomalies: a practical level of effort for a routine sonogram. AB - To evaluate the efficacy of examining the lateral ventricular atrium, cisterna magna, and cavum septi pellucidi as a means of ascertaining that the development of the fetal central nervous system (CNS) is normal, a retrospective evaluation of the sonograms of 112 fetuses (15-39 weeks gestational age) with sonographically diagnosed CNS anomalies was performed. Malformations included in the study were diverse. The lateral ventricular atrium was enlarged (greater than 10 mm) in 99 (88%) fetuses. Of the remaining 13 fetuses, seven had an abnormal sized cisterna magna (less than 2 mm or greater than 11 mm). These two measurements alone could be used to identify the presence of a CNS abnormality in 95%. Three of the six remaining fetuses exhibited gross abnormalities easily seen on the standard axial images obtained for biparietal diameter measurement. Although the cavum septi pellucidi was absent in a number of cases, its absence did not enhance sensitivity in the cohort examined. Prospective examination of 130 consecutive normal fetuses (15-40 weeks gestational age) was also performed. When specifically sought, the ventricular atrium was identifiable and measurable 99% of the time; the cisterna magna, 90% of the time; and the cavum septi pellucidi, 95% of the time. Because major CNS anomalies are uncommon and these measurements afford high sensitivity, an extremely low probability (0.005%) of abnormal brain or spinal cord development can be predicted if a normal-sized lateral ventricular atrium and cisterna magna are present. These results should not be construed as a license to underexamine fetuses for malformations. Rather, these measurements should serve as simple positive steps to assist in a difficult task. PMID- 2664865 TI - Effacement of the fetal cisterna magna in association with myelomeningocele. AB - The cisterna magna is effaced in association with myelomeningocele. The authors retrospectively investigated the size of the fetal cisterna magna as a predictor of fetal myelomeningocele in 67 pregnant women (17-38 menstrual weeks) referred for prenatal sonography because of an elevated serum alpha-fetoprotein level (n = 61) or a suspicion of fetal ventriculomegaly on previously obtained sonograms (n = 6). Twenty fetuses had myelomeningocele, 14 had isolated ventriculomegaly, and 33 were normal. A normal-sized cisterna magna (range, 4-9 mm in depth) was present in all normal fetuses. In 19 of 20 fetuses with myelomeningocele, the views of the posterior fossa were adequate, and in each of these the cisterna magna was effaced (n = 18) or very small (n = 1). The cisterna magna was effaced in five of 13 (38%) fetuses with isolated ventriculomegaly in whom the posterior fossa was adequately imaged. Although effacement of the cisterna magna is a nonspecific finding, the high negative predictive value of this sign is useful during routine screening of the fetal neural axis. PMID- 2664866 TI - Mature teratoma of the retroperitoneum: radiologic, pathologic, and clinical correlation. AB - The authors retrospectively evaluated radiologic, clinical, and pathologic findings in 23 cases of mature teratoma arising within peri- or pararenal spaces. Radiologic studies--including abdominal radiographs (21 cases), excretory urograms (12 cases), sonograms (17 cases), and computed tomographic (CT) scans (18 cases)--were evaluated for tumor location, mass effect, calcification, fat, tumor invasion, echo pattern, and tissue characteristics. Most patients were female (3.4:1), younger than 6 months (50%), and asymptomatic. Abdominal radiography demonstrated a mass in 95%, calcium in 92%, and fat in 60% of cases in which CT revealed these components. Similarly, sonography showed uncomplicated fluid in 76% and calcium in 50% of cases. Fat was not reliably distinguished from other soft-tissue components on sonograms. The most characteristic radiologic findings of mature teratoma of the retroperitoneum are a complex mass containing a well-circumscribed fluid component of variable volume, adipose tissue and/or sebum in the form of a fat-fluid level, and calcification in either a congealed or linear strand pattern. These findings are better demonstrated by CT than by sonography. PMID- 2664867 TI - Indications for breast imaging in women under age 35 years. AB - To determine appropriate indications for breast imaging in young women, the authors correlated patient histories with mammographic and/or sonographic findings and biopsy or follow-up results for 625 patients aged 13-34 years. The only important indications were a palpable mass and suspicion of an abscess. Of the 335 studies performed for evaluation of a palpable mass, 184 (55%) were normal, 28 (8%) were compatible with benign disease, and 123 (37%) were suggestive of malignancy. Biopsies were performed in 73 patients; the findings were benign in 67 cases, and carcinoma was found in six. Imaging studies were considered helpful in four of the 15 cases of suspected abscess, in that the studies established the presence and extent of an abscess. Studies in 275 women were performed for a variety of other indications. The findings were normal in 239 (87%) studies, benign in 21 (8%), and suggestive of malignancy in 15 (5%); there were no known carcinomas in any of the patients. Women with the "low-yield" indications identified in this study should be followed up clinically rather than referred for imaging studies. PMID- 2664868 TI - Frequency measurements in real-time US equipment: variations from expected values. AB - The frequency responses of nine real-time mechanical probes and two pulsed Doppler probes from four manufacturers were measured. The reflected frequency was measured in a clinical environment by evaluating the pulser, transducer assembly, and receiver as a system. Two independent systems were used for these measurements: a spectrum analyzer and a data acquisition system that computed the fast Fourier transform of the reflected waveform. Results showed that probe frequency (calibrated by the manufacturer in the transmit mode with a hydrophone) was as much as 30% higher than that found by means of frequency measurement procedures with the probe attached to the ultrasound system and evaluated in the receive mode. Such large discrepancies indicate that if acceptance testing of the frequency spectrum is not performed at a clinical facility, prolonged clinical evaluation of new equipment should be arranged. PMID- 2664869 TI - Parasternal sonography of the internal mammary vessels: technique, normal anatomy, and lymphadenopathy. AB - Metastasis to the internal mammary lymph nodes adversely affects the disease-free interval and long-term survival in women with breast carcinoma. Since staging of disease in this lymphatic chain is rarely performed at the time of definitive surgical treatment, noninvasive methods have been advocated. The authors present their preliminary experience with a sonographic technique for evaluating the internal mammary lymph nodes, artery, and vein. Longitudinal and transverse images of the first through fourth parasternal rib interspaces were acquired with a 5.0- or 7.5-MHz linear-array real-time system. The method was evaluated prospectively in 36 control subjects and in seven patients (six with metastatic breast cancer and one with lymphocytic lymphoma) who had enlarged internal mammary lymph nodes at thoracic computed tomography (CT). The longitudinal scans routinely demonstrated the internal mammary vessels in the upper interspaces. Lymphatic structures were not identified in the control group. In contrast, sonographic findings corresponding to the CT findings of lymphadenopathy were present in all seven patients. The authors believe that parasternal sonography is a promising technique that merits further study. PMID- 2664870 TI - Mediastinal tumors: biopsy under US guidance. AB - Percutaneous biopsies of mediastinal tumors were successfully performed under sonographic guidance in 14 of 21 patients. In 10 of 11 malignant lesions, malignancy was determined by means of cytologic and histologic examination of the specimens obtained. A histologic diagnosis was reached in seven patients with malignant mediastinal tumors, including all four cases of Hodgkin lymphoma. Mediastinal biopsy under sonographic guidance is a technically simple, rapid, and accurate procedure, but its application is limited to tumors of the anterior mediastinum. PMID- 2664871 TI - Expert system-controlled image display. AB - Conventional computer-based medical expert systems deliver advice to physicians as written text. While such advice is useful, it has distinct limitations in a visually oriented discipline such as diagnostic radiology, in which decisions often depend on pattern recognition and appreciation of subtle morphologic features. The authors developed a prototype expert computer system, IMAGE/ICON, which displays groups of images sorted into a series of axes based on different ways in which they may be similar. They may share a common feature, group of features, causes, or clinical setting. IMAGE/ICON may display examples of morphologic variations of a dominant finding or a spectrum of abnormalities seen in an specific disease or group of diseases. The system also assembles a written analysis of key features of a case. Such a tool may be useful as a diagnostic aid or for continuing medical education. It is likely to have particular impact in the form of an intelligent radiologic workstation, as picture archiving and communication systems become available. PMID- 2664872 TI - Osteomyelitis: detection with US. AB - To evaluate the role of ultrasound (US) in the detection of osteomyelitis, the authors prospectively studied 48 patients clinically suspected of having osteomyelitis. A sonographic diagnosis was made if fluid was seen directly in contact with bone, without intervening soft tissues. Twelve of the 48 patients were subsequently found to have osteomyelitis. In 10 of them, US demonstrated abnormal fluid adjacent to the bone. This fluid was thought to represent an inflammatory exudate dissecting in a subperiosteal and/or extraperiosteal location. Eight of the 48 patients had soft-tissue fluid collections. The rest of the patients either had no abnormalities or had cellulitis. The authors conclude that US can be useful in the detection of osteomyelitis. PMID- 2664873 TI - Radiology residency training in diagnostic sonography: recommendations of the Society of Radiologists in Ultrasound. PMID- 2664874 TI - Needle localization of nonpalpable breast lesions with current dedicated mammographic systems. PMID- 2664875 TI - An evaluation of the pooling culture method for the detection of Escherichia coli enterotoxins. AB - The efficiency of the pooling method for the detection of enterotoxigenic Escherichia coli (ETEC) strains associated with children acute diarrhea, was evaluated. This study involved the analysis of 6989 E. coli strains corresponding to 1485 cases, coming from 7 hospitals at different geographic locations. Three to five strains from each case were inoculated in pool in Casamino-acids-yeast extract-salts medium plus lincomycin (30 micrograms/ml) and incubated at 37 degrees C during 18 hours with shaking. Polymyxin sulphate B (2200 U/ml) was added to the cultures, and incubation with shaking continued for additional 30 minutes. The culture was then centrifuged and the supernatant tested by a) the enzyme-linked immunosorbent assay to detect heat-labile enterotoxin (LT) and b) the suckling mouse assay for the detection of heat-stable enterotoxin (ST). Strains from a pool were individually studied in all positive cases as shown by the pooling methodology. Also, in 1 out of every 15 negative cases by the pool method, their component strains were individually analyzed, to confirm that there were no false negatives. Fifty seven LT-ETEC, 61 ST-ETEC and 15 LT-ST cases were detected. From the 89 negatives selected by the pool method, 2 cases were positive when the component strains were individually tested (p1 = 2.25%, 95% confidence interval from 0.27 to 7.88%). In both cases one of the non ETEC strains inhibited the ETEC strain. In other 5 negative cases (p2 = 5.62%, 95% confidence interval from 1.85% to 12.63%), ETEC strains were detected when analyzed individually, and gave a positive result when the pooling method was repeated.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 2664876 TI - [Klebocins K6 and K150: production and activity in various experimental conditions]. AB - Klebsiella is a common agent in hospital-acquired infections and its importance in disease transmission was evident in the isolation obtained in a health center in the city of Rio Cuarto. Bacteriocinogenic strains by the cross-streak method in tryptic-soy agar were investigated. Two Klebsiella produced bacteriocins with broad patterns of sensitivity among the tested strains. The K150 klebocin was more active than the K6 klebocin, but this one was more heat-stable than K150. The klebocins were not detected in the synthetic media employed and they caused inhibitory areas in complex media, except in triptose-beef extract. K150 was not active in eosine-methylene blue and nutrient agar. The bacteriocins were associated to lipase activity and hemolytic effect on chicken erythrocytes. The strains 6 and 150 were multiresistant to antimicrobial agents, with a pattern of sensitivity different from that of other multiresistant strains. PMID- 2664877 TI - Trypanosoma cruzi: conditions required to improve metacyclic differentiation in axenic culture. AB - This work is a study on the behaviour of Epi from various T. cruzi strains and clones grown in media stimulating differentiation such as M 16, TAUP, TAUS, LIT hemin and G-IH. Results showed that in our experimental conditions the G-IH medium was the only suitable one to induce Epi-Mtc morphogenesis. Optimal temperature for both multiplication and differentiation in this medium was 28 degrees C. The use of G-IH medium after nutrient depletion by dilution failed to induce differentiation. Parasites obtained from biphasic medium at 24-48 h culture proved the best to achieve morphogenesis. External Ca++ supply blockage affected the differentiation capacity of Tul and RA strains to a variable degree. PMID- 2664878 TI - Syndrome of mitral valve prolapse: current perspectives. PMID- 2664879 TI - The cardiac effects of adenosine. PMID- 2664880 TI - The effects of methylmercury on the developing brain. PMID- 2664881 TI - Taurine in the central nervous system and the mammalian actions of taurine. PMID- 2664882 TI - Doubleblind evaluation of the antimanic properties of carbamazepine as a comedication to haloperidol. AB - 1. Today carbamazepine is the most important alternative to neuroleptic drugs for the treatment of manic psychoses. Often carbamazepine is administered as a comedication to a neuroleptic. 2. A doubleblind study with 20 patients suffering from manic or schizomanic psychoses was performed to determine whether carbamazepine and haloperidol in comedication are more effective than haloperidol alone. 3. Under the tested conditions (24 mg haloperidol p.d.) only the smaller amount of additional medication with levomepromazine in the experimental group gave evidence for the antimanic effect of carbamazepine in combination with haloperidol. 4. Especially the patients with pure manic psychoses seem to benefit from carbamazepine as an adjunct to haloperidol. PMID- 2664883 TI - Tranylcypromine in depression resistant to cyclic antidepressions. AB - 1. Non-responders to cyclic antidepressants were treated with the MAO-inhibitor tranylcypromine in two studies: the first study in an open comparison with L-5 hydroxytryptophan (L-5HTP), the second study in a double blind comparison with nomifensine. 2. While both L-5HTP and nomifensine appeared to be ineffective, tranylcypromine was effective in 26 out of 45 patients. 3. It is concluded that besides ECT also MAO-inhibitors such as tranylcypromine are an effective alternative for depressed patients not responding to cyclic antidepressants. PMID- 2664884 TI - The relationship between perphenazine plasma levels and clinical response in acute schizophrenia. AB - 1. Twelve patients with schizophrenia according to RDC participated in a double blind study, comparing two dose levels of perphenazine, 16 or 32 mg, during four weeks. 2. The patients were assessed with a subscale to CPRS and global scores, measuring improvement of regular intervals during four weeks. 3. Blood samples for assay of plasma perphenazine were collected once a week. 4. These results are in many respects in accordance with earlier published data with perphenazine, that is a good clinical response is achieved with a plasma concentration of perphenazine between 1-5 nmol/L. 5. No incidence of severe adverse symptoms were observed. PMID- 2664885 TI - Neuropeptide Y (NPY) and the central nervous system: distribution effects and possible relationship to neurological and psychiatric disorders. AB - 1. NPY is a 36 amino acid tyrosine-rich peptide. It is one of the most abundant and widely distributed neuropeptides known today within the central nervous system with particularly high concentrations in the hypothalamus and in several limbic regions. 2. NPY seems to coexist with other on neurotransmitters like somatostatin, galanin, GABA and the catecholamines noradrenaline and adrenaline in discrete brain regions. 3. NPY binding sites are widely distributed in the brain. However they do not always overlap with the distribution of NPY-like immunoreactivity. 4. NPY is suggested to be involved in a large number of neuroendocrine functions, stress responses, circadian rhythms, central autonomic functions, eating and drinking behaviour, and sexual and motor behaviour. 5. Psychotropic drugs and neurotoxins can alter the NPY concentrations in discrete brain regions. 6. It is possible that NPY is related to various neurological and psychiatric illnesses, like Huntington's chorea, Alzheimer's disease, Parkinson's disease, eating disorders, and major depressive illness. PMID- 2664887 TI - Perspectives in Canadian neuro-psychopharmacology. Proceedings of the 1th annual meeting of the Canadian College of Neuro-psychopharmacology. Montreal, Quebec, May 3-6, 1988. PMID- 2664886 TI - Double blind study on the efficacy and safety of tetrabamate and chlordiazepoxide in the treatment of the acute alcohol withdrawal syndrome. AB - 1. Efficacy and safety of tetrabamate and chlordiazepoxide in the treatment of the acute or Primary Alcohol Withdrawal Syndrome (PAWS) were assessed during a randomized double blind clinical trial, carried out on sixty male alcoholic in patients. 2. The two drugs were administered four times a day in double dummy conditions, according to a fixed-flexible decreasing dosage schedule (six days basic regimen). 3. Drug efficacy was measured daily throughout the study period using a battery of standard instruments for collecting quantitative clinical, behavioral, psychopathological and laboratory data. Side effects were daily recorded. 4. Tetrabamate was found to be as efficient as chlordiazepoxide in reducing the intensity of the PAWS, improving sleep and vital signs rapidly and alleviating anxiety progressively. 5. Tetrabamate was found particularly beneficial for severe tremor. Psychomotor and mood scores consistently favored tetrabamate, suggesting psychoanaleptic properties of this compound (increased diurnal vigilance). 6. Side effects were minimal with tetrabamate and generally of weak intensity with chlordiazepoxide. 7. The results of this study indicate that tetrabamate may represent a new alternative drug of choice for the therapy of the acute alcohol withdrawal syndrome. PMID- 2664888 TI - Ageing and neurotoxins as causative factors in idiopathic Parkinson's disease--a critical analysis of the neurochemical evidence. AB - 1. Idiopathic Parkinson's disease (PD) is set apart from other Parkinsonian conditions by a specific interregional (caudate-putamen) as well as a subregional (rostral-caudal) pattern of striatal dopamine (DA) loss. 2. Using the characteristic patterns of striatal DA loss as neurochemical criteria, a critical evaluation of the "ageing/neurotoxin" hypothesis of idiopathic PD is presented. 3. Although both ageing of the brain DA neurones and MPTP (as an example of a DA specific neurotoxin) reproduce some aspects of the subregional striatal DA loss found in idiopathic PD, neither of these two mechanisms mimicks the large caudate putamen difference in DA loss (with the putamen much more affected than the caudate nucleus) which is typical of idiopathic PD. 4. From the discussed observations the conclusion is drawn that the pathoetiological factor, or factors, operative in idiopathic PD must involve a mechanism preferentially damaging the nigral DA neurones which project to the putamen. PMID- 2664889 TI - The gabaergic hypothesis of depression. AB - 1. GABAergic mechanisms have been generally ignored in the study of mood disorders and antidepressant drug (AD) action. Recently data have accumulated indicating that GABAergic mechanisms may be involved in both of these. 2. Mood disorders: GABA levels are reported to be low in the CSF and plasma of depressed patients and are related to mood changes. GABAB receptors are decreased in the frontal cortex in two rodent behavioral models of depression and GABA release is reported diminished in the hippocampus. GABAergic drugs (progabide, fengabine) reverse the behavioral deficits in the rodent models and exert clear therapeutic effects in depressed patients. 3. AD action: In behavioral models imipramine upregulates GABAB receptors only in those animals which respond behaviorally to the AD. In naive rats repeated administration of varied ADs upregulates GABAB receptors in the frontal cortex whereas non-ADs (including amphetamine) do not. Bicuculline inhibits the action of imipramine in the learned helplessness model. GABAA receptor stimulation enhances noradrenaline release in the ventral NA pathway. 4. CONCLUSIONS: GABAergic mechanisms likely play a role in the modulation of mood and increasing GABAergic tone exerts and antidepressant effect. Actions at GABA synapses appear to be a fundamental facet of ADs, perhaps together with beta-adrenoceptor mediated events. PMID- 2664890 TI - Tryptophan availability, 5HT synthesis and 5HT function. AB - 1. Tryptophan increases 5HT synthesis, but the extent to which it increases 5HT release and therefore 5HT function is unclear. 2. The possibility that increased 5HT levels will lead to increased 5HT release is enhanced when 5HT neurons are firing at a higher rate. The rate of firing of 5HT neurons is increased as the level of behavioral arousal increases. Thus, altered tryptophan levels will be more likely to influence brain function at higher levels of arousal. 3. In the rat, tryptophan administration increased CSF 5HT appreciably when the animals were aroused by being put in the dark, but not when they were left in a lighted room. 4. In monkeys, the level of behavioral arousal does seem to influence the effect of altered tryptophan levels on aggression. This is consistent with the fact that altered tryptophan levels had no effect on aggression in normal subjects, but that tryptophan had a therapeutic effect in pathologically aggressive patients. 5. The confusing literature on the antidepressant effect of tryptophan can, to some extent, be explained by considering the circumstances in which tryptophan administration will lead to increases in 5HT release as well as increases in 5HT synthesis. 6. Although in some circumstances tryptophan can decrease pain perception by activation of spinal 5HT pathways, when it was given to postoperative patients it attenuated morphine analgesia by activation of a 5HT pathway in the brain. 7. The effect of altered tryptophan levels depend critically on the circumstances in which it is given. PMID- 2664891 TI - Metabolism of monoamine oxidase inhibitors. AB - 1. Despite the fact that monoamine oxidase inhibitors have been used clinically and in animal experiments for many years, much still remains unknown about their metabolism. An overview of the metabolic aspects of several monoamine oxidase inhibitors, including phenelzine, tranylcypromine, pheniprazine, pargyline and deprenyl, is presented. 2. There is still considerable controversy surrounding the role of acetylation in the metabolism of phenelzine. The possibility of ring hydroxylation as well as the formation of beta-phenylethylamine, phenylacetic acid and rho-hydroxyphenylacetic acid from phenelzine is explored. 3. Tranylcypromine has been shown to undergo acetylation and ring hydroxylation. Opening of the cyclopropyl ring is also possible, although this still remains a matter of debate. The pharmacological activity and pharmacokinetic properties of the enantiomers of tranylcypromine are discussed. Chemical substitution in the 4 position of the phenyl ring has been utilized in the design of tranylcypromine analogues with potential antidepressant activity. 4. The formation of amphetamine from pheniprazine and the metabolism of the N-propargyl drugs pargyline and deprenyl are discussed. PMID- 2664892 TI - Metabolic implications of chiral centres in psychotropic drugs. AB - 1. Various drugs of neuropsychopharmacological importance contain one or more chiral centres, or centres of asymmetry are introduced during drug metabolism. 2. A drug or drug metabolite with one asymmetric centre exists in two enantiomeric forms, of which usually only one possesses the desired pharmacological activity. The other enantiomer may be inert, or possess an undesired activity. 3. In certain circumstances it is appropriate to administer the racemic drug (mixture of enantiomers), while on other occasions only the pure enantiomer which possesses the desired activity should be given. 4. Drugs employed in psychiatry that contain centres of asymmetry, or are metabolized to pharmacologically active chiral products are identified and implications of chirality are discussed. PMID- 2664893 TI - Sleep architecture changes in depression: interesting finding or clinically useful. AB - 1. Since the late 1970's, considerable progress in the description and quantification of EEG sleep changes in depression has been made. A consistent finding in the sleep of depressed patients is a shortening of the time from sleep onset to the appearance of the first REM period (short REM latency) suggesting that this finding might be used as a clinical test to differentiate depressed from nondepressed patients. 2. Sleep architecture changes in depression are described and factors influencing REM sleep are identified. The stability of REM sleep abnormalities and the specificity of these changes for depression are discussed. Methodological issues, which have been identified as possible contaminants affecting the reliability of research findings, are described before the author concludes with a summary of current obstacles to using polysomnography in the clinical assessment of depressed patients. PMID- 2664894 TI - Functional interactions of 2-phenylethylamine and of tryptamine with brain catecholamines: implications for psychotherapeutic drug action. AB - 1. The relevance of trace amine research is outlined for PEA and T in the context of psychotherapeutic drug action, particularly in relation to the actions of MAO inhibitor antidepressant drugs. 2. Evidence for the neuronal localization of these amines and their relationship to brain catecholamines is discussed with respect to possible co-localization with DA and their distribution within the nigro-striatal/striato-nigral system. 3. The results of recent experiments assessing the behavioural effects of prodrugs for PEA and T are described. The interactions of these compounds with MAO inhibitors are assessed and the actions of PEA prodrugs are discussed in relation to brain DA systems. 4. Recent evidence for functional decreases in beta-adrenergic receptors following chronic administration of MAO inhibitors is outlined. The lack of association of such effects with the percentage of MAO inhibition observed after these treatments indicates influences of these compounds (or metabolites) on factors other than MAO activity as mediators of these effects. The possible role of PEA (as a metabolite of PLZ) in this context is proposed. The possible involvement of PEA in emergent changes in beta-adrenergic receptors induced by chronic antidepressant drugs is hypothesized in relation to ongoing research. PMID- 2664895 TI - Functional compensation afforded by grafts of foetal neurones. AB - 1. Adult neurones grafted to the adult nervous system show limited survival and growth potential. By contrast, certain foetal neurones of a defined age, when grafted to the damaged adult nervous system survive, and form a dense innervation of the host brain with morphologically defined synapses. Monamine containing neurones in the rat have these properties. In a number of model systems their ability to survive grafting to the adult brain has been demonstrated, the optimal conditions for their survival and the importance of endogenous growth factors continue to be investigated. 2. Lesions of the ascending dopamine pathways to the dorsal and ventral striatum result in profound motor disorders. Dopamine-rich foetal neurones from the mesencephalon grafted as blocks of tissue or as cell suspensions provide a rich innervation to the dopamine-depleted target areas and reverse many of these motor impairments. Similar models have been developed for the cholinergic innervation from the basal forebrain to the hippocampus and cortex. Cholinergic depletion of these forebrain structures impair performance on spatial memory tasks, which are reversed by grafts of foetal basal forebrain neurones to cortex or hippocampus. 3. The grafting model is a powerful tool with which to define the functional role of neurotransmitters in brain function. The neurological properties of foetal monoamine and cholinergic neurones which underlie their ability to afford functional compensation to the damaged nervous system and their vulnerability in certain degenerative diseases of the CNS in man remain obscure. PMID- 2664896 TI - Translational control of gene expression in the human brain. AB - 1. Translational control is the regulation of protein synthesis as an alteration in the efficiency of mRNA translation and is a common mechanism by which cells regulate gene expression. 2. Alternations of total protein synthesis are often the responses of cells to various stress stimuli including starvation, viral infection, and heat shock. 3. Numerous specific genes including ferritin heavy chain, tubulin, vimentin and the lck proto-oncogene have also been shown to be under translational control. 4. Unlike cultured cells or intact organisms, the investigation of translational control in the human brain requires the measurement of components of protein synthesis, especially polysomes. Therefore, we have purified and characterized polysomes from human postmortem brain tissues and compared them to polysomes purified from the adult rat brain. 5. The yield (as A260 units per gram brain tissue), size (as number of ribosomes per message), translational efficiency (as amount protein synthesized per A260 unit), and ability to reinitiate (as amount of protein synthesis prevented by initiation inhibitors) were all significantly lower as exhibited by the human polysomes compared with the rat polysomes. However, the human and rat polysomes synthesized similar polypeptides. 6. Thus, the human polysomes differed from the rat polysomes principally in the efficiency of mRNA translation which is likely due to the greatly reduced ability of the human polysomes to initiate protein synthesis. PMID- 2664897 TI - Autonomic hyperreactivity and risk for alcoholism. AB - 1. Studies which illustrate autonomic hyperreactivity in sons of alcoholics are reviewed and discussed. This response is elicited by a wide range of stimuli which vary from the stressful to the incidental. It also occurs independently of coping strategy. This hyperreactivity, which is particularly characteristic of multigenerational sons of alcoholics is significantly dampened by alcohol. This pattern of results supports a negative reinforcement model of alcohol abuse in these individuals. PMID- 2664898 TI - [Structure and function of NADH-quinone oxidoreductase in respiratory chain]. PMID- 2664899 TI - [Arginylendopeptidase]. PMID- 2664900 TI - [Molecular aspects of mating reactions and sexual interactions in ascosporogenous yeasts]. PMID- 2664901 TI - Pronounced reduction of in vivo prostacyclin synthesis in humans by acetaminophen (paracetamol). AB - The effect of a single dose of 500 mg acetaminophen (paracetamol) on the in vivo synthesis of prostacyclin was studied in healthy volunteers by measurements of the urinary excretion of 2,3-dinor-6-keto-PGF1 alpha. Acetaminophen caused a marked reduction of prostacyclin synthesis for 6-8 hours without any obvious effect on the thromboxane synthesis. Thus, acetaminophen may at least theoretically be disadvantageous for patients suffering from diseases where prostacyclin mediated vascular defence mechanisms are activated, like myocardial infarction, deep vein thrombosis and following surgery. PMID- 2664902 TI - [Psychoanalysis, romantic nature philosophy and German idealistic thinking]. AB - The author examines the historical roots of Freud-revision at the Stuttgart Institute of Psychotherapy and Depth Psychology during post-war times. There had been strivings then for a synthesis of Freud's materialistic analytic theory, the holistic worldly-spiritual theory especially of C. G. Jung and philosophical anthropology. The author suggests that this revision of Freud's theory and thoughts is based on specifically German traditions of romantic and idealistic thinking which predestined the willingness of psychoanalysts to participate in the integration of psychotherapeutic schools being prescribed by the Nazi-regime and also having determined the continuation of this "synoptic" project after the end of the "Goring-Institut". PMID- 2664903 TI - Clinical management of psychiatric disorders in HIV spectrum disease. PMID- 2664904 TI - Psychoneuroimmunology and human immunodeficiency virus infection. PMID- 2664905 TI - Medical aspects of HIV spectrum disease. PMID- 2664906 TI - The neuropsychological aspects of HIV-1 spectrum disease. AB - A relatively high prevalence of neuropsychological impairment has been reported among individuals within the spectrum of HIV-1 disease. These deficits range from mild motoric slowness to a severe dementia characterized by forgetfulness, psychomotor slowing, impaired performance on "frontal systems" tasks, and frequently, dysphoric affect. This paper reviews the preliminary evidence to date on the prevalence and pattern of neuropsychological deficits within the spectrum of HIV-1 infection. Common methodologic pitfalls in this research arena are reviewed. Finally, implications for clinical practice are discussed, with emphasis on construction of screening and more comprehensive neuropsychological test batteries specifically for this population. PMID- 2664907 TI - Risk reduction for transmission of human immunodeficiency virus in high-risk communities. PMID- 2664908 TI - Social support and HIV spectrum disease: clinical and research perspectives. PMID- 2664909 TI - Cell proliferation kinetics in human solid tumors: relation to probability of metastatic dissemination and long-term survival. AB - A large number of studies have investigated the relationship between the long term survival and the percentage of tumor cells in S phase assessed by autoradiography after tritiated thymidine labelling, image cytometry, flow cytometry or labelling with an halogenated analog of thymidine, in various types of human solid tumors. The survey of the results clearly shows that the S-phase fraction (SPF) is of high prognostic significance in several types of cancers, in particular in breast cancers, non-Hodgkin lymphomas, ovarian cancers, neuroblastoma, bladder cancers and lung cancers. SPF was found of high independent significance in 10 of the 11 studies in which multivariate analyses of prognostic factors had been carried out. Proliferation appears generally to be of higher prognostic significance than ploidy. In view of the wide differences in the biological characteristics of the tumors studied, it is likely that the association between a high proliferation rate and the degree of tumor aggressiveness is a general feature of human solid tumors. However, high proliferative rate of tumor cells is probably not the cause of tumor biological aggressiveness but a variable associated with it. The extent to which cells escape from the regulatory systems which control their proliferation appears to be a good index of tumor progression. PMID- 2664910 TI - The effect of actinomycin D on split-dose recovery and repopulation in jejunal crypt cells in vivo. AB - The effect of actinomycin D in combination with radiation on the survival of mouse jejunal crypt cells was measured using the microcolony technique. When administered 30 min before irradiation the drug was seen to enhance the cell killing of single doses of radiation. No significant changes in the rate or amount of repair in split-dose irradiation were found. Protracted split-dose intervals revealed cell repopulation commenced within 12 h after the first radiation dose. When given 6 h post-conditioning dose actinomycin D did not inhibit cell repopulation. PMID- 2664911 TI - Drug therapy in elderly patients: diagnosis of drug-related problems. AB - Given the multiple diseases and vulnerability of the elderly to develop adverse drug effects, it is incumbent on the nurse to monitor and critically evaluate the patient's conditions. Attempts must be made to further develop and/or refine existing systematic process to delineate and prevent drug-related health problems. Non-drug form of treatment or use of the fewest possible medications (three or less) must always be considered. The wide variation from one elderly individual to another requires careful individualized monitoring of drug effects on an ongoing basis. Knowledge of geropharmacology and continuous study of new drugs and their effects are essential to recognize actual and potential drug related problems and promote the health, and safety of elderly individuals. PMID- 2664912 TI - Articulation of a nursing theoretical framework within institutional environments for our aging adults. PMID- 2664913 TI - [Ultrasonic diagnosis and other techniques of forming an image. Inaugural address presented at the MEDI-ECO Congress. Palermo, 28-30 April 1989]. PMID- 2664914 TI - [Ultrasonic diagnosis and clinical medicine. Inaugural address from the President of the Italian Society of Ultrasonics in Medicine and Biology at the MEDI-ECO Congress. Palermo, 28-30 April 1989]. PMID- 2664915 TI - [The role of echography in the diagnosis of neonatal clavicular fractures]. AB - The authors' aim was to investigate the utility of US in the diagnosis of clavicular fractures in neonates. The technique, which is quite simple, consists in obtaining longitudinal scans of the bone by directing the probe along its axis. Ten cases of clavicular fracture were demonstrated in 11 neonates. Some patients were reexamined after 15 days to investigate fracture healing. After US examination, plain X-rays were always performed and the results compared: perfect correspondence was demonstrated between US and X-ray findings. Since clavicular fractures have a very good prognosis, this affection only needs documenting, for which purpose US can fully replace conventional X-rays, being quite simple to perform and avoiding the use of ionizing radiations, though yielding the same diagnostic results. PMID- 2664916 TI - [Gastric lymphomas. The role of echotomography]. AB - Even after the advent of endoscopic ultrasonography, conventional US can still be useful in the follow-up of advanced gastric lymphomas. Typical US pattern is (diffuse) hypoechoic thickening of the gastric wall. The conventional US findings, together with the barium examination, the endoscopic, histological and CT results were retrospectively (5 patients) and prospectively (5 patients) evaluated and compared of 10 patients with primary (n = 4) or secondary gastric lymphomas. Normal US gastric thickness was assessed as less than or equal to 7 mm. Four unresectable patients with secondary non-Hodgkin lymphomas underwent chemotherapy; their conventional US follow-up has been shown to correspond to CT findings and endoscopically-guided biopsies. Preliminary results show that increased echogenicity and reduced thickness in conventional US scans correspond to regression of the disease. The maximum gastric wall thickness found after chemotherapy was 10 mm, due to residual scarring. PMID- 2664917 TI - [Ultrasonography in abdominal emergencies]. AB - From February 1986 to March 1988 113 abdominal US exams were performed in emergency situation to evaluate the accuracy of this methodology: 13 were blunt traumas, 18 postoperative complications. A real-time scanner with a linear probe of 5 MHz was employed. The results were confirmed by surgical and/or clinical and instrumental evaluation. In 81% of the examinations, ultrasonography allowed a diagnosis to be made. Gallbladder and biliary pathologies were the most common findings. The results (sensibility 96%, specificity 88%, accuracy 95%) confirm the reliability of ultrasonography in abdominal emergencies, as shown in literature. PMID- 2664918 TI - [Varicography in the preoperative assessment of primary varices. A study of 100 cases]. AB - Primary varicose veins in the lower limb are usually well evaluated by the surgeon, who avails himself of tourniquet tests and Doppler US. However, the operation is often followed by failure or recurrence, or else it requires ugly skin dissection to eradicate an unforeseeably complicated varicose vein. We suggest that, whenever the surgeon considers the information obtained with tests and Doppler US inadequate for planning surgery, varicography be performed to get further morphological (and functional) data about the origin of varicose veins, which is of fundamental importance for an accurate surgical planning (cross section stripping, ligation, sclerosis). Out of 100 varicographies consecutively carried out on patients in whom clinical examination was not conclusive, 62% allowed an already planned surgical approach to be changed. The figure rose to 100% in case of unusual varicose veins. Such a result allowed the needs of both the surgeon (selectivity, effectiveness, radicality) and the patient (narrow scars, absence of relapse) to be respected. Furthermore, it has been pointed out that some vein segments are often only pathological, and they are to be adequately treated, while others can be undamaged, and they are to be preserved for both their function and an eventual by-pass surgery. Varicography is rapidly performed, without complications, and is well accepted by the patient. It is a fundamental help in the preoperative study of primary varicose veins, especially in case of unusual ones, whenever the surgeon is in the slightest diagnostic--and therefore surgical--doubt. PMID- 2664919 TI - [Treatment technic and clinical dosimetry in whole-body irradiation]. AB - At the Istituto Nazionale Tumori, Milan, total-body irradiation (TBI) is delivered by a 15 MV linear accelerator, with two lateral opposed beams. Maximum build-up at the skin is achieved by lateral slabs of perspex 3 cm thick. Attenuation filters or bolus are used for dose compensation, or reduction, to the head and lungs. The dose delivered to clinically relevant anatomic regions is determined by "in vivo" dosimetry. For this purpose, calibrated diodes are employed, which are positioned at the entrance and at the exit of the beams. "In vivo" dosimetry data show our TBI technique to allow an homogeneous irradiation of all body areas, with maximum deviation of the mean dose value from reference point dose of -11% in the posterior abdomen, at the spinal cord shielded by arms. PMID- 2664920 TI - [Radiation exposure of the embryo and the fetus: real risks or unjustified fears?]. AB - The authors discuss the problem of radiation damage to the individual developing in utero, and summarize the information available in the literature on the subject. Additional risks induced by ionizing radiations are classified with reference to gestational age and dose absorbed by the fetus. Such risks concern the possibility of mental retardation from the 8th to the 15th gestational week, and of developing a malignant disease from the 3rd to the 15th gestational week. We report the dose values received by the fetus as a result of both radiodiagnostic examinations and the Chernobyl nuclear accident: the doses were generally very low, which leads us to the conclusion that additional risks are of the same order of magnitude as the fluctuations in the natural congenital malformations. Thus, prenatal irradiation for diagnostic examinations does not generally represent a reason to recommend therapeutic abortion. However, it is always important to carry out a careful evaluation of the dose absorbed by the fetus and to correctly inform the mother about eventual radiation-induced risks. PMID- 2664921 TI - [Distension of the mucous bursa of the iliopsoas muscle: a rare expansive process of the pelvic cavity]. PMID- 2664922 TI - [Vesical endometriosis. 2 case reports]. PMID- 2664923 TI - [Echotomographic diagnosis of a case of schwannoma of the median nerve]. PMID- 2664924 TI - [Role of insulin and counter-regulatory hormones in the metabolic changes caused by insulin deprivation in diabetic patients]. AB - In eight insulin dependent diabetic patients treated by continuous subcutaneous insulin infusion (1.1 +/- 0.2 U/h), the levels (measured hourly from 23 h to 05 h) of blood glucose, non esterified fatty acids (NEFA), glycerol and 3-OH butyrate (3-OH-B) have been correlated to the circulating levels of free insulin (FIRI), glucagon, growth hormone or cortisol, in two experimental conditions: A. Insulin being infused as usual (physiological FIRI levels) and B. Progressively declining FIRI levels (insulin infusion arrested at 23 h). In condition A, blood glucose levels correlated significantly to both insulin and glucagon; NEFA, glycerol and 3OH-B correlated only to insulin. In condition B, blood glucose was significantly correlated to insulin but not to glucagon while NEFA, glycerol and 3-OH-B were significantly correlated to both hormones but not to growth hormone or cortisol. Therefore, on the metabolic deterioration that follows insulin withdrawal, growth hormone and cortisol seem to play a minor role, the main role being played by the decrease in circulating insulin levels and to a lesser extent by the increase in glucagon levels. PMID- 2664925 TI - Sexuality concerns of the post-stroke patient. AB - Sexuality concerns of the post-stroke patient often are overlooked in the clinical setting during rehabilitation and post-discharge care. Research has indicated that patients welcome frank and open discussion of the topic, although it seldom occurs. Research findings also indicate that changes in sexuality after a stroke often are due to changes in role function because of the increased dependency of the afflicted partner. This article discusses the research related to sexuality in the post-stroke patient, as well as indicators of sexual dysfunction in this population. Research findings are related to nursing care. Specific patient examples are given, along with suggestions for incorporating assessment of sexuality concerns into nursing care of the post-stroke patient. PMID- 2664926 TI - [Use of nonradioactive probes to detect the gene for 3-aminoside acetyltransferase type IV in strains of Escherichia coli and Salmonella spp]. AB - Forty-three isolates of Escherichia coli, Salmonella dublin and S. thyphimurium of animal origin were studied by colony hybridization using an intragenic probe specific for the gene encoding 3-aminoglycoside acetyltransferase type IV, which confers resistance to apramycin and gentamicin. Non-radioactive biotinylated and sulphonated DNA probes were used. No false-positive results were found and the positive results obtained were in agreement with those previously revealed with radioactive probes. PMID- 2664927 TI - Rapid identification of Mycobacterium species. AB - Identification of Mycobacterium species is currently a long and fastidious procedure. We have developed a rapid (5-h) standard method using the API-ZYM system and rapid nitratase, urease and catalase tests. Pigmentation and growth rate were noted (but were only necessary for complete identification of 6% of strains). The tests were assigned numerical values from which a profile number was derived. A total of 716 strains were studied: 434 belonging to the M. tuberculosis complex and 282 other mycobacteria including 21 from M. avium complex. All M. tuberculosis complex strains were differentiated from all other mycobacteria and M. bovis was clearly separated from M. tuberculosis. All M. avium complex strains were differentiated from other mycobacteria. Among mycobacteria other than tubercle bacilli, 97% of the strains studied were identified. The method has proven to be simple, rapid and standardizable. It is suggested that the use of a code list could permit identification of most mycobacteria. PMID- 2664928 TI - Doubling time of Mycobacterium lepraemurium in mouse footpads. AB - The doubling time of Mycobacterium lepraemurium (MLM) was measured in CBA/Ca mice. In eight experiments, 5 X 10(3) MLM were inoculated into the hind footpads of groups of mice, and the organisms were harvested from 1-45 days later. The harvested organisms were enumerated, and the doubling time was calculated assuming that MLM had multiplied without a lag phase and that multiplication continued at a constant rate from inoculation to harvest. Simultaneously, the proportions of viable organisms in the inocula were determined by inoculation of serially diluted suspensions into the footpads of other mice, harvesting 4 months later and calculating the most probable number. MLM were observed to multiply rapidly during the first several days, and more slowly thereafter; the mean initial doubling time was determined to be 0.5 days, a value much smaller than those previously reported by other workers. PMID- 2664929 TI - [Early administration of antibiotic susceptible strain of Escherichia coli in the intestine of the premature infant]. AB - An antibiotic-susceptible, innocuous Escherichia coli strain of human origin was administered to premature infants in order to protect them from nosocomial colonization by antibiotic-resistant enteric organisms. The strain was given to 16 untreated patients in the first six hours of life, and to 11 patients treated with antibiotics in the first six hours after cessation of treatment. The strain was able to colonize the intestinal tracts of all treated infants and 14/16 untreated infants. Colonization of these patients by antibiotic-resistant enteric organisms was compared with results obtained in a control group of 15 unadministered and untreated infants. A significant difference was recorded in the first ten days after administration. Our results show that previous antibiotic treatments did not impair intestinal colonization by an antibiotic susceptible strain, and demonstrate the in vivo antagonistic abilities of the administered strain. Such antagonistic strains might thus be used for control of nosocomial infections of intestinal origin due to antibiotic-resistant enteric organisms. PMID- 2664930 TI - [Effects of tachykinins on respiratory epithelial functions]. PMID- 2664931 TI - [A clinical study of pulmonary edema on paraquat poisoning by double indicator dilution method using heat and sodium]. AB - We studied the formation of pulmonary edema on 9 patients with paraquat poisoning using thermal-sodium double indicator dilution method for the measurement of lung water. In survivors group (n = 4) extravascular thermal volume (EVTV) was not almost changes. In non-survivors group (n = 5) EVTV increased about three times as much as that in survivors group on 32 hours after admission. EVTV was correlated with PCP-PCOP in both survivors group and non-survivors group (n = 64, r = 0.665, p less than 0.01). But EVTV in non-survivors group was higher than that in survivors group within same PCP-PCOP. In non-survivors group delta EVTV/delta (PCP-PCOP) in 24 hours after admission was correlated with initial PCP PCOP (r = 0.984, p less than 0.01). We propose that the formation of pulmonary edema on paraquat poisoning is mainly due to the increased capillary permeability, influenced by the increased pressure gradient of capillary barrier. PMID- 2664932 TI - [A case of mitral stenosis with left atrial thrombus arose and reduced in a short term]. AB - A case of mitral stenosis with left atrial thrombus which rapidly arose and reduced within a month was reported. A 61-year-old female was admitted to our hospital on November 14, 1986 because of a syncopal attack due to ventricular tachycardia. On admission she had typical auscultatory signs of mitral stenosis, mild hepatomegaly and no neurological abnormality. Laboratory findings included coagulation studies were normal, and atrial fibrillation was noted on ECG. Heart catheterization revealed low cardiac output, the mitral orifice area to be 2.4 cm2 and left ventriculography showed mild mitral regurgitation. Ventricular tachycardia was controlled following improvement of heart failure. On two dimensional echocardiography performed on December 24, left atrial thrombus was revealed which was not detected on December 3. Through the continuous administration of warfarin and aspirin to prevent the thrombus' growth, it markedly reduced in size, from 3 x 2 x 4.5 cm on December 24, 1986 to 1.5 x 1 x 2.5 cm on January 30, 1987 without systemic embolism. Then a mitral valve replacement and a left atrial thrombectomy were performed on February 3, with the removal of a red thrombus, partially organized, measuring 1 x 0.7 x 2.5 cm. This case is unique in its clinical outcome and further investigation is necessary for the management of patients as our case. PMID- 2664933 TI - The ventilatory response to lowering potassium with dextrose and insulin in subjects with hyperkalaemia. AB - Arterial plasma potassium concentration ([ K+]a) is increased during exercise. This change is sufficient to excite arterial chemoreceptors and stimulate ventilation (VE) in the anaesthetized cat. Moreover, changes in [K+]a and VE are highly correlated during exercise, however the contribution that [K+]a makes to the control of breathing in man is not yet known. Four otherwise relatively healthy male hyperkalaemic renal patients had their VE measured before, during and after an intravenous infusion of dextrose and insulin to lower their [K+]a. Thirty-six minutes after the infusion began [K+]a had been reduced by ca. 2 mM. Ventilation was virtually unchanged throughout the experiment. These results suggest that [K+]a does not significantly affect VE in this group of subjects. The assumptions that would need to be made to extrapolate this conclusion to the general population are discussed. PMID- 2664934 TI - Pneumocystis carinii pneumonia in patients with the acquired immunodeficiency syndrome: pathophysiology, therapy, and prevention. AB - The continuing growth of the acquired immunodeficiency syndrome (AIDS) epidemic has caused a parallel increase in patients with Pneumocystis carinii pneumonia (PCP). PCP has a wide spectrum of severity, from mild disease to severe parenchymal lung damage. Outcome is determined by severity of lung injury, the underlying physical condition of the patient, and concomitant infections. Both trimethoprim-sulfamethoxazole (TMP-SMX) and pentamidine are effective therapeutic agents; however, both cause a high incidence of adverse reactions. TMP-SMX therapy can be made safer by careful monitoring and dose adjustment. Pentamidine toxicity, especially hypoglycemia, appears to be cumulative dose-dependent. Experimental therapies, including TMP-dapsone and aerosolized pentamidine, appear promising in mild to moderate disease, while trimetrexate may be more effective in severe disease. Corticosteroids are unproven in decreasing mortality. Prophylaxis of PCP is possible with TMP-SMX but the high rate of adverse reactions make long-term therapy difficult. Other oral therapies such as dapsone, pyrimethamine/sulfadoxine are also promising but not yet tested. Aerosolized pentamidine is effective and safe for prophylaxis regimen when administered correctly. Airway irritation as manifested by cough and/or wheezing is a common adverse effect of aerosolized pentamidine. PMID- 2664935 TI - Tuberculosis and human immunodeficiency virus infection. AB - Because of the abnormalities of host defenses caused by the human immunodeficiency virus (HIV), persons with HIV infection are vulnerable to tuberculosis. Inferential data from several parts of the country indicate increases in tuberculosis case rates, probably occurring in patients with HIV infection. In a person infected with both HIV and Mycobacterium tuberculosis, attack rates of tuberculosis seem to be very high. In general, the disease tends to occur earlier in the course of HIV infection than other opportunistic processes that serve to define the acquired immunodeficiency syndrome (AIDS), presumably because M tuberculosis is more pathogenic than Pneumocystis carinii or Mycobacterium avium complex, for example. The clinical features of tuberculosis in this patient population seem to vary depending on the stage of the HIV infection. Late in the process, tuberculosis usually has atypical features with chest films showing diffuse infiltration, no cavities, and intrathoracic adenopathy. Tuberculin skin tests commonly are negative. At earlier stages of HIV infection, the clinical findings are similar to those in HIV-seronegative persons. Response to treatment is generally good; however, it is recommended that the standard duration be at least 9 months, using isoniazid and rifampin usually supplemented by pyrazinamide in the first 2 months. The use of isoniazid for preventive therapy is recommended for all HIV-seropositive persons who have tuberculin skin test reactions greater than or equal to 5 minutes. Those implementing infection-control measures for HIV-infected patients who have pulmonary findings should take tuberculosis into account until the disease is excluded. Medical personnel providing care for patients with tuberculosis should use universal blood and body substance precautions because of the possibility of undetected HIV infection in patients with tuberculosis. PMID- 2664936 TI - Mycobacterium avium complex and other nontuberculous mycobacteria in patients with HIV infection. AB - Nontuberculous mycobacteria (NTM) have been frequently identified as opportunistic pathogens in individuals with advanced human immunodeficiency virus (HIV) infection. The majority of these infections have been caused by members of the Mycobacterium avium-intracellulare complex (MAC). Disseminated MAC infection has generally been diagnosed late in the course of HIV infection, and it is often associated with persistent nonspecific symptoms of fever, generalized weakness, and weight loss. Abdominal pain and/or diarrhea with malabsorption may also occur in some patients. Despite frequent isolation of MAC organisms from respiratory secretions in these patients, significant pulmonary involvement has not been seen commonly with disseminated MAC infection. While MAC can be isolated from a variety of clinical specimens in infected individuals, culturing of blood is the single most useful diagnostic procedure to evaluate for MAC infection. The prognosis for disseminated MAC infection in HIV-infected patients has been poor, with a reported median survival of 7.4 months after diagnosis. The overall contribution of MAC infection to mortality in these patients has not been clearly delineated. Treatment of MAC infection in HIV-infected individuals using a variety of drug regimens has not been effective in clearing mycobacteremia or improving overall survival in the majority of patients. However, initiation of drug therapy for MAC may decrease the severity of disease symptoms in some patients. Several NTM other than MAC have also been reported as causing infection in HIV-infected patients. Many of these organisms are ubiquitous in the environment and are frequent colonizers of biologic specimens. Although many NTM are regarded as relatively avirulent, these organisms need to be recognized as potentially important pathogens in HIV-infected patients with significant immunosuppression. PMID- 2664937 TI - Effects of human immunodeficiency virus on pulmonary host defenses. AB - The ability of a microorganism to establish pulmonary infection depends not only upon its pathogenicity, but also on its ability to overcome host defense mechanisms. The frequency of pulmonary infections in patients with the acquired immunodeficiency syndrome (AIDS) suggests that pulmonary host defenses are compromised. The defense capabilities of the upper and lower airways, which prevent the majority of infectious organisms from reaching the lungs in healthy individuals, are not well characterized in AIDS. In the lower respiratory tract, direct infection of pulmonary alveolar macrophages by the human immunodeficiency virus may alter clearance of microorganisms. It is also likely that soluble signals required to activate alveolar macrophages are deficient in AIDS. Peripheral T and B lymphocytes from AIDS patients do not respond to antigen normally, and the resultant defects in cellular and humoral immunity may impair defenses against a variety of pulmonary pathogens. The defective microbicidal function of polymorphonuclear leukocytes from AIDS patients, and reduced migration of blood leukocytes into the lungs, may result in an insufficient cellular response to an infectious challenge. As the multiple defects in pulmonary host defenses associated with AIDS become characterized more fully, effective interventions for prevention and treatment of AIDS-related pulmonary infections can be developed. PMID- 2664938 TI - [Identification of group B beta hemolytic Streptococcus in infections of adults and children]. AB - The frequency of isolation of group B beta-hemolytic streptococcus was investigated in samples from the skin, genitourinary tract and respiratory tract in adults and children, in 2 periods, 1977-79 and 1984-86. Hydrolysis of sodium hippurate or bile and sensitivity to bacitracin were used to identify the germ. Serologic group was confirmed by coagglutination. The incidence of isolation increased from 6.1% (n = 18) to 28.7% (n = 119) from the first to the second period, ranking second among all S groups. Isolation from blood and from spinal fluid in newborns was observed only in the second period. PMID- 2664939 TI - [Cutaneous angiitis: direct immunofluorescence and morphopathology in 23 cases]. AB - We reviewed the findings in 23 patients with histologically diagnosed cutaneous angiitis, between 1981 and 1985. There were 8 males and 15 females, with a mean age of 43 years. Four histological patterns were identified: leukocytoclastic angeitis in 9 (31%), lymphocytic angeitis in 8 (35%), capillaritis in 2 (9%) and minimal alterative angeitis in 4 (17%). Serum complement levels were normal in 56% and low in the remainder. Fourteen patients (61%) showed positive direct immunofluorescence for complement fractions and different immunoglobulins in skin lesions. All cases with lymphocytic angeitis yielded a positive reaction as compared to only 66% in leucocytoclastic angeitis. No correlation was found between serum complement levels and histologic pattern of angeitis. The present results suggest that direct immunofluorescence in diseased skin is a more sensitive procedure for identifying active cutaneous angeitis. PMID- 2664940 TI - [Beta 2 microglobulin in some hematologic neoplasms]. AB - Beta 2 microglobulin is a low molecular weight protein integrating the light chain HLA antigens. Its serum concentration is increased in different neoplasias and in renal failure. Using solid phase RIA we determined the concentration of beta 2 microglobulin in plasma and spinal fluid of 57 healthy individuals and patients with hematologic neoplasia. Serum levels were 1.34 +/- 0.34 mg/l and spinal fluid levels were 1.3 +/- 0.7 mg/l in healthy subjects. Serum levels in 29 patients with myeloma was 7.51 mg/l, significantly higher in those with renal failure (12.35 mg/l) compared to those without (4.54). In 30 patients with non Hodgkin lymphoma the mean serum levels were 2.90 mg/l, significantly greater in those with active disease (3.18) than in those with remission (1.5). No difference was found according to the degree of malignancy. Patients with acute lymphatic leukemia had elevated values of beta 2 microglobulin while the disease was active (3.37 mg/l), decreasing to normal levels after remission (1.79 mg/l). Spinal fluid levels of beta 2 microglobulin were elevated only in patients with central nervous system involvement. Our results indicate that serum levels of beta 2 microglobulin are helpful in patients with hematologic neoplasia in assessing the activity of the disease and tumor mass, especially in multiple myeloma. PMID- 2664941 TI - [Splenic abscess]. AB - Splenic abscess is an uncommon condition associated with a high mortality. In most cases an hematogenous focus can be identified. Early diagnosis is essential for recovery. CT scan and ultrasound tomography are the best diagnostic tools. The latter was used to establish the diagnosis in 2 patients who were successfully treated by surgery. PMID- 2664942 TI - [Hepatorenal syndrome]. AB - The clinical and laboratory features of this syndrome are reviewed, with special emphasis upon different mechanisms that may be involved in its pathogenesis. PMID- 2664943 TI - Nutrition and health. PMID- 2664944 TI - Occupational health services in the Nordic countries--organization, tasks, trends and problems. PMID- 2664945 TI - Review of experience gained in 40 years occupational medicine and over 20 years teaching. PMID- 2664946 TI - Occupational health services in the United States. PMID- 2664947 TI - Epidemiological and experimental applications to occupational cancer prevention. AB - At present, there is a whole array of risk factors, such as industrial chemicals, drugs, pesticides, complex chemical mixtures, physical and biological agents, for which there is a proven causal relationship with human cancer. The epidemiological studies are essential in providing proof for a causal relationship in humans. However, the epidemiological approach to the identification of the etiology of cancer is limited for two main reasons: only relatively high risks can be detected; and, secondly, the epidemiological surveys are based on observations of the effects as a consequence of an exposure that took place many years before. It can be estimated that epidemiological cancer research on common types of tumours is able to detect risk levels ranging from 5 x 10(-2) to 10(-3). This is, of course, far from commonly defined "acceptable risk" of 10(-5) - 10(-6). Frequently, negative epidemiological studies are thought to provide evidence of non-carcinogenicity, even though the exposure levels were so low that no such effect could even be expected. While the epidemiological studies have their greatest limitation in not being able to detect a low risk, that is to produce "false negative" results, carcinogenicity tests in experimental animals have been criticized in producing "false positive" results, i.e., in picking up cancer risks at very high exposure levels. Some investigators hold that the relatively high exposure levels given to experimental animals often results in carcinogenicity because of compensatory cell proliferation from toxic effects of the chemical, and accordingly, they have questioned the use of the Maximum Tolerated Dose (MTD). However, most of the chemicals determined to be carcinogenic would exhibit carcinogenic effects at exposure levels below the level of target organ toxicity. All epidemiologically proven human carcinogens which have been adequately studied, are also carcinogenic in laboratory animals. This does not necessarily mean that all animal carcinogens are human carcinogens. A more comprehensive evaluation of interspecies correlation between humans and rodents is limited by the lack of known human non-carcinogens. Nevertheless, the high interspecies correlation shown between rats and mice supports the view that extrapolation of carcinogenicity outcomes to other species, including humans, is appropriate. There is now a range of short-term laboratory tests which have been used to predict the results of long-term tests of carcinogenicity in mammalian species. Prediction is not entirely accurate, mainly because a fraction of carcinogens is active via a mechanism not employed by the short-term tests.(ABSTRACT TRUNCATED AT 400 WORDS) PMID- 2664948 TI - Mutagen, carcinogen and tumor promoter in daily life. PMID- 2664949 TI - Determination of carcinogen-DNA adducts by immunoassay. PMID- 2664950 TI - 32P-postlabeling assay for carcinogen-DNA adducts and other dna modifications. AB - 32P-postlabeling analysis is a recently developed, highly sensitive method for the detection and measurement of covalent DNA adducts. Since the method does not require radioactive carcinogens, it is suitable for DNA of humans exposed to environmental or occupational genotoxicants. The basic procedure entails the enzymatic incorporation of 32P-label into enzymatic digestion products of DNA, the chromatographic separation and autoradiographic detection of the 32P-labeled digestion products and their quantitation by scintillation counting. Since only microgram amounts of DNA are required, the assay is well suited for the analysis of DNA lesions whenever only limited amounts of cells or tissue may be available. Various versions of the assay have been described affording different sensitivities of adduct detection. Under optimal conditions, one aromatic or bulky/hydrophobic adduct in 10(8) - 10(10) nucleotides can be detected and measured (this corresponds to 0.0003 - 0.03 fmol adduct/microgram DNA or 0.1 - 10 nmol adduct/mol DNA-P). The assay has been successfully applied to a variety of mutagenic (genotoxic) as well as non-mutagenic carcinogens. Among the latter are estrogens and 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD). In addition, the assay detects age-dependent DNA modifications (I-compounds) in animals that have not been knowingly exposed to mutagens/carcinogens. In humans, the 32P-postlabeling assay has been applied to cigarette smokers, iron foundry workers and coke oven workers. Estimation of total aromatic adduct levels in exposed individuals gave values of 1 adduct in 10(6) - 10(8) DNA nucleotides. These values are similar to the total levels of persistent adducts in tissues of animals after exposure to initiating or carcinogenic doses of authentic aromatic geno-toxicants. PMID- 2664952 TI - Stress and cardiovascular disease. PMID- 2664951 TI - Metabolic activation of aromatic amine carcinogens in vitro and in vivo. PMID- 2664953 TI - Mutation in ras proto-oncogenes and malignancy. PMID- 2664954 TI - Congenital malformations as a consequence of parental exposure to radiation and chemicals in mice. PMID- 2664955 TI - Teratogenic effect of fission neutron and tritium water on rat embryo. AB - The method employed was to give a single whole body exposure of Cf-252 at various doses to pregnant rats on day 8 or 9 of pregnancy, performing microscopic autopsy of the fetuses at the terminal stage of pregnancy, and examining the external and internal organ anomalies. For comparison, an experiment was also made by irradiating pregnant rats with various doses of Co-60 standard gamma-rays at the same dose rate (1 rad/min.). As a result, relative biological effects (RBE) of 2.3-2.7 was obtained from the straight line that was given by modifying by the method of least squares the curves of the frequency of anomalous fetuses in total implants and survived embryos irradiated from 20 to 120 rad by Cf-252 and from 80 to 220 rad by Co-60 on day 8 of pregnancy. Further, the anomalies of Cf-252 and Co-60 irradiated cases were alike in their types of malformations. Using fetal LD50 as an index, 2.4 was obtained as the RBE of cases irradiated on day 8 of pregnancy and 3.1 as that of cases irradiated on day 9. The teratogenic effects of HTO on rat embryos were also examined and the results obtained were compared with those of tritium simulator (Cs-137 gamma-rays) for determining the RBE for the incidence of malformations. Six groups of pregnant rats were injected intraperitoneally with HTO containing 25, 50, 75, 100, 125 or 150 mCi HTO/300g B.W. on day 9 of pregnancy. To obtain accurate RBE values of HTO in rats, six groups of pregnant rats were exposed to Cs-137 gamma-rays by tritium simulator on days 9-18 of pregnancy at exponentially decreasing doses in accordance with body tritium concentration. The rats were sacrificed on day 18 and the offsprings were examined for external and internal malformations. Malformations were seen at the highest incidence of 100% of the survived embryos and 81.3% of total implants in the group given 100 mCi (accumulated doses were about 451 rad) of HTO on day 9 of pregnancy. Tritium simulator accumulated doses of Cs-137 gamma-rays irradiation at 680 rad induced 98.4% malformation in survived embryos and 71.7% of the total implants on day 9 of pregnancy. Both radiations (HTO and Cs-137 gamma-rays) induced similar anomalies of the cardiovascular system in rat embryos.(ABSTRACT TRUNCATED AT 400 WORDS) PMID- 2664956 TI - Some psychophysiological aspects of an Oriental method of stress reduction. AB - To summarize, SRM induces a state of relaxation as observed by psychological tests and by effects such as increases in the surface temperature of the hands. Such effects tend to occur from an early stage of training. Furthermore, SRM induces a state of "relaxed-alertness" as opposed to a drowsy state. A method to induce such a state of relaxation may be particularly suitable as a method of stress reduction in industrial settings, where a certain degree is vigilance is required. Currently, the authors are applying SRM in an industrial setting, hoping that such methods may result in stress reduction in a high-tech society. PMID- 2664957 TI - Psychological stress in the workplace. PMID- 2664958 TI - Physical works and cardiovascular disease--effect of exercise on the heart and current state of exercise therapy in Japan. PMID- 2664959 TI - Cardiovascular reactions to vibration stress. PMID- 2664960 TI - Estimation of sojourn time distributions and false negative rates in screening programmes which use two modalities. AB - Day and Walter derived methods of joint maximum likelihood estimation for the sojourn time distribution and the false negative rate for a screening programme. Their methods are not directly applicable to a programme which uses alternate screening by two modalities whose sojourn times and false negative rates will differ. A modification is proposed and the results applied to data from the Edinburgh Randomised Trial of Breast Cancer Screening. This enables the effects of mammography and clinical examination to be separated. It is estimated that in a programme using both modalities 79 per cent of tumours arising in regularly screened women would be detected by screening and if the clinical examination were omitted this figure would be reduced by 5 per cent. The confidence intervals are, however, quite wide. PMID- 2664961 TI - A new method of estimation of interobserver variation and its application to the radiological assessment of osteoarthrosis in hip joints. PMID- 2664962 TI - [Transfusional alloimmunization]. AB - In this condensed review, we present some of the most important mechanisms which induce allo-immunisation among patients who receive blood transfusions. The understanding of these mechanisms implies simple blood transfusion rules which guarantee the recipient's safety. PMID- 2664963 TI - [Value of POR 8 in the treatment of burns]. AB - Excision and skin grafting is the best treatment for burn wounds. In order to avoid excessive bleeding during the operation, sub-eschar infiltration with POR 8 (para ornithine 8 - vasopressin) has been performed in 115 patients between 1979 and 1984. The results being encouraging, infiltration was later also performed under the donor site. Bleeding was reduced enough by this technique to allow one stage excision and grafting of surfaces up to 20% of the body surface. No general or local complication of POR 8 infiltrations has been observed except a slight increase of blood pressure without clinical consequence. PMID- 2664964 TI - [Hairy cell leukemia: 30 years later]. PMID- 2664965 TI - [Corticosteroids and bone tissue]. PMID- 2664966 TI - [Cholesterol in 1989]. PMID- 2664967 TI - [Neurological complications of Paget's disease of bone]. PMID- 2664968 TI - [Leg ulcers and surgical repair]. PMID- 2664969 TI - [Clinical trials with ACTISORB--carried out on 20 cases of complex wounds]. PMID- 2664970 TI - [Cerebrovascular accidents in relation to drug consumption or drug abuse]. AB - Many drugs may cause cerebral infarction or hemorrhage. The authors describe the epidemiology and the physiopathological aspects of stroke in patients using anticoagulant therapy, oral contraception or ergot alkaloids. Cerebrovascular complications are also noticed in abusers of cocaine or other stimulants of the central nervous system: amphetamine, phenylpropanolamine, xanthines. PMID- 2664971 TI - [The diagnosis and treatment of diarrhea following travel]. PMID- 2664972 TI - [Pathogenesis of biliary cholesterol lithiasis]. PMID- 2664973 TI - [Depression]. PMID- 2664974 TI - Pain mechanisms underlying vascular headaches. Progress Report 1989. AB - Vascular headaches are among the most prevalent yet poorly understood problems in clinical neurology. Headaches may develop in association with hypertension, seizures, stroke or without a recognizable pathophysiology such as during migraine and cluster headaches. Cephalic blood vessels (pial and dural vessels) are implicated as the most important source for all headaches and are innervated by sensory fibers which arise from ganglia innervating the forehead, scalp and neck. Sensory fibers contain vasoactive neuropeptides which become released from peripheral (perivascular) and central terminations to mediate vasodilation and pain, respectively. The presence of vascular headache implies activation of this final common pain pathway which we have termed the trigeminovascular system. The presence of vascular headache implies activation of this final common pain pathway which we have termed the trigeminovascular system. The existence of such a system a) clarifies certain pain patterns which develop following stimulation of cephalic blood vessels, b) suggests a mechanism to explain the referral of pain to the forehead, c) provides a mechanism to explain the action of certain antimigraine drugs, d) suggests a local mechanism which enhances blood flow under certain pathological conditions. Hence, this review will update existing knowledge about the trigeminovascular system and its role in headache pathophysiology. PMID- 2664975 TI - [Neurologic involvement in campylobacter infections. 5 cases]. AB - Campylobacter are a newly recognized class of human infectious agents. Campylobacter fetus subspecies fetus is a cause of sepsis in immunocompromized hosts. Secondary neurological determinations, meningitis and meningoencephalitis appear to be rare. We report 2 cases, and 8 previously reported cases are reviewed. Campylobacter jejuni appears to be a common bacterial pathogen causing a syndrome of enteritis. Since 1982 it has been associated with Guillain-Barre syndrome (GBS). In one serological retrospective study, Campylobacter jejuni was the most common single pathogen identifiable in association with GBS, and these cases were significantly more severe. We report 3 cases with weakness and amyotrophy of distal limbs. Only 10 other cases have been found in the literature. Diarrhoea antedated the neurological illness by 4 to 21 days. In 4 syndromes of Miller-Fisher the prognosis was good. However electrophysiological axonal loss was reported in 6 GBS with poor functional prognosis. The pathogenic role of bacterial toxins and humoral immune response are discussed. Cross reactivity between Campylobacter jejuni and human sciatic nerve proteins has not been demonstrated using sera from patients with GBS and serological evidence of Campylobacter enteritis. PMID- 2664976 TI - [Cerebral vascular complications in the population of Dijon. Incidence-breakdown mortality]. AB - Since 1985, a stroke registry has registered every stroke in this town, of about 140,000 inhabitants. A CT Scan and numerous sources of information have allowed to achieve an exhaustive survey. The annual incidence of stroke has been 145/100,000. The annual specific incidence for age is 170/100,000 in men, 126/100,000 in women. The annual specific incidence for age and sex has shown a female preponderance until 30 and a male preponderance after this age. At 80, the rates became equal. Sixty-eight per cent of stroke were due to an infarct, 12 p. 100 to lacunae, 5 p. 100 to subarachnoid hemorrhage and 15% to cerebral hemorrhage. A preponderance of young people was found in subarachnoid hemorrhage, of the fifth decade in cerebral hemorrhage, while infarct rose up with age in the 2 sexes. Infarcts appeared predominantly during winter, while transient ischemic attacks appeared more often during summer. Cerebral hemorrhage had a constant incidence over the year. Mortality was high, mainly during the first month with 12.5 p. 100 during the first week, 21.5 p. 100 during the first month, and 30 p. 100 the first year. Our results appear to set in the mean of white occidental countries as opposed to Japan. They emphasize the important and underestimated place of lacunae and the seasonal variations of several causal varieties of stroke. PMID- 2664977 TI - [Congenital hydrocephalus after intraventricular hemorrhage in utero]. AB - A case of congenital hydrocephalus following a foetal intraventricular bleeding is reported. The diagnosis was made at 36th week by ultrasonography. Whether this mechanism could be involved in some cases of "idiopathic" congenital hydrocephalus is discussed. PMID- 2664978 TI - [Sensory neuropathy of the trigeminal nerve and scleroderma]. AB - Sensory neuropathy of trigeminal nerve is one of the neurological complications of systemic diseases, particularly scleroderma. Three cases are reported in which onset occurred at different stages of the disease, the main symptom being painful dysesthesias. All three branches of the trigeminal nerve may be affected but a preference is apparent for V2 and V3. Signs are usually limited to hypoesthesia and the chronic course is influenced little by treatment. PMID- 2664979 TI - [Pseudotumoral spinal cord dilatation during multiple sclerosis. 2 cases with magnetic resonance imaging]. AB - We report 2 patients presenting with signs and symptoms of a medullary lesion. Spinal magnetic resonance imaging (MRI) using surface coils showed a volume increase of the spinal cord. Multiple sclerosis (MS) was suspected on the clinical evolution, the cerebrospinal fluid oligoclonal pattern in one case and the return of the cervical cord to an almost normal calibre on successive MRI. This diagnosis was further supported by the results of encephalic MRI. Such a pseudotumoral aspect of the spinal cord in MS has rarely been reported, and probably has been underestimated. MS should be considered in the differential diagnosis of localised enlargement of the spinal cord. PMID- 2664980 TI - [Painless apoplectiform paralysis of the brachial plexus]. AB - A 40 year-old glass-blower suddenly experienced a painless weakness of his left shoulder and arm, more severe in C5 and C6 territories. The disorders regressed. Il was suspected that this brachial plexus neuropathy was of ischemic origin. However the absence of pain was surprising. PMID- 2664981 TI - [Intramedullary epidermoid cyst. Contribution of magnetic resonance imaging]. AB - Epidermoid tumors are seldom found as a cause of spinal cord compression; still fewer involve the spinal cord itself. We report a case of a thoracic intramedullary epidermoid tumor documented by MRI. PMID- 2664982 TI - [Surgical treatment of gonarthrosis deformans in middle-aged and elderly patients]. AB - For treatment of deforming gonarthrosis in old and senile patients the authors developed and successfully applied extra-articular surgical methods. In stage I II of the disease--prolonged osteotomy of the tibial bone was made; in disorders of the extremity axis--the correcting osteotomy of the tibial bone was made. According to the authors' opinion restorative treatment in the postoperative period is very important. PMID- 2664983 TI - [Hypermobility of the knee joint in osteoarthrosis]. AB - In order to study the status of the ligamentous-muscular system of the knee joint in patients with osteoarthrosis using functional roentgenological method hypermobility of the knee joint was determined. Hypermobility of the joint was observed even in the early stage of osteoarthrosis which progressed with the development of the disease. PMID- 2664984 TI - [Rheumatic fever in Cuba]. AB - Rheumatic fever--is a social disease; it's incidence is connected with the sensitivity of the patients and infection--group A streptococcus. Such factors as social and economic conditions, accessibility of public health services and environmental factors may influence the spread of streptococcus. In the last decade the mortality rate (rheumatic cardiac failure) decreased in the Republic of Cuba from 4.2 x 10(5) in 1968 down to 2.1 in 1985. It's incidence was within 2.1 and 6.0/1.000 (children at an age of 5-14 years). PMID- 2664985 TI - [Therapeutic effectiveness of D-penicillamine in ankylosing arthritis of the spine in relation to the degree of pathological changes in the joints]. AB - On the basis of biochemical indices the anthors assessed the efficacy of a 6 month treatment with D-penicillin in 49 patients with ankylosing arthritis of the spine who did not respond to nonsteroid antiinflammatory drugs. Improvement in the movements of the spine was observed in patients with less marked roentgenological changes. PMID- 2664986 TI - [Gonadotropic and sex hormones in women with systemic lupus erythematosus]. AB - The authors studied gonadotropic and sex hormones of the blood as well as estrogens and hestagens in 100 women (70--with systemic lupus erythematosus and 30 healthy subjects). A decrease in the level of folliculostimulating hormone has been observed. Hyperestrogenic nature of the hormonal balance was diagnosed in patients with the newly developed systemic lupus erythematosus. The degree of the hormonal balance changes was connected with markedness of autoimmune process. PMID- 2664987 TI - [Plasma macroproteins in the evaluation of the effectiveness of therapeutic plasmapheresis in patients with rheumatoid arthritis]. AB - In 32 patients with RA before and after lymphocyto- and/or plasmapheresis the authors determined the content of high molecular protein fraction (macroproteins) in the blood plasma. In the consecutive analysis of the body response and procedure effects it was found out that decrease in the level of macroproteins correlated with the changes of immunological status and state of the patients. The index of macroproteinemia can be used for quantitative assessment of plasmacytopheresis effect. PMID- 2664988 TI - [Significance of the changes in the level of expression of HLA antigens on the surface of T lymphocytes in differential diagnosis of joint diseases of different nature]. AB - The authors calculated sensitivity, specificity, informativeness and diagnostic coefficient and relative risk of the joint index reflecting the degree of T lymphocytes activation in patients with RA as compared with healthy persons and patients in the control group. PMID- 2664989 TI - [Characteristics of microcirculatory changes in various forms of rheumatoid arthritis in children]. AB - Using the method of biomicroscopy of bulbar conjunctiva with application of vessel gaging the authors made observation of 125 patients: 110--with RA and 15- with reactive arthritis. Marked vascular and intravascular changes in combination with dilatation of the capacitive vessels and narrowing of the resistive ones in vasculo-visceral form of RA correlated with the increase of immunological indices of the blood. In patients with vascular form of RA less marked changes of the vessels in dilatation of the capacitive part correlated with immunological indices of the synovial fluid. PMID- 2664990 TI - [Computer-assisted evaluation of the symptoms of juvenile rheumatoid arthritis]. AB - Data on 371 patients with juvenile RA were processed on a special computer program. Special informative signs were determined for various forms of juvenile RA have been established. Efficacy of computer processing for the diagnosis of RA has been stressed. PMID- 2664991 TI - [Diagnosis of osteopenia using roentgenological and histomorphometric methods]. PMID- 2664992 TI - [Study of functional activity in rheumatoid arthritis]. PMID- 2664993 TI - [Metastatic calcinosis]. PMID- 2664994 TI - [Characteristics of the articular syndrome at the early stages of ankylosing spondyloarthritis]. PMID- 2664995 TI - [A case of systemic lupus erythematosus associated with cancer of the lung]. PMID- 2664996 TI - [Postrheumatic Jaccoud's arthritis (description of a case)]. PMID- 2664997 TI - [A universal goniometer for measuring the mobility in the cervical segment of the spine]. PMID- 2664998 TI - [Various aspects of teaching the methods of diagnosis of rheumatic heart defects during the preparatory course on internal diseases]. PMID- 2664999 TI - Inoculum effect. AB - The inoculum effect (IE) is a laboratory phenomenon that is described as a significant increase in the minimal inhibitory concentration of an antibiotic when the number of organisms inoculated is increased. The IE generally occurs with beta-lactam antibiotics in relation to beta-lactamase-producing bacteria. An IE occurs with the first- and second-generation cephalosporins against Staphylococcus aureus and less often with the quinolones, beta-lactam-resistant penicillins, cefoxitin, and aminoglycosides. An IE occurs with the penicillins against the Enterobacteriaceae and Pseudomonas species, and a variable IE occurs with cephalosporins; however, no IE occurs with aminoglycosides, quinolones, imipenem, and chloramphenicol against these organisms. An IE occurs with beta lactam antibiotics against Haemophilus influenzae and with the penicillins and the cephalosporins against penicillinase-producing Neisseria gonorrhoeae and Branhamella catarrhalis. An IE occurs with the penicillins and cephalosporins against the Bacteroides fragilis group; no IE occurs with cefoxitin and imipenem. Although certain antibiotics exhibit an IE, they are still capable of eradicating infections when administered appropriately. Thus, the clinical significance of this laboratory phenomenon has yet to be elucidated. PMID- 2665000 TI - Suppression of transmission of malaria through source reduction: antianopheline measures applied in Israel, the United States, and Italy. AB - To provide a conceptual basis applicable to future antimalarial efforts, we sought to identify the sources of success in three notable campaigns that were consummated largely before DDT became available. A variety of measures directed against the aquatic stages of the anopheline vectors provided the main strategy for the antimalarial programs in Palestine/Israel, Italy, and the Tennessee River Valley of the United States. Source reduction-the modification or elimination of aquatic habitats to reduce mosquito breeding-was applied extensively and proved decisive. In all three regions, transmission of malaria was reduced to the point of extinction. Effective measures against anopheline larvae, in particular through source reduction, depend upon locally derived ecologic concepts that can be adapted to each vector species and applied continuously without limit of time. An integrated control program based on the long-term application of such measures can suppress transmission of malaria in edemic areas, as well as contain episodes of locally increased transmission of malaria. PMID- 2665001 TI - Melioidosis: review and update. AB - Melioidosis prevails in Southeast Asia and northern Australia. Sporadic cases have been increasingly reported from countries located between 20 degrees north latitude and 20 degrees south latitude as well as in travelers and in soldiers who have resided in these areas. The organisms are commonly found in water and soil and are usually transmitted to humans by cutaneous or respiratory routes. Clinical manifestations range from subclinical infection to overwhelming septicemia that resembles disseminated or localized suppurative infection due to various pathogens. A rapid and accurate diagnosis can be made by demonstration of small, few, and frequently bipolar-stained gram-negative bacilli in exudate or pus. The indirect hemagglutination test is of diagnostic value in cases with involvement of the internal organs or pyrexia of unknown origin. Chloramphenicol, doxycycline, trimethoprim-sulfamethoxazole, and kanamycin constitute conventional and effective chemotherapy. Newer antimicrobial agents such as piperacillin, amoxillin-clavulanic acid, ceftazidime, imipenem, and carumonam are active in susceptibility tests against the causative microorganism, Pseudomonas pseudomallei. Clinical trials for demonstration of the effectiveness of the latter agents in overwhelming septicemic melioidosis are ongoing in endemic areas. PMID- 2665002 TI - Nature of protective immunity to Francisella tularensis. AB - Tularemia is caused by the facultative intracellular bacterium Francisella tularensis. Attenuated live vaccines, such as F. tularensis LVS (live vaccine strain), afford good--although not complete--protection; how to judge the degree of this protection has long been a problem. Both natural infection and vaccination result in immunospecific and long-lasting humoral and cell-mediated immunity. The latter is the crucial protective mechanism, whereas the humoral response protects only against strains of reduced virulence, such as those used in the vaccines. Immune serum has been used to screen for structures of F. tularensis with the ability to induce a protective immune response. This immune serum is, however, primarily directed toward antigens different from those involved in cell-mediated immunity. Serum antibodies from primed individuals recognize carbohydrate capsule antigens of F. tularensis, whereas T lymphocytes recognize membrane polypeptides of the organism. The preparation of membrane polypeptides from F. tularensis is now facilitated by the availability of a capsule-deficient mutant of F. tularensis LVS. In vitro, several membrane polypeptides of the mutant stimulate T lymphocytes from vaccinees and from naturally infected individuals. Further studies of the mechanisms of induction of protective immunity should focus on these membrane polypeptides. PMID- 2665003 TI - Pathogenesis of experimental endocarditis. AB - Numerous important observations concerning the pathogenesis of infective endocarditis have been made over the past 18 years. Many of these observations have been obtained with animal models of endocarditis in which an indwelling catheter has been used to produce predisposing endocardial lesions for subsequent infection. Unlike several previously used animal models, the catheter-induced endocarditis models have many characteristics similar to infective endocarditis in humans. Key findings regarding microbial adherence and persistence and the host response to endocardial infection have led to a better appreciation of the complex issues operative in the pathogenesis of endocarditis. PMID- 2665004 TI - Impact of atmospheric dispersion and transport of viral aerosols on the epidemiology of influenza. AB - Current theories of influenza viral epidemiology have not explained the persistence, seasonality, and explosive outbreaks of virus over large geographic areas. It is postulated in this paper that atmospheric dispersion and intercontinental scale transport of airborne aerosolized influenza virus may contribute to the spread, persistence, and ubiquity of the disease, the explosiveness of epidemics, and the prompt region-wide occurrence of outbreaks and that seasonal changes in circulation patterns and the dispersive character of the atmosphere may help to explain the regular annual cycle of influenza activity. PMID- 2665005 TI - Acute respiratory infection in children of developing countries: challenge of the 1990s. PMID- 2665006 TI - Viruses and hemostasis. AB - The great majority of viral infections are not associated with significant alterations in hemostasis. Occasionally, common viral pathogens lead to illnesses in which hemostatic impairment is an important feature. In these instances, two clinical syndromes usually are present: thrombocytopenic purpura and disseminated intravascular coagulation. Immune mechanisms are implicated in the first, while the second is associated with severe disease. Hepatitis viruses produce hemorrhage by a third mechanism. In cases of fulminant hepatitis, hepatocellular injury leads to decreased production of multiple coagulation factors and impairment of other hepatic functions that modulate hemostasis. A small number of viruses stand apart by virtue of the frequency with which they cause hemorrhage. These are the hemorrhagic fever viruses. Much more needs to be learned about how these viruses cause disease and induce hemorrhage. The first line of therapy in viral infections complicated by hemorrhage is early treatment with an antiviral agent. Unfortunately, effective antiviral therapy is usually not available. There is little useful information and no controlled studies on the efficacy of therapy aimed directly at correcting hemostatic impairment. PMID- 2665007 TI - Contact systems in infectious disease. AB - The current state of knowledge of contact coagulation pathways activated by exposure of blood to foreign surfaces such as occur with endothelial damage is reviewed. Changes in the contact proteins in normally occurring and experimentally induced infections in humans are summarized. The use of mutant alpha 1-antitrypsin to inhibit activation of this pathway in experimental porcine sepsis is also described. The principles developed may be applicable in studies of the pathogenesis and treatment of viral hemorrhagic fevers. PMID- 2665008 TI - Infection of endothelial cells by common human viruses. AB - Common human viruses were evaluated for their ability to replicate in the endothelial cells of human umbilical vein and bovine thoracic aorta in vitro. Infection occurred with most viruses. The susceptibilities of endothelial cells derived from bovine aorta, pulmonary artery, and vena cava were compared. Among the viruses studied, no differences were noted in the ability to grow in endothelial cells from these three large vessels. One virus, herpes simplex virus type 1, was evaluated for its ability to produce persistent infection of endothelial cells. Infection developed and persisted for up to 3 months. After the first week, productive infection was found in less than 1% of cells. Nevertheless, the infection markedly affected the growth and morphology of the endothelial monolayer. Infection with any of several different viruses was noted to alter endothelial cell functions, including adherence of granulocytes, production of colony-stimulating factor, and synthesis of matrix protein. In addition, herpes simplex virus type 1 induced receptors for the Fc portion of IgG and for complement component C3b. These findings indicate that common human viruses can profoundly affect the biology of the endothelium. PMID- 2665009 TI - Disorders associated with antibodies to endothelial cells. AB - Antibodies that bind to endothelial cells have been identified in patients with diverse forms of vasculitis and thrombosis. Sera from patients with systemic lupus erythematosus contain both complement-fixing antibodies and immune complexes that bind to cultured endothelial cells. Sera from patients with heparin-associated thrombocytopenia and thrombosis contain antibodies that react with heparin bound to the endothelium and cross-react with heparan sulfate synthesized by endothelial cells. Children with Kawasaki syndrome may develop cytolytic IgM antibodies that recognize surface antigens induced on endothelial cells by interferon-gamma, interleukin 1, and tumor necrosis factor. The presence of alloantibodies to tissue-restricted polymorphic antigens expressed by endothelial cells is frequently associated with thrombotic microvascular injury and hyperacute allograft rejection. Binding of antibodies and immune complexes to endothelial cells in vitro initiates platelet adherence, production of tissue factor, and secretion of plasminogen activator inhibitor. Antibody-mediated endothelial cell injury may play a role in other vascular disorders of unknown cause. PMID- 2665010 TI - Replication of hemorrhagic fever viruses in monocytic cells. AB - Monocytes play a central role in protection against many viruses. In some infections they are target cells for viral replication. There is increasing evidence that these cells may also be important in regulation of hemostasis. The part played by monocytic cells in the pathogenesis of hemorrhage in the viral hemorrhagic fevers is presently uncertain. Monocytes and monocytic cell lines have been used to investigate the ability of viruses to infect these cells in vitro. Several factors may affect the ability of a particular virus to infect monocytic cells, including specific antiserum to virus and the degree of cellular maturation. The effect of cellular maturation on the replication of Rift Valley fever virus in the U937 cell line is discussed in light of studies on the infectivity of other viruses for monocytic cells. Data supporting the ability of specific antibody to enhance the infectivity of Pichinde virus and Lassa fever virus for U937 cells are presented. PMID- 2665011 TI - Pathogenesis of viral hemorrhagic fevers: Rift Valley fever and Lassa fever contrasted. AB - Although many viral infections have on occasion been associated with hemorrhagic complications, infection with any of several RNA viruses regularly results in vascular involvement and the syndrome called viral hemorrhagic fever (VHF). In spite of clinically useful similarities among various VHFs, there are significant differences in their pathogenesis and clinical evolution; these are often related to characteristics of their viral taxon. Infection with Rift Valley fever (RVF) virus, a phlebovirus, appears to be regulated by interferon and terminated by neutralizing antibody. In contrast, Lassa fever (LF) virus, an arenavirus, is resistant to interferon, and LF is terminated by cellular immune effector mechanisms. The lytic virus-cell interaction typical of RVF virus suggests its major effects occur by direct, virus-induced cellular necrosis, particularly in the liver. In the primate RVF model, disseminated intravascular coagulation (DIC) may be important. LF virus--characteristically noncytopathic--may exert its effects through induction of mediator secretion from infected macrophages. DIC does not appear to be a central pathogenetic mechanism in LF. Pichinde virus, which is not pathogenic for humans, provides an alternate model for study of LF. Infected guinea pigs do not show histologic lesions that could explain their body wasting, cardiovascular deterioration, and pulmonary edema. In the heart, for example, loss of tissue mass, protein, and contractile function proceed without direct viral involvement or myocarditis. Sulfidopeptide leukotrienes have been implicated as one relevant soluble mediator participating in the disease state. PMID- 2665013 TI - Clinical aspects of African viral hemorrhagic fevers. AB - Three hemorrhagic fevers occur in southern Africa: Rift Valley fever, Marburg virus disease, and Crimean-Congo hemorrhagic fever. The patient's history of travel in Africa, visits to rural areas, contact with sick animals or their carcasses, or contact with a tick-infested environment or tick bites is important. Rift Valley fever is characterized by an incubation period of approximately 3 or 4 days, sudden onset of fever with a biphasic course, and signs and symptoms of liver and kidney disorder. The commonest complication is retinitis with a central scotoma. Severe cases may develop a hemorrhagic state, which may be fatal. Marburg virus disease was studied in two Australian students after a tour of Rhodesia (now Zimbabwe) and in a nurse who cared for them. The incubation period of approximately 7 days is followed by sudden onset of fever (typically lasting 7 days) and the appearance of a maculopapular petechial rash on the 5th day. A hemorrhagic state develops about the same time and may be fatal. Crimean-Congo hemorrhagic fever is widespread in South Africa; it may be transmitted by tick bite of the species Hyalomma, by contact with the tissues of animals, or by contact with infected patients. PMID- 2665012 TI - Hemostasis and the complement system in Argentine hemorrhagic fever. AB - The salient abnormalities of blood coagulation found in the acute phase of Argentine hemorrhagic fever (AHF) were thrombocytopenia, prolonged partial thromboplastin time activated with kaolin, low factor VIII:C activity concurrent with high levels of von Willebrand factor, and increased values of factor V. No evidence of disseminated intravascular coagulation (DIC) was observed. Therefore, the hemostatic abnormalities detected in patients with AHF could not be attributed to DIC. There was no correlation between severity of the disease and occurrence of impairment of coagulation. Complement activation was observed during the acute phase of AHF. There was reduction of total complement and C2 activity. Antigenic levels of C1q, C3, and C5 were low; level of C4 antigen was high. Degradation products of C3 and B were demonstrated before day 11. Experimental models of AHF were developed (guinea pigs, Callitrix jacchus). These models may be useful, but they reproduced only some of the features of blood coagulation and complement abnormalities described in human AHF. PMID- 2665014 TI - Hemostatic defects in dengue hemorrhagic fever. AB - Dengue hemorrhagic fever is characterized by a sudden onset of fever that lasts for 2-7 days and then subsides, at which time hemorrhagic manifestations become evident. Sometimes there is an associated form of hypovolemic shock known as dengue shock syndrome. There are usually significant changes in the liver, the reticuloendothelial system, and the vascular system (e.g., necrosis of liver cells and focal hemorrhage, increase in turnover of lymphocytes, and diapedesis of erythrocytes through vessel walls). Because of the lack of pathologic findings in major organs and the rapid recovery (without sequelae) of survivors, physiologic dysfunction is thought to be secondary to the action of biologic mediators that are capable of producing severe illness with minimal structural injury. PMID- 2665015 TI - Antibody, macrophages, dengue virus infection, shock, and hemorrhage: a pathogenetic cascade. AB - Dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS) in children is reliably associated with the presence of dengue antibody--actively or passively acquired- before the onset of illness. Limited observations by electron microscopy and fluorescent antibody testing and the recovery of virus from tissues obtained at autopsy show that dengue viruses are consistently associated with cells of mononuclear phagocyte lineage. In particular, virus is associated with Kupffer cells, pulmonary macrophages, and mononuclear cells in skin and blood. Endothelial cells fail to demonstrate necrosis or inflammatory changes. Since acute vascular permeability, shock, and hemorrhage occur late in illness, a plausible hypothesis is that phlogistic factors, resulting from interactions with elements of the immune response, are released from virus-infected mononuclear phagocytes. Such phenomena as generalized depression of mitotic activity of bone marrow cells, destruction of mature polymorphonuclear leukocytes, complement activation, and abnormal hemostasis may serve as markers of these phlogistic factors. It will be of interest to establish whether other viral hemorrhagic fevers involve the same target cells as in DHF/DSS and are mediated by similar effector mechanisms. PMID- 2665016 TI - Disease exacerbation caused by sequential dengue infections: myth or reality? AB - Dengue can be caused by any one of four viruses that are antigenically related but not cross-protective. It has been proposed that the disease may be more severe if an infection with one dengue serotype follows infection with another serotype. Both experimental and epidemiologic data have been cited to substantiate this concept, but the present reviewer does not find the data convincing. The issue is of practical importance because of its relevance to the use of dengue vaccines now under development. It is impossible to prove that clinical manifestations of dengue are not exacerbated by sequential infections. Negative findings can always be countered by arguments that exacerbation occurs only with certain serotypes, only with certain strains of those serotypes, or only when infections occur at critical intervals. Interested persons can examine the relevant data and decide whether the concept of disease exacerbation following sequential dengue infections is myth or reality. PMID- 2665017 TI - The reemergence of dengue in China. AB - In 1978, dengue was reported in China for the first time in 32 years. Since then, epidemics involving hundreds of thousands of people have occurred in Guangdong and Guangxi provinces and on Hainan Island. These epidemics were caused by all four types of dengue virus. Aedes aegypti was the vector in coastal areas, while Aedes albopictus was the vector in inland regions. During these epidemics, case rates were very high (greater than 50%) in some areas. Case-fatality rates were generally less than 0.1% except during the 1986 outbreak on Hainan Island, when the rate was 0.25%. Hemorrhagic disease occurred in both children and adults. On Hainan Island, hemorrhagic disease was more than three times as common in the 1986 outbreak as in the 1980 outbreak; the 1980 outbreak was caused by dengue virus type 3 and the 1986 outbreak by dengue virus type 2. The weight of the evidence suggests that the reemergence of dengue in China resulted from the introduction of the infection by travelers and refugees from areas of Asia where dengue is endemic. PMID- 2665018 TI - Clinical, clinicopathologic, and hematologic features of Kyasanur Forest disease. AB - In 1957, a fatal disease occurred among monkeys in a forested area of Shimoga District, Karnataka State, India. Concurrently, there was an outbreak of febrile, occasionally fatal illness among people living in the vicinity. The disease was caused by a new tick-borne flavivirus belonging to the Russian spring-summer encephalitis complex of viruses. The early clinical description of the disease included severe cases with hemorrhagic manifestations, including intermittent epistaxis, hematemesis, melena, and frank blood in the stools. Pathologic and hematologic investigations emphasized similarities with Omsk hemorrhagic fever. Two years later there was a shift in clinical emphasis from hemorrhagic to neurologic complications; this could have resulted from the special interests or bias of the principal investigator or the changing patterns of intercurrent infections. Clinical, clinicopathologic, hematologic, and hemostatic features of Kyasanur Forest disease (KFD) are described, particularly in relation to IgE as a cofactor in the immunopathology of KFD and possibly of other hemorrhagic fevers. PMID- 2665019 TI - [Serious head injuries--sequelae and their management]. PMID- 2665020 TI - The mission of the Journal. PMID- 2665021 TI - The Rhode Island Medical Journal heritage. PMID- 2665022 TI - The reconstruction principle. AB - The theory of epigenesis is the undisputed paradigm of embryology, and it is still based on the classical concept proposed by Aristotle: the idea that embryonic development is a generation of structures which takes place according to a design--today we say a set of instructions--already present in the fertilized egg. This is a doctrine which can be referred to as 'pre-information', since it claims the preexistence of information exactly as the old theory of preformation claimed the preexistence of form. Here, however, it is shown that a more general version of epigenesis can be held, because of a new principle which states that it is mathematically possible to obtain not only a convergent generation of form, or structure, but also a convergent generation of information. PMID- 2665023 TI - The origin of Metazoa and Weismann's germ line theory. AB - Weismann's theory asserts that the continuity of germ cells throughout the entire life cycle is insured by the protection of the somatic cells which represent a distinct lineage. On the basis of embryological data and the organization pattern displayed by some highly differentiated unicellular organisms, it is postulated that the soma of multicellular animals has probably arisen as an accessory structure for an initially unicellular system. PMID- 2665024 TI - The problem of adaptations: an holistic approach. AB - On the basis of recent advances in molecular genetics and embryology the role of phenotypic plasticity in the origin of adaptations has been reviewed and emphasized. Carrying on Waddington's experimental research on genetic assimilation, the epigenetic landscape, where genotype, phenotype and environment meet, should be investigated as the place in which environmental information may be embodied in the organism and evolutionary novelties could arise. An holistic, multilevel approach, with the organism as the basic level for the genesis of adaptations and the population as upper level as improving and/or altering, through selective and random factors, the evolutionary pattern, is then envisaged. PMID- 2665025 TI - [Depression and anxiety in allergic diseases. The role of emotions in the pathogenesis of allergy]. PMID- 2665026 TI - [Origin and development of allergy in Mexico]. PMID- 2665028 TI - Pancreatic hepatocytes associated with chronic 2,6-dichloro-p-phenylenediamine administration in Fischer 344 rats. AB - Pancreatic tissue (original and recut sections) from Fischer 344 rats fed 2,6 dichloro-p-phenylenediamine in a chronic (2-year) carcinogenesis bioassay was evaluated for presence of pancreatic hepatocytes (PH) by light microscopy. PH were found in dose groups as follows: males--0 ppm (controls)--0/50 (0%), 1,000 ppm--4/50 (8%), 2,000 ppm--9/50 (18%); females--0 ppm (controls)--1/50 (2%), 2,000 ppm-15/50 (30%), 6,000 ppm--15/49 (31%). This represented a significant dose-related increased incidence of PH in 2,000-ppm males, and 2,000- and 6,000 ppm females. A statistically significant increase (p less than 0.01) in pancreatic acinar atrophy and fibrosis was also seen in treated female rats, but the relationship of these lesions to the PH is unclear. PMID- 2665027 TI - [Placebo-controlled comparative study of clenbuterol and terbutaline in asthmatic children]. AB - In order to evaluate clinically and spirometrically the efficacy and safety of clenbuterol in comparison with terbutaline and placebo, 30 pediatric patients, in three groups of ten subjects each one, were studied. The study was designed single blind with control group (placebo), randomized, prospective and observational. Total average age was 8.2 years, weight 29 kg and size 130 cm. Nineteen subjects were male and 11 female. Group I received clenbuterol (0.0012 mg/kg/day) solution bid during one week; group II received terbutaline (0.075 mg/kg/day) solution tid and group III, placebo. There were differences statistically significant in the group treated with clenbuterol in FEV1, PMF and VC. Side effects were without importance. PMID- 2665029 TI - Animal models of vasculitis. AB - There are several naturally occurring and iatrogenic models of vasculitis available in animals, although few have primary coronary vessel lesions. Aleutian disease of mink and equine viral arteritis are 2 well studied natural diseases which may be produced experimentally and, thus, make good animal models. Several drugs have been identified which produce myocardial lesions, including vasculitis, in susceptible individuals or when given in high enough doses. Immune mediated mechanisms are probably among the most important etiologic factors for the development of vasculitis and must be given high priority when exploring the pathogenesis of any vasculitis. PMID- 2665030 TI - Immunopathogenesis of arterial diseases in animals and man. AB - This brief review summarizes our current understanding of vasculitis mediated by phlogistic immune complexes. The Arthus reaction and serum sickness both represent experimental models for immune complex disease. Immune complex phenomena occur in conjunction with C3 deficiency of dogs during canine distemper virus infection and, presumably, as a part of the beagle pain syndrome. PMID- 2665031 TI - Vasculitis in MRL/1 pr mice: model of cell-mediated autoimmunity. AB - The destruction of vascular smooth muscle cells (VSMC) in autoimmune arteritis is a poorly understood phenomenon. To approach this problem, VSMC cultures were established. The interaction of these cells (from normal or autoimmune mice) with lymphocytes was then evaluated. Specifically, splenocytes from MRL/1pr or C3H mice were co-cultivated with MRL/1pr or C3H VSMCs. Massive mononuclear inflammatory cell clusters enveloped MRL/1pr VSMCs which culminated in the detachment of MRL/1pr VSMCs from the culture plate. In contrast, the interaction of splenocytes from normal or autoimmune mice did not destroy normal VSMCs. Further investigation indicated that MRL/1pr VSMCs spontaneously expressed both Ia-k and Ia-d, as assessed by fluorescence microscopy and flow cytometry, and released interleukin-1-like factors--characteristics of accessory cells to T lymphocyte function. Evaluation of VSMCs accessory function in antigen presentation suggests that these cells may present antigen under specific experimental conditions. As a result of these studies, a novel mechanism of autoimmune vasculitis is proposed. Our hypothesis is that defective biological function of VSMCs from autoimmune mice stimulates a mononuclear inflammatory cell response which culminates in VSMC autodestruction. PMID- 2665032 TI - Review of cardiovascular findings in humans treated with minoxidil. AB - Minoxidil is an antihypertensive vasodilator with no known capability of inducing human cardiovascular pathology; however, the compound does cause a late, canine specific lesion of the right atrium and acute right atrial and ventricular papillary muscle changes. In all the autopsy cases of minoxidil-treated humans to date, 9 cases were reported with significant right atrial or other cardiac pathology and were carefully reviewed for similarity to either the early or late canine lesion. Three new cases (G, H, and I) were added in this update to 6 cases already described. None of the 3 cases newly analyzed in this paper, as well as the previously reported 6 cases, had gross or histologic constellations which could be diagnosed as associated with minoxidil treatment. Further, the examination of autopsy cases of minoxidil-treated hypertensive right atrial histology findings appear no different than those found in the baseline non minoxidil treated hypertensive and non-hypertensive cases. PMID- 2665033 TI - Classification and pathogenesis of arteritis in children. AB - Systemic necrotizing vasculitis in children is a rare but serious disorder. During the past 25 years, 121 children within this disease category have been referred to the Hospital for Sick Children, London (HSC). Classification is difficult but the largest subgroups identified were polyarteritis nodosa (PAN)- 29 children and Kawasaki syndrome (KD)--42 children. In spite of modern therapy including steroids, cyclophosphamide, anti-platelet medication, plasma exchange, prostacyclin, high dose gamma globulin and cyclosporin, mortality remains high. Overall mortality for HSC patients was 12% (66% for pulmonary vasculitis, 21% for PAN, and 2% for KD). Recent advances are beginning to shed some light on the etiology and pathogenetic mechanisms involved in PAN and KD. There is now good evidence to support roles for platelet immune complex interactions, anti neutrophil cytoplasmic antibodies, and anti-endothelial cell antibodies in the pathogenesis. It seems likely that, in KD at least, retroviruses may have an etiological role either by directly infecting endothelial cells or indirectly via T-cells, antibody, or immune complex formation. PMID- 2665034 TI - An overview of human arterial pathology. AB - In this manuscript the pathology of human arterial disease, including diseases of the aorta, coronary arteries, and peripheral arteries, is reviewed. Common atherosclerotic-related lesions and varied forms of aortitis, arteritis, and dissecting aneurysms are described in terms of their gross and microscopic characteristics. In addition, rarer occurrences, such as congenital hypoplasia of the arteries, are mentioned. Finally, morphologic changes in blood vessels that have been affected by drugs or toxins are summarized. PMID- 2665035 TI - Cellular mechanisms in the response of the arterial wall to injury and repair. AB - This synopsis emphasizes the inappropriateness of a "single stimulus-single response" approach in understanding the response of the arterial wall to injury and repair. The outcome of any injurious stimulus is a series of interactive cascades among the endogenous and exogenous cellular and non-cellular components of the arterial wall, and the cellular and non-cellular elements of the blood. Both genetic and hemodynamic factors can further influence this response. The more prominent of the cellular and non-cellular components have been discussed. These include: 1) the vascular endothelium, its dynamic interaction with macromolecules and formed elements of the blood, its role in the transport of plasma proteins, its influence on the function of arterial smooth muscle cells and the recruitment of blood-born monocytes; 2) the arterial smooth muscle cell, its role in the vasomotor function of the artery wall, arterial repair and reconstruction, metabolism of lipids and the secretion of cytokines regulating monocyte recruitment; 3) the mononuclear phagocyte, its role in arterial debridement, metabolism of modified LDLs, a precursor of the cholesteryl ester rich foam cell, and the secretion of neutral hydrolases, bioactive lipids and cytokines; 4) lymphocytes, as mediators of the inflammatory response and possible autoimmune reactions; 5) platelets, their roles in hemostasis, thrombosis, atherogenesis, and the repair process and 6) plasma LDLs, their oxidative modification by cells of the vessel wall and their roles in the injury process. The interactive processes among arterial and circulating components in both injury and repair is emphasized. PMID- 2665036 TI - The human vasculitis syndromes. AB - The vasculitides consist of a spectrum of clinical syndromes having in common necrotizing inflammation of the vascular system. Typical classification systems are based on both size of vessel involved and clinical gestalt. The author favors a pragmatic classification. Symptoms are manifestations of systemic inflammation and of organ ischemia secondary to inflammatory vascular occlusion. Multicenter studies suggest that the most common vasculitides do not satisfy criteria for one of the specific nosological entities and would be classified as "other" vasculitides. For those syndromes fitting a classical description (e.g., Wegener's, polyarteritis nodosa, Henoch-Schoenlein purpura), therapy is straight forward. For those defying classification, therapy must be empirically directed at the manifestations causing symptoms. PMID- 2665037 TI - Classification of naturally occurring arterial disease in the dog. AB - Evaluation of induced arterial toxicity in safety assessment of drugs involves recognition of morphologic differences between groups of animals. In this organ system, as in all others, it is necessary to be familiar with the background pathology that can occur in control animals of the test species, since such lesion "noise" may complicate the evaluation of drug-related effects if naturally occurring diseases have morphologic features in common with those that can be produced by drugs. Background arterial lesions have been regarded as relatively unimportant in both the laboratory-maintained beagle and in the larger range of domesticated breeds of dog and few of these vascular lesions lead, per se, to functional organ compromise. At least this appears to be the case in young and middle-aged subjects, within the epidemiologic limits of data from veterinary medical centers where systematic and thorough necropsies are done and recorded. Arterial lesions are, however, not uncommon naturally occurring incidental necropsy findings in dogs; however, in most cases they are of uncertain functional significance. This presentation summarizes the main pathologic patterns of lesions that can affect arteries in dogs that are not used in safety evaluation studies. The main patterns can be classified as degenerative, proliferative, and inflammatory, although there is some overlap between these partly arbitrary designations. In some cases, etiopathogenesis of the arterial lesion is unclear; in others, there are clear associations with disease processes in other organ systems. Congenital vascular lesions and vascular components of congenital cardiac defects are excluded from consideration since such lesions are unlikely to occur in dog populations used in the safety assessment of drugs. PMID- 2665038 TI - Spontaneous and induced arterial disease in the dog: pathology and pathogenesis. AB - The spontaneous arterial diseases of the dog relevant to safety assessment studies of drugs are the extramural coronary arteritis of Hartman, intramural coronary arteriosclerosis (with amyloid deposition) occurring in older dogs with cardiac disability, intramural arteriosclerosis without amyloid deposition in the left ventricle of dogs with congenital subaortic stenosis or in the right ventricle in dogs with severe pulmonic stenosis, and necrotizing polyarteritis (nodosa). Experimentally induced lesions include right atrial necrosis and arteritis produced by minoxidil and theobromine, extramural coronary arteritis produced by positive inotropic/vasodilator drugs, intramural coronary arteriosclerosis associated with decreased peripheral resistance and tachycardia induced by hypotensive drugs (including antihypertensive and positive inotropic/vasodilator agents), and intramural arteriosclerosis associated with rapid ventricular pacing. The pathogenesis of none of these lesions is known. The left ventricular subendocardial and papillary muscle intramural coronary arterial lesions are associated with hyperdynamic activity and, in the case of drugs and subaortic stenosis, the possibility of lowered perfusion pressure and tachycardia. This has led to the supposition that these are ischemic lesions, but the evidence available either does not support or refutes that conclusion since subendocardial coronary flow and perfusion pressure are adequate with pacing tachycardia and in toxicity trials. Necrotizing polyarteritis appears to be an immune mediated disease that may appear in genetically prone beagles when they are placed under the stresses of experimental manipulation and/or a new environment. Since the right atrial minoxidil lesion can also be produced by theobromine in dogs and minoxidil can cause a left atrial lesion in swine, it is neither species nor drug specific. Its cause, however, escapes us. There appears to be little in common between the extramural coronary artery Hartman lesion and that caused by positive inotropic/vasodilator drugs. Left ventricular subendocardial and papillary muscle intramural coronary arterial lesions induced by ventricular pacing at 250 beats/min for 2 months are generally similar to those seen in toxicity trials with peripheral vasodilator drugs that induce tachycardia in electrocardiograms exceeding 200 beats/min, although in acute pacing experiments subendocardial perfusion is adequate at these heart rates. Coronary artery autoregulation may be compromised or so destabilized by the drugs that episodes of underperfusion can account for these lesions.(ABSTRACT TRUNCATED AT 400 WORDS) PMID- 2665039 TI - Remembering yesterday. Helen K. Mussallem. PMID- 2665040 TI - [Acute infectious pneumopathies in adults: methods of identifying the causative agent]. AB - Many sampling methods have been proposed to make a bacteriological diagnosis of community-acquired pneumonia. The diagnostic accuracy of these methods depend upon technical constraints which are hardly obtainable in real world situations. In hospitals, close cooperation between clinicians and bacteriologists can help improve the reliability of these techniques, but in current practice the benefits of bacteriological identification often compete with the empirical therapeutic approach. This approach must remain within defined limits, since its uncontrolled widening can lead to major drawbacks. Whenever possible, bacteriological identification of the offending organism must be of concern. PMID- 2665041 TI - [Nosocomial pneumopathies]. AB - The criterion used for the diagnosis of nosocomial pneumonia is an infiltrate on X-ray of the chest, not present on admission, associated with new sputum production. The main causative pathogens are Staphylococcus spp. and Gram negative bacilli. The most common pattern in the development of pneumonia is colonization of the oropharynx followed by aspiration into the lungs in patients with impaired normal defences. The factors which significantly predispose to nosocomial pneumonia are tracheal intubation, low level of consciousness, chronic lung disease, thoracic or upper abdominal surgery, large volume aspiration and age over 70 years. The fatality rate is high (32 p. 100 to 55 p. 100). In most cases the curative treatment requires a combination of antimicrobial agents. At the moment, preventive measures remain an elusive goal. PMID- 2665042 TI - [The beginning of kidney transplantation]. PMID- 2665043 TI - Anatomoclinical correlations in coronary heart disease: recent advances and unanswered questions. AB - An attempt is made to summarize the recent available information on anatomoclinical correlations in coronary heart disease. The paper focuses attention on: (a) the role in the pathogenesis of unstable angina pectoris, severe arrhythmias and sudden cardiac death, of repeated cycles of formation, disintegration and peripheral embolization of intramural thrombi or of thrombi developed on preexisting atherosclerotic plaques; (b) a still apparently unsolved problem: which comes first, coronary thrombosis or myocardial infarction? (c) the pathophysiological and clinical significance of the "border zone" of myocardial infarcts; (d) the importance, in the pathogenesis of coronary heart disease and particularly of sudden cardiac death, of obstructive lesions which occur in the vessels supplying the conduction system of the heart. PMID- 2665044 TI - The therapy with cyclosporin A in rheumatoid arthritis. AB - Cyclosporin A (CyA) was administered in 6 cases of classical or definite, seropositive rheumatoid arthritis (RA), stages II or III, resistant to the antiinflammatory or nonsteroid therapy, or dependent on high Prednisone doses. An intramuscular daily dose of 1.5 g CyA for a three-week period had good clinical and biologic results. The first signs of improvement, occurring after 14 days of therapy, were manifested by a reduction of the articular inflammation, increase in amplitude of the articular mobility, decrease of the morning stiffness and lowering of the ESR rate. The short-term application of this treatment permits the reintroduction of the nonsteroid drugs and a lowering of the daily dose of Prednisone. PMID- 2665045 TI - [Reconstruction of the interruptive loss of substance of the mandible]. PMID- 2665046 TI - [I.V. administration of Mendiaxon in ultrasonography of the gallbladder and bile ducts]. AB - Group of 48 patients was ultrasongraphically examined for suspicion of a pathological process in the gallbladder and bile passages region. Because of inadequate depicting spamocholeretic agent Mendiaxon was administered. In slow i. v. administration no side effects were observed. Improvement of the gallbladder picture was scored in 51.4%, bile passages in 50% of investigations. Mendiaxon administered during the examination itself represents possibility how to influence successfully ultrasonographic diagnostics. PMID- 2665047 TI - [Role of free oxygen radicals in the pathogenesis of internal diseases]. AB - In the organism a part of molecular oxygen is converted into highly reactive radicals (superoxid, hydroxyl radical), which react with biological structures (proteins, nucleic acids, membranes). It is one of the general mechanisms of tissue damage, which occurs e. g. in ischemic reoxygenation, i. e. following intestinal, myocardial infarction; further in the site of inflammation the macrophages release superoxid extracellularly; in acute pancreatitis; in oxygenotherapy and other pathologic conditions. In all tissues there exists a protective system which, under physiological conditions, inactivates the toxic radicals. Enzymes (superoxid dismutase, physiological conditions, inactivates the toxic radicals. Enzymes (superoxid system, alpha-tocopherol, ascorbic acid are part of this system. The concept of tissue damage by radicals enables a new view on etiopathogenesis of some diseases and leads to endeavour to use the acquired knowledge in human medicine. PMID- 2665048 TI - [Treatment of pyogenic liver abscesses using percutaneous transparietal drainage]. AB - Authors present their own experience with the method of external transparietal drainage of pyogenic hepatic abscesses. It is both effective and available method with minimum complications if performed in time. Mortality rate is much lower than in surgical drainage. Percutaneous drainage of hepatic abscesses depends on the possibility of their diagnostics by means of ultrasonography or computer tomography and access to special instruments. PMID- 2665049 TI - Campylobacter pylori: Swedish experiences. AB - All patients referred for gastroscopy were investigated by Campylobacter pylori culture and antibody titration. An enzyme immunoassay was developed and found to have a negative predictive value of 0.997, which indicates that serologic tests could be used for screening of patients before gastroscopy. A close correlation was found between active and inactive duodenal and gastric ulcer and positive C. pylori culture. Small open treatment trials with the antibiotics doxycycline, tinidazole, amoxycillin, and norfloxacin were ineffective for the eradication of C. pylori. Treatment with the new anti-ulcer agents enprostil, rioprostil, and omeprazole had no effect on the presence of C. pylori. PMID- 2665050 TI - Review of the modes of action of colloidal bismuth subcitrate. AB - In recent years considerable progress has been made to elucidate the modes of action of colloidal bismuth subcitrate (CBS). CBS accelerates the healing of experimental chronic ulcers in rats by the formation of occlusive complexes and/or the accumulation of epidermal growth factor (EGF) in the ulcer crater. CBS exhibits gastric protection (cytoprotection) against, for example, ethanol lesions. Microscopic analysis of these lesions reveals that CBS protects against deep mucosal necrosis but not superficial injury, a property also found with prostaglandins. Dose-dependent increases in gastric prostaglandin E2 (PGE2) and bicarbonate secretion were found after CBS, in both animals and human volunteers. CBS in normal clinical doses increases PGE2 output from the gastric mucosa of human volunteers. Gastric injury in human volunteers produced by unbuffered aspirin is also reduced by concomitant administration of CBS, whereby PGE2 production is inhibited. This indicates that CBS exerts its gastric protection by both prostaglandin- and non-prostaglandin-mediated mechanisms. Campylobacter pylori is considered to be a causative factor of chronic antral gastritis and is a potential prerequisite for peptic ulcer disease. CBS, in contrast to other anti ulcer drugs, prevents the growth of C. pylori in vitro. CBS eradicates C. pylori in patients and resolves chronic antral gastritis. The favourable relapse rates with CBS might be explained by the permanent eradication of C. pylori. PMID- 2665051 TI - The role of Campylobacter pylori in the pathogenesis of peptic ulcer disease. AB - Most patients with peptic ulceration have chronic gastritis, which typically involves predominantly the antrum. The association between Campylobacter pylori associated gastritis and peptic ulceration has recently been repeatedly demonstrated. Evidence is accumulating that the bacterium plays a causal role in type-B chronic gastritis. C. pylori also colonizes the duodenum when gastric metaplasia is present. It is likely that the inflamed mucosa is more susceptible to ulcerogenic influences affecting either the stomach or duodenum. PMID- 2665052 TI - Self, identity, and subjective experiences of schizophrenia: in search of the subject. AB - Schizophrenia is an I am illness--one that may overtake and redefine the identity of the person. This essay explores concepts of personhood and subjectivity from social science that are useful in understanding the experiencing subject in schizophrenia. Relationships between the self and sickness have not been investigated adequately with reference to their influence on prognosis. Chronicity is conceived of as a loss of self and of positive social roles and identity. Methods for the study of self and identity in relation to schizophrenia include analysis of illness-identity representations made by persons with schizophrenia. PMID- 2665053 TI - The self and schizophrenia: a cultural perspective. AB - Much of what is known about schizophrenia necessarily reflects and deals with what is expected of and known about the self and human subjectivity. Schizophrenia is a disorder that by definition affects individual perception and cognition, and compromises social identity and functioning. The changes wrought by schizophrenia affect the self in a broad context, encompassing such things as self-concepts, self-awareness, self-functioning, and self-career. Thus, schizophrenia erodes and undermines the organization and functioning of the self, and because of this, schizophrenia and self/subjectivity are integrally linked. However, our knowledge of self and human subjectivity is a Western European influenced knowledge. A basic assumption of this article is that there exist other, non-Western varieties of selves and human subjectivities that provide essential information for understanding human psychological and social behavior. The aim of this article is to show how an account of such alternative psychologies through cross-cultural anthropological studies may contribute to a fuller understanding of schizophrenia and the self in a cultural and cross cultural perspective. PMID- 2665054 TI - Schizophrenia and the self: contributions of psychoanalytic self-psychology. AB - This article explores the unique contribution of psychoanalytic self-psychology to an indepth understanding of the subjective experience of the self in schizophrenia. The author makes the argument that with creative adaptation Kohut's experience-near concept of the primacy of the self--its development and vicissitudes of fragmentation/cohesion--and the salience and legitimacy of self object needs in all human relationships can be applied to psychotic and schizophrenic experience. When so applied, there is reason to suspect that an important bridge to the subjective inner life of the schizophrenic patient will be achieved. PMID- 2665055 TI - Unemployment, re-employment and mental well-being. A panel survey of industrial jobseekers in Finland. PMID- 2665056 TI - Methodological considerations in the study of frequency, risk factors and outcome of reduced fertility. AB - Infertility is a major health problem for many couples. Many clinicians believe that its prevalence is increasing. This may be attributable to greater concern about infertility in society and development of new treatment methods. Infertility is also a complex medical, social and individual problem. We do not know enough about the risk factors and their mechanisms of action. In the study of reduced fertility there is a need for clear definitions and careful selection of study populations. There are several sources of bias. One is selection bias in the ascertainment of infertility couples, others are recall bias and exposure assessment bias. Furthermore, medical classification of causes is difficult in population based studies. This paper will discuss problems in the interpretation of results of past studies and in methods already in use. Some new design options in future research are presented. PMID- 2665057 TI - Late results after pericardectomy for constrictive pericarditis via left thoracotomy. AB - Pericardectomy was performed on 28 men and 8 women (mean age 56, range 18-74 years) with diagnosis constrictive pericarditis. The etiology was unknown in 16 cases. Left anterior thoracotomy was employed in all but one case, in which median sternotomy was preferred because of extensive left pleural calcifications. There were three early and 11 late deaths. Actuarial survival at 5 and 10 years was 77% and 64%, respectively. Relief of symptoms was reported by 16 of the 33 patients (49%), who survived the postoperative period. These 16 were among the 22 survivors observed for a median of 8 (range 2-17) years postoperatively. Complete pericardectomy was achieved in all 16 asymptomatic patients, but in only nine of the 17 hospital survivors (53%), with persistent heart failure (p less than 0.01). Pericardial calcifications were significantly less common in the former than in the latter group. Lack of postoperative improvement was related to severe, nonresectable calcifications, and probably in some cases to associated fibrous epicarditis or restrictive myocardial disease. Left thoracotomy permits easier and more complete left ventricular pericardectomy, but is less safe when severe calcifications involve the right ventricle and atrium. PMID- 2665058 TI - Insulin as a vasodilating agent in the first hour after cardiopulmonary bypass. AB - To study the vasodilating effect of insulin after termination of ECC in aortocoronary bypass surgery, 21 patients were randomized to treatment with 7.5 U of fast-acting insulin/kg b.w. as a bolus injection followed by continuous infusion of 15 U/kg b.w. for 1 hour, or to serve as controls. Insulin administration was begun when the last proximal anastomosis had been completed. Cardiac output and central pressures were monitored for 1 hour after termination of ECC. Systemic vascular resistance in both groups was lower at the end of ECC than before surgery (reduction 39% in the controls, 51% in the insulin-treated group). During the following hour the peripheral resistance increased significantly in the controls (from 20 +/- 2 to 29 +/- 2 mmHg X min X m2/l), but no change was found in the insulin group. It is concluded that insulin can maintain a low vascular resistance after aortocoronary bypass surgery. PMID- 2665059 TI - Glucose and lactate balances in heart and leg after coronary surgery: influence of insulin infusion. AB - Glucose and lactate balances in leg (representing mainly skeletal muscle) and heart were studied 1 hour after aortocoronary bypass surgery and insulin treatment. Seventeen men were randomized to receive 25 U fast-acting insulin as a bolus injection, followed by continuous infusion of 1 U/kg b.w. for 1 hour, or to serve as controls. In the leg a small glucose uptake was found while the lactate balance was negative. During the study period the lactate release increased further in the control group. In the myocardium no significant extraction of glucose or lactate could be demonstrated. Insulin treatment resulted in a fivefold increment of leg glucose uptake and in significant myocardial glucose uptake. Myocardial lactate balance was also improved by insulin treatment, with fractional extraction increased from 6 to 21%. It is concluded that myocardial carbohydrate metabolism is restricted in the early period after cardiac surgery, and that this seems to result from insulin resistance induced by the surgical trauma. PMID- 2665060 TI - Primary tumours of the sternum. AB - In 1966-1986, two men and four women (mean age 47.5 years) underwent surgery for primary sternal tumour. Three of the tumours were benign (two condromata, one osteochondroma) and three were malignant (two chrondrosarcomata, one reticulum cell sarcoma). Inflammatory or degenerative lesions impeded differential diagnosis in three additional cases (without tumour). The tumours were treated with radical resection of the affected part of the sternum, including the relevant attached structures. Marlex-mesh reconstruction of the defect was necessary in four cases. There was no operative mortality. One Marlex graft became infected. At follow-up (average 11.1 years, range 9.0-14.7 years), five patients were alive without recurrence of tumour and the sixth had died of unrelated cause. PMID- 2665061 TI - Intrathoracic tumors arising from the vagus nerve. Review of resected tumors in Japan. AB - Nineteen surgically treated intrathoracic vagus nerve tumors (16 neurilemmomas, 3 neurofibromas), including three treated by the authors, were reviewed. Tumor resection with vagus nerve amputation was performed in 14 and intracapsular excision without nerve amputation in 3 of the 17 adequately recorded cases. The location of vagus nerve tumor was the left upper mediastinum in 11 patients, almost all of whom were hoarse postoperatively due to sacrifice of the recurrent laryngeal nerve. PMID- 2665062 TI - Peroral N-acetylcysteine as prophylaxis against bronchopulmonary complications of pulmonary surgery. AB - In a randomized, double-blind study, 38 patients undergoing elective pulmonary surgery were given N-acetylcysteine (Fabrol, Ciba-Geigy) in recommended dosage (200 mg X 3) or placebo. The prophylactic effect on postoperative bronchopulmonary complications was evaluated from arterial blood-gas analyses and chest radiography. The alveolo-arterial oxygen difference increased substantially and similarly in both patient groups, and no intergroup difference was found in incidence of atelectasis or pneumonic infiltration. Thus there was no demonstrable benefit of N-acetylcysteine in the recommended dosage. For future similar studies, employment of considerably higher doses is proposed. PMID- 2665063 TI - Coronary endarterectomy--angiographic and clinical results. AB - Of 75 patients who underwent coronary endarterectomy, 16% had left main stem stenosis, 4% one-vessel, 27% two-vessel and 53% three-vessel disease. On average 2.9 grafts per patient were inserted, in conjunction with 82 manual endarterectomies (38 right coronary, 35 left anterior descending, 9 circumflex branches). In 68/75 cases (91%) the endarterectomy was not preplanned and in 39 cases (52%) greater than or equal to 3 cm of the atherosclerotic core was removed. All four early deaths (5%) followed endarterectomy of LAD. Acute perioperative myocardial infarction was confirmed in 19% and probable in further 8%. At angiography 1-139 (median 25) months postoperatively, all three internal mammary artery grafts and 19/34 saphenous vein grafts (56%) to endarterectomized vessels were patent, though in 4 of the 19, the coronary artery was occluded distal to the anastomosis. In addition 17/18 conventional internal mammary artery (94%) and 48/59 conventional saphenous vein grafts (81%) were patent. The vein graft patency rate was not significantly influenced by postoperative anticoagulant therapy, but was significantly increased among patients with relief of angina: 44% reported freedom from angina and 92% at least some relief after a median of 3 years. The 5-year and 10-year survival rates were 85% and 68%. Despite the increased risk, endarterectomy can be recommended for severely diseased major coronary arteries. PMID- 2665064 TI - [Results in microsurgical carotid artery endarterectomy]. AB - 100 consecutive carotid endarterectomies were performed by a microscopic technique with monitoring of cerebral perfusion by transcranial Doppler sonography and EEG. No additional cerebral deficits occurred in this series. Perioperative mortality due to medical complications occurred in 2 instances. During the average follow-up period of 15 months, 1 patient suffered a lethal cerebral infarction ipsilateral to the operated carotid artery and 1 patient a contralateral minor stroke. 2 patients died from unrelated causes during follow up. PMID- 2665065 TI - [Medial necrosis of the pulmonary artery in ruptured aneurysm]. AB - Fifty years ago the first author of this paper described the entity known as idiopathic medial necrosis of the aorta. The present report describes two cases of ruptured aneurysm of the main pulmonary artery. The histologic alterations of the arterial wall were the same as in the much more common aneurysms of the aorta, viz. severe medial necrosis and mucoid degeneration. The findings are discussed and compared with 20 cases documented in the literature. Physical (hypertension) as well as biochemical factors appear to play an essential role in the pathogenesis of medial necrosis. PMID- 2665066 TI - [Radiological methods for visualization of the urinary tract]. AB - The methods of radiologic investigation of the urinary tract have radically altered. Sonography has established itself as the basic method of demonstrating the size and shape of the kidney. Ultrasound reliably identifies cysts among renal tumors. It is increasingly used as the primary method in the search for nephrolithiasis or ureteral stones. Urography offers the highest resolution for the delineation of pathologic changes in the renal pelvis. It is no longer available as a screening method in suspected renovascular hypertension. CT serves to clarify doubtful sonographic renal findings. It is the method of choice for staging of renal tumors and the definition of parenchymal as well as perirenal damage after trauma. Angiography, especially as regards the diagnostic value of digital subtraction angiography, is the diagnostic method of choice in suspected renovascular hypertension. The diagnostic value of magnetic resonance imaging in nephrology and urology cannot yet be finally assessed. PMID- 2665067 TI - [Clinical and radiologic follow-up of coronal restoration with a standard radicular retainer]. AB - The purpose of this study was to assess clinically and radiographically at mid term the anchoring of custom posts in flat and curved roots. The results were compared to those of a similar study done in vitro (Brustlein-Rathle et al. 1988). 342 root canals from 143 premolars and molars were treated with standardized procedures by undergraduate students at the "Section de Medecine dentaire" of the University of Geneva. The results, which corroborated the above mentioned in vitro observations, confirmed that the endodontic preparation as well as the canal widening for the post insertion straightens and thins the canal walls in 60% of the round and curved roots and in 25% of the flat and curved roots, also named root at risk. The study also demonstrated the difficulties of estimating and visualizing radiographically the weakening and possible cracks within the root wall because of radicular and osseous radiographic superimposition. PMID- 2665068 TI - [Quantitative measurement of sulcus fluid with new self-coloring paper indicator strips: a comparison with Periotron]. AB - Quantitative measurements of gingival crevicular fluid are used to examine gingival inflammation. In order to simplify such measurements we evaluated for the first time testing papers with chemically bound pH indicators. The height of the fluid can be seen instantly as a color change. Calibration curves showed a rise in linear proportional increments in the magnitude of 1 mm per 0.1 microliters. To evaluate this method, we made a comparative study using 26 patients and Periotron ratings. Both methods can be regarded as congruent. Using the color-indicator paper is a methodological advantage, as measurements can be taken without the need of further devices, chemical substances or procedures. PMID- 2665069 TI - Sweet success. A critical glucose transporter has been found. PMID- 2665070 TI - Increasing organ donation--a review. PMID- 2665071 TI - A comparison of cyclosporin versus azathioprine treatment in renal transplants in Edinburgh. AB - Three year graft survival rates were calculated for 66 patients on cyclosporin and prednisolone immuno-suppression and compared to survival rates for 73 patients on azathioprine and prednisolone. There was a temporary early advantage for the cyclosporin treatment group up to four months post transplant. There was no further significant difference between the two treatment groups with graft survival rate of 81.4% in cyclosporin and 76.7% in azathioprine group at three years post transplant. Fewer of the patients on cyclosporin had acute episodes of rejection. There was no significant difference in serum creatinine or urea at one year, but the haemoglobin level was higher in cyclosporin treated patients. Cyclosporin does not appear to have increased the survival rate significantly in our centre where there is already a high graft survival with azathioprine. PMID- 2665072 TI - Rene Laennec: his brilliant life and tragic early death. AB - 1. Laennec's lung disease lasted for at least 20 years. Its stigmata included chronic cough, sputum production and intermittent wheeze. 2. Laennec had long term stigmata commonly associated with chronic bronchiectasis, sinusitis, physical frailty, and short stature (5ft 2in). 3. Chronic diarrhoea of at least 20 years duration is not strongly associated with tuberculosis. 4. During Laennec's last illness his physicians equivocated as to whether he had respiratory disease at all. Bronchial breathing at the apex, if indeed present, could have been caused by compensatory emphysema secondary to middle lobe bronchiectasis rather than to active tuberculosis. 5. Laennec did not have haemoptysis in his final illness. 6. Laennec's last illness, a wasting illness characterised by intermittent fevers, cardiac murmur, and persistent tachycardia followed a dental manipulation. The painful "abdominal abscess" noted by Laennec's colleagues may actually have been splenomegaly. These features suggest endocarditis. The cardiac murmurs associated with pulmonary hypertension secondary to bronchiectasis are not usually audible at a remote distance from the patient. Endocarditis was a disease largely unknown to physicians of the early 19th century before Osler clarified its pathology in the 1880s. PMID- 2665073 TI - About our new president. PMID- 2665074 TI - Management of the second stage of labor: a review (Part II). Maternal positioning as it relates to the management of the second stage of labor is reviewed. AB - In the previous article, the rigid use of the Friedman Curve, breathing techniques, and other management options for the second stage of labor were examined. This article concentrates on the affect of maternal positioning, on the length of the second stage of labor, and summarizes the contents of that former article and this one. PMID- 2665075 TI - Chemistry of mutagenic by-products of water chlorination. AB - The strong Ames mutagen 3-chloro-4-(dichloromethyl)-5-hydroxy-2 (5H)-furanone (MX) and its geometric isomer E-2-chloro-3-(dichloromethyl)-4-oxobutenoic acid (E MX) have been shown to be present in chlorinated drinking waters. MX accounts for approximately 30% and E-MX for a few percent of the overall mutagenicity. MX and E-MX are unstable in water and undergo both pH dependent isomerization (MX in equilibrium E-MX) and hydrolytic degradation. Alternative methods of disinfection have been found to produce mutagenicity, and MX and E-MX but to a lesser extent than disinfection with chlorine. The MX analogues 3-chloro-4-(dichloromethyl)-2 (5H)-furanone (red-MX) and 2-chloro-3-(dichloromethyl)-2-butenedioic acid (ox-MX) have also been identified in chlorinated water. However, the relatively low mutagenicity of these compounds suggests that their contribution to the overall mutagenicity of chlorinated water is of only moderate significance. PMID- 2665076 TI - DNA mismatch correction in a defined system. AB - DNA mismatch correction is a strand-specific process involving recognition of noncomplementary Watson-Crick nucleotide pairs and participation of widely separated DNA sites. The Escherichia coli methyl-directed reaction has been reconstituted in a purified system consisting of MutH, MutL, and MutS proteins, DNA helicase II, single-strand DNA binding protein, DNA polymerase III holoenzyme, exonuclease I, DNA ligase, along with ATP (adenosine triphosphate), and the four deoxynucleoside triphosphates. This set of proteins can process seven of the eight base-base mismatches in a strand-specific reaction that is directed by the state of methylation of a single d(GATC) sequence located 1 kilobase from the mispair. PMID- 2665077 TI - G1/S transition in normal human T-lymphocytes requires the nuclear protein encoded by c-myb. AB - Exposure of peripheral blood mononuclear cells (PBMC) to an 18-base c-myb antisense oligomer before mitogen or antigen stimulation resulted in almost complete inhibition of c-myb messenger RNA and protein synthesis and blockade of T lymphocyte proliferation. Expression of early and late activation markers, interleukin-2 receptor and transferrin receptor, respectively, by PBMC was unaffected by antisense oligomer exposure as was the expression of c-myc messenger RNA. In contrast, histone H3 messenger RNA levels and DNA content were selectively decreased. These results suggest that c-myb protein deprivation does not perturb T lymphocyte activation or early molecular events that may prepare the cell for subsequent proliferation. Rather, it appears to specifically block cells in late G1 or early S phase of the cell cycle. PMID- 2665078 TI - Structure of ras proteins. AB - In the Table of Contents of the 24 March 1989 issue, the title of the report "Histamine is an intracellular messenger mediating platelet aggregation" by S. P. Saxena et al. appearing on page 1596 was incorrectly printed. PMID- 2665079 TI - The rat as an experimental animal. AB - The development and characterization of many inbred, congenic, and recombinant strains of rats in recent years has led to the detailed genetic description of this species, especially in regard to its major histocompatibility complex. This information has contributed substantially to the study of comparative genetics and has greatly enhanced the utility of the rat in a variety of areas of biomedical research. This article focuses on the use of the rat in immunogenetics, transplantation, cancer-risk assessment, cardiovascular diseases, and behavior. PMID- 2665080 TI - Localization of the pancreatic beta cell glucose transporter to specific plasma membrane domains. AB - Immunocytochemical techniques revealed that the "liver-type" glucose transporter is present in the insulin-producing beta cells of rat pancreatic islets but not in other islet endocrine cells. Ultrastructural analysis of the transporter by the protein A-gold technique showed that it is restricted to certain domains of the plasma membrane, its density being sixfold higher in microvilli facing adjacent endocrine cells than in the flat regions of the plasma membrane. These results support a possible role for this glucose transporter in glucose sensing by beta cells and provide evidence that these cells are polarized. PMID- 2665082 TI - Current perspectives in the treatment of thrombotic disorders. AB - New trends in antithrombotic therapy should reside in a better adaptation, both in potency and in target to the involved thrombogenic mechanism. Thrombogenesis as hemostasis is the result of cooperation between plasma coagulation factors and platelet functions, and these two systems are themselves in equilibrated antagonism with the vessel wall, mainly endothelial cells. These triangular relations between coagulation factors, platelet functions, and endothelial cell reactivity are quantitatively regulated by flow conditions. The relative importance of each of these protagonists in the genesis of vascular thrombosis varies along the vascular tree, mainly due to changes in flow characteristics, and explain the usual separation between venous and arterial thrombosis: venous thrombosis involves mainly coagulation factors and the vascular fibrinolytic response whereas arterial thrombosis involves the thromboresistant characteristics of the endothelial cell membrane and platelet functions. The real blood flow characteristics may be altered by local disease and influences the relative involvement of coagulation and fibrinolytic factors, platelet functions, and endothelial cells. Prevention of thrombosis must take into account all these phenomena and must be targeted to the predominant factor or factors. Depending on the local conditions, the therapeutical goal can be: (1) limitation of platelet functions or coagulation factors; (2) stimulation of thromboresistant properties of the endothelium (mainly its profibrinolytic characteristics); and (3) modification of the flow conditions. Several targets can be associated: the level of inhibition or stimulation of a function depends on the dysequilibrium, and efficient prevention does not always require complete inhibition of a function. Once a thrombus has developed, antithrombotic treatment will prevent its extension, and thrombolytic therapy will try to restore vascular patency. Once patency has been restored antithrombotic therapy is still needed to prevent recurrence of the thrombus. Even if the main targeting is on platelets, the choice in the molecule to be clinically used must be defined by the function of the platelet involved: thrombogenesis or vasospasm, and even by the metabolic pathway predominantly activated. In coagulation strategy, differences must be drawn between antithrombotic therapy directed against thrombin formation, complexes of coagulation, free enzymes or activation phases. In thrombolytic therapy all procedural uses of extrinsic thrombolytic agents (natural, modified, or artificial), increase of susceptibility to endogenous thrombolytic systems, and stimulation of endogenous thrombolytic activity do not bear the same efficiency. As a consequence, the responsibility for clinical use of new molecules with more specific activity can allow more efficient antithrombotic therapy directed at the condition of an indication targeted at the exact mechanisms involved.(ABSTRACT TRUNCATED AT 400 WORDS) PMID- 2665081 TI - The reservoir for HIV-1 in human peripheral blood is a T cell that maintains expression of CD4. AB - Human immunodeficiency virus type 1 (HIV-1) selectively infects cells expressing the CD4 molecule, resulting in substantial quantitative and qualitative defects in CD4+ T lymphocyte function in patients with acquired immunodeficiency syndrome (AIDS). However, only a very small number of cells in the peripheral blood of HIV 1-infected individuals are expressing virus at any given time. Previous studies have demonstrated that in vitro infection of CD4+ T cells with HIV-1 results in downregulation of CD4 expression such that CD4 protein is no longer detectable on the surface of the infected cells. In the present study, highly purified subpopulations of peripheral blood mononuclear cells (PBMCs) from AIDS patients were obtained and purified by fluorescence-automated cell sorting. They were examined with the methodologies of virus isolation by limiting dilution analysis, in situ hybridization, immunofluorescence, and gene amplification. Within PBMCs, HIV-1 was expressed in vivo predominantly in the T cell subpopulation which, in contrast to the in vitro observations, continued to express CD4. The precursor frequency of these HIV-1-expressing cells was about 1/1000 CD4+ T cells. The CD4+ T cell population contained HIV-1 DNA in all HIV-1-infected individuals studied and the frequency in AIDS patients was at least 1/100 cells. This high level of infection may be the primary cause for the progressive decline in number and function of CD4+ T cells in patients with AIDS. PMID- 2665083 TI - Development of anisoylated plasminogen-streptokinase activator complex from the acyl enzyme concept. PMID- 2665084 TI - Polypharmacologic interactions in the management of thrombosis. AB - Pathologic evidence indicates that thrombosis in coronary arteries is most frequently initiated by fissures in atheromatous plaques and that the associated hemorrhage induces platelet aggregation. Less frequently, thrombosis may be initiated by arterial spasm or by pathologic abnormalities affecting the platelets or the mechanisms of plasma coagulation. For the rational development of antithrombotic drugs on the basis of aggregation inhibitors, the cause (or causes) of plaque fissure and of the ensuing platelet aggregation need therefore to be elucidated. Our current research is based on the working hypothesis that fissuring occurs when plaques have acquired a particular composition that can be disrupted by the cumulative effect of continuously varying hemodynamic forces (reminiscent of fatigue failure in artificial materials), and that fissure associated hemorrhage, like hemorrhage anywhere else, initiates platelet aggregation via a concurrence of hemodynamic and biochemical mechanisms. Detailed studies are currently being directed toward establishing the sequence of events that determine the contributions of adenosine diphosphate, thromboxane A2, and other endogenous agents in promoting hemostatic platelet aggregation in real life and, by implication, arterial thrombosis. Important recent evidence has demonstrated repeated thrombosis in unstable angina patients. In such patients, aspirin diminishes by about half the incidence of myocardial infarction and death. Presumably, it prevents the formation of platelet thrombi, which would tend to be produced in the turbulent blood flowing through arterial segments severely narrowed by hemorrhage plaques or in spasm. Several other platelet active drugs are also under investigation. PMID- 2665085 TI - Current perspectives in the antiplatelet therapy of thrombotic disorders. PMID- 2665086 TI - Pharmacology of ticlopidine: a review. PMID- 2665087 TI - Ticlopidine in the treatment of peripheral occlusive arterial disease. PMID- 2665088 TI - Perspective on antiplatelet drugs. PMID- 2665089 TI - Endothelium in health and disease. PMID- 2665090 TI - Perturbation of endothelial functions by ionizing irradiation: effects on prostaglandins, chemoattractants and mitogens. AB - Numerous studies have shown that early radiation injury is characterized by vascular damage and that the initial site of damage appears to be the EC lining of the vessel wall. Chronic irreversible tissue reactions to radiation include thrombotic occlusion of capillaries, enhanced atherosclerosis in larger vessels, inflammatory changes, and late tissue fibrosis. These processes may be mediated by endothelial products released as a result of cellular injury. Using EC cultures, we show that ionizing irradiation affects one of the major vascular defense mechanisms against platelet activation, thrombosis, and atherosclerosis- the capacity to produce PGI2. Dose- and time-related damage to enzymes of the arachidonic acid cascade were demonstrated. Radiation damage is associated with oxidant stress and production of free radicals. The oxygen radical scavenger, vitamin C, was found to protect the capacity of irradiated ECs to produce PGI2. Radiation injury often induces an acute inflammatory response. We found that irradiated ECs release a chemotactic factor for neutrophils, which is a lipid product of the lipoxygenase pathway. Late radiation-induced tissue fibrosis and the capacity of radiation to enhance arteriosclerosis may involve participation of mitogens released from perturbed and damaged ECs. We show that conditioned medium of irradiated ECs contain larger amounts of newly synthesized mitogens capable of stimulating the proliferation of fibroblasts, SMCs, and ECs. Hence, it may be assumed that the mitogenic activity released by irradiated ECs includes both PDGF and FGF-like mitogens. PMID- 2665091 TI - Antithrombotic drugs in pelvic surgery. AB - From the discussion, it is clear that several agents are available for the prophylactic antithrombotic management of pelvic surgery. Unlike other surgical procedures, the interventions are performed in women with many physiologic and pathologic predisposing factors. There is an increased risk of bleeding in these patients and the selection of an antithrombotic drug with a high safety to efficacy ratio is imperative. Although the introduction of newer drugs, such as defibrotide and low molecular weight heparins, provides certain advantages over the conventional drugs, large-scale prospective clinical trials are required to justify their use. Combination therapy will also be a useful and more effective approach in the management of pelvic surgical patients. However, optimization of dosage and an empiric determination of the safety and efficacy of different drugs used in combination will have to be made. Newer therapeutic agents will have a direct impact in this area in coming years. The practicing clinician should keep an open mind to provide better patient care. PMID- 2665092 TI - Overview of the management of thrombotic disorders. PMID- 2665093 TI - [Ultrasound sonography in the diagnosis and follow-up of Achilles tendon rupture]. AB - In addition to allowing definite diagnosis of Achilles tendon rupture and localization of the rupture site, ultrasonography also enables the examiner to grade the rupture and the course of healing for quantity and quality. Twenty patients with subcutaneous achilles tendon rupture were examined in a prospective study that is still in progress. In this trial an operative and a conservative functional treatment with a newly developed shoe were compared. The dynamic examination revealed adaptation of the tendon in plantar flexion in two-thirds of the patients. After 2 weeks continuity of the tendon was restored in all patients. A remarkable increase in the regeneration of the tendon at the rupture or suture site was observed from the 4th to the 12th week. The variations in tendon structure were assessed, and a classification is presented. PMID- 2665094 TI - [Rib span-plasty in sequestered osteomyelitis of the femoral diaphysis]. AB - A case is reported of a 6-year-old boy with acute pyogenic osteomyelitis. A delay in making the diagnosis or inadequate early treatment led to chronic osteomyelitis. A delay in making a diagnosis is the most important factor in the prognosis of acute osteomyelitis. Sophisticated techniques are only indicated to detect and confirm the nature of the lesion, but they should not delay identification of the causative organisms. In our case, the diagnosis was delayed, and there was complete sequestration of the femur shaft as a result of insufficient early treatment. After diagnosis, the initial step was surgical debridement. After complete necrotomy, continuous irrigation with suction drainage was begun. To fill the defect and accelerate bone reconstruction, we performed an autogenous graft taking the 8th rib and splitting it into nine fragments. After identification of Pseudomonas aeruginosa as the causative organism, parenteral antibiotic therapy was begun and maintained. Nine weeks after admission, the boy was able to leave the hospital. Ten weeks later he was examined in the outpatient clinic and was walking and running quite normally. To date, there has been no recurrence of the infection. PMID- 2665095 TI - Nutrition during pregnancy. PMID- 2665096 TI - Biological factors affecting intrauterine growth. PMID- 2665097 TI - The role of the placenta in lipid metabolism and transport. PMID- 2665098 TI - Fetal protein metabolism. PMID- 2665099 TI - Fatty acid metabolism in the fetus. PMID- 2665100 TI - Treatment of the growth-retarded fetus by augmentation of substrate supply. PMID- 2665101 TI - Functional development of the fetal gastrointestinal tract. PMID- 2665102 TI - Maternal malnutrition and the fetus. PMID- 2665103 TI - Limited sensitivity of ultrasound for the detection of rotator cuff tears. AB - Bilateral rotator cuff sonography was performed on 56 patients referred for shoulder arthrography to detect rotator cuff tears. Since one patient had bilateral arthrography there were 57 arthrograms. Twenty-seven shoulders had rotator cuff tears shown on arthrography, 15 of which were detected by sonography. Eleven were false negative by sonography, and one was indeterminate. Of the 30 shoulders with negative arthrograms, 28 had normal sonograms and two were false positive. Sensitivity was 58%, specificity was 93% and overall accuracy was 77%. The positive and negative predictive values were 88% and 72%. These results suggest that sonography has limited value in screening patients for rotator cuff tears and that a positive sonographic reading is more reliable than a negative one. Theories relating to the variable anatomic configuration of a tear are postulated to explain these results, which differ from those previously reported. PMID- 2665104 TI - Intra-osseous ganglion. Report of four cases and review of the literature. AB - Intraosseous ganglia are histologically identical to their soft tissue counterparts. Most commonly seen adjacent to the hip, ankles, knee, or wrist, they are often mistaken for other neoplasms occurring in the epiphysis. We discuss the characteristic clinical, radiological, and pathologic features of four cases of intraosseous ganglia. Intraosseous ganglia should be included in the differential diagnosis of well-demarcated lucent epiphyseal lesions of bone. PMID- 2665105 TI - Ultrasonic diagnosis of Osgood-Schlatter and Sinding-Larsen-Johansson diseases of the knee. AB - High resolution ultrasonography of the knee was performed on 82 young patients with clinically suspected Osgood-Schlatter disease and on 30 normal subjects; in 45 pathological cases (55%) comparative X-ray films were taken. The ultrasound pictures were equally or more effective than X-ray images in 45/45 cases; their value was particularly marked for soft tissue study. The typical sonographic changes of the ossification center, of the cartilage, and of the surrounding soft tissues are described and classified, both for Osgood-Schlatter and for Sinding Larsen-Johansson diseases. These signs are based mainly upon cartilage swelling and edema, fragmentation of the ossification center, thickening of the patellar tendon, and bursitis of the infra-patellar bursa. Ultrasonography is proposed as a simple and reliable method for the diagnosis of knee joint osteochondrosis. The ultrasound picture is also suitable for periodical follow-up the course of the disease. PMID- 2665106 TI - Conceptual, theoretical and methodological issues in self-care research. PMID- 2665107 TI - Self-care in health promotion. AB - About 10 years ago academics discovered the fact that people actually take care of themselves. This was a process rather reminiscent of the academic discovery of poverty in the sixties [1. Poverty Studies in the Sixties. A Selected and Annotated Bibliography. U.S. Department of Health, Education and Welfare, Washington, D.C., 1970]. Like poverty, self-care had 'always been with us', but it had not been deemed worthy of scientific interest. Not only did this expose a gap within sociological research on health and medicine, it also gave new impetus to long-standing debates within sociology of knowledge and epistemiology. But not only academia discovered self-care. It was a key issue of the most influential social movement of the seventies, the women's movement, although often expressed in a terminology very different from that in academic quarters. And it was debated heavily in the medical system based on the growing popular interest in self-help and wellness. When it first emerged therefore, self-care was both an academic and a political issue--and it was unavoidable that the two should not only influence each other, but at times clash. PMID- 2665108 TI - Self-care within a model for demand for medical care. AB - Self-care is interpreted from a health economic point of view. Various approaches are presented. It is stressed that the decision-oriented approach used by other health service researchers is an integral part of the economic approach to the topic as is the idea of a continuum of care, from self-care to professional care. A new approach is taken to the modeling of self-care, in that self-care becomes part of a four-part demand for care model. This makes it possible to model the demand for care for three different groups separately: 1--persons with zero episodes; 2--persons with pure illness episodes and illness episodes with self care; 3--persons with episodes involving professional care or professional care combined with self-care. Another contribution is due to the so-called episodic approach to the demand for care. The natural counting units are illness and treatment episodes, i.e. instead of counting for instance number of times a general practitioner is consulted we ought to count the number of episodes involving professional care, self-care or both types of care. The episodic approach seems to be well suited for work with self-care. The empirical part is based on a unique Danish panel study using health diaries returned weekly. Data from 27 of the 52 reporting weeks are used, involving more than 14,000 episodes distributed across about 2800 persons belonging to about 1000 households. The use of health diaries seems to be very well suited to the study of self-care in that less salient events and activities than professional care are picked up far better in prospective health diary studies than in retrospective questionnaire based surveys. Descriptive and regression (logistic and ordinary) results are presented. PMID- 2665109 TI - A clinical trial of a self-care approach to the management of chronic headache in general practice. AB - This paper reports a trial which assessed the clinical effectiveness of adding a behavioural self-management programme to the existing management of chronic headache by general practitioners (GPs). Eighty-seven chronic headache sufferers, referred to the study by 35 GPs, were randomly allocated to either a self-care group or a GP-control group. Headaches, drug usage, visits to health-care providers and time off work were self-monitored daily by all subjects for 4 weeks prior to intervention, for 4 weeks during intervention, and for 4 weeks immediately after intervention. Additionally, self-monitoring was carried out for two further 4-week periods, one at 6 months and one at 12 months post intervention. Headache records showed that the self-care program significantly enhanced GP management. This effect was well maintained. However, drug usage, visits to health-care providers and time off work did not differ significantly between the treatment and control groups. 'No-show' rates, defined as those referred by a GP but who did not attend, were high--largely due to time requirements of the self-care program. However, drop-out rates, defined as those who left the self-care groups were low. It was concluded that this behavioural self-management program was a clinically effective adjunct to general practice management of headache but its use is likely to be limited due to problems of patient enrollment. PMID- 2665111 TI - Statistical analysis of complex health and social data. AB - The selection of appropriate statistical models is a vital aspect of the analysis of complex health and social data. This paper examines issues related to model selection. It is concluded that the range of methods now available makes old controversies less relevant. Researchers may now look for strategies that combine the advantages of non-parametric and parametric approaches without automatically accepting the limitations of either. Examples of new directions are provided. PMID- 2665110 TI - Long-term outcomes of an arthritis self-management study: effects of reinforcement efforts. AB - An underlying assumption of self-care interventions is that they are most effective when reinforced. To test this assumption, 8 months after baseline, 589 subjects who had taken a 6-week Arthritis Self-management Course (ASMC) were randomized to (1) receive a bi-monthly arthritis newsletter, (2) attend a new 6 week Arthritis Reinforcement Course (ARC) or (3) receive no reinforcement. Between 8 and 20 months there were no significant differences among the three randomized groups. The results were unaltered by inclusion of assumed data of no change for the 46 subjects who did not complete the full 20-month study. Between baseline and 20 months all participants reduced their pain by 20%, depression by 14%, and visits to physicians by 35% (P less than 0.01). There were no trends toward loss of these effects over time. These findings indicate that the effects of a self-care intervention were sustained over 20 months and that the tested forms of reinforcement did not alter those effects. PMID- 2665112 TI - [Insulin therapy. The new insulins]. PMID- 2665113 TI - [Conventional insulin therapy, infusion pumps, injector syringes. Different methods of administration]. PMID- 2665114 TI - [New tools in the screening for and treatment of type I diabetes mellitus]. PMID- 2665115 TI - [Sanyrene--a new approach in the prevention of eschars]. PMID- 2665116 TI - [Interpersonal relations and dynamics of nursing care]. PMID- 2665117 TI - [The liar--a self-instruction program on alcohol]. PMID- 2665118 TI - [A history of nursing care. "A critical approach"]. PMID- 2665119 TI - [Burnout and fatigue in caregivers]. PMID- 2665120 TI - [The influence of psychiatry on the law of june 30, 1838]. PMID- 2665121 TI - [Development of psychiatric theories]. PMID- 2665122 TI - [The biologic approach to psychiatry]. PMID- 2665123 TI - [History of practices ... caring, social, and educational. A rediscovered text...]. PMID- 2665124 TI - [Evolution of ideas in psychiatry since...]. PMID- 2665125 TI - Into the nineties and beyond: medicine in short supply. PMID- 2665126 TI - Combined transurethral resection of the prostate and inguinal herniorrhaphy. AB - From 1983 to 1985, ten men had combined transurethral resection of the prostate (TURP) and inguinal herniorrhaphy; hernia repair immediately preceded transurethral resection. Eight men had unilateral inguinal hernia repair and two had bilateral inguinal herniorrhaphy. Four men had additional procedures done concurrently. Follow-up ranged from 14 to 33 months (mean 22.4 months). There were no recurrent hernias or infections of the hernia incision. These results suggest that combined TURP and inguinal herniorrhaphy can be safely accomplished during a single period of anesthesia. PMID- 2665127 TI - Disease states in which blood pressure is lowered. AB - Hypertension can be ameliorated by certain concomitant disease states, especially those in which serum globulin is elevated. Blood pressure has been reduced in cases of cirrhosis of the liver, chronic alcoholism, congestive heart failure, arthritis, hypothyroidism, and myeloma. These clinical findings were confirmed experimentally when animals with various models of hypertension became normotensive after the development of a modest degree of liver damage with hyperglobulinemia. Other diseases, not associated with hyperglobulinemia, that can lower blood pressure are stroke, uremia, hyperparathyroidism, and malnutrition. When any of these diseases occur in hypertensive patients, their influence on blood pressure must be considered when determining treatment and prognosis. PMID- 2665128 TI - Bronchoprovocational challenges in the assessment of the efficacy of therapeutic agents. AB - Bronchoprovocational challenge techniques are useful clinical and research tools for evaluating airway hyperreactivity. Not only are they useful in guiding management of patients with asthma, but also are commonly used to assess the efficacy of bronchodilating agents. The mechanisms involved in the development of bronchoconstriction are poorly defined, but continued work with challenge procedures may increase our understanding of the factors responsible for asthma. This paper will review some of the challenge techniques currently in use and outline the usefulness and limitations of these procedures. PMID- 2665129 TI - Pulmonary function testing: sources of error in measurement and interpretation. AB - Valid pulmonary function data require that attention be paid to issues that can lead to errors in measurement or in interpretation. Routine procedures designed to reduce errors should be established. Among the most important of these are (1) assuring the accurate measurement and calculation of lung function parameters, which requires attention to accuracy when an instrument is brought into service in a laboratory and again when it is updated; (2) selecting reference equations and lower limits of normal appropriate for the patients being studied and for the equipment being used; (3) avoiding the errors introduced by using an excessive number of measurements in generating an interpretation; and (4) avoiding interpretation of results without considering the clinical setting and the pertinent elements of a complete data base. PMID- 2665130 TI - Evolution of civil aeromedical helicopter aviation. AB - The rapid increase in the use of helicopters for hospital transport during the 1980s is the culmination of several hundred years of military medical innovation. Mass battefield casualties spurred both technologic and medical changes necessary for today's sophisticated helicopter systems in use worldwide, particularly in the United States. The Napoleonic Era and the American Civil War provided the framework for the evolution of today's state-of-the-art emergency medical techniques. The use of airplanes to evacuate the wounded eventually led to using helicopters for rescue missions in World War II. The combat experiences of the United States in Korea, the British in Malaya, and the French in Indochina proved that rotary-wing aircraft were invaluable in reducing battlefield death rates. Any skepticism about the efficacy of helicopter medical evacuation was erased during the Vietnam conflict. As an integral part of the modern battlefield, these specialized aircraft became a necessity. The observations and experience of American servicemen and medical personnel in Vietnam established the foundation for the acceptance of helicopter transport in modern hospital systems. PMID- 2665131 TI - Spontaneous streptococcal gangrenous myositis: survival with early debridement. AB - Spontaneous gangrenous myositis caused by Streptococcus pyogenes is usually fatal, but no longer uniformly so. There appears to be a spectrum of disease due to beta-hemolytic streptococci, from necrotizing fasciitis to pyomyositis to spontaneous gangrenous myositis. Survival is possible with early surgical debridement, reexploration at 24 to 36 hours, and intensive supportive care. PMID- 2665132 TI - Villous tumors of the ampulla of Vater: local resection versus pancreatoduodenectomy. AB - Villous adenomas involving the ampulla of Vater are uncommon. In particular, malignant potential of villous tumors may be difficult to determine preoperatively. In such cases, the decision to perform a conservative local excision or the more radical pancreatoduodenectomy should be based on accurate histologic assessment and the possibility of obtaining adequate margins of resection. PMID- 2665133 TI - [Pre-peritoneal reconstruction in recurrent inguinal hernia]. AB - In 1973 Horny described preperitoneal implantation of a skin graft in relapses of inguinal hernias by the inguinal route. The graft is fixed to Cooper's ligament and by stitches across the entire abdominal wall attached by knots to the aponeurosis of the external oblique abdominal muscle on the sheath of the m. rectus abdominis. Above it the fascia transversalis is sutured. Its margin must be beyond the outline of the trigona imguinale by at least 20 mm. In this way since Jan. 1, 1966 to Dec. 31, 1979 82 men were operated and followed up for five years. During this period a total of two secondary relapses developed, i.e. 2.44%. It was found that the effect of this type of operation depends on covering of the trigonum inguinale by a skin graft and its perfect stretching. PMID- 2665134 TI - [Ultrasonography in emergency abdominal surgery]. AB - Based on examinations of 416 patients with acute abdomen the authors discuss the importance of ultrasonographic examinations. In all conditions and pathological conditions with an acute abdominal symptomatology ultrasonography of the abdomen is a valuable diagnostic asset. In the complex of clinical, biochemical and X-ray examinations it hastens the diagnosis and makes it more accurate, makes an early and expedient conservative or surgical intervention possible and improves the prognosis. PMID- 2665135 TI - Review of diagnostic methods in abdominal trauma. AB - The diagnostic methods used in examining 1,214 patients who underwent laparotomy for abdominal injury are evaluated. Diagnosis was based on clinical examination and the results of tests. Peritoneal lavage was useful for the early detection of bleeding, especially in unconscious patients, paraplegics and intoxicated patients. Radiological examination of the abdomen was unreliable in patients with blunt injury. Routine radiography of the pelvis was rewarding. Intravenous pyelography is now used only in patients with frank haematuria. Transurethral cystography was reliable when 350-400 ml contrast fluid was used. A radiograph of the chest should seldom be omitted in patients with blunt injury. PMID- 2665136 TI - Traumatic rupture of the diaphragm. An analysis of 121 cases. AB - Rupture of the diaphragm from blunt injury occurred in 4.4% of patients submitted to surgery for abdominal injury. Rupture should be suspected when there are physical signs of a crush injury to the lower chest or upper abdomen. Typical radiological signs are often obscured by a haemothorax. Passage of a nasogastric tube before radiography for blunt injury or the placing of metal markers on wounds in the 'nipples to umbilicus' area assist in diagnosis. Peritoneal lavage may be negative. Prognosis depends on associated injuries. Only 2 deaths in this series were directly related to the diaphragmatic injury. PMID- 2665137 TI - The Jewish contribution to medicine. Part II. The 19th and 20th centuries. AB - Despite the opening of German universities to Jews in the 1860s, they were restricted to fields not attractive to their gentile colleagues, e.g. the basic sciences, dermatology, psychiatry, neurology, paediatrics and venereology. They pioneered these specialties when the latter were still in their infancies and made fundamental discoveries. This brilliant period of Jewish medicine in Germany included the renowned immunologists Ehrlich and Wassermann and neurologists Romberg and Freud. Eminent workers from France were Metchnikoff, who discovered phagocytosis, Haffkine for his plague vaccine and Widal, who discovered bacterial agglutination. Chain, the biochemist, shared the Nobel Prize for medicine for his part in the discovery of penicillin in England. PMID- 2665138 TI - Antecedents of "the principles of socialist health". PMID- 2665139 TI - Pathophysiology and pathogenesis of aortic aneurysms. Current concepts. AB - From an engineering point of view, the development of an arterial aneurysm is a classic case of material failure that may involve two factors: excessive applied load and inadequate material strength. The author describes a hypothesis that explains how atherosclerosis could increase the pressure load on the vessel and at the same time decrease the capacity of the wall to bear that load. It will be of interest to learn precisely what the genetic trait is that causes the atherosclerotic aorta to fail structurally in some patients while allowing the vessel to remain intact and develop occlusive lesions in others. PMID- 2665140 TI - Incidence and etiology of abdominal aortic aneurysms. AB - Unlike coronary artery disease and cerebrovascular disease, the incidence of abdominal aortic aneurysms has increased dramatically over the past three decades. There appears to be a correlation between both hypertension and smoking and the development of aneurysms, and there is a substantial predominance of white men among the patients. Recent studies have also documented a strong genetic component to this disease. Several biochemical abnormalities have been noted in those with aortic aneurysms, including increased proteolysis (elastolysis and collagenolysis). At present, the precise etiology of aneurysmal disease remains unclear, but it will most likely turn out to be a heterogenous disease with several molecular forms. PMID- 2665141 TI - Preoperative imaging of aortic aneurysms. Conventional and digital subtraction angiography, computed tomography scanning, and magnetic resonance imaging. AB - Aneurysm imaging is important in deciding on the timing of and operative approach for aneurysmorrhaphy. Various noninvasive and invasive imaging techniques are available for the anatomic definition of abdominal aortic aneurysms, involvement of adjacent structures, and intra-abdominal pathology. Careful preoperative evaluation can avert hemorrhagic, embolic, and ischemic complications of elective aneurysm repair. PMID- 2665142 TI - Preoperative evaluation and management of coronary and carotid artery occlusive disease in patients with abdominal aortic aneurysms. AB - Aortic aneurysms rarely exist without systemic manifestations of atherosclerosis beyond the confines of the aneurysm. Preoperative evaluation of coronary and carotid disease is critical in the management of patients with abdominal aortic aneurysms in the perioperative period as well as in the long term. PMID- 2665143 TI - Unusual manifestations of abdominal aortic aneurysms. AB - Repair of an asymptomatic infrarenal abdominal aortic aneurysm is straightforward and can be accomplished with low morbidity and mortality rates. However, certain complications of abdominal aortic aneurysm, such as contained rupture, inflammatory aneurysm, aortovenous fistula, infected aneurysm, primary aortoenteric fistula, and lower-extremity atheroembolism can be both limb- and life-threatening. Unusual signs and symptoms in a patient with an abdominal aortic aneurysm should alert the physician to the possibility of one of these complications. Careful history-taking and physical examination and appropriate diagnostic imaging, combined with a well-planned operation, will minimize the morbidity and mortality rates otherwise associated with these complications. PMID- 2665144 TI - Treatment options for aneurysms in high-risk patients. AB - The increasing prevalence of aneurysms in an aging population bears with it increasing numbers of patients who are less than optimal candidates for resection. It is likely that the majority of such patients can undergo standard resection, either by referral to a center where the management of the elderly chronically ill is commonplace or by providing intensive preoperative metabolic, cardiac, pulmonary, and nutritional resuscitation. Such preoperative preparation might well include coronary revascularization or carotid endarterectomy. For the occasional patient in whom medical comorbidity is advanced and fixed, or in whom rapid aneurysm expansion or worsening symptoms mandate immediate management, yet operative risk for standard aneurysm resection seems inordinately high, several nonresective options have been identified and tested. Among these options, aneurysm exclusion appears to have significantly better results (in terms of lower rates of operative mortality and subsequent aneurysm rupture) than distal aneurysm ligature. A more recent technique, aneurysm bypass, may have potential but has not been tested for a long enough period, or by an adequate number of surgeons, to have established itself as a nonresective option. Clinical judgment, technical expertise, and a willingness to seek assistance and consultation remain the hallmarks of the optimal management of the patient with an abdominal aortic aneurysm. PMID- 2665145 TI - Intraoperative management of abdominal aortic aneurysms. The anesthesiologist's viewpoint. AB - Factors that influence the choice of anesthetic, monitoring methods, and fluid management for aneurysm repair are reviewed, with particular attention to epidural anesthesia and analgesia and the pulmonary artery catheter. Management of bleeding, renal preservation, temperature control, and myocardial ischemia are discussed, and special anesthetic issues associated with ruptured aneurysms and juxtarenal and suprarenal surgery are summarized. PMID- 2665146 TI - Retroperitoneal versus transperitoneal approach for repair of abdominal aortic aneurysms. AB - We, as well as other authors, believe that the retroperitoneal approach is an excellent alternative to the transperitoneal route for the repair of abdominal aortic aneurysms. This approach is associated with a significant decrease in pulmonary and cardiac complications and therefore can be used in selected high risk patients with expanding aneurysms. A well-controlled randomized multicenter trial should answer the question: "Is this approach the surgical access of choice for the elective repair of abdominal aortic aneurysms?" PMID- 2665147 TI - Abdominal aortic aneurysmorrhaphy combined with biliary or gastrointestinal surgery. AB - Abdominal aortic aneurysms occur in 2 to 5 per cent of the population over 60 years of age. Statistically, 7 per cent of patients with aneurysms will have associated cholelithiasis. The incidence of other concomitant intra-abdominal disease is much less. Because of the catastrophic complications associated with infection of synthetic aortic grafts, most authors have advised against opening a hollow viscus during aneurysm resection. Although Staphylococcus is the predominant organism responsible for graft infections, Szilagyi and associates and Liekweg and Greenfield found gram-negative organisms in 40 per cent of infected aortic prostheses. Thomas, Bickerstaff, and Fry and their coauthors have recommended caution when considering aneurysm resection and concomitant nonvascular operations. On the other hand, there is suggestive evidence that the risk of aneurysm rupture is increased in the postoperative period, especially if the aneurysm is greater than 6 cm in diameter. Therefore, optimum management of patients with aneurysms and other intra-abdominal pathology must reduce both the risk of graft infection and the risk of postoperative rupture. To reduce morbidity and mortality rates, careful preoperative evaluation for the detection and management of coexistent disease, the proper choice of intraoperative procedures, and close postoperative monitoring with prompt surgical intervention, as indicated, are essential. PMID- 2665148 TI - Minimizing the use of homologous blood products during repair of abdominal aortic aneurysms. AB - The recent threat of post-transfusion AIDS and increased awareness of blood related hepatitis have compelled surgeons to minimize the use of homologous blood products during aortic aneurysm repair. Reducing or eliminating homologous blood transfusion can be achieved by aggressive attention to three aspects of patient care: (1) routine use of autologous transfusion; (2) careful surgical technique, emphasizing the minimum dissection needed to expose the aneurysm adequately; and (3) a higher threshold for use of any blood products. In a prospective study of 100 consecutive aortic reconstructions, 80 per cent of patients undergoing aneurysm repair received only their own blood during hospitalization. Routine intraoperative autologous red-cell salvage has also conserved the bank blood supply by reducing usage of homologous blood by 75 per cent. The key to minimizing homologous blood requirements for aneurysm repair has been the development of rapid cell-washing autotransfusion devices. PMID- 2665149 TI - Management of aneurysms that involve the juxtarenal or suprarenal aorta. AB - Juxtarenal and suprarenal aneurysms are being seen with increasing frequency as CT and magnetic resonance imaging expand the examination of the aorta. Careful exposure of the suprarenal aorta, either by a direct anterior transperitoneal or an extraperitoneal approach, facilitates repair of the aneurysms. Direct graft replacement can then be performed with low morbidity and mortality rates. PMID- 2665150 TI - Repair of abdominal aortic aneurysms in patients with renal, iliac, or distal arterial occlusive disease. AB - Appropriate preoperative vascular assessment of patients presenting with aortic aneurysms and arterial occlusive disease is essential to obtain the optimal results from aneurysm repair. The renal arteries should be evaluated in patients with hypertension or renal dysfunction, and stenosis must be addressed when seen on arteriograms. Hemodynamically significant lesions are candidates for bypass concomitant with aortic replacement. The stump pressure of a patent inferior mesenteric artery should be assessed intraoperatively, and bypass or reimplantation should be performed if colon ischemia might result from internal mesenteric artery ligation. If vasculogenic impotence is suggested by preoperative studies, meticulous nerve-sparing dissection and revascularization of the internal iliac arteries may result in recovery of erectile function in some patients. In all cases of aneurysm repair, the hypogastric circulation must be maintained through either direct revascularization or bypass to major collateral arteries. Iliac occlusive disease may be evaluated with several modalities, including physical examination, noninvasive laboratory testing, arteriography, and the papaverine test, to determine whether critical or subcritical stenoses are present. Aortic bifurcation grafts should be used to construct the distal anastomoses beyond areas of significant disease. The extent of lower-extremity occlusive disease directly affects the long-term patency of aortic replacement, and diligent follow-up is necessary for timely intervention to maintain patency of vascular reconstructions. PMID- 2665151 TI - Ruptured abdominal aortic aneurysms. Special considerations. AB - The keys to a better outcome in the management of ruptured aneurysm are early diagnosis, aggressive resuscitation, and early operation, with prompt achievement of proximal control. Having achieved these goals, there is a tendency to let down one's guard and relax; indeed, the principles of aneurysm repair beyond this point are similar to those of elective surgery. However, it should be remembered that nearly every complication is more likely in emergency than in elective operations. Therefore, even more care needs to be taken with the technical details at this point to avoid the complications discussed in the following article. The perioperative management must continue at the same heightened level to combat acidosis, hypothermia, coagulation disorders, cardiac dysfunction, fluid overload with pulmonary edema, renal failure, and other common sequelae of this challenging undertaking. PMID- 2665152 TI - Prevention and management of surgical complications during repair of abdominal aortic aneurysms. AB - Abdominal aortic aneurysms can be repaired with a mortality rate of 3 per cent or less under optimal conditions. To achieve these results, every effort must be made to prevent disastrous surgical complications in this elderly population. This review covers some of the more common and serious complications associated with aneurysm repair: their causation, prevention, diagnosis, and treatment. The majority of these complications are preventable with a carefully planned and executed operation. The result will be a patient with a normal age-adjusted life expectancy. PMID- 2665153 TI - [Smoking: research in a cloud of smoke]. PMID- 2665154 TI - [Death in a high-risk pediatric service--the role of the supervisor]. PMID- 2665155 TI - Therapeutic implications of immune mechanisms in myocarditis. PMID- 2665157 TI - Neurologic function seven years after crowbar impalement of the brain. AB - The management of impalement injuries to the brain presents formidable problems. A 39-year-old man was impaled by a crowbar which penetrated the brain. The prompt rescue and resuscitation, thorough surgical debridement, control of intracranial pressure and rehabilitation are described. PMID- 2665156 TI - Immunomodulating therapy in experimental myocarditis. PMID- 2665158 TI - Cruveilhier on meningiomas (1829-1842). AB - The early contribution of various authors to the pathologic anatomy and clinical symptoms of meningiomas is presented with special regard to the work of Jean Cruveilhier. PMID- 2665159 TI - [Performance diagnosis of the locomotor system and sensory organs?]. AB - The quantitative significance of the sensory organs in sport is discussed by means of the visual parameters static and dynamic visual acuity and the equilibrium that is specific for a particular kind of sport. Spectators with normal visual acuity can identify footballs, tennis balls etc. used in game sports, with relative ease, compared with sports equipment used in athletics. However, since moving objects can attain an angular velocity of 400 degrees/s and higher in certain sports, the mean dynamic visual acuity is unable to cope with such speeds, this being only 200 to 230 degrees/s. Dynamic visual acuity can be trained, thus attaining higher levels in game sports. Processes of balance regulation during cycling (or in rhythmical sports gymnastics) are discussed in connection with and subsequent to the problem of the intersensory perception conflict. Finally, the article sums up criteria for the observation of movement and for minimising intersensory perception conflicts. PMID- 2665160 TI - [Basic principles of after care following autoplastic reconstruction of the cruciate ligament]. AB - Since 1984 we avoided immobilization after reconstruction of the anterior and/or posterior cruciate ligament. Principles of kinematics were taken in consideration during aftertreatment. Results were very satisfactory in anterior cruciate ligament reconstruction. Subjective assessment of knee function (Lysholm score), objective measurement of anterior-posterior knee stability (KT-1000 arthrometer) and clinical follow-up results were good without immobilization.--This cannot be said for the posterior cruciate ligament, because the number of patients was too small. Our current concept of rehabilitation after reconstruction of the posterior cruciate ligament may yet serve as a reasonable but still unproven approach to the problem. PMID- 2665161 TI - [Possibilities for using sonography in sports injuries of the shoulder joint]. AB - Sonography is a useful tool for the examination of the shoulder joint. Concomitant cartilaginous and soft tissue lesions (Hill-Sachs, effusion, cuff tears) can be visualized. Subacromial pathology can be differentiated. The type of instability in the unstable shoulder can be documented. The ultrasound investigation is of diagnostic value for the unstable shoulder as well as for the impingement shoulder in athletes. Therefore it may be helpful for planning the adequate treatment and also for the follow up of the patients. PMID- 2665162 TI - [Historical perspective. Attitudes to sexually transmitted diseases and AIDS]. PMID- 2665163 TI - In memoriam: James G. Wilson (1915-1987). PMID- 2665164 TI - Studies of the factor Xa-dependent inhibitor of factor VIIa/tissue factor (extrinsic pathway inhibitor) from cell supernates of cultured human umbilical vein endothelial cells. AB - Cultured human umbilical vein endothelial cells (HUVEC) have been reported to produce extrinsic pathway inhibitor (EPI), the factor Xa-dependent inhibitor of factor VIIa/tissue factor (TF). We examined the release of this inhibitor from HUVEC as a function of their growth state and in response to the induction of endothelial cell TF activity. HUVEC constitutively produced significant amounts of EPI at all stages of their growth in culture including the post-confluent state. Rate of release varied over a 3-fold range for primary cultures from 12 different batches of pooled umbilical cord cells. Constitutive EPI release was unaltered during a 6 hour period of induction of TF activity with thrombin or phorbol ester but slowed during longer incubation of the cells with phorbol ester. Whereas plasma contains two molecular weight forms of EPI, only the higher of these two molecular weight forms was demonstrable by Western analysis of HUVEC supernatants with 125I-factor Xa as the ligand. PMID- 2665165 TI - Thrombin stimulates inositol phosphate accumulation and prostacyclin synthesis in human endothelial cells from umbilical vein but not from omentum. AB - We have compared the effects of thrombin on the accumulation of inositol phosphates and the synthesis of prostacyclin in cultured human endothelial cells from umbilical vein and the microvasculature of omentum. Active human thrombin induced a dose-dependent accumulation of inositol phosphates and a concomitant synthesis of prostacyclin in endothelial cells from human umbilical vein. However, thrombin at all concentrations tested was unable to stimulate inositol phosphate accumulation and prostacyclin synthesis in microvascular endothelial cells from human omentum. Bradykinin was able to stimulate these effects in both types of cell. These results demonstrate that although inositol phosphate turnover is an initial event associated with prostacyclin synthesis in endothelial cells, there are differences in the way microvascular endothelial cells respond to thrombin. PMID- 2665166 TI - Impairment of platelet behaviour by isosorbide dinitrate. PMID- 2665167 TI - Kininogens, kinins and kinships. AB - This article reviews most recent developments in the field of the multifunctional kininogens which are involved in major physiologic systems such as the blood coagulation cascade, the inflammatory reaction, the inhibitor defense mechanism, and the acute phase response. Particular attention is given to the interaction of kininogens with endothelial cells and platelets, the post-translational modification of kinin(ogen)s by proline hydroxylase, and the placing of kininogens among structurally and functionally related plasma proteins. PMID- 2665169 TI - Endothelial prostacyclin release in systemic lupus erythematosus. AB - The ability of sera from patients with SLE to stimulate endothelial cell prostacyclin production was studied using a standardized assay system for testing the effects of serum on cultured human endothelial cell monolayers. The effects of 20 normal and 32 SLE sera on endothelial prostacyclin production were measured. No differences between the rates of prostacyclin production were seen between the two groups, either basally or when prostacyclin release was stimulated with thrombin or bradykinin. In the SLE samples there was no correlation between anticardiolipin IgG or IgM titres and their ability to stimulate basal or agonist-induced prostacyclin release. These results suggest that the elevated risk of thrombosis in SLE patients is not associated with inhibition of endothelial cell prostacyclin synthesis. PMID- 2665168 TI - Platelet interaction with vessel wall and collagen in pigs with homozygous von Willebrand's disease associated with abnormal collagen aggregation. AB - A subgroup of pigs with von Willebrand's disease from the Mayo Clinic stock shows abnormal platelet aggregation in response to collagen [vWD-Homo(-)], in contrast to the normal aggregation responses observed in the main colony of pigs with homozygous vWD [vWD-Homo(+)]. This subgroup has been characterized at Mayo as a storage pool deficiency due to the reduced levels of ADP and Serotonin in the platelet dense granules. In the present studies, an ex-vivo perfusion chamber was utilized to investigate the deposition of 111In-labeled platelets on aortic subendothelium and collagen type I exposed to blood from vWD-Homo(-), vWD-Homo(+) and normal animals. Both non-anticoagulated and heparinized blood were exposed for wall shear rates ranging from 212 sec-1 to 3380 sec-1 and exposure times as long as 30 min. An enhanced decrease in platelet deposition in the vWD-Homo(-) animals was observed compared to vWD-Homo(+) animals. The decrease was observed primarily at the higher shear rates and was more pronounced in the absence of heparin and on the collagenous substrate. Thus, the abnormality in collagen induced aggregation, which has been characterized as a storage-pool type defect, results in a decreased platelet deposition compared with that produced by severe vWD alone. PMID- 2665170 TI - A Multi-centre study to evaluate method dependency of the international sensitivity index of bovine thromboplastin. AB - In The Netherlands, a particular coagulometer method for prothrombin time (PT) determination with reduced sample and reagent volumes is used by 62% of the laboratories controlling oral anticoagulant therapy. This "micro-method" has been calibrated against the manual tilt-tube technique for PT determination by six Dutch laboratories. Each laboratory tested 20 fresh normal blood samples and 60 fresh patient blood samples using both methods with the same batch of bovine thromboplastin reagent, according to a detailed protocol. Both methods were comparable as to their precision, but PTs measured by the micro-method were significantly prolonged (p less than 0.001, Student's t-test) as compared to the manual method. This effect is stronger for samples of normal subjects than for patients' samples. It was assumed that the International Sensitivity Index (ISI) of the bovine thromboplastin for the manual method was 1.00 in each laboratory. The ISI-values of the bovine thromboplastin for the micro-method determined by the six laboratories ranged from 1.00 to 1.07 (mean 1.03, SD 0.03). Our results indicate that any other laboratory, using this thromboplastin and the micro method, should obtain accurate assessment of the International Normalized Ratio from their own mean normal PT and an ISI which is 3% higher than the ISI supplied by the thromboplastin manufacturer for the manual tilt-tube method. PMID- 2665171 TI - Risks to the fetus of anticoagulant therapy during pregnancy. AB - The use of anticoagulants during pregnancy is problematic because of the potential adverse effects to the mother and the fetus. Heparin does not cross the placenta, and thus, it was surprising that a recent report concluded that heparin therapy during pregnancy was as risky as oral anticoagulant therapy. Therefore, we performed a literature review of fetal/infant outcomes following anticoagulant therapy during pregnancy. We examined 186 reports which described fetal/infant outcomes in 1,325 pregnancies associated with anticoagulant therapy. The rates of adverse fetal/infant outcomes including death, prematurity and cogenital malformations following treatment with heparin, oral anticoagulants, or both were calculated. The previously described high rate of adverse fetal/infant outcomes with heparin-treated patients, could be accounted for by the frequent use of heparin in pregnancies with comorbid conditions independently associated with adverse outcomes and by reports of uncomplicated prematurity. After excluding such pregnancies, outcomes in heparin-treated patients are similar to the normal population. PMID- 2665172 TI - Measurement of aspirin concentrations in portal and systemic blood in pigs: effect on platelet aggregation, thromboxane and prostacyclin production. AB - Low doses of enteric-coated aspirin were administered orally to pigs. Plasma aspirin concentrations measured in blood obtained simultaneously from permanent catheters in a systemic artery and portal vein for 6 hours after dosage showed a large variation in the plasma aspirin concentration: time profile between pigs. After 50 mg single dose the ratio of the arterial: portal area under the plasma concentration versus time curve (AUC) was 0.63 +/- 0.08 (mean +/- SE, n = 6). In three pigs which received all three dosage regimens, the arterial: portal AUC ratios were 0.48 +/- 0.05 after 50 mg single dose, 0.52 +/- 0.02 after 100 mg single dose and 0.47 +/- 0.02 after 100 mg daily for 1 week. Platelet aggregation in response to sodium arachidonate (1.65 mM) was completely abolished after chronic aspirin administration of 100 mg daily. Thromboxane production (pg/10(6) platelets) induced by this stimulus decreased from 536 +/- 117 before aspirin to 57 +/- 14 after aspirin (mean +/- SE, n = 4; p = 0.03). Aortic prostacyclin synthesis, measured as 6-keto PGF1 alpha (ng/disc after 10 min incubation), was 1.66 +/- 0.28 (mean +/- SE, n = 4) in untreated pigs and 0.95 +/- 0.25 (n = 5) in treated pigs (p = 0.07). Results from this study support the idea that a difference between aspirin concentrations in the portal and systemic circulations can be achieved. Whether this can be translated into a clinically useful differential effect on the vessel wall compared to the platelet remains to be determined. PMID- 2665173 TI - Endothelial cells and normal circulating haemopoietic cells share a number of surface antigens. AB - Human endothelial cells, cultured from umbilical cord veins, have been evaluated for expression of a large number of cell surface antigens with known haemopoietic, particularly myeloid, cell distribution. This was achieved by evaluating endothelial reactivity (using non-fixed cells) with groups of monoclonal antibodies (MAB) belonging to distinct Clusters of Differentiation (CD), as defined by the Third International Workshop on Leukocyte Differentiation Antigens (ILWS). Results indicate that many antigens known to be present on haemopoietic cells, including those on platelets, are co-expressed on endothelial cells. The most intense degree of reactivity was seen using MAB to CD-9 and CD 13, although significant reactivity was also observed using MAB to CD-31 and CD 32. Data also suggests weak binding to endothelial cells of MAB belonging to CD 14, CD-15 and CD-16. A number of unclustered MAB reactive with haemopoietic antigens can also be shown to bind to endothelial cells. PMID- 2665174 TI - Prostacyclin and thromboxane production by autogenous femoral veins grafted into the arterial circulation of the dog. AB - Vascular prostacyclin (PGI2) production is different in the arteries and veins of the dog. Experiments were performed to determine whether chronic grafting of the femoral vein into the arterial circulation would alter the normal PGI2 and thromboxane (TxA2) synthesis of the "arterialized" veins. Spontaneous and arachidonic acid (AA) stimulated PGI2 and TxA2 production (measured by radioimmunoassay of 6-keto PGF1 alpha and TxB2 respectively) were analysed in full thickness punch biopsies of the middle part of the grafts after 3 and 16 months and compared with unoperated veins and arteries. PGI2 production was significantly higher in arteries than in veins but no significant difference in TxB2 production was found. Middle "arterialized" venous graft produced significantly lower amounts of PGI2 and higher amounts of TxB2 than unoperated vessels. PGI2 production was more reduced in the distal than in the middle or the proximal parts of the venous grafts especially when stimulated with AA. These findings do not support the concept that the venous graft was biochemically adapted or "arterialized" in terms of PGI2 production when implanted for 3 months or longer. Rather, the markedly decreased PGI2/TxB2 ratio in the middle of the graft may be a contributory cause of thrombogenicity and may be implicated in the pathogenesis of neointimal hyperplasia. PMID- 2665175 TI - The measurement of haemostatic factors in 16 European laboratories: quality assessment for the Multicentre ECAT Angina Pectoris Study. Report from the European Concerted Action on Thrombosis and Disabilities (ECAT). AB - As part of a European multicentre prospective study involving the measurement of a number of haemostatic factors, a quality assessment (QA) scheme was organized. This paper describes the preparation, design and results of the first QA exercise, involving 16 European laboratories and 10 haemostatic assays. The design allowed the investigation, for each assay, of the variability between duplicates and the variability between days within each centre, and of the agreement between centres. A graphical presentation of each centre's performance in comparison to that of others was adopted, which preserved the confidentiality of each centre's results. The factor VIII clotting activity assay (VIII:C) and the rocket immuno-electrophoresis assays of von Willebrand factor related antigen (vWF R:Ag), antithrombin III, protein C and histidine-rich glycoprotein showed the highest between-duplicate and between-day coefficients of variation (CVs), whereas the clotting assays of activated partial thromboplastin time and fibrinogen had the lowest CVs. CVs for the enzymatic assays using synthetic substrates of antithrombin III, plasminogen and alpha-2-antiplasmin were between these extremes. The between-centre CVs were high for both the VIII:C and vWF R:Ag assays. The QA exercise showed that, in multicentre studies involving the measurement of haemostatic factors, it is feasible to undertake analysis locally at each centre. PMID- 2665176 TI - [Acute pulmonary embolism--a diagnostic challenge]. AB - The article reviews various methods for diagnosing acute pulmonary embolism, discusses their usefulness and outlines a practical diagnostic approach. PMID- 2665177 TI - [Cytokines with effects on myelopoiesis. On mice, molecular biology and men]. AB - The proliferation and differentiation of hematopoietic progenitors to mature blood cells are regulated by a family of glycoprotein cytokines with paracrine functions. Here in, the biology, possible pathogenic functions, and pharmacological potential of cytokines stimulating myelopoiesis are briefly reviewed. PMID- 2665178 TI - [The contaminated chocolate epidemic of 1987]. AB - The article describes a nationwide outbreak of Salmonella typhimurium infection in 1987 caused by contaminated chocolate products from one particular factory. A total of 349 bacteriologically verified cases were recorded. It was estimated, however, that 20,000-40,000 persons became ill during the outbreak. We describe the epidemiological and bacteriological investigations which led to identification of the source of infection, and discuss two epidemiological models for investigation of food-borne outbreaks. The article emphasizes the importance of collaboration between the community health service and the local food inspection laboratories during investigation of foodborne outbreaks. PMID- 2665179 TI - [From butterflies to neurobiology and the diagnosis of AIDS. The 100th anniversary of the discovery of pteridines]. AB - The first report on the isolation of pteridines from biological materials was published in 1889. During the last 100 years a large number of pteridines have been isolated from many different organisms and have been shown to be involved in several biochemical processes. The best characterized biologically occurring unconjugated pteridine, i.e. tetrahydrobiopterin, is a cofactor for amino acid hydroxylases, such as phenylalanine, tyrosine and tryptophan hydroxylase. The last two enzymes catalyze the rate-limiting steps in the synthesis of important biogenic amines, such as dopamine, noradrenaline, adrenaline and serotonin. Several inborn errors in the biosynthesis of tetrahydrobiopterin have provided more insight into variant forms of phenylketonuria (Folling's disease). Recently, it has been shown that pteridines also are involved in immunological responses, and neopterin has been suggested as a diagnostic marker for malignancies, virus infections and acute rejection episodes following allotransplantation. PMID- 2665181 TI - [Insufficient therapeutic possibilities in alcoholic hepatitis]. PMID- 2665180 TI - [Women and iron deficiency--a problem? Iron levels in a group of fertile Norwegian women and the bioavailability of 3 low-dose iron supplements in women with low iron stores]. AB - Serum ferritin levels were determined in 170 healthy Norwegian women (18-48 y, median age 36 y) including 23 blood donors. Exhausted iron stores, defined by serum ferritin levels less than 17 micrograms/l, were found in 21.8% of the non donors, and in 30.4% of the donors. Women with serum ferritin levels less than or equal to 20 micrograms/l participated in a bioavailability study. They were randomized to one of three groups and given one of three different low dose iron supplements (18-20 mg iron per day) for six months. One of the supplements contained heme iron and non-heme iron, the other two contained non-heme iron only. Mean serum ferritin increase was significant for two of the supplements, the one containing heme iron giving the best result. All the supplements resulted in a significant decrease in TIBC. PMID- 2665182 TI - [Candida species produce IgA proteases--an important biological property]. AB - IgA-specific microbial proteases possess the ability to reduce the protective effects of secretory IgA antibodies. The fact that fungi such as Candida produce both IgA1-and IgA2-specific proteases has not been acknowledged in articles and discussions concerning the chronic Candida syndrome. Therefore a short survey of these interesting proteases is presented, along with hypotheses concerning alterations IgA fragments may induce in immunoregulation and uptake of antigens from the gut. PMID- 2665183 TI - Feline hepatic disease. PMID- 2665184 TI - Diagnosis and management of selected feline immunologic diseases. PMID- 2665185 TI - Comparative assessment of the toxicology of vitamin A and retinoids in man. AB - As the title implies, any assessment of the toxic effects of vitamin A derivatives must distinguish between vitamin A in the truest sense, i.e. retinol, and retinoic acid and its synthetic derivatives. Just as no single description is universally applicable to the mode of action of vitamin A derivatives, so too do their toxic effects defy generalization. The recommendation made in 1982 by IUPAC [Eur. J. Biochem., 129 (1989) 1] to designate all derivatives with the typical structure of the vitamin as being retinoids may be chemically logical and correct but, when it comes to describing the effects and side-effects of vitamin A derivatives, it leads to misunderstandings. Retinol, which is frequently used as synonym for vitamin A, can eliminate all symptoms of vitamin A deficiency if it is taken in sufficient quantity with the diet. The term retinol will therefore be used here as a synonym for vitamin A whereas retinoic acid and its derivatives- including the synthetic ones--will be referred to as retinoids because they do not cover the whole spectrum of effects exerted by retinol and because they also vary markedly in their side-effects. In contrast to the nomenclature proposed by IUPAC, this system provides a clear and logical distinction for describing biological processes. Other authors have favoured it in recent times [Chytil, F., J. Am. Acad. Dermatol., 15 (1986) 741; Olson, J.A., Semin. Oncol., x (3) (1983) 290; Olson, J.A., Am. J. Clin. Nutr., 45 (1987) 704; Zbinden, G., Acta Dermatovener., 74 (1975) 36]. By vitamin A, therefore, is meant all derivatives that can possibly originate from retinol in the organism. This also covers the small quantities of retinoic acid formed from retinol. On the other hand, by retinoids is meant the natural retinoic acid derivatives and their synthetic forms in their special modes of action. Since retinoic acid cannot be reduced to retinol in the organism, this nomenclature provides a clear demarcation within the biological system. Vitamin A is essential to the growth and development of higher life forms and functions in many different ways within the organism. Although vitamin A was one of the first vitamins to be described, even today there is still some uncertainty as to its mode of action, with the exception of that of retinal (vitamin A aldehyde) in vision.(ABSTRACT TRUNCATED AT 400 WORDS) PMID- 2665186 TI - A model to explain the pharmacological effects of snake venom phospholipases A2. AB - Snake venom phospholipase A2 enzymes induce a wide variety of pathological symptoms in animals, despite sharing a common catalytic activity and similar structural features with nontoxic mammalian pancreatic enzymes. A hypothetical model is described to explain how specific pharmacological effects, such as presynaptic neurotoxicity, cardiotoxicity, myotoxicity, anticoagulant and platelet effects are exhibited by venom PLA2 enzymes. The model is an effort to elucidate many controversial and contradictory observations which have previously been difficult to interpret. The essential feature of the model is the targeting of venom PLA2 enzymes to the specific tissue or cell due to their affinity towards specific proteins, rather than lipid domains. After the initial binding, PLA2 enzymes induce various pharmacological effects by mechanisms which are either dependent or independent of their enzymatic activity. The model and its predicted target proteins thus provide a new focus for toxin research. PMID- 2665187 TI - Time-dependent inactivation of glucose-6-phosphate dehydrogenase from yeast by aluminum. AB - Aluminum inhibited yeast glucose-6-phosphate dehydrogenase (EC 1.1.1.49) by a pseudo-first-order reaction. The inhibition was proportional to the incubation time and the concentration of aluminum. Double reciprocal plots gave a straight line with a kinact of 8.3 min-1 and indicated the presence of a binding step prior to inhibition. The kinetic study showed that 1 mol of aluminum was bound per mol of enzyme subunit. PMID- 2665188 TI - Toxicity of aminochromes. AB - The first part of the present review deals with the chemical and enzymatic synthesis of adrenochrome and other aminochromes from the corresponding catecholamines. A description of the most significant pathways of formation and the reactivity of the aminochromes is presented. In the second part of the toxicity of aminochromes, mainly at the cardiac and CNS level, is described and some of the molecular mechanisms of the toxic action are outlined. The toxicity of the aminochromes appears to depend mainly on the production of reduced oxygen species through redox cycling. The interaction of aminochromes with sulfhydryl groups and the induced depletion of oxygen, ascorbate and glutathione are additional mechanisms resulting in noxious effects at a cellular level. PMID- 2665189 TI - Effect of norharman on the mutagenicity of toluidine metabolites. AB - Among the different metabolites of o-toluidine only the nitroso and hydroxylamino derivatives were found to be very potent frameshift mutagens in the presence of the co-mutagen norharman and S9. In the absence of norharman and S9 they are only base pair mutagens. Norharman failed to evoke the mutagenicity of the non carcinogenic m- and p-toluidine and their respective nitroso and hydroxylamino metabolites. This report highlights that norharman plays a role in the appearance of mutagenicity of certain carcinogenic amines and metabolites. PMID- 2665190 TI - [Effect of the type of dental burs, their rotation rate and load on the quality of the cavity wall preparation]. AB - In 540 extracted teeth the cavities were drilled using different burs at various rotation speeds. Microphotometry of the quality of walls preparation showed that steel drills had an optimum of under 10,000 rev/min while for hard-alloy and diamond drills the quality increased parallel with the drilling speed. PMID- 2665191 TI - [Nitrate reductase activity of the oral fluids in periodontitis]. AB - In patients with parodontitis varying in severity, nitrites content and nitrate reductase activity were measured in the oral and gingival fluids (OF, GF). In patients, as compared to control subjects, OF displayed a tendency to reduce nitrates concentration which was lowered fourfold in exacerbations. Nitrate reductase activity was distinctly reduced in remissions of light and mild parodintitis, and increased in exacerbations. GF showed a low nitrite content with its nitrate reductase activity varying from 0 to 1.66 mumol/min per 1 ml. These levels were not different in patients and control group. The data indicate different states of oral homeostasis in parodontitis varying in severity. PMID- 2665192 TI - [Profilometric research on silicone impression materials]. AB - The data suggest that none of the materials produced in the USSR or imported, did fully reproduce the microrelief of the surface of metal standard. This is accounted for by the processes taking shape on the surfaces of elastomeric compositions upon their vulcanization. PMID- 2665193 TI - [Removal of dental calculus using ultrasound and its effect on gingival function]. AB - Dental concrements were evacuated in 2 groups of 40 patients each using an ultrasonic device "Ultrastom" or a manual excavator. On the 3rd, 7th and 21st days the patients were reexamined. Parodontal and hygienic indices were evaluated and the gingival liquid production measured. A substantial rise in the antiinflammatory action of the procedure was characteristic of the use of the ultrasound as compared to manual operation. PMID- 2665194 TI - [A method for determining nonspecific body resistance]. AB - The general resistance of the organism was studied. This included humoral factors (lysozyme activity, titers of the normal agglutini) and cellular link: total leukocytes and neutrophyls count, the indices of neutrophylic phagocyte response. The index of general resistance of an organism of 110 to 140 indicated its normal level and those below 110 were considered as reduced resistance scores. The technique implies an improved evaluation of an organism's own defenses. This allowed to diagnose the severity or oral mucosa inflammation and so provided grounds for indicating the unspecific stimulating therapy. PMID- 2665195 TI - [Ultrasonic diagnosis of salivary gland diseases]. AB - Ultrasonic tomography was applied to diagnose salivary gland diseases in 201 patients. Malignant disorders were found in 53 cases, benign in 127, and inflammation in 21. The investigation yielded some echographic diagnostic criteria for tumors and non-tumorous salivary gland diseases. PMID- 2665196 TI - [Use of magnets for improving the fixation of removable plate dentures]. AB - An experience is summarized in using the removable dentures with fixation improved by magnets secured on their bases so that their flat surfaces were in contact with the analogous surfaces in the pin insertions located on the residual teeth roots. The technique was applied to manufacture the 21 dentures in 14 patients. The advantages of the technique are presented with the indications to its use. PMID- 2665197 TI - [Chemical agents for the prevention of dental caries]. PMID- 2665198 TI - [The use of hyperbaric oxygenation for the prevention of complications in local plastic operations on the face and neck]. AB - Studied were 37 patients in which defects and deformations of various etiology were corrected using plastic with local tissues excised from face and neck. Polarography, thermography and thermometry proved that 5 sessions of hyperbaric oxygenation (HO) at 1.5 atm. sharply reduced the incidence of complications after the surgery. This effect was accounted for by providing optimal conditions to accelerate the microcirculatory improvement, oxygen transport and tissue utilization. HO decreased the incidence of complications that influence the reconstructive surgery outcome. PMID- 2665199 TI - [The characteristics of producing a mold for preparing a clasp denture in tooth mobility]. AB - The techniques available to date are discussed in terms of their relative advantages and drawbacks. A novel technique is offered by the authors which allows to replicate the surface with the position of loose teeth unchanged. This proved essential for attaining a good functional effect of the clasp prosthesis. PMID- 2665200 TI - [The relationship of Christensen's phenomena to the structure of the temporomandibular joints]. AB - Sagittal and transversal phenomena of Christensen were found to correlate with the structure of temporomandibular joints. The close correlation was found between the markedness of the phenomena, mandible forward and lateral shifts, and the height of articular head. A weak correlation was found between the markedness of the phenomena, articulation fissure width in anterior, upper and dorsal parts, and between sagittal dimension of articulation head and articulation fossa depth. The results can be used to construct dentitions in cases of full removable dentures. PMID- 2665201 TI - [Experimental restoration of the patency of the efferent ducts of the salivary glands]. AB - In order to introduce the microsurgical technique of suturing the salivary ducts' lesions, microsurgical anatomy of ducts draining large salivary glands was studied in 12 human autopsies and 10 dogs. Experimental surgery was performed in 10 dogs: the sectioned parotid and submandibular ducts were repaired. Sialographic evidence of recanalization was obtained in 8 of the dogs. Histological investigation showed minimal inflammatory response within 20 to 60 days after surgery. PMID- 2665202 TI - [Sodium hypochlorite and its use in oral medicine]. PMID- 2665203 TI - [A decrease in the level of pathological states occurring from the use of dentures made of stainless steel or cobalt-chromium alloy]. PMID- 2665204 TI - [The political activities of M. M. Chemodanov (on the 80th anniversary of his death)]. PMID- 2665205 TI - Study design for randomized prospective trial of carotid endarterectomy for asymptomatic atherosclerosis. The Asymptomatic Carotid Atherosclerosis Study Group. AB - This report summarizes the study design and organization of a multicenter, randomized trial of carotid endarterectomy for the treatment of asymptomatic carotid stenosis. The Asymptomatic Carotid Atherosclerosis Study will determine whether the addition of carotid endarterectomy to aspirin plus risk factor modifications affects the incidence of ipsilateral transient ischemic attack, amaurosis fugax, and retinal and cerebral infarction in patients with asymptomatic hemodynamically significant carotid stenosis in at least one artery. Power calculations are based on assumptions of alpha = 0.05 (two-sided test) with annual event rate 3% transient ischemic attack and 1% cerebral infarction per year. The study has 90% power for detection of a 25% difference in events in a 5 year study. Two continuous validation programs are in use: a Doppler/angiogram correlation study for each Doppler instrument used in screening potential candidates and a transient ischemic attack/stroke questionnaire/validation study for verification of end points. Quality assurance is a major component in study design. PMID- 2665206 TI - Comparison of cerebral angiography and transcranial Doppler sonography in acute stroke. AB - We compared digital intra-arterial angiography and transcranial Doppler sonography in acute cerebral ischemia as part of a wider study on a continuous series of 48 patients with acute focal cerebral ischemia in the carotid territory, observed within 4 hours of the onset of symptoms. The most significant Doppler findings of the middle cerebral artery included no detection of the artery when occlusion of the carotid siphon or the middle cerebral artery at its origin was shown by angiography and reduced flow velocities and asymmetry (symptomatic less than asymptomatic) when the occlusion was located in the terminal tract of the middle cerebral artery mainstem or in numerous terminal branches. Higher flow velocities in the anterior cerebral artery or posterior cerebral artery, mostly in the symptomatic hemisphere, often accompanied middle cerebral artery pathology, probably indicating collateral compensatory pathways. PMID- 2665207 TI - Long-term culture of microvascular endothelial cells derived from Mongolian gerbil brain. AB - A method for long-term culture of microvascular endothelial cells from Mongolian gerbil brain and their biologic properties in vitro are described. Microvessels were isolated from Mongolian gerbil brain by a combination of enzymatic treatment, filtration, and centrifugation and were seeded onto a gelatin-coated dish. A morphologically homogeneous cell plaque showing a cobblestone appearance was removed 2 to 3 weeks after the seeding, and the cells were subcultured. The cultured cells grew as monolayers of flat polygonal cells and were carried for more than 20 passages without morphologic change. These cells synthesized prostacyclin and retained an endothelial specific marker, factor VIII-related antigen. When the cells were cultured in a collagen gel, they rapidly formed capillarylike tubular structures without endothelial cell growth factor or special substrata. Long-term culture of purified microvascular endothelial cells derived from Mongolian gerbil brain will facilitate the study of the function of microvascular endothelial cells in human brain under normal and pathologic conditions. PMID- 2665208 TI - The voyage of Captain Munk to Hudson Bay in 1619: an analysis of a medical catastrophe. PMID- 2665209 TI - The Vienna College of Physicians and its sesquicentennial. PMID- 2665210 TI - As far as the eye can see: ophthalmology in the Historical Collections of the Library of the College of Physicians of Philadelphia. PMID- 2665211 TI - Ex Libris Bibliothecae Collegiensis Medicorum Philadelphiensis: the growth of a library as seen from its bookplates. PMID- 2665212 TI - Philadelphia seen: two centuries of ophthalmology. PMID- 2665213 TI - The first American ophthalmologist. PMID- 2665214 TI - Samuel X Radbill, 1901-1987, a personal appreciation. PMID- 2665215 TI - Culture and class conflict at the New York Asylum for Lying-In Women, 1823-1850. PMID- 2665216 TI - Anesthetist and anesthesiologist: technology in the social context of a medical and nursing specialty. PMID- 2665217 TI - "Looking forward": an exhibit on women and medicine at the College of Physicians of Philadelphia. PMID- 2665218 TI - 24-hour rat liver preservation using UW solution and some simplified variants. AB - The results of a series of 32 rat liver transplants are described to analyze the efficacy of components of UW solution. Rat livers were stored at 4 degrees C in standard UW solution or one of three simplified variants for 24 hr prior to orthotopic liver transplantation. In standard UW solution (solution A) the one week survival rate was 3 of 8. Using solution B, which differs from solution A in the omission of hydroxyethyl starch and adenosine, the one-week survival rate was 2 of 8. Solution C, a further-simplified version of solution B with omission of allopurinol, Bactrim, and insulin, gave a one-week survival rate of 3 of 8. Solution D is identical to solution B except that the sodium and potassium concentrations are reversed. Using this solution, 5 of 8 rats survived more than one week. We conclude that the effectiveness of UW solution is maintained in a substantially simplified form, and that solution D, with the Na/K ratio reversed to give a high Na variant, may improve survival. PMID- 2665219 TI - Evidence that matching for HLA antigens significantly increases transplant survival in 1001 renal transplants performed in the northwest region of England. AB - In the 20-year period from March 1968 to March 1988, 860 patients received 1001 renal transplants in the Northwestern Regional Renal Transplant Unit at Manchester Royal Infirmary. Through a continuing policy of avoiding mismatches for HLA antigens and lymphocytotoxic antibody crossmatching, transplant survival rates were found to correlate with the degree of HLA-A and B antigen mismatching from 1968 to 1978 and with HLA-B and DR antigen mismatching from 1979 to 1988. Mismatching for HLA-B and DR antigens was also found to correlate with transplant survival in highly sensitized patients and in patients transplanted since 1981, the "cyclosporine era." Recipients who were HLA-DR1 positive were found to have the highest graft survival compared to recipients negative for this antigen. In contrast, HLA-DR3 positive recipients had the poorest outcome. Transplants from HLA-DRw6 positive donors showed higher transplant survival rates than donor kidneys positive for any other HLA-DR antigen. A correlation of transplant survival with HLA-B and DR mismatching was seen whether kidneys were collected within our region or received through the UK Transplant Service. We conclude that avoidance of mismatching for HLA-B and DR antigens confers high transplant survival rates (91.1% at 5 years for 0 HLA-B and DR mismatches), and in order to achieve this rate for most recipients exchange of donor kidneys between transplant centers will be essential. PMID- 2665220 TI - Kaposi's sarcoma in a transplanted kidney. PMID- 2665221 TI - Diagnosis of acute bacterial pyelonephritis of the renal allograft by fine-needle aspiration cytology. PMID- 2665223 TI - Plasma interleukin 2 receptor levels in renal allograft dysfunction. PMID- 2665222 TI - Indication for routine allograft nephrectomy in cases of irreversible rejection. PMID- 2665224 TI - Severe hyponatremia associated with combined pancreatic and renal transplantation. PMID- 2665225 TI - Orthotopic liver transplantation resulting in amitriptyline toxicity in the recipient. PMID- 2665226 TI - Transdiaphragmatic exposure for direct atrial-caval anastomosis in liver transplantation for Budd-Chiari syndrome. PMID- 2665227 TI - Prolongation of skin allograft survival in antilymphocyte serum-treated mice by posttransplant administration of peripheral blood lymphocytes. PMID- 2665228 TI - A new method for orthotopic rat liver transplantation with arterial cuff anastomosis to the recipient common hepatic artery. PMID- 2665229 TI - Prognosis of liver transplantation in patients with erythropoietic protoporphyria. PMID- 2665230 TI - Hepatic iron in the control of iron absorption in a rat liver transplantation model. AB - Rat liver transplantation was utilized to study the effect of hepatic iron on the control of iron absorption. Six iron-loaded and six normal livers were transplanted into normal or iron-loaded animals. Iron absorption was measured pretransplant and 10 days posttransplant by total-body counting (59Fe). The animals were loaded with oral carbonyl iron to produce a predominantly parenchymal hepatic iron distribution and with parenteral iron dextran to produce a predominantly reticuloendothelial iron distribution. The carbonyl iron-loaded livers contained 175 +/- 6.6, the iron dextran livers 180 +/- 41, and the normal livers 6.6 +/- 2.8 mumol FE/g dry wt. Iron absorption was unchanged by the insertion of normal livers into normal animals. The transplantation of carbonyl iron-loaded livers into normal animals caused a marked decrease in iron absorption posttransplant from 7.2 +/- 0.9% to 0.3 +/- 0.4% (P less than .001) posttransplant. Neither the transplantation of iron dextran-loaded livers into normal animals nor the transplantation of normal livers into iron-loaded animals significantly altered iron absorption at 10 days posttransplant. These results are consistent with the hypothesis that hepatocyte iron stores are a major determining factor controlling iron absorption. PMID- 2665231 TI - The feasibility of in vivo resection of the left lobe of the liver and its use for transplantation. AB - The anatomical possibility of resecting the left lobe of the liver (segments II and III) in living subjects and using it for transplantation was evaluated. A group of 60 cadaveric livers were dissected at autopsy. The vascular and biliary elements of the left lobe were isolated and the lobe was resected and evaluated for possible grafting. The left lobe was 12-28% (mean 19.4%) of the liver mass. An extrahepatic segment of the left hepatic vein was isolated in 95% of specimens. Arterial blood supply to the left lobe consisted of a single artery (92%) or two arteries (8%). A single portal vein segment to the left lobe (type I) was found in 35% livers. Portal vein branches originated from a common orifice (type II, 35%) or separately (type III, 30%) from the left portal vein, and in these instances, preparation of a portal segment necessitated partial section of the left portal vein wall. Biliary drainage was extrahepatic in 56 livers and consisted of a single duct (type I, 78%), or two ducts (type II, 15%). The resected left lobe was evaluated as satisfactory (single hepatic vein and artery, types I or II portal vein, type I bile duct) in 48% of cases, while a less satisfactory lobe (type III portal vein or type II bile duct) was obtained in 33%. It was found anatomically difficult or impossible to resect the left lobe for possible transplantation in 11 (19%) liver specimens. PMID- 2665232 TI - The effects of OKT3 therapy on infiltrating lymphocytes in rejecting renal allografts. AB - OKT3 antibody therapy is effective in the treatment of renal allograft rejection. However its exact mode of action is unknown. Following OKT3 administration, peripheral blood lymphocytes fail to express the CD3 antigen, although other membrane antigens are relatively preserved. In this way the lymphocytes are unable to respond to foreign antigens. It is not known whether this modulation of CD3 on lymphocytes occurs within the rejecting allograft. Ten patients who received OKT3 therapy for steroid-resistant renal allograft rejection were studied. The aim of the study was to examine whether OKT3 antibody therapy altered the degree or the relative composition of the inflammatory infiltrate and to assess whether OKT3 treatment resulted in modulation of CD3 on intragraft lymphocytes. The study involved immunoperoxidase examination of biopsy material and flow cytometric analysis of peripheral blood lymphocytes obtained before and during treatment with OKT3 antibody. The results show that the total number of infiltrating leukocytes decreased after 5 days of treatment (3215 +/- 700 cells/l. 0 mm2 of tissue before vs. 1730 +/- 635 at day 5; P less than 0.001). The relative proportions of macrophages, total lymphocytes, CD4 +ve and CD8 +ve cells did not alter during therapy. Despite marked modulation of peripheral blood lymphocytes (CD3/CD2 ratio 0.89 +/- 0.13 before vs. 0.10 +/- 0.11 during treatment, P less than 0.001), there was no evidence of modulation of intragraft lymphocytes (CD3/CD2 ratio 0.98 +/- 0.14 before vs. 0.90 +/- 0.21 during treatment, P = NS). Although OKT3 antibody therapy is effective clinically at improving renal allograft rejection, this study demonstrates that it does not appear to cause modulation of the CD3 antigen on intragraft lymphocytes. PMID- 2665233 TI - Lipid abnormalities in cyclosporine-prednisone-treated renal transplant recipients. AB - Hyperlipidemia and hypertension, two major risk factors for accelerated atherosclerosis, undoubtedly contribute to the excessive cardiovascular morbidity and mortality experienced by renal transplant recipients. The present survey of posttransplant hyperlipidemia in 500 cyclosporine-treated patients documented a 37.6% incidence of hypercholesterolemia, which occurred within 6 months posttransplant in 82% of patients. An etiologic relation to corticosteroid therapy was suggested by the strong correlation between prednisone doses and cholesterol levels, by the reduced cholesterol levels in patients undergoing steroid withdrawal, and by the reduction in hypercholesterolemia to 13% by 3 years posttransplant when steroid doses were less than 10 mg daily. Hypertriglyceridemia, which was present in 14.7% of the patients, was more severe under CsA-prednisone compared with azathioprine-prednisone therapy. Hypertriglyceridemia, which occurred later in the posttransplant course than hypercholesterolemia, strongly correlated with an excessive percent relative weight and elevated serum creatinine but not with steroid or CsA doses. Increasing age, diabetes mellitus, beta-blockers and nephrotic syndrome contribute to posttransplant hyperlipidemia in the CsA-Pred era as they did in the azathioprine era of immunosuppression. PMID- 2665234 TI - The influence of immunosuppressive treatment on immune responsiveness in vivo in kidney transplant recipients. AB - In this study, we have compared the influence of CsA and pred/aza on the immunocompetence in man. Therefore, kidney-transplant recipients were tested for their primary keyhole limpet hemocyanin and secondary (tetanus and KLH) humoral immune responses and their primary dinitrochlorobenzene and secondary (recall antigens) cellular immune responses. We demonstrate that primary immune responses are inhibited by CsA, whereas secondary immune responses are relatively resistant. Pred/aza therapy seems to inhibit all cellular immune responses, as we demonstrated before, as well as the primary humoral immune responses. Secondary humoral immune responses are only slightly affected by pred/aza. Our results provide a strong argument for starting immunosuppression with CsA, either with or without a low-dose pred. PMID- 2665235 TI - Pretransplant assessment of renal viability by phosphorus-31 magnetic resonance spectroscopy. Clinical experience in 40 recipient patients. AB - A group of 40 cadaveric kidneys was studied just prior to planned transplantation to further assess the applicability of 31P-MRS in the analysis of clinical renal transplant viability. Renal intracellular high-energy phosphorus metabolites (ATP [or NADP], phosphomonoester [PME] and inorganic phosphate [Pi]) and pH were measured noninvasively with MRS surface coils external to cold storage containers. Pretransplant MRS parameters were correlated with subsequent renal function in recipient patients (measured one week postoperatively by the need of dialysis, drop in serum creatinine, urine output, and 123I or 131I Hippuran assessed renal tubular function). ATP and NADP was detected in eleven kidneys and was significantly (P less than 0.001) associated with the best renal function posttransplantation. These kidneys also had the highest PME/Pi ratios (1.66 0.54), while lower ratios (0.36-0.10) were associated with prolonged acute tubular necrosis. The PME/Pi ratios significantly (P less than 0.0001) correlated with subsequent clinical renal function, whereas cold storage times (37 +/- 10 hr) or intracellular renal pH (6.53-7.91) did not. These preliminary data suggest that MRS is a noninvasive, nondestructive and sterile method for assessing clinical viability during hypothermic storage of human cadaver kidneys and the subsequent recovery of renal function postrenal transplantation. PMID- 2665236 TI - Association of antiidiotypic antibody with successful second transplant of a kidney sharing HLA antigens with the previous hyperacutely rejected first kidney. AB - The evolution of HLA antibodies and autoantiidiotypic antibodies (AB2) were studied during an 18-month period in a patient who hyperacutely rejected an HLA A2-positive kidney, but tolerated a second HLA-A2-positive kidney one year later. Following rejection of the first kidney, the patient's serum contained an HLA-A2 antibody that reacted with 100% of HLA-A2-positive panel cells. After several months, the HLA-A2 antibody activity was precipitously lost over a one-month period and could no longer be identified by sensitive lymphocytotoxicity procedures. Approximately one year later, the patient received a second HLA-A2 positive kidney that has survived for a 2-year period and was not associated with significant rejection episodes during the early posttransplantation period. Prior to and episodically following the second transplant, the patient's sera contained antiidiotypic-like antibodies that specifically inhibited HLA alloantibodies directed against HLA-A2. AB2, with specificity for a putative idiotype on HLA-A2 alloantibodies, existed concurrently with other HLA alloantibodies in the patient's serum that had not been lost over the course of several months. This case study demonstrates a temporal association between the loss of a specific HLA antibody and the development of an AB2 with inhibitory specificity for the antibody. The study also confirms that anamnestic responses to donor-specific antigens do not always occur in previously alloimmunized patients rechallenged with the same HLA antigens. PMID- 2665237 TI - Immunopathology of graft-versus-host disease in the upper gastrointestinal tract. AB - Class I and class II (HLA-DR, DP and DQ) MHC antigen expression and the phenotypic nature of the inflammatory infiltrate in gastric and duodenal biopsies in bone marrow transplantation patients with and without graft-versus-host disease were investigated. Increased expression of class I (P less than 0.016) and class II (HLA-DR, DP) antigens (P less than 0.002) was associated with GVHD. The epithelium in two GVHD-positive biopsies was HLA-DP-positive and HLA-DR negative. None of the tissues expressed HLA-DQ. Association between MHC antigen expression and phenotype of infiltrating cell was then examined. The majority of GVHD biopsies showed an infiltrate composed of CD4+ cells and CD8+ cells. However, the two DP+, DR- biopsies were associated exclusively with CD8+ intraepithelial cells, suggesting sequential events in GVHD, with CD8+ cells infiltrating tissue first associated with HLA-DP expressions, followed by accumulation of CD4+ as well as CD8+ cells in association with expression of HLA DR. PMID- 2665238 TI - Bone marrow transplantation without total-body irradiation in patients aged 40 and older. AB - We evaluated relapse-free survival and the incidence and type of complications in 17 patients aged 40 or older with chronic myelogenous leukemia, acute myelogenous leukemia, or lymphoma who underwent allogeneic marrow transplantation following busulfan 16 mg/kg and cyclophosphamide 120 mg/kg. Nine patients are disease-free survivors 5-38 months (median 26 months) following transplantation. The incidence of grades II-IV acute graft-versus-host disease was 35%. No significant difference was detected in the incidence of GVHD or interstitial pneumonia between patients aged 40 and older and a group of younger patients transplanted over the same time period. These observations should encourage consideration of allogeneic marrow transplantation in older patients and suggest that this busulfan-cyclophosphamide regimen is a promising alternative to regimens containing total-body irradiation in older individuals. PMID- 2665239 TI - Predictability before transplant of hepatic complications following allogeneic bone marrow transplantation. AB - This study was undertaken to evaluate the occurrence of VOD and other liver diseases following BMT in a patient population with a high incidence of hepatitis before conditioning regimen. We prospectively reviewed 186 consecutive patients undergoing BMT from 1976 to 1986 to determine incidence and type of liver disease after BMT and predisposing factors. Two of 186 patients experienced VOD (1.07%). Acute and chronic liver GVHD were found in 25.8% and 36% of the patients, respectively. Acute hepatitis (AH) was diagnosed in 29.4% and chronic hepatitis (CH) in 42.6% of the patients. Statistical analysis showed no influence of pretransplant variables on the occurrence of acute GVHD and AH; there was a weak correlation (P = 0.01) between pre-BMT abnormal transaminases and occurrence of chronic GVHD. Contingency table and Cox analysis showed a greater risk of CH for patients with abnormal pretransplant SGPT levels (P = 0.0004 and P = 0.0022). No other variables could be associated with posttransplant CH. Actuarial survival was 71% versus 69% for patients with normal versus abnormal transaminases (P = 0.2). As VOD was a rare event, despite 53% of patients having abnormal transaminase values before transplant, we suggest that a lower and slower TBI is more important than pretransplant normal transaminases in preventing this complication. We conclude that evidence of compensated hepatitis is not a relative contraindication for BMT. PMID- 2665241 TI - Selective proliferation of chemically altered rat liver epithelial cells following hepatic transplantation. AB - Although proliferation of oval cells is often observed during the early stages of chemical hepatocarcinogenesis, the role of these putative hepatic stem cells during the neoplastic process is unknown. In earlier studies our laboratory showed that feeding a choline-deficient (CD) diet containing 0.05% 2 acetylaminofluorene (CD-AAF) to rats produced three subpopulations of oval cells that antigenically resemble biliary duct cells, fetal liver cells, and transitional cells. In the present investigation we have employed a semiallogeneic transplantation protocol in order to study the fate of these nonparenchymal epithelial cells (NPEC) beyond the 4-week endpoint imposed by the lethality of CD-AAF diet. An enriched NPEC suspension containing gamma-glutamyl transpeptidase (GGT)-positive oval cells (greater than 75%) was isolated from ACI rats maintained on CD-AAF diet for 3 weeks. The donor cells were transplanted via the portal vein into livers of male F1 progeny (LExACI) that had been fed a CD diet for 7 days prior to receiving a partial hepatectomy and the cell suspension. Host rats were then fed either a CD or choline-supplemented (CS) diet for 12 weeks and killed. Colonies of donor-derived cells identified in frozen sections by their lack of reactivity with ACI anti-LE alloantiserum in indirect immunofluorescence (IF) assays were only observed in rats continuously fed the CD diet. Histochemical analysis indicated that the donor-derived colonies expressed GGT, a preneoplastic marker for liver cancer. IF assays using MAbs previously shown to be capable of distinguishing between oval cells and mature hepatocytes indicated that the donor-derived colonies consisted of a mixture of cells with phenotypes resembling those of mature and immature hepatocytes rather than those of oval or ductal cells. Although the cellular origin of the GGT+ donor-derived colonies has not been unequivocally resolved, our results demonstrate that the livers of rats fed a CD-AAF diet contain a chemically altered call population that can be induced to proliferate by a CD diet. In contrast, a CD diet did not promote colonization when normal hepatocytes were employed as the donor cell population, suggesting that the GGT+ oval cells and not the few contaminating GGT hepatocytes (1%) in the CD-AAF donor cell suspension were the preneoplastic precursors that gave rise to donor-derived colonies. This transplantation protocol will be useful to define the biological potential of chemically altered liver cells during carcinogenesis. PMID- 2665240 TI - The effect of idarubicin monoclonal antibody treatment of first-set rejection of murine skin allografts. AB - Idarubicin was conjugated to anti-Ly-2.1 and anti-L3T4 monoclonal antibodies. These conjugates were used to investigate their effects on skin graft survival in mice. Several donor and recipient combinations were used so that the effect of individual or mixtures of conjugates on class I and class II antigenic differences, as well as multiple H-2 and non-H-2 antigenic differences could be studied. Ida-anti-Ly-2.1 prolonged skin grafts for class I antigenic differences. A mixture of Ida-anti-L3T4 and Ida-anti-Ly-2.1 was more effective than either conjugate alone in prolonging the survival of skin grafts with class II antigenic differences. However, idarubicin conjugates alone or in combination were unable to prolong graft survival when multiple H-2 and non-H-2 differences existed. In all models free idarubicin or unconjugated monoclonal antibody did not prolong the skin grafts. PMID- 2665243 TI - Growth factors, oncogenes and anti-oncogenes in cancer. PMID- 2665242 TI - Enhancement of immunosuppression by substitution of fish oil for olive oil as a vehicle for cyclosporine. AB - As previously reported, acute cyclosporine-induced nephrotoxicity is characterized by a decline in glomerular filtration rate and a selective intrarenal production of the vasoconstrictor thromboxane (TxA2), but not vasodilator prostaglandin E2 (PGE2), or prostacyclin (PGI2), cyclooxygenase metabolites. Fish oils (FO), that are rich in n-3 polyunsaturated fatty acids have a high affinity for cyclooxygenase but serve as poor substrate inhibit TxA2 synthesis. We have shown that when FO replaces olive oil (OO) as the vehicle for CsA, CsA-induced nephrotoxicity and increased TxA2 synthesis are obviated in rodent models. In this study, we demonstrate that the FO vehicle for CsA does not compromise CsA's immunosuppressive properties as deduced from studies of a delayed-type hypersensitivity (DTH) model in BALB/c mice and in a rat heart transplant model. In fact, concurrent FO administration with CsA actually enhances immunosuppression. A dose of CsA incapable of blunting DTH when injected in OO was suppressive when given in FO. Administration of as little as 0.05 ml of FO vehicle potentiated the suppressive action of CsA. In addition, nonconcurrent dietary supplementation of FO in animals receiving CsA caused an increase in the immunosuppressive action of CsA in DTH. FO alone reduced DTH as compared with OO, but was far less effective than CsA plus FO. Furthermore, doses of CsA (5 mg/kg/day or 1.5 mg/kg/day), which are subtherapeutic when administered with OO, prolonged engraftment of Lewis recipients of Lewis x Brown-Norway F1 hearts when CsA was solubilized with FO. These studies indicate that concurrent administration of CsA and FO potentiates the activity of CsA and thus increases its therapeutic index. Thus, CsA plus FO is potentially a safe, potent antirejection therapy worthy of clinical testing, especially insofar as FO prevents CsA-induced acute nephrotoxicity in the rodent. PMID- 2665244 TI - Interactions between dopamine and 5-HT3 receptors suggest new treatments for psychosis and drug addiction. PMID- 2665245 TI - Species differences in the pharmacology of terminal 5-HT autoreceptors in mammalian brain. PMID- 2665246 TI - Effects of nerve growth factor on cholinergic brain neurons. AB - Nerve growth factor (NGF) is a fully characterized molecule, well known for its actions in the differentiation and maintenance of peripheral neurons. However, recent studies suggest that its actions are not limited to the periphery, but may extend to the CNS. In particular, this trophic agent appears to affect development and survival of a variety of brain cell populations. Noteworthy are its actions on cholinergic neurons that degenerate in Alzheimer's disease and Huntington's chorea. However, studies of NGF receptor sites suggest that effects of NGF may also extend to non-cholinergic cell groups. Cheryl Dreyfus summarizes these data and points to future work necessary to define further the underlying mechanisms of action and to examine the function of NGF on diverse brain populations. PMID- 2665247 TI - Regulation of sexual differentiation in drug and steroid metabolism. AB - Certain members of the cytochrome P-450 family are expressed at different levels in the livers of male and female rats. Although little is known of the functional significance of these sex differences, progress has been made towards the understanding of the endocrine control of hepatic sex differences in cytochrome P 450 levels. Jan-Ake Gustafsson and colleagues describe a subpopulation of hepatic sexually differentiated P-450s that is regulated by sex differences in growth hormone (GH) secretory pattern. This secretory pattern is in turn regulated by gonadal steroids. These studies demonstrate a novel action of GH and suggest that the hormonal secretory rhythm is pivotal in determination of biological effects. PMID- 2665248 TI - Pharmacology of the colony-stimulating factors. AB - Leukocyte production is influenced by a family of glycoproteins called colony stimulating factors. Two of these have been purified, cloned and produced in quantities sufficient for clinical use. Granulocyte colony-stimulating factor (G CSF) preferentially stimulates neutrophil production and has been shown to reduce the duration of neutropenia following chemotherapy. G-CSF therapy also has beneficial effects in a variety of other neutropenic states. Granulocyte macrophage colony-stimulating factor (GM-CSF) stimulates neutrophil, monocyte and eosinophil production and function. GM-CSF is associated with more diverse haematological and clinical effects. George Morstyn and colleagues summarize the promising results from the early clinical trials with these new therapeutic agents. PMID- 2665249 TI - [Comparative study of the mutagenic activity of dicurin on five test-objects]. AB - Mutagenic activity of dicourol belonging to coumarol derivatives has been studied on 5 test-objects (mice, cultivated lymphocytes of human blood, yeast saccharomycetes, Tradescantia, Crepis). Results of investigations allowed attributing dicourol to highly hazardous mutagens. In this connection it is admitted unadvisable to enforce it into agricultural practice. The tested objects differ in their dicourol mutagenic sensibility as follows: cultivated lymphocytes of human blood - Tradescantia - yeast - Crepis - mice. PMID- 2665250 TI - [Antigenic divergence in a primary rat hepatocyte culture after exposure to the hepatic carcinogen N-diethylnitrosamine]. AB - Using the indirect immunofluorescence method, the appearance of membrane hetero organic antigens of kidney origin associated with the Zajdela hepatoma cells was observed on the surface of cells of the rat liver primary culture following a single hepatocarcinogen N-diethylnitrosamine (DENA) treatment before and after explantation. A correlation of antigenic alterations after a single DENA treatment in vivo and in vitro was discovered. No antigens under investigation were discovered in cultured hepatocytes of intact adult rats. PMID- 2665251 TI - [Georgii Petrovich Pinaev (on his 60th birthday)]. PMID- 2665252 TI - Protection of goats against Caribbean and African heartwater isolates by the Ball 3 heartwater vaccine. AB - Two groups of castrated male adult goats (three goats/group) were infected intravenously with the Ball 3 vaccine strain of Cowdria ruminantium and treated with long-acting oxytetracycline at the onset of clinical disease 10 days later. Five weeks post-vaccination one group was challenged with a Caribbean isolate (Gardel) and the other group with a West African isolate (Mali) of C. ruminantium. Non-vaccinated controls infected with either the Gardel or Mali isolate died. All of the vaccinated animals challenged with the Gardel strain reacted and survived. The three vaccinated animals challenged with the Mali isolate also reacted and two died of heartwater. PMID- 2665253 TI - Transmission of Theileria parva bovis (Boleni strain) to cattle resistant to the brown ear tick Rhipicephalus appendiculatus (Neumann). AB - Four crossbred Bos taurus oxen resistant to Rhipicephalus appendiculatus and three tick naive oxen of the same breed, which were all infested with adult R. appendiculatus infected with the Boleni strain of Theileria parva bovis, acquired Theileria infection. All four tick resistant oxen recovered after a mild febrile reaction. Two of the tick naive oxen died while the third recovered after a protracted period. It is suggested that tick resistance in cattle may be an important factor in establishing and maintaining enzootic stability in Theileria endemic areas. PMID- 2665254 TI - Comparison between Sri Lankan and Australian strains of Babesia bovis in the vaccination of imported cattle in Sri Lanka. AB - A Sri Lankan strain of Babesia bovis (designated A strain) was isolated from larval ticks and prepared for use as vaccine by syringe-passage in 20 splenectomised calves followed by irradiation. The A strain and a vaccine strain of Babesia bovis (designated K strain) brought in frozen form from Australia were used to vaccinate 37 susceptible bulls imported from southern Australia. Rectal temperatures, packed cell volumes, parasitaemias and overt clinical signs were monitored for three weeks following vaccination. The results indicated that the A strain was slightly more virulent than the K strain but suitable for the vaccination of well-supervised cattle. PMID- 2665256 TI - Prevalence of bovine tuberculosis among trade cattle in southern Nigeria. PMID- 2665255 TI - Contagious caprine pleuropneumonia: some observations in a field vaccination trial using inactivated Mycoplasma strain F38. AB - The efficacy of an inactivated Mycoplasma strain F38-saponin vaccine in natural infection with contagious caprine pleuropneumonia was investigated. A total of 10,000 goats were vaccinated, out of which 400 were regularly monitored for a period of six months post-vaccination. Immunised animals remained free from infection throughout the period of observation. The antibody response was followed using complement fixation and slide agglutination tests. Both tests could detect F38 antibody in the majority of vaccinated goats but the slide agglutination test was found to be more sensitive than complement fixation. The significance of the results is discussed. PMID- 2665257 TI - Surveillance and monitoring programmes in the control of rinderpest: a review. PMID- 2665258 TI - [Metabolic system of acid-base homeostasis in the human and animal body]. AB - Peculiarities of carbohydrate, lipid, amino acid nucleotide metabolism, of the tricarboxylic acid cycle functioning and of the oxidative phosphorylation have been studied in man and animals under conditions of changes in the acid-base equilibrium (ABE) state in the organism. The results of studies are analyzed and generalized. Strictly defined peculiarities of changes in the mentioned aspects of metabolism depending on the ABE state in the organism are revealed. Basing on a new interpretation of the experimental data and detected regularities in the metabolism, the author has drawn a conclusion on the existence of the previously unknown system of acid-base homeostasis in tissues. The physiological sense of this system functioning is the regulation of the intracellular acid-base equilibrium stability. The regulation mechanisms promoting functioning of this system are discussed. The system is shown to be of great applied significance for improvement of methods to cure a number of human and animal diseases as well as for an increase of the productivity of animals. PMID- 2665259 TI - [Rat brain catecholamines in the initial period of acute radiation exposure]. AB - Total X-ray irradiation (0.21 C/kg of rats induces an hour later an increase in the dopamine and norepinephrine content in the grey matter by 11 and 60%, respectively. The spontaneous release of dopamine and norepinephrine from the brain synaptosomes of the irradiated rats falls causing a decrease of the initial rate of the process. Potassium chloride depolarization of synaptosome membranes of the control rat brain increases both the maximal and initial rate of the process of neuromediators' release; in irradiated animals only the maximal rate of the process grows, the initial rate of the dopamine release being unchanged and that of norepinephrine increasing but less that in the control. After irradiation maximal rate of the by synaptosomes dopamine uptake is 2.6 times as high, while that of norepinephrine is 4.6 times as low; Km of the highly specific uptake of norepinephrine decreases. PMID- 2665260 TI - Immunotherapy of metastasizing renal cell carcinoma. Results of a multicentered trial. AB - 119 patients with stage-IV renal cell carcinoma were treated using immunotherapy with autologous tumor vaccine. The immunization was carried out at monthly intervals, the patients were restaged every 3 months using X-ray, ultrasound scanning or computed tomography as well as bone scintigraphy in the follow-up. The patients' follow-up periods run from 6 to 66 months averaging in 38.5 months. 6 complete remissions, 4 partial responses and 29 stable diseases were seen, whereas 54 patients had progressive disease. Patients with a T1 primary tumor all survived the follow-up period irrespective of whether lymph node metastases (n = 2), venous invasion (n = 12) or distant metastases (n = 6) were present at the time of operation. Follow-up periods run from 12 to 48 months (averaging 23 months). Patients with T2 tumors showed survival up to 50 months postoperatively, of these only 3 died. Follow-up averages 30 months. The 3 patients died within the first year after operation. Patients with very large primary tumors showed the poor prognosis normally expected. 23 of these 40 patients died after a mean follow-up of 15 months. These results may indicate that immunotherapy can slow down tumor progression and induce objective responses. Those patients with small primary lesions apparently benefit from the treatment even though metastases are present at the time of diagnosis. PMID- 2665261 TI - Azoospermic male with a balanced Y-autosome translocation. AB - Structural chromosomal aberrations, such as translocations or inversions, may cause spermatogenic failure. We report a rare chromosomal anomaly 46,X,t(Y;3)(q12;p21) in an azoospermic male with normal phenotype. Twenty-two cases of a balanced Y-autosome translocation have been reported in the literature and the majority of them have been detected among azoospermic males at male infertility clinics. This structural chromosomal anomaly brings spermatogenic arrest at the primary or secondary spermatocyte. PMID- 2665262 TI - Polyorchidism: preoperative diagnosis by ultrasonography. AB - Polyorchidism is an unusual abnormality of the genital tract in which supernumerary testicles are present, usually within the scrotum. We report a recently encountered case with no remarkable symptoms. Preoperative ultrasonographic evaluation differentiates this rare benign entity from more ominous abnormalities such as neoplastic involvement of the scrotal contents. PMID- 2665263 TI - Immunohistochemical detection of tissue-infiltrating lymphocytes in bladder tumors. AB - Local immunocompetence in patients with bladder tumors was evaluated immunohistochemically using monoclonal antibodies. As well as investigating the subsets of peripheral blood lymphocytes by flow cytometry, the subpopulations of tissue-infiltrating lymphocytes were investigated in frozen specimens from bladder cancers (n = 25) and from noncancerous tissues (n = 4). Six serial sections were stained with Leu4, Leu7, Leu10, LeuM3, OKT4, and OKT8 antibodies, respectively. Marked lymphocytic infiltration into bladder tumors was a favorable prognostic sign. T cell infiltration was marked in the noninvasive group and was prominent around tumor cells, whereas B cells were rare in the stroma. T cells predominated over B cells in 19 of 25 bladder tumors. In patients with low-stage tumors, OKT8 cells were more prominent than OKT4 cells. NK cells accumulated around the cancer cells and infiltrated within cancer nests; NK cell infiltration was scanty in high-stage cases. There was a slight scattering of macrophages in 13 cases. In contrast to the findings in subsets of tissue-infiltrating lymphocytes, subsets of peripheral blood lymphocytes did not correlate with stage of disease. These findings suggest the presence of local immunosurveillance against bladder tumors. To elucidate host immune response against tumor, it may be important to characterize tissue-infiltrating lymphocytes. PMID- 2665264 TI - Paraepididymal relapse of follicular small cleaved cell lymphoma. AB - We report a case of follicular small cleaved cell lymphoma (nodular poorly differentiated lymphocytic lymphoma) that recurred in the paraepididymal area after extensive chemotherapy for stage IV-A disease. PMID- 2665265 TI - Case report: secondary penile carcinoma. AB - We report a case of secondary penile carcinoma with primary tumor in the pancreas. Immunoperoxidase tissue staining of carbohydrate antigen 19-9, carcinoembryonic antigen and prostate-specific antigen was useful for diagnosis of original tumor. PMID- 2665266 TI - Evaluation of the T stage of carcinoma of the bladder by transurethral ultrasonography. AB - In order to evaluate the accuracy of transurethral ultrasonography in predicting the T stage of bladder tumors a prospective study was initiated. Transurethral ultrasonography was performed in 308 consecutive patients prior to cystoscopy, transurethral resection, biopsy or cystectomy. The findings of ultrasonography were compared with the histopathologic results. In 218 out of the 308 patients a carcinoma of the bladder was diagnosed histologically, whereas in 90 patients a tumor could not be detected on histological examination. In 78.2% of those patients, in whom a carcinoma of the bladder was present, it was possible to predict the correct T stage. It was not possible, however, to distinguish tumors of stage TA from those of stage T1. Further analysis of the results revealed an overstaging of the tumor in 12.0%, whereas in 8.0% of the cases the tumor was understaged or had not been recognized at all by ultrasonography. PMID- 2665267 TI - Retroperitoneal Castleman's disease: a case report and brief review of tumors of the pararenal area. AB - We report a case of retroperitoneal Castleman's disease of the hyaline vascular type. The tumor was excised with the left kidney because of tenacious adhesion to the renal pedicle. We suggest that knowledge of Castleman's disease in the retroperitoneal area would help to avoid an unnecessarily extensive operation. PMID- 2665268 TI - Anatomy and pathology of the adrenal glands. AB - The adrenals are paired glands that lie in the retroperitoneum and have a close anatomic relation to the kidneys. Each gland has a cortex and a medulla, which act as separate entities. The adrenals are affected by various pathologic conditions, including congenital abnormalities, hypofunction, nodular enlargement, hyperplasia, and malignant and benign tumors. Newer developments in pathologic evaluation are fine-needle aspiration biopsy, immunohistochemistry, and ploidy and oncogene analysis. PMID- 2665269 TI - Physiology of the adrenal cortex. AB - Knowledge of the functional morphology and physiology of the adrenal cortex and of the regulation of its secretory products is essential to understanding the meaning of the results of various tests in the diagnosis of adrenocortical disease and to providing the postoperative care necessary to correct this condition. Removal of a cortisol-producing adenoma will necessitate replacement of glucocorticoids only, whereas after resection of an aldosterone-producing adenoma, no steroid replacement will be required. PMID- 2665270 TI - Physiology of the adrenal medulla. AB - As can be appreciated from this discussion, catecholamines derived from the adrenal medulla have far-reaching effects on human physiology, ranging from direct effects on individual cells to participation in complex behavioral responses. PMID- 2665271 TI - Cushing's syndrome. AB - Cushing's syndrome remains one of the great diagnostic challenges to internists and endocrinologists. Urologists have the primary role in the treatment of many of the forms of Cushing's syndrome, especially adrenal tumors and micronodular hyperplasia. As we continue to gain experience with Cushing's disease treated with pituitary surgery and with etopic ACTH syndrome and the other forms of Cushing's syndrome, urologists are likely to become even more involved in the therapy of all types of Cushing's syndrome. PMID- 2665272 TI - Adrenocortical carcinoma. AB - In reviewing the experience of a number of authors and investigators, it is clear that early diagnosis of adrenocortical carcinoma is essential for cure. Of all the modalities of therapy currently available, surgical resection holds the most promise for cure or prolonged survival. Treatment for extensive local disease or metastatic disease has been discouraging, and the prognosis for reasonable, comfortable survival is poor. Unfortunately, the toxicity of mitotane, an adrenolytic agent and currently the most effective drug available, is often unacceptable and may militate against its use. Because many of the debilitating side effects of these tumors are related to hormone production, newer drugs that result in hormonal blockade may add considerably to the comfort of the patient. The development of less toxic chemotherapeutic agents presents a challenge for both the oncologist and the endocrinologist. PMID- 2665273 TI - Adrenocortical carcinoma in children. AB - Adrenocortical carcinoma in childhood is a rare, potentially fatal disease. Despite its often-dramatic presentation, there typically has been a distressingly long delay between the onset of symptoms and the time of diagnosis, which undoubtedly has contributed to the poor prognosis in these children by permitting the disease to reach an advanced stage before treatment is started. It is therefore imperative that the physician recognize the endocrine manifestations of these tumors. Although biochemical evaluation is helpful, it often cannot differentiate benign from malignant neoplasms and therefore should not unduly delay intervention. Aggressive surgical resection continues to be the mainstay of treatment as the role of adjuvant therapy continues to evolve. It is hoped that increased familiarity with this unusual tumor will result in earlier detection, prompt intervention, and improved survival for children with adrenocortical carcinoma. PMID- 2665274 TI - Primary aldosteronism. AB - Primary aldosteronism remains a diagnostic challenge. Despite the availability of sensitive and specific immunoassay techniques, the simplification of diagnostic testing, and the introduction of sensitive imaging techniques, there remain uncertainties about the optimal methods of screening, the sensitivity and specificity of various tests, diagnostic criteria, and differentiation among the growing number of etiologic subgroups of the disorder. The author stresses the differentiation of the surgically correctable lesion (adenoma) from the other etiologic subgroups. PMID- 2665276 TI - Adrenal imaging. Computed tomographic scanning and magnetic resonance imaging. AB - On the basis of this review and others, adrenal imaging using MRI requires functional biochemical data, such as scintigraphy (NP-59 and MIBG), for cortical adrenal assessment. For medullary hyperfunction such as intra-adrenal pheochromocytomas and neuroblastomas, MRI provides excellent staging and localization. Computed tomography is preferred for biochemically established hyperfunction such as Cushing's and Conn's syndromes. PMID- 2665275 TI - New perspectives in pheochromocytoma. AB - Pheochromocytomas are tumors that arise from chromaffin cells. Although the majority occur in the adrenal gland, these tumors can be found anywhere from the neck to the base of the pelvis. This condition, which is the cause of hypertension in only a small percentage of patients, can be cured in approximately 90 per cent of cases but can be lethal if left untreated. Pheochromocytomas may be familial in 10 per cent of patients, and in such cases, they may be associated with a variety of other conditions. The authors review the biochemical and radiologic diagnosis of adrenal and extra-adrenal tumors and discuss the treatment, including the special problems of pheochromocytoma during pregnancy. PMID- 2665277 TI - Adrenal arteriography and venography. AB - Although no longer the primary diagnostic examination, angiography of the adrenal gland remains a safe, reliable tool for identifying adrenal disorders. Selective venous sampling for hormone assay is important in localizing functional adrenal lesions. PMID- 2665278 TI - Operative approaches to the adrenal gland. AB - Various adrenal disorders necessitate surgical intervention, and familiarity with adrenal pathophysiology and surgical anatomy is crucial to the success of these procedures. A number of operative approaches--anterior, posterior, flank, and thoracoabdominal--are available; the choice must be made on the basis of the patient's adrenal pathology, body habitus, and surgical history as well as the surgeon's experience and familiarity with the different options. PMID- 2665279 TI - Surgery for primary hyperaldosteronism. AB - The most common underlying disorder in primary aldosteronism is a benign unilateral adenoma. Some cases, termed idiopathic, are secondary to bilateral adrenal hyperplasia, and a few are caused by adrenocortical carcinoma. The therapeutic alternatives are pharmacologic management with an aldosterone antagonist and surgical adrenalectomy. The author reviews patient selection and preparation for surgery, the technical details of adrenalectomy in this setting, and relevant postoperative considerations. PMID- 2665281 TI - Anesthesia in adrenal surgery. AB - Although adequate preoperative readiness of patients with pheochromocytoma decreases the myocardial oxygen imbalance with which the anesthesiologist must deal, these patients remain a challenge, requiring attention to detail. Thorough knowledge of the pathophysiology and applicable pharmacology will aid in the selection of the most appropriate drugs for the task. Preoperative evaluation, adequate monitoring, protection against stimulating maneuvers, and prompt response to hemodynamic changes remain the hallmarks of good anesthetic care for these interesting patients. PMID- 2665280 TI - Surgical management of Cushing's syndrome. AB - Cushing's syndrome represents a constellation of symptoms of various origins. In most patients, detailed endocrinologic and radiologic testing will differentiate between Cushing's disease, adrenal adenoma, adrenal carcinoma, primary bilateral nodular hyperplasia, and ectopic corticotropin-producing tumors. Although adrenal surgery affords rapid and reliable remission in patients with Cushing's syndrome, it is associated with significant morbidity and mortality. Complications can be minimized by careful perioperative preparation. The indications for adrenal surgery for Cushing's disease have been altered radically by the success and low morbidity of transsphenoidal surgery. Total adrenalectomy is indicated in patients with bilateral nodular hyperplasia and should be considered for adults who have failed selective pituitary adenectomy or hypophysectomy and in whom ectopic corticotropin secretion has been unequivocally ruled out. At the Lahey Clinic, total adrenalectomy is performed through an anterior abdominal incision. Anterior approaches are especially indicated in those patients who require abdominal exploration for other intra-abdominal pathologic conditions that require surgery. Total adrenalectomy is indicated in the very rare patient who has Cushing's syndrome caused by ectopic corticotropin production when the patient is severely ill, a primary tumor is not found, and medical therapy fails or is poorly tolerated. Small adrenal tumors are best approached through a flank incision. Larger potentially malignant tumors should be approached through a thoracoabdominal incision. PMID- 2665282 TI - Transsphenoidal pituitary surgery in the treatment of patients with Cushing's disease. AB - Transsphenoidal adenomectomy is the treatment of choice for patients with Cushing's disease. The combination of high serum and urinary cortisol and high plasma ACTH point to a nonadrenal source for Cushing's syndrome. It is important to rule out an ectopic source of ACTH production. Imaging of the sella with MRI and CT and sampling petrosal sinus blood for ACTH measurement should allow differentiation between the two conditions. For younger patients, every effort should be made to preserve the normal gland. If in the younger patient the adenoma cannot be clearly demonstrated, it is appropriate to remove the central portion of the gland, as advocated by Hardy. Should hypercortisolism persist, radiation therapy to the sella should be considered before attempting total hypophysectomy. In the woman past childbearing age, a total hypophysectomy can readily be considered if a sharply demarcated adenoma is not found. In fact, we counsel our older patients before operation that a total hypophysectomy is a possibility. For the patient with an aggressive tumor that is not cured by pituitary operation, radiation therapy must be considered. If it is not possible to wait for the therapeutic effect of radiation, adrenal suppression with aminoglutethimide, metyrapone, or ketoconazole is indicated. Adrenalectomy may be considered. PMID- 2665283 TI - Perioperative complications of adrenal surgery. AB - Complications of adrenal surgery may be medical or surgical. The latter are related to the operative approach as well as to the type and extent of the adrenal lesion and are in general similar to those seen in other open procedures. The medical complications include adrenal insufficiency as a result of bilateral adrenalectomy or continuing contralateral suppression, as well as more specific problems resulting from the physiological derangements of Cushing's syndrome, pheochromocytoma, and primary aldosteronism. Nevertheless, with meticulous preoperative management and postoperative care, adrenal surgery can be performed with low morbidity and mortality rates. PMID- 2665284 TI - Computer assisted pantropic urethral pressure profile. AB - A computerized method for urethral pressure measurement along the whole length and at every angle of the urethra is presented. The main advantage is the exact study of physiological versus artificial factors in pressure distribution in the urethra. Details of the technique are presented. PMID- 2665285 TI - Biocarbon ureterostomy device for urinary diversion. Multicenter clinical trial. AB - The bioCarbon ureterostomy device is a stomal prosthesis for upper tract urinary diversion that has had preliminary successes in animal and human trials in Europe and Peru. Implantation of a pure carbon stomal prosthesis offers the potential advantages of high biocompatibility, lack of encrustation, and elimination of stomal stenosis which is frequently associated with cutaneous ureterostomy. Nine bioCarbon ureterostomy devices were implanted from August, 1984 through July, 1985. Although successful implantation was achieved in 2 patients, the complication rate was high. The bioCarbon ureterostomy device has potential as an alternative form of urinary diversion. However, significant problems need to be remedied before it can be recommended for routine clinical application. PMID- 2665286 TI - Renal cell carcinoma in horseshoe kidney associated with Turner syndrome and caval extension. AB - The first case of renal cell carcinoma in a horseshoe kidney associated with Turner syndrome is reported. Therapeutic and diagnostic aspects are discussed; the literature is reviewed. PMID- 2665287 TI - Testicular plasmacytoma. AB - The case of a sixty-five-year-old man with multiple myeloma and a testicular plasmacytoma is described. This represents the thirty fourth reported case of testicular plasmacytoma and the first in which immunoperoxidase histochemistry has been used to demonstrate that the testicular plasma cells contain immunoglobulin of the same isotype as the patient's paraprotein. The clinical and morphologic features of previously reported testicular plasmacytoma are reviewed. PMID- 2665288 TI - Transrectal ultrasound in early detection of clinical stage A prostate cancer. AB - A group of 40 select men were studied to assess the value of transrectal ultrasound in the early detection of prostate cancer. All had a benign digital rectal examination and had either irritative lower tract symptoms, hematospermia, microhematuria, or an elevated acid phosphatase. Of the men, 28 had an abnormal ultrasound and underwent a directed prostate needle biopsy to assess the ability to detect clinical Stager A cancer. Eleven men (40%) were found to have cancer, all having hypoechoic lesions. The remainder were found to have benign prostatic hypertrophy (BPH) with hyperechoic lesions predominating (88%). Our results suggest that transrectal ultrasound is a useful and sensitive method for the detection of prostate tumors not clinically evident on digital rectal examination in select patients. PMID- 2665289 TI - [The 1st experience with complete stromaplasty--transplantation of the cornea]. AB - The results of experimental and clinical trials of a new type of transplantation of the cornea, stromaplasty, have shown the possibility of a blunt detachment from Descemet's membrane and removal of the deep lamellae of recipient's stroma, followed by replacement of the defect with a through allotransplant. Further studies are necessary to validate this first successful surgery and to objectively assess the prospects of such surgery. PMID- 2665290 TI - [Open auto-keratoplasty and reflected-light microscopy of the endothelium]. AB - Reflecting microscopy of the endothelium is recommended for assessment of the corneal status before open autokeratoplasty and volumic keratoplasty. The density of 1000 per mm2 has been estimated as the transplantation minimum of endothelial cells. The results of autokeratoplasty have been better if the Healon viscous elastic bioprotector has been employed. The findings of the dynamic follow-up of the endothelial cell density after surgery are presented. PMID- 2665291 TI - [Gamma resonance velocimetry of the eye]. AB - A new method for the registration of ocular orbital pulse in humans is suggested, based on the nuclear gamma resonance effect. In normal subjects the velocity of the corneal movement over the period of a cardiac contraction is under 0.3 mm/s, and the mean amplitude of corneal transposition is 21.8 +/- 0.6 microns. The amplitude of corneal transposition and the cardiac cycle length are in square relationship. PMID- 2665292 TI - [Automated training system used for a course on eye diseases at a medical institute]. AB - The authors have developed this system (AIS), realized via CM 1420 mini-computer for many-terminal regime. The program provides operation in both the instruction and control modes; the control is realized via a display, that permits individual dialogues of students with the computer. The dialogue involves 12-16 questions in the curriculum. The answers are estimated and remembered by the computer. When the operation in the control mode is over, a register with students' marks is printed out. Therefore, the suggested AIS promotes autotraining of the students in this course and rules out the subjective aspects in assessment of students' knowledge. PMID- 2665293 TI - [Factors influencing the effects of radial keratotomy and methods of prognostication of end results]. PMID- 2665294 TI - [A method of tubular resection of the stomach with formation of a rectangular oblique gastro-jejunal anastomosis]. AB - The method of tubular resection of the stomach with deomentization, subtotal resection of the lesser curvature and formation of the retrocolic right-angled gastro-jejunal anastomosis on a short loop with an oblique section of the jejunum was developed experimentally and successfully used in 98 patients for the treatment of complicated forms of gastroduodenal ulcers and of oncological patients with the tumorous involvement of the outlet portion of the stomach. PMID- 2665295 TI - [The organization, equipment and performing of microsurgical operations on the bile ducts]. PMID- 2665296 TI - [Causes of postoperative intra-abdominal complications in emergency surgery and ways of their prevention]. PMID- 2665297 TI - [Complications of bougienage of cicatricial strictures of the esophagus]. PMID- 2665298 TI - [Surgery of the esophagus in the Tomsk A.G. Savinykh Hospital Surgical Clinic]. PMID- 2665299 TI - [The surgical prize of I.F. Bush (on the 150th anniversary of its establishment]. PMID- 2665300 TI - [Endogenous toxemia in acute pancreatitis]. PMID- 2665301 TI - [Surgical treatment of portal hypertension syndrome complicated by hemorrhage]. PMID- 2665302 TI - [Reconstructive surgery of blood vessels of the lower extremities using the great saphenous vein in situ]. PMID- 2665303 TI - [Surgery of the thyroid]. PMID- 2665304 TI - [Treatment of patients with lung abscess by local administration of papain]. AB - Under study were results of treatment of 109 patients with lung abscess aged from 17 to 76 years. All the patients were treated by active antiinflammatory therapy, bronchosanitation measures. In addition, local treatment by transthoracal punctures and drainage of the abscess cavity was used. Patients of the main group (52 patients) were given transthoracal injections of 0.5% solution of papain. The inclusion of papain in the complex therapy of patients with a lung abscess allowed to improve results of the treatment of this severe disease. The method may be recommended for wide use in pulmonology. PMID- 2665305 TI - [Therapeutic endoscopy in the complex treatment of patients with chronic gastroduodenal ulcer]. AB - Under the ambulatory treatment there were 300 patients: 120 of them had gastric ulcers and 180 had ulcers of the duodenum. The immediate and long-term results of the treatment were followed-up in 243 patients. The analysis has shown that Solcoseryl and film-forming glue "Statizol" included in the complex of general therapy of chronic ulcers of the stomach and duodenum by means of a local application (through the endoscope) made the average terms of healing 2 times shorter as compared with the routine treatment of ulcers and considerably reduced recidivation of the disease (in the main group recurrences took place in 19-10%, in the control group--in 36-42.4% of the cases). Most effective was the complex treatment including the application of Solcoseryl and film-forming glue "Statizol" simultaneously. PMID- 2665306 TI - [Complex prevention of suture incompetence of the duodenal stump in penetrating duodenal ulcers]. AB - Data on 323 patients operated upon for penetrating duodenal ulcers (resection of the stomach) are presented. New procedures are described which elevate hermeticity of the duodenal stump as well as prophylactic measures against incompetence of sutures of the duodenum stump. Six patients had incompetent sutures of the duodenum stump which was of limited character and was completed by the formation of a duodenal fistula. Lethality from this complication was not noted. PMID- 2665307 TI - [Ultrasonic echography in evaluating splenic blood circulation]. PMID- 2665308 TI - [Peptic ulcer perforation in children]. PMID- 2665309 TI - [Principles of creating anastomoses of hollow organs of the gastrointestinal tract with reference to characteristics of their regeneration]. AB - The authors have elaborated a method of the formation of anastomoses on hollow organs of the gastro-intestinal tract which consists in placing precision interrupted extramucosal sutures. It allows to adapt all the layers of the organ sutured. So, the tender mucosa is intact, muscular and serous layers are healing by first intention. The method was developed in experiment and tested in 192 patients with good results. PMID- 2665310 TI - Swine cysticercosis: detection of parasite products in serum. PMID- 2665311 TI - Transmission of Salmonella enteritidis in poultry. PMID- 2665312 TI - [The quality of life of cancer patients after radical treatment]. PMID- 2665313 TI - [Differential diagnostic cytologic signs of atypical hyperplasia and cancer of the endometrium]. AB - Computerized multifactorial analysis of 56 cytologic features was performed in 135 cases suffering glandular and atypical hyperplasia and well-differentiated endometrial carcinoma (45 patients in each group). The established regularities enabled students to differentiate between hyperplasia and cancer in 95% of cases in classes and in 73-83% at examination. PMID- 2665314 TI - [Acute cholecystitis in cancer patients in the postoperative period]. PMID- 2665315 TI - The fine specificity of Lewis blood group antibodies. Evidence for maturation of the immune response. AB - Eight human Lewis blood group antibodies were characterized for their fine specificity by the use of specific immunoadsorbents and a kinetic enzyme-linked immunosorbent assay technique. Examination of sera following immunoglobulin fractionation showed IgM anti-Le(a) exhibiting broad cross-reactivity with structures biochemically related to the Lewis antigens. IgG anti-Le(a) binding was restricted to Le(a) and Le(b) These findings are consistent with the concept of affinity maturation of the immune response, which has been previously demonstrated only in animal model systems. PMID- 2665316 TI - Stability of murine monoclonal anti-A, anti-B and anti-A,B ABO grouping reagents and a multi-centre evaluation of their performance in routine use. AB - We have previously reported the production of 3 murine monoclonal reagents for ABO typing (designated ES-9, ES-4 and ES-15). This study presents results of tests of stability of these 3 reagents, together with a fourth murine monoclonal antibody (LM103/107). In addition, data are also presented from a multi-centre evaluation of the performance of the murine monoclonal reagents in routine ABO typing of both donors and patients using a wide variety of techniques, both manual and automated. The potency and stability of the 4 monoclonal antibody based reagents is compared with a broad selection of monoclonal and polyclonal ABO typing reagents. The reagents used for comparison were produced by European and United States manufacturers in both the public and private sector and are widely used in routine ABO typing. The Scottish monoclonal reagents have been used successfully to ABO type over 500,000 blood samples in 7 centres within the UK, with no discrepant results. PMID- 2665317 TI - [Pleuropulmonary manifestations of rheumatoid arthritis (a review of the literature)]. PMID- 2665318 TI - The use of fine-needle aspiration biopsy in children. AB - Fine-needle aspiration biopsy has become increasingly popular for evaluating both palpable and nonpalpable masses. Judging from the current body of literature, this procedure is underused by American pediatricians. We report a series of 84 pediatric patients--younger than 16 years--who underwent 92 fine-needle aspiration biopsies to evaluate a large variety of masses. The results of 51 (55%) were benign, and 33 (36%) biopsies revealed malignancy. In two cases (2%) the findings were suggestive of malignancy, and in six cases (7%), insufficient material was rendered for diagnosis. Either histologic or clinical follow-up or both were available for 85 procedures. Based on these cases, the sensitivity of 97% and the specificity was 95%, indicating that fine-needle aspiration biopsy is a good method for screening and observing patients for various malignant tumors in a variety of organs. PMID- 2665319 TI - Hepatitis B in pregnancy. AB - Chronic infection with the hepatitis B virus can result in the development of serious liver disease such as chronic active hepatitis, cirrhosis, and hepatocellular carcinoma. Vertical transmission from infected mothers to infants is thought to be partially responsible for the high prevalence of infection in certain high-risk groups. Immunoprophylaxis using hepatitis B vaccine and hepatitis immune globulin has been highly effective in decreasing the probability of chronic hepatitis B virus infection in infants with exposure. Previously, the Centers for Disease Control recommended screening pregnant women considered at high risk of hepatitis B infection to detect newborns who would benefit from postnatal immunizations directed at preventing the HBV carrier state. Because of the poor sensitivity of high-risk criteria in distinguishing pregnant women who harbor the hepatitis B virus, these recommendations have recently been revised to call for the routine screening of all pregnant women in the United States. PMID- 2665320 TI - Ununited lower limb fractures. AB - Nonunion is a fairly common complication of fracture management, with an overall rate of about 3% for the skeleton as a whole and 9% for the tibia. High-energy injury fractures have a nonunion rate as high as 75%. Other factors that may lead to nonunion are inappropriate treatment, infection, and preexisting disease. The diagnosis of nonunion is based largely on clinical examination. Plain radiographs and tomograms, computed tomograms, and contrast imaging may be used to confirm nonhealing. Radionuclide imaging can help determine the presence of infection, an impaired blood supply, or impaired osteogenic activity at the fracture site. The treatment of ununited fractures is based on the principles of good fracture management: adequate immobilization, asepsis and soft tissue cover, osteoconduction (bone contact), osteoinduction (stimulation of bone growth), and metabolic well-being. New modalities for osteoinduction are promising adjuncts to standard treatment, the autogenous bone graft, but conclusive proof of efficacy in humans does not yet exist. PMID- 2665321 TI - Tuberculosis in patients with human immunodeficiency virus infection. Review of current concepts. AB - Tuberculosis is a frequent complication of human immunodeficiency virus (HIV) induced immunosuppression. The diagnosis of extrapulmonary tuberculosis in patients with evidence of HIV infection qualifies as a criterion of the acquired immunodeficiency syndrome. Demographic characteristics of patients with tuberculosis and HIV infection vary by region and reflect the degree to which patients with Mycobacterium tuberculosis infection adopt behaviors that put them at risk for HIV infection. The clinical features of tuberculosis in patients with HIV infection are atypical. Extrapulmonary disease, tuberculin anergy, and unusual findings on chest radiographs occur most frequently when tuberculosis afflicts patients with other clinical evidence of HIV infection at the time tuberculosis is diagnosed. Treatment is effective for tuberculosis in HIV seropositive patients, and isoniazid prophylaxis is recommended for HIV-infected patients with positive tuberculin skin tests. PMID- 2665322 TI - [The Delphi panel "atherosclerosis report"--concept and experiences]. AB - While the overall mortality in Austria is decreasing and life expectancy is increasing the mortality rate from ischaemic heart disease has been stable for more than 15 years despite therapeutic progress. In many countries well established prevention programs have helped to decrease the cardiovascular mortality by more than the overall mortality. In order to provide the basis of a nationwide program to reduce morbidity from cardiovascular diseases, their epidemiological importance must be documented convincingly, as well as the available strategies for their prevention and therapy. The most convincing form of documentation is a joint statement by leading medical experts. Hence, the "Delphi panel" method was chosen as the most appropriate approach. In Austria, the Institute of Social Medicine, University of Vienna and the Austrian Society of Hygiene, Microbiology and Preventive Medicine published the "Atherosklerosebericht" (atherosclerotic report), result of a written Delphi panel, in June 1988. Concept and practical experiences are reported below. PMID- 2665324 TI - Medicare and the so-called excess charges. PMID- 2665323 TI - [Arteriosclerosis and cancer--fats or carbohydrates?]. AB - The big field studies failed to yield the results expected from the lipid theory of arteriosclerosis. By only lowering the intake of animal fats and cholesterol (MRFIT) the death rate from cardiovascular disease was not significantly decreased whilst the use of strong drugs to lower the cholesterol level (LRC, Helsinki Heart) did not influence total mortality. The carbohydrate theory of arteriosclerosis according to epidemiological studies explains the results on the basis of evolutionary concepts through the different time spans a population had to adapt to the new foodstuff, carbohydrate appearing in the Neolithic Age. Studies on the effect of carbohydrates in humans are proposed. PMID- 2665325 TI - Urinary and biliary metabolites of mephentermine in male Wistar rats. AB - 1. Excretion of urinary and biliary radioactivity, and metabolites of [3H]mephentermine (MP), after i.p. or subcutaneous administration of [3H]MP to male Wistar rats, were determined by preparative t.l.c.-liquid scintillation counting. 2. About 45% of the radioactivity administered i.p. was excreted in the 24 h urine. The major urinary metabolite was conjugated p-hydroxymephentermine (p hydroxy-MP), which accounted for about 18% of the administered radioactivity in the 24 h urine. 3. About 4.2% of the radioactivity administered subcutaneously was excreted in bile during 24 h. The major biliary metabolite was conjugated p hydroxy-MP, which accounted for about 39% of the radioactivity excreted in the bile in 24 h. 4. Urinary and biliary minor metabolites detected were phentermine (Ph), p-hydroxyphentermine (p-hydroxy-Ph), N-hydroxyphentermine (N-hydroxy-Ph), N hydroxymephentermine (N-hydroxy-MP) and their conjugates, and conjugated MP. 5. The conjugates were considered to be glucuronides from the inhibitory effect of saccharic acid 1,4-lactone on their hydrolysis with beta-glucuronidase. 6. Biliary excretion rates of conjugated p-hydroxy-Ph and p-hydroxy-MP reached maxima at 3 to 4 h, and non-conjugated metabolites were maximal at 1 to 2 h, after administration. 50% of the biliary metabolites was excreted within 5 h. PMID- 2665326 TI - The pharmacokinetics and metabolism of (1R, cis)- and (1R, trans)-tetramethrin in rats. AB - 1. The pharmacokinetics and metabolism of (1R, cis)- and (1R, trans)-isomers of tetramethrin (i.v. 0.25 mg/kg) were studied in rats. 2. The experimental data for the time course of the concentration of tetramethrin isomers in plasma fit a pharmacokinetic two-compartmental open model. Plasma levels of both isomers were similar. The terminal half-life of the trans-isomer in plasma was greater (125 min) than the cis-isomer (72 min). 3. The concentrations of the two metabolites, 3,4,5,6-tetrahydrophthalimide (TPI) and N-(hydroxymethyl)-3,4,5,6 tetrahydrophthalimide (MTI), were consistently higher in the plasma of rats treated with the trans-isomer than in those treated with the cis-isomer. 4. In rats treated with the trans-isomer, the majority of radioactivity excreted after 96 h was found in urine. The faeces was the major excretory route for rats treated with the cis-isomer (26% urine, 69% faeces with cis-isomer; 64% urine, 29% faeces with trans-isomer). 5. Metabolism of each isomer was rapid and complete. Parent chemical was not detected in urine and only small quantities of the intact cis-isomer were found in the faeces. MTI, TPI, and cyclohexane-1,2 dicarboximide (HPI) were detected in both urine and faeces. 6. The amount of radioactivity excreted into the bile was similar for both isomers. However, levels of the intact parent compound and TPI were higher in the bile isolated from rats treated with the trans-isomer. The trans-isomer was found to undergo enterohepatic circulation. PMID- 2665327 TI - A new method for the measurement of nitrosoureas in plasma: an h.p.l.c. procedure for the measurement of fotemustine kinetics. AB - 1. An analytical method for a novel nitrosourea, fotemustine, has been developed using solid-phase extraction and h.p.l.c. with u.v. detection. As part of the development, different methods for stabilising fotemustine after sample collection have been investigated. The method has been successfully applied to pharmacokinetic studies in monkeys and man. 2. Providing plasma was separated immediately from blood and frozen within 3 min of collection, negligible degradation of fotemustine occurred. The samples could then be stored at -20 degrees C in the dark for up to six days particularly if thawing prior to analysis was accelerated using a 50 degrees C water-bath so that it was complete within 3 min. Equivalent results were also obtained with samples stabilised with 0.1 M citric acid immediately after the preparation of plasma. 3. The analytical method showed good precision with a within-day variation ranging between +/- 10.7% at the lowest concentration investigated (0.1 micrograms ml-1) to 2.0% at 50.0 micrograms ml-1. The accuracy of measurement was from 108.9% to 97.6% at 0.1 and 50.0 micrograms ml-1 respectively and the response was linear up to 50 micrograms ml-1. The minimum level of quantitation was 20 ng ml-1. 4. After a single intravenous bolus dose of [14C]fotemustine (100 mg m-2) to Cynomolgus monkeys, intact drug levels rapidly declined (t1/2 12.6 +/- 0.5 min) although the half-life of radioactivity (approx 100 h) was much longer. The plasma clearance of fotemustine was 225 +/- 63 ml min-1 with a volume of distribution based on area of 4.1 +/- 1.2 litres. 5. As with monkey, plasma levels of intact fotemustine in a patient given [14C]-drug as a 1 h constant rate intravenous infusion (approx. 100 mg m-2), declined rapidly but with a half-life of 23.2 min. Again, the half-life for total radioactivity was considerably longer (30.8 h). The plasma clearance was 1426 ml min-1 and the volume of distribution based on area was 47.71. PMID- 2665328 TI - [Pheochromocytoma--a review]. PMID- 2665329 TI - [Differential diagnosis and therapy of goiter]. PMID- 2665330 TI - [Hypothyroidism in adulthood]. PMID- 2665331 TI - [Ultrasound diagnosis--a health problem?]. PMID- 2665332 TI - [Renal failure--symptoms, diagnosis, differential diagnosis]. PMID- 2665333 TI - [Portable infusion pumps for insulin administration in type I diabetic patients]. PMID- 2665334 TI - [Possibilities and limits of ambulatory flexor tendon surgery]. PMID- 2665335 TI - [Diagnosis, therapy and prognosis of rectal cancer]. PMID- 2665336 TI - [Current aspects of giardiasis]. AB - Modern epidemiological, clinical, diagnostic and therapeutic aspects of giardiasis are described. PMID- 2665337 TI - [Computer-assisted evaluation and analysis of bacteriologic findings]. AB - A computer-aided information system was developed for registration and analysis of microbiological findings. The base of the system is a microcomputer with a 16 bit-processor and a hard disc ensuring the analysis of a great number of material. Besides the printing of bacteriological findings for the senders detailed questions can be analysed to give informations about the distribution and frequency of bacterial species in certain specimens, about the bacterial resistance in dependence on a definite time and about the choice of combinations of chemotherapeutics as well as the existence of multiple resistances. PMID- 2665338 TI - [The effect of thiocyanate on bacterial plasmids using the plasmid screening test]. AB - A plasmid screening test (alkaline lysis and agarose gel electrophoresis) was used to assess the effect of thiocyanate on the plasmid replication on two bacterial strains with plasmids of different size, Klebsiella pneumoniae and Acinetobacter calcoaceticus. At concentrations physiologic for mammals (5-50 mg SCN-/l) no effect on the replication of extrachromosomal DNA was noted. This reaffirms the concept that a physiologic anion may be responsible for biological regulatory processes but will not affect the synthesis of extrachromosomal DNA when applied in vitro in physiologic concentrations. PMID- 2665339 TI - [The public health association and the proletarian naturopathy movement (1891 1933)]. AB - The Public Health Association emerged from the proletarian nature healing movement developing in the late 19th century and united organizations that were interested in the preservation of health of the working people. As against the bourgeois nature healing movement, the Association searched for the reasons of the absolutely unsufficient protection of health of the working class in the capitalist society. The fall of this system and the setting-up of socialism were in the opinion of the Association - the preconditions of social safety and protection of the health of all people. As a self-help organization of the working class, the Association strove for education in the field of health and a healthy life-style and for the application of natural cures. Progressive physicians supported the work of this organization. PMID- 2665340 TI - Causes of infant mortality in the Middle Ages revealed by chemical and palaeopathological analyses of skeletal remains. AB - In most prehistoric and historic populations, mortality of small infants is very high. Causes of death are mainly discussed in analogy to the situation in modern preindustrial societies. The children are at high risk to fall ill or even die especially in times of weaning. Trace element analysis of the skeletal remains of small infants excavated in Schleswig (northern Germany, 11th/12th century AD) led to the estimation of weaning age as well as to the reconstruction of a stepwise substitution of mothers' milk by other food items. Subsequent palaeopathological analysis confirmed high mortality in this age-group. Thus, causes of death of small infants in a medieval town can be outlined. PMID- 2665341 TI - Incremental lines in prehistoric cremated teeth. A technical note. AB - Incremental lines have been examined in cementum of modern human teeth. Their number is related to age. These lines are demonstrated in cremated teeth too and offer an additional feature for age determination in cremations. PMID- 2665342 TI - [Lumbar diskectomy without or with spondylodesis? Revival of an old dilemma]. AB - Indications for spine fusion in combination with removal of a lumbar intervertebral disc are not as well defined or as widely accepted. Extreme opinions have been expressed on both side of this issue, but it seems unreasonable that every segment should be fused after removal of a disc or that none should be. The indication for fusion or for no fusion is often based on the specialist to whom the patient is referred. Orthopedists perform often fusion, neurosurgeons rarely. The problem is not the superiority of combined operation or simple disc excision, but the right indication for one or other procedure. It is clear that for the patient with acute disc displacement with leg-pain as the predominant symptom, simple laminectomy and disc excision will yield good results in most cases. Basically the are two indications for combined operation: the first of this is a strong history of instability troubles prior to the disc prolapse; second indication is the bilateral hemilaminectomy and discectomy, which can lead the spine quite instable. Indication for secondary spinal fusion are: 1) the presence after disc excision of complain of pain in the back with relatively little sciatic radiation, sometimes as intermittent claudication; 2) the overproduction of scar tissue is seen very often in instable segment after disc excision and partial or complete facetectomy. Decompression of the nerve root and fusion may result in a great benefit. Finally we recall the possibility to perform simple fusion in flexion without excision of the disc and without laminectomy in cases with median protrusion of the disc, seen in CT in patients with chronic low back pain and inconstant radicular pain radiation. We describe our own technic of combined operation. PMID- 2665343 TI - [Revision interventions in aseptic and infected loose knee endoprostheses]. AB - From 1984 to 1988 20 revisions for aseptic or septic loosening of knee prosthesis were performed. In 12 case there was an aseptic- and in 8 cases a septic loosening of the prosthesis. Most revision surgery for loosening of knee replacement needs reconstruction of bone stock. In loosening of unconstrained knee prostheses (uni-, totalcondylar knees) it was possible to insert a total condylar knee for revision surgery. Partially gross deviations had to be corrected, but in all cases a good alignment and ligamentous stability were effected. In septic loosening we had good experience with the two stage procedure. We temporarily implanted a gentamycine-PMMA-Spacer to avoid soft tissue contracture and to inhibit fusion of the cancellous bone. Arthodesis after knee replacement is difficult to manage, because the sclerotic bone of the site the prosthesis doesn't easily fuse. PMID- 2665344 TI - [Spinal dysraphia and disordered ascension of the spinal cord in adults]. AB - Spinal dysraphism and tethered cord syndrome which frequently present with clinical symptoms during infancy, childhood and adolescence are rarely encountered in adults. In this retrospective study covering a period of 15 years were report of 12 patients aged from 22 to 71 years with delayed symptoms from the tethered spinal cord. The clinical signs and symptoms which consisted of progressing neurological, urological and orthopedic malfunctions as well as the aspects of current neuroradiological diagnosis including myelography, CT-scan and MRI are presented. The possible pathophysiological mechanism responsible for the delayed onset of the sequelae of the tethered cord are discussed. It is concluded that neurosurgical therapy should be performed in cases of progressing clinical deterioration and the results of surgery in our patient group are presented. PMID- 2665345 TI - [Pathogen spectrum and resistance status of infections following orthopedic operations--an evaluation of 5 years]. AB - This study reports of 191 infections that occurred after 14807 primary clean operations from 1982 to 1986. The spectrum of organism and the resistancy of bacteria has been analysed. 5 groups of organisms (Staphylococcus aureus, Staphylococcus epidermidis, Streptococcen, Enterococcen and Pseudomonas aeruginosa) are responsible for 82% of the infections. 88% of the bacteria in monoinfections were sensitive to Cefazedon. The development of resistancy against this type of Cefalosporin could not be seen. PMID- 2665346 TI - [Factors of neurotrophic control of acetylcholine reception of skeletal muscles]. PMID- 2665347 TI - [The sympathetic nervous system and body temperature regulation in endothermic animals]. PMID- 2665348 TI - [A neuronal ensemble (idea, experiment, theory)]. PMID- 2665349 TI - [A circadian pattern of food consumption in laboratory rats: characteristics and hypothalamic regulation]. PMID- 2665350 TI - Oral cholera vaccines containing B-subunit-killed whole cells and killed whole cells only. II. Field evaluation of cross-protection against other members of the Vibrionaceae family. AB - Because of demonstrable cross-reactivity of cellular antigens contained in B subunit-killed whole-cell (BS-WC) and killed whole-cell-only (WC) oral cholera vaccines with antigens of various non-cholera species of the family Vibrionaceae (NCV), the protection conferred by the vaccines against diarrhoea associated with NCV was evaluated during a randomized, double-blind field trial in Bangladesh. Children aged 2-15 years and women aged greater than 15 years (62,285 in number) received three doses of BS-WC vaccine, WC-only vaccine, or a placebo consisting of Escherichia coli K12 strain (K12). During 1 year of follow-up, the incidence of treated episodes of diarrhoea associated with non-cholera vibrios known to be enteric pathogens (non-01 Vibrio cholerae, V. fluvialis, V. parahaemolyticus, V. mimicus) in the placebo group was low (1.9 cases per 10,000 recipients) and identical to that for the two vaccine groups combined. The incidence (per 10,000 recipients) of treated diarrhoeal episodes associated with Aeromonas species was considerably higher, but nearly identical in the three groups (26.1 cases for BS WC, 26.0 cases for WC; 25.9 cases for K12). Pleisiomonas shigelloides was not isolated from any participant. It is concluded that NCV other than Aeromonas were rarely isolated from diarrhoeal patients in our study population and that killed oral vaccines which were effective against cholera exhibited no detectable cross protection against diarrhoea associated with NCV organisms. PMID- 2665351 TI - Comparative study of the safety and protective value, in pre-exposure use, of rabies vaccine cultivated on human diploid cells (HDCV) and of the new vaccine grown on Vero cells. AB - The object of the study is to compare the tolerance and the efficacy of a new inactivated rabies vaccine grown on Vero cells (PVRV), with the vaccine cultivated on human diploid cells (HDCV), using the schedule recommended by WHO for pre-exposure on days 0, 7 and 21. Of students exposed to a risk of rabies at Alfort Veterinary School, 144 volunteers received either HDCV or PVRV vaccine. No student received a booster between the first blood sample before immunization on day 0 and the last antibody titration 21 months after the beginning of immunization. No serious side-effect occurred with either vaccine, although some vaccinees complained of redness, induration or local pain and, exceptionally, of fever. The study indicates the excellent immunogenicity of both HDCV and PVRV vaccines in all vaccinees. The geometric mean of antibody titres shows a higher titre in the PVRV group and a rapid decline in immune response with both vaccines, four months after the first injection, followed by a stabilization of the antibody level throughout the rest of the study. It should be noted, however, that very few individuals were found to be seronegative 21 months after the first injection. PMID- 2665352 TI - ICRC 'anti-leprosy vaccine'. AB - A vaccine containing ICRC bacilli, which are leprosy-derived cultivable mycobacteria, induces lepromin conversion in LL patients and lepromin-negative persons. 'Up-grading' of lesions and reversal reaction are observed in some vaccinated patients. The bacillus shows antigenic cross-reactivity with Mycobacterium leprae. These observations provided the basis for launching a large scale field trial of the vaccine in India in February 1987. The objective of the two-arm trial is to assess efficacy of the ICRC vaccine against BCG, which forms the control arm, in lowering the incidence of leprosy in healthy household contacts of leprosy patients. Recently, a very high molecular weight fraction, named PP-I, has been isolated from the sonicate of ICRC bacilli. PP-I, which is a glycolipoprotein, is a strong T-cell immunogen and shows antigenic cross reactivity with a similar fraction isolated from M. leprae. A 'subunit' vaccine containing the PP-I of ICRC bacilli is currently undergoing phase I and II clinical trials in India. PMID- 2665353 TI - New cholera vaccines. AB - Development of improved cholera vaccines has progressed rapidly in recent years. An oral killed vaccine, designed to evoke antibacterial as well as antitoxic intestinal immunity, has proved to be completely safe and to protect against cholera for at least 3 years. This vaccine also confers substantial though more short-lasting immunity against diarrhoea caused by enterotoxigenic Escherichia coli. Significant progress has also been made towards developing a live attenuated cholera vaccine using recombinant DNA techniques. The advent of effective oral cholera vaccines gives hope for improved control of cholera in the Third World. PMID- 2665355 TI - Pathogenic yeasts. PMID- 2665354 TI - Anti-fertility vaccines. AB - Vaccines are under development for the control of fertility in males and females. This review discusses developments in anti-fertility vaccines at the National Institute of Immunology, New Delhi, India. A single injection procedure for the sterilization or castration of male animals depending on the site at which the injection is given, has passed through field testing and is expected to be on the market in the near future. Vaccines inducing antibodies against the human chorionic gonadotropin have gone through phase I trials with satisfactory results. A vaccine producing a consistently bioeffective antibody response against gonadotropin-releasing hormone is ready for phase I/II clinical trials in patients of carcinoma of prostate after due experimentation in animals and toxicology studies. Research to identify sperm antigens for incorporation into second generation vaccines is in progress. PMID- 2665356 TI - Isolation and chemical and biological characterization of antigenic mutants of Candida albicans serotype A. AB - Candida albicans serotype A possesses a specific antigen designated antigenic factor 6, that resides in the mannans on the cell surface. To define the molecular structure of antigenic factor 6, as well as to determine the role of cell wall mannan in the ability of C. albicans to adhere to epithelial cells, we isolated antigenic factor 6-deficient mutants by screening with agglutinating monoclonal antibody (MAb) CA4-2 which corresponds to polyclonal antibody (PAb) factor 6. 1H-NMR spectral analyses of the purified mannans from the parent and the mutants showed loss of the signal at 4.77 ppm, corresponding to the beta linkage of the side chain, in the mutants. Although the parent whole mannan as well as its mannohexaose fragment (M6) inhibited the agglutination reaction between C. albicans serotype A cells and MAb CA4-2, the mutant mannan showed lower inhibitory activity and a decreased amount of M6 in its acetolyzed products. These results indicate that the mutant mannan is defective in the side chain of M6 which is bound, via beta-linkage, to a branch of the inner side chains, resulting in the loss of reactivity with MAb CA4-2. Experiments on the adherence of C. albicans showed that the antigenic mutants as well as C. albicans serotype B strains, which lack antigenic factor 6, had significantly (p less than 0.01) less adherence ability than the parent strain. These results suggest that the side chains of M6 specific for C. albicans serotype A mannan are heavily involved in the adherence mechanisms as ligands. PMID- 2665357 TI - Enolase activity associated with a C. albicans cytoplasmic antigen. PMID- 2665358 TI - Alpha-omega alkanedithiol, inhibitors of Candida albicans germ tube autoaggregation. A study model of the adherence of pathogenic agents on host cells. PMID- 2665359 TI - The genome of bakers yeast-the benchmark for a eukaryotic cell. PMID- 2665360 TI - Inhibition of mating process by caffein and its effect on antibiotic marker segregation in yeast Saccharomyces cerevisiae. PMID- 2665361 TI - Quaternary ammonium salt-resistant mutants in yeast Saccharomyces cerevisiae. PMID- 2665362 TI - Isolation and characterization of Saccharomyces cerevisiae mutants resistant to sulphite. AB - Several spontaneous and UV-induced sulphite resistant mutants of Saccharomyces cerevisiae have been isolated and characterized. Some of the UV-induced mutants appeared to be much more resistant than the spontaneous ones, as judged by their plating efficiency and cellular growth in the presence of increasing concentrations of sulphite. All the resistant mutants seemed to have an intracellular glutathione content and glutathione reductase activity higher than and an extracellular glutathione concentration lower than the parental strain. PMID- 2665363 TI - Complementation of auxotrophic requirements in a diploid strain of Saccharomyces cerevisiae by protoplast fusion with protoplasts of Hansenula wingei. PMID- 2665364 TI - Comparative analysis of alternating purine-pyrimidine sites in yeast chromosomes. AB - It is known that under some circumstances DNA sequences made up of purine and pyrimidines in repeated alternation can undergo a transition from the right handed to a left handed helical configuration which has been called Z-DNA. We have analyzed yeast chromosomal DNAs for the presence of alternating purine pyrimidine stretches using a new strategy. Our strategy takes advantage of pulsed field gel electrophoresis (PFGE) to separate yeast chromosomal DNAs. They are subsequently analyzed by molecular hybridization with radioactive (dC-dA)n.(dG dT)n or (dG-dC)n.(dC-dG)n probes, autoradiography and densitometric scanning. Preliminary results obtained by the application of the new method to Saccharomyces cerevisiae are described. PMID- 2665365 TI - Polyamines, macromolecular synthesis and ribosomes in Saccharomyces cerevisiae. PMID- 2665366 TI - Estimation of phylogenetic distances among ascomycetous yeasts from partial sequencing of ribosomal RNA. AB - Extent of taxonomic resolution obtained from nuclear DNA complementarity and ribosomal RNA sequencing is discussed. The phylogenetic relationships of Schizosaccharomyces pombe, Pichia stipitis, Pachysolen tannophilus, and Saccharomyces cerevisiae are compared from partial sequences of 18S and 26S ribosomal RNA. PMID- 2665367 TI - Restriction endonuclease analysis of mitochondrial DNA from Candida parapsilosis and other Candida species. AB - Mitochondrial DNA has been studied in a number of eukaryotic organisms. Differences in inter- and intraspecies mitochondrial DNA restriction patterns have been shown to be due to differences in nucleotide sequences and have been used to study evolutionary relationships and the mode of inheritance of the mitochondrial genome. A relatively rapid and efficient method for the extraction of mitochondrial DNA from Candida parapsilosis and other Candida species was developed. Zymolyase was used to induce yeast protoplasts and mitochondrial DNA was extracted from DNase I-treated mitochondrial preparations. Digestion with the restriction endonucleases Eco RI, Hind III and Bam HI yielded the most definitive restriction patterns. The results of the restriction endonuclease analysis were in agreement with the current identification of these organisms. Candida parapsilosis, Candida albicans and Candida kefyr showed different restriction patterns. Eight Candida parapsilosis strains were compared and all had identical fragment patterns. The molecular size was approximately 30 kilobase pairs and the GC content was 33.2%. The results of these experiments demonstrate the potential of a simple molecular technique for the differentiation of yeast species. PMID- 2665368 TI - A genetic analysis of taxonomic relation between Saccharomyces cerevisiae and Saccharomyces bayanus. PMID- 2665369 TI - Yeast biochemistry: present status and future prospects. PMID- 2665370 TI - Modulation of lipid composition of yeast in stress conditions. PMID- 2665371 TI - Induction of superoxide dismutase by methanol and structural modifications in Candida albicans. PMID- 2665372 TI - Evidence for two mechanisms of flocculation in Saccharomyces cerevisiae. AB - Inhibition of flocculation by sugars was studied in 41 strains of Saccharomyces cerevisiae. Two distinct groupings were found. The first type, including all strains containing FLO 1, FLO 4, FLO 5, FLO 8 and TUP 1, were partially inhibited by mannose only. The second type (NewFLO) were completely inhibited by mannose, maltose, glucose and sucrose. Sugar inhibitions were reversible and were exacerbated by increased agitation. NewFLO strains were more sensitive to inhibition by inorganic salts than the FLO 1 type strains. This inhibition is probably chaotropic in nature. Most FLO 1 type strains are constitutive, expressing flocculation throughout growth, whereas, NewFLO strains are completely repressed by the presence of excess ammonium ions. It is proposed that this indicates two entirely distinct mechanisms of flocculation, probably involving a mannose-specific lectin in the FLO 1 type and a broad specificity lectin in the NewFLO type. PMID- 2665373 TI - Identity of soluble thiamine-binding protein with thiamine repressible acid phosphatase in Saccharomyces cerevisiae. AB - Two secretory glycoproteins of S. cerevisiae, a soluble thiamine-binding protein and a thiamine-repressible acid phosphatase, were shown to be repressed to a similar extent by excess thiamine in the growth medium. Thiamine-repressible acid phosphatase was co-purified throughout the purification of the soluble thiamine binding protein. Purified and deglycosylated soluble thiamine-binding proteins exhibited both thiamine-binding and acid phosphatase activities on non-denaturing polyacrylamide gel electrophoresis. Heat treatment of the purified soluble thiamine-binding protein caused a decrease in both activities with a similar inactivation profile. Two thiamine-repressible acid phosphatase-defective mutants isolated were found to be also defective in soluble thiamine-binding activity. The uptake of [14C]thiamine phosphate esters, such as thiamine monophosphate and thiamine pyrophsphate, was remarkably impaired in the mutant cells, whereas the uptake of [14C]thiamine by the mutant was almost the same with that by the parent strain. From these results, it was concluded that the soluble thiamine-binding protein is identical to the thiamine-repressible acid phosphatase in S. cerevisiae, which is involved in the hydrolysis of exogenous thiamine phosphate esters in the periplasmic space prior to the uptake of their thiamine moiety by yeast cells. PMID- 2665374 TI - Sterol uptake by anaerobically grown Saccharomyces cerevisiae. AB - Wild-type Saccharomyces cerevisiae Y185 grown anaerobically was used to investigate the uptake and subsequent utilisation of sterol in S. cerevisiae. Results confirmed a minimum free sterol concentration below which growth was retarded. The yeast does, however, appear capable of taking up sterol well in excess of that required for growth. Evidence is presented indicating the ability of the yeast cell wall to bind cholesterol both in vivo and with isolated cell walls. There appears to be a role for low density vesicles in the movement of sterol once within the cell. PMID- 2665375 TI - Yeast as source of oncoproteins. AB - The properties of a Saccharomyces cerevisiae 20 kDa polypeptide (Yp20) and its relationship to human ras antigen were tested. Yp20 was isolated from commercial yeast cells by the procedure of Sommer (1978). Proteins associated with yeast chromatin were released by micrococcal nuclease digestion and purified by sucrose gradient centrifugation. Rabbit polyclonal and mouse monoclonal antibodies specifically detecting the Yp20 antigen have been generated. We observed that Yp20 was recognized by anti-ras polyclonal and monoclonal antibodies. Mammalian Ha-ras and Ki-ras proteins were specifically detected by anti-Yp20 antibodies. Based on immunological cross-reactivities, we believe that Yp20 may share some homology with the yeast YP2 gene previously described. Anti-Yp20 antibodies will be used to isolate the gene that encodes the protein. Practical applications of our antibodies for the detection of tumor specific antigens will be discussed. PMID- 2665376 TI - Resistance of Plasmodium falciparum to chemotherapy with 4-aminoquinolines in the Ok Tedi area of Papua New Guinea. AB - In the North Fly region of the Western Province of Papua New Guinea 491 cases of Plasmodium falciparum infection were monitored in vivo for sensitivity to chloroquine and amodiaquine over a 2-year period; 41% resistance was detected. The RI type accounted for 74% of the resistant strains detected; 43% of these recrudesced on day 28 or shortly thereafter. 22% of resistant strains were RII type and 4% R III. The infections were categorized as imported or locally acquired. Imported infections accounted for 58% of the cases monitored and showed a resistance rate of 49%. Resistance was detected in 24% of the cases indigenous to the North Fly region (13% in the Kiunga-Ningerum area and 38% in the Ok Tedi Star Mountains area). Linguistic groups immediate to the Ok Tedi mining operation, the Wopkaimin and Kamfaiwolmin, showed an increase in resistance from 28% in 1986 to 55% the following year. This increase was associated with renewed construction activity within the mine's development area. Two falciparum malaria outbreaks were experienced during this study, the second being attributed to introduced strains. The study showed the impact of age and variation of malaria endemicity in suppressing resistance. The study also demonstrated a possible cross-resistance problem between imported cases of P. falciparum treated with amodiaquine and chloroquine, with resistance rates of 58% and 60%, respectively, demonstrated in children under 10 years of age. The 61% amodiaquine resistance rate in locally acquired infection in children was attributed to drug pressure, since chloroquine resistance in the same group was reported at 19%. RIII-type resistance in children was only detected in those treated with amodiaquine. The efficacy of amodiaquine in clearing only 41% of the P. falciparum infections in children was a major concern. All 201 resistant P. falciparum infections detected over the 24-month monitoring period responded to treatment with quinine and Fansidar. PMID- 2665377 TI - [Microorganisms in our food: yesterday, today and tomorrow]. AB - The development of fermented foodstuffs can be considered as one of the greatest achievements of human civilization and goes back thousands of years. It arose from the necessity to conserve foods, to make them more digestible and also more enjoyable. During the centuries man learned by trial and error to conduct the fermentation processes by changing physical and chemical parameters in the basic food ingredients. It took much longer, however, to discover the cause of fermentation processes: only towards the end of the 19th century it was demonstrated, for example, that baker's yeast is the cause of alcoholic fermentation. Through the development of the technique of "pure microbial culture", developed again with yeast, the basis for a controlled use of microbes in food industry was established. The movement from artisan to industrial scale fermentations made necessary a systematic strain development by the "classical" techniques of "mutation, selection and recombination". The modern techniques of genetic engineering have hardly been applied to food microorganisms so far. These methods, which usually have been developed with laboratory strains, would give us the possibility to change or disrupt genes very specifically and even to introduce new genes into established food microorganisms. Some possible applications with the baker's yeast are discussed in this article. PMID- 2665378 TI - [Energy metabolism in the pregnant woman]. AB - The maternal and foetal anabolic phase characterizing pregnancy requires energy storage and hence a state of positive energy balance. Dietary surveys, however, have shown an increase in energy intake during pregnancy of small magnitude only. Furthermore, indirect calorimetry measurements indicate an elevation of basal or resting energy expenditure (EE), particularly during the 3rd trimester of pregnancy. These results are confirmed by measurements performed in a respiration chamber which showed that the rate of 24 hours EE of pregnant women is significantly more elevated in the 3rd trimester than in the nonpregnant state; the latter is explained by a rise of basal EE and to a smaller extent by an increase in energy cost of moving around as a result of the greater body weight. In contrast, when the results are expressed per unit body weight, the difference in 24 hours EE observed during pregnancy disappeared. It seems that energy sparing mechanisms-which are still largely unknown-may come into play during this period: postprandial thermogenesis appears to be blunted during pregnancy. This indicates an increase in net efficiency of food energy utilization. The degree of adaptation of physical activity-which has not been previously investigated remains a research topic of great interest for the future. PMID- 2665379 TI - [Energy metabolism in the elderly]. AB - The energy metabolism in elderly subjects is discussed on the basis of previous analyses of the influence of age on the three components of energy expenditure in man: basal metabolic rate, thermogenesis and physical activity. All three components are diminished in elderly people. We conclude that the modifications of body composition, in particular the age-related loss of lean body mass, result in decreased basal metabolic rate and probably also a blunted diet-induced thermogenesis. Moreover we emphasize that the decrease in physical activity observed in elderly people is the most likely causal factor. PMID- 2665380 TI - [The significance of selenium supply]. AB - Selenium deficiency leads in animal and man to rare diseases, which are unknown in Switzerland. Epidemiologically there is a negative correlation between selenium intake and the incidence of certain cancers, possibly also with cardiovascular mortality. It is unknown whether the antioxidative protection by the selenium-containing enzyme glutathione-peroxidase is the only and decisive pathogenetic mechanism. The selenium supply in Switzerland is only partially investigated. It seems to be on the lower limit of the RDA, but does not justify increased selenium intake generally or in potential risk groups. PMID- 2665381 TI - [Sonography of the thyroid gland in children]. AB - The total volume of the thyroid gland is 1.2/1.0 ccm in male/female newborns; it increases with age up to 7.4 ccm in boys and 7.5 ccm in girls (13-16 years). The relation of total thyroid volume and body surface area is without a significant sex difference 4.5/4.8 ccm/sqm in newborn and about 4.8 ccm/sqm in children aged more than 9 years. Thyroid disorders to be discussed are a cyst, a nodule with an echo-free centre, connatal athyreosis and goitre. PMID- 2665382 TI - [Traumatic hip dislocation in childhood]. AB - The article reports on eight cases of traumatic dislocation of the hip in children. Six of these were genuine dislocations and two dislocation fractures. The children were between 5 and 13 years of age at the time of injury. Seven of these 8 children could be followed up one to 21 years after the accident. All 7 children were free from complaints at the time of follow-up examination; in one case only we found a moderate loss of function in the injured hip joint. In this patient the x-ray film showed deformation of the head of the femur after partial necrosis of the femoral head, as well as initial signs of coxarthrosis. Prognosis of this rare injury in children is favourable if repositioning is performed in time and if relief of the hip is effected for the proper period of time, depending on the individual case. PMID- 2665383 TI - Pseudopericardial cyst in a neonate--a case report and review of the literature. AB - Report on a pericardial cyst called a pseudopericardial cyst. In a female newborn with cyanosis a mediastinal tumour was noticed on a thorax x-ray, interpreted at first as an enteral duplication. Surgery revealed a pericardial cyst. This was confirmed by histological examination. PMID- 2665384 TI - [Para-pelvic cysts: difficulties in differential diagnosis]. AB - According to their different etiology, parapelvic cysts must be differentiated from simple renal cysts, pararenal pseudocysts, intramural renal pelvis cysts and suprarenal pseudocysts. An important criterium of parapelvic cysts is their epithelial lining. According to their radiological features, these cysts must be described as "parapelvically located cysts" until the definite histological diagnosis is made by the pathologist. The exact differentiation between a parapelvic cyst and a pararenal pseudocyst may be of forensic importance in posttraumatic patients. PMID- 2665385 TI - [Comparative studies of the effect of mictonorm (propiverin hydrochloride) and Spasuret (flavoxate hydrochloride) on the bladder detrusor muscle]. AB - 46 patients suffering from urgency/urge incontinency were treated with Mictonorm and Spasuret in a crossing-over study. In consideration of the placebo effect in this disease both agents were tested versus a non-verum. The application period was 4 weeks and the dosage was 45 mg/d Mictonorm and 300 mg/d Spasuret, respectively. Both with Mictonorm and with Spasuret a significant reduction of micturition frequency and an increase of the compliance could be observed, whereas the placebo was ineffective. A markedly growth of the maximal bladder capacity (16.9%) was obtained only by Mictonorm. Both agents keep likewise to an improvement of the symptoms or urgency/urge incontinency. Side effects could observed in a small size without a breaking-off of the treatment. PMID- 2665386 TI - [Clinical significance of beta 2 microglobulin determination in dialysis patients]. AB - In radioimmunological estimation of beta 2-microglobulin significant higher serum values were found in 36 dialysis patients (44.4 +/- 20.3 mg/l) in comparison with healthy probands (1.5 +/- 0.2 mg/l). A significant relation to the duration of dialysis, rest diuresis and serum level of aluminium was found. Significant higher concentrations were observed in patients suffering from pain in the shoulder-limb-region and with ostealgia in other regions, but not in radiological verified destructive arthropathy and spondylarthropathy. The used dialyzers MLW 1.3/1.8 m2 did not eliminate the beta 2-microglobulin from the blood. PMID- 2665387 TI - [Differentiation of hematuria by phase contrast microscopy studies of urine erythrocytes]. AB - The results of phase-contrast microscopic investigations of urinary erythrocytes in 300 patients (120 patients with bioptical verified glomerulonephritis, 54 patients suffering from interstitial nephritis, 56 patients with urinary tract diseases and 70 healthy probands) are discussed. The portion of glomerular erythrocytes is dependent on diuresis, renal function and activity of glomerulonephritis. This non-invasive procedure is quick and easy practicable and its results are reliable (sensitivity and specifity of more than 90%). The proof of mainly glomerular erythrocytes save from instrumental and invasive diagnostic procedures in nephrological diseases, whereas non-glomerular erythrocytes may have an urological or hematological origin. PMID- 2665388 TI - [Early embryonal signals]. AB - As early pregnancy signals are known up to now: early pregnancy factor (EPF), early pregnancy associated protein (EPAP), early pregnancy associated thrombocytopenia (EPAT), platelet activating factor (PAF) and the so-called amplified pregnancy signals. Clinical relevance in the near future may obtain EPF estimations for diagnosis of early pregnancy after sterility therapy and for monitoring of the first trimester of pregnancy. PMID- 2665389 TI - [Effectiveness of perioperative preventive use of antibiotics with ampicillin/gentamycin or cefotiam in abdominal cesarean section]. AB - To prove the effectiveness of perioperative antibiotics prophylaxis (pabp) in prevention of postoperative infections after caesarean section the efficiency of a Ampicillin/Gentamycin combination was compared with that of Cefotiam (Halospor). The infectious morbidity after both prophylactic antibiotic regimes was compared to that of an untreated sectioned group. The feverish standard morbidity (fsm) of all caesarean sections (between 1. 7. 1986-30. 6. 1988; n = 354) decreased by selective pabp from 25.3% to 16.7%. Compared with untreated patients (no infectional risk; fsm: 22.4%) the infectional morbidity after caesarean section was reduced by Ampicillin/Gentamycin (fsm: 10.0%; p less than 0.05) and also by Halospor (fsm: 13.7; p greater than 0.05). Uterine (14.5%) and urinary tract infections (6.6%) were the most frequent causes of fever during puerperium. After pabp the frequency of this causes decreased evidently. The rate of postoperative antibiotics therapies went down from 26.3% without pabp to 13.3% (p less than 0.05) with Ampicillin/Gentamycin respectively 13.7% (p less than 0.05) with Cefotiam. It is concluded, that the feverish standard morbidity was reduced by a selective papb both with Ampicillin/Gentamycin and Halospor. As a consequence of our results we are performing the pabp with a single dose of 2 g Halospor combined with 0.5 g Metronidazol in all sections generally. PMID- 2665390 TI - [The exact prenatal diagnosis of abnormalities of the kidneys and efferent urinary system--a possibility for further decreasing perinatal morbidity and mortality]. AB - Early detection of fetal malformations has become possible owing to the availability of highly advanced ultrasound systems. Majority of malformations, 30 per cent, has been recordable from urinary system. This system is early of access for the examiner, so that even sophisticated diagnosis of malformation is possible. High accuracy diagnosis has been increasingly helpful in forecasting pregnancy prognosis. Hence, with adequate perinatological management, it will be possible to influence on perinatal morbidity and mortality positively. 70 fetuses with malformations of kidneys and to urinary system have been observed in the context of this study. An assessment was made of diagnostic efficiency, postpartum development and long-range prognosis. Recommendations are derived from the above mentioned findings for perinatological approach in cases of diagnosed malformations of kidneys and the other urinary system. PMID- 2665391 TI - [Vaginal sonography in the diagnosis of premature rupture of fetal membranes]. AB - 68 patients have been examined by vaginal scanning one time in the second and third trimester of pregnancy. Chorion and amnion could be correctly identified in 89.7%. It was possible to recognize rupture of the membranes using a vaginal scan probe in 17 patients. PMID- 2665392 TI - [Evgenii Mikhailovich Kreps (on the 90th anniversary of his birth)]. PMID- 2665393 TI - [Evolutionary aspects of studying glycoconjugates of animal cell membranes]. PMID- 2665394 TI - [Principles of the organization and evolution of biological systems]. PMID- 2665395 TI - [Sensitivity of chemosensory systems of amphibia and reptiles to amino acids]. PMID- 2665396 TI - [Jean Francois Fernel as a scientist and physician of the renaissance and his place in the history of psychiatry]. PMID- 2665397 TI - [200th anniversary of the I. P. Pavlov Municipal Hospital of Clinical Psychiatry of Kiev]. PMID- 2665398 TI - [Oxygen balance of the brain in exogenous neurotoxicoses (review of the literature)]. PMID- 2665399 TI - [Use of fenibut in psychiatry and neurology and its place among other psychotropic drugs (review of the literature)]. PMID- 2665400 TI - [Dynamics of restoration of the motor and sensory functions of the upper extremity after suturing]. AB - In 46 patients 63 nerves of upper extremities were sutured and clinico electroneuromyographic investigations performed. The restitution of motor and sensory functions ran slowly over 7 to 36 months depending on the level injured. Full restoration of motor functions surpassed the restoration of sensory functions in the autonomic zone of the nerve lesioned. Electroneuromyographic investigation showed that clinical healing provides no real indices of the final nerve regeneration as the nervous condition velocity remained altered. This allows recommending nonsurgical treatment for several months after surgery under electroneuromyographic control. PMID- 2665401 TI - [Primary cranioplasty using ground autologous bone]. PMID- 2665403 TI - [The Royal Belgian Society of Surgery. Composition of the society]. PMID- 2665402 TI - [Digital subtraction angiography in the diagnosis of emergency neurosurgical states]. AB - Digital subtraction angiography (DSA) was used in the examination of 203 patients with various forms of acute diseases and injuries of the brain. The method of the examination is described and its advantages and shortcomings in each type of pathology are revealed. DSA meets the requirements placed upon angiographic examination of patients with acute diseases of the brain and craniocerebral injury and may be used successfully in the diagnosis of emergency neurosurgical conditions. PMID- 2665404 TI - [Professor Bozdech has departed...(3 August 1925-29--September 1988)]. PMID- 2665405 TI - Bronchoalveolar lavage in the assessment of pulmonary Hodgkin's disease. AB - Abnormal chest radiographs in patients with Hodgkin's disease are occasionally due to pulmonary Hodgkin's disease. The fluids recovered from bronchoalveolar lavages (BALs) from 50 patients prior to autologous bone marrow transplantation for advanced Hodgkin's disease were examined. Abnormal chest roentgenograms were present in 24 patients (48%); 4 (17%) of these had Reed-Sternberg cells or their mononucleated variants in the lavage fluid and an alveolar lymphocytosis averaging 31.4% (normal: 11.5%). The lymphocytes were small and monotonous. Of the 20 patients with abnormal chest roentgenograms but no Reed-Sternberg cells in the lavage fluid, the lymphocyte count was 10.88%, with only 3 patients exceeding 17%. Two patients with normal chest roentgenograms had Reed-Sternberg-like cells in their lavage fluids and averaged 23% lymphocytes in their lavage differential count. Eosinophils averaged 1% or less of the lavage differential and were not predictive of pulmonary Hodgkin's disease. This experience suggests that pulmonary Hodgkin's disease can be diagnosed by BAL. Reed-Sternberg cells and their mononucleated variants can be recognized by their characteristic cytomorphologic features, although care must be taken not to misinterpret reactive binucleated macrophages as neoplastic cells. In patients with Hodgkin's disease, Reed-Sternberg cells should be sought when an alveolar lymphocytosis is present. PMID- 2665406 TI - Gastric inhibitory polypeptide (GIP) hypersecretion in obesity depends on meal size and is not related to hyperinsulinemia. AB - The response of immunoreactive gastric inhibitory polypeptide (IR-GIP), immunoreactive insulin (IRI) and immunoreactive C-peptide (IR-C-peptide) to the ingestion of mixed liquid test meals containing 1031 kcal (550 ml) and 422 kcal was studied in 17 obese and 17 normal weight control subjects. When the 422 kcal load was ingested in a volume of 550 ml, the plasma IR-GIP response was significantly greater than in a volume of 225 ml at 15 and 30 min in lean and obese subjects, but the total integrated IR-GIP response was not significantly different between the obese and lean group. Also intraduodenal infusion of 150 ml (280 kcal) of the test meal elicited identical plasma IR-GIP concentrations in lean and obese subjects. An exaggerated IR-GIP response in obese subjects was seen only following the 1031 kcal load (integrated IR-GIP response: 23.6 +/- 1.9 in lean subjects vs 50.3 +/- 3.8 nmol/l/180 min in obese subjects; p less than 0.01). The IRI response was always significantly greater in obese than in lean subjects and not related to the GIP response. Fasting plasma IR-C-peptide levels were significantly elevated in obese subjects (lean: 0.52 +/- 0.04; obese: 1.42 +/- 0.12 nmol/l; p less than 0.005), but the postprandial integrated IR-C-peptide responses in the obese and lean group were identical, indicating decreased hepatic insulin extraction in obesity. It is concluded that an exaggerated IR-GIP response in obesity occurs only after ingestion of a high calorie meal probably as consequence of an increased gastric emptying rate and that the hyperinsulinemic response of obese subjects is not attributable to GIP hypersecretion. PMID- 2665407 TI - Controlled study comparing treatment with monocomponent insulin and conventional insulin in patients with lipoatrophy. AB - Twenty-one patients with evident lipoatrophy treated with conventional (Conv.) insulin were either allocated to continuation of treatment with previously used insulin (Conv. group, n = 10) or were transferred to Lente MC (monocomponent) insulin with or without supplementary Actrapid MC insulin (MC group, n = 11). On entry and after 3, 6 and 12 months of follow-up, serum insulin-, pancreatic polypeptide- and proinsulin-binding IgGs were determined by radioimmunoelectrophoresis according to the method of Christiansen. Prior to determination of proinsulin-binding IgG, the insulin-binding IgG was removed by means of sepharose-bound insulin according to the method of Heding. In both groups a slight decrease in the titer of insulin-binding IgG was observed: in the Conv. group from 5.33 +/- 0.92 (SEM) to 4.66 +/- 1.17 mU/ml after 12 months, and in the MC group from 3.22 +/- 0.64 to 2.66 +/- 0.46 mU/ml, respectively. Due to the small number of patients with pancreatic polypeptide antibody titers above the detection limit no statistical evaluation was carried out. The level of serum proinsulin-binding IgG decreased in the MC group only (from 9.3 +/- 2.2 to 1.9 +/ 0.6 ng/ml after 12 months), and even showed a slight increase in the Conv. group (the respective titers were: 14.0 +/- 4.6 and 14.9 +/- 4.6 ng/ml). In the MC group 10 patients (91%) showed improvement and 7 (64%) complete regression of their lipoatrophy corresponding to 6 (60%) and 2 (20%) in the Conv. group. This finding suggests a possible role of proinsulin-binding antibodies in the pathogenesis of insulin lipoatrophy. PMID- 2665409 TI - [Current status of balloon valvuloplasty in adulthood]. AB - The percutaneous transluminal balloon valvuloplasty has been in use for several years as part of interventional cardiology for treating acquired aortic and mitral stenosis. In spite of a high primary success rate the difficulty of this procedure lies not only in the problem of reststenosis but also in a possible development of restenosis. In aortic stenosis the indication for valvuloplasty must be restricted to special patients, such as elderly people or those with poor left ventricular function, whereas in selected patients, mitral valvuloplasty appears as a true alternative to operative commissurotomy. There can be no doubt that by intensive patient selection and progress in the technology of balloon catheters and insertion sheaths, possibly enhanced by laser application, even better results are to be achieved in the near future. PMID- 2665408 TI - The first experimental diabetes mellitus. AB - In the history of diabetes research, surgically induced experimental diabetes is usually associated with the names of Minkowski and von Mering on the basis of their investigations in 1889. However, temporary diabetes mellitus had already been induced 200 years previously by Johann Conrad Brunner (1653-1727) in an experiment in dogs. According to present-day knowledge, this temporary diabetes mellitus must be ascribed to subtotal pancreatectomy and reversible traumatic damage to the remaining endocrine pancreas. The brilliant experimenter Brunner did not associate the symptoms he produced with diabetes. Diabetes research would possibly have taken a different course had he done so. PMID- 2665410 TI - [Ginkgo biloba extract and folic acid in the therapy of changes caused by autonomic neuropathy]. AB - 10 patients suffering from neuropathies caused by various diseases and with an autonomic disregulation of skin were treated intravenously with a new combination of 87.5 mg Ginkgo-biloba-extract standardized to 21.0 mg Flavonglycosids and 3 mg folic acid during 14 days. The autonomic nerve-function was measured immediately before onset and after the end of therapy with the hyperthermal laser-Doppler Flowmetry. Additionally pain, superficial and deep sensibility were described. After the end of treatment the autonomic nerve-function was improved in a significant manner (p less than 0.01). An improvement of the described parameters for pain and for perception could be observed too. Therefore this new combination seems to be suited for treatment of polyneuropathies. PMID- 2665411 TI - [Thyroid gland volumes of healthy adults in an area with endemic goiter]. AB - Thyroid volume was measured by ultrasonography in 500 healthy adults living in an area with endemic goitre: in all subjects the mean value was 13.35 ml, in males (14.94 ml) the volume was significantly greater than in females (12.09 ml). The thyroid volume was significantly correlated with age, body weight and body surface. These data are compared with the results of other investigators. The ultrasonic procedure is the only exact method for thyroid volume calculation, the palpation of thyroid gland only is less accurate. PMID- 2665412 TI - [Hypertriglyceridemia: an independent risk factor for cardiovascular diseases?]. AB - This review deals with the question whether hypertriglyceridemia represents an independent risk factor for the development of cardiovascular disease. The accepted definition of hyper- and "borderline"-hypertriglyceridemia is presented as well as its most frequent causes. After discussion of the hypotheses of the possible ways of mechanisms by which elevated serum triglycerides may be atherogenic the available epidemiologic data are analysed: summarizing these results it can be stated that in contrast to previous statements hypertriglyceridemia seems to be an independent risk factor for the development of cardiovascular disease, even after correction for other risk factors like total cholesterol, smoking, familial history, age or similar well known factors. Even the Framingham study that in earlier studies denied an independent role of the serum triglycerides showed recently that serum triglycerides correlated significantly with coronary heart disease after correction of other risk factors, especially in women. In conclusion, the recommendations of the European and American Consensus Conferences for patients with hypertriglyceridemia are presented: these conferences agree that even borderline hypertriglyceridemia should be investigated for its cause and treated by diet and if this fails by drugs. PMID- 2665413 TI - Articulation and baccalaureate entry into nursing practice in Alberta. (Part one- Study methodology). PMID- 2665414 TI - Immunohistochemical study of the developing endocrine pancreas of the opossum (Didelphis virginiana). AB - Cells immunoreactive for insulin, glucagon, somatostatin, bovine pancreatic polypeptide and 5-hydroxytryptamine are found in the pancreas of the newborn opossum and of all later stages examined. All immunoreactive cell types are present in primary and secondary islets and within elements of the exocrine pancreas. Cells immunoreactive for glucagon, bovine pancreatic polypeptide, somatostatin and 5-hydroxytryptamine generally are confined to the periphery of secondary (intralobular) islets, whereas insulin-immunoreactive cells occupy the central region. Endocrine cells within primary (interlobular) islets are randomly scattered. A small number of pancreatic-polypeptide-immunoreactive cells are reactive for the amine 5-hydroxytryptamine also, but the reverse is not observed. The endocrine pancreas continues to differentiate and develop throughout postnatal life and into adulthood. Little difference was observed between the head and tail regions of the opossum pancreas for the measurements made. PMID- 2665415 TI - Repair of bone defects with marrow cells and porous ceramic. Experiments in rats. AB - We studied the role of bone-marrow reconstituted porous ceramics in enhancing healing of a 5-mm femoral diaphyseal defect fixed with a rigid polyethylene plate in rats. Osseous repair was evaluated by histologic scoring. When blocks of porous calcium phosphate ceramics alone were introduced into the defects, most cases showed fibrous tissue interposition at the host bone-ceramic junction 1 month after implantation, and only four of 12 defects developed osseous or osteochondral union at both the proximal and distal junctions 2 months after surgery. However, when the ceramic was combined with syngeneic viable marrow cells, new bone formation occurred in isolated pore regions of the ceramic at 1 month, and extensive bone formation was seen in most pore regions 2 months after implantation. Out of 12 implants, complete bone union was seen in eight, and one showed osseous or osteochondral union at both junctions 2 months after surgery. Our results indicated that composite grafts of porous calcium phosphate ceramics and marrow cells may be clinically applicable to enhance osteogenesis and osteoconduction. PMID- 2665416 TI - Molecular biology of growth hormone. PMID- 2665417 TI - Cell multiplication and differentiation. PMID- 2665418 TI - Fetal growth: an endocrine perspective. PMID- 2665419 TI - Syndromes associated with growth deficiency. PMID- 2665420 TI - Standardization of growth. PMID- 2665421 TI - Adolescent chemical use and dependence: current issues in epidemiology, treatment and prevention. AB - This review provides a pragmatic and clinical orientation to current issues in adolescent chemical dependence in addition to exploring legitimate and relevant unanswered questions about chemical dependence. The lack of research on adolescent chemical dependence is addressed in light of the updated epidemiology. Patterns of use, abuse and dependence among adolescents are reviewed. The article examines treatment issues as well as prevention strategies among children and adolescents. Future clinically oriented research directions are suggested to promote further investigation into these areas. PMID- 2665422 TI - Four hours a month. PMID- 2665423 TI - Papanicolaou smear adequacy: the cervical cytobrush and Ayre spatula compared with the extended-tip spatula. AB - Papanicolaou smears have false-negative rates of 6 percent to 56 percent that are due, in large part, to inadequate sampling of endocervical cells. A randomized, prospective trial was conducted comparing the adequacy of Papanicolaou smears obtained with the cytobrush and Ayre spatula with smears obtained with the extended-tip spatula, as measured by the presence of endocervical cells. One hundred of 111 Papanicolaou smears obtained with a cytobrush and Ayre spatula contained endocervical cells (90.1 percent), compared with 68 of 105 smears obtained with the extended-tip spatula (64.8 percent) (chi 2 = 18.6, P less than 0.0001). There were no other significant differences between the two study groups for age, gravidity, parity, and hormone usage. The combination of the cytobrush and Ayre spatula appears to be superior to other methods that are currently used to obtain Papanicolaou smears. PMID- 2665424 TI - Exercise stress testing in blood pressure evaluation. AB - The purpose of this study was: (1) to confirm exercise stress testing as a standard in the diagnosis of hypertension, (2) to clarify which measurements during exercise testing are most reliable, and (3) to refine the definition of normal blood pressure response during ergometric exercise testing. Blood pressure response during maximal ergometric exercise testing was observed in 183 persons with no history of hypertension, 176 persons with borderline blood pressure readings, and 60 established hypertensives. Men and women had significantly different blood pressure response to exercise (P less than 0.05). Comparison of blood pressures at 100-watts workload, at peak exercise, and 5-minutes postexercise provided significant information for distinguishing between normal, borderline, and established hypertensive persons (P less than 0.025-0.001). Comparing the slopes of pulse rate versus blood pressure linear regression curves was not helpful. Regression equations generated for predicting correct blood pressure classification improved classification accuracy (compared with random classification) by 44.9 percent in men and by 66.8 percent in women. The results showed that ergometric stress testing in blood pressure evaluation is a safe and reliable procedure for aiding in a more accurate diagnosis of hypertension. PMID- 2665425 TI - A primer for users of medical bibliographic databases. AB - A database is electronic information. Perhaps one of the most important information sources in medicine is that which is accessed electronically through a database named MEDLINE, the core medical literature published since 1966. MEDLINE is sold by three major vendors (BRS, Dialog, and the National Library of Medicine) to information experts and to medical experts. Information experts (librarians) and medical experts (physicians) can access MEDLINE by two different methods. This article discusses both and emphasizes use by the medical practitioner. An annotated guide to database vendors is provided, and guidelines are offered that will assist the physician in selecting equipment and assessing services. PMID- 2665427 TI - Social development in infancy: a 25-year perspective. PMID- 2665428 TI - Children's learning revisited: the contemporary scope of the modified Spence discrimination theory. PMID- 2665426 TI - Achilles tendinitis in running athletes. AB - Achilles tendinitis is an injury that commonly affects athletes in the running and jumping sports. It results from repetitive eccentric load-induced microtrauma that stresses the peritendinous structures causing inflammation. Achilles tendinitis may be classified histologically as peritendinitis, tendinosis, or partial tendon rupture. Training errors are frequently responsible for the onset of Achilles tendinitis. These include excessive running mileage and training intensity, hill running, running on hard or uneven surfaces, and wearing poorly designed running shoes. Biomechanical abnormalities that predispose to Achilles tendinitis include gastrocnemius-soleus muscle weakness or inflexibility and hindfoot malalignment with foot hyperpronation. The initial treatment should be conservative with relative rest, gastrocnemius-soleus rehabilitation, cryotherapy, heel lifts, nonsteroidal anti-inflammatory drugs, and correction of biomechanical abnormalities. Surgery is recommended only for persons with chronic symptoms who wish to continue running and have not benefited from conservative therapy. PMID- 2665429 TI - Discrimination learning set in children. PMID- 2665430 TI - A developmental analysis of rule-following. AB - The development of rule-governed behavior begins when a class of verbal forms called instructions, in conjunction with other variables, systematically occasion functional consequences for compliance (or noncompliance). These instructional forms then function as specific stimulus controls for compliance, with the other variables potentially taking on conjoint or conditional stimulus control of that compliance. Experience with numerous instructions occasioning functional consequences for compliance can establish generalized compliance to an indefinitely large stimulus class of instructions, a stimulus class that readily and naturally includes those forms that describe relationships between events and response to them that we also call rules. The important conjoint variables may well be the instruction giver (rule stater), any of their other systematic characteristics that have occasioned functional consequences for compliance in the past, and the topography of the response requested. Generalization of compliance across people, settings, and topography can occur; this generalization can extend to self-instruction, and can fail to extend to certain topographies ("Thou shalt not kill"), certain rule staters (nonpeers who say "Don't use drugs" when peers say it is fun), and certain settings ("Don't play with John in class"). Finally, children's experiences with describing behavior can lead to new self-instructions that fit the already established discriminative-stimulus class of rules and instructions for compliance, so that the novel self-instruction produces compliance. Compliance-oriented research has demonstrated how instruction givers can establish instructions as a discriminative-stimulus class for compliance, and how generalized compliance to new instructions and new instruction givers can be accomplished. Correspondence-training research has demonstrated that self-instructions can become discriminative for later performance of the described behaviors. Self-instruction research suggests that these forms of instructions also can control subsequent behavior, and that instructions and rules may be produced covertly as well as overtly. What has yet to be demonstrated is an ability to produce a novel self-instruction that controls subsequent behavior. The argument has been that the development of a behavior class, compliance to instructions, could provide a reasonable explanation for the acquisition of rule-governed behavior. Experiences within the natural environment, as well as research on compliance, correspondence, and self instruction, suggest that a behavior class, compliance to instructions, could provide a reasonable model of the acquisition and ge PMID- 2665431 TI - Childhood events recalled by children and adults. PMID- 2665432 TI - On the uses of the concept of normality in developmental biology and psychology. PMID- 2665433 TI - Cognitive psychology: mentalistic or behavioristic? AB - We have examined the question, is modern cognitive psychology a return to classical structural or functional psychology or does it conform to the methodological behaviorism first advocated by John B. Watson? We began with a brief description of the methods and goals of classical psychology, noting that observations of the mental phenomena were made by highly trained observers who were themselves scientists (or at least, scientists-in-training). These scientists were searching for cross-sectional laws that connected mental elements with complex mental phenomena. Among the primitive terms of these psychologists were some that referred to simple mental events. Classical psychologists failed to reach their goals for empirical reasons; their failure was not due to methodological (logical) inadequacies. We examined methodological behaviorism and found it to have two main principles. The first is that the primitive terms of psychology should refer to the simple properties of, and simple relations among, physical objects and events--the same primitives used in the physical sciences. The second is that psychologists should look for process laws that permit the prediction of future behavior given knowledge of the physiological, environmental, and other behavioral variables. Next, we analyzed the activities of cognitive psychologists. We found that they do not treat their subjects as if they were trained observers. Rather, they consistently employ "catch trials" and other checks on the quality of the subjects' observations. We noted that cognitive psychologists could, but usually do not, provide behaviorally and environmentally based "operational definitions" for many of the mentalistic sounding terms that they introduce into the psychological language. Many of their terms, however, are introduced through the time-honored use of models. That is, they construct models that are only partially interpreted to the empirical world. Some of the concepts in the model remain uninterpreted, and of these, some appear to refer to the mental phenomena that classical psychologists attempted to study and describe. This latter feature is probably what most misleadingly suggests that modern cognitive psychology is a return to classical structural or functional psychology. Finally, we found that cognitive psychology is not, as many believe, a revolution against methodological behaviorism. It is rather a rebellion against the conditioning-based theories that constrained psychologists to the study of the simpler behavioral phenomena. PMID- 2665434 TI - Some current issues in children's selective attention. AB - A large part of the history of learning theory of the last 25 years consists of devising ways to deal with stimulus selectivity. Earlier theories that assumed contiguity of stimulus and response to be a sufficient condition for formation of an association were found wanting. This paper has described some of the ways theorists have attacked the problem. These theoretical solutions were of two general types--two-stage theories with stimulus selection preceding association and theories that altered associative processing. Both types of theories successfully handled selective phenomena, and there is no clear basis at present for preferring one or the other. A question generally neglected by early attention theorists concerns the nature of a stimulus. How is the stimulus complex available to a subject divided into cues or elements that can be selectively responded to? Related questions are whether the experimenter's perception of stimulus elements correspond to the subject's view, and whether elements are perceived the same by all subjects. The answer to the last two questions appears to be in the negative. Recent research relative to these questions with children, adults, and nonhuman organisms is reviewed. PMID- 2665435 TI - National and international strategies to control drug abuse. AB - Since drug problems continue to produce health problems in our society, it is important to understand world-wide issues favoring the continued existence of drug abuse. National decisions to attack the problem at the production end outside the U.S. have been viewed as being more efficient, more effective, less disruptive and less expensive than approaches to reduce consumption within our own boundaries. This review aims at clarifying the issues involved in national versus international strategies against drugs. PMID- 2665436 TI - Substance abuse and international travel. AB - Travel for both business and pleasure can be a risk factor for substance abuse problems, for clinical deterioration in those with chemical dependence, and for relapse when an addiction has been in remission. Sedatives, opioids and alcohol can complicate many of the physiologic adjustments mandated by modern jet travel, such as adaptation to different altitudes, climates, and time zones. Additionally, substances of abuse can result in a deterioration of many clinical conditions during travel, and they can precipitate other medical problems while underway, including motion sickness, heat-related illness and diarrheal disease. Drugs and alcohol are crucial factors in both serious accidents and legal difficulties while traveling. Finally, involvement with drugs as well as close and intimate liaison with drug abusers and their consorts has associated with it a high degree of risk for exposure to serious infectious diseases worldwide. PMID- 2665437 TI - Cellular interactions in the humoral immune response. PMID- 2665438 TI - MHC-antigen interaction: what does the T cell receptor see? PMID- 2665439 TI - Synthetic T and B cell recognition sites: implications for vaccine development. PMID- 2665440 TI - Rationale for the development of an engineered sporozoite malaria vaccine. PMID- 2665441 TI - Virus-induced immunosuppression: infections with measles virus and human immunodeficiency virus. PMID- 2665442 TI - The regulators of complement activation (RCA) gene cluster. PMID- 2665443 TI - Origin and significance of autoreactive T cells. PMID- 2665444 TI - Our unique society. PMID- 2665445 TI - [Anaphylatoxin in the aqueous humor of rabbit with endotoxin induced endophthalmitis]. AB - Anaphylatoxin-activated complement fragment is an important mediator of inflammation. In this study, trends of anaphylatoxin in clinical and experimental endophthalmitis was evaluated. The level of anaphylatoxin (C3a, C4a and C5a) and protein of human aqueous humor aspirated from patients with senile cataracts before surgery was measured. As a model of acute endophthalmitis, endotoxin Lipopolysaccharide from E. coli (LPS) was used intravitreously in albino rabbits. The level of anaphylatoxin of aqueous humor was measured by radioimmunoassay. The level of C3a was 44.0 +/- 13.4 ng/ml in aqueous humor of cataract patients. An increase of cell count and protein was demonstrated in the aqueous humor of rabbits 24 hrs after endotoxin injection. The level of C3a increased remarkably with time. It was suggested that C3a in aqueous humor of the rabbit eye with endotoxin-induced endophthalmitis plays an important role in chemotaxis and in mediating the inflammatory process. PMID- 2665446 TI - [Penetrating keratoplasty and cataract surgery]. AB - Of 46 eyes undergoing simultaneous penetrating keratoplasty and cataract extraction, 25 grafts (54%) remained clear with an average follow-up of 37 months. This low success rate can be party explained by the fact that more than 50% of our patients had unfavourable ocular conditions preoperatively. In case of simultaneous procedures, methods of cataract extraction (ICCE or ECCE) did not have any significant affect on the rate of clear grafts. In eyes with favourable ocular conditions preoperatively, the rates of clear grafts were similar (approximately 75%) in cases of simultaneous operation (21 eyes) and separate operation (8 eyes). PMID- 2665447 TI - Walter B. Cannon lecture. Shock-wave lithotripsy of gallstones. PMID- 2665448 TI - Edward B. Neuhauser lecture. Current concepts of brain injury in the premature infant. PMID- 2665449 TI - Gallstone recurrence after cholecystolithotomy. AB - Surgical cholecystostomy is performed often at our institution for emergent management of acute calculous cholecystitis in high-risk elderly patients. Gallstones are removed either during surgery or by subsequent radiologic manipulation. Most such patients do not undergo subsequent cholecystectomy. The frequency of gallbladder stone and/or biliary symptom recurrence was studied in 63 patients who had undergone successful cholecystolithotomy. Follow-up examinations in 48 of these patients, performed at a mean of 18 +/- 12 months after surgery, showed recurrence of gallstones in 13 patients (27%). This included 12 of 38 patients who had follow-up sonograms and one of two cadavers that underwent autopsy. None of eight patients who had a subsequent cholecystectomy had recurrent stones. Two of 17 patients studied within 1 year of cholecystolithotomy had recurrent calculi, as did six of 21 patients studied at 1 2 years, four of five patients studied at 2-3 years, and one of five patients studied at 3-4 years. Biliary symptoms were assessed in 46 of the 48 patients who had follow-up examinations (two patients died) and in the 15 other patients who had undergone successful cholecystolithotomy. Recurrent or residual symptoms were present in seven (11%) of 61 patients, including three of the 13 patients with recurrent calculi. Six of these seven patients underwent further hospital treatment. These results confirm the anticipated high frequency of stone recurrence after cholecystolithotomy. However, because most patients with recurrent stones were asymptomatic, routine interval cholecystectomy may not be necessary. PMID- 2665450 TI - The detection of adrenal tumors and hyperplasia in patients with primary aldosteronism: comparison of scintigraphy, CT, and MR imaging. AB - We retrospectively reviewed the imaging studies in 17 proved cases of primary aldosteronism to determine the value of the procedures used to detect adrenal tumors or adrenal hyperplasia. The procedures included CT with 3-, 5-, and/or 10 mm-thick sections (17 patients), 131I-6 beta-iodomethyl-19-norcholesterol (NP-59) scintigraphy (16 patients), and MR imaging (six patients). Proof of the adrenal abnormality was established in cases of tumor (seven adenomas, one carcinoma) by surgery and in cases of adrenal hyperplasia by surgery (three cases); venous sampling (three cases); or combined clinical, biochemical, and imaging data (three cases). Both CT and scintigraphy detected six of the seven adenomas and the adrenal carcinoma (88%). Regarding hyperplasia, CT was correct in five of six and scintigraphy was correct in two of four cases proved by surgery or venous sampling. CT and NP-59 were concordant and suggested the diagnosis of hyperplasia in the remaining three cases without surgical or venous sampling proof. MR detected both cases of adenoma in which it was performed and showed evidence of hyperplasia in one of the four cases of hyperplasia in which it was performed. Although the number of patients in this series is too small to have much statistical power, these results suggest that CT and NP-59 scintigraphy are equivalent in the detection of adrenal abnormalities in patients with primary aldosteronism. The value of MR in the detection of small adrenal contour abnormalities was limited by slice thickness capabilities. PMID- 2665451 TI - Fluoroscopically guided retrograde brush biopsy in the diagnosis of transitional cell carcinoma of the upper urinary tract: results in 45 patients. AB - This is a retrospective review of 45 patients suspected of having transitional cell carcinoma of the upper urinary tract who underwent fluoroscopically guided retrograde brush biopsy at our institution during a recent 3-year period. All patients evaluated had an abnormal IV urogram or retrograde pyelogram in which the diagnosis of transitional cell carcinoma of the kidney or ureter was suspected or could not be excluded. The results of the brush biopsy were compared with the final diagnosis established at surgery or through clinical and surgical follow-up. Results of the biopsies were classified into five categories: (I) normal transitional epithelium (16 patients), (II) atypical cells (eight patients), (III) dysplastic cells (two patients), (IV) suspicious for malignancy (four patients), and (V) conclusive evidence of malignancy (eight patients). In four additional patients, other miscellaneous diagnoses were made, and in three others the procedure was nondiagnostic. Brush biopsies interpreted as Categories III, IV, and V had a positive predictive value of 100% (14/14) for the diagnosis of transitional cell carcinoma, and biopsies showing atypical cells (Category II) had a positive predictive value of 75% (6/8). Tabulating all diagnostic categories except for normal as a positive diagnosis, the procedure had a sensitivity of 91%, a specificity of 88%, and an accuracy of 89%. No significant complications were encountered. This experience suggests that brush biopsy is a valuable technique in patients suspected of having transitional cell carcinoma. PMID- 2665452 TI - The hypoechoic band: a normal finding on testicular sonography. AB - High-resolution sonograms were obtained in 119 patients in whom intrascrotal disease was suspected on the basis of history and physical findings. In 20 of these patients, a total of 22 conspicuous hypoechoic intratesticular bands (18 unilateral and four bilateral) were seen in the middle third of the testicle on scans obtained axially or slightly oblique to conventional axial scans. The bands were up to 3 mm wide and 3 cm long. The bands were on the side with suspected disease in six patients. Of these, three patients had a small epididymal cyst, one had a mild hydrocele, and two had no other sonographic finding. The remaining 16 bands were on the side opposite that with clinically suspected disease and were seen in otherwise normal testes. Follow-up examination in 11 of the 20 patients with the band showed no change. In four of eight patients examined with pulsed Doppler sonography, a normal low-resistance waveform was seen that was characteristic of intratesticular arteries (with gradual descent after peak systole and relatively high diastolic flow). In three of these patients, color Doppler imaging corroborated the presence of arterial flow, which did not fill the entire width of the band, thus suggesting an additional venous component of lower velocity in the band. Identification of flow in only half the cases may have been caused by the limitations in sensitivity of the equipment. We conclude that the hypoechoic bands noted on gray-scale testicular sonography are caused by a normal variant of intratesticular vessels, artery and vein, and that they are of no clinical significance. PMID- 2665453 TI - The clinical and radiologic manifestations of hemangiopericytoma. AB - The clinical and radiologic findings in nine patients with hemangiopericytoma were reviewed. There were eight women and one man with a mean age of 46 years. Seven of the neoplasms, including two locally recurrent tumors, were in the pelvis and two were in the thigh. Conventional radiographs were available for all patients. Five patients were evaluated by sonography, four by CT, three by angiography, and two by MR imaging. There was evidence of compression of adjacent viscera by six of the seven pelvic tumors with associated hydronephrosis in one patient. One thigh lesion had focal areas of speckled calcification. All five neoplasms evaluated by sonography showed a well-circumscribed hypoechoic lesion and three had significant sound through-transmission. Hypervascularity was documented by contrast-enhanced CT or angiography in each of three patients in whom these procedures were performed. Surgical resection of the pelvic neoplasms was complicated by marked hemorrhage. Hemangiopericytoma should be considered in the differential diagnosis of well-circumscribed hypervascular tumors in a middle aged patient. PMID- 2665454 TI - Cerebrovascular accidents in neonates treated with extracorporeal membrane oxygenation: sonographic-pathologic correlation. AB - Neonates treated with extracorporeal membrane oxygenation are at high risk for the development of intracranial hemorrhage and infarction. The appearance of these lesions on cranial sonography is often unusual and may be confusing. We compared the findings at autopsy with premorbid cranial sonograms in 17 nonsurviving neonates to define better the anatomic basis for the sonographic appearance of these lesions. Macroscopic abnormalities were identified at autopsy in 13 of the 17 neonates. Five neonates had multifocal hemorrhagic white-matter infarcts, three had large parenchymal hemorrhages with adjacent areas of parenchymal necrosis, three had hemorrhagic infarcts of the cerebellum, one had a germinal matrix and intraventricular hemorrhage, and one had bilateral periventricular cysts with surrounding gliosis. All 17 neonates had abnormalities on microscopic examination. Although sonography was accurate in the detection of macroscopic lesions (11 of 13 lesions detected with sonography), the nature and extent of these abnormalities were difficult to judge because of the variable echogenicity of unclotted blood and the presence of focal areas of abnormal echogenicity associated with microscopic calcification and gliosis. Sonography is excellent for the detection of acute cerebrovascular complications during extracorporeal membrane oxygenation, but the appearance of these lesions is variable and nonspecific. PMID- 2665455 TI - Acute appendicitis in children: sonographic findings. PMID- 2665457 TI - Detection of psoas abscess by gallium-67 scintigraphy, sonography, and CT. PMID- 2665456 TI - Spontaneous resolution of a cystic neck mass in a fetus with normal karyotype. PMID- 2665458 TI - Cyst of the kidney or spontaneous splenorenal shunt? Differentiation by pulsed Doppler sonography. PMID- 2665459 TI - Doppler and M-mode sonography of mobile carotid plaque. PMID- 2665460 TI - Circulating autoantibodies in patients with pigeon breeder's disease. AB - Sera from 19 patients with hypersensitivity pneumonitis induced by avian antigens were studied in order to determine the presence of circulating autoantibodies. IgM and IgG rheumatoid factors were positive in 68% and 100% of the cases respectively. IgM-rheumatoid factor was detected with at least two methods, showing titers between 1:20 and 1:1280 by the latex agglutination test and between 140 and 579 IU/ml by nephelometry test. The IgG rheumatoid factor was studied by the indirect immunofluorescence technique, showing positive determinations in all of our hypersensitivity pneumonitis patients. Titers of these autoantibodies ranged from 1:80 to 1:640. In addition, we studied the presence of antinuclear, anti-nDNA, anti-mitochondrial, and anti-smooth muscle antibodies by the immunofluorescence test using HEp-2 cells, mouse kidney, and Crithidia luciliae targets. Sera from all of our hypersensitivity pneumonitis patients have negative results of autoantibodies to these antigens. Negative results of autoantibodies to the nRNP, Sm, SS-A(Ro) and SS-B(La) nuclear antigens by counterimmuno-electrophoresis and double immunodiffusion techniques were also obtained. As controls we studied 14 healthy individuals and 8 subjects exposed to avian antigens but without hypersensitivity pneumonitis symptoms and no positive determinations for rheumatoid factor, antinuclear antibodies, as well as to anti mitochondrial and anti-smooth muscle antibodies, were found. These findings support that different immune abnormalities are present in patients with hypersensitivity pneumonitis induced by avian antigens. One of these immune alterations or a combination of them may promote or facilitate the acute interstitial lung injury and/or perpetuate a chronic inflammatory process. PMID- 2665461 TI - Survival patterns in clinical and angiographic subsets of medically treated patients with combined proximal left anterior descending and proximal left circumflex coronary artery disease (CASS). AB - Baseline, clinical, and angiographic features of 1014 Coronary Artery Surgery Study (CASS) registry patients with combined proximal left anterior descending and proximal left circumflex coronary disease were examined to define determinants of prognosis in this clinical high-risk patient subset. A stepwise Cox regression analysis identified congestive heart failure score, left ventricular contraction score, mitral regurgitation, age, and digitalis usage as independent variables predictive of 8-year survival. When patients were stratified by left ventricular contraction score, the 8-year survival rate was 62%, 49%, and 19%, respectively, for patients with a left ventricular score of 5 to 9, 10 to 14, and greater than or equal to 15 (p less than 0.0001). The presence of a stenosis greater than or equal to 70% in the right coronary artery was associated with worse survival (47% versus 54% at 8 years; p = 0.051). In conclusion, the diagnosis of combined proximal left anterior descending and left circumflex coronary artery disease represents a large prognostic spectrum that needs to be considered when counselling individual patients. PMID- 2665462 TI - Hemodynamic abnormalities following cardiac transplantation: relationship to hypertension and survival. AB - The prevalence and long-term implications of hemodynamic abnormalities seen at 1 year following orthotopic heart transplantation and their relationship to post transplant hypertension were prospectively evaluated in 82 consecutive asymptomatic recipients taking cyclosporine and prednisone who underwent annual catheterization. Abnormal left ventricular end-diastolic pressure (LVEDP), ejection fraction (EF), and left ventricular end-diastolic pressure-volume ratio (R) were the most prevalent hemodynamic abnormalities (27%, 14%, and 23%, respectively, at 1 year). Patients with abnormal LVEDP or R had higher (p less than 0.05) mean systemic arterial pressure (MAP). During follow-up, hemodynamic abnormalities disappeared in some patients while they developed in some others. Transplant patients with abnormal LVEDP, EF, or R at 1 year who normalized at 2 years had a significant (p less than 0.05) decrease in MAP. Likewise, patients with normal LVEDP, EF, or R at 1 year who subsequently developed abnormalities had a significant (p less than 0.05) increase in MAP. The presence of hemodynamic abnormalities at 1 year was not associated with a poorer survival (mean follow-up 2.6 +/- 1.1 years). In summary, hemodynamic abnormalities in asymptomatic transplant recipients taking cyclosporine and prednisone appear to be related to the level of post-transplant hypertension and do not signify an adverse prognosis over the first 3 years. PMID- 2665463 TI - Electromechanical dissociation: diagnosis, pathophysiology, and management. PMID- 2665464 TI - Influence of drug therapy on the ischemic response to acute coronary occlusion in man: supply-side economics. PMID- 2665465 TI - What's right/wrong with the drug benefit of the Medicare Catastrophic Coverage Act? PMID- 2665466 TI - Ciprofloxacin: a fluoroquinolone antimicrobial. Part 1. PMID- 2665467 TI - Patient selection for thrombolytic therapy. AB - Recent studies have shown that the use of thrombolytic therapy in patients with acute myocardial infarction can reduce mortality 20 to 52%. However, patient selection issues remain to be resolved. These issues include the time window for therapy, treatment based on the site of infarction, treatment based on electrocardiographic criteria and treatment of the elderly population. PMID- 2665468 TI - New concepts in the pathophysiology of acute myocardial infarction. AB - Recent findings concerning the pathophysiology of acute myocardial infarction are reviewed and related to the potential for myocardial salvage. The myocardial infarction process can be divided into 2 phases, an early evolving phase (the first 6 hours) and a later convalescent phase. An evolving infarction is associated with an occluded coronary artery; in most cases, a thrombotic occlusion occurs. The human coronary artery normally has an intact endothelium, which has protective vasodilatory and antiplatelet-aggregating effects that are lost when the endothelium is damaged. The endothelium is exquisitely sensitive to trauma and can be damaged by high shear stress produced by narrowing of the coronary arteries that is not associated with reduced coronary blood flow. In addition, during this acute endothelial damage, monocellular infiltration of the coronary arteries has the potential to release factors that may cause platelet aggregation, enhance blood coagulation, attract other white blood cells or exert other effects on the coronary tree. Myocardial damage occurring in the early evolving stage is usually responsive to treatment that either restores myocardial oxygen supply or reduces myocardial oxygen demand. However, coronary events occurring after the first 6 hours usually are not responsive to such treatment. Certain clinical variables may shorten or extend the time period within which damaged myocardium can be saved. The findings suggest important approaches for intervention to modify the acute phase. PMID- 2665469 TI - Antithrombotic therapy in acute myocardial infarction: prevention of venous, left ventricular and coronary artery thromboembolism. AB - The antithrombotic approach to patients with acute myocardial infarction in the prevention of venous, left ventricular and coronary artery thromboembolic events should be based on an understanding of pathogenesis and risk. Coronary thrombotic events involve conditions of high shear rate present in areas of vessel stenosis or disrupted atherosclerotic plaque, which lead to activation of both platelets and the coagulation system, and are best prevented by platelet inhibitors alone or in combination with an anticoagulant. However, thromboembolism that originates in the venous system or cardiac chambers is related to situations of blood stasis and low shear rate, which predominantly result in clotting activation and fibrin thrombus formation and are best approached with anticoagulant therapy. For prevention of venous thrombosis and pulmonary embolism, early mobilization is essential and should be supplemented by low-dose heparin in patients at high risk, including the elderly and those with large infarcts, heart failure or previous thromboembolic events. For prevention of left ventricular mural thrombosis and systemic embolism, high-dose heparinization is indicated in patients with large infarcts, particularly in the anterior location and in those with heart failure. Subsequently, warfarin therapy should be considered for patients at high embolic risk, including those with echocardiographic evidence of mobile and protruding thrombi, severe left ventricular dysfunction or prior emboli. In patients with acute infarction, aspirin is recommended for preventing coronary reocclusion and reinfarction. Although anticoagulants may also be of benefit for this purpose, their use is still controversial.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 2665470 TI - Regional alveolar damage (RAD). A localized counterpart of diffuse alveolar damage. AB - Diffuse alveolar damage (DAD) is usually considered a generalized lung process. During five years the authors observed 83 patients with generalized DAD in 827 adult autopsies (10.1%) and 10 patients with identical, but localized, lesions. The authors propose the term regional alveolar damage (RAD) to designate localized "DAD." RAD was unilateral in six patients and most frequently involved the upper lobe. All ten patients had chronic systemic diseases and presented with life-threatening illnesses. The probable causes of RAD were multifactorial and included hypotensive shock, septicemia, pneumonia, hyperoxia, and pancreatitis. All patients developed respiratory failure, requiring supplemental oxygen and, in nine patients, mechanical ventilation. Chest roentgenograms revealed alveolar or combined alveolar and interstitial infiltrates that corresponded to the lesions found at autopsy. The reasons for localization of RAD within the lung are unclear, but the presence of proliferative lesions and frequent involvement of the upper lobe suggests that RAD is not simply an early phase of DAD and implicates additional pathogenetic factors. PMID- 2665471 TI - Polymorphous low-grade adenocarcinoma of seromucous glands of the nasopharynx. A report of a case and a discussion of the morphologic and immunohistochemical features. AB - Polymorphous low-grade adenocarcinoma (PLGA) is a minor salivary gland neoplasm that is characterized by morphologic variability, cytologic uniformity, and an infiltrating growth pattern. To date, this entity has been identified either within the confines of the oral cavity or, rarely, in the nasal cavity. The authors report a case of PLGA that arose in the nasopharynx of a 44-year-old female, representing the first documented occurrence of this tumor outside the oral cavity or the sinonasal tract. The histopathologic and immunohistochemical differentiation from pleomorphic adenoma and adenoid cystic carcinoma is discussed. PMID- 2665472 TI - Disseminated Trichosporon beigelii infection after orthotopic liver transplantation. AB - A 25-year-old male, who received an orthotopic liver transplant for fulminant hepatic failure resulting from hepatitis B, had disseminated Trichosporon beigelii infection develop. Of the 55 cases of disseminated T. beigelii that have been reported in the English-language medical literature, most have occurred in patients who were both neutropenic and had compromised cell-mediated immunity. Mortality has ranged from 60 to 78%. Outcome appears to depend significantly on leukocyte recovery. Histologically, Trichosporon can be confused with Candida; however, recognition of the arthroconidia and pleomorphic hyphae and pseudohyphae of Trichosporon should allow their differentiation. PMID- 2665473 TI - Bond strength and durability of glass ionomer cements used as bonding agents in the placement of orthodontic brackets. AB - One potential risk of orthodontic treatment is the development of surface decalcification in association with use of brackets and bands. A bonding agent that could render tooth structure more resistant to the caries process clearly would reduce the negative iatrogenic outcomes of orthodontic therapy and thereby benefit the patient. Glass ionomer cement (GIC) bonds chemically to both enamel and dentin. In addition its high fluoride content makes enamel more resistant to caries. The purpose of this study was to evaluate the bond strength and durability of GIC when used as a bonding agent in the placement of orthodontic brackets. The materials tested were three GICs (Ketac-Fil, Ketac-Cem, and Chelon) and a standard bonding agent currently in widespread use (Rely-A-Bond). Brackets were attached to the facial surface of 96 premolar specimens and half the specimens for each bonding agent were thermocycled. Bond shear strength was determined with an Instron testing device by applying a load to the occlusal margin of each bracket to the point of failure. A two-way ANOVA indicated a significant bonding agent by thermocycling interaction (F = 4.78, p less than 0.01). Thermocycling decreased bond strength significantly for all materials, but had the greatest impact on Rely-A-Bond. However, Rely-A-Bond provided the strongest bond with and without thermocycling. Although bond strength for the standard orthodontic bonding agent deteriorates significantly under thermal stress, these results suggest that it is still greater than the bond strength provided by GIC materials. PMID- 2665474 TI - Distortion of edgewise orthodontic brackets associated with different methods of debonding. AB - The effects of three different methods of bracket removal on the dimensions of the arch wire slot of edgewise brackets were examined. Gross distortion (visible to the naked eye) and microscopic distortion were found for all three methods. Gross bracket distortion was found infrequently with one method. At a microscopic level, all methods produced approximately equal levels of distortion, principally an increase in vertical slot dimensions. The implications of these findings for recycling brackets are discussed. PMID- 2665475 TI - Pros and cons of the reuse of direct-bonded appliances. PMID- 2665476 TI - Monthly injectable steroid contraceptives and cervical carcinoma. AB - The World Health Organization Collaborative Study of Neoplasia and Steroid Contraceptives is a large multinational hospital-based case-control study of steroid contraceptives and gynecologic, hepatobiliary, and mammary neoplasms. Monthly injectable steroid contraceptives which contained the long-acting progestogen dihydroxyprogesterone acetofenide plus a shorter-acting estrogen (usually estradiol enanthate) were used by women in two of the countries (Chile and Mexico) from which data were collected. In preliminary analyses of data from Chile (1979-1983), a strong association was observed between use of these products and invasive cervical cancer. Therefore, three additional data sets from these two countries were analyzed in further detail for this report. Analyses of additional data from Chile on invasive cervical cancer (1983-1985) and cervical carcinoma in situ (1979-1986) and of data on invasive cervical cancer from Mexico (1979-1986) failed to confirm the initially observed association. The original finding was probably due to chance, but a causal interpretation cannot be confidently ruled out, and additional studies are warranted. PMID- 2665477 TI - On the measurement of tobacco use by adolescents. Validity of self-reports of smokeless tobacco use and validity of cotinine as an indicator of cigarette smoking. AB - This study assessed the validity of self-reports of smokeless tobacco use by adolescents and the validity of cotinine as a measure of adolescent cigarette smoking. For a sample of 1,854 persons aged 12-14 years living in the southeastern United States in 1985, a combination of three biochemical measures (salivary cotinine, salivary thiocyanate, and alveolar carbon monoxide) and self reports of cigarette smoking were used to identify subjects who used only smokeless tobacco and subjects who did not use smokeless tobacco. The sensitivity and specificity of self-reports of smokeless tobacco use were 40.8% and 97.9%, respectively. It was determined that of the 175 subjects who ordinarily would be considered smokers because they had salivary cotinine levels greater than or equal to 10 ng/ml, 43.4% used only smokeless tobacco. PMID- 2665478 TI - The feasibility of matching and quota sampling in epidemiologic studies. AB - Matching is often used to eliminate the effects of potential confounders. The practical execution of a matched design will usually involve additional sampling effort to find appropriate quotas of persons who satisfy the matching criteria. If this effort is substantial, it may render the matched design less attractive than using unmatched samples with covariance adjustment in the analysis. This paper presents numerical results on the sampling effort needed to complete various matched designs: The effort is measured by the number of candidates (N) that must be sampled to identify the matches for analysis. Feasibility of matched sampling is described by the ratio of the expected value of N to its theoretical minimum, and by its coefficient of variation. Feasibility must be weighed against the resulting quality of matches and the possibility of residual confounding. The results show that designs with smaller matching quotas in larger numbers of categories are more difficult to execute. However, the relative variation in N is mainly a function of the category quotas and is only weakly dependent on the number of categories. Recommendations are made regarding the number of categories and the quota sizes that lead to acceptable matched designs. The results are applicable to both observational and experimental studies in which matching or other quota sampling is used. PMID- 2665479 TI - Spinal origin of human lead neuropathy: this paper marks the 150th anniversary of Paralysie de Plomb ou Saturnine by L. Tanquerel des Planches. AB - One hundred fifty years ago a young but distinguished French scientist, L. Tanquerel des Planches, published a most comprehensive work dealing with almost every known clinical, epidemiological, and occupational aspect of lead poisoning, Traite des Maladies de Plomb ou Saturnines exposing in its second volume, Paralysie de Plomb ou Saturnine his invaluable experience on lead palsy. Among his ideas, based on a rather unique accumulation of human cases of lead palsy, the theory of the neurotoxic action of lead on the spinal cord is of outstanding importance. This site and the mode of action of lead have long been unsettled, although both the nineteenth century classics in neurology and the classics in industrial medicine of the first half of the twentieth century have contributed to solving the pathophysiology of lead palsy. The contributions from these reports, which concur with Tanquerel's assumptions, are presented and discussed. It must be emphasized, however, that only with the advent of electrophysiology has it become possible definitely to recognize the spinal cord involvement as the cause of lead neuropathy. The hypothesis of the axonal degeneration of the "dying back" variant, starting in the biochemical lesion of perikaria of the anterior horn cells in the spinal cord, is in full agreement with both the electromyographic signs of denervation and the electroneurographic normal range of conduction velocity. This presumptive conclusion confirming the spinal origin of human lead neuropathy is very much in line with the concepts of Tanquerel des Planches. PMID- 2665481 TI - Cigarette smoking and pneumoconiosis: structuring the debate. PMID- 2665480 TI - Occupational cancer mortality in Illinois white and black males, 1979-1984, for seven cancer sites. AB - A death certificate mortality odds ratio study of seven cancer sites was conducted by using 1979-1984 data on Illinois deaths in white and black males. Cancer sites selected include stomach, pancreas, lung, prostate, bladder, brain, and non-Hodgkin's lymphomas. This surveillance study was undertaken to detect occupational associations that might suggest further avenues of research. Some of the occupations and industries found to have elevated cancer risks and that are consistent with previous studies include: brickmasons and stonemasons (stomach); metal workers (pancreas, lung); photoengravers and lithographers (pancreas); butchers (lung); locomotive operators and truck drivers (lung); farmers (prostate, brain, non-Hodgkin's lymphoma); mechanics and repairers, especially auto mechanics (prostate); physicians (brain); glass products manufacturing workers (brain); and communications industry (brain) and chemical plant workers (non-Hodgkin's lymphomas). It was also noted that for black males, the death certificate occupational data are of limited usefulness due to the high percentage of missing or inexact information. The Division of Vital Records in the State of Illinois should make an effort to improve the reporting of this data through additional training of the funeral directors and hospital clerks who collect this information and by follow-up of incomplete or missing data. PMID- 2665482 TI - Integrating human resources and program-planning strategies. AB - The integration of human resources management (HRM) strategies with long-term program-planning strategies in hospital pharmacy departments is described. HRM is a behaviorally based, comprehensive strategy for the effective management and use of people that seeks to achieve coordination and integration with overall planning strategies and other managerial functions. It encompasses forecasting of staffing requirements; determining work-related factors that are strong "motivators" and thus contribute to employee productivity and job satisfaction; conducting a departmental personnel and skills inventory; employee career planning and development, including training and education programs; strategies for promotion and succession, including routes of advancement that provide alternatives to the managerial route; and recruitment and selection of new personnel to meet changing departmental needs. Increased competitiveness among hospitals and a shortage of pharmacists make it imperative that hospital pharmacy managers create strategies to attract, develop, and retain the right individuals to enable the department--and the hospital as a whole--to grow and change in response to the changing health-care environment in the United States. Pharmacy managers would be greatly aided in this mission by the establishment of a well defined, national strategic plan for pharmacy programs and services that includes an analysis of what education and training are necessary for their successful accomplishment. Creation of links between overall program objectives and people planning strategies will aid hospital pharmacy departments in maximizing the long term effectiveness of their practice. PMID- 2665483 TI - Infection with the human immunodeficiency virus: epidemiology, pathogenesis, transmission, diagnosis, and manifestations. AB - The epidemiology, pathogenesis, transmission, and manifestations of infection with the human immunodeficiency virus (HIV) are described, along with the development of diagnostic tests and drugs to combat it. Acquired immunodeficiency syndrome (AIDS) is caused by HIV infection. The syndrome was first reported in 1981, and as of March 31, 1989, nearly 90,000 cases had been reported in the United States alone. Most U.S. adults with AIDS are homosexual or bisexual men; intravenous drug abusers, heterosexuals, hemophiliacs, and blood transfusion recipients account for 17%, 4%, 1%, and 2% of AIDS cases, respectively. HIV is transmitted by sexual, blood, and perinatal routes; infection leads to a profound immunosuppression involving both the cellular and humoral immune systems. The hallmark of AIDS is a quantitative deficiency of T4 lymphocytes bearing CD4+ receptors, to which the virus binds. Monocytes are believed to be the major route of infection into the CNS. There has been rapid progress in the development of sensitive and specific diagnostic tests for HIV infection. The enzyme-linked immunosorbent assay and Western blot test are the most widely used; both are used to detect antibodies to the virus. Two major classes of drugs are under development for use against HIV: antiviral agents and immunomodulatory agents. Thus far only one drug, zidovudine (AZT), has decreased mortality and improved quality of life. Infection with HIV encompasses a broad spectrum of clinical manifestations, from seroconversion to AIDS-related complex to full-blown AIDS. AIDS is a clinical diagnosis based on the presence of recurring opportunistic infections, previously rare cancers, and neurologic manifestations. Because of the many people infected and the long incubation periods, AIDS will continue to be a major issue in health care. Continued education of health-care personnel and the public is needed. PMID- 2665484 TI - Nonspecific cytotoxicity of recombinant interleukin-2 activated lymphocytes. AB - The administration of interleukin-2 (IL-2) and lymphokine activated killer (LAK) cells to patients with advanced metastatic cancer has yielded encouraging results. The purported ability of LAK cells to be discriminatively tumoricidal, thus sparing normal host tissue, represents a major advance over conventional chemotherapy. However, IL-2 adoptive immunotherapy results in dose-limiting toxicity characterized by weight gain, dyspnea, ascites, and peripheral-pulmonary edema suggestive of a vascular leak syndrome. It is unclear whether the observed toxicity is directly related to IL-2 and/or LAK cells. The authors examined the cytolytic nature of human LAK cells against human endothelial, epithelial, and fibroblast cell lines. Bovine endothelial cells also were studied. Using a 51Cr release assay, the cytolytic potential, time course, and effect of reactive oxygen intermediate inhibitors were studied. LAK cells were uniformly toxic against all cell lines, in contrast to high dose rIL-2 and excipient. Significant cytolysis was observed within 30 minutes and increased over the first 2 hours of LAK cells coming in contact with target cells. Reactive oxygen intermediate inhibitors did not reduce cytolytic activity. The authors thus found human LAK cells to be rapidly cytolytic against a variety of human and bovine cell lines. This cytolysis was independent of reactive oxygen intermediates. PMID- 2665485 TI - Re-expansion, re-oxygenation, and rethinking. AB - In a 1902 American Journal of the Medical Sciences case report, Riesman described "albuminous expectoration" following thoracentesis, a phenomenon that is now recognized as re-expansion pulmonary edema (RPE). Both cellular and biochemical mechanisms that produce lung injury in RPE have been described recently. Pathophysiologically, this unilateral edematous lung injury resembles the adult respiratory distress syndrome (ARDS) because both are characterized by intra alveolar-activated neutrophils and markedly increased lung capillary permeability. Biochemical mechanisms that operate in RPE are analogous to those in diverse re-oxygenation (reperfusion) injuries that have been described recently in the heart, kidney, brain, and intestine. Re-oxygenated lung tissue appears to produce excess superoxide and other cytotoxic oxygen metabolites, although lung xanthine oxidase, the commonly recognized source of these oxidants, is exceedingly low. Riesman's critical analyses of the re-expansion edema fluid in his case provided an impetus for others to hypothesize that increased permeability pulmonary edema in RPE represented re-oxygenation injury of the lung microvasculature. PMID- 2665486 TI - The role of parathyroid ultrasonography in the management of primary hyperparathyroidism. AB - High-resolution, real-time sonography can be used to assess the size and location of the parathyroid glands. The authors review the types of information provided by sonography and outline the ways in which it contributes to the management of primary hyperparathyroidism. Sonography usually can differentiate parathyroid adenoma from hyperplasia. In milder cases, with less parathyroid enlargement, this differentiation is difficult but can be facilitated by determining three dimensions for each gland. Preoperative knowledge of the presumptive location of an adenoma is most useful when the strategy of unilateral neck exploration is to be used because it will allow the exploration always to begin on the correct side. Sonographic evidence of hyperplasia should trigger a preoperative search for multiple endocrine neoplasia and will alert the surgeon that a bilateral neck exploration and thymectomy will be needed. A more universal benefit is the ability to predict or exclude intrathyroidal and subcapsular parathyroid tumors, thus guiding the decision for thyroid versus thymic exploration in the event of a missing abnormal gland. Sonography often fails to visualize parathyroid tumors in an ectopic position away from the thyroid bed. Such tumors, however, may be anticipated when the sonogram shows only three enlarged glands in cases of hyperplasia, or only three glands of normal size in a patient with strong biochemical evidence of hyperparathyroidism. Because it is noninvasive and inexpensive and can provide a wealth of information, the authors have adopted sonography as a routine preoperative procedure for primary hyperparathyroidism. PMID- 2665487 TI - Glipizide: an oral hypoglycemic drug. PMID- 2665488 TI - Two infants with del(3)(p25pter) and a review of previously reported cases. AB - Del(3)(p25pter) is associated with a characteristic multiple congenital anomalies/mental retardation syndrome. Early recognition of these manifestations and identification of the chromosome defect are essential for proper management and counseling. PMID- 2665489 TI - Optic atrophy, hearing loss, and peripheral neuropathy. AB - Here we report on two families with a previously apparently undescribed, autosomal dominant disorder resulting in optic atrophy and subsequent development of hearing loss and peripheral neuropathy. This disorder differs from previous syndromes resulting in this triad of effects both in the severity and early onset of the optic atrophy and in its mode of transmission. Review of published cases of optic atrophy + hearing loss + peripheral neuropathy suggests that there are at least three such specific disorders; classification of these published cases by first-appearing symptom also results in a clean division by most-likely inheritance. PMID- 2665490 TI - Saline solution amnioinfusion for oligohydramnios after premature rupture of the membranes. A preliminary report. AB - In the conservative management of premature rupture of the membranes, most patients have oligohydramnios caused by continuous leakage of amniotic fluid. To avoid unfavorable effects of oligohydramnios on fetal development and well-being, we infused physiologic saline solution continuously into the amniotic cavity at a flow rate of 10 to 20 ml/hr with a new cervical indwelling catheter (PROM-fence). As a result the average pocket size of amniotic cavity was 2.7 cm before amnioinfusion, 5.9 cm 1 day after, 5.8 cm 5 days after, and 5.0 cm 10 days after amnioinfusion. The saline solution amnioinfusion made it possible to keep the amniotic cavity fluid level adequate. Variable deceleration disappeared in one case. No side effects such as uterine contractions were observed. We recommend the method of saline solution amnioinfusion for its favorable effects on fetal environment during management of premature rupture of membranes. PMID- 2665491 TI - Prematurity among insulin-requiring diabetic gravid women. AB - From Jan. 1, 1983, through Dec. 31, 1987, 420 gravidas with insulin-requiring diabetes antedating pregnancy delivered on the Joslin Clinic service. Among them, 110 pregnancies (26.2% of the total) delivered before 37 completed weeks of gestation compared with a 9.7% incidence (906/9368) for the general population at the Brigham and Women's Hospital during calendar year 1985. Thirty-three percent of all premature deliveries were the result of the development of preeclampsia. The relative risk of prematurity for diabetic patients with any hypertensive complication was 2.0 (95% confidence interval, 1.40 to 2.87) compared with normotensive diabetic subjects. Compared with the general population, most of the excess risk of prematurity was confined to hypertensive diabetics and normotensive patients of more advanced White class. A history of having had a previous premature delivery, increasing duration of diabetes antedating pregnancy, and carrying a male fetus in the index pregnancy were significantly associated with premature delivery. Future efforts to reduce the incidence of prematurity among diabetic gravidas should be directed toward reducing the incidence of preeclampsia. PMID- 2665492 TI - Magnesium supplementation during pregnancy: a double-blind randomized controlled clinical trial. AB - Four hundred young normotensive primigravid women between 13 and 24 weeks' gestation were randomly allocated to one of two study groups. One group received placebo tablets and the other group received 365 mg of elemental magnesium daily (as magnesium aspartate hydrochloride). Three hundred seventy-four patients completed the study, 189 in the placebo group and 185 in the treatment group. There were no significant differences between the two groups regarding serum calcium, uric acid, or electrolyte levels. However, the magnesium-supplemented group had significantly higher magnesium levels at delivery (1.68 +/- 0.03 mg/dl vs. 1.56 +/- 0.03 mg/dl, p less than 0.01). There were no significant differences in either systolic or diastolic blood pressures between both groups either at time of enrollment or at subsequent gestational ages later during pregnancy. Analysis of variance for repeated measurements and Fisher's least significant difference testing indicated a significant increase (p less than 0.01) in blood pressure from the level at the time of enrollment to the level achieved at or beyond 37 weeks' gestation in each group. There were no significant differences between the two groups regarding any of the following parameters: incidences of preeclampsia, fetal growth retardation, preterm labor, birth weight, gestational age at delivery, or number of infants admitted to the special care unit. Magnesium supplementation during pregnancy did not improve pregnancy outcome in our population. PMID- 2665493 TI - Removing a retained placenta by oxytocin--a controlled study. AB - No increase in maternal plasma oxytocin concentration was detected after administration of 100 IU oxytocin into the umbilical veins of seven women immediately after delivery. The delivery of the placenta was accelerated after umbilical vein injection of 100 IU oxytocin in a placebo-controlled study of 40 women: 12 minutes (4 to 40) in the oxytocin group versus 40 minutes (29 to 40) in the placebo group (median and interquartile ranges), p less than 0.05. PMID- 2665494 TI - The use of transvaginal ultrasonography in the diagnosis of ectopic pregnancy. AB - Despite advances in diagnosis made by the introduction of serum beta-subunit of human chorionic gonadotropin determinations and transabdominal ultrasonography, ectopic gestations still present a major diagnostic challenge. The increased resolution of the transvaginally introduced high-frequency ultrasound transducer probes seems to solve this diagnostic problem. In this study 145 patients were referred for ultrasonographic workup because of a suspected ectopic gestation. In 38 patients a diagnosis could be made with classical transabdominal scanning. One hundred seventeen patients required additional transvaginal scanning with a 5.0 and a 6.5 MHz probe. In 98 patients a diagnosis was made during the first transvaginal scan; nine patients were rescanned within 3 days for the final diagnosis. In 56 patients, ectopic pregnancy was successfully ruled out by transvaginal scanning. Thirty-nine ectopic pregnancies were diagnosed. Only one false-positive identification was made. The sensitivity of diagnosing ectopic pregnancy by high-frequency transvaginal sonography was 100%; the specificity was 98.2%. The positive predictive value of this method was 98%, and the negative predictive value was 100%. The rate of the beating fetal heart was seen in the tube (23%). The high number of unruptured tubal pregnancies in this series (66%) suggests the possibility of an early diagnosis that may have therapeutic implications. The use of higher-frequency transvaginal transducer probes improves the diagnosis of the ectopic gestation. PMID- 2665496 TI - Fetal radius length: a critical evaluation of race as a factor in gestational age assessment. AB - Growth of the fetal radius was examined ultrasonographically in a prospective cross-sectional study of 290 white and 63 black patients between 12 and 43 weeks' gestation. The mean of radius length and 95% predictive intervals were calculated for each week. The most efficient description of the data was given by a simple log-linear model. The slopes for the white and black study groups estimated were distinctly different. Consequently, a single equation was estimated that considers race when assessing gestational age from radius length. PMID- 2665495 TI - Renal artery flow-velocity waveforms in normal and hypoxemic fetuses. AB - Color flow mapping was used to identify the fetal renal artery and to obtain flow velocity waveforms. A reference range of the fetal renal artery pulsatility index with gestation was constructed from a cross-sectional study of 114 appropriate for gestational age fetuses of 17 to 43 weeks' gestation. The pulsatility index decreased linearly with gestation, indicating a fall in impedance to flow, and presumably an increase in renal perfusion. The renal artery pulsatility index was also determined in 18 small-for-gestational-age fetuses and was higher than the appropriate-for-gestational-age group. The small-for-gestational-age fetuses also had fetal blood sampling performed by cordocentesis. A significant, direct correlation was found between blood oxygen deficit and increased renal artery pulsatility index. PMID- 2665497 TI - The importance of ultrasonography in infertile women with "forgotten" intrauterine contraceptive devices. AB - Seven cases in which an unknown intrauterine contraceptive device in situ was the cause of infertility were referred to our infertility Clinic after each patient had been told by her physician that she no longer had an intrauterine contraceptive device. In some cases, there were lapses in the infertility workup that might explain how the cause of infertility of an intrauterine contraceptive device in situ was missed. In other cases, a thorough investigation was made and infertility treatment was started without the existence of an intrauterine contraceptive device in situ being diagnosed. PMID- 2665498 TI - Fetal liver length in normal and isoimmunized pregnancies. AB - The length of the right lobe of the fetal liver was measured by means of ultrasound examined on 53 occasions in 21 isoimmunized pregnancies. Fetal blood samples were taken in all patients within 24 hours. Comparisons were made with 350 measurements of liver length in normal pregnancies. A good correlation was found between liver length and fetal hemoglobin level (r = 0.794, p less than 0.001) and between liver length and reticulocyte count (r = 0.721, p less than 0.001). At the time of first sample, all fetuses with a hemoglobin of less than 100 gm/L had a liver length that was greater than the ninetieth percentile. Liver length measurement seems to be a useful indicator of the degree of fetal anemia in isoimmunized pregnancies. PMID- 2665499 TI - Asymptomatic thrombocytopenia associated with chorioangioma of placenta. AB - Chorioangioma is a common primary tumor of the placenta. Most tumors are small and are only detected by careful sectioning of the placenta. Large tumors can be diagnosed antenatally by ultrasonography and may result in maternal and fetal complications. PMID- 2665500 TI - Enlarged cisterna magna in trisomy 18: prenatal ultrasonographic diagnosis. AB - Ultrasonographic visualization of an enlarged cisterna magna was the initial clue that led to the prenatal diagnosis of trisomy 18 in five patients. Prenatal diagnosis of trisomy 18, a lethal defect, is important for proper patient counseling and management. PMID- 2665501 TI - Results of silicone oil removal in advanced proliferative vitreoretinopathy. AB - We reviewed the results of silicone oil removal after vitreous surgery for recurrent retinal detachment with proliferative vitreoretinopathy in 55 eyes. The minimum follow-up period was six months. Retinal detachment recurred in five eyes (9%). Evidence of recurrent epiretinal membrane formation at the time of or after silicone oil removal was noted in 21 eyes (38%). Penetrating keratoplasty combined with silicone oil removal was successful in five of six patients. Mild corneal changes noted in ten eyes (18%) remained the same or cleared in seven eyes after silicone oil removal. Overall, postoperative visual acuity improved in 24 eyes (44%), remained the same in 18 eyes (33%), and decreased in 13 (24%). In 22 eyes without clinical evidence of silicone-associated complications at the time of silicone oil removal, postoperative visual acuity remained unchanged or improved in 20 (91%). PMID- 2665503 TI - Penetrating keratoplasty and intraocular lens exchange for pseudophakic bullous keratopathy associated with a closed-loop anterior chamber intraocular lens. AB - We reviewed the records of 20 consecutive eyes with pseudophakic bullous keratopathy associated with a closed-loop anterior chamber lens that underwent penetrating keratoplasty, total anterior vitrectomy, and anterior chamber intraocular lens exchange. On reexamination, all corneal grafts had remained clear during an average follow-up period of 15 months (range, four to 45 months). Seven eyes (35%) attained a visual acuity of 20/40 or better with spectacle correction; however, 15 of 20 eyes (75%) attained a best-corrected visual acuity of 20/40 or better using a pinhole and a gas-permeable contact lens. In five eyes visual acuity was 20/400 or poorer because of cystoid macular edema, as documented by fluorescein angiography, age-related macular degeneration, or optic atrophy. Localized, minimal peripheral anterior synechiae were present on gonioscopy in seven eyes. The one-piece flexible anterior chamber lens implants used for exchange appeared to be well tolerated in this series of patients. PMID- 2665502 TI - Corneal compression sutures for the reduction of astigmatism after penetrating keratoplasty. AB - We placed interrupted 9-0 nylon sutures across the graft-host interface of ten eyes with more than 5 diopters of keratometric cylinder after penetrating keratoplasty in order to steepen the flattest corneal meridian and reduce the amount of corneal cylinder. Placement of compression sutures reduced corneal cylinder by an average of almost 6 diopters one week later. Average corneal cylinder was 5.1 diopters nine to 12 months after surgery. Best-corrected visual acuity with spectacles improved by an average of two Snellen lines (20/60 to 20/40) and uncorrected visual acuity improved by an average of one line (20/300 to 20/200). There were no complications related to placement of the sutures. This procedure provides a rapid and simple method for reducing astigmatism after penetrating keratoplasty. PMID- 2665504 TI - 125th anniversary of the New York Ophthalmological Society. PMID- 2665505 TI - Bird T. Baldwin: a holistic scientist in occupational therapy's history. AB - Holistic patient care and the scientific research method are two important aspects of occupational therapy. Bird T. Baldwin contributed to the formulation of these tenets at the beginning of this century. Baldwin, a psychologist by training, became the director of the occupational therapy department at Walter Reed General Hospital in Washington, DC, during World War I. In his department, functional rehabilitation was achieved via scientifically analyzed purposeful activities. He believed that purposeful activity was superior to exercise. Activity choice was based on physical, vocational, social, and emotional considerations. True to his scientific approach, Baldwin designed and adapted devices to provide standardized treatment protocols. Because Bird T. Baldwin's approach to rehabilitation remains of value today, a review of his work is relevant to the occupational therapy community. PMID- 2665506 TI - Therapies for tinnitus. PMID- 2665507 TI - Immunology of hearing: experiments of nature. AB - Cellular and humoral immune reactions may play a role in the ethiopathogenesis of an audiovestibular dysfunction. Immune-mediated inner ear disorders can be of cochlear and retrocochlear origin. Autoimmunity plays occasionally a role, but is certainly not obligatory. PMID- 2665508 TI - Autoimmune hearing loss. AB - Tissue nonspecific antibodies may give an idea about the etiopathogenesis of the inner ear disease. They are of some prognostic and therapeutic value. They are routinely tested in most inner ear patients. On the other hand, inner ear specific autoantibodies do exist. Their diagnostic, prognostic and therapeutic significance are still unclear. Cellular immunity is tested only in selected cases based upon the clinical picture and the results of humoral immunity testing. It needs whole fresh blood as well as facilities not available in all laboratories. Their main role seems to be in providing solid basis for cortisone therapy justification. Our therapeutic concept proved to be promising in some cases. Immune-mediated inner ear disorders do not form a separate clinical entity. We would rather add immune mediation to the different causes postulated for the various inner ear disorders, as a plausible explanation for a certain percentage of the group categorized as idiopathic of unknown etiology. PMID- 2665509 TI - Autoimmunity of the inner ear. PMID- 2665510 TI - Medical malpractice tort reform: balancing the interests of providers, patients and public. PMID- 2665511 TI - Cholesteatoma in 3-D. AB - 1. In Shambaugh's primary acquired cholesteatoma, the surgical approach of choice is the direct endaural transcanal modified radical mastoidectomy and tympanoplasty in continuity. 2. In Shambaugh's classification of the secondary acquired cholesteatoma developing in a previously pneumatic mastoid with the infection of short duration, the postauricular transcortical mastoidectomy and facial recess approach and tympanoplasty in continuity is worthy of consideration if there is a reasonable possibility that the eustachian tube function may return to normal. 3. In Shambaugh's classification of a secondary acquired cholesteatoma in a large mastoid with the infection of long duration, there is probably cicatricial stenosis of the eustachian tube with a postauricular transcortical mastoidectomy and facial recess approach. It is probably a futile procedure because of the high incidence of recurrent attic retraction cholesteatoma requiring a secondary modified radical mastoidectomy. 4. Recurrent attic retraction cholesteatoma is subject to external reinfection and may cause a subperiosteal abscess or other complications many years after the primary surgery. 5. Residual cholesteatoma is the "bug bear" of any closed technique. This self-contained cyst is slow growing and may not become apparent for many years. Since it is not subject to reinfection, it is an insidious, destructive, silent lesion which may ultimately present itself as a postauricular pitting mass, erosion of the canal wall, facial paralysis, or a fistula in the labyrinth. 6. In invasive cholesteatoma and in long-standing secondary acquired cholesteatoma, the attempted preservation of the canal wall is a futile process and the surgeon is able to perform more accurate surgery with the direct primary transcanal approach to the mastoid.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 2665512 TI - Idiopathic sudden sensorineural hearing loss. AB - Idiopathic sudden sensorineural hearing loss remains one of the major unsolved otologic emergencies. In this paper the most important recent clinical literature is reviewed, a new method of clinical staging is presented, and unexplored potential treatments are presented. The method of clinical staging presented here is based on four elements represented by the acronym HEAR. The individual elements of the staging are hearing threshold (H), elapsed time from onset (E), audiogram shape (A), and related vestibular symptoms (R). Insufficiently explored potential treatments of sudden hearing loss include antiviral drugs, rheologic agents, and free radical scavengers. PMID- 2665513 TI - Incidence and patterning of dental enamel hypoplasia among the Neandertals. AB - Dental enamel hypoplasia (DEH), as an indicator of nonspecific stress during development, provides an assessment of the relative morbidity of past human populations. An investigation of 669 Neandertal dental crowns yielded an overall DEH frequency of 36.0% by tooth (41.9% for permanent teeth; 3.9% for deciduous teeth) and about 75% by individual. These incidences place the Neandertals at the top of recent human ranges of variation in DEH frequencies, indicating high levels of stress during development. The paucity of deciduous tooth DEH and M1 DEH, combined with generally increasing levels of DEH through later calcifying teeth, suggests that the stress was primarily nutritional, beginning at weaning and continuing through adolescence. This supports paleontological and archeological interpretations implying significantly lower effectiveness for Neandertal foraging compared to that of modern humans. PMID- 2665514 TI - Glucagon is a primary controller of hepatic glycogenolysis and gluconeogenesis during muscular work. AB - The effects of the exercise-induced rise in glucagon were studied during 2.5 h of treadmill exercise in 18-h fasted dogs. Five dogs were studied during paired experiments in which pancreatic hormones were clamped at basal levels during a control period (using somatostatin and intraportal hormone replacement), then altered during exercise to stimulate the normal exercise-induced fall in insulin, while glucagon was 1) increased to mimic its normal exercise-induced rise (SG) and 2) maintained at a basal level (BG). Six additional dogs were studied as described with saline infusion alone (C). Gluconeogenesis (GNG) and glucose production (Ra) were measured using tracers [( 3-3H]glucose and [U-14C]alanine) and arteriovenous differences. Glucose fell slightly during exercise in C and was infused in SG and BG so as to mimic the response in C. Glucagon rose from 60 +/- 3 and 74 +/- 5 pg/ml to 118 +/- 14 and 122 +/- 17 pg/ml with exercise in C and SG and was unchanged from basal in BG (67 +/- 6 pg/ml). In C, SG, and BG, insulin fell during exercise by 5 +/- 1, 6 +/- 1, and 6 +/- 1 microU/ml. Ra rose from 3.3 +/- 0.2 and 3.0 +/- 0.2 mg.kg-1.min-1 to 8.6 +/- 0.8 and 9.5 +/- 1.5 mg.kg-1.min 1 with exercise in C and SG, but from only 3.0 +/- 0.2 to 5.5 +/- 0.8 mg.kg-1.min 1 in BG. GNG increased by 248 +/- 38 and 183 +/- 75% with exercise in C and SG but by only 56 +/- 21% in BG. Intrahepatic gluconeogenic efficiency was also enhanced by the rise in glucagon increasing by 338 +/- 55 and 198 +/- 52% in C and SG but by only 54 +/- 46% in BG. The rise in hepatic fractional alanine extraction was 0.38 +/- 0.04 and 0.33 +/- 0.04 during exercise in C and SG and only 0.08 +/- 0.06 in BG. Ra was increased beyond that which could be explained by effects on GNG alone, hence hepatic glycogenolysis must have also been enhanced by the rise in glucagon. In conclusion, in the dog, the exercise-induced rise in glucagon 1) controls approximately 65% of the increase in Ra, 2) increases hepatic glycogenolysis and GNG, and 3) enhances GNG by stimulating precursor extraction by the liver and precursor conversion to glucose within the liver. PMID- 2665515 TI - L-leucine or its keto acid potentiate but do not initiate insulin release in chicken. AB - In the isolated perfused chicken pancreas, 20 and 40 mM L-leucine or 10-40 mM alpha-ketoisocaproic acid (alpha-KIC) did not initiate insulin release. In the presence of 14 mM glucose (a noninsulinotropic concentration), 20 mM L-leucine and 10 mM alpha-KIC evoked a slight biphasic insulin release. The response to 20 mM L-leucine was further increased when 14 mM glucose was combined with 10 mM L glutamine (10 mM glutamine alone did not induce insulin release and did not potentiate the response to 10 mM L-leucine). At 1 mM, 8-bromo-adenosine 3',5' cyclic monophosphate (8-BrcAMP) alone caused a slight and progressive increase in insulin secretion but did not sensitize the pancreas to either 20 mM L-leucine or 10 mM alpha-KIC, whereas it facilitated a marked insulin release in response to 14 mM glucose. On the other hand, 10-40 mM K+ or 20 mM L-arginine induced a rapid monophasic insulin output. In conclusion, L-leucine or alpha-KIC, which do not initiate insulin release alone and are not potentiated by 8-BrcAMP, may not be regarded as primary insulinotropic agents in the chicken. This result, together with the previously documented resistance of the chicken pancreas to glucose alone or to D-glyceraldehyde, strongly suggests that the mechanisms initiating insulin secretion are different in chickens and mammals, whereas potentiating mechanisms (low glucose concentration, arginine, acetylcholine, and cAMP) and membrane depolarization events (K+ and arginine) are present in both chickens and mammals. PMID- 2665516 TI - Contribution of cortisol to glucose counterregulation in humans. AB - To test the hypothesis that cortisol secretion plays a counterregulatory role in hypoglycemia in humans, four studies were performed in eight normal subjects. In all studies, insulin (15 mU.m-2.min-1) was infused subcutaneously (plasma insulin 27 +/- 1 microU/ml). In study 1, plasma glucose concentration and glucose fluxes [( 3-3H]glucose), substrate, and counterregulatory hormone concentrations were simply monitored, and plasma glucose decreased from 89 +/- 2 to 52 +/- 2 mg/dl for 12 h. In study 2, (pituitary-adrenal-pancreatic clamp), insulin and counterregulatory hormone secretion (except for catecholamines) was prevented by somatostatin (0.5 mg/h, iv) and metyrapone (0.5 g/4 h, per os), and glucagon, cortisol, and growth hormone were infused to reproduce the concentrations of study 1. In study 3 (lack of cortisol increase), the pituitary-adrenal-pancreatic clamp was performed with maintenance of plasma cortisol at basal levels, and glucose was infused, whenever needed, to reproduce plasma glucose concentration of study 2. Study 4 was identical to study 3, but exogenous glucose was not infused. Isolated lack of cortisol increase caused a approximately 22% decrease in hepatic glucose production (P less than 0.01) and a approximately 15% increase in peripheral glucose utilization (P less than 0.01), which resulted in greater hypoglycemia (37 +/- 2 vs. 52 +/- 2 mg/dl, P less than 0.01) despite compensatory increases in plasma epinephrine. Lack of cortisol response also reduced plasma free fatty acid, beta-hydroxybutyrate, and glycerol concentrations approximately 50%. We conclude that cortisol normally plays an important counterregulatory role during hypoglycemia by augmenting glucose production, decreasing glucose utilization, and accelerating lipolysis. PMID- 2665517 TI - Effect of 7 days of bed rest on dose-response relation between plasma glucose and insulin secretion. AB - Physical training decreases glucose-stimulated insulin secretion. To further explore the influence of the level of daily physical activity on beta-cell secretion, the effect of 7 days of bed rest was studied in six young, healthy men by sequential hyperglycemic clamp technique (7, 11, and 20 mM glucose, each step lasting 90 min). At 11 and 20 mM glucose, insulin concentrations in plasma were higher after (87 +/- 11 and 303 +/- 63 microU/ml) than before (63 +/- 5 and 251 +/- 50 microU/ml, P less than 0.05) bed rest. Also C-peptide levels were higher after bed rest than before during glucose stimulation. The responses of other hormones, metabolites, or electrolytes influencing beta-cell secretion were not influenced by bed rest. In spite of increased insulin levels after bed rest, glucose disposal at 20 mM of glucose was significantly lower after bed rest than before. It is concluded that bed rest for 7 days increases the glucose-stimulated insulin response, at least partly due to a beta-cell adaptation increasing glucose-stimulated insulin secretion. However, the insulin secretion does not increase adequately compared with the peripheral insulin resistance induced by bed rest. PMID- 2665518 TI - Time dependence of the interaction between lipid and glucose in humans. AB - The time-dependent effect of Intralipid infusion on glucose metabolism was examined in seven healthy young subjects who participated in the following three experimental protocols: study I, a 4-h euglycemic insulin clamp (0-240 min) with [3-3H]glucose and indirect calorimetry; study II, a 4-h insulin clamp with Intralipid infusion started at time 0; and study III, a 4-h insulin clamp with Intralipid infusion started at 120 min. When Intralipid infusion was begun at the start of the insulin clamp, the increase in insulin-mediated glucose oxidation was completely inhibited, and the rise in nonoxidative glucose disposal was diminished by 22%. When Intralipid infusion was begun 120 min after the start of the insulin clamp, no inhibitory effect on either glucose oxidation or nonoxidative glucose disposal was observed. The change in lipid oxidation was closely and inversely correlated with the change in glucose oxidation (r = 0.826, P less than 0.001) during studies I-III; no correlation between the change in lipid oxidation and nonoxidative glucose disposal was observed. These results indicate that, in healthy subjects, the metabolic competition between lipid and glucose is very time dependent. Furthermore, mitochondrial oxidative processes are more sensitive and are affected earlier than the cytosolic metabolic pathways, i.e., nonoxidative glucose disposal. PMID- 2665519 TI - Sustained increases in plasma epinephrine concentration do not modulate renin release. AB - We examined the relationship between plasma renin activity (PRA) and renal arterial pressure (RAP) during 1) control conditions, 2) acute, and 3) chronic intravenous epinephrine (EPI) infusion (125 ng.kg-1.min-1). In eight conscious uninephrectomized dogs maintained on a normal sodium intake, the renin stimulus response curve (RSRC) was determined by a stepwise reduction in RAP with an inflatable occluder around the renal artery controlled by a servo unit. The RSRC could be approximated by two lines intersecting at a threshold pressure (approximately 20 mmHg below control RAP). In the high-pressure range, PRA was relatively insensitive to changes in RAP, whereas, below threshold pressure, changes in RAP had large effects on PRA. During acute EPI infusion there was approximately a 40% increase in heart rate (control = 57 +/- 3 beats/min) and hematocrit (control = 30 +/- 1%) in association with a rise in plasma EPI concentration from 73 +/- 16 to 1,413 +/- 100 pg/ml; mean arterial pressure (MAP) was unchanged (94 +/- 3 mmHg). Moreover, EPI acutely increased basal PRA from 0.3 +/- 0.1 to 0.8 +/- 0.3 ng angiotensin I.ml-1.h-1 and shifted the RSRC to the right (increasing threshold pressure 7 mmHg) without altering the slope of the RSRC curve either above or below threshold pressure. In contrast, although plasma EPI concentration and hematocrit remained elevated during chronic EPI infusion, heart rate and basal PRA returned to preinfusion values. In addition, there were no significant long-term changes in MAP or in any of the parameters of the RSRC.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 2665520 TI - Phosphorylase synthesis in diabetic hepatocytes and cardiomyocytes. AB - Whereas total cardiac glycogen phosphorylase activity appears to be unaffected by severe insulin deficiency, a diabetes-induced decreased in hepatic glycogen phosphorylase activity has been demonstrated by our laboratory and others using liver extracts, isolated perfused liver, and cultured hepatocytes. The loss of activity in diabetic liver can be correlated with a drop in protein levels. Using primary cultures of cells from normal and diabetic rats and phosphorylase specific antibodies, we found a corresponding decrease in phosphorylase synthesis in diabetic hepatocytes cultured for 2 days in a serum-free, chemically defined medium. When hepatocytes are cultured in the presence of insulin, triiodothyronine, and cortisol, there is a significant recovery in the rate of phosphorylase synthesis after 3 days. Over the 3-day time period, there is no significant difference in the rate of phosphorylase degradation in normal compared with diabetic hepatocytes. Total protein synthesis in both hepatocytes and cardiomyocytes is unaffected by diabetes, as is phosphorylase synthesis in cultured cardiomyocytes. PMID- 2665521 TI - Lethal ischemia due to intracoronary endothelin in pigs. AB - Endothelin is a recently discovered endothelium-derived peptide with potent coronary constrictor properties in vitro. To evaluate endothelin's cardiac actions in vivo, we measured coronary flow and regional myocardial shortening when intracoronary porcine endothelin was given to anesthetized open-chested pigs. Bolus adminstration into the left anterior descending (LAD) coronary artery of six pigs caused dose-related rapidly reversing depression of LAD flow and local shortening. Marked reductions in flow [-71 +/- 8 (SE) %] and shortening ( 83 +/- 2%) after 30 pmol/kg demonstrated endothelin's potency in cardiac tissues. Systemic hemodynamic values were unaltered except for transient rises in left ventricular end-diastolic pressure. Endothelin-induced decrement in LAD flow was accompanied by electrocardiographic signs of myocardial ischemia and net release of local myocardial lactate. Intracoronary infusion of endothelin, 15 pmol.kg 1.min-1, caused progressive decline in LAD flow and local shortening followed by severe persistent hypotension and terminal ventricular fibrillation in four of five pigs. Unlike intracoronary delivery of other potent coronary constrictors, intracoronary administration of endothelin did not lead to rapid escape from the peptide's deleterious influence. Coronary exposure to endothelin under pathophysiological circumstances could result in uniquely persistent decrements in myocardial perfusion and contractile function. PMID- 2665522 TI - Role of the renin-angiotensin system in hypertension during reduced uteroplacental perfusion pressure. AB - Utero-placental ischemia is known to cause systemic hypertension in various species, but the mechanisms are unknown. These studies were designed to test the hypothesis that the increased systemic arterial pressure that occurs during reduced utero-placental perfusion pressure is mediated by the renin-angiotensin system, possibly due to release of renin or angiotensin from the ischemic gravid uterus. In trained, chronically instrumented pregnant dogs (gestational age 47 +/ 2 days, term = 60 days) maintained on a normal Na+ intake (approximately 80 meq/day), uterine perfusion pressure was reduced to 60 mmHg with an inflatable aortic occluder positioned distal to the renal arteries but proximal to the uterine arteries and was servo-controlled at this level for 1 h. Systemic arterial pressure rose by 14 +/- 2 mmHg, from 96 +/- 7 to 110 +/- 8 mmHg. Plasma renin activity and angiotensin II levels did not change significantly. On another day in the same animals, the activity of the renin-angiotensin system was fixed by infusing captopril and sufficient angiotensin II to restore arterial pressure to normal (2-5 ng.kg-1.min-1 iv). Reduction of uterine artery pressure to 60 mmHg caused systemic arterial pressure to increase by 10 +/- 2 mmHg with the renin angiotensin system fixed, a response not different from that in the control experiments. These data suggest that the increase in systemic arterial pressure during reduced uteroplacental perfusion pressure is independent of the renin angiotensin system. PMID- 2665523 TI - Cold exposure reverses inhibitory effects of fasting on peripheral glucose uptake in rats. AB - The effects of fasting and cold exposure on glucose uptake in skeletal muscles (tibialis anterior, quadriceps, and soleus), heart, and brown adipose tissue (BAT) were studied in conscious rats. Glucose uptake was estimated by determining the glucose metabolic index of individual tissues using the 2-[3H]deoxyglucose method. Fasting for 18 h at 25 degrees C decreased plasma glucose levels (-40%) and glucose uptake in heart (-95%) and skeletal muscles (-64-90%) but did not significantly affect glucose uptake in BAT. Fasting for 48 h did not further decrease these parameters. On the other hand, cold exposure (48 h at 5 degrees C) of fed animals did not alter plasma glucose levels but increased glucose uptake in heart (73%), skeletal muscles (126-326%), and particularly in BAT (95-fold). Remarkably, cold exposure stimulated glucose uptake in BAT and skeletal muscles of 18-h fasted rats by the same order of magnitude as in fed animals (percentagewise), thereby indicating that glucose represents an essential metabolite for shivering (muscles) and nonshivering (BAT) thermogeneses. In the heart of starved animals, the cold-induced increase in glucose uptake was even more important (8-fold) than in fed animals. Considering that cold exposure of fasted rats results in a severe insulinopenia, it is suggested that cold exposure stimulates glucose uptake in peripheral tissues primarily by enhancing glucose oxidation via insulin-independent pathways. PMID- 2665524 TI - Self-defeating personality disorder and DSM-III-R: development of the diagnostic criteria. AB - One of the major controversies during the development of DSM-III-R was the possible inclusion of self-defeating personality disorder. The authors review the clinical literature that serves as the conceptual basis for this diagnosis. The development of the diagnostic criteria is described, including the rationale for specific criteria and the objections raised by opponents of the category. The authors describe how some of these objections led to changes in the diagnostic criteria in an attempt to distinguish self-defeating personality disorder from normal reactions to victimization and abuse. PMID- 2665525 TI - Psychiatric Genetics. PMID- 2665526 TI - Psychotic disorders in DSM-III-R. AB - The authors review the important changes in the three sections of DSM-III-R that include only psychotic disorders (schizophrenia, delusional disorder, and psychotic disorders not elsewhere classified), outline the rationale for these changes, and, where available, review their empirical basis. In addition, they review two proposed changes that were not incorporated into DSM-III-R. They conclude by calling for an increasingly rigorous and data-based process of nosologic revision. PMID- 2665527 TI - Psychiatric aspects of organ transplantation. AB - Technical advances in surgery and the new antirejection agents cyclosporine and muromonab-CD3 have led to improved outcome for organ transplantation. Allograft rejection and complications of immunosuppressant therapy are often associated with considerable stress, so availability of psychiatric consultation is a necessity. As a transplant team consultant, the psychiatrist treats perioperative anxiety, depression, and organic brain dysfunction and addresses medical and ethical aspects of patient selection. Studies indicate that many patients with psychopathological conditions have good postoperative results and that most living kidney donors participate spontaneously and consider donation a positive experience. PMID- 2665528 TI - Ann Sexton and the daemonic lover. PMID- 2665529 TI - Toward a psychology of human survival: psychological approaches to contemporary global threats. AB - Nuclear weapons, population explosion, resource and food-supply depletion, and environmental deterioration have been posing increasing threats to human survival. Moreover, for the first time in history, all these major global threats are human caused and can, therefore, be traced in large part to psychological origins. After a brief overview of the nature and extent of current threats, this paper suggests criteria for an adequate psychology of human survival. The causes and effects of the threats are examined from various psychological perspectives and the psychological principles underlying effective responses are deduced. The ways in which mental health professionals may contribute to this most crucial task are discussed. PMID- 2665530 TI - Specifics and nonspecifics in psychotherapy. AB - The specifics/nonspecifics issue in psychotherapy has given rise consecutively to three major positions: (a) The systems' position, in which each specific approach to therapy views itself alone as embodying true theory and rightful practice, while rivaling approaches are seen as superficial or unscientific. (b) The nonspecifics' position in which the latter are seen as sole carriers of therapeutic effects. (c) The recent integrative position in which instead of the systems' self-immured isolation or the nonspecifics' paralyzing equivalence of all therapies, a synthesis of specific approaches within a larger nonspecific theory or practical strategy is attempted. PMID- 2665531 TI - The dynamics of posttraumatic stress disorder in South African political ex detainees. AB - This paper explores the dynamic factors involved in the generation of the classical posttraumatic stress disorder (PTSD) in a population of Black South African political ex-detainees. A model is proposed of the evolution of inner psychic events in response to the detention-related trauma which result in the typical symptom cluster. PMID- 2665532 TI - Formaldehyde exposures from tobacco smoke: a review. AB - Reports of formaldehyde levels in mainstream, sidestream, and environmental tobacco smoke from nine studies are reviewed. Considerable disparity exists between formaldehyde production rates determined from mainstream-sidestream studies and those reporting levels in environmental tobacco smoke. Tobacco smoke does not appear to increase vapor-phase formaldehyde levels significantly in indoor environments, but formaldehyde exposure in mainstream smoke may pose a risk of upper respiratory system cancer and increase the risk of cancer in smokers. PMID- 2665533 TI - On shock absorbent insoles to prevent bone fractures. PMID- 2665534 TI - Localized benign and malignant fibrous tumors of the pleura. A clinicopathologic review of 223 cases. AB - We reviewed 223 localized fibrous tumors of the pleura and divided them histologically into 141 benign and 82 malignant neoplasms. The criteria used for a judgement of malignancy were high cellularity and mitotic activity (more than four mitotic figures per 10 high-power fields), pleomorphism, hemorrhage, and necrosis. The tumors occurred equally in both sexes, most commonly in the sixth to seventh decades of life. Presenting symptoms included chest pain, dyspnea, and cough; they were observed in three-fourths of patients with a malignant tumor. One in every four of these patients had hypoglycemia, clubbed digits, or pleural effusion. Two-thirds of the tumors were attached to visceral pleura, often by a pedicle. The rest arose from the parietal pleura of the chest wall, diaphragm, or mediastinum. Neoplasms in these atypical sites, together with fissural lesions and tumors "inverted" into peripheral lung, were more often malignant. Most neoplasms measured 5-10 cm and weighed 100-400 g. Microscopically, the "patternless pattern," or hemangiopericytic type, was seen in the majority of cases, and mixed patterns were seen in nearly 40% of tumors. Of the 169 tumors where follow-up was available, all of the benign and 45% of the malignant tumors were cured by simple excision. Patients surgically cured of a malignant neoplasm had pedunculated or well-circumscribed lesions. However, 55% of patients with malignant tumors succumbed to their disease secondary to invasion, recurrence, or metastasis. Resectability is the single most important indicator of clinical outcome. No tumor expressed epithelial differentiation, either immunohistochemically or ultrastructurally; therefore, we favor the term "localized fibrous tumor" of pleura instead of "localized mesothelioma." PMID- 2665535 TI - A multilobular variant of hairy cell leukemia with morphologic similarities to T cell lymphoma. AB - Hairy cell leukemia is a distinct chronic lymphoproliferative disorder composed of morphologically unique B-lymphocytes. The diagnosis of hairy cell leukemia is usually based on the morphology of blood/bone marrow aspirate smears and bone marrow sections. We report three cases of hairy cell leukemia that had an unusual multilobated nuclear appearance seen on both smears and tissue sections. Many of the hairy cells exhibited marked nuclear lobulations and convolutions, giving rise to clover leaf-like nuclear configurations. The nuclear chromatin was finely reticular and characteristic of hairy cell leukemia. Bone marrow sections were hypercellular and the leukemic infiltrate was loosely distributed. A leukemic infiltrate was also seen in splenic sections in two cases in which splenectomy was carried out. Tartrate-resistant acid phosphatase cytochemistry was positive in all three cases. Flow cytometric analysis and paraffin section immunoperoxidase studies confirmed the B-cell lineage of the leukemic cells in all cases. The multilobulated nuclei described in these three cases are quite unusual in hairy cell leukemia; they could potentially lead to an erroneous diagnosis of T-cell lymphoma or leukemia. Features typical of hairy cell leukemia, such as the nuclear chromatin distribution and pattern of bone marrow infiltration, together with the clinical history, are helpful in establishing a correct diagnosis of these variant cases of hairy cell leukemia. PMID- 2665536 TI - Multiple lymphomatous polyposis of the gastrointestinal tract. A clinicopathologically distinctive form of non-Hodgkin's lymphoma of B-cell centrocytic type. AB - Multiple lymphomatous polyposis of the gastrointestinal tract was initially described as mucosal lymphomatous involvement by any of a variety of Hodgkin's or non-Hodgkin's lymphomas that produced a polypoid appearance over long segments of the gastrointestinal tract. We studied four patients in whom histology revealed diffuse small cleaved cell lymphoma (one case), or intermediate lymphocytic lymphoma of diffuse type (one case), or mantle zone pattern (two cases). All four cases are classifiable as centrocytic lymphoma. Cell suspension and immunocytochemical studies demonstrated B-cells of IgMD or M type with light chain restriction (two kappa, two lambda) showing a B1+ HLA Dr+ LN2+ CD5+ CD10+. Although all four patients had a partial response to combination chemotherapy, three of them died within 3 years. Analysis of 24 cases reported since 1971 (including the present cases) suggests that MLP is a distinct clinicopathological entity that results from gastrointestinal involvement by a B-cell centrocytic lymphoma. It is distinct from the recently described clinicopathological forms of centrocytic lymphoma and intermediate lymphocytic lymphoma, which both show extensive peripheral lymphadenopathy and splenomegaly, but it is probably closely related to them. The differences are probably attributable to distinct cell tropism or homing properties rather than to cellular histogenesis or degree of maturation. PMID- 2665537 TI - The 1988 Fred W. Stewart Award. PMID- 2665538 TI - [The role of enzymes in the pathogenesis of genital tumors]. PMID- 2665539 TI - [Pathophysiology of the polycystic ovary syndrome]. PMID- 2665540 TI - [Value of echography in the diagnosis of postoperative complications]. AB - The results of ultrasonic investigation of 54 females with a variety of complications following uterine and adnexal surgery are reviewed. Echograms are presented, and echographic description of intraperitoneal hemorrhages, hematomas at various sites, peritonitis, infiltrations, abscesses, ligature fistulas, pelvic foreign bodies, etc. is made. Echography is shown to be a highly valuable method for the diagnosis of postoperative complications. PMID- 2665541 TI - [Various anatomic and functional characteristics of the urinary system in patients with a history of adnexitis]. AB - Anatomical and functional urinary parameters were assessed, by means of radioisotopic dynamic renal scintigraphy, in 60 female patients with a history of chronic adnexitis. Most of the patients showed anatomical of functional urinary disorders, such as nephroptosis, an enlargement of one of the kidneys, ureteral dilatation, bladder reflux and reduced renal excretion. The disorders were more marked in those cases where chronic adnexitis had been accompanied by genital tumor growth. PMID- 2665542 TI - [Colpopoiesis using an epidermo-dermal flap in vaginal aplasia]. PMID- 2665543 TI - [The role of the thyroid in the female reproductive system]. PMID- 2665544 TI - [Surgical treatment of vaginal and uterine prolapse associated with elongation of the cervix uteri and stress-induced urinary incontinence]. PMID- 2665545 TI - [Surgical treatment of rectovaginal fistula and inveterate stage III perineal rupture]. PMID- 2665546 TI - Effectiveness of rubidomycin in induction therapy with vincristine, prednisone, and L-asparaginase for standard risk childhood acute lymphocytic leukemia: results of a Dutch phase III study (ALL V). A report on behalf of the Dutch Childhood Leukemia Study Group (DCLSG). AB - The Dutch Childhood Leukemia Study Group (DCLSG) performed a phase III study Study (ALL) V-to evaluate the effectiveness of rubidomycin in induction therapy with vincristine, prednisone, and L-asparaginase for children (0-15 years) with standard risk acute lymphoblastic leukemia (ALL) (white blood cell [WBC] counts less than 50.10(9)/L, absence of mediastinal mass, and/or cerebromeningeal leukemia). Furthermore, the influence of initial patient and disease characteristics on the outcome was analyzed. Between May 1979 and December 1982, 240 patients entered the study and were randomized into two groups: group A (n = 122) received induction treatment with vincristine (VCR), prednisone (Pred), and L-asparaginase (L-Asp); for group B (n = 118), induction therapy consisted of VCR, Pred, L-Asp, and rubidomycin (Rub). All patients subsequently underwent cranial irradiation (doses adjusted to age) in combination with intrathecal methotrexate; maintenance therapy of 6-mercaptopurine and methotrexate for 5 weeks followed by vincristine and prednisone for 2 weeks was given for 24 months. The complete remission (CR) rate was similar in both groups (94.5%). Event-free survival (EFS) 5 years after diagnosis was higher in group B (62.5 +/- 4.5%) than in group A (54.7 +/- 4.5%), although the difference is not significant (p = 0.20). A high initial WBC (greater than or equal to 10.10(9)/L), age (greater than or equal to 10 years), a low platelet count (less than 100.10(9)/L), and a positive acid phosphatase reaction of the leukemic cells were unfavorable prognostic factors (p less than 0.05). Sex, French-American-British (FAB) classification group, immunophenotype, and treatment in specialized centers did not have a significant impact on event-free survival. PMID- 2665547 TI - Growth in children following irradiation for bone marrow transplantation. AB - Longitudinal height data from 46 pediatric bone marrow transplant (BMT) patients, including 18 with aplastic anemia (AA), 19 with acute nonlymphoblastic leukemia (ANLL), and 9 with acute lymphoblastic leukemia (ALL), were analyzed to assess growth posttransplantation. Patients were prepared for BMT with high-dose cyclophosphamide followed by 7.5 Gy single-dose irradiation; AA patients received total lymphoid irradiation (TLI), and leukemia patients received total body irradiation (TBI). AA patients demonstrated reduced height posttransplant as reflected in a negative mean standard deviation score. The observed reduction was statistically significant only at 3 years following transplant. In contrast, leukemia patients showed a significant loss in relative height that was first visible at 1 year post-BMT and continued until at least 4 years post-BMT. Mean growth velocities in the leukemia patients were significantly below median for the 3 years following transplant. With a median follow-up of 4 years, antithymocyte globulin plus steroids in combination with methotrexate as graft vs. host prophylaxis was associated with less severe growth suppression than methotrexate alone, while there were no significant associations between growth during the first 2 years following transplant and prepubertal status at transplant (as defined by age), graft vs. host disease, thyroid or gonadal function, or previous therapies received by the leukemia patients. Children undergoing marrow transplantation, particularly those receiving TBI, are at significant risk of subsequent growth suppression. PMID- 2665549 TI - Pathogenesis and pathology of graft-vs.-host disease. AB - Over the past decade, there has been a significant increase in the number of patients with a variety of malignant and nonmalignant disorders referred for bone marrow transplantation. Despite numerous advances in the care of such patients after allogeneic bone marrow transplantation, acute and chronic graft-vs.-host disease continues to be a principal cause of morbidity and mortality. In this article, we will present an overview of the pathogenesis, clinical presentation, and pathological manifestations of these two major complications. PMID- 2665548 TI - Effective therapy for a severe case of the idiopathic hypereosinophilic syndrome. AB - An 8-year-old boy with idiopathic hypereosinophilic syndrome (HES) is reported. He has been maintained in prolonged hematologic remission with vincristine and mercaptopurine despite an initial eosinophil count of 186 X 10(9)/L and a poor response to prednisone and hydroxyurea. Success with this combination of chemotherapeutic agents has not previously been reported in the management of HES. Progressive endomyocardial fibrosis required cardiac surgery 11 months after diagnosis. The management of this disorder is discussed with a review of the published literature. PMID- 2665550 TI - Neutrophil kinetics in the fetus and neonate. AB - Delineation of neutrophilic pool sizes and kinetics during the steady state and during various perturbations has improved the clinical approach to adult patients with abnormalities of blood neutrophil concentration. Perhaps a better understanding of neutrophil kinetics in the fetus and neonate might similarly permit a less empiric approach to neutropenia and neutrophilia in newborn infants. The relatively few studies that have been performed suggest that substantial differences in pool sizes and kinetics exist between neonates and adults, with even greater differences between extremely preterm infants and those delivered at term. PMID- 2665551 TI - Neutrophil transfusions in the treatment of neonatal sepsis. AB - Neonatal host defense simulates a clinical state of immunodeficiency that predisposes the preterm and term newborn to overwhelming bacterial sepsis. Defects in both the quantitative and the qualitative aspects of the neonatal phagocyte contribute significantly to the immaturity of their immune system. The neonate lacks adequate numbers of granulocyte bone marrow progenitor cells and has a decreased neutrophil storage pool and an increased tendency to peripheral neutropenia during neonatal sepsis. Additionally, the neonatal granulocyte demonstrates altered physiological function compared with that found in the adult with respect to chemotaxis, phagocytosis, oxidative metabolism, and bacterial killing. Reduced circulating immunoglobulins and impaired production of specific antibody are additional hallmarks of altered neonatal immunity. The use of adult neutrophil transfusions for the treatment of neonatal sepsis has shown promise in some clinical studies and no difference in others. Recent investigations have examined the use of intravenous gamma-globulin for prophylaxis and treatment of neonatal sepsis. The following review summarizes the state of immunodeficiency in the newborn and the potential role of polymorphonuclear leukocyte transfusions in the treatment of overwhelming neonatal bacterial sepsis. PMID- 2665552 TI - Ethanol reinforcement in the alcohol nonpreferring rat: initiation using behavioral techniques without food restriction. AB - Genetic selection of rats can markedly alter their ethanol consumption. The manner in which environmental factors interact in these genetically selected animals to influence ethanol consumption has not been thoroughly investigated. Using the alcohol-nonpreferring (NP) line of rats selectively bred at the Indiana University School of Medicine, alcohol self-administration in an operant situation was initiated using either a sucrose-fading or a secondary-conditioning procedure. These initiation procedures do not require any food or fluid restriction. Initiation was successful in 10 out of 12 NP animals, with the initiated rats self-administering ethanol at concentrations as high as 40%. Following initiation, a retest of home-cage ethanol preference found increases in ethanol acceptability. When tested in a concurrent operant situation, the initiated NP rats also chose ethanol over water. However, the NP rats had lower alcohol intakes and a different pattern of drinking over time when compared to that of nonselected Long-Evans rats. While the NP rats could be initiated to lever-press for ethanol, at no time did their intake approach that of the selected line of alcohol-preferring (P) rats. Thus, while an upward shift from the genetic baseline in ethanol preference and intake can result from the environmental initiation manipulations employed in these studies, genetic factors would appear to limit the extent to which ethanol ingestion can be increased. PMID- 2665553 TI - Psychophysiological effects of alcohol-related stimuli: I. The role of stimulus intensity. AB - The present study extends previous research on conditioning factors in the physiological and subjective responses to naturalistic alcohol-related stimuli. Specifically, the effects of differential alcohol ingestion histories and of stimulus intensity were examined on the occurrence of conditioned responses in the laboratory. Twelve alcoholic subjects and twelve moderate drinkers participated in a single experimental session consisting of randomized presentations of three types of stimulus trials. Each trial included gustatory and visual presentation of alcohol, pepper juice (as a control for stimulus intensity) or water. Both alcohol and pepper juice stimuli significantly increased heart rate and skin conductance responses as compared with water stimuli. In contrast, subjects significantly increased self-report ratings of high and feel different following alcohol stimuli only. Physiological and subjective responses were similar in alcoholics and social drinkers with the exception of significantly higher self-reported craving in alcoholic subjects. These findings suggest that stimulus intensity contributes to the magnitude of physiological but not subjective responses to alcohol-related stimuli. PMID- 2665554 TI - Psychophysiological effects of alcohol-related stimuli: II. Enhancement with alcohol availability. AB - This laboratory study examined methods of enhancing physiological and subjective responses of alcoholics to naturalistic alcohol-related stimuli by repeated exposures to a high-dose alcohol drink. Individual subjects participated in five successive daily sessions consisting of randomized-block presentations of gustatory and visual presentation of alcohol, pepper juice (as a control for stimulus taste intensity), or water stimuli. Following the stimulus trial series, all subjects ingested 1.5 oz of alcohol in a shot glass. Twelve subjects next received a 1.7 g/kg alcohol drink ("high dose alcohol group") on Days 1-4 and placebo on Day 5, and 12 subjects received a placebo drink on all study Days (1 5) ("placebo drink group"). On Day 1, alcohol stimuli generally elicited larger heart rate and skin conductance increases and skin temperature decreases than water or pepper juice stimuli. Alcohol stimuli also elicited greater subjective responses than either pepper juice or water. Alcohol availability within the taste trial markedly increased physiological and subjective reactivity to alcohol related stimuli, perhaps due to the closer approximation to natural drinking behavior. A comparison with previous data from this laboratory suggests that prestudy deprivation from alcohol, instructions to expect alcohol, a conductive drink setting, and the opportunity to drink alcohol within the session may enhance reactivity to alcohol stimuli in alcoholics. PMID- 2665555 TI - Underreporting of alcohol use in pregnancy: relationship to alcohol problem history. AB - Assessment of alcohol-related fetal risk is complicated by difficulties in assessing alcohol exposure. We previously described considerable underreporting of alcohol use during pregnancy, particularly among problem drinkers. This report is of the relationship between severity of drinking problems and the magnitude of underreporting. Pregnant disadvantaged women responded to the Michigan Alcoholism Screening Test (MAST) at the first antenatal visit and provided self-report data regarding alcohol use at each antenatal visit. Five years later, 238 of these women again provided self-report information about drinking during the target pregnancy. Underreporting was defined as a positive difference between the indices computed from the retrospective and the in-pregnancy data. The relationship of underreporting to the MAST score was highly significant and indicated a 20-fold increase in underreporting from the lowest to highest MAST score. However, the marked individual variability seen in this relationship indicates that while the MAST may be a better indicator of risk than self-reports of drinking, it is also not sufficient for the purpose. Further work examining other measures and techniques for obtaining drinking information is indicated. PMID- 2665556 TI - Chronic tolerance to ethanol in the N:NIH rat. AB - As the basis for selectively breeding rats from the N:NIH stock on the basis of differential development of tolerance to ethanol, chronic tolerance to the motor disrupting effects of ethanol was examined. Male (n = 50) and female (n = 46) rats were administered 2.5 g/kg ethanol (i.p.) and the blood-ethanol concentration (BEC) at the time of regain of aerial righting reflex (RARR) was measured. The rats were then placed in inhalation chambers for 8 consecutive days and chronically exposed to ethanol. Thirty-two hours following the cessation of chronic ethanol exposure, the rats were again given a 2.5 g/kg dose of ethanol and the BEC at RARR was again measured. The amount of chronic ethanol tolerance developed, as measured by the difference in BEC at RARR prior to and after chronic ethanol administration, was widely and normally distributed for both male and female rats. Control rats, which did not receive chronic ethanol exposure between the two tests of RARR, did not show tolerance on this measure. A negative correlation (r = -0.46) was found between BEC at RARR prior to chronic ethanol treatment and the amount of chronic tolerance developed using the difference in BEC measure. This correlation suggested that the rats who were initially more sensitive to the effects of ethanol were more likely to display the greatest amount of chronic tolerance. However, using the residuals of the regression analysis of post-chronic ethanol BEC at RARR on prechronic BEC at RARR as an index of tolerance, this negative correlation was not found.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 2665557 TI - Ethanol administration diminishes the endotoxin-induced increase in glucose metabolism. AB - The metabolism of ethanol (ETOH) is known to increase the cytosolic NADH/NAD ratio and consequently impairs hepatic glucose output in the fasted state. In contrast, one of the characteristic alterations in glucose metabolism produced by the administration of endotoxin is an increase in the de novo synthesis of glucose. Therefore, the present study tests the hypothesis that the acute administration of ETOH will prevent the endotoxin-induced increase in glucose production. In vivo glucose kinetics were determined by the infusion of [6-3H, U 14C]glucose in catheterized conscious rats. The intravenous infusion of tracer glucose, and ETOH (100 mg/100 g b.w./hr) or saline were started at the same time and both continued throughout the experiment. Two hours later the ETOH infusion rate was decreased to maintain the blood ETOH levels between 100 and 160 mg/dl. At 140 min, endotoxin (100 micrograms/100 g b.w.) was injected. ETOH alone did not alter basal values of plasma glucose (5 mM), glucose rate of appearance (Ra; 35 mumols/min/kg) or metabolic clearance (MCR; 7 ml/min/kg). Endotoxin alone increased plasma glucose (80%) and lactate (140%) concentrations, glucose Ra (60%) and recycling (40%) in saline-infused rats, whereas in ETOH-infused animals, plasma glucose and lactate levels were only elevated 40% and glucose Ra and recycling were unchanged. The results show that acute ETOH administration diminishes the increased glucose production and utilization seen in endotoxemia. The attenuation of the endotoxin effect by ethanol is due to inhibition of hepatic glucose production and peripheral glucose utilization. PMID- 2665558 TI - Length changes in dendritic networks of cerebellar Purkinje cells of old rats after chronic ethanol treatment. AB - Dendritic networks of cerebellar Purkinje neurons from aging ethanol-treated Fisher 344 rats were analyzed for metric changes in terminal and internal segments of the networks. Mean lengths of three categories of dendritic segments were determined. No significant metric changes in segment lengths were detectable immediately at the termination of 24 weeks of ethanol treatment, but significant changes were apparent after 8 weeks of recovery from ethanol treatment. Return to a diet of standard laboratory chow was associated with a period of dendritic extension in networks from pair-fed control rats but not in those from the ethanol-treated rats. The resulting significant differences in mean segment length were restricted to the paired terminal segments at the peripheral tips of the bifurcating networks. Unpaired terminal segments and internal segments of the networks showed no significant changes in length during the recovery period. PMID- 2665559 TI - Effect of three alcohol doses on breathing during sleep in 30-49 year old nonobese snorers and nonsnorers. AB - To test the effect of alcohol ingestion and snoring on sleep-disordered breathing (SDB), the sleep and respiration of 31 nonobese healthy males ages 30-49 (15 snorers, 16 nonsnorers) were studied overnight after alcohol ingestion. Subjects received placebo, 0.32, 0.65, and 0.81 g alcohol/kg body weight prior to their evening bedtime, with each dose given on one of four nonconsecutive nights in a repeated-measures counterbalanced design. On each night, respiration was assessed by recording respiratory effort from intercostal surface electromyography (EMG), ventilation from oral and nasal thermistors, and arterial oxygen saturation (SaO2) from an ear oximeter (BIOX III). Snorers had significantly: (a) more total SDB, (b) more obstructive sleep apnea (OSA), and (c) lower minimum SaO2 than nonsnorers after the placebo and each alcohol dose. Snorers had more hypoxic events than nonsnorers after each alcohol dose but not after placebo. Increasing alcohol dose caused a statistically significant (p = 0.0004) decrease in minimum SaO2 in snorers only, but this decrease was small and probably not clinically important. Alcohol did not cause significant increases in SDB and hypoxic events, and did not have different effects on SDB and hypoxic events for snorers versus nonsnorers. Because this experiment included only nonobese 30-49-year-old males, these results do not imply that alcohol has no significant effects on obese subjects or those older than 50. PMID- 2665560 TI - Ethanol-induced hydrolysis of brain sialoglycoconjugates in the rat: effect of sialic acid in antagonizing ethanol intoxication. AB - Several reports indicate that acute ethanol promotes the cleavage of brain sialoglycoconjugates (SGC). We attempted to confirm this effect by monitoring cleavage of sialic acid (SA) that had been radiolabeled by pretreatment with the specific precursor of SA, N-[3H]acetyl-D-mannosamine, injected intracerebroventricularly into rats 20 h prior to ethanol injection (2 or 3 g/kg, given four times in a simulated "binge drinking" protocol). Analysis of the residual labeled material revealed a significant reduction of radiolabel (p less than 0.01), as compared to saline controls. A dose of 3 g/kg diminished the total labeled SGC by half. Brain sialidase activity was not affected by the ethanol treatment. Since ethanol intoxication is associated with enhanced SA cleavage, one hypothesis needing testing is that loss of SA might help to cause intoxication. If so, pretreatment with SA might antagonize intoxication, presumably by offsetting loss due to cleavage of SA. Consistent with our earlier results, we found that when sialic acid was given i.p. (25 mg/kg), 1, 6, or 24 h prior to ethanol injection (4 g/kg, i.p.), the sleep time was reduced by 35-40% and the performance on rotorod was significantly enhanced (p less than 0.01). When ethanol was replaced by pentobarbital (40 mg/kg), the sleep time was increased (approximately 30%) at 6 h after injection with either 25 or 100 mg/kg sialic acid, whereas at the 24 h postinjection it was decreased (approximately 20%) at both doses. The results suggest that sialic acid is a key component in mediating ethanol effects and perhaps also, in a different way, anesthetic effects. PMID- 2665561 TI - In vivo effect of chronic ethanol abuse on membrane alpha 1-glycoprotein of lymphocytes and immune response to various stimulating agents. AB - Data on the immune status of chronic alcoholic patients are rather conflicting probably due to the interference of liver disease and/or malnutrition on immune function. In order to avoid this kind of interference, peripheral lymphocytes from 12 chronic alcoholic patients in good nutritional status and without heavy liver damage and 15 healthy controls were examined in this study. Lymphocyte functional activity was evaluated by means of response to phytohemagglutinin, calcium ionophore A 23187, and autologous non-T-cells [autologous mixed lymphocyte reaction (AMLR)]. Phenotypical analysis was carried out by the indirect immunofluorescence technique using monoclonal antibodies specific to CD5 (mature T-lymphocytes), CD4 (helper/inducer T-lymphocytes), CD8 (suppressor/cytotoxic T-lymphocytes), glycoproteins, and an immunoglobulin fraction from rabbit directed to membrane alpha 1 acid glycoprotein (AGP) that is involved in T-cell activation process. Our results show significant impairment in AMLR while response to phytohemagglutinin, heterologous non-T-cells and carcinoma ionophore did not differ from controls. No differences were present in circulating T-lymphocytes expressing CD5, CD4, and CD8 on their membrane, whereas AGP-bearing lymphocytes were significantly lower in chronic alcoholics (14.4 +/- 8.6) than in controls (31.9 +/- 8.1; p less than 0.001). These results support the hypothesis of a direct action of alcohol on one of the pathways of lymphocyte activation and the role of the lymphocyte membrane AGP on the AMLR. PMID- 2665562 TI - Acute hypocalcemic effect of ethanol in dogs. AB - Ethanol has been shown to reduce serum calcium in multiple animal studies. However, in human studies done using lower doses of alcohol, only inconclusive results have been obtained. This study was undertaken to evaluate the effects of varying doses of oral ethanol on total serum calcium. Fifteen adult mongrel dogs (17-25 kg) were divided into three groups which differed in the dosage of ethanol given. Group I animals received 0.5 g/kg of ethanol; Group II, 1.0 g/kg ethanol; and Group III, 2.0 g/kg of ethanol. Venous blood was sampled for estimation of concentrations of total serum calcium and ethanol. In the animals in Group I, serum calcium levels were unchanged by the ethanol. In both Groups II and III, significant reductions in serum calcium were demonstrated, which occurred within 5 min of intoxication. The mean decrease in serum calcium in Group III animals was significantly greater than that in either Group I and II. We conclude that the rapid hypocalcemic effect requires a threshold amount of ethanol before it becomes chemically evident. This critical value in dogs approximated 1 g/kg which results in a mean peak serum alcohol concentration of 117 +/- 6 mg/dl. PMID- 2665563 TI - Acceleration of ethanol metabolism by past thiamine deficiency. AB - Six months after severe thiamine deficiency, when their body and liver weights had normalized, male Sprague-Dawley rats were exposed to constant ethanol vapor concentrations for 6 days in an inhalation chamber and blood ethanol concentrations (BECs) were determined. Previously induced thiamine deficiency was associated with about a 50% reduction of BECs and a significant increase in liver alcohol dehydrogenase (ADH) activity suggesting a persistent acceleration of ethanol metabolism. No significant changes were found in liver aldehyde dehydrogenase activity, plasma levels of thyroxine, testosterone, or estradiol, or brain or liver histology. Plasma growth hormone concentrations were about 60% lower in the experimental group than in controls, but this effect of previous thiamine deprivation did not correlate with changes in ADH activity. Therefore, it remains to be elucidated how thiamine deficiency-induced central nervous system alterations may contribute to the development of metabolic tolerance to ethanol. PMID- 2665564 TI - Noninvasive estimation of blood alcohol concentrations by eye vapor analysis using an electrochemical fuel cell detector. AB - A widely used breath analysis instrument was adapted for the noninvasive determination of blood alcohol in small animals. The instrument's response to ethanol in vapor above the lacrimal fluid was analyzed subsequent to taking vapor samples from a small eye cup for 15 sec. After ethanol administration (1.5 g/kg, orally) to rats, eye vapor measurements and venous blood samples were obtained over 5 hr. Eye vapor measurements were transposed into blood alcohol concentrations and compared with concentrations obtained by gas chromatographic analysis of blood. The correlation of concentrations obtained by the two methods yielded correlation coefficients of 0.93 and 0.95 depending on the calculation used. Eye vapor response and blood alcohol concentration were also found to be highly correlated (r = 0.96) after alcohol administration to mice and sampling for 2.5 hr after ethanol administration. Kinetic profiles obtained by eye vapor analysis and gas chromatography are virtually identical. The method described allows widespread use of a new, noninvasive approach to alcohol analysis in laboratory animals. PMID- 2665565 TI - [Papillary carcinoma in a cyst of the thyroglossal duct. Review]. AB - The AA. report a new case of papillary carcinoma inside a cyst of the thyroglossal duct and give a survey of the related literature. They point out the importance of echography when a case of the kind is suspected. PMID- 2665566 TI - Isolating enzymes by reversed micelles. PMID- 2665567 TI - Vitamin K (menaquinone) biosynthesis in bacteria: high-performance liquid chromatographic assay of the overall synthesis of o-succinylbenzoic acid and of 2 succinyl-6-hydroxy-2,4-cyclohexadiene-1-carboxylic acid synthase. AB - An early enzyme in menaquinone (vitamin K2) biosynthesis is the synthase forming 2-succinyl-6-hydroxy-2,4-cyclohexadiene-1-carboxylic acid (SHCHC) from isochorismic acid. In turn, SHCHC is aromatized to o-succinylbenzoic acid (OSB) by OSB synthase. An assay for the combined activity of these two enzymes ("overall OSB synthesis") has been developed using a high-performance liquid chromatographic method for the quantitation of OSB. The assay, which measures as little as 0.1 nmol of OSB, is vastly superior to the radiogas chromatographic method previously used to estimate overall OSB synthesis. To measure SHCHC synthase activity separately, the enzymatically formed SHCHC is converted nonenzymatically to OSB (heating to 80 degrees C, pH 10, 10 min), which is then quantitated by the HPLC assay. The preparation of the substrate, isochorismic acid, and its purification by preparative HPLC are also described. PMID- 2665568 TI - Isotope dilution gas chromatography/mass spectrometry for the determination of nickel in biological materials. AB - Precise and accurate methods are required to measure nickel in urine and serum samples to identify clinical states of either deficiency or toxicity. This paper presents an isotope dilution gas chromatography/mass spectrometry method for the measurement of nickel in biological samples. The method involves the preparation of a thermally stable and volatile nickel chelate using lithium bis(trifluoroethyl)dithiocarbamate as the chelating agent. Conditions were optimized for the digestion of the sample and quantitative preparation of chelate as well as the precise and accurate measurements of the isotope ratios using a capillary column gas chromatograph with a general purpose mass spectrometer. The memory effect between samples of different isotope ratios was evaluated and was found to be negligible. The quantitative accuracy of isotope dilution was validated by measuring nickel in the NIST freeze-dried urine reference material, SRM 2670, with comparison to the recommended value. PMID- 2665569 TI - Research and development of biosensors. A review. PMID- 2665571 TI - Fifty years of Anesthesiology. PMID- 2665572 TI - Continuous cardiac output determination using transtracheal Doppler: initial results in humans. AB - Transtracheal Doppler, a procedure developed in the authors' laboratory, provides an estimate of cardiac output in endotracheally intubated dogs. The present study reports initial results in humans with a Doppler probe incorporated into an endotracheal tube. The system was first calibrated by empirically determining phi, the angle of the ultrasound beam with respect to the blood velocity vector. For a best least squares fit for phi, aortic diameters can be calibrated over a range of 22-37 mm. The calibration was then tested in a separate group of patients using the same empirically derived angle to calculate cardiac outputs. The transtracheal Doppler cardiac outputs show good correlation with those obtained by thermodilution over a range of cardiac outputs, 2.69-8.62 1/min, R2 = 0.835. PMID- 2665573 TI - Controversial issues in cardiopulmonary resuscitation. PMID- 2665570 TI - Morphologic and regulatory aspects of prostatic function. AB - Current concepts of the structural and functional organization of the human prostate are presented and are related to endocrine principles which have been studied in experimental animals. Based on embryological and histological studies, the internal structure of the human prostate gland is divided into four subdivisions: 1. the anterior nonglandular fibromuscular stroma. 2. the periurethral portion, 3. the peripheral zone, and 4. the central zone. The central zone which accounts for 25% of the gland, is formed by a wedge-shaped group of ducts, arising close to the orifices of the ejaculatory ducts and is surrounded by the peripheral zone (75% of the gland). The functional interdependence and relationship between the stroma and the epithelium observed during embryological development, postnatal maturation and under certain pathological conditions, has led to the concept of a functional prostatic unit, which is useful for the explanation of prostatic growth and the expression of specific genes. There is growing evidence of a functional heterogeneity within the prostatic secretory duct system, with a concentration of estrogen-sensitive cells close to the urethra, and a relatively long persistence of undifferentiated nonsecretory acini at the peripheral tips of the gland ducts close to the dorsal capsule until late puberty. Secretory and proliferative activities of the gland are strictly androgen-dependent. Of particular importance with respect to glandular and stromal proliferation are the recent reports on the presence of different growth factors in the prostate. Hormonally induced imbalances in the system of growth factor production, androgen- and estrogen-dependence and general ageing of the cells have to be taken into consideration in understanding various prostatic pathologies such as benign prostatic hyperplasia and prostate cancer. PMID- 2665574 TI - An increase in prostacyclin accompanies reduction of blood pressure following peritoneal closure in patients undergoing cesarean section. PMID- 2665575 TI - Intraoperative coagulation changes in children undergoing liver transplantation. AB - Intraoperative changes in blood coagulation were observed in eight children undergoing liver transplantation using a simplified coagulation profile (prothrombin time [PT], activated partial thromboplastin time [aPTT], and platelet count) and thrombelastography. Preoperatively, PT and aPTT were moderately prolonged (1.5 times control), and platelet count was greater than 100,000/mm3 in all patients but one (91,000/mm3). During the preanhepatic and anhepatic stages, PT, aPTT, reaction time, and coagulation time improved toward normal values, but platelet count and maximum amplitude did not change. Significant changes in coagulation occurred on reperfusion of the grafted liver: PT, aPTT, reaction time, and coagulation time were prolonged, and platelet count, maximum amplitude, and clot formation rate decreased. A heparin effect, which did not require treatment, was seen on reperfusion in four patients. Fibrinolysis occurred during the operation in five patients and was treated with Epsilon aminocaproic acid (EACA) in one. Blood coagulation improved slowly, and values were close to baseline 90 min after reperfusion. In general, the coagulation changes seen in these children are similar to those in adults but less severe, possibly because of the preponderance of cholestatic disease in children compared with the more common hepatocellular disease in adults. PMID- 2665576 TI - [Aneurysm of the abdominal aorta compromising the origin of the visceral branches: an idea on surgical treatment]. AB - After a review of the best surgical technics in the treatment of aortic abdominal or thoraco-abdominal aneurysms engaging its abdominal visceral branches, an infrequent situation is exposed: broken aneurysms in which, after laparatomy, its abdominal extension, proximal to renal emersion, even affecting descendent thoracic aorta, is verified. Authors propose (in a theoric way, by the moment), a catheter for internal derivation, temporal and multiple, to solve this situation in a medium without the resorts and the suitable experience to approach this contingency. PMID- 2665577 TI - [A personal technic using a pediculate flap in the treatment of postmastectomy lymphedema]. AB - A new technic of pediculate lymphoangioplasty for the treatment of postmastectomy lymphedema in order to achieve an effective drainage of the upper extremity, is presented. It may be associated to lymphatic venous anastomosis or the Thompson's surgery, according to the evolutive state of the illness. This technic consists of two steps: 1) flap's drawing as to direct the vascular flow to its base, 2) implantation of the flap, without epithelium, in the posterior face of the arm, after celuloaponeurectomy and invagination of the skin's edges of the arm, also without epithelium, over the flap. The lymphatic drainage is then improved to the supraclavicular, contra lateral axillary, inter costal and/or inguinal lymphnodes. PMID- 2665578 TI - [Establishment of a range of phtalate density for studying profiles of erythrocyte density]. AB - The determination of the density distribution of erythrocyte population is one of the biological parameters used in several hemoglobin disorders. Many difficulties to obtain reproducible results between different laboratories lead to make a reference phtalate ester range for two hospitals. In this paper, the conditions of preparation and use of the method are described. Then, factors affecting determinations are discussed. Finally the authors give reference values in child and adult. This work forms the first stage of a standardized study of erythrocyte populations with hemoglobinopathies. PMID- 2665579 TI - [Reference values of erythrocyte ferritin in children and adults]. AB - The erythrocyte ferritin content was measured in 183 healthy subjects in age from 4 to 68 years; 80 were male and 103 were female. In children between the ages of 4 and 12 years there is no significant difference in the mean value between boys and girls. In females the erythrocyte ferritin concentration is independent of age. After 12 years of age the erythrocyte ferritin content is higher in men. Reference intervals were determined by the two quantiles 0.05 and 0.95. The reference interval is 3-24 age by cell in boys between 4 and 12 and females between 4 and 63; the reference interval is 5-38 age by cell in males between 13 and 68 years of age. PMID- 2665580 TI - [Evaluation of a new semi-automatic method of identifying enterobacteriaceae, M.I.S.-Enterobacteriaceae]. AB - M.I.S.-Enterobacteriaceae is a new kit for identifying Enterobacteriaceae using a microplate consisting of 21 biochemical characters with automated reading and interpretation. The validity of this method was studied by the identification of 350 strains of enterobacteria belonging to 44 species and comparison with the classical method of identification in test-tubes. Results showed a diagnosis accuracy of 96 p. cent at the species level and 97.7 p. cent at the genus level. Diagnosis accuracy reached 100 p. cent for those bacterial species isolated routinely: Proteus, Providencia, Morganella, Klebsiella, Enterobacter. Accuracy was 97 p. cent for E. coli, 95 p. cent for Serratia marcescens and 94 p. cent for C. freundii. For several less frequently isolated species such as Salmonella, Hafnia, Shigella and Yersinia, diagnosis accuracy was 100 p. cent. This identification system for enterobacteria can however also be used for identification of Aeromonas genus and for Pseudomonas maltophilia and Acinetobacter baumannii non fermenting Gram-negative bacilli with oxidase negative reaction. PMID- 2665581 TI - [Is it still necessary to do research on native anti-DNA antibodies by indirect immunofluorescence on Crithidia lucilliae?]. PMID- 2665582 TI - Should PEEP be used in airflow obstruction? PMID- 2665583 TI - Hypothermia with and without end-expiratory pressure in canine oleic acid pulmonary edema. AB - An important goal in managing patients with respiratory failure using mechanical ventilatory support and positive end-expiratory pressure (PEEP) is to optimize tissue oxygen delivery relative to oxygen consumption. To this end, systemic hypothermia has been reported to reduce oxygen consumption. Cooling, however, may antagonize hypoxic pulmonary vasoconstriction and depress cardiac output. To determine whether these potentially adverse effects of cooling on tissue oxygen delivery would outweigh any potential benefits, we studied the effects of systemic hypothermia and end-expiratory pressure on venous admixture, intrapulmonary blood distribution, and oxygenation variables in 40 dogs with oleic acid-induced pulmonary edema of the right lung. The dogs were randomly assigned to four treatment groups of 10 dogs each: normothermia and zero end expiratory pressure (ZEEP); normothermia and 10 cm H2O PEEP; hypothermia and ZEEP; hypothermia and PEEP. Hypothermia to 31.9 +/- 0.1 degree C (mean +/- SEM) caused no adverse effects on intrapulmonary blood flow distribution (measured by radioactive microspheres) or on venous admixture. Tissue oxygen delivery and arterial oxygenation did not improve with hypothermia, the latter being 109 +/- 13 mm Hg and 70 +/- 8 mm Hg with PEEP and ZEEP, respectively. However, hypothermia significantly reduced oxygen consumption, so that the coefficient of oxygen delivery (i.e., the ratio of oxygen supply to consumption) increased from 2.5 +/- 0.1 to 3.2 +/- 0.2 (p less than 0.01) with ZEEP and from 2.0 +/- 0.1 to 2.6 +/- 0.3 with PEEP (p = 0.016). Thus, although systemic hypothermia failed to improve arterial oxygenation and tissue oxygen delivery, it decreased systemic oxygen demands, thereby improving the oxygen supply-demand balance. PMID- 2665584 TI - High doses of inhaled corticosteroids in unstable chronic asthma. A multicenter, double-blind, placebo-controlled study. AB - In a multicenter, randomized, double-blind study, inhaled beclomethasone dipropionate (BDP) 1,500 micrograms/day was compared to placebo in 43 chronic asthmatic patients uncontrolled by inhaled salbutamol and oral theophylline. During the prestudy period, a test of maximal steroid reversibility with oral prednisolone 0.5 mg/kg/day for 14 days was performed. The therapeutic response was measured over an 8-wk period as the ability to maintain the clinical improvement and the optimal pulmonary function induced by prednisolone. During the study, severe asthma exacerbation occurred in one (5%) of the 21 patients who received BDP and in 15 (78%) of the 22 patients who received placebo (p less than 0.001). In patients who received BDP, FEV1 and peak expiratory flow (PEF) remained above the optimal postprednisolone value, with a trend to improvement during the 8-wk study period. In patients who received placebo, FEV1 and PEF decreased and remained below the optimal value. We conclude that, in chronic asthma, inhaled BDP 1,500 micrograms/day maintains the optimal pulmonary function in addition to the clinical benefit induced by a short course of oral corticosteroids. PMID- 2665585 TI - Firefighting acutely increases airway responsiveness. AB - The acute effects of the products of combustion and pyrolysis on airway responsiveness among firefighters are poorly documented. To study this relationship, spirometry and methacholine challenge testing (MCT) were performed on 18 active Seattle firefighters before and 5 to 24 h after firefighting. Body plethysmography was used to measure changes in specific airway conductance (SGaw), and results of MCT were analyzed using PD35-SGaw, the cumulative dose causing a 35% decrease in SGaw. Subjects who did not react by the end of the protocol were assigned a value of 640 inhalational units, the largest cumulative dose. Fire exposure was defined as the total time (hours) spent without a self contained breathing apparatus at the firesite and was categorized as mild (less than 1 h, n = 7), moderate (1 to 2 h, n = 5), or severe (greater than 2 h, n = 6). Mean age of the 18 firefighters was 36.7 +/- 6.7 yr (range, 25 to 51), with a mean of 9.1 +/- 7.9 active years in the trade (range, zero to 22). None was known to be asthmatic. After firefighting, FEV1 % predicted (%pred) and FEF25-75 %pred significantly decreased by means of 3.4 +/- 1.1% and 5.6 +/- 2.6%, respectively. The mean decline in PD35-SGaw after firefighting was 184.5 +/- 53.2 units (p = 0.003). This observed decline in PD35-SGaw could not be explained by decrements in prechallenge SGaw, FEV1, or FVC.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 2665586 TI - Smoking habit and bronchial reactivity in normal subjects. A population-based study. AB - The relationship between smoking habits and airway responsiveness has been studied in a cross-sectional sample of subjects in a small Lombardy (Italy) town. The subjects were between 15 and 64 yr of age; they were representative of the general population. There were 295 normal nonsmokers, 70 normal smokers, and 50 past smokers. All clinically asymptomatic and functionally normal subjects underwent methacholine challenge. The distribution of responsiveness to methacholine (as expressed by LnPD15FEV1) was found to be significantly different between these normal smokers and nonsmokers. A multinomial logistic regression model showed a statistically significant difference in the response to the challenge on the basis of pack-years. When the number of years of smoking and the daily number of cigarettes were separately considered, the current amount had the significant correlation with LnPD15FEV1. Bronchial reactivity for past smokers was found not to be different from that for normal nonsmokers. We conclude that smoking habits, especially current habits, affect bronchial reactivity even in the absence of airway obstruction. PMID- 2665587 TI - The role of allergy and nonspecific airway hyperresponsiveness in the pathogenesis of chronic obstructive pulmonary disease. AB - Although the information that has been reviewed leaves many questions unanswered, some conclusions can be drawn from available data. (1) Smoking appears to increase the risk of sensitization to certain inhaled antigens encountered in the workplace; however, there is no definite evidence that smoking increases the frequency or intensity of allergy to common aeroallergens in the general population. On average, smokers have higher serum total IgE concentrations and blood eosinophil counts than do nonsmokers, but the mechanisms underlying these alterations are not clear. Analysis of these relationships is complicated by observations suggesting that atopic persons are less likely to become and to remain regular cigarette smokers. (2) Long-term cigarette smoking may be associated with increased nonspecific airway responsiveness, although the magnitude of this effect is relatively small when one adjusts for prechallenge level of pulmonary function. This effect of smoking may be more pronounced in atopic persons. (3) Atopy, as assessed by skin testing and serum IgE concentrations, is associated with asthma, nonspecific airway hyperresponsiveness, and reduced pulmonary function level in population data. However, there is no clear evidence that atopy is a risk factor for irreversible airflow obstruction in persons without asthma. Population data do not indicate how much of the reduction in pulmonary function associated with atopy and asthma is potentially reversible. (4) Blood eosinophil count appears inversely related to the level of pulmonary function and directly related to the rate of decline of pulmonary function among nonsmokers. Reports vary concerning whether the relationship of eosinophil count to level of pulmonary function remains after excluding subjects with diagnosed asthma. This relationship may be determined largely by a clinically distinguishable subset of nonsmokers with "asthmatic bronchitis." Presumably, these observations reflect an adverse impact of eosinophilic inflammation in the airways or lung parenchyma. It is not clear whether this represents an allergic response because skin-test reactivity to common aeroallergens and serum total IgE concentration do not show similar relationships to reduced level and rapid decline of pulmonary function. (5) Among smokers, nonspecific airway hyperresponsiveness appears to be associated with an accelerated longitudinal decline of pulmonary function, although most studies indicating this association are limited by either a retrospective design or lack of adjustment for prechallenge level of pulmonary function.(ABSTRACT TRUNCATED AT 400 WORDS) PMID- 2665588 TI - Chest wall distortion in patients with flail chest. AB - Ventilators can impose resistive and elastic loads during subject-initiated and spontaneous breaths. Such loads might worsen the chest wall distortion that is characteristic of patients with flail chest. We have tested this expectation in nine patients with flail chest and four normal subjects. All subjects breathed for 3 to 5 min on each of the following modes: assist control, intermittent mandatory ventilation (IMV), continuous positive airway pressure 5 to 10 cm H2O by demand valve and by a high flow system (CPAP-HF), and spontaneously (T-piece). Pressure at the airway opening was evaluated as a measure of ventilator loading, and magnetometric displacements of the major chest wall dimensions were evaluated to assess chest wall distortion. In contrast to the normal volunteers, patients with flail chest displayed chest wall distortion during active inspirations. The patterns of distortion were variable among patients. The degree of distortion varied among ventilator modes; generally, there was a greater degree of chest wall distortion in breaths with greater loading. For example, distortion was greater during the spontaneous breaths taken on the IMV-mode than during spontaneous breaths taken on the T-piece. The CPAP-HF mode resulted in the least distortion, reversing chest wall distortion in five patients, improving it in two, and not changing the distortion in the remaining two. The improvements may be related to positive pleural pressures and to the minimal ventilator-imposed load of the high gas flow system. The distortion imposed by ventilators increases the work of breathing in these patients and may thus contribute to difficulty in weaning. PMID- 2665589 TI - Detrimental effects of positive end-expiratory pressure during controlled mechanical ventilation of patients with severe airflow obstruction. AB - Positive end-expiratory pressure (PEEP) in treatment of asthma may be beneficial by dilating airways or detrimental by increasing hyperinflation. Several studies have reported beneficial results but with conflicting effects on lung volume. We studied the effects of PEEP on pulmonary hyperinflation, gas exchange, and circulation in six patients (59 +/- 19 yr, four men, two women) with severe airflow obstruction requiring mechanical ventilation (four with asthma, two with an exacerbation of chronic airflow obstruction). Three levels of PEEP (5, 10, and 15 cm H2O) were studied. All patients were paralyzed and ventilated with a tidal volume of 1.0 L, and respiratory rates (R) of 10, 16, and 22 breaths per min. End inspiratory lung volume (VEI) or the degree of pulmonary hyperinflation above functional residual capacity (FRC) was quantified by measuring total exhaled gas volume during a period of apnea following steady-state tidal inspiration (1). Two patients were not studied at 15 cm H2O PEEP because of hypotension. Without PEEP, all patients showed gas trapping above FRC that increased progressively as R was increased (i.e., expiratory time decreased). At each R, increases in PEEP progressively increased FRC up to 1.42 +/- 0.43 L (mean +/- SD) at 15 cm H2O PEEP (n = 4) and progressively reduced the degree of gas trapping above the PEEP FRC.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 2665590 TI - Screening for lung cancer. AB - Lung cancer is the commonest cause of death from cancer in both men and women, with approximately 152,000 new cases and 139,000 deaths in 1988. The incidence and mortality rates are increasing rapidly in women. Two main tests have been used to screen for lung cancer: chest roentgenography and sputum cytology. Four recent controlled trials and one case-control study failed, however, to show that screening reduces lung cancer mortality even in high-risk persons (smokers). In the Mayo Lung Project, for example, the lung cancer death rate in high-risk men offered sputum cytology and chest roentgenogram every 4 months was 3.1 per 1000 person-years, compared with 3.0 per 1000 person-years in a control group. Chest roentgenograms and sputum cytology lead to false-positive test results in smokers of approximately 5% and 0.5%, respectively. Because of the lack of evidence of benefit and because of its potential harms and costs, screening for lung cancer is not recommended. PMID- 2665591 TI - American College of Physicians Ethics Manual. Part 1: History; the patient; other physicians. American College of Physicians. PMID- 2665592 TI - Fulminant hepatic failure after ingestion of sustained-release nicotinic acid. PMID- 2665593 TI - Collagenous colitis and histiocytic lymphoma. PMID- 2665594 TI - GM-CSF treatment and hypokalemia. PMID- 2665595 TI - Cellular and genetic characterization of UV sensitive Chinese hamster mutants. AB - Results of cellular and genetic characterization of UV sensitive clones (UVs) isolated from CHO-K1 cell line are reported. The cross-sensitivity to agents inducing a variety of DNA lesions, the induction of chromosome aberrations and of 6-thioguanine and ouabain resistant mutants, the occurrence of methotrexate resistant cells were analyzed in clones showing different degrees of UV sensitivity. Genetic analysis was performed by complementation analysis of hybrids obtained by fusion of our mutants with UVs cells belonging to the six complementation groups (c.g.) so far identified. Three clones were assigned to c.g. 2, one clone to c.g. 5. Two clones (CHO7PV and CHO4PV), were able to complement each other and showed complementation after fusion with any of the six c.g.; these clones were considered carriers of two new mutations in genes presumably involved in DNA repair. PMID- 2665596 TI - The pR plasmid: a tool for studying DNA repair and mutagenesis in prokaryotic and eukaryotic cells. AB - The pR plasmid, a derivative of R46 plasmid, offers the possibility to have an experimental approach to three important problems related to UV repair and mutagenesis. By using this plasmid we were able to show: a) the pR mucAB genes need the cooperation of uvpl gene product to carry out their UV repair function; b) the expression of mucAB genes is regulated not only by lexA gene, but by a gene localized in the rep region of pR itself. This gene acts as an antirepressor of lexA; c) mammalian cells show an enhanced resistance to UV light when transformed by pR plasmid carrying the mucAB genes. PMID- 2665598 TI - Molecular analysis of mutagenesis in E. coli. AB - In this paper we present a general strategy that is suitable for the analysis of the forward mutation spectrum induced by any physical or chemical mutagen or carcinogen. The assay is based upon the inactivation of the tetracycline resistance gene located on plasmid pBR322. Plasmid DNA is treated in vitro with the mutagen and transformed into the host bacteria of choice. Mutant clones are selected and analysed by sequencing. We present also two techniques that allow the determination of the DNA modification spectrum. The comparison for a given mutagen of the modification spectrum and the induced mutation spectrum permits the identification of hot spot sequences. Using different chemical mutagens (derivatives of the carcinogenic aromatic amide N-2-acetylaminofluorene, cis platinum, etc.) this assay was found to be able to detect the different classes of mutagenic events: base substitutions, frameshifts, insertions and deletions. The advantages and limitations of this assay are discussed. PMID- 2665597 TI - Mutagenic specificity of alkylated and oxidized DNA bases as determined by site specific mutagenesis. AB - This work demonstrates the use of the tools of site-specific mutagenesis to study the mutagenic activity of two DNA adducts, O6-methylguanine and cis-thymine glycol. The former adduct is one of the methylated bases formed by carcinogenic and mutagenic alkylating agents. It was built into the single-stranded genome of bacteriophage M13 and replicated in Escherichia coli (E. coli). The mutation frequency of O6-methylguanine was 0.4% in physiologically normal cells. In cells in which the repair systems for O6-methylguanine were compromised by challenge with an alkylating agent, the mutation frequency rose to approximately 20%. DNA sequencing revealed that O6-methylguanine induced exclusively G----A transitions, which was most consistent with it pairing with thymine during DNA synthesis. The mutagenic effects also were investigated of cis-thymine glycol isomers, which are major, stable products of ionizing radiation and oxidative damage to DNA. By techniques similar to those employed for the study of O6-methylguanine mutagenesis, a single thymine glycol was situated in an M13 phage genome. The genome was replicated in E. coli that were physiologically normal, induced for SOS functions, or deficient in the nth gene product and, in all cases, the mutagenic processing of thymine glycol in vivo yielded mutant progeny phage at a frequency of 0.3-0.4%. All mutations occurred at the site that originally contained thymine glycol, and all were demonstrated by DNA sequencing to have resulted from targeted T----C transitions. These data suggest that thymine glycol pairs with guanine during replication. PMID- 2665599 TI - In vitro mutagenesis and SOS repair. AB - SOS repair in Escherichia coli (E. coli) utilizes inducible gene products to "fix" mutations in the genome. It has been supposed that an "error prone" system is induced which makes errors in the course of bypassing lesions. An alternative model has been proposed by Bridges and Woodgate which suggests that it is the elongation step rather than the insertion opposite a damaged site which is critical in SOS mutagenesis. A variety of in vitro evidence supports this more recent model. DNA polymerases can be shown to insert bases opposite non instructional lesions in DNA. It can be demonstrated that it is the elongation rather than the insertion step which is rate limiting in such in vitro reactions. An in vitro mutagenesis system can be devised using a processive polymerase with a reduced 3'----5' exonuclease activity. This system mimics the mutagenic specificity seen in vivo. PMID- 2665600 TI - Processing of ring saturation and fragmentation products of DNA thymine in Escherichia coli. AB - The biological processing of thymine ring saturation and fragmentation products is summarized in Table 1. The ring saturation product, thymine glycol, is a block to in vitro DNA synthesis, whereas the ring saturation product, dihydrothymine, is not. Both these lesions are recognized in vitro by endonucleases III and VIII. Since thymine glycol is a replicative block, it is a lethal lesion in vivo. The excision repair process for removal of thymine glycols from DNA is initiated in vivo by endonuclease III and is followed by the action of either exonuclease III or endonuclease IV. Thymine glycol is very efficiently bypassed by translesion bypass in both single and double stranded DNA, however, because thymine glycol templates an adenine (A) and retains pairing characteristics, it is at best a weakly mutagenic lesion. The thymine ring fragmentation product, urea, and apurinic/apyrimidinic (AP) sites are both strong blocks to in vitro DNA synthesis. Both are substrates in vitro for endonucleases III, IV, VIII and IX as well as exonuclease III. Both are lethal lesions in single stranded and double stranded phage transfecting DNA. The excision repair of urea residues and AP sites is initiated in vivo by either exonuclease III or endonuclease IV. Neither of these noninstructive lesions are efficiently bypassed by UV-induced translesion bypass, however, when bypass occurs mutations result. beta ureidoisobutylic acid is also a block to DNA synthesis in vitro. DNA containing this lesion is a substrate for endonucleases VIII and IX. The biological processing of this ring open thymine fragmentation product has yet to be determined. Thus, these ring saturation and fragmentation products of thymine have provided a point of departure for understanding the biological processing of modified bases with altered pairing and/or stacking properties. PMID- 2665601 TI - Repair of cytotoxic lesions introduced into DNA by methylating agents. AB - We have investigated the biological role of O6-methylguanine and methylphosphotriesters in the DNA of mammalian cells. Our approach has been to express Escherichia coli (E. coli) DNA repair activities of well-defined specificity in Chinese hamster cells. Expression of O6-methylguanine-DNA methyltransferase is necessary and sufficient to confer resistance to the cytotoxic action of N-methyl-N'-nitro-N-nitrosoguanidine (MNNG) indicating the potential involvement of O6-methylguanine in cell killing by this compound. We present evidence that methylphosphotriesters in DNA do not constitute a cytotoxic threat. Despite this, cell lines resistant to MNNG may display elevated expression of a methylphosphotriester repair function. This may be the result of fortuitous co-amplification of transfected sequences and indicates that care should be exercised in correlating resistance to methylating agents with particular DNA repair enzymes. PMID- 2665602 TI - Relationship between DNA-adduct formation, DNA repair, mutation frequency and mutation spectra. AB - DNA-adduct formation by a series of ethylating agents was determined and correlated with induction of gene mutations. This approach gave information concerning the DNA-adduct(s) likely to be responsible for the observed mutations. A methodology has been developed which is used for the DNA sequence analysis of point mutations in the HPRT gene of mammalian cells. This method can be used to obtain mutation spectra and to determine whether the base-pair changes do occur at those sites where DNA-adducts are likely to occur. Measurements of DNA repair in specific DNA sequences show that actively transcribed genes are repaired faster than the genome overall. This stresses the importance of studying removal DNA-adducts in the gene that is used for the analysis of mutation induction. PMID- 2665603 TI - Repair of imidazole ring-opened purines in DNA: overproduction of the formamidopyrimidine-DNA glycosylase of Escherichia coli using plasmids containing the fpg+ gene. AB - The formamidopyrimidine-DNA glycosylase (Fapy-DNA glycosylase) of Escherichia coli (E. coli) was overexpressed by cloning the fpg+ gene on a multicopy plasmid and placing this gene under the control of the lac promoter. The lac promoter contributed significantly to the overall expression of the fpg gene only after the deletion of an inverted repeat sequence located immediately upstream from the fpg promoter. The biological purpose of the inverted repeat sequence may be associated with the termination of an adjacent gene transcribed in the same direction as the fpg gene in E. coli. Cells harboring the fpg gene under the control of the lac promoter were able to produce the Fapy-DNA glycosylase as at least 17% of the total soluble proteins. Such strains allow the preparation of milligram quantities of pure protein for use in the study of its catalytic properties and three dimensional crystal structure. PMID- 2665604 TI - Radiation damage and chromatin structure. AB - The recent advances made in the knowledge of chromatin structure have important implications in molecular and cellular radiobiology. There are now many lines of evidence that the chromatin organization can affect the production, the distribution and the repair of radiation-induced damage in DNA. Experiments with polynucleosomes show that DNA double strand breaks (dsb) are not randomly distributed along the DNA molecule. Rather, they are preferentially localized in linker regions, while core regions are more resistant. Isolated DNA is about 4 fold more susceptible to dsb than DNA irradiated as a part of polynucleosomes. This differential radiosensitivity is apparently due to the close association of DNA with proteins. The analysis of DNA single strand breaks production and repair in a human erythroleukemic cell line that can be induced to differentiate in vitro, showed that the repair kinetics in differentiated cells appears significantly slower than in undifferentiated ones. This can be interpreted as a decrease in the genome accessibility to repair enzymes due to the presence of more structured regions in chromatin after differentiation. It appears that a high degree of genome compactness could imply, on one hand, a high DNA radioresistance and, on the other hand, a slow DNA repair so that the identification of chromatin domains which are critical, from the structural point of view, in determining cellular effects such as cell killing and mutation, should take into account a sort of balance between the amount of damage and the extent of repair. PMID- 2665605 TI - Dynamics of the Escherichia coli nucleotide excision repair system. AB - Ultraviolet light induced pyrimidine dimers in DNA are recognized and repaired by a number of unique cellular surveillance systems. At the highest level of complexity Escherichia coli (E. coli) has a uvr DNA repair system comprising the UvrA, UvrB and UvrC proteins responsible for incision. There are several preincision steps governed by this pathway which includes an ATP-dependent UvrA dimerization reaction required for UvrAB nucleoprotein formation. This complex formation driven by ATP binding, is associated with localized topological unwinding of DNA. This protein complex can catalyze an ATP-dependent 5'----3' directed strand displacement of D-loop DNA or short single strands annealed to a single stranded circular or linear DNA. This putative translocational process is arrested when damaged sites are encountered. The complex is now primed for dual incision catalyzed by UvrC. The remainder of the repair process involves UvrD (helicase II) and DNA polymerase I for a coordinately controlled "excision resynthesis" step accompanied by UvrABC turnover. Furthermore, it is proposed that levels of repair proteins can be regulated by proteolysis. UvrB is converted to truncated UvrB* by a stress induced protease which also acts at similar sites on the E. coli Ada protein. Although UvrB* can bind with UvrA to DNA it cannot participate in helicase or incision reactions. It is also a DNA-dependent ATPase. PMID- 2665606 TI - Excision repair genes of Saccharomyces cerevisiae. AB - In the yeast Saccharomyces cerevisiae, at least ten genes are involved in excision repair of DNA damaged by UV radiation and by other agents that distort the DNA helix. Mutations in the RAD1, RAD2, RAD3, RAD4 and RAD10 genes render cells highly defective in the incision of damaged DNA, whereas mutations in the RAD7, RAD14, RAD16, RAD23 and MMS19 genes reduce the level of damage excision. This review summarizes the evidence for the involvement of these genes in excision repair and highlights the important features in the structures of the proteins encoded by the various RAD genes. The RAD3 protein has been purified and characterized in our laboratory, and it possesses single stranded DNA dependent ATPase and DNA helicase activities. The RAD3 helicase moves along the single stranded DNA in the 5'----3' direction. We suggest that this activity plays a role in strand displacement synthesis during excision repair and in DNA replication. PMID- 2665607 TI - [A study using laser-Doppler velocimetry of modifications of the labyrinthine microcirculation induced by chemical and physical stimuli]. AB - Vasomotor activity induced by physical and chemical stimuli in the cochlear microcirculation was evaluated by laser-doppler flowmetry. Cochlear flow changes were studied after pharmacological administration and noise exposure. The reaction of cochlear microcirculation after drug administration is similar to that observed in the brain. After phenylephrine injection the authors observed an increase of cochlear blood flow, contrary to that observed in the peripheral vessels. The authors studied the difference in time-activity and quantitative effect of several drugs commonly used in cochlear vascular diseases. Cochlear flow decrease after exposure to noise is proportional to the stimulus intensity and the exposure time. PMID- 2665609 TI - [Possible oral traumatic and infectious risks in sexual relations]. AB - Oro-genital and oro-anal practices have nowadays extended to the mouth the scope of clinical signs of previously pure venereal diseases. Through the description of the clinical oro-pharyngeal manifestations of these diseases, this paper is intended only to stress the possibilities nowadays of these diagnoses. Described in this paper are the traumas, and bacterial, viral and mycotic infections that may now affect the mouth after sexual practice. PMID- 2665608 TI - [The thyroid nodule. A retrospective study of 200 cases]. AB - We analysed 200 cases of thyroid nodules collected in 2 units of the Laennec Hospital. The results of clinical examination, complementary investigations per and post-operative histology and medical follow up were analysed and compared with those in the literature. The malignancy rate was 18%. With the exception of 5 cases, a rigorous medical examination revealed at least one suspicious clinical sign in these patients. Thyroid isotope scan, which was cold in 82% of cases was of no value in distinguishing between benign and malignant nodules. The authors were not in agreement on the policy to be followed when faced with an isolated cold nodule. Fine needle aspiration is the only method which allows diagnosis but it is of low reliability. Ultrasound may be reassuring when it demonstrates fine walled, small diameter cysts only, but this situation is rare. We analysed the limits and pitfalls of these various methods. It is difficult to submit a patient to regular follow up for several years with antagonist treatment, where appropriate, and in addition malignant transformation may not be recognized. With knowledge of the good prognosis of cancers operated on at the microscopic intracapsular stage and the significant number of microscopic carcinomas discovered fortuitously in the course of surgery, it would appear reasonable to at least perform a cervicotomy with extemporaneous histological examination of any cold or isofixing nodule. Lobo-isthmectomy is in practice the solution adopted and its complications are rare and minimal. PMID- 2665610 TI - Nerve endings in palm skin grafts. AB - We examined regeneration of Meissner corpuscles in palm skin grafts. In only one of the specimens (split-thickness skin graft from the sole of the foot), numerous regenerated Meissner corpuscles were found in the dermal papilla. This suggests that the nerve pattern of the graft depends on reinnervation from the recipient site and the regeneration of encapsulated nerve endings contained in the graft. It is recommended that skin grafts containing the encapsulated nerve endings be used in digits to obtain a satisfactory recovery of the sensory function. PMID- 2665612 TI - The dermal pursestring suture: a new technique for a short inframammary scar in reduction mammaplasty and dermal mastopexy. AB - The author hypothesized the possibility of reducing the extent of the scar formed at the inframammary sulcus in reduction mammaplasty and mastopexy by burying the dogear of excess skin in the region of the inframammary sulcus using a pursestring suture after first removing the epithelium. The results of 15 patients with follow-up periods ranging from 20 to 150 days encourage further application of this technique, which leaves a very small, aesthetically satisfactory scar. PMID- 2665611 TI - Skin graft survival--the bacterial answer. AB - An in vitro wound model was created to determine the mechanism by which bacteria cause skin graft failure. A wound surface was simulated by a human fibrin clot. Staphylococcus aureus or group A streptococcus was incubated over the clot. Either saline, human plasminogen, aprotinin, or epsilon-aminocaproic acid (EACA), or a combination of these, was added to the tubes. After 30 hours, the tubes were examined for the presence of the clot. The supernatant was then examined for the presence of fibrin degradation products (FDP). S. aureus was incapable of destroying the fibrin clot without the presence of plasminogen in the culture media. Group A streptococcus was capable of some clot degradation, but this was markedly improved in the presence of plasminogen. High FDP levels correlated with the destruction of the clot. Both aprotinin and EACA were capable of preserving the fibrin clots. In this study we carefully controlled the chemical and bacterial milieu on a simulated wound. PMID- 2665613 TI - The reverse digital artery flap for fingertip reconstruction. AB - Reverse digital artery flaps were performed successfully to resurface the major fingertip defect in 10 patients and the volar defect of the middle phalanx in 1. This thin flap with its long vascular pedicle containing a digital artery and its perivascular cuff tissue has a wide arc of transposition. It can be used to reconstruct the defect located from the proximal phalanx to the fingertip of all fingers. No loss of the flap in this series was noted. The procedure is a time saving, one-stage operation. Patients who received this procedure had no uncomfortable immobilization of the hand or long hospitalization. It also causes no disfigurement and no functional loss of the involved digit. Our clinical experience showed favorable results. PMID- 2665614 TI - Median forehead island skin flap for the correction of severely collapsed nose. AB - Five cases of severely collapsed nose as a result of infection were corrected by excision of intranasal scar and lining the intranasal defect with median forehead island skin flaps based on supratrochlear vessels. Simultaneous bone grafting was undertaken to support the reexpanded nose. Clinical experiences are presented. PMID- 2665615 TI - Re: Park and Park: Fasciocutaneous V-Y Advancement Flap for Repair of Sacral Defects. PMID- 2665616 TI - Refractive surgery: psychophysical considerations in progressive myopia. AB - There is a trend towards recommending refractive surgery for young patients with high degrees of progressive myopia. Although many can benefit from certain procedures, staphylomatous eyes present unique impediments to normal visual acuity, visual field, binocularity and stereopsis. They are also prone to premature cataract formation, glaucoma and retinal detachment. An initially good result can be destroyed by continued scleral expansion with posterior retinal degeneration. A review of these limitations should be included in discussions with patients considering refractive surgery. PMID- 2665617 TI - The current and future status of refractive surgery. AB - Kerato-refractive surgery has developed rapidly over the past decade. Many surgical procedures have been described for the correction of myopia, hyperopia, and aphakia. For the treatment of myopia, radial keratotomy has been utilized extensively. Most investigators agree that radial keratotomy results seem to be better in patients with 3 diopters or less of myopia. Keratomileusis is a complicated procedure which can correct high degrees of myopia, however, this technically difficult procedure is performed by very few surgeons in North America. Epikeratophakia for the treatment of aphakia is promising especially in the treatment of pediatric patients. The Excimer laser is evolving from a research tool to clinical reality with the coupling of the laser to computer controlled programs to reshape the cornea. The use of synthetic material inlays and intrastromal corneal ring implants are also being developed to modify the refractive status of the cornea. PMID- 2665618 TI - Radial keratotomy: in-to-out and out-to-in. Preliminary results in the Singapore General Hospital. AB - This is a preliminary report of 81 eyes which had Radial Keratotomy from March 1987 to November 1988. Fifty-nine eyes had In-To-Out surgery and the subsequent 22 had Out-To-In surgery. Follow-up was from 1 month to 20 months. At 3 months, the overall unaided visual acuity of 6/12 (20/40) or better for the In-To-Out group was 58.9% (33 of 56 eyes) and that for the Out-To-In group was 86.7% (19 of 22 eyes). Four eyes had microperforations, all from Out-To-In surgery. Steroid induced glaucoma was noted in 31 eyes. One eye developed ulcerative keratitis originating in an incision. The Out-To-In technique was superior to the In-To-Out technique in terms of consistency of depth as well as reduction of myopia. The underlying reasons are discussed. Reversion to myopia was a problem. A smaller Chinese corneal diameter and stiffer corneas may be of significance here. The surgery has proved effective and relatively safe thus far. Predictability remains a significant problem. Further evaluation and long term follow up is required. PMID- 2665619 TI - The corneal endothelial dystrophies. AB - Three major types of corneal endothelial dystrophies i.e. congenital hereditary corneal oedema, posterior polymorphous dystrophy and Fuchs endothelial dystrophy are reviewed. Clinical and histopathological characteristics are discussed and results of surgical management presented. PMID- 2665620 TI - Current status of corneal transplantation. AB - Corneal transplantation offers the cure for those with blinding corneal disease. Sourcing of a shortage of corneas are important. Graft survival depends on a number of factors, the most important of which is the recipient bed. The management of graft failure by rejection includes tissue matching, local and systemic immunosuppression. PMID- 2665621 TI - Penetrating keratoplasty and raised intraocular pressure. A brief review of the problems and its management. AB - Postkeratoplasty glaucoma is a serious sight-threatening problem that is likely to remain with us for the foreseeable future. It is common yet unsatisfactory to deal with. It is only by meticulous assessment of patients and rigorous aftercare that the condition can be adequately managed. Modern surgical techniques may improve the prognosis in cases which are uncontrolled by traditional methods. PMID- 2665622 TI - Current and future trends in the correction of aphakia: a local perspective. AB - Over the last 20 years, the correction of aphakia has moved from spectacles and contact lens to intraocular lenses. Advances in lens design and implantation techniques are now in the exciting process of refinement--the aim being bionic perfection. PMID- 2665623 TI - A common sense approach to the retina. AB - Retinal surgery can be simple if the binocular indirect ophthalmoscope is mastered and certain surgical principles followed. Mastering the binocular indirect ophthalmoscope is described in step by step detail. Thereafter which eyes develop which sort of retinal detachment are discussed with special reference to the type and position of retinal breaks. Treatment emphasises that there is no such thing as a single retinal operation but rather a series of legitimate manoeuvres which may be used alone or in combination as the eye demands. To seek the simplest intervention that seals the retinal break(s) is the aim; to do so without closing off the central retinal artery is the art. PMID- 2665625 TI - Toxoplasmic retinochoroiditis--a historical review and current concepts. AB - Toxoplasmic retinochoroiditis usually presents during the first three decades of life as a consequence of intra-uterine infection by Toxoplasma gondii. The ingestion of infected undercooked meat, or foodstuffs contaminated by infected cat faeces, constitute the primary sources of infection for the non-immune mother. It is thought that following congenital infection, Toxoplasma cysts remain dormant in otherwise normal retina and that acute retinochoroiditis is the result of reactivation of the parasite, perhaps by cyst rupture. Treatment is indicated for sight threatening disease and comprises anti-Toxoplasma agents. The addition of steroids may be required to diminish the inflammatory response. Photocoagulation of normal retina around focal lesions probably decreases the incidence of recurrent inflammation. Women should be advised not to eat undercooked meat and to avoid contact with cat excrement during pregnancy. These measures will decrease the incidence of both eye disease and the more severe manifestations of congenital toxoplasmosis, which include congenital abnormalities, mental retardation, hydrocephalus and blindness. PMID- 2665624 TI - Diabetic retinopathy: pathogenesis and management of complications. AB - Diabetic retinopathy, one of the ocular complications of the metabolic imbalance that characterize diabetes mellitus is a major cause of irreversible blindness. This article reviews the concepts of the pathogenesis of this complex disease. The management of this blinding disease is multifaceted and should be based on the sound understanding of the pathophysiologic mechanisms involved. The rationale, techniques, results and complications of the different treatment modalities including glycemic control, laser photocoagulation and vitrectomy are discussed. PMID- 2665626 TI - Controlled-release carbidopa-levodopa (Sinemet) in combination with standard Sinemet in advanced Parkinson's disease. AB - Twelve of 23 patients with Parkinson's disease and motor fluctuations who entered a double-blind study comparing controlled-release carbidopa/levodopa (Sinemet CR 4) with standard Sinemet (SS) continued into open label follow-up on a combination of CR-4 and SS (C/S); the rest continued on CR-4 alone. Significant improvement on C/S compared with CR-4 was noted for shorter duration and reduced disability of dyskinesias, and more hours "on" without dyskinesias (all p less than 0.05). Total number of hours "off" was improved on C/S over SS (p less than 0.01). Sinemet CR-4 proved to be better than C/S for sleep disturbance (p less than 0.05). Although the total number of tablets and doses per day of CR-4 was reduced during the C/S period, total levodopa dosage per day was not significantly changed from either of the previous periods. The C/S therapy for advanced parkinsonism can be more efficacious for fluctuators than either CR-4 or SS alone. PMID- 2665627 TI - Hematologic side effects of drugs. AB - Bone marrow and peripheral blood cells may be adversely affected by drugs. Although the risk from most drugs is very small, many cases are reported because of the millions of doses of drugs taken each year by the population. Neutropenia, thrombocytopenia, hemolytic anemia, aplastic anemia, and macrocytic anemia are the commonest effects, in that order. Aplastic anemia is rare, but very serious when it does occur. Adverse effects may be produced by a direct toxic action of the drug or its metabolites on the bone marrow or, less often, on circulating cells. Antineoplastic drugs and chloramphenicol are examples. Most drugs produce their adverse effects through an immunological mechanism. The drug may act as a hapten or may affect the immune system leading to the production of antidrug antibodies and sometimes autoantibodies. Hemolytic anemia may result. Penicillins may behave in this manner. Some drugs act on erythrocytes with enzyme defects, e.g. glucose-6-phosphate dehydrogenase (G-6-PD) abnormalities, to produce hemolysis. In many cases, the mechanism underlying the adverse effect is unknown. The paper lists the drugs reported to have caused some hematological adverse effect and describes the mechanisms in those cases where they are known. PMID- 2665628 TI - Automatic instrumentation for hematology. PMID- 2665629 TI - Regional mapping of the human renin gene to 1q32 by in situ hybridization. AB - Renin, related to other aspartyl proteases, plays an important role in the cascade which regulates blood pressure and salt metabolism. A human renin 1 100 bp long cDNA including most of the coding region and the 3' non coding region has been subcloned by Soubrier et al., 1983. A 1000 b RNA probe derived by subcloning into pSP64 vector was hybridized to EcoRI and HindIII digests of the DNA of a panel of 24 man-rodent somatic cell hybrids. With HindIII, four restriction fragments were observed, two of them revealing polymorphism (8.4 kb and 6.0 kb). Analysis of the distribution of the human signal among the hybrids confirms the localization of the renin gene (REN) to human chromosome 1. The whole plasmid including the 1 100 bp long insert was used for regional mapping by in situ hybridization; 45% of silver grains were found on chromosome 1, with a clear peak at band 1q32 (33% of silver grains on chromosome 1) and a smaller one at band 1q42 (17%). These data favour a regional localization of the renin gene to 1q32 1q42. Mac Gill et al. (1987) have localized the REN gene to 1q25-1q32 using in situ hybridization. Thus, 1q32 could be the most probable localization. No other peak could be observed. This is in agreement with results obtained with somatic cell hybrids. PMID- 2665630 TI - Robertsonian translocations and abnormal phenotypes. Groupe de Cytogeneticiens Francais. AB - The Groupe de Cytogeneticiens Francais collected 32 cases of Robertsonian translocations with an abnormal phenotype of which 21 t(13q;14q)'s. Nineteen were inherited, four had had occurred de novo; and nine were of unknown origin. The 21 t(13q;14q)'s were grouped according to the phenotype. Some suggested partial 13 trisomy (hexadactyly; eye defect), others partial 13 monosomy (facial dysmorphism; thumb anomalies). Three de novo t(15;15)'s with Prader-Willi syndrome show that non identifiable partial monosomies may be associated with the occurence of Robertsonian translocations. The mechanism leading to the fusion of accrocentrics are discussed. PMID- 2665631 TI - Chromatin bodies in multidrug resistant hybrid cells have centromeres and originate from homogeneously staining regions. AB - Antikinetochore antibodies from patients with the CREST syndrome of scleroderma were used as probes to study homogeneously staining regions (HSRs) in multidrug resistant (MDR) mouse tumor cells, and chromatin bodies (CBs) in MDR mouse hamster hybrid cells. In one mouse tumor line the C-band positive HSR showed antigenic properties and displayed many weekly fluorescent spots, i.e. it contained kinetochore proteins. The immunofluorescence pattern of the HSR could also be observed in interphase nuclei. The C-band positive CBs of the hybrid cells had active centromeres, as shown by double kinetochore spots. These results support our hypothesis that CBs originate from C-band positive HSRs. PMID- 2665632 TI - Antibacterial and cytotoxic effect of ceftazidime-mitoxantrone association. AB - Microbial infections are a major problem in tumor-bearing and in immunocompromised patients. In such conditions it is of paramount importance to know the possible interactions between anti-tumor and antimicrobial drugs. In the present work we investigated the relationship between Ceftazidime and Mitoxantrone. Ceftazidime and Mitoxantrone were tested alone and in combination for antibacterial activity against different strains of Gram- and Gram+ bacteria. The cytotoxic effect of combination Mitoxantrone-Ceftazidime was determined in cultured P388 leukemia cells. No interference with the antibacterial activity of Ceftazidime or with the cytotoxic activity of Mitoxantrone was observed. PMID- 2665633 TI - Immunohistochemical detection of human lung and gastric cancer antigen in human salivary gland tumors. AB - Immunohistochemical identification of human lung and gastric carcinoma antigen detected with monoclonal antibodies (MoAbs) KM-93 and KM-231 respectively, was described in 83 salivary gland tumors, including 67 pleomorphic adenomas, 5 adenolymphomas, 3 mucoepidermoid tumors, 6 sialadenocarcinomas, and 2 adenoid cystic carcinomas as well as in normal salivary glands. The binding patterns of these two MoAbs was compared with that of MoAb recognizing epithelial membrane antigen (EMA). Serous cells of normal salivary glands showed positive KM-93 staining, whereas ductal cells were positive with KM-231, with ductal basal cells being characteristically so. EMA staining was confined to luminal and lateral borders of serous acini and ducts. Pleomorphic adenomas indicated positive depositions for both KM-93 and KM-231 in luminal tumor cells or luminal borders of tubuloductal structures. Adenolymphomas showed positive KM-231 staining in basal tumor cells and a positive KM-93 reaction in luminal tumor cells. Mucoepidermoid tumors revealed positive KM-231 staining in mucous-secreting cells, whereas weak KM-93 staining was found in all tumor cells. Sialoadenocarcinomas exhibited varying degrees of positive staining with KM-93 and KM-231 in their neoplastic cells. Adenoid cystic carcinomas showed luminal staining with KM-93 and KM-231 to their neoplastic cells. Adenoid cystic carcinomas showed luminal staining with KM-93 and MoAb EMA. The histogenesis of these salivary gland tumors is discussed in terms of the immunohistochemical features of staining patterns obtained with MoAbs KM-93 and KM-231. PMID- 2665634 TI - Evaluation of combinations of CuDIPS, Tween 80 and cyclophosphamide as therapy for reticulum cell sarcoma in SJL/J mice. AB - Three agents, shown previously to have anticancer activity in the SJL/J tumor system, were tested in combinations for effects on survival rate and incidence of reticulum cell sarcoma at 52 weeks of age. Combined treatment with Cu(II)2(3,5 diisopropylsalicylate)4 (CuDIPS) and polyoxyethylenesorbitan monooleate (Tween 80) proved of no value. Indeed, inhibitory influence on tumorigenesis was diminished when Tween 80 was injected weekly at 24 hours or at 72 hours after weekly injections of CuDIPS. However, tumor incidence was reduced significantly, 90% (controls) to 7%, in mice treated weekly with cyclophosphamide (CY) at 24 hours after weekly injection of CuDIPS. Further, weekly administration of CY at 72 hours after weekly injection of Tween 80 resulted in a significant decrease in tumor incidence, 85% (controls) to 0%, and an increase in survival rate, 75% (controls) to 100%. Implications of these findings are discussed. PMID- 2665635 TI - Human immunodeficiency virus long terminal repeat responds to transformation by the mutant T24 H-ras1 oncogene and it contains multiple AP-1 binding TPA inducible consensus sequence elements. AB - We have employed a short term transfection assay to examine the response of HIV-1 LTR to transformation by the human normal and mutant T24 H-ras1 genes. The plasmid pBC12HIVCAT which carries the HIV-1 LTR sequences linked to the reporter gene chloramphenicol acetyl transferase (CAT) was transfected into rat 208F fibroblasts and their derivatives RFHO6N1-1 and RFHO6T1-1 transfectants. RFHO6N1 1 and RFHO6T1-1 express an exogenous human normal or mutant T24 H-ras1 gene respectively. Expression of the mutant T24 but not the normal H-ras1 gene resulted in increased levels of HIV-1 LTR driven CAT activity. We have noted four motifs in the HIV-1 LTR region which resemble TPA-inducible and AP-1 binding consensus sequences. Since H-ras1 fos and jun/AP-1 respond to TPA and T24 H-ras1 is known to induce both fos and jun/AP-1 nuclear transcriptional factors, it is possible that the latter genes play a role in HIV-1 transcription. Moreover, H ras1 oncogene activation may play an important role in HIV gene expression and in the activation of latent HIV. PMID- 2665636 TI - The tumor-associated antigens BR55-2, GA73-3 and GICA 19-9 in normal and corresponding neoplastic human tissues, especially gastrointestinal tissues. AB - Immunohistochemical analysis with a monoclonal antibody, anti-BR55-2, was carried out on 163 tumors with their adjacent normal tissues and on 51 normal tissues from various organs by the ABC method. The expression of the antigen BR55-2 was compared with the expression of the colorectal carcinoma (CRC) associated antigens, GA73-3 and GICA19-9. BR55-2 was expressed in most normal epithelial tissues, whereas in the colon it seems to be exclusively a tumor-associated antigen. MAb55-2 might be of value in studying dysplastic lesions of the colon and in assessing the depth of invasion of CRC. In CRC, the expression of BR55-2 was complementary to that of GA73-3. MAb55-2 may therefore be of value in immunotherapy of CRC. PMID- 2665637 TI - Infections associated with indwelling devices: concepts of pathogenesis; infections associated with intravascular devices. PMID- 2665638 TI - Infections associated with indwelling devices: infections related to extravascular devices. PMID- 2665639 TI - Failure of zinc gluconate in treatment of acute upper respiratory tract infections. AB - Zinc is a trace metal with in vitro activity against rhinovirus, the major etiologic agent in acute upper respiratory tract infections (URIs). A previous trial of zinc gluconate supported its efficacy in treating URIs, but the effectiveness of blinding was uncertain. We conducted a prospective randomized trial of zinc gluconate versus a taste-matched placebo of sucrose octaacetate. Lozenges containing either 23 mg of elemental zinc or placebo were taken every 2 h. Eleven URI symptoms were rated daily on a scale of 0 (not present) to 3 (severe). Duration of illness, reflected in the proportion of subjects remaining symptomatic on each day, was not significantly reduced (maximum difference of 12.6% on day 7, P = 0.09; 95% confidence interval, -6 to 31%) by either treatment. Severity of illness, assessed by using a summed severity score, was reduced incrementally by 7 to 8% on days 5 to 7 (P = 0.02) in subjects taking zinc. Adverse effects, mostly nausea and altered taste, were reported by 50% of subjects taking zinc. We conclude that while zinc gluconate may produce a small reduction in overall severity of symptoms, this is not clinically significant. Given the additional high incidence of adverse effects, zinc gluconate cannot be recommended for use in the treatment of acute URIs. PMID- 2665641 TI - Simulation of human serum pharmacokinetics of ticarcillin-clavulanic acid and ceftazidime in rabbits, and efficacy against experimental Klebsiella pneumoniae meningitis. AB - The penetration into cerebrospinal fluid (CSF) and efficacy of ticarcillin clavulanic acid, ticarcillin alone, and ceftazidime were compared in rabbits with experimentally induced Klebsiella pneumoniae meningitis. The compounds were administered to simulate in rabbit plasma the concentration-versus-time curves observed in humans after 30-min infusions of Timentin (3 g of ticarcillin plus 100 mg of clavulanic acid), ticarcillin (3 g), and ceftazidime (2 g). Single- and multiple-dosing schedules were used. The penetrations of clavulanic acid into CSF (expressed as [area under the concentration-time curve for CSF/area under the curve for plasma] x 100) after the two dosing schedules were 28 and 24.5%, similar to that for ceftazidime (21%; multiple-dosing only) and greater than those for ticarcillin (8.4 and 9.3%). Ticarcillin was ineffective in reducing viable counts in CSF but, in the presence of clavulanic acid, reduced bacterial numbers by approximately 99% at 4 h after a single dose and by 99.99% at 12 h after three doses given at 4-h intervals. Two doses of ceftazidime given 8 h apart were more effective than the three doses of ticarcillin-clavulanic acid, in keeping with the in vitro activities of these compounds against the infecting organism. These results illustrate the ability of clavulanic acid to penetrate the blood-CSF barrier such that concentrations of the inhibitor in CSF potentiate the activity of ticarcillin against the ticarcillin-resistant, beta-lactamase producing strain of K. pneumoniae. PMID- 2665640 TI - In vitro effects of antimicrobial agents on Mycobacterium leprae in mouse peritoneal macrophages. AB - Mycobacterium leprae synthesizes large quantities of a specific phthiocerol containing phenolic glycolipid in vivo. We have shown earlier that viable M. leprae readily incorporates radiolabeled palmitic acid into phenolic glycolipid I when residing in cultured macrophages in vitro and that this process is inhibited by the antileprosy drug rifampin. In the present paper we report that application of this observation to the rapid evaluation of over 25 antimicrobial agents for potential antileprosy activity in vitro. All the known antileprosy drugs rifampin, dapsone, clofazimine, and ethionamide inhibited phenolic glycolipid I synthesis. Rifabutin, a spiropiperidyl derivative of rifamycin, also reported to be active in the mouse model, was very effective. Interestingly, the macrolides erythromycin, clarithromycin, and roxithromycin were also found to be active in this system, while D-cycloserine and other cell wall synthesis inhibitors showed no effect. Many of the compounds found to be active in this system have been reported to be effective in vivo in mice. This correlation lends support to the feasibility of using phenolic glycolipid I synthesis for the rapid evaluation of new drugs against leprosy. PMID- 2665642 TI - Isolation and characterization of an Escherichia coli strain exhibiting partial tolerance to quinolones. AB - Quinolone antimicrobial agents rapidly kill bacteria by largely unknown mechanisms. To study this phenomenon, a strain of Escherichia coli inhibited but inefficiently killed by (i.e., partially tolerant to) norfloxacin was isolated and characterized. E. coli KL16 (norfloxacin MIC, 0.10 microgram/ml; MBC, 0.20 microgram/ml) was mutagenized with nitrosoguanidine and cyclically exposed to 3 micrograms of norfloxacin per ml. After five cycles, a bacterial strain (DS1) which was killed 1,000-fold less than KL16 during 3 h of drug exposure was isolated. The MIC and MBC of norfloxacin for DS1 were 0.20 and 1.5 micrograms/ml, respectively. Over a range of norfloxacin concentrations, DS1 was killed 2 to 4 orders of magnitude less than KL16. DS1 grew more slowly than KL16 but after normalization for growth rate was killed four times less rapidly than KL16 at drug concentrations 10-fold higher than respective MICs. DS1 and KL16 cells filamented similarly upon exposure to norfloxacin. DS1 exhibited tolerance to other DNA gyrase A subunit antagonists (ofloxacin and ciprofloxacin) and DNA gyrase B subunit antagonists (novobiocin and coumermycin) but not to the aminoglycoside gentamicin, suggesting involvement of DNA gyrase. DS1 also appeared to be minimally tolerant to the beta-lactam cefoxitin. DS1 exhibited increased susceptibility to the mutagen methyl methanesulfonate, implying a defect in DNA repair. This report describes the first use of quinolone enrichment for isolation of a bacterial strain partially tolerant to quinolones. The study of defects in such tolerant strains offers an approach to an increased understanding of the mechanisms of bacterial killing by quinolones. PMID- 2665643 TI - Multifactorial analysis of effects of interactions among antifungal and antineoplastic drugs on inhibition of Candida albicans growth. AB - Interactions among antineoplastic and antifungal drugs affecting the inhibition of Candida albicans growth are complex functions of the nature of the drugs used in combination, their absolute concentrations, and also their relative concentrations. Studies of drug interactions involving the use of test drugs in fixed concentration ratios can lead to inaccurate conclusions about synergism or antagonism among the drugs. A multifactorial experimental design procedure in which the concentrations of all drugs in test combinations were simultaneously varied has been used to identify and quantify drug interactions. The methods have been applied to combinations of two, three, and four drugs, including antineoplastic drugs, antifungal drugs, and combinations of antineoplastic and antifungal drugs. Results were obtained which allow predictions of effects of combinations and provide maximum effectiveness in growth inhibition with minimum levels of the test drugs. PMID- 2665644 TI - Plasmid-mediated beta-lactamases in clinical isolates of Klebsiella pneumoniae and Escherichia coli resistant to ceftazidime. AB - Low-level transferable resistance to ceftazidime was detected in seven strains of Klebsiella pneumoniae and one strain of Escherichia coli. Six of the Klebsiella strains and the E. coli strain were shown to produce a novel beta-lactamase (CAZ lo) with a pI of 5.6 that hydrolyzed broad-spectrum cephalosporins at low but comparable levels. One strain of K. pneumoniae was of a serotype different from that of the other strains and produced a plasmid-encoded cefuroximase (FUR) with a pI of 7.5 that mediated moderate levels of resistance to different broad spectrum cephalosporins. High-level resistance to ceftazidime was detected in one other strain of K. pneumoniae, which produced a beta-lactamase with a pI of 6.5 (CAZ-hi). Apart from its pI, this enzyme differed from CAZ-lo by a specific and high hydrolytic activity against ceftazidime. The epidemiological context suggested that CAZ-hi may be a mutant of CAZ-lo, and this hypothesis was supported by the isolation of laboratory mutants of CAZ-lo showing properties identical to those of the clinical CAZ-hi enzyme. PMID- 2665645 TI - Ceftriaxone-netilmicin combination in single-daily-dose treatment of experimental Escherichia coli endocarditis. AB - We evaluated the activities of ceftriaxone (15 mg/kg), netilmicin (6 mg/kg), and their combination given intramuscularly once daily for 4 days for the treatment of experimental Escherichia coli endocarditis in rabbits. In vitro, a greater rate of killing and an increased trough serum bactericidal titer (P less than 0.01) were achieved with the combination. In vivo, the combination had a greater bactericidal effect (P less than 0.01) and resulted in a greater number of sterile vegetations (P less than 0.05) than single-drug therapy. Thus, in vivo, an increased effect can be obtained despite a single daily dose of a long-acting cephalosporin and an aminoglycoside. PMID- 2665646 TI - Perioperative nursing research. Part VI: Postoperative phase. AB - The universe of knowledge applicable to the nursing care of patients during the postoperative phase is quite diverse. Interpretation of clinical studies requires caution when confounding variables are not controlled. The variety of articles applicable to postoperative nursing care clearly demonstrates the need for nurses to have advanced knowledge in science, particularly physiology, to fully grasp the phenomena occurring in the postoperative patient. Nurse investigators are commended for their research efforts and are encouraged to continue challenging intuitive and traditional clinical nursing practices. PMID- 2665647 TI - A history of trauma care. From cutter to trauma surgeon. PMID- 2665648 TI - L-histidinol dehydrogenase, a Zn2+-metalloenzyme. AB - The enzymatic activity of L-histidinol dehydrogenase from Salmonella typhimurium was stimulated by the inclusion of 0.5 mM MnCl2 in the assay medium. At pH 9.2 the stimulation was correlated with binding of 1 g-atom of 54Mn2+/mol dimer, KD = 37 microM. ZnCl2, which prevented the MnCl2 stimulation, also bound to the enzyme, 1.2 g-atom/mol dimer, KD = 51 microM, and prevented Mn2+ binding. Enzyme activity was lost when histidinol dehydrogenase was incubated in 8 M urea. Reactivation was observed when urea-denatured enzyme was diluted into buffer containing 2-mercaptoethanol but required either MnCl2 or ZnCl2. Histidinol dehydrogenase was inactivated by the transition metal chelator 1,10 phenanthroline or by high levels of 2-mercaptoethanol. The nonchelating 1,7 phenanthroline was not an inactivator, and inactivation by either 1,10 phenanthroline or 2-mercaptoethanol was prevented by MnCl2. Enzyme inactivated by 1,10-phenanthroline could be reactivated by addition of MnCl2 or ZnCl2 in the presence of 2-mercaptoethanol. Reactivation was correlated with the binding of 1.5 g-atom 54Mn2+/mol dimer. Atomic absorption analysis of the native enzyme indicated the presence of 1.65 g-atom Zn/mol dimer, and no Mn was detected. The results demonstrate, therefore, that histidinol dehydrogenase contains two metal binding sites per enzyme dimer, which normally bind Zn2+, but which may bind Mn2+ while retaining enzyme function. Histidinol dehydrogenase is thus the third NAD linked oxidoreductase in which Zn2+ fulfills an essential structural and/or catalytic role. PMID- 2665649 TI - Structural study of phosphomannan of yeast-form cells of Candida albicans J-1012 strain with special reference to application of mild acetolysis. AB - Structural analysis of the phosphomannan isolated from yeast-form cells of a pathogenic yeast, Candida albicans J-1012 strain, was conducted. Treatment of this phosphomannan (Fr. J) with 10 mM HCl at 100 degrees C for 60 min gave a mixture of beta-1,2-linked manno-oligosaccharides, from tetraose to biose plus mannose, and an acid-stable mannan moiety (Fr. J-a), which was then acetolyzed by means of an acetolysis medium, 100:100:1 (v/v) mixture of (CH3CO)2O, CH3COOH, and H2SO4, at 40 degrees C for 36 h in order to avoid cleavage of the beta-1,2 linkage. The resultant manno-oligosaccharide mixture was fractionated on a column of Bio-Gel P-2 to yield insufficiently resolved manno-oligosaccharide fractions higher than pentaose and lower manno-oligosaccharides ranging from tetraose to biose plus mannose. The higher manno-oligosaccharide fraction was then digested with the Arthrobacter GJM-1 alpha-mannosidase in order to cleave the enzyme susceptible alpha-1,2 and alpha-1,3 linkages, leaving manno-oligosaccharides containing the beta-1,2 linkage at their nonreducing terminal sites, Manp beta 1- --2Manp alpha 1----2Manp alpha 1----2Manp alpha 1----2Man, Manp beta 1----2Manp beta 1----2Manp alpha 1----2Manp alpha 1---- 2Manp alpha 1----2Man, and Manp beta 1----2Manp beta 1----2Manp beta 1----2Manp alpha 1---- 2Manp alpha 1----2Manp alpha 1----2Man. However, the result of acetolysis of Fr. J-a by means of a 10:10:1 (v/v) mixture of (CH3CO)2O, CH3COOH, and H2SO4 at 40 degrees C for 13 h was significantly different from that obtained by the mild acetolysis method; i.e., the amount of mannose was apparently larger than that formed by the mild acetolysis method. In summary, a chemical structure for Fr. J as a highly branched mannan containing 14 different branching moieties was proposed. PMID- 2665650 TI - Orotate phosphoribosyltransferase from yeast: studies of the structure of the pyrimidine substrate binding site. AB - The pH dependencies of both the forward and reverse orotate phosphoribosyltransferase (ORPTase)-catalyzed reactions have been examined and determined to be dissimilar, with maximal activity for the forward reaction near to pH 8. The maximal activity of the reverse pyrophosphorolysis was observed between pH 6.5 and 7.5. Appropriate pK values were determined using computer fitting exercises. One such pK value (equal to 8.6) suggested the presence of lysine residues at the OPRTase active site. Incubations of OPRTase with the substrate analog, uracil 6-aldehyde, in the presence of sodium borohydride, suggested that this compound is a covalent modifier of OPRTase lysine residues, and substrate protection studies provided evidence that the affected lysine residues were located near to both the phosphoribosyl 1-pyrophosphate (PRibPP) and the orotate binding sites. Similar studies with pyridoxal 5-phosphate and labeled sodium borohydride as modifiers have revealed that two modified active site lysine residues per OPRTase subunit account for the loss of 90% of the enzymatic activity with this reagent. We suggest that essential lysine residues, along with divalent metal ions, are located at the OPRTase active site, and form ion-pair bonds with anionic PRibPP and orotate as these substrates bind to the enzyme. We also report that 5-azaorotate is an alternate substrate for OPRTase (Km = 75.5 +/- 0.1 microM) leading to formation of an unstable nucleotide product). PMID- 2665651 TI - Plant glucosidase II catalyzes a transglucosylation reaction in addition to the hydrolytic reaction. AB - When the purified plant glucosidase II was incubated with [3H]Glc2Man9GlcNAc in the presence of glycerol and the products were analyzed by gel filtration, a large peak of radioactivity emerged just before the glucose standard. The formation of this peak was dependent on both the presence of Glc2Man9GlcNAc and the presence of glycerol, and the amount of this product increased with time of incubation and amount of glucosidase II in the incubation. When the incubation was performed with [3H]Glc2Man9GlcNAc plus [14C]glycerol, the product contained both 14C and 3H. Strong acid hydrolysis of the purified product gave rise to [14C]glycerol and [3H]glucose. Various other chemical treatments and chromatographic techniques showed that the product was glucosyl----glycerol. Since the glucose was released by alpha-glucosidase, the product must be glucosyl alpha-glycerol. This study demonstrates that the processing glucosidase II catalyzes a trans-glycosylation reaction in the presence of acceptors like glycerol. Since this transglycosylation reaction may give rise to unexpected products, investigators should be aware of its possible occurrence. PMID- 2665652 TI - [Clinical application of anti-idiotypic antibody]. AB - The concept of idiotype networks are supposed to play important roles in regulation of the immune response, and anti-idiotypic (anti-Id) antibodies have enabled to analyze the pathogenesis of autoimmune diseases and structural relations of receptors and ligands in clinical fields. We applied anti-idiotypic monoclonal antibodies (MoAb) to tumor immunology to analyze idiotype network system of tumor associated antigen (TAA) and to investigate the fine structure of TAAs and their corresponding antibodies. New assays were established to detect circulating TAAs, anti-TAA antibodies and their immune complex regarding YH 206 antigen and carcinoembryonic antigen (CEA) systems. The measurement of anti-TAA antibodies and immune complex was found to be of value for the cancer diagnosis. The results about immune response with use of anti-Id monoclonal antibodies suggest that some of the anti-Id antibodies might be useful for cancer therapy, since anti-Id antibody could induce anti-anti-Id antibodies reactive with tumor antigen. In this review, the usefulness of anti-Id MoAb to serodiagnosis and immunotherapy for cancer was discussed. PMID- 2665653 TI - [Flow cytometric analysis of oncogene products]. AB - Flow cytometry (FCM) of oncogene products which opens new avenues of cell biological investigation of human neoplasia is being reviewed. Using H-ras p21/DNA dual FCM, patients with DNA-aneuploid multiple myeloma (MM) were examined. The patients whose MM cells expressed high level of H-ras p21 had poor prognosis. Specificity of this assay was appraised extensively. It is not likely that H-ras p21 expressed in MM is of oncogenic form since point mutation of H-ras gene was not reported in B cell chronic lymphocytic leukemia which is closely located to MM in B lymphocyte differentiation lineage. High expression of H-ras p21 in MM seems to be related to cell proliferation and/or differentiation. H-ras p21/DNA dual FCM is applicable to analyse the pathophysiology of tumor cells. FCM analyses of other oncogene products and proteins related to cell proliferation, c myc, p53 and Ki-67, were also described. Multiparameter FCM analysis is quite suited to examine expression of these proteins in situ. PMID- 2665655 TI - [Malignant pericardial effusion after esophageal cancer surgery successfully treated by intrapericardial instillation of CDDP]. AB - The patient is a 63-year-old male with pericardial effusion who fell into cardiac tamponade one year and eight months following radical operation for esophageal cancer (stage IV). Because the cytological diagnosis for the punctured specimen of pericardial effusion indicated class V, we recognized it as pericardial recurrence and instilled CDDP 20 mg and 25 mg into the pericardial cavity. The pericardial effusion disappeared completely. There are many reports of CDDP instillation into the pleural cavity or the peritoneal cavity, but few into the pericardial cavity. For esophageal cancer, this is the first report in Japan. The patient is still alive at present after fourteen months have passed. It is considered that this method is effective for malignant pericardial effusion due to advanced esophageal cancer. PMID- 2665654 TI - [The pharmacokinetics of cisplatin and its influence on renal function according to different infusion methods (report II)--alleviation of renal impairment by bismuth subnitrate combined with ginseng and tang-koui ten]. AB - In the previous report, we discussed in vivo dynamics and renal impairment resulting from the difference in cisplatin CDDP administration. In the present study, we investigated in vivo dynamics and renal impairment under 1 h of continuous drip infusion of CDDP. The free-type Pt concentration ratio, which is considered to indicate antitumor activity in the overall plasma Pt concentration at the end of the administration, was noted to be approximately 64%. This was significantly higher than other administration methods, making this an effective administration procedure. However, NAG, which is considered to be an index of renal impairment along with the amount of beta 2-microglobulin urine excretion, showed higher values than those by other administration methods. Thus, using the 1-hr continuous CDDP drip infusion, we attempted to alleviate the renal impairment, combining bismuth subnitrate with ginseng and Tang-koui ten. As a result, the amount of beta 2-microglobulin excretion in the urine was diminished as well as NAG, and a reduction of the renal impairment was noted. These alleviational effects of the renal impairment were attributed to the method of consistent oral administration by which alleviation could take place with little load on the patient. PMID- 2665656 TI - [High-dose etoposide therapy of bone marrow transplantation: the improved method for infusion]. PMID- 2665657 TI - Haemophilus influenzae type b conjugate vaccine trial in Oxford: implications for the United Kingdom. AB - The safety and immunogenicity of a Haemophilus influenzae type b conjugate vaccine was investigated in 103 infants immunised at 3, 5, and 9 months of age; the infants also received diphtheria, pertussis, and tetanus and polio vaccines. Side effects were compared with 99 matched infants receiving diphtheria, pertussis, and tetanus and polio vaccines only. No serious side effects were observed and the incidence of minor side effects was no greater in the recipients of H influenzae type b conjugate vaccine. Two doses of the vaccine (standard and low) were compared: geometric mean titres of serum anticapsular antibody rose from 0.11 microgram/ml before immunisation to 26.4 micrograms/ml after three immunisations with the standard dose and 14.6 micrograms/ml with the low dose. The geometric mean titre among 21 unimmunized infants at this age was 0.06 micrograms/ml. Both doses therefore generated antibody concentrations likely to be protective after three immunisations. There were no non-responders. Incorporation of an H influenzae type b conjugate vaccine into the primary immunisation schedule has the potential for preventing over 1000 cases of systemic H influenzae type b disease and 50 deaths each year in the United Kingdom. PMID- 2665659 TI - Cranial ultrasound assessment of gestational age in low birthweight infants. AB - The anatomical features of the cerebral hemispheres of 97 infants were studied by ultrasonography. A scoring system was devised based on anatomical and ultrasound appearances and compared with gestational age calculated from the date of the mother's last period. There was a significant positive correlation between gestational age and ultrasound score. Cranial ultrasonography is an accurate and reproducible method of assessing gestational age in low birthweight infants. PMID- 2665658 TI - Newborn splenic volumes vary under different malaria endemic conditions. AB - Ultrasound was used to measure newborn splenic dimensions and calculate the volumes in a malarious and a non-malarious region of Papua New Guinea. The median splenic volume of infants born in Madang, where malaria transmission is high throughout the year, was 5.2 cm3/kg, while that of infants born in Goroka, where malaria is not endemic, was 2.6 cm3/kg. The cause of this difference is unknown, but possible explanations include fetal exposure to malaria antigens in utero and the high incidence of inherited red cell disorders in the malarious regions of Papua New Guinea. PMID- 2665660 TI - Neonatal urological ultrasound: diagnostic inaccuracies and pitfalls. AB - Ninety one patients with urinary tract abnormalities diagnosed before birth were reviewed. Diagnoses based on prenatal and postnatal ultrasound scans alone were compared with the final diagnoses after full urological investigations, with operative or necropsy confirmation in 79 cases. The results confirmed that ultrasound examination before birth usually detects nonspecific abnormalities and although scanning after birth is more accurate it is not absolutely reliable. A diagnosis of "multicystic kidney' made on ultrasound scan alone is especially prone to error. Such mistakes can be avoided if full urological investigation is undertaken in every case. PMID- 2665662 TI - Are babies more satisfied by casein based formulas? AB - A review of 173 infants who were started on whey based formula showed that 40 (23%) had their feeds changed, usually to a casein based feed by 6 weeks. A double blind randomised trial, comparing casein based with whey based formula confirmed that about 20-25% of babies have their formula changed within six weeks irrespective of the nature of the feed on which the infant was started. PMID- 2665661 TI - Single dose trimethoprim for urinary tract infection. AB - A randomised clinical trial of single dose trimethoprim against a seven day course of co-trimoxazole (trimethoprim/sulphamethoxazole) for the treatment of uncomplicated urinary tract infection was carried out in 106 children aged between 2 and 16 years. Of the 50 children with confirmed urinary tract infections who were followed up 48 hours after treatment with a single dose of trimethoprim all were free of infection, whereas two of the 56 who received the course of co-trimoxazole (4%) had persisting infections. At follow up after 10 days, however, significantly more of the group treated with trimethoprim had evidence of recurrent urinary tract infection compared with those who had received co-trimoxazole (10 of 44, 23%, compared with one of 46, 2%). Of the recurrences in the trimethoprim group, six were asymptomatic. We conclude that single dose trimethoprim is effective in clearing the urine of bacteria, but the risk of asymptomatic bacteriuria soon after treatment is high. PMID- 2665663 TI - Management of diabetes mellitus. PMID- 2665664 TI - Neonatology--then and now. Assisted ventilation in the newborn (1964). PMID- 2665665 TI - Epidemiologic and toxicologic evidence for chronic health effects and the underlying biologic mechanisms involved in sub-lethal exposures to acidic pollutants. AB - Since the 1880s, a disparate and extensive literature has evolved examining the biologic effects of acidification on cells. More recently, effects on the health of human and other species of acidic agents contained, for example, in pollutants have been suggested, particularly relating to long-term exposures. This paper provides a review of the epidemiologic and toxicologic evidence concerning health effects--particularly carcinogenicity--attributable to sub-lethal acid exposure. Underlying biologic mechanisms that explain adverse health outcomes include pH modulation of toxicity for a number of xenobiotics (including carcinogens, genotoxins, and teratogens), and low-pH-induced changes of cells involving, for example, alterations in mitotic and enzyme regulation. More focused research is recommended to test the relationship between long-term exposures to acidic agents (with a consequent lowered cellular pH) and various health effects. PMID- 2665666 TI - Behavioral treatment of panic-related disorders: a review. AB - Behavioral theories and therapy techniques for panic-related disorders are reviewed. A variety of research studies and measurement techniques are discussed, and methodological issues are highlighted, particularly with respect to outcome measures and controversies in the literature regarding treatment assessments. The preponderance of treatments and research to date have examined the effects of various combinations of treatments on panic disorder. More recently, the use of behavioral therapy for panic disorders has received increasing empirical support. This paper describes treatments for panic-related disorders, especially phobic avoidance behavior, from a behavioral therapy context. PMID- 2665667 TI - Existentialism as a theoretical basis for counselling in psychiatric nursing. AB - Counselling is increasingly described in the literature as an important part of the psychiatric nurse's role. Often, the type of counselling described in that literature is of the client-centered type developed by Carl Rogers. This report outlines the philsophical position known as existentialism and offers suggestions as to how that philosophy may be used to develop a more vigorous and more egalitarian approach to counselling in nursing. PMID- 2665668 TI - [Thymoma. Anatomo-clinical results apropos of 16 cases]. AB - We report a clinicopathologic study in sixteen patients (11 male and five female) with thymomas. The fairly large proportion of children (3 cases: 12.5%) and significant number of advanced forms may at least partly explain the low survival rate (27% at five years) in our series. Advances in histologic studies of tumors have made possible the accurate diagnosis of thymomas, but the value of a histologic classification is still under debate. Conversely, pathologic and surgical classification is at present the best predictor of outcome. PMID- 2665669 TI - [Initial immunolabelling in the diagnosis of solid tumors undergoing cytologic studies (cytopuncture and imprints)]. AB - A minimum immunocytolabelling panel was applied to cytologic specimens from 112 solid tumors obtained by operative specimen imprints or fine needle biopsies of superficial or deep organs. A confirmatory histopathologic study was performed subsequently in all cases. Cases were divided into two groups: group 1 (n = 69) included the malignant tumors exhibiting diagnostic morphologic features; this group served as a control. Group 2 (n = 43) included the undifferentiated malignant tumors that were not classifiable on the basis of routine cytomorphologic data. Immunocytolabelling was done using immunofluorescence and/or PAP and a minimum panel of monoclonal antibodies against keratin (KL1), epithelial membrane (EMA), vimentin, and leukocyte common antigens. In the overwhelming majority of cases, immunocytolabelling provided useful diagnostic information (carcinomas/malignant lymphomas, carcinomas/malignant melanomas, carcinomas/sarcomas, etc...). Some tumors simultaneously expressed an epithelial antigen and a vimentin-like antigen. The problem of such coexpression is discussed. In our opinion, immunocytolabelling of cytologic samples is especially useful for studying needle biopsy specimens of organs, particularly deep organs. PMID- 2665670 TI - Post-operative Doppler evaluation of 48 arterial reconstructions at the wrist. AB - C. W. Doppler ultrasound was used for the assessment and follow-up of 35 ulnar or radial arteries, repaired in emergency, and 13 secondarily repaired arteries, after traumatic section. Doppler examination appeared to be more sensitive than Allen test, because it can distinguish, among non functional arteries, those with or without Doppler signal. Moreover, when a Doppler signal is present, the compression test of the other artery can increase or not this signal. Thus, Doppler examination gives an help for surgical decision. PMID- 2665671 TI - [Anatomic variations of the vascular network of the first dorsal commissure. Uses of the kite flap]. AB - Thirty dissections were performed on fresh, unfixed, adult cadavers after vascular injection of silastic or methylene blue. Analysis of the results led to replacement of the concept of a single dorsal intermetacarpal artery, the constant pedicle of the kite flap, by that of an intermetacarpal vascular system composed of one or two supra- and/or sub-aponeurotic vessels. The existence of distinct direct skin branches of this intermetacarpal vascular system is defined. The various possible modes of vascularisation of the kite flap are listed, defining the situations at risk and leading to precise practical applications in terms of surgical technique. PMID- 2665672 TI - [Radiographic effects in surgery of the hand]. AB - Numerous radiographic views are available for visualisation of the skeleton of the hand. After an analysis of the literature, the authors selected those approaches which are simple and yield the best results. PMID- 2665673 TI - Primary repair of extensor tendons with assisted post-operative mobilisation. A series of 48 cases. AB - Forty-eight patients with lesions of the extensor apparatus of the hand were treated by primary repair with assisted post operative mobilisation by means of a dynamic extension, low profile splint. They were divided into three groups: 25 simple wounds of the extensor tendons of the fingers; 14 simple wounds of the extensor tendon of the thumb; 9 complex lesions. The mobility of the tendinous suture and the callus displacement were monitored by means of metallic markers implanted at operation. Functional electromyographic study during physiotherapy permitted refinement of the technique of reeducation by a limitation of the range of flexion of the proximal interphalangeal articulations. The results are divided into 4 categories: excellent 33 (60%), good 9 (16.4%), average 4 (7.3%), bad 9 (16.4%). No complications (infection, loosening of suture, reflex sympathetic dystrophy) were detected in this short preliminary series. The proposed technique produced improvement of only minor significance in comparison with traditional methods, when applied to uncomplicated wounds. Significantly improved results were obtained in the group of patients with complex lesions. PMID- 2665674 TI - [Study of amino acid utilization by isogenic strains of Escherichia coli in relation to the culture growth and biosynthesis of penicillin amidase]. AB - Dynamics of free amino acid utilization by isogenic strains of Escherichia coli differing in intensity of their growth and levels of penicillin acylase biosynthesis in media containing corn steep liquor or peptone was studied. It was shown that in both the media some amino acids such as serine, threonine, glutaminic and asparaginic acids were actively utilized by the strains mainly during the culture intensive growth while others such as glycine, alanine and tyrosine were actively utilized during the enzyme biosynthesis. Intensively utilized arginine and proline were probably used for the growth and biosynthesis. The other amino acids were not utilized completely from the media. The lowest levels of their utilization were observed when the strains were cultivated in the medium with peptone. PMID- 2665675 TI - [A microbiological test system for determining dioxidine levels in biological fluids]. AB - A microbiological procedure for determining dioxidine concentrations in biological fluids with using E. coli AB 2472 rec A 16, a reparation deficient strain as a test organism is described. Cell suspension of the strain 24-hour culture is added to 1.2 per cent agar with Hottinger digest (140 mg per cent of amine nitrogen), 3 g/l of disubstituted sodium phosphate and 0.4 per cent of glucose cooled to 50 degrees C. 10 ml of the medium are added to every Petri dish with metallic cylinders put on the agar. After the medium solidification the cylinders are removed and 0.1 ml of the solution being tested is added to every well. The dishes are incubated for 24 hours under anaerobic conditions. The test system sensitivity is 0.2 microgram/ml of dioxidine. The relationship between the growth inhibition zone and the drug concentration is linear within dioxidine concentrations of 0.2 to 3.2 micrograms/ml. PMID- 2665676 TI - [Study of immunoregulating properties of an interferon inducer in animals with various reactions to the antigen]. AB - Influence of dsRNA isolated from killer yeast of S. cerevisiae on humoral and cellular immune responses in mice CBA/CaY and C57Bl/6Y with opposing reaction to the antigen was studied. It was shown that after administration of the yeast dsRNA preparation to the animals simultaneously with the antigen there was an increase in the number of the antibody forming cells in the spleen and the titer of hemolytic antibodies in blood serum of the animals with high and low reactions to the antigen. After sensitization with different doses of sheep red blood cells (10(7) and 10(8)) the preparation had immunomodulating action on development of DTH in mice CBA/CaY. The effect of the dsRNA preparation on the immunity system depended on the preparation dose, antigen loading and animal genotype and was the most marked in mice CBA/CaY with interferon levels in blood serum 2-3 times higher than those in mice C57Bl/6Y. PMID- 2665677 TI - [Antibacterial therapy of urinary tract infections]. PMID- 2665679 TI - Testicular ultrastructure in infertile men. AB - The review shows typical ultrastructural alterations of germ, Sertoli, and Leydig cells in infertile men. Regardless of the cause of infertility, the disruption of the spermatogenic process usually occurs in the pachytene stage of meiotic prophase and in the stages of early spermatid maturation. The disturbances affect the cytoplasm more than the nucleus, and the synaptonemal complexes have shown significant stability even in the severely injured testes. An acrosome formation is found to be open to injury in more advanced germ cells during spermatid maturation. The manner of reaction of the Sertoli cells under different pathological conditions depends on the presence and degree of maturation of the neighboring germ cells. The appearance of immature Sertoli cells is accompanied by the loss of germ cells more advanced in their differentiation. In most pathologically altered testes, mature Sertoli cells reveal a universal manner of reaction of cell organelles. Leydig cell ultrastructure fluctuates considerably, and the alterations predominantly affect the sites of steroid synthesis, in spite of disease specificity. It becomes clear that a complex estimation of a real testicular state requires the application of new techniques as well as recognition of local control mechanisms. This will provide evidence toward elucidation of male infertility. PMID- 2665678 TI - [Pharmacokinetic interpretation of the nephrotoxic effect of aminoglycosides. Pharmacodynamic aspects of the nephrotoxic effect of aminoglycosides]. PMID- 2665680 TI - Biochemical changes in testicular varicocele. AB - The precise mechanism of the hypospermatogenesis associated with varicocele has remained uncertain, although there have been a number of speculations on the etiology of the associated infertility. The altered spermatogenesis has been attributed to the reflux of toxic metabolites from either adrenal or renal origin, disturbed hormone status, spermatic venous hypertension, testicular hypoxia secondary to stasis, and abnormal temperature regulation. However, the biochemical changes of the testicular tissue with varicocele have been only partially explored. This overview includes the available information on the biochemical change in the testes associated with varicocele as well as the introduction of basic biochemical aspects on the testes, which may give new insights into the possible pathophysiological mechanism of male infertility. PMID- 2665681 TI - [Does iron deficiency in young children have an impact on psychomotor development?]. PMID- 2665682 TI - [Recto-colic polyps in the child. Analysis of 183 cases]. AB - Between January 1974 and April 1988, 1,533 colonoscopy were carried out in children less than 15 years old. Two hundred and seventy-four polyps were demonstrated in 183 children (106 boys, 77 girls, mean age: 6 years). The main symptom in most cases was rectal bleeding during defecation. A family history of polyps or digestive cancer was found in 6% of all patients. Two hundred and thirty-nine polyps were removed by endoscopic resection, 232 of them by the diathermic snare and 7 by William's hot biopsy technique. Histological examination of 129 polyps revealed a juvenile polyp in 125 cases, an hyperplastic polyp in 2 cases, a lymphoid polyp in 1 case and an adenoma in 1 case. No complications were observed except for one case each of hemorrhage and perforation following endoscopic polypectomy. PMID- 2665683 TI - [Cayler's cardio-facial syndrome. Apropos of 19 cases]. AB - Hypoplasia of the depressor angulae oris muscle can be detected in the crying newborn by an asymmetry of the facies, and it must be differentiated from facial palsy. Asymmetry of the facies during crying spells associated with a congenital cardiac abnormality constitutes the Cayler's cardiofacial syndrome. Nineteen cases of this syndrome are reported. A wide spectrum of congenital heart defects of varying severity was observed, ventricular septal defect being the most common along with frequent malformations involving systems and organs other than the heart. PMID- 2665684 TI - [Anaphylaxis syndrome induced by exercise]. AB - The authors report the case of a 12 year-old boy with exercise-induced anaphylaxis. Angioedema was the main symptom and was accentuated by ingestion of an orange prior to exercise. Exercise-induced anaphylaxis is due to mast cell degranulation that is triggered by exercise alone or, less commonly, by the combination of a sensitizing food and exercise. The symptoms of exercise-induced anaphylaxis may be moderate or severe, with laryngeal dyspnea and shock. Prevention is based on avoidance of the offending food before exercise and a reduction of the intensity (and even the suppression) of exertion. PMID- 2665685 TI - [Lyme disease in the child]. PMID- 2665686 TI - [Contributions of echography in obstetrics. Consensus conference. Paris, 2-3 December 1987]. PMID- 2665687 TI - Controlled study of haloperidol, pimozide and placebo for the treatment of Gilles de la Tourette's syndrome. AB - The results of this controlled study of the treatment of 57 patients with Gilles de la Tourette's syndrome suggested that both haloperidol and pimozide were more effective than placebo, but that haloperidol was slightly more effective than pimozide. Adverse effects occurred more frequently with haloperidol vs placebo than with pimozide vs placebo, but the frequency was not significantly different for haloperidol compared with pimozide. Clinically significant cardiac effects did not occur at a maximum dosage of 0.3 mg/kg or 20 mg/d for pimozide and 10 mg/d for haloperidol. However, the QTc interval was prolonged during pimozide treatment compared with that during haloperidol treatment, although the values for both medications were not in an abnormal range. PMID- 2665688 TI - Cholinergic hyperactivity and negative schizophrenic symptoms. A model of cholinergic/dopaminergic interactions in schizophrenia. AB - Despite renewed interest in negative schizophrenic symptoms, the pathophysiological mechanisms involved in their development remain obscure. Although the cholinergic system has been implicated in schizophrenia, it has not been accorded a major role in current theories of pathophysiology. We present evidence from several lines of research that suggests that muscarinic hyperactivity may be implicated in the pathogenesis of negative schizophrenic symptoms. Specifically, cholinergic overdrive leads to a behavioral syndrome strikingly similar to the negative schizophrenic syndrome, anticholinergic agents may alleviate negative symptoms, schizophrenic patients with negative symptoms tend to "abuse" anticholinergics, and polysomnographic, neuroendocrine, and other pharmacological findings appear to be generally consistent with this hypothesis. The hypothesis is testable and is presented as a heuristic model that focuses on the dynamic interplay between cholinergic and dopaminergic systems in schizophrenia. PMID- 2665689 TI - Retraction. PMID- 2665690 TI - Biotechnology aids to improve feed and feed digestion: enzymes and fermentation. PMID- 2665692 TI - [Smooth muscle cells (current issues of ultrastructural organization]. PMID- 2665693 TI - [Quantitative approaches to the morphologic assessment of the functional activity of the parathyroid glands]. PMID- 2665691 TI - Detection of measles virus genome in blood leucocytes of patients with certain autoimmune diseases. AB - RNA isolated from lymphocytes of peripheral blood was dot-hybridized to a hybrid plasmid containing specific sequences for measles virus nucleocapsid protein. Viral RNA was detected in the lymphocytes of 28 of 34 (82%) patients with systemic lupus erythematosus (SLE) and of 40 of 68 (59%) patients with chronic glomerulonephritis (CGN), and was not detected in 29 control patients. PMID- 2665694 TI - [The Medical Anthropology Section of the All-Union Scientific Society of Anatomists, Histologists and Embryologists: experience and prospects]. PMID- 2665695 TI - Standardized echography in the diagnosis of lacrimal drainage dysfunction. AB - Fifteen patients with symptoms of nasolacrimal duct obstruction were evaluated with B-scan and standardized A-scan ultrasonography. Results were correlated with findings on routine clinical tests of lacrimal drainage function, and echographic findings were confirmed at surgery in all cases. Ten normal lacrimal systems were also examined. In all patients the lacrimal sac and duct were easily visualized as an echolucent defect bounded by the bony lacrimal crests. Abnormal dilatation, diverticuli, and inflammatory exudates were readily detected. Surgically created dacryocystorhinostomy ostia were imaged on both A- and B-scans, as were obstructing membranes seen before surgical revision. Physiologic lacrimal pump failure could not be evaluated, and the exact site of obstruction could not be determined. PMID- 2665696 TI - Hyperproliferation of conjunctival fibroblasts from patients with cicatricial pemphigoid. AB - The characteristic conjunctival scarring in cicatricial pemphigoid is a consequence of subepithelial fibrosis. The fibroblast is the cellular element responsible for fibrosis. To increase the understanding of the pathogenesis of abnormal fibrosis in cicatricial pemphigoid, the growth characteristics of conjunctival fibroblasts, from untreated patients with cicatricial pemphigoid (n = 9) and normal controls (n = 6), were studied in tissue culture. The latent period until fibroblast outgrowth began from the conjunctival explant was determined, as were the plating efficiency and doubling time of cells from first passage cultures. Outgrowths of fibroblasts from patients with cicatricial pemphigoid appeared significantly sooner than from controls, 8.1 +/- 3.8 vs 19.3 +/- 6.4 (mean +/- SD) days. While there was no significant difference in the plating efficiency between fibroblasts from cicatricial pemphigoid (mean +/- SD, 116.4% +/- 44.6%) and those from controls (71.0% +/- 39.4%), the doubling time was significantly faster for cicatricial pemphigoid than for controls, 26.5 +/- 8.5 vs 50.7 +/- 7.8 hours. Thus, conjunctival fibroblasts from patients with cicatricial pemphigoid are hyperproliferative in tissue culture when compared with normal controls. Therefore, scarring, which characterizes cicatricial pemphigoid, may be due, in part, to excessive fibroblast proliferation. PMID- 2665697 TI - Posterior chamber intraocular lens implantation in the absence of capsular support. AB - To avoid the complications associated with anterior chamber intraocular lenses (IOLs), we have developed a technique for the implantation of a posterior chamber IOL in the absence of capsular support. The IOL is secured in the ciliary sulcus by suturing the haptics to the sclera at the ciliary sulcus inferiorly and to the sclera or iris superiorly. We have used this technique for secondary IOL implantation in 16 contact lens-intolerant patients with aphakia with a mean follow-up of 9 months (range, 5 to 20 months) and in eight eyes at the time of IOL removal. All eyes with secondary implants had equal or improved vision postoperatively; none developed persistent angiographic cystoid macular edema. In the 8 patients with IOL exchange, visual acuity improved in five eyes, remained the same in two, and decreased two lines in one. Suturing of an IOL in the ciliary sulcus has enabled us to use a posterior chamber IOL in eyes without a posterior capsule when secondary IOL implantation or IOL exchange is indicated. Secondary posterior chamber IOL implantation is recommended only when satisfactory vision cannot be achieved with glasses or contact lenses, and further follow-up is needed before this procedure can be widely recommended. PMID- 2665698 TI - Fixation of posterior chamber lenses by transscleral sutures: technique and preliminary results. PMID- 2665699 TI - Documentation of suprachoroidal hemorrhage during B-scan ultrasonography. Case report. PMID- 2665701 TI - George Lyman Duff memorial lecture. Cholesterol revisited. Molecule, medicine, and media. PMID- 2665700 TI - Eicosanoids in regulation of arterial smooth muscle cell phenotype, proliferative capacity, and cholesterol metabolism. PMID- 2665702 TI - Insulin, body mass index, and cardiovascular risk factors in premenopausal women. AB - This study assessed the relationship between insulin, glucose, body mass index, and cardiovascular risk factors in a sample of 489 white premenopausal women. All women were participants in the Healthy Women Study (University of Pittsburgh) and had normal blood pressure and fasting blood glucose of less than 140 mg/dl and a 2-hour value after a 75-g glucose load of less than 200 mg/dl. Both body mass index and fasting insulin were significantly and independently associated with blood pressure, triglycerides, and high density lipoprotein (HDL) cholesterol and its subfractions. Body mass index and fasting insulin were more strongly associated with coronary heart disease (CHD) risk factors than were 2-hour insulin, or fasting or 2-hour glucose; glucose levels did not contribute independently to multivariate predictions of any of the CHD risk factors. When patients were divided into tertiles according to fasting insulin and body mass index, there were significant main effects of insulin and body mass index on blood pressure, triglycerides, and HDL cholesterol and its subfractions; the interaction of insulin times body mass index was also significant for systolic blood pressure, triglycerides, and apoprotein B. These data confirm the previous findings of a strong association between insulin and CHD risk factors and extend this to healthy premenopausal women. PMID- 2665703 TI - Changes in pure-tone thresholds in individuals aged 70-81: results from a longitudinal study. AB - The results of audiometric evaluation of 376 randomly selected men and women, 70 years old and born in 1901, are reported. The investigation is part of a large study on a gerontological population in which the original participants were tested again with pure-tone and speech audiometry at ages 75, 79 and 81. We also report audiometric results obtained at ages 70 and 75 from a second group, consisting of 297 men and women born in 1906. Hearing loss was most pronounced at higher frequencies for both sexes, and men had an average of 10 dB greater hearing loss at 8 kHz than women. The decrease in hearing threshold in men between the ages of 70 and 81 was more pronounced at 2 kHz (27 dB) than at 4 and 8 kHz (15 and 20 dB, respectively). The average hearing loss in women increased at a constant rate between the ages of 70 and 79 (15 dB), while between the ages of 79 and 81 the changes in pure-tone threshold was minimal. There were no significant differences in pure-tone thresholds for women born in 1901 when compared to those born in 1906 at the ages of 70 and 75. However, men born in 1906 had a more pronounced hearing loss at the age of 75 than those born in 1901. PMID- 2665704 TI - Tests of fetal welfare. AB - The importance of maternal recording of fetal movements is emphasised by the authors and the value of ultrasound and cardiotocography for follow up examination is discussed. The newer modalities of flow velocity waveforms and cordocentesis should be reserved for specialist units. Other important tests include fetal heart rate monitoring and scalp blood monitoring, and their uses and limitations are reviewed. PMID- 2665705 TI - Emotional factors in pregnancy. AB - Most writings on pregnancy detail the physical changes a woman undergoes during this period. This review shifts the focus to look specifically at emotional factors involving both the mother and father. Many general practitioners, obstetricians and paediatricians are unaware of and therefore insensitive to the development crisis ushered in by the state of pregnancy and so cannot offer emotional support to the couple at a time when they may require assistance. PMID- 2665706 TI - Radiation hazards and victims--a bitter legacy. PMID- 2665707 TI - Bone marrow transplantation. PMID- 2665708 TI - Liver surgery: a revolution. PMID- 2665709 TI - Craniofacial surgical resection: new frontier in advanced head and neck cancer. AB - Craniofacial surgery has revolutionized the management of extensive malignancies and histologically benign but locally invasive tumours which encroach upon or directly invade the undersurface of the brain case. Approaches have been devised for tumours that involve the anterior middle and posterior fossae. Teamwork between head and neck and neurological surgeons is essential. Comprehensive pre operative evaluation, especially the adequacy of cross-fill of the cerebral circulation via the contralateral arterial system through the circle of Willis, must be done. Management of the internal carotid artery and cavernous sinus presents the most difficult surgical problems during the resection. During the closure, separation of the intracranial dissection from the paranasal sinuses and epipharynx by the use of flaps and grafts is essential to prevent cerebrospinal fluid leakage, cerebral support, and isolation of the carotid and dura from upper respiratory tract organisms. Well-planned and executed craniofacial surgery can be done with acceptable morbidity and mortality rates and reasonable survival rates. PMID- 2665710 TI - Carotid artery atheroma: ultrasound appearance in symptomatic and asymptomatic vessels. AB - The distribution of carotid plaque ultrasound appearance has been evaluated using duplex ultrasound in symptomatic and asymptomatic patients. There were 134 patients with unilateral carotid territory symptoms who subsequently underwent endarterectomy of the symptomatic carotid bifurcation, and 92 asymptomatic patients. Both carotid bifurcations in all patients were examined, thus providing three groups of vessels for study: (i) asymptomatic vessels in asymptomatic patients (n = 184); (ii) asymptomatic vessels in symptomatic patients (n = 134); and (iii) asymptomatic contralateral vessels in symptomatic patients (n = 134). Ultrasound appearances were classified as types 1-4. This classification has previously been compared prospectively with endarterectomy specimen pathology where the more echolucent type 1 and 2 lesions correlated well with the presence of intraplaque haemorrhage or ulceration. In the symptomatic arteries, type 1 and 2 lesions were predominant, whereas in the asymptomatic patients the most common lesions were types 3 and 4. This difference was statistically significant (P less than 0.01). Evaluation of the asymptomatic contralateral vessel in the symptomatic patients showed a pattern of plaque type distribution between the other two groups. PMID- 2665711 TI - Granulomatous lobular mastitis. AB - The clinical and histological features of six cases of granulomatous lobular mastitis are presented. All six patients were parous. 1-6 years after their last pregnancy with a mean age of 34 years; all had unilateral disease and presented with an extra-areolar breast lump. Histologically, all demonstrated a non caseating granulomatous inflammatory condition centered on breast lobules; in four women there was an acute inflammatory process with micro-abscess formation. Five of the six cases had persistent or recurrent disease despite wide local excision: surgery might not be the best treatment for recurrent disease. PMID- 2665712 TI - Acute perirenal lymphocele formation 8 years after renal transplantation. AB - The majority of lymphoceles forming as a result of renal transplantation present or are detected within 6 months of surgery. A rare case of late presentation is reported, where the lymphocele developed 8 years after renal transplantation, due to leakage of lymph from the transplant kidney surface. PMID- 2665713 TI - Colonization of the intestine of turkey embryos exposed to Mycoplasma iowae. AB - Eight-day-old turkey embryos were inoculated into the yolk sac with 3 X 10(5) colony-forming units of Mycoplasma iowae strain D112 in order to study the growth depressing effect, the histopathological changes, and colonization of the intestinal tract. The embryo: egg weight ratio was significantly lower in the inoculated eggs than in controls. Histologically, there were infiltrations in parenchymatous organs and chorioallantoic membranes with heterophilic granulocytes. M. Iowae was demonstrated on the intestinal mucosa by antibody fluorescent microscopy and by transmission electron microscopy. Attaching mycoplasmas had a distinct morphology; the segment in contact with enterocytes was cone-shaped and had finely granulated cytoplasma which was abruptly separated from the distal coarsely granulated area. We conclude that M. iowae has a predilection for the intestinal tract of avian hosts. PMID- 2665714 TI - In vitro attachment of Salmonella typhimurium to chick ceca exposed to selected carbohydrates. AB - This investigation was designed to study the effect of selected carbohydrates on the in vitro attachment of Salmonella typhimurium to the ceca of chickens 1 and 2 weeks of age. Ceca were surgically removed from chickens immediately after euthanasia, inverted on glass rods, and then rinsed with sterile saline before being exposed to S. typhimurium in a solution of saline containing the carbohydrate to be evaluated. Attachment of S. typhimurium to ceca was reduced in 1-week-old chicks in the presence of N-acetyl-D-galactosamine, L-fucose, D galactose, L+arabinose, and D+mannose. Minimal or no reduction in attachment of S. typhimurium was noted when ceca from 2-week-old chicks were exposed to the same compounds. Carbohydrates investigated and found to be ineffective for reduction of S. typhimurium attachment to chick ceca were D+fucose and N-acetyl-D glucosamine. PMID- 2665718 TI - The inadequacies of instruments used for cervical screening. AB - Cervical cytology has a high false negative rate, especially for adenocarcinoma and its precursors. This study compares the traditional spatula with the cytobrush. Both the modified Ayre spatula and the cytobrush were found to be inadequate in a significant number of patients with known cytological atypia. It is concluded that inadequate sampling instruments make a contribution to false negative rates and that brush cytology is superior to rigid instrument cytology in routine cervical screening. PMID- 2665719 TI - Fetal head injury following motor vehicle accident; an unusual case of intrauterine death. AB - This case report documents fetal death in utero at 30 weeks' gestation due to subdural and subarachnoid haemorrhages, resulting from a motor vehicle accident in which the mother sustained 'seat belt' and facial injuries. There was no evidence of placental abruption. The causes of fetal deaths in utero following maternal involvement in motor vehicle accidents are discussed. PMID- 2665727 TI - Medical studies in aviation: II. Physiologic observations and methods. 1918. PMID- 2665728 TI - Behavioral science space contributions. AB - In anticipation of longer missions on the space stations, Mir and Freedom, as well as a potential return to the Moon and the exploration of Mars, human survival and the quality of life aloft will be increasingly dependent upon research in the behavioral and biological sciences. This article reviews the possible contributions to space habitation of the behavioral sciences--especially anthropology, psychology, and sociology. Before space settlements become a reality, the author makes a case for the broadening of the engineering approach to human factor studies, and consideration of the integrative living systems theory in space planning and management. PMID- 2665729 TI - Selective thermal neutron capture therapy and diagnosis of malignant melanoma: from basic studies to first clinical treatment. PMID- 2665730 TI - Research on neutron capture therapy in the USSR. PMID- 2665731 TI - Blood-brain-barrier impairment after irradiation: implication in boron neutron capture therapy. PMID- 2665732 TI - Implications of genotypic and microenvironmental heterogeneity for the cure of solid tumors by neutron capture therapy. PMID- 2665733 TI - Proposed clinical trial studying the pharmacokinetics of B.S.H. PMID- 2665734 TI - Dose fractionation in neutron capture therapy for malignant melanoma. PMID- 2665735 TI - Thermal neutron capture therapy: the Japanese-Australian clinical trial for malignant melanoma. PMID- 2665736 TI - [Glucagon degradation in the in vitro recycling perfused rat liver during acute energy deficiency]. AB - Hepatic glucagon degradation was studied using recycling perfused livers from 24h fasted rats in the absence of glucose. In comparison with normoxic conditions, a significantly reduced glucagon cleavage was observed within the first 30 min of hypoxic perfusion (acute energy deficiency). On the contrary, glucagon degradation was markedly increased after 30 min. At the same time, increased release of intracellular glucagon-degrading activity occurred. Partial characterization of the degrading activity showed high specificity for glucagon. Both its metal- and thiol-dependent activity and immunological reaction against specific antibodies are characteristic of the insulin-glucagon-proteinase (IGP) of rat liver. These results indicate that a substantial part of the liver-bound glucagon is internalized via an energy-dependent step followed by degradation by IGP. PMID- 2665737 TI - Concomitant secretion of big endothelin and its C-terminal fragment from human and bovine endothelial cells. AB - A specific radioimmunoassay (RIA) for the carboxyl-terminal fragment (CTF) of big porcine endothelin (pET), an intermediate form of pET, was established to characterize big ET-like and its CTF-like immunoreactivity (LI) secreted from cultured bovine and human endothelial cells (EC). The antibody used crossreacted equally with big pET(1-39) and its CTF(22-39), but not with pET(1-21). Serial dilution curves of the culture media from bovine and human EC were parallel to that of standard CTF. Reverse-phase HPLC coupled with RIAs for big ET and ET of the culture media from bovine and human EC revealed essentially the same elution profiles: two major CTF-LI components, one corresponding to big pET(1-39) and the other to its CTF(22-39), in addition to one major ET-LI component corresponding to pET(1-21). The amounts of CTF-LI were almost equal to that of ET-LI on a molar basis. These data suggest that big ET is processed by a putative ET converting enzyme to yield its CTF and the mature ET(1-21) in EC. PMID- 2665738 TI - Total synthesis of the lipopeptide a-mating factor of Saccharomyces cerevisiae. AB - The a-mating factor of Saccharomyces cerevisiae was synthesized using both solution phase and solid phase strategies. Structure of the final peptide was confirmed using amino acid analysis, fast atom bombardment mass spectroscopy and 400 MHz proton NMR. The synthetic farnesylated dodecapeptide, YIIKGVFWDPAC (S farnesyl) OCH3, exhibited chromatographic and spectroscopic properties identical to the natural pheromone and had significant biological activity at nanomolar concentrations. PMID- 2665739 TI - Presence of endothelin-1 in porcine spinal cord: isolation and sequence determination. AB - We investigated the molecular forms of endothelin (ET) related peptides in porcine spinal cord by high performance liquid chromatography coupled with radioimmunoassays using three antisera raised against ET-1 and C-terminal fragments of ET-1 and big ET-1. ET-1 and its oxidized form were isolated as major immunoreactive peptides and sequenced. Furthermore, immunoreactivities like ET-3 and big ET-1(22-39) (contents: less than 8% and less than 1% of ET-1, respectively) were detected based on their chromatographic retention times and characteristics of immunoreactivity to the antisera. Big ET-1 was only scarcely detected. Immunohistochemical study showed the presence of ET-1-like immunoreactivity in motoneurons, dorsal horn neurons and dot- and fiber-like structures in the dorsal horn of lumbar spinal cord. These results indicate that ET-1 is present not only in endothelial cells but also in spinal cord, and that big ET-1 is converted into ET-1 in spinal cord by specific processing between Trp21-Val22. The data also indicate that ET-1 may act as a neuropeptide in the central nervous system. PMID- 2665740 TI - Vasoconstrictor effects of sarafotoxins in rabbit aorta: structure-function relationships. AB - The sarafotoxins SRTX-a, b and c from the venom of the snake Atractaspis engaddensis are 21-amino acid peptides that affect the cardiovascular system. They are strong vasoconstrictors, the potency of which may be in correlation with their primary structure: SRTX-a, which differs from SRTX-b in a single amino acid residue (Asn instead of Tyr), shows about half of its maximal vasoconstriction, while SRTX-c, which differs in 3 additional residues is a very weak vasoconstrictor and, at high doses, shows vasodilatory effects. Sequential application of the three isotoxins result in a summated response. PMID- 2665741 TI - Immunoreactive endothelin in rat kidney inner medulla: marked decrease in spontaneously hypertensive rats. AB - Using a specific and sensitive radioimmunoassay for endothelin, the regional distribution and molecular form of endothelin was investigated in rat tissue. The highest concentration was observed in the inner medulla of the kidney (8.7 +/- 2.2 pg/mg wet weight). On two kinds of reverse phase high performance liquid chromatography, immunoreactive endothelin in the inner medulla of the kidney was separated into two peaks at positions where authentic porcine/human and putative rat/human endothelin eluted. Furthermore, the concentration of immunoreactive endothelin in the inner medulla of the kidney was remarkably decreased in spontaneously hypertensive rats (SHR) compared with normotensive control Wistar Kyoto rats (WKY) but no difference was observed in lung immunoreactive endothelin. PMID- 2665742 TI - Endothelin stimulates a sustained 1,2-diacylglycerol increase and protein kinase C activation in bovine aortic smooth muscle cells. AB - Endothelin is a long-lasting potent vasoconstrictor peptide. We report here that in bovine aortic smooth muscle cells, endothelin biphasically increased total cellular diacylglycerol (DAG) content. When cellular DAG was labeled with [14C] glycerol for 48h, endothelin stimulated [14C]DAG formation in a biphasic pattern. Only one prolonged phase of DAG accumulation was observed when cells were labeled with [3H]glycerol for 2 h. Endothelin induced an increase in the membranous protein kinase C (PKC) activities, which lasted for more than 20 min. These data suggest that (i) endothelin stimulates a sustained generation of DAG, (ii) this accumulation of DAG results in a sustained translocation of cytosolic PKC activities to the membrane. PMID- 2665744 TI - Metal composition analysis of hydrogenase from Thiocapsa roseopersicina by proton induced X-ray emission spectroscopy. AB - Polyacrylamide gel electrophoresis combined with proton induced X-ray emission spectroscopy is suitable to identify and to determine the relative amounts of protein bound metals in situ. An analysis of the hydrogenase from Thiocapsa roseopersicina has shown the feasibility of the technique and provides new insight into the relative amount as well as the intramolecular location of Fe and Ni metal atoms in this enzyme. PMID- 2665743 TI - Neutrophil activating factor (NAF) induces polymorphonuclear leukocyte adherence to endothelial cells and to subendothelial matrix proteins. AB - Neutrophil activating factor is a polypeptide cytokine released from stimulated mononuclear phagocytes and endothelial cells. We found that neutrophil activating factor induced time- and concentration-dependent binding of human polymorphonuclear leukocytes to endothelial monolayers and subendothelial matrix proteins, via a mechanism that involves altered expression of the leukocyte CD11/CD18 glycoproteins. Thus, neutrophil activating factor is a third mediator, in addition to platelet-activating factor and endothelial leukocyte adhesion molecule 1, that is synthesized by activated endothelium and that can induce polymorphonuclear leukocyte adhesion to endothelial cells. Because NAF is released into the pericellular fluid, it may also stimulate binding of the leukocytes to exposed subendothelial structures at sites of vascular injury. PMID- 2665745 TI - Comparisons of maltase activities in kidney brush border membranes from normal, diabetic, glucose-infused and maltose-infused rabbits. AB - The specific activities of membrane-bound maltase (alpha-D-glucoside glucohydrolase, EC 3.2.1.20) in isolated brush border membranes (BBMs) of alloxan induced diabetic, glucose-infused and maltose-infused rabbits were 30%, 140% and 160%, respectively, of those of control rabbits. Differences in the relative activities of trehalase (EC 3.2.1.28), another disaccharidase, in these groups were similar but less marked. However, the activities of two other marker enzymes of the brush border, alkaline-phosphatase and gamma-glutamyl transpeptidase, were similar in the 4 groups of rabbits. The decreases in the activities of the two disaccharidases were due to changes in the Vmax values of the enzymes without change in their Km values for maltose and trehalose. The maltase activities in the 4 groups showed similar dependences on Tris-HCl, KCl and NaCl. The electrophoretic profiles of the BBMs of the 4 groups on SDS-polyacrylamide gel showed slight differences. From these results, we conclude that diabetes, glucose infusion and maltose infusion probably change the concentrations of active enzymes in the BBM of the kidney in rabbits. PMID- 2665746 TI - Perturbations in nitrogen metabolism of brain and liver of rat following repeated benthiocarb administration. AB - Effects of repeated administration of benthiocarb on the nitrogen metabolism of hepatic and neuronal systems have been studied. Repeated benthiocarb treatment was associated with significant decrease in proteins with a concomitant increase in free amino acids (FAA) and specific activity levels of proteases suggesting impaired protein synthesis or elevated proteolysis. The glycogenic aminotransferases showed a significant elevation in both the tissues indicating high feeding of ketoacids into oxidative pathway for efficient operation of TCA cycle to combat energy crisis during induced benthiocarb stress. However, the activity levels of branched-chain aminotransferases decreased suggesting their reduced contribution of intermediates to TCA cycle. A comparative evaluation of the activity levels of ammonogenic enzymes, AMP deaminase, adenosine deaminase and glutamate dehydrogenase (GDH) indicated that ammonia was mostly contributed by nucleotide deamination rather than by oxidative deamination. GDH exhibited reduced activity due to low availability of glutamate. In accordance with increased levels of urea, the activity levels of arginase, a terminal enzyme of urea cycle was increased suggesting increased urea cycle operation in order to combat the increased ammonia content. As the presence of urea cycle in the brain is rather doubtful, the conversion of ammonia to glutamine for the synthesis of GABA is envisaged in brain whereas in liver, excess ammonia was converted to urea through ornithine-arginine reacting system. The increased glutaminase activity observed during benthiocarb intoxication is accounted for counteracting acidosis or maintenance of metabolic homeostasis. Arginase, a terminal enzyme of ornithine cycle showed increased activity denoting the efficient potentiality of tissues to avert ammonia toxicity. The changes observed in tissues of rat administered with benthiocarb reflects a shift in nitrogen metabolism for efficient mobilization of end products of protein catabolism. PMID- 2665747 TI - Do cytochromes P-448 and P-450 have different functions? PMID- 2665748 TI - Electroreception and magnetoreception in simple and complex organisms. AB - A considerable body of evidence now indicates that electromagnetic and geomagnetic detection systems exist in both simple, unicellular organisms and in more complex species such as avians, bees, and marine animals. A major challenge that faces researchers in this field is the identification of physiological mechanisms through which the detection of weak fields provides significant somatosensory cues for direction finding, foraging, and predation. Many of the anatomical, physiological, and biophysical approaches that are being taken in studies of this nature are described in the series of review articles that appear in this issue of Bioelectromagnetics. PMID- 2665749 TI - Magnetite and magnetotaxis in microorganisms. AB - Magnetotactic bacteria from freshwater and marine sediments orient and navigate along geomagnetic field lines. Their magnetotactic response is based on intracellular, single magnetic domains of ferrimagnetic magnetite, which impart a permanent magnetic dipole moment to the cell. PMID- 2665750 TI - Magnetite biomineralization and geomagnetic sensitivity in higher animals: an update and recommendations for future study. AB - Magnetite, the only known biogenic material with ferromagnetic properties, has been identified as a biochemical precipitate in three of the five kingdoms of living organisms, with a fossil record that now extends back nearly 2 billion years. In the magnetotactic bacteria, protoctists, and fish, single-domain crystals of magnetite are arranged in membrane-bound linear structures called magnetosomes, which function as biological bar magnets. Magnetosomes in all three of these groups bear an overall structural similarity to each other, which includes alignment of the individual crystallographic [111] directions parallel to the long axis. Although the magnetosomes represent only a small volume fraction in higher organisms, enough of these highly energetic structures are present to provide sensitivity to extremely small fluctuations and gradients in the background geomagnetic field. Previous experiments with elasmobranch fish are reexamined to test the hypothesis that gradients played a role in their successful geomagnetic conditioning, and a variety of four-turn coil designs are considered that could be used to test the various hypotheses proposed for them. PMID- 2665751 TI - Conditioning analysis of magnetoreception in honeybees. AB - A central problem in the study of magnetic sensitivity in animals has been the lack of behavioral techniques sufficiently powerful for the systematic psychophysical work required for an understanding of magnetosensory capacity and of the transduction mechanism. In recent experiments, free-flying honeybees have been conditioned to discriminate the presence and absence of localized magnetic dipole anomalies superimposed on the uniform background field of the earth. The results obtained thus far suggest that movement is necessary for conditioned responding to magnetic field stimuli and support the hypothesis that magnetic field transduction is based on single-domain particles of magnetite found in the anterodorsal abdomen of honeybees. PMID- 2665752 TI - [A method of screening artificial substrates for proteolytic enzymes]. AB - A method of screening of proteolytic enzyme's substrates is proposed. An equimolar mixture of substrates consisting of peptide and easily detectable chromophore moieties (all chromophores in the mixture must be different) is subjected to enzymatic treatment. The cleaved chromophore groups, which are products of the substrate proteolysis, are quantitatively determined by chromatography. The Kcat/Km ratio is greater for substrates with higher initial rate accumulation of proteolysis products. The method is illustrated by screening of peptide derivatives of aminonaphtalene sulphonamides for trypsin assay. Proteolysis products are determined by HPLC with absorption detection or by TLC with fluorescence detection. PMID- 2665753 TI - [Synthesis and expression of an artificial gene of an IgG-binding fragment of protein A from Staphylococcus aureus]. AB - The chemical-enzymatic synthesis of a gene for IgG-binding fragment of the staphylococcal protein A has been carried out. The design of the gene, which consists of signal peptide and modified E and B domains, and strategy of the synthesis provided possibility of various degrees of polymerization of the gene fragment coding for B domain and of the whole gene. Several protein A-like polypeptides composed of the leader sequence, E domain and 1 to 4 copies of B domain were produced in E. coli cells under the lac promoter control. PMID- 2665754 TI - [Synthesis of oligoribonucleotides with the use of RNA polymerases of E. coli and immobilized synthetic DNA-templates]. AB - A new approach to synthesis of oligoribonucleotides is suggested, based on transcription by E. coli RNA polymerase of synthetic immobilized DNA-templates with AUG as primer. The approach has been experimentally verified by synthesis of two oligonucleotides, viz., a RNA fragment of the fr phage (16 nucleotides long) and a RNA fragment of the tickborne encephalitis virus (18 nucleotides long). Fraction of the synthesized RNA fragments in the whole nucleotide material is about 20%. The templates can be used repeatedly. Sequences of the oligoribonucleotides were confirmed. Advantages of this approach and its usefulness for SP6 DNA-dependent RNA polymerase are discussed. PMID- 2665755 TI - A strategy for determining the pathogenesis of systemic sclerosis. Is transforming growth factor beta the answer? PMID- 2665756 TI - Sensitivity of a health status measure to short-term clinical changes in arthritis. AB - To assess the sensitivity of the Arthritis Impact Measurement Scales (AIMS), we analyzed data from 3 clinical trials. One trial involving 255 patients with rheumatoid arthritis (RA) was a 12-week, randomized controlled trail of diclofenac, naproxen, and aspirin. Two trials were open-label studies of 24 weeks duration that included 165 RA and 355 osteoarthritis (OA) patients, all of whom were treated with diclofenac. In addition to the AIMS, tender joint count, morning stiffness, and erythrocyte sedimentation rate were used as outcome measures in the trials. The AIMS results showed substantial improvements in Physical Function, Psychological Status, and Pain, as well as in overall Arthritis Impact. These improvements were detected by the time of the initial outcome assessment at 4 weeks or 8 weeks, and were detected in patients with either OA or RA. These AIMS results closely parallel improvements shown by traditional clinical measures, and demonstrate that the AIMS health status measure is sensitive to improvements in OA as well as in RA. The AIMS also detects responses produced by therapy with nonsteroidal antiinflammatory drugs (NSAIDs), and these improvements can be demonstrated in as short a treatment time as 4 weeks. These findings confirm the utility of the AIMS for assessing outcome in rheumatic disease studies, and they have implications for the design of future clinical trials of NSAIDs. PMID- 2665757 TI - In vitro cardiac effects and antiarrhythmic properties of guanfacine. AB - Guanfacine (Estulic, Tenex), a centrally acting antihypertensive, was investigated for its effects on the heart using isolated cardiac preparations and in patients for antiarrhythmic properties. The tachycardic effects of sympathetic nerve stimulation in spontaneously beating atria were concentration-dependently suppressed by guanfacine. A 50% inhibition was observed in atria from Syrian hamsters, guinea-pigs and rabbits with 1, 5.4 and 20 nmol/l, respectively. In guinea-pig atria the concentration-response curve of guanfacine was shifted to the right in a parallel manner by rauwolscine (pA2 8.58) but was not displaced by prazosine 1 mumol/l. In rabbit right papillary muscles guanfacine 1 to 10 mumol/l increased force of contraction by 13 to 91%. The positive inotropic effect was antagonized by prazosine 1 mumol/l but was not influenced by cimetidine 1 mumol/l or rauwolscine 1 mumol/l. It is concluded that guanfacine activates cardiac postsynaptic a1- and neuronal presynaptic a2-adrenoceptors with a preference to the latter of about 2 orders of magnitude. Direct membrane stabilizing effects in guinea-pig atria were negligible. In 4 patients with coronary heart disease associated with arrhythmia guanfacine 1 mg per day during 10 days decreased ventricular premature contractions, couplets and abolished appearance of ventricular tachycardias. These preliminary clinical results indicate that guanfacine may reduce cardiac risk factors. PMID- 2665758 TI - Specific binding of the new stable epoprostenol analogue beraprost sodium to prostacyclin receptors on human and rat platelets. AB - Binding of beraprost sodium (sodium dl-4-[(1R,2R,3aS,8bS)-1,2,3a,8b-tetrahydro-2 hydroxy-1-[(3S, 4RS)- 3-hydroxy-4-methyl-oct-6-yne-(E)-1-enyl] -5- cyclopenta[b]benzofuranyl]butyrate, TRK-100), a new potent antithrombotic agent, to washed platelets of humans and rats was studied. [11-3H]-TRK-100 binding was rapid, reversible, saturable, and highly specific. Scatchard analysis of concentration-dependent binding to human platelets revealed a single class of specific binding sites with an equilibrium dissociation constant (Kd) of 133 nmol/l and a maximal concentration of binding sites (Bmax) of 46 fmol/10(8) platelets (275 sites/cell). Similar binding was observed on rat platelets. The Kd and Bmax were 66 nmol/l and 124 fmol/10(8) platelets (750 sites/cell), respectively. Competitive studies indicated that TRK-100 was 1.5 times less active than prostacyclin (epoprostenol, PGI2), but was 3 times more potent than PGE1 in displacing [3H]-TRK-100 from the binding sites on rat platelets. PGE2, PGD2, PGF2 alpha, and pinane thromboxane A2, a stable thromboxane A2 analogoue, had no affinity for the binding sites. The relative affinity of the four enantiomers of TRK-100--APS-314d, 315d, 3141 and 3151--for the binding sites was 100: 14: less than 1: less than 1, respectively. These results suggest that TRK 100 is a useful tool for studying biological roles of PGI2 as well as for use as an antithrombotic agent since TRK-100 mimics its actions via specific interaction with PGI2 receptors. PMID- 2665759 TI - Additional myocardial salvage by coadministration of the epoprostenol analog taprostene to recombinant single-chain urokinase-type plasminogen activator in a canine coronary thrombosis model. AB - In open chest dogs myocardial ischemia was induced by formation of an occlusive thrombus in the left anterior circumflex artery (LCX). Reperfusion of the LCX was achieved by infusion of the fibrin specific recombinant single-chain urokinase type plasminogen activator (r-scu-PA). The myocardial salvage by r-scu-PA alone and in combination with the epoprostenol (prostacyclin) analog taprostene (CG 4203) was compared. There were four experimental groups: group 1 (n = 4) did not receive any treatment after LCX thrombosis; in group 2 (n = 9) at 100 min after LCX thrombosis r-scu-PA (20 micrograms.kg-1.min-1 i.v. for 30 min) was infused; in groups 3 and 4 treatment with taprostene started concomitantly with r-scu-PA infusion. The taprostene infusions lasted for 120 min and the doses were 0.1 microgram.kg-1.min-1 in group 3 (n = 6) and 0.215 microgram.kg-1.min-1 in group 4 (n = 6). Time to r-scu-PA-induced recanalisation ranged from 18-22 min with no significant difference between groups 2-4. Percent of left ventricle at risk did not differ between the groups. Infarct size as percent of the risk zone was 48.3 +/- 7.7 in group 1, 25.3 +/- 3.7 in group 2, 21.3 +/- 6.5 in group 3 and 17.1 +/- 3.5 in group 4 (p less than 0.05 groups 2-4 vs group 1). Incidence of ectopic beats increased after r-scu-PA-induced reperfusion in groups 2-4, but was significantly reduced by taprostene.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 2665760 TI - Current status of bone marrow transplantation. PMID- 2665761 TI - [A clinical study of selective gut decolonization in 204 long-term ventilated intensive care patients undergoing abdominal and accident surgery]. AB - In a randomized clinical trial the effects of selective digestive decolonization (SDD) on the frequency of pneumonia and sepsis and the rate of lethality as well as the resistance quota and colonization of bacteria were studied in 102 surgical ICU-patients requiring prolonged mechanical ventilation. These patients received non-resorbable antibiotics: 4 x 100 mg of polymyxin B, 4 x 500 mg of amphotericin B, and 4 x 80 mg of tobramycin via gastric tube. One hundred and two patients served as controls. Patients with an expected period of mechanical ventilation of more than 4 days were included into the study. In both groups there were no significant differences regarding the degree of severity of the primary disease. The rate of pneumonia in the SDD-group was significantly lower after the third day compared with the frequency in the control group. The rate of sepsis was significantly lower after the thirteenth day, and the survival rate in the SDD group was significantly higher after the twenty-fourth day of artificial ventilation compared with the control group. A significant reduction of the incidence of potential pathogenic gram-negative aerobe germs detected bronchially and rectally could be demonstrated within the first week in patients of the SDD group. A secondary colonization of the oropharynx in patients of the SDD-group could not be observed. 38.8% of the patients in the control group showed potentially pathogenic microorganisms in oropharyngeal swabs. A development of resistance of pseudomonas aeruginosa against tobramycin occurred in 2.3% of the patients in the SDD-group and in 3.1% of the patients in the control group. It can be concluded that the administration of non-resorbable antimicrobials against gram-negative aerobes is an effective method for prevention of potentially fatal pneumonia and sepsis, and for the first time a significant improvement of the survival rate could be demonstrated. PMID- 2665762 TI - [Therapy of cancer pain--a comprehensive therapy concept]. AB - A comprehensive concept for cancer pain treatment is presented. The main idea of this concept is systematic analgesic pharmacotherapy. It is carried out in three steps, such as recommended by the WHO. This kind of therapy enables an individual adaptation or an increase of analgesic intensity when using non-narcotic analgetics, weak and strong opioids and adjuvant drugs. The principles of their application are discussed, detailed information about the dosage of certain drugs, their effects, side-effects and possible interactions is given, and examples of their clinical use are presented. The local peridural or intradural application of morphine enables a further increase in analgesic intensity. It is carried out by means of peridural and intradural catheters. Also for these cases dosages, side-effects and possible complications are described. The possibilities and advantages of prolonged analgesia with implantable systems (pain ports) and external portable or implantable pumps are discussed. PMID- 2665763 TI - The role of autoreactive T-cell lines in the restoration of the immune response to sheep red blood cells in C57Bl/6-lpr/lpr mice. AB - Although autoimmune-prone mice bearing the lymphoproliferation (lpr) gene have polyclonally activated B cells and high serum titers of autoantibodies, they mount poor immune responses to exogenous antigens. In addition, they exhibit very low or nonexistent autologous mixed lymphocyte responses. Previous studies have shown that autoreactive T-cell clones have immunoregulatory properties: they can help suppress, or contrasuppress an immune response. Here we show that two autoreactive T-cell lines, GB4 and B1H1, can restore the defective response of C57Bl/6-lpr/lpr mice to the antigen sheep red blood cells. This restoration is antigen-dependent and requires the presence of other T cells. PMID- 2665764 TI - Amino acid sequence of the 9-kDa iron-sulfur protein of photosystem I in barley. AB - The 9-kDa thylakoid polypeptide which in vivo carries the iron-sulfur centers A and B of photosystem I was isolated from barley (Hordeum vulgare L.) and the complete amino acid sequence determined. The polypeptide shows a very high degree of homology with the corresponding polypeptides in other plant species. The polypeptide is not post-translationally processed except for the removal of the N terminal formyl-methionine and the insertion of the iron-sulfur centers. PMID- 2665765 TI - Purification and characterization of a Serratia marcescens nuclease produced by Escherichia coli. AB - The primary structure and physical chemical properties were determined of a nuclease expressed and secreted by Escherichia coli. The plasmid p403-SD2 carried a DNA sequence isolated from Serratia marcescens encoding the enzyme. During cultivation of the E. coli cells, 85% of the enzyme was released to the growth medium. The enzyme was purified and exhibited a single band with a molecular weight about 30,600 daltons on SDS-PAGE similar to nuclease isolated from S. marcescens. The amino acid composition and the amino acid sequence determined directly confirmed the primary structure of 245 amino acids predicted from the DNA sequence, and, in addition, the two disulfide bridges were assigned. Several physical chemical properties were examined. The ability of the enzyme to cross the outer membrane is proposed to depend upon the formation of the proper structures during the folding process. PMID- 2665766 TI - Tuberculosis: a six-month cure. AB - Today the treatment of tuberculosis can be based on a course of chemotherapy that lasts only 6 months, giving patients the best change of cure and affording the health personnel an exceptional opportunity to improve both their patients' compliance with the treatment and the overall efficiency of their own activities. PMID- 2665767 TI - Brock Chisholm: words of wisdom from the past. AB - The late Dr Brock Chisholm was WHO's first Director-General. Like his successors, he gave inspired leadership to the Organization. Dr Chisolm's foresight is clearly shown in the following transcript of some of his handwritten notes, which we publish unedited. PMID- 2665768 TI - Implications of a Fab-like structure for the T-cell receptor. AB - The antigen-specific receptor of T lymphocytes (TCR) and the Fab moiety of immunoglobulins are expected to fold into similar three-dimensional structures because of their identical protein domain organization, the conservation of key residues and their overall sequence homology. However, T cells mostly appear to recognize short peptide antigens bound to MHC class I or class II presenting molecules. A complete model of the human leucocyte antigen molecule (HLA-A2) reconstructed from the alpha-carbon coordinates was used to investigate the putative organization of a TCR/peptide/HLA-A2 complex. In this article, Jean Michel Claverie and co-workers show that the respective geometries of a Fab-like TCR structure and of the HLA-A2 antigen binding site suggest a model where the third variable regions of both chains of the TCR mainly interact with the peptide antigen, while the first and/or second less variable regions are in position for making contact with residues pointing up from the alpha 1 and alpha 2 helical regions of the HLA-A2 molecule. PMID- 2665769 TI - Mechanisms and regulation of lymphocyte migration. AB - Lymphocyte traffic seems to be an essential requirement for an adequate immune response both in lymphoid tissues and local inflammatory sites. In this review, Adrian Duijvestijn and Alf Hamann discuss how selective migration of lymphocytes is directed by lymphocyte-endothelial interactions and what mechanisms may control this. PMID- 2665770 TI - Antigen processing--from cell biology to molecular interactions. AB - Antigen presentation is now a central theme in molecular cell biology. A recent meeting focused on the developments in the field and their implications for future manipulation of the immune system. The following report was written from a round-table discussion involving a number of participants'. PMID- 2665771 TI - Molecular interactions in macrophage activation. AB - Macrophage activation, broadly defined as the acquisition of competence to execute a complex function, continues to intrigue biologists, because of its fundamental importance to the host and the fascinating scientific challenges it poses. A recent meeting* emphasized the considerable progress made in this area since the topic was last considered in such a workshop. The workshop focused sharply on one aspect of the field: the molecular basis of macrophage activation, and covered the multiple, specific signals that induce and suppress activation, how these signals are transduced and thus affect macrophage behaviour and how induced function, in turn, is effected. PMID- 2665772 TI - Pathways of viral antigen processing and presentation to CTL: defined by the mode of virus entry? AB - Processing requirements for antigen presentation to cytotoxic T lymphocytes (CTL) vary among viruses and between major histocompatibility complex (MHC) class I- and class II-restricted responses to the same virus. In this article, Eric Long and Steven Jacobson argue that the mode of virus entry may define processing pathways and that the invariant chain associated with MHC class II molecules may account for the distinct processing requirements for MHC class I- and class II restricted CTL. PMID- 2665773 TI - IgM--molecular requirements for its assembly and function. AB - The conventional model of IgM structure depicts a unique, array of mu, L and J chains, held together by well-defined disulfide bonds and other interactions. Some, but not all, recent data support this model. Here Ann Davis and Marc Shulman review recent, as well as older, studies of IgM and consider their implications for our understanding of IgM structure and function. PMID- 2665774 TI - The mosaic of autoimmunity. AB - The term 'autoimmune' is applied to a wide spectrum of diseases, which, although they may differ in pathology, share many factors. In their review, portrayed as a mosaic, Yehuda Shoenfeld and David Isenberg illustrate the complexity of these conditions, outlining the many pieces, genetic, hormonal, immunological and environmental that contribute to auto-immunity, and show how their varying combinations lead to diverse diseases. PMID- 2665775 TI - Why peptides? Their possible role in the evolution of MHC-restricted T-cell recognition. AB - The peptide-presenting function of major histocompatibility complex (MHC) molecules permits pathogenic microorganisms to evade the host's immune system in two different ways: first, by escape of pathogen-derived antigenic peptides from presentation, and second, by molecular mimicry, that is resemblance between MHC bound self and foreign peptides. These two mechanisms could have served as selective pressures in the evolution of the MHC. In this article, Zoltan Nagy and colleagues propose that escape from presentation selects for one or a few MHC molecules with the capacity to bind a broad range of different peptides. In contrast, molecular mimicry is considered to be the driving force for MHC diversification, that is it increases the number (polymorphism) and selectivity of peptide-binding sites. PMID- 2665776 TI - The role of lymphokines in common variable hypogammaglobulinemia. AB - Common variable (acquired) hypogammaglobulinemia (CVH) is a rare primary immunodeficiency disease of great interest as an immunological model of defects in antibody production. In this article, Gavin Spickett and John Farrant discuss evidence of abnormalities in lymphokine production and responses in the generation of the functional failure. It is not yet clear whether the B cell is intrinsically abnormal or lacks appropriate signals, but the block appears to occur in the differentiation phase of B cells, since membrane (but not secreted) IgG is made. Some T-cell defects also occur in this disease. The cause of CVH is unknown, although a viral aetiology has been suggested. Better understanding of lymphokine networks may allow the provision of specific signals to overcome the block in antibody production. PMID- 2665777 TI - Ly-6: a multigene family in search of a function. AB - Differentiation antigens can be simply defined as cell surface antigens that distinguish one cell type from another. The Ly-6 family of cell surface antigens might easily be regarded as a prototype for the analysis of the function of differentiation antigens on immunocompetent cells. Although a number of studies with antisera, in the late 1970s, established that the Ly-6 antigens exhibit an unusual pattern of expression on T and B lymphocytes, functional studies failed to demonstrate that the expression of Ly-6 defines a unique subpopulation of immunocompetent cells. Paradoxically, the development of anti-Ly-6 monoclonal antibodies led to a further decline in interest in this group of antigens, as the complexity of the results relegated Ly-6 to the realm of the die-hard immunogeneticist. Over the past five years, interest in Ly-6 has been rekindled and in this review Ethan Shevach and Patricia Korty summarize recent studies on the serology, biochemical and molecular structure, and the function of the products of this multigene family. PMID- 2665778 TI - Alien antigens return to the fold. AB - Theories rationalizing major histocompatibility complex (MHC) class I polymorphism and the high frequency of alloreactive T lymphocytes initiated the search for expression of genetically inappropriate MHC class I molecules by tumour cells. Many examples of such 'Alien Antigens' have been reported in the past fifteen years. Some were previously shown to result from a variety of serological artefacts. Recent papers describe structural and genetic analysis of two extensively studied and outstanding systems. In both cases the Alien Antigens are also artefacts, resulting from genetic heterogeneity in either mice or cell lines. No Alien Antigens have survived rigorous evaluation and they are unlikely to constitute a significant biological phenomenon. It is also unlikely that the successive experimental plagues that created the Alien Antigens are unique to this corner of tumour immunology. Sophisticated innovation in experimental systems makes much immunological investigation increasingly dependent on the genetic integrity of mice and cell lines. PMID- 2665779 TI - Gastric inhibitory polypeptide: a gut hormone with anabolic functions. AB - The gastrointestinal hormone, gastric inhibitory polypeptide (GIP), has been isolated and characterized because of its enterogastrone-type effects. It is also named glucose-dependent insulinotropic polypeptide and is actually considered to be the main incretin factor of the entero-insular axis. Besides these well described effects on gastric secretion and pancreatic beta cells, it also has direct metabolic effects on other tissues and organs, such as adipose tissue, liver, muscle, gastrointestinal tract and brain. In adipose tissue it is involved in the activation and regulation of lipoprotein lipase (LPL); it also inhibits glucagon-induced lipolysis and potentiates the effect of insulin on incorporation of fatty acids into triglycerides. It may play a role in the development of obesity because of the hypersensitivity of adipose tissue of obese animals to some of these actions. In the liver it does not modify insulin extraction, and its incretin effects are due only to the stimulation of insulin secretion and synthesis. It reduces hepatic glucose output and inhibits glucagon-stimulated glycogenolysis. It might increase glucose utilization in peripheral tissues such as muscle. GIP also has an effect on the volume and/or electrolyte composition of intestinal secretion and saliva. The functional importance of its effect on the hormones of the anterior pituitary lobe remains to be established, as it has never been detected in the brain. Its links with insulin are very close and the presence of insulin is sometimes necessary for the greater efficiency of both hormones. GIP can be considered as a true metabolic hormone, with most of its functions tending to increase anabolism. PMID- 2665781 TI - Pressure ulcers prevalence, cost and risk assessment: consensus development conference statement--The National Pressure Ulcer Advisory Panel. PMID- 2665780 TI - Effects of antioestrogens on the proliferation of MCF-7 human breast cancer cells. AB - Non-steroidal antioestrogens, such as tamoxifen, inhibit the growth of human breast cancer cells. The experiments described here compare and contrast the efficacy of tamoxifen and the 'pure' antioestrogen, ICI 164384, on the inhibition of proliferation of MCF-7 cells. Previous studies have shown that ICI 164384 has a greater maximal inhibitory effect than conventional antioestrogens on the growth of MCF-7 cells. Both types of compound block progression of cells through the cell cycle in the early G1 phase. These studies have been extended to measure the population distribution of antioestrogen-treated cells by the use of two parameter flow cytometry. ICI 164384 proved to be more effective than tamoxifen in decreasing the proportion of actively growing cells in an asynchronous population. In cells grown in the complete absence of exogenous oestrogens, growth was stimulated by oestradiol, insulin, insulin-like growth factor-I (IGF I) or transforming growth factor-alpha (TGF-alpha). The potent metabolite of tamoxifen, trans 4'-hydroxytamoxifen (4'-OHT), alone also stimulated growth, whereas ICI 164384 did not. Oestradiol and insulin added together demonstrated a clear synergistic enhancement of cell growth. Correspondingly, the stimulatory effect of 4'-OHT on growth was magnified in the presence of insulin, and a combination of ICI 164384 with insulin revealed a much weaker stimulatory action of the 'pure' antagonist. For both compounds the interaction with insulin was complex and characterized by a bell-shaped dose-response curve. However, for 4' OHT at all concentrations in the range 1 pM-1 microM in the presence of insulin, cell numbers were greater than in cultures exposed to insulin alone. This was not the case for ICI 164384 which suggested that differences in efficacy may be due to interactions between oestrogen and growth factor-mediated mechanisms. Furthermore, ICI 164384 was more effective in inhibiting the action of IGF-I and TGF-alpha alone or in combination, although both antioestrogens produced a partial blockade of growth factor responses in the complete absence of oestradiol. It is concluded that the difference in efficacy between partial agonist and 'pure' antagonist antioestrogens to inhibit growth in vitro is consistent with the difference in the pharmacological profile of these compounds. The absence of stimulatory activity of ICI 164384 is of particular significance in reducing to a minimum the synergistic interaction between oestrogens and insulin.(ABSTRACT TRUNCATED AT 400 WORDS) PMID- 2665782 TI - Epidemiology of pressure sores in different populations. AB - The data available regarding the epidemiology of pressure ulcers suggest that they are a serious public health problem in the United States, particularly among the elderly. Factors that are associated with increased risk of pressure ulcer development are being defined in different populations. Future studies need to include clear-cut definitions of pressure ulcers that permit lesions of varying severity to be distinguished. Such research should ultimately facilitate the development of more effective prevention strategies for patients at highest risk. PMID- 2665784 TI - [Rabies as a public health problem]. AB - Rabies virus belong to the family Rhabdoviridae; it has a coiled RNA core surrounded by a bullet-shaped envelop, covered with glycoproteins surface projections. After entry into a new host in the bite site, the virus multiplies in muscle cells and it spreads through neural pathways, without stimulating a protective host immune-response. Transmission depends on simultaneous delivery of virus to the salivary gland and the limbic system of the brain, which is the cause of the animal fury and biting tendency. In Mexico, rabies continues to be a serious health and economic problem, and urban rabies still predominates with a large number of human and animal cases recorded yearly. A total of 426 human deaths were reported between 1978 and 1983. Over 9,069 cases of animal rabies were reported in 1986 and 50,000 patients required antirabies postexposure vaccinations. Infected animals can be identified by demonstration of specific fluorescence in brain tissue. A dog or cat which has bitten a human should be captured and observed by a veterinarian for 15 days. The immediate objective of postexposure treatment is to prevent virus from entering and damaging neural tissue, therefore, promptness is essential. All wounds should be thoroughly cleared with soap and water concurrent use of both passive and active immunization provides optimal therapy. Wherever possible, human rather than equine products should be used for passive immunization, and Fuenzalida's nerve tissue rabies vaccine should be used for active protection. Paediatricians should urge parents to caution children attempting to get stray or wild animals as pets. Domestic dogs and cats should be thoroughly vaccinated. PMID- 2665783 TI - [Penta-X syndrome. Report of a case with 47,XXX/48,XXXX/49,XXXXX mosaicism]. AB - A two year five months old girl is presented with chromosomic complement 47,XXX/48,XXXX/49,XXXXX and presence of 2, 3 and 4 corpuscles in the nuclei of epithelial cells of oral mucosa. It is clinically characterized by short stature, mental retardation, generalized hypotony, bilateral elbow sub-luxation, mesotaurodontism and patent ductus arteriosus. The comparison of the clinical findings between the reported mosaics and the present case indicate the dealing with a specific pattern, recognizable clinically. In the etiologic analysis of this disease the review of pertinent literature suggests the occurrence of successive non-disjunction of the chromosomes X in more than one postzygotic divisions originating more than two stem-cell lines. PMID- 2665785 TI - Electrical phenomena at the surface of phospholipid membranes relevant to the sorption of ionic compounds. AB - The change in electrostatical potential-profile across the phospholipid membranes caused by the binding or sorption of ionic compounds (metal cations, ionic surfactants, lipid-soluble ions, and ionophore-metal complexes) can be estimated by the direct measuring method (combination of zeta potential of lipid vesicles and surface potential of lipid monolayer). The analysis of the data by a simple electrical double layer theory reveals the binding/sorption location of these ions. The coexistent effect of metal ions and lipid-soluble ions on the sorption behavior is described from the interfacial electrochemical view point. The coagulation of lipid vesicles caused by those ionic compounds is also discussed. PMID- 2665786 TI - Calcium antagonists and the kidney. AB - Recently, attention has focused on the effects of calcium antagonists on renal function. When administered in vitro to the isolated perfused kidney, calcium antagonists exhibit consistent actions, permitting characterization of their renal effects. Calcium antagonists do not affect the vasodilated isolated perfused kidney, but they do dramatically alter the response of the kidney to vasoconstrictor agents. In the presence of norepinephrine, calcium antagonists markedly augment the glomerular filtration rate, but produce only a modest improvement in renal perfusion. By use of the postischemic, hydronephrotic rat kidney model, which permits direct visualization of afferent and efferent arterioles, it can be demonstrated that the above-mentioned preferential augmentation of glomerular filtration rate may be attributable to a selective vasodilation of preglomerular vessels. Although the clinical implications of such observations are not yet clear, preliminary studies in experimental animal models indicate that calcium antagonists might exert salutary effects on renal function in clinical settings characterized by impaired renal hemodynamics. There is a need to carry out prospective studies to determine the benefits of calcium antagonists in ameliorating the development of renal dysfunction in patients at risk of acute renal insufficiency. PMID- 2665787 TI - Impact of antihypertensive therapy on progressive kidney damage. AB - Our ability to measure precisely the pressures and flows within the glomerular microcirculation has enabled us to begin to unravel the complex relationship between systemic hypertension and kidney disease. Although a number of factors have been implicated in the development of glomerular sclerosis, one consistent finding has been that glomerular injury occurs when elevated pressures are transmitted to the glomerular capillaries. Intrarenal hypertension, in conjunction with renal hypertrophy, and, possibly, disturbances in lipid metabolism and blood coagulation constitute secondary processes through which those nephrons not severely injured by the primary renal disease are eventually destroyed. Ultimately, all renal function is lost. Clinically, increased glomerular pressure is likely to contribute to glomerular injury in those patients in whom hypertension and renal insufficiency coexist. In patients with diabetes, as yet unidentified factors cause preglomerular resistance to fall so that glomerular hypertension develops even in the absence of elevation in systemic blood pressure. Although no therapy has been proven to slow the rate of progression to end stage renal failure in humans, a number of promising interventions have been identified. These include dietary protein or salt restriction, and medication, with either converting enzyme inhibitors or calcium channel blockers. PMID- 2665788 TI - Do calcium antagonists protect the human hypertensive kidney? AB - The natural course of essential hypertension, and hypertension associated with advanced renal parenchymal disease, is characterized by a progressive deterioration of renal function. If calcium antagonists can control both systemic and glomerular hypertension, they may be able to attenuate this process. Short term studies in our laboratory suggest that the calcium antagonists amlodipine, diltiazem, and nifedipine preserve and/or improve renal function; there were no adverse effects on glomerular filtration, effective renal plasma flow, and/or urinary protein excretion. However, long-term clinical trials are required to determine if the observed short-term renal responses are sustained and if calcium antagonists protect the human kidney from systemic and glomerular hypertension. PMID- 2665789 TI - Calcium metabolism in the pathophysiology and treatment of clinical hypertension. AB - Two parallel lines of research increasingly implicate calcium in the pathophysiology of hypertension. Studies at the molecular-cellular level reveal that, as part of a second messenger system, calcium plays a critical role in cellular responses that are of special relevance to blood pressure homeostasis. Investigations at the epidemiological and clinical levels have also increasingly involved calcium in hypertension, although the data produced are often contradictory, suggesting alternately that hypertension involves excess calcium and that the disorder is associated with a calcium deficiency. In our own research, which emphasizes both the biochemical and the clinical heterogeneity of the hypertensive process, we have found that divalent cation metabolism may be shifted in both directions away from average normotensive values among different types of hypertension. In addition, these calcium metabolic shifts appear to mediate the pressor effects of salt in both human and experimental forms of hypertension and may help identify individuals for whom different therapeutic regimens would be appropriate. We have developed a working cellular hypothesis in which all forms of hypertension are seen as calcium-dependent. One form is more critically dependent on extracellular calcium and is characterized by low plasma renin activity, dietary salt sensitivity, and therapeutic responsiveness to oral calcium supplementation and to calcium-channel blockade. At the opposite extreme, the intracellular calcium-dependent, angiotensin II-mediated form is characterized by high renin, lack of salt sensitivity, and preferential response to beta-blockade and converting-enzyme inhibition. PMID- 2665790 TI - The ototoxicity of ceftazidime in the chinchilla middle ear. AB - Ceftazidime (Tazicef) is a broad-spectrum cephalosporin antibiotic that may be useful as a topical agent in the treatment of otorrhea. To test the potential ototoxicity of the drug, 0.5 mL of a 10% solution of ceftazidime was introduced into the bullae of 22 chinchillas. The organ of Corti was normal in 20 temporal bones examined at 1 week after administration of the ceftazidime solution. Only 2 of 24 temporal bones examined after 4 weeks showed minor outer hair cell loss of the basal turn of the organ of Corti. Focal hemorrhage and occasional serous effusions were found in the middle ears of all animals after 1 week; these findings had mostly cleared after 4 weeks. Our results indicate that ceftazidime causes reversible middle ear inflammation, and may have some minor ototoxic potential under these experimental conditions. PMID- 2665791 TI - Studies of the horizontal vestibulo-ocular reflex in spaceflight. AB - Changes in the vestibulo-ocular reflex (VOR) during space flight have been suspected of contributing to space motion sickness. The horizontal VOR was studied in nine subjects on two space shuttle missions. Active unpaced head oscillation at 0.3 Hz was used as the stimulus to examine the gain and phase of the VOR with and without visual input, as well as the visual suppression of the reflex. No statistically significant changes were noted inflight in the gains or phase shifts of the VOR during any test condition, or between space motion sickness susceptible and nonsusceptible populations. Although VOR suppression was unaffected by spaceflight, the space motion sickness-susceptible group tended to exhibit greater error in the suppression than the nonsusceptible group. It is concluded that at this stimulus frequency, VOR gain is unaffected by spaceflight, and any minor individual changes do not seem to contribute to space motion sickness. PMID- 2665792 TI - Geometry of the vascular pedicle in free tissue transfers to the head and neck. AB - Traditionally, the most important parameters for success in free tissue transfer have been expertise in performing small vessel anastomoses, meticulous donor site dissection, and careful recipient vessel preparation. It has been our experience, in free flap transfers for head and neck reconstruction, that a very crucial, often unrecognized, parameter is the geometry of the vascular pedicle. This term encompasses the three-dimensional positioning of the nutrient vascular pedicle as well as vessel tension and redundancy. The ideal axis for the lie of the vascular pedicle in the neck is in the longitudinal direction. This configuration helps to eliminate the kinking of the pedicle that is observed with side-to-side movements of the head. The primary objectives in recipient vessel selection are to use a healthy artery and vein and to perform the anastomoses in a location that provides easy access for the surgeon and assistant. Recipient vessel selection is also a major determining factor in the achievement of the desired pedicle geometry. We believe that the transverse cervical artery and the external jugular vein are the best recipient vessels for free tissue transfer. The reasons for this selection, as well as technical details to improve pedicle geometry, are discussed in depth. Representative cases that demonstrate pitfalls in vascular pedicle geometry are presented. PMID- 2665793 TI - Characterization of the enolase isozymes of rabbit brain: kinetic differences between mammalian and yeast enolases. AB - Two isozymes of enolase, alpha alpha and gamma gamma, have been purified from rabbit brain and characterized. The kinetic properties of alpha alpha and gamma gamma (pH optimum, Km for phosphoglycerate and phosphoenolpyruvate, requirement for a divalent cation) are very similar to those of rabbit enolase, form beta beta, and to those of enolase isozymes from other species. However, several novel properties were observed. (i) All the enolases studied were inhibited by Na+ and Li+. (ii) The rabbit enolases, but not yeast enolase, were activated by K+, NH4+, Cs+, and Rb+. (iii) Rabbit enolase is more susceptible to inhibition by excess Mg2+ than is the yeast enolase; the increased inhibition by Mg2+ above pH 7.1 accounts, at least in part, for the observed differences between mammalian and yeast enolases in their pH optima for activity. PMID- 2665794 TI - Regulation of phosphatidylcholine metabolism in mammalian hearts. AB - Phosphatidylcholine is the major phospholipid in the mammalian heart. Over 90% of the cardiac phosphatidylcholine is synthesized via the CDP-choline pathway. The rate-limiting step of this pathway is catalyzed by CTP:phosphocholine cytidylyltransferase. Current evidence suggests that phosphatidylcholine biosynthesis in the heart is regulated by the availability of CTP and the modulation of cytidylyltransferase activity. Phosphatidylcholine is degraded mainly by the actions of phospholipase A1 and A2, with the formation of lysophosphatidylcholine. Lysophosphatidylcholine may be further deacylated by lysophospholipase or reacylated back into the parent phospholipid by the action of acyltransferase. The accumulation of lysophosphatidylcholine in the heart may be one of the biochemical factors for the production of cardiac arrhythmias. PMID- 2665795 TI - Mutation of amino acids thought to polarize the oxaloacetate carbonyl in citrate synthase severely reduces but does not abolish activity of the enzyme. AB - Oligonucleotide-directed mutagenesis has been used to alter two active site residues of Escherichia coli citrate synthase, histidine-305 and arginine-314. Both residues are thought to be involved in the polarization of the carbonyl group of oxaloacetate and thus facilitate attack at the carbonyl carbon by acetyl CoA. In one mutant, designated CS305H----A, His-305 was mutated to alanine and in the other, designated CS314R----L, Arg-314 was changed to leucine. Both mutants have greatly reduced turnover numbers, less than 0.1% of the wild-type value. The dissociation constant for formation of the binary enzyme-oxaloacetate complex, Ki, OAA, is at least 950 microM for CS305H----A, and about 500 microM for CS314R- --L, 28 and 15 times the wild-type value, respectively. The Michaelis constants for the two substrates, KOAA and KAcCoA, which measure the affinity of the enzyme for the catalytically significant ternary complex, are less radically altered: values of KAcCoA are actually 3.5-fold and 4.6-fold lower for CS305H----A and CS314R----L, respectively. These kinetic effects are taken to mean that both His 305 and Arg-314 are important for the successful formation of an efficient transition state, very likely by polarizing the carbonyl group of oxaloacetate as has been suggested, and that the residual kinetic activity, in both mutants, occurs by a mechanism which benefits from only part of this polarization. Allosteric properties of the mutant enzymes, as measured by NADH inhibition and binding, and KCl activation, are normal.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 2665796 TI - A maintenance strategy for discontinuing aversive procedures: a 52-month follow up of the treatment of aggression. AB - A strategy for systematically discontinuing aversive treatment components is illustrated with a 52-month follow-up of the treatment of severe aggression by an institutionalized, dually diagnosed deaf male. Phase 1 lasted 28 months and included: (a) contingent electric shock, (b) a high density positive reinforcement, (c) compliance training, (d) transfer of programmatic responsibility to others, and (e) a relaxation procedure. Phase 2 has lasted for 24 months and features (a) replacing shock with decreasing durations of nonexclusionary timeout and (b) naturally occurring reinforcers. Aggression has remained very low for over 4 years. The client is in an all day workshop, visits home frequently, and accompanies his parents on vacation. A social validity questionnaire revealed that he has become more sociable and less dangerous. PMID- 2665797 TI - A multidimensional model of mental retardation: impairment, subnormal behavior, role failures, and socially constructed retardation. AB - A multidimensional model of mental retardation was proposed in which impairment, subnormal behavior, and role failures were underpinned by medical, statistical, and social models of normal, respectively. Thus, individuals may be designated "retarded" in one or a combination of logically independent senses. A framework for research and theory was also provided. A new fourth dimension, socially constructed retardation or mental handicap, was defined and its etiological influences in medical, statistical, and social dimensions of retardation was considered, as were interactions of these dimensions. New strategies for operationalizing and alleviating mental retardation were identified. PMID- 2665798 TI - Collagen induced arthritis as an experimental model for rheumatoid arthritis. Immunogenetics, pathogenesis and autoimmunity. AB - The type II collagen (CII) induced arthritis animal model (CIA) provides opportunities to study the nature of autoimmune reactions leading to arthritis and may be used as a model for rheumatoid arthritis (RA). Thus, in similarity with RA, the CIA model, when induced with autologous CII, shows a chronic and progressive disease course. The susceptibility to both RA and CIA are correlated to the expression of certain MHC class II allotype genes. In both diseases are autoantibodies to CII and rheumatoid factors produced. Immunohistopathology of affected joints show in both diseases a dominance of activated macrophages/fibroblasts with a significant infiltration of activated T cells and an infiltration of granulocytes. We do here suggest that both RA and CIA are dependent on a synergy between delayed type hypersensitivity and immune complex mediated inflammatory mechanisms and that CIA provides opportunities for studies of immunospecific reactions leading to arthritis. PMID- 2665799 TI - Pregnancies after childhood cancer. PMID- 2665800 TI - Antenatal administration of betamethasone to prevent respiratory distress syndrome in preterm infants: report of a UK multicentre trial. AB - In a prospective, randomized, double-blind, multicentre trial the effect of antenatal treatment with betamethasone phosphate was compared with placebo in the prevention of the respiratory distress syndrome (RDS) in preterm infants. The dose of betamethasone was 4 mg every 8 h for six doses, unless delivery occurred. The 251 women who were enrolled gave birth to 262 liveborn infants, 130 in the beta-methasone and 132 in the placebo group; the two groups were evenly matched in most respects. The diagnosis of RDS in the newborn was confirmed by two independent assessors. Seven of the 130 infants in the betamethasone group and 16 of the 132 in the placebo group developed RDS. In infants whose mothers had received at least three injections, RDS was also less frequent in the steroid group than in the placebo group (3/104 and 10/104 respectively; P less than 0.05). There was a significant reduction of RDS in those born between 24 h and 6 days after entry into the trial (0/30 and 8/45 respectively; P less than 0.05). The largest difference in frequency of RDS occurred in the subgroup of infants born before 34 weeks gestation, within 8 days of trial entry, and whose mothers had received at least three injections (0/27 steroid group and 7/32 placebo group; P = 0.03), and there were also significantly fewer neonatal deaths (2/27 and 13/32, respectively; P less than 0.01) in this subgroup. Betamethasone did not provoke earlier delivery. Premature rupture of the membranes and maternal hypertension did not seem to contraindicate the use of steroids: there was no increase in maternal or neonatal sepsis nor in stillbirth in hypertensive pregnancies in the steroid group. Neonatal jaundice was significantly less frequent in the steroid (55/129) than in the placebo group (81/127; P less than 0.01) but not in the subgroups born before 34 completed weeks gestation. PMID- 2665801 TI - The prevalence of pleural effusions in pre-eclampsia: an ultrasound study. AB - A prospective ultrasound study was undertaken to investigate the prevalence of pleural effusion in patients with moderate or severe pre-eclampsia. The costophrenic angles of 34 consecutive patients were scanned postpartum with a real-time sector scanner. Six patients had pleural effusions. These patients did not have a greater degree of hypertension or proteinuria than the group without pleural effusion but had early severe disease requiring early delivery. The prematurity of these infants resulted in tenfold increase in perinatal death. PMID- 2665802 TI - Ultrasound and pulsed electromagnetic energy treatment for perineal trauma. A randomized placebo-controlled trial. AB - Ultrasound and pulsed electromagnetic energy therapies are increasingly used for perineal trauma sustained during childbirth. The study included 414 women with moderate or severe perineal trauma randomly allocated to receive active ultrasound, or active pulsed electromagnetic energy, or corresponding placebo therapies; the allocation was double-blind for each machine. Overall, more than 90% thought that treatment made their problem better. There were no clear differences between the groups in outcome either immediately after treatment, or 10 days or 3 months postpartum, other than more pain associated with pulsed electromagnetic energy treatment at 10 days. Bruising looked more extensive after ultrasound therapy but then seemed to resolve more quickly. Neither therapy had an effect on perineal oedema or haemorrhoids. The place of these new therapies in postnatal care should be clarified by further controlled trials before they become part of routine care. PMID- 2665803 TI - Minimal/mild endometriosis and infertility. A review. PMID- 2665804 TI - Retention of iris supported intraocular lenses at the time of penetrating keratoplasty for pseudophakic corneal oedema. AB - The long-term follow-up of patients undergoing penetrating keratoplasty for pseudophakic corneal oedema is reported. The cause and frequency of corneal decompensation following intracapsular cataract extraction with insertion of an iris supported lens was assessed and found to be unrelated to the implant in the majority of cases. The most common cause of decompensation was endothelial touch during the cataract extraction. In all eyes the intraocular lens was retained at the time of penetrating keratoplasty. The hazards of removal of the lens are discussed and the recommendations made that lenses be retained when penetrating keratoplasty is undertaken for pseudophakic corneal oedema, other than in exceptional cases. PMID- 2665805 TI - Treatment of ptosis by levator resection with adjustable sutures via the anterior approach. AB - The authors describe a one-step anterior approach levator resection technique with intraoperative adjustable sutures. Forty-four ptotic eyes were divided into five groups, and the results of this technique were evaluated for each of these five types of ptosis. Our results show that it is not possible to predict the extent of a levator resection preoperatively from the assessment of the levator function and degree of ptosis. We therefore propose this flexible method as the operation of choice for the correction of senile, traumatic and congenital ptosis. PMID- 2665806 TI - How do serine proteases really work? AB - Recent advances in genetic engineering have led to a growing acceptance of the fact that enzymes work like other catalysts by reducing the activation barriers of the corresponding reactions. However, the key question about the action of enzymes is not related to the fact that they stabilize transition states but to the question to how they accomplish this task. This work considers the catalytic reaction of serine proteases and demonstrates how one can use a combination of calculations and experimental information to elucidate the key contributions to the catalytic free energy. Recent reports about genetic modifications of the buried aspartic group in serine proteases, which established the large effect of this group (but could not determine its origin), are analyzed. Two independent methods indicate that the buried aspartic group in serine proteases stabilizes the transition state by electrostatic interactions rather than by alternative mechanisms. Simple free energy considerations are used to eliminate the double proton-transfer mechanism (which is depicted in many textbooks as the key catalytic factor in serine proteases). The electrostatic stabilization of the oxyanion side of the transition state is also considered. It is argued that serine proteases and other enzymes work by providing electrostatic complementarity to the changes in charge distribution occurring during the reactions they catalyze. PMID- 2665807 TI - A scanning calorimetric study of the thermal denaturation of the lysozyme of phage T4 and the Arg 96----His mutant form thereof. AB - High-sensitivity scanning calorimetry has been employed to study the reversible thermal unfolding of the lysozyme of T4 bacteriophage and of its mutant form Arg 96----His in the pH range 1.80-2.84. The values for t1/2, the temperature of half denaturation, in degrees Celsius and for the enthalpy of unfolding in kilocalories per mole are given by (standard deviations in parentheses) wild type t1/2 = 9.63 + 14.41 pH (+/- 0.58) delta Hcal = 5.97 + 2.33t (+/- 4.20) mutant form t1/2 = -19.84 + 21.31 pH (+/- 0.51) delta Hcal = -8.58 + 2.66t (+/- 4.48) At any temperature within the range -20 to 60 degrees C, the free energy of unfolding of the mutant form is more negative than that of the wild type by 3-5 kcal mol-1, indicating an apparent destabilization resulting from the arginine to histidine replacement. The ratio of the van't Hoff enthalpy to the calorimetric enthalpy deviates from unity, the value expected for a simple two-state process, by +/- 0.2 depending on the pH. It thus appears that the nature of the unfolding of T4 lysozyme varies with pH in unknown manner. This complication does not invalidate the values reported here for the temperature of half-completion of unfolding, the calorimetric enthalpy, the heat capacity change, or the free energy of unfolding. PMID- 2665808 TI - High-resolution structure of the temperature-sensitive mutant of phage lysozyme, Arg 96----His. AB - The structure of the temperature-sensitive mutant lysozyme of bacteriophage T4 in which arginine 96 is replaced by histidine has been determined crystallographically and refined to a residual of 17.6% at 1.9-A resolution. Overall, the three-dimensional structure of the mutant protein is extremely similar to that of wild type. There are local distortions in the mutant structure suggesting that the substituted His 96 residue is under strain. This appears to be one of the major reasons for the decreased thermostability. In wild-type lysozyme the guanidinium of Arg 96 is located at the carboxy terminus of alpha helix 82-90 and makes a pair of hydrogen bonds to two of the carbonyl groups in the last turn of the helix. The loss of this "helix dipole" interaction also appears to contribute to the destabilization. The pKa* of His 96 in the mutant lysozyme has been determined by nuclear magnetic resonance and found to be 6.8 at 10 degrees C. This relatively normal value of the histidine pKa* suggests that the protonated and unprotonated forms of the imidazole ring are perturbed equally by the protein environment or, what is equivalent, the mutant lysozyme is equally stable with either histidine species. PMID- 2665809 TI - Estimation of free energy barriers in the cytoplasmic and mitochondrial aspartate aminotransferase reactions probed by hydrogen-exchange kinetics of C alpha labeled amino acids with solvent. AB - The existence of the postulated quinonoid intermediate in the cytoplasmic aspartate amino-transferase catalyzed transamination of aspartate to oxaloacetate was probed by determining the extent of transfer of tritium from the C alpha position of tritiated L-aspartate to pyridoxamine 5'-phosphate in single turnover experiments in which washout from the back-reaction was obviated by product trapping. The maximum amount of transferred tritium observed was 0.7%, consistent either with a mechanism in which a fraction of the net transamination reaction proceeds through a quinonoid intermediate or with a mechanism in which this intermediate is formed off the main reaction pathway. It is shown that transfer of labeled hydrogen from the amino acid to cofactor cannot be used to differentiate a stepwise from a concerted transamination mechanism. The amount of tritium transferred is a function of the rate constant for torsional equilibration about the epsilon-amino group of Lys-258, the presumptive abstractor of the C alpha proton; the relative rate constants for hydrogen exchange with solvent versus cofactor protonation; and the tritium isotope effect on this ratio. The free energy barriers facing the covalent intermediate between aldimine and keto acid product (i.e., ketimine and possibly quinonoid) were evaluated relatively by comparing the rates of C alpha-hydrogen exchange in starting amino acid with the rates of keto acid formation. The value of theta (= kexge/kprod) was found to be 2.6 for the reaction of cytoplasmic isozyme with aspartate and ca. 0.5 for that of the mitochondrial form with glutamate. PMID- 2665810 TI - Kinetic characterization of the recombinant ribonuclease from Bacillus amyloliquefaciens (barnase) and investigation of key residues in catalysis by site-directed mutagenesis. AB - Barnase, the ribonuclease from Bacillus amyloliquefaciens, has been cloned and expressed in Escherichia coli [Hartley, R. W. (1988) J. Mol. Biol. 202, 913-915], thus enabling the overproduction and site-directed mutagenesis of one of the smallest enzymes (Mr equals 12,382). As barnase is also composed of just a single polypeptide chain with no disulfide bridges and has a reversible folding transition, it affords a fine system for studying protein folding and design. We show here that the recombinant enzyme has properties identical with those of the authentic enzyme, characterize the basic kinetics and specificity of the enzyme, and, using site-directed mutagenesis, identify key residues involved in catalysis to provide evidence that supports the classic ribonuclease mechanism. The wild type enzyme catalyzes the hydrolysis of dinucleotides of structure GpN. There is a prime requirement for G and a preference for A greater than G greater than C greater than U for N. The pH-activity curve for the transesterification step of dinucleotides is bell shaped with an optimum for kcat/KM and kcat at about pH 5. The enzyme is far more active toward long RNA molecules, and the pH optimum for kcat is at 8.5. The activity of barnase toward dinucleotide substrates is about 0.5% of that of the highly homologous T1 nuclease at pH 5.9, but barnase is twice as active as T1 toward RNA at pH 8.5. There must be important subsite interactions that contribute to catalysis in barnase in addition to those immediately on either side of the scissile bond.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 2665811 TI - NMR assignments for the amino-terminal residues of trp repressor and their role in DNA binding. AB - The trp repressor of Escherichia coli specifically binds to operator DNAs in three operons involved in tryptophan metabolism. The NMR spectra of repressor and a chymotryptic fragment lacking the six amino-terminal residues are compared. Two dimensional J-correlated spectra of the two forms of the protein are superimposable except for cross-peaks that are associated with the N-terminal region. The chemical shifts and relaxation behavior of the N-terminal resonances suggest mobile "arms". Spin-echo experiments on a ternary complex of repressor with L-tryptophan and operator DNA indicate that the termini are also disordered in the complex, although removal of the arms reduces the DNA binding energy. Relaxation measurements on the armless protein show increased mobility for several residues, probably due to helix fraying in the newly exposed N-terminal region. DNA binding by the armless protein does not reduce the mobility of these residues. Thus, it appears that the arms serve to stabilize the N-terminal helix but that this structural role does not explain their contribution to the DNA binding energy. These results suggest that the promiscuous DNA binding by the arms seen in the X-ray crystal structure is found in solution as well. PMID- 2665812 TI - Translation of the human C3b/C4b receptor mRNA in a cell-free system and by Xenopus oocytes. AB - The C3b/C4b complement receptor (CR1) is a large, single-chain integral membrane glycoprotein present on erythrocytes, leukocytes, glomerular podocytes, and splenic dendritic-reticular cells that mediates the binding of complement-coated particles and immune complexes. CR1 is unusual in that it is polymorphic in size with the four allelic variants having molecular weights of 190,000, 220,000, 250,000, and 280,000 (SDS-PAGE, reducing conditions). The in vitro translation of the common (Mr 220,000) allelic variant CR1 has been achieved by using mRNA in lysates of rabbit reticulocytes and in Xenopus oocytes. HL-60, a promyelocytic human leukemic cell line, was treated with DMSO to induce differentiation and synthesis of CR1. Poly(A+) RNA was purified from these cells by column chromatography on oligo(dT)-cellulose. In the rabbit reticulocyte system, no CR1 was detected unless the translation mixture was denatured. In the presence of methylmercuric hydroxide, the CR1 translation product, unlike most translation products, had the same molecular weight in gel electrophoresis as the high mannose-containing pro-CR1 and was 15-20K larger than nonglycosylated CR1. This suggests that a cotranslational modification of CR1 structure occurs, probably involving a proteolytic cleavage event. When poly(A+) RNA was translated in Xenopus oocytes, CR1 could be detected by treatment of oocytes with anti-CR1 monoclonal antibody followed by fluorescein-conjugated goat anti-mouse IgG. CR1 was diffusely distributed but preferentially localized to the vegetal surface. The molecular weight of this product, identified in immunoprecipitates of lysates of [35S]methionine-labeled oocytes, was identical with that of CR1 of HL-60. PMID- 2665813 TI - Comparative cross-linking study on the 50S ribosomal subunit from Escherichia coli. AB - We have carried out an extensive protein-protein cross-linking study on the 50S ribosomal subunit of Escherichia coli using four different cross-linking reagents of varying length and specificity. For the unambiguous identification of the members of the cross-linked protein complexes, immunoblotting techniques using antisera specific for each individual ribosomal protein have been used, and for each cross-link, the cross-linking yield has been determined. With the smallest cross-linking reagent diepoxybutane (4 A), four cross-links have been identified, namely, L3-L19, L10-L11, L13-L21, and L14-L19. With the sulfhydryl-specific cross linking reagent o-phenylenedimaleimide (5.2 A) and p-phenylenedimaleimide (12 A), the cross-links L2-L9, L3-L13, L3-L19, L9-L28, L13-L20, L14-L19, L16-L27, L17 L32, and L20-L21 were formed; in addition, the cross-link L23-L29 was exclusively found with the shorter o-phenylenedimaleimide. The cross-links obtained with dithiobis(succinimidyl propionate) (12 A) were L1-L33, L2-L9, L2-L9-L28, L3-L19, L9-L28, L13-L21, L14-L19, L16-L27, L17-L32, L19-L25, L20-L21, and L23-L34. The good agreement of the cross-links obtained with the different cross-linking reagents used in this study demonstrates the reliability of our cross-linking approach. Incorporation of our cross-linking results into the three-dimensional model of the 50S ribosomal subunit derived from immunoelectron microscopy yields the locations for 29 of the 33 proteins within the larger ribosomal subunit. PMID- 2665814 TI - Time-resolved fluorescence studies on the ternary complex formed between bacterial elongation factor Tu, guanosine 5'-triphosphate, and phenylalanyl tRNAPhe. AB - Time-resolved fluorescence spectroscopy was used to investigate the solution dynamics of Escherichia coli tRNAPhe, Phe-tRNAPhe, and Phe-tRNAPhe associated with GTP and elongation factor Tu (EF-Tu) in a ternary complex. Two fluorescence probes were employed: fluorescein, covalently bound to Phe-tRNAPhe at the s4U8 base (Phe-tRNAPhe-Fl8), and ethidium bromide, noncovalently associated with the tRNA (EB.Phe-tRNAPhe). The lifetimes observed for ethidium bromide were 1.89 ns, free in solution, and 26.3 ns, bound to its tight binding site on tRNA. Fluorescein-labeled tRNA had a lifetime of 4.3 ns, with no significant difference among the values for aminoacylated, unacylated, and EF-Tu-bound Phe-tRNAPhe-Fl8. Differential phase and modulation data for each fluorophore-tRNA system were fit with local and global Debye rotational relaxation times. Local motion of the labeled fluorescein in Phe-tRNAPhe-Fl8, tRNAPhe-Fl8, and Phe-tRNAPhe-Fl8.EF Tu.GTP was characterized by rotational relaxation times of 2.7 +/- 0.5, 2.4 +/- 0.4, and 2.4 +/- 0.1 ns, respectively. These values are equal, within experimental error, and suggest that the rotational mobility of the s4U8 conjugated dye is unaffected by either tRNAPhe aminoacylation or ternary complex formation. Global rotational relaxation times for Phe-tRNAPhe-Fl8, 97 ns, and EB.Phe-tRNAPhe, 140 ns, were equivalent to those determined for the unacylated species, denoting little change in the overall size or shape of the tRNA molecule upon aminoacylation. These values for (Phe-)tRNA were larger than expected for a hydrated sphere of equivalent volume, 83 ns, and therefore confirm the asymmetric nature of the tRNA structure in solution.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 2665815 TI - Heparin decreases the degradation rate of hepatic lipase in Fu5AH rat hepatoma cells. A model for hepatic lipase efflux from hepatocytes. AB - The mechanism for the stimulation of hepatic lipase secretion by heparin was studied in cultured Fu5AH rat hepatoma cells. Quantitative immunoprecipitation followed by electrophoresis and fluorography were used to isolate and quantitate the radioactive enzyme; hepatic lipase protein mass was quantitated by ELISA. Addition of heparin to the medium resulted in a 2-fold increase in lipase secretion rate, whereas cell-surface-associated and intracellular lipase decreased by 76 and 20%, respectively. Rates of synthesis of hepatic lipase measured by incorporation of Trans 35S-label into enzyme protein were not different in control or heparin-treated dishes. In pulse-chase studies, it was estimated that the degradation rate constants for control and heparin-treated cultures were 0.51 +/- 0.09 and 0.14 +/- 0.13 h-1 for control and heparin-treated cultures, respectively. 52% of the synthesized enzyme was degraded in control cultures; addition of heparin to the culture medium reduced this figure to 11% of the synthetic rate. Equilibrium binding data of highly purified 125I-hepatic lipase to Fu5AH cells at 4 degrees C demonstrate the presence of a class of high affinity binding sites. At 37 degrees C, cell-surface-bound 125I-hepatic lipase is internalized and either degraded or recycled to the medium. The half intracellular residence times of hepatic lipase were 55 and 31 min in control and heparin-treated cultures, respectively. Radioactivity incorporated in the 55.4 kDa high-mannose-containing lipase and the mature 57.6 kDa species was measured as a means of locating the enzyme in the secretory pathway before or beyond the medial Golgi. The disappearance of the 55.4 kDa species from the cell is similar in control and heparin-treated cultures with half-intracellular residence times of 29 and 25 min, respectively. In contrast, the amount of radiolabeled 57.6 kDa species in control cells remained constant from 15 min to 2 h, whereas it decreased by 79% in heparin-treated cells. The above data demonstrate that the increase in hepatic lipase secretion is due to a decreased degradation rate with no change in synthetic rate and that heparin primarily affected the residence time of hepatic lipase in the medial Golgi-plasma membrane region. PMID- 2665816 TI - Autologous bone-marrow transplantation in non-Hodgkin's lymphomas. PMID- 2665817 TI - Genetic principles of tumor suppression. PMID- 2665818 TI - Molecular aspects of the metastatic cascade. PMID- 2665819 TI - Biochemical changes in the gastric mucosa after injury in young and aged rats. AB - Changes in gastric mucosal thymidine kinase (TK) activity (an indicator of proliferative activity) were examined in young (4 month) and aged (24 month) Fischer-344 male rats 6 h after intragastric administration of either 2 M NaCl (1 ml/130 g b.w.) or an equivalent volume of water (control). These changes were related to the expression of c-myc gene, tyrosine kinase (Tyr-K) activity and tyrosine-specific phosphorylation of proteins in the gastric mucosa. Basal gastric mucosal TK activity (data from the controls) in the aged rats was found to be 75% (P less than 0.001) above the young animals. This was accompanied by increased expression of c-myc gene and a 67% (P less than 0.001) enhancement in Tyr-K activity. Intragastric administration of 2 M NaCl resulted in gastric mucosal damage (as evidenced by lesions index) in both age groups. However, in aged rats, the lesions index was found to be about 75% higher than in their younger counterparts. In young rats, mucosal injury resulted in a 95% rise in TK activity, whereas in aged rats it was increased by only 38%, when compared with corresponding controls. This 2-fold rise in TK activity in young rats was also associated with increased expression of the c-myc gene. In young rats, administration of hypertonic saline caused a 90% (P less than 0.001) increment in Tyr-K activity and significantly stimulated tyrosine-specific phosphorylation of five mucosal proteins with an apparent molecular mass of 170, 120, 100, 55 and 43 kDa. On the other hand, administration of hypertonic saline to the aged rats caused only a small 16% (P less than 0.025) increase in Tyr-K activity, and produced no apparent change in either expression of c-myc gene or tyrosine specific phosphorylation of any of the proteins in the gastric mucosa, when compared with the corresponding controls. We conclude that aging increases the susceptibility of the gastric mucosa to damaging agents and diminishes its regenerative capacity. We also suggest that Tyr-K may play a role in determining these events. PMID- 2665820 TI - Localization and kinetics of pyruvate-metabolizing enzymes in relation to aerobic alcoholic fermentation in Saccharomyces cerevisiae CBS 8066 and Candida utilis CBS 621. AB - The role of pyruvate metabolism in the triggering of aerobic, alcoholic fermentation in Saccharomyces cerevisiae has been studied. Since Candida utilis does not exhibit a Crabtree effect. this yeast was used as a reference organism. The localization, activity and kinetic properties of pyruvate carboxylase (EC 6.4.1.1), the pyruvate dehydrogenase complex and pyruvate decarboxylase (EC 4.1.1.1) in cells of glucose-limited chemostat cultures of the two yeasts were compared. In contrast to the general situation in fungi, plants and animals, pyruvate carboxylase was found to be a cytosolic enzyme in both yeasts. This implies that for anabolic processes, transport of C4-dicarboxylic acids into the mitochondria is required. Isolated mitochondria from both yeasts exhibited the same kinetics with respect to oxidation of malate. Also, the affinity of isolated mitochondria for pyruvate oxidation and the in situ activity of the pyruvate dehydrogenase complex was similar in both types of mitochondria. The activity of the cytosolic enzyme pyruvate decarboxylase in S. cerevisiae from glucose-limited chemostat cultures was 8-fold that in C. utilis. The enzyme was purified from both organisms, and its kinetic properties were determined. Pyruvate decarboxylase of both yeasts was competitively inhibited by inorganic phosphate. The enzyme of S. cerevisiae was more sensitive to this inhibitor than the enzyme of C. utilis. The in vivo role of phosphate inhibition of pyruvate decarboxylase upon transition of cells from glucose limitation to glucose excess and the associated triggering of alcoholic fermentation was investigated with 31P-NMR. In both yeasts this transition resulted in a rapid drop of the cytosolic inorganic phosphate concentration. It is concluded that the relief from phosphate inhibition does stimulate alcoholic fermentation, but it is not a prerequisite for pyruvate decarboxylase to become active in vivo. Rather, a high glycolytic flux and a high level of this enzyme are decisive for the occurrence of alcoholic fermentation after transfer of cells from glucose limitation to glucose excess. PMID- 2665822 TI - Pressure-induced changes in the secondary structure of the Escherichia coli methionine repressor protein. AB - The effect of hydrostatic pressure on the conformational properties of the E. coli methionine repressor protein in aqueous solution was investigated by infrared spectroscopy. Changes in hydrostatic pressure produce dramatic changes in the spectral region of the conformation-sensitive amide I band. As the pressure is raised up to 18 kbar, the protein undergoes a rearrangement of alpha helical segments into beta-type structures; after the pressure is released the beta-strands reconvert into less ordered alpha-helical or random segments. PMID- 2665821 TI - Characterization of adenine phosphoribosyltransferase from the human malaria parasite, Plasmodium falciparum. AB - Because of their inability to synthesize purines de novo, malaria parasites rely on purine phosphoribosyltransferases (PRTases) to convert purine bases salvaged from the host cell (the erythrocyte) into the corresponding purine nucleoside monophosphates. Our studies with late trophozoites of the human malaria parasite, Plasmodium falciparum, showed that virtually all of the purine PRTase activity is accounted for by two distinct enzymes. One enzyme utilizes hypoxanthine, guanine and xanthine (Queen, S.A., Vander Jagt, D. and Reyes, P. (1988) Mol. Biochem. Parasitol. 30, 123-134). The second enzyme utilizes only adenine and is the subject of this paper. This latter enzyme exhibits a biphasic pH-activity profile and is moderately to weakly inhibited by several divalent metal ions. Several of the properties of the P. falciparum enzyme were found to differ significantly from those of human erythrocyte adenine PRTase. (1) The molecular weight (18,000) of the parasite enzyme is smaller than that of the host cell enzyme. (2) The parasite enzyme, unlike the erythrocyte enzyme, is not significantly inhibited by sulfhydryl reagents. (3) 6-Mercaptopurine and 2,6-diaminopurine proved to be competitive inhibitors of the parasite enzyme (Ki 0.70 and 1.0 mM, respectively); on the other hand, the human enzyme is not inhibited by these agents. (4) The Km for adenine (0.80 microM) and 5-phosphoribosyl-1-pyrophosphate (0.70 microM) displayed by the parasite enzyme are significantly smaller than the corresponding Km values shown by the erythrocyte enzyme. These distinctions between the parasite and host enzymes point to the possibility that adenine PRTase of P. falciparum may represent a potential target for chemotherapeutic attack. PMID- 2665823 TI - EMG feedback for the treatment of upper-extremity dysfunction: can it be effective? AB - This paper examines the application of EMG feedback for upper-extremity dysfunction secondary to neurologic injury. A rationale for the use of EMG feedback to enhance rotational components of upper-limb movement, train recruitment of the prime movers, and promote inhibition of motor responses that interfere with efficient and effortless movement is presented. Specific strategies that can be used to reinforce functional movement patterns are elaborated. A case study illustrating the application of the feedback strategies is provided. Despite sensory, perceptual, and cognitive impairments, a 53-year old left hemiplegic obtained significant clinical upper-limb functional gains when given EMG feedback in conjunction with occupational therapy. PMID- 2665824 TI - [A new type of Clostridium thermocellum endoglucanase produced by the recombinant strain of E. coli. Some properties and identification in donor cells]. AB - The properties of endoglucanase produced by the recombinant strain of E. coli carrying plasmid pCU 104 with a 2.9 kb insert of chromosomal DNA of C. thermocellum encoding the multiple forms of the 35.5 kD polypeptide (pI 4.3-4.7) were studied. The enzyme has a broad pH optimum of activity (6.0-7.5). The half inactivation time for different forms of the enzyme at 65 degrees C is similar and is equal to 25-30 minutes. The enzyme is related to endoglucanases weakly adsorbed on cellulose (Kp = 0.065 1/g). Hydrolysis of microcrystalline cellulose is completed within 7 days (7-9%) and is accompanied by the formation of cellobiose and cellotriose. The enzyme splits dyed lichenan (mixed 1,3-1,4-beta glucane) at a higher rate than the dyed CM-cellulose. A guinea pig antiserum to enzyme isoforms with a pI of 4.46-4.54 was obtained. Using direct solid phase immunoenzymatic analysis, it was demonstrated that all the enzyme isoforms under study (pI 4.3-4.7) are immunologically related (serum titers for different enzyme isoforms vary from 1:20,000 to 1:50,000). In the original culture fluid of C. thermocellum, the antigen related to the enzyme isolated from the recombinant strain was unobserved. However, SDS-PAAG electrophoresis of SDS- and mercaptoethanol-treated culture fluids revealed among 11 protein bands at least 4 antigens interacting with antibodies (Mr = 107, 76, 67 and 37 kD), although their antibody titers were far lower and did not exceed 1:300-1:500. The cumulative data suggest that the endoglucanase under study is not identical to the earlier described enzymes encoded by the cel A- and ceI B-genes of C. thermocellum. PMID- 2665825 TI - [Comparative characteristics of tRNA-methyltransferases from rabbit liver and myocardium under normal conditions and in experimental ischemia]. AB - Comparative studies of the state of aggregation and activity of tRNA methyltransferases in cytosol (105,000 X g supernatant) from normal and ischemic rabbit liver and myocardium were carried out. The optimal conditions (pH, protein concentration, ionic composition of incubation mixture) for the determination of activity of tRNA-methyltransferases were elaborated. The protein fraction precipitated at 55% saturation of ammonium sulfate was shown to inherit the highest activity of tRNA-methyltransferases. In rabbit liver cytosol, the bulk of the tRNA-methyltransferase activity (approximately 50%) was found to be associated with high molecular weight complexes containing aminoacyl-tRNA synthetases. The tRNA-methyltransferase activity was increased almost 1.4-fold both in the myocardium cytosol under total ischemia of isolated heart (30 min, 37 degrees C) and in liver cytosol under experimental myocardial infarction (EMI, occlusion of anterior coronary artery for 12 hours). Moreover, the labilization of high molecular weight complexes was observed: up to 80% of the tRNA methyltransferase activity was localized in the fraction of lower molecular weight complexes and free enzyme fraction. In the total set of eight methylated nucleotides (products of submethylated tRNA methylation by liver enzymes), the decreased m1A content and the increased m7G and m1G contents were observed at EMI. It was assumed that the observed changes in the state of aggregation of tRNA methyltransferases, in particular, their dissociation from the high molecular weight amino-acyl-tRNA-synthetase complexes are prerequisites for the suppression of protein biosynthesis under ischemic conditions. PMID- 2665826 TI - [Effect of lipopolysaccharide toxin on lipid and protein composition of human serum low density lipoproteins]. AB - Complexes of lipopolysaccharide (LPS) B of Salmonella typhimurium with human low density lipoproteins (LDL) formed during in vitro coincubation via spontaneous incorporation of LPS (complex LDL-LPS) or through the incorporation stimulated by the serum protein fraction (LPS/LDL complex) were studied. The LPS/LDL complex was shown to maximally bind 0.24 mg of LPS per 1 mg of LDL protein, whereas the LDL-LPS complex contained only 0.07 mg of LPS per 1 mg of LDL protein. The observed incorporation of LPS into LDL particles was not possibly associated with a transfer of lipids or proteins from high density lipoproteins to LDL. The insertion of LPS was probably accompanied by the expulsion of a small portion of phosphatidylcholine molecules from the outer monolayer of LDL into the aqueous medium and by an increase in the phosphatidylethanolamine concentration in LDL. Simultaneously, the level of esterified cholesterol in the LPS/LDL complex decreased, and the concentrations of free cholesterol and triacylglycerols showed a rise. The level of free fatty acids in the LPS/LDL complex increased more than twofold compared with intact LDL. The enhancement of LPS incorporation did not result in the insertion of any serum proteins into LDL, in which apoB-100 remained the major apolipoprotein (ca. 90%); apoB-100 fragments made up to 5-7%, whereas apoE and apoC contained altogether ca. 3-5%. It is suggested that the LPS/LDL complex obtained can bind to three types of cell receptors, i.e., apoB/E receptors, LPS receptors and scavenger receptors of macrophages (monocytes); the increased level of free fatty acids in the LPS/LDL complex may accelerate its subsequent catabolism. PMID- 2665827 TI - [Kinetics of dissolution of solid protein substrates by proteinases. Selection of the reaction mechanism]. AB - Experimental data on the rate of enzymatic degradation of a solid protein phase in relation to reagent concentrations in the gelatin gel--proteolytic enzyme solution system was obtained. It was shown that different transformations of the Michaelis-Menten equation do not provide any satisfactory description of the reaction kinetics. A method for the discrimination of putative reaction mechanisms based on the analysis of effective values of constants in the general equation for the rates of dissolution of proteins with different molecular weights was proposed. The experimental results are in favour of a two-step consecutive mechanism taking account of surface concentrations of the adsorbed enzyme and hydrolyzable bonds. PMID- 2665828 TI - [Inhibition of free-radical lipid oxidation in the mechanisms of immediate and long-term adaptation to stress]. AB - The literary data and own results concerning the stages of free radical lipid oxidation inhibition during the adaptation of animals to stress are reviewed. Using the chronic stress models such as immobilization, experimental neurosis, it has been shown, that in general adaptation syndrome the stage of permanent adaptation to stress corresponds to a permanent inhibition of free radical processes in animal tissues. This stage is accompanied by the activation of superoxide radical scavenging and corresponding changes of lipid composition. similar results are obtained on the model of the development of permanent compensation processes after brain injury. Studying the acute stress it has been found, that during first minutes the inhibition of lipid peroxidation which precedes its further activation takes place. This stage corresponds to the realization of urgent adaptation phase to stress. The role of inhibition of free radical processes in mechanisms of urgent and permanent adaptation to stress is under discussion. PMID- 2665829 TI - Disparate effects of estrogens on in vitro steroidogenesis by mammalian and avian granulosa cells. AB - Estrogens exert a number of stimulatory effects on ovarian follicles, particularly in the hypophysectomized, immature female rat treated with diethylstilbestrol; in contrast, the majority of effects observed in numerous other mammalian or avian species is inhibitory. This minireview will first analyze the actions of estrogens on follicular function in vivo, and will then focus on this steroid's effect on steroidogenesis by granulosa cells in vitro. In vitro analysis will also allow us to discern some bases for the apparent dichotomy observed for estrogen action, and will aid in the elucidation of the mechanism(s) involved. PMID- 2665830 TI - Catecholamine effects on testicular testosterone production in the gonadally active and the gonadally regressed adult golden hamster. AB - Several lines of evidence support a role of testicular innervation and peripheral catecholamines in the control of male gonadal function, particularly before puberty. It was therefore of interest to compare the effects of catecholamines on androgen production during the periods of gonadal activity and quiescence in a seasonally breeding species. We have examined direct effects of epinephrine (EPI), norepinephrine (NE), the beta-adrenergic agonist isoproterenol (ISO), and the alpha-adrenergic agonist phenylephrine (PHE) on testicular testosterone (T) production in hamsters with gonadal regression induced by 12 wk exposure to short photoperiod (SD) and in gonadally active hamsters maintained in long photoperiod (LD). Fragments of decapsulated testes were incubated with various combinations of these catecholamines (10(-5)-10(-9) M), human chorionic gonadotropin (hCG; 3.1 mIU/ml), the beta-receptor antagonist propranolol (10(-5) M) and the alpha-l receptor antagonist prazosin (10(-5) M), for 6 h. In the incubations of testes from LD hamsters, the accumulation of T in the medium was stimulated by hCG but not affected by either catecholamine. However, EPI, NE, and PHE at 10(-5) M, but not ISO, augmented the stimulation of T by hCG. In sharp contrast to these findings, T production by the regressed testes of SD animals was stimulated by EPI (at 10(-8)-10(-5) M), NE (at 10(-6)-10(-5) M), and PHE (at 10(-6)-10(-5) M) in a dose-related manner, but unaffected by ISO. These stimulatory effects were prevented by prazosin, but not by propranolol. Moreover, 10(-5) M of EPI, NE, and PHE augmented the stimulatory effect of hCG on T production. We conclude that the seasonal transition from gonadal activity to quiescence in the adult golden hamster is accompanied by a major increase in the responsiveness of testicular steroidogenesis to catecholamines acting via the alpha-1-adrenoreceptor and that catecholamines can modulate Leydig cell response to gonadotropins in this species. These findings could be related to up-regulation of the alpha-1-receptor in the testis of the SD animal and suggest that catecholamines may be involved in the regulation of the testis during physiological suppression of gonadotropin release and during stress. PMID- 2665831 TI - Localization of relaxin during formation of the porcine corpus luteum. AB - The presence and localization of relaxin (RLX) in luteal tissue during the estrous cycle of the pig have been studied using the avidin-biotin immunoperoxidase method and homologous antisera to purified RLX. Prepubertal gilts were induced to ovulate by treatment with pregnant mare's serum gonadotropin (PMSG) and human chorionic gonadotropin (hCG). Ovaries were obtained at laparotomy during the periovulatory period and at specified times through Day 19 post-ovulation. Emphasis was placed on obtaining ovarian tissue at 12- and 24 h intervals up to 96 h after ovulation. RLX immunostaining was evident in theca interna (TI) cells before and at 6 h after ovulation. At 18 h after ovulation, RLX immunostaining comparable to that seen in TI cells was observed for the first time in luteinizing granulosa (G) cells. As luteinization progressed, it became difficult to identify the origin of the RLX immunostaining cells. However, the intensity of RLX immunostaining increased with corpus luteum (CL) development, with the staining becoming localized in the large luteal cells. By Day 19 after ovulation, RLX immunostaining was undetectable. These results indicate RLX is present in the CL during its formation and functional lifespan. Also, it would appear that the presence of RLX in G cells post-ovulation is associated with cell luteinization. PMID- 2665832 TI - Heat-shock cognate protein (hsc71) and related proteins in mouse spermatogenic cells. AB - A monoclonal antibody (13D3) has been developed that recognizes a 71 kilodalton (71 kDa) protein on two-dimensional immunoblots of proteins extracted from a mixture of mouse spermatogenic cells (mainly pachytene spermatocytes and spermatids). This protein was shown by immunoblotting and adenosine triphosphate (ATP)-binding characteristics to be identical to a 71 kDa mouse heat-shock cognate (hsc) protein, hsc71, present in 3T3 cells. Along with a 70 kDa heat shock inducible protein (hsp70), and a 74 kDa heat-shock cognate protein (hsc74), hsc71 is a product of the mouse HSP70 multigene family. Although antibody 13D3 reacted strongly with hsc71, it reacted only faintly with hsp70 in 3T3 cells, and not at all with hsc74 or a germ cell-specific hsp70-like protein (P70) on immunoblots of mixed germ cells. Antibody 13D3 is unique among known antibodies in its pattern of reaction with these heat-shock proteins. In immunofluorescence studies on isolated germ cells, 13D3 reacted uniformly with the cytoplasm of pachytene spermatocytes, round spermatids, and residual bodies, but only with the midpiece of spermatozoa. Antibody 13D3 recognizes other proteins in addition to hsc71 on two-dimensional immunoblots of condensing spermatids and spermatozoa. Two of the proteins (70 kDa/pI 6.4 and 70 kDa/pI 6.5) were present in condensing spermatids and spermatozoa, and another protein (69 kDa/pI 7.0) was detected only in spermatozoa. The new proteins also were recognized by monoclonal antibody 7.10, which reacts specifically with hsp70, hsc71, hsc74, and P70. Although [35S]methionine was incorporated into the new proteins in condensing spermatids, hsc71, hsc74, and P70 were not labeled. These results suggest that unique heat shock proteins are synthesized late in spermatogenesis. PMID- 2665833 TI - Incorporation of ionic channels from yeast plasma membranes into black lipid membranes. AB - Recently, patch-clamping of yeast protoplasts has revealed the presence of plasma membrane K+ channels (Gustin, M. C., B. Martinac, Y. Saimi, M. R. Culberston, and C. Kung. 1986. Science (Wash. DC). 233:1195-1197). In this work we show that fusion of purified plasma membranes into planar bilayers allows the study of the yeast channels. The main cationic conductances detected were of 64 and 116 pS, however, larger and smaller conductances have been observed. The two main conductances were sensitive to the K+ channels blockers tetraethylammonium (TEA+) and Ba2+. Bionic experiments indicated that both conductances were K+ selective. PMID- 2665834 TI - Antenna structure and excitation dynamics in photosystem I. II. Studies with mutants of Chlamydomonas reinhardtii lacking photosystem II. AB - Using time-resolved single photon counting, fluorescence decay in photosystem I (PS I) was analyzed in mutant strains of Chlamydomonas reinhardtii that lack photosystem II. Two strains are compared: one with a wild-type PS I core antenna (120 chlorophyll a/P700) and a second showing an apparent reduction in core antenna size (60 chlorophyll a/P700). These data were calculated from the lifetimes of core antenna excited states (75 and 45 ps, respectively) and from pigment stoichiometries. Fluorescence decay in wild type PS I is composed of two components: a fast 75-ps decay that represents the photochemically limited lifetime of excited states in the core antenna, and a minor (less than 10%) 300 800 ps component that has spectral characteristics of both peripheral and core antenna pigments. Temporal and spectral properties of the fast PS I decay indicate that (a) excitations are nearly equilibrated among the range of spectral forms present in the PS I core antenna, (b) an average excitation visits a representative distribution of core antenna spectral forms on all pigment-binding subunits regardless of the origin of the excitation, (c) reduction in core antenna size does not alter the range of antenna spectral forms present, and (d) transfer from peripheral antennae to the PS I core complex is rapid (less than 5 ps). PMID- 2665835 TI - Functional domains in the heavy-chain region of factor XI: a high molecular weight kininogen-binding site and a substrate-binding site for factor IX. AB - To probe the molecular interactions of factor XI we have prepared two monoclonal antibodies (MoAbs; 5F7 and 3C1), each of which binds the heavy chain of reduced and alkylated factor XIa. Competitive solid phase radioimmunoassay (RIA) binding studies revealed that 5F7 and 3C1 are directed against different epitopes within factor XI. One antibody (5F7) blocked the surface-mediated proteolytic activation of factor XI and its binding to HMW kininogen, but had no effect on factor-XIa catalyzed factor IX activation. The other antibody (3C1) is a competitive inhibitor of factor-IX activation by factor XIa, but blocked factor-XI binding to HMW kininogen only at 1,000-fold higher concentration than 5F7. Moreover, HMW kininogen had no effect on the kinetics of factor-XIa-catalyzed factor-IX activation. Furthermore, factor XI CNBr peptide fragments that bind to the 5F7 and 3C1 antibodies were isolated. The peptides that bound to the 5F7 antibody blocked the binding of HMW kininogen to factor XI but did not inhibit factor-XIa catalyzed factor-IX activation. However, the peptides isolated by the 3C1 antibody inhibited factor-XIa-catalyzed factor-IX activation and had no effect on factor-XI binding to HMW kininogen. Our results indicate that distinct functional domains within the heavy chain region of factor XI are important for the binding of factor XI to HMW kininogen and for activation of factor IX by factor XIa. PMID- 2665836 TI - Effect of recombinant human granulocyte-macrophage colony-stimulating factor on myelopoiesis in patients with refractory metastatic carcinoma. AB - The effect of human recombinant GM-colony-stimulating factor (CSF) was evaluated in ten patients with refractory metastatic carcinoma. Initially they received an intravenous (IV) bolus injection of 5 or 25 micrograms/m2 for assessment of acute responses. Six days later, continuous IV infusions of 100 or 500 micrograms/m2 were initiated for a 14-day treatment course. All patients developed profound leukopenia within five to 30 minutes of the bolus injection. This appeared to result from increased expression of an adhesion-promoting glycoprotein (GP) on neutrophils and monocytes as judged by increased reactivity to the Mo1 monoclonal antibody (MoAb). Leukocyte counts returned to normal levels within two hours as cells were released from marrow stores. With the continuous infusion, leukocyte counts increased by 24 hours; peak values of 22,960 and 75.900/microL were achieved after ten to 14 days of treatment with the two dose levels of GM-CSF. This leukocytosis was due to an increase in virtually all cell types. At the high dose level, there was a striking increase in neutrophils (49,400/microL) and eosinophils (20,905/microL) with a sixfold increase in monocytes and two- to threefold increase in lymphocytes. Leukocyte counts declined promptly after cessation of the infusion but remained above baseline for as long as 2 weeks in some patients. These results suggest that GM-CSF may be useful as an adjuvant therapy by stimulating myelopoiesis in cancer patients. PMID- 2665837 TI - Monoclonal antibodies reactive with hairy cell leukemia. AB - Monoclonal antibodies reactive with hairy cell leukemia were developed to aid in the diagnosis of this subtype of B cell chronic lymphocytic leukemia and to gain better insight into the origin of hairy cells. Three antibodies were found to be of value in the diagnosis of hairy cell leukemia. Antibody B-ly 2 can be considered a pan-B cell reagent and generally reacts similar to CD22 antibodies. Antibody B-ly 6 is reactive with the same antigen as CD11c (p150/95), an antigen that is present on hairy cell leukemia, macrophages, and a minor subpopulation of lymphocytes. Antibody B-ly 7 is a unique antibody reactive with 144 Kd antigen present only on hairy cell leukemia and a very small population of normal B lymphocytes. This subpopulation may be the counterpart of hairy cells. PMID- 2665838 TI - Production of interleukin-1 by bone marrow myeloma cells. AB - Plasma cells isolated from bone marrow (BM) aspirates of 12 patients with multiple myeloma (MM) and nine patients with monoclonal gammopathy of undetermined significance (MGUS) were analyzed for production of cytokines with bone-resorbing activity, such as interleukin-1 (IL-1), tumor necrosis factor (TNF), and lymphotoxin (LT). Culture supernatants of plasma cells from MM, but not from MGUS or normal donor, invariably contained high amounts of IL-1-beta and lower amounts of IL-1-alpha. With a single exception, TNF/LT biologic activity was not detected in the same supernatants. IL-6 was present in two of five supernatants tested. Normal B lymphocytes released both IL-1 and TNF/LT activities for four days after activation in vitro; however, production of these cytokines ceased at the final stage of plasma cell. Unexpectedly, the mRNA extracted from MM plasma cell hybridized with TNF- and LT-specific, as well as IL 1-specific probes, although the culture supernatants did not contain detectable TNF/LT biologic activity. When tested in the fetal rat long bone assay, MM plasma cell supernatants displayed a strong osteoclast-activating factor (OAF) activity, which was greatly reduced but not completely abolished by neutralizing anti-IL-1 antibodies. Anti-TNF or anti-LT antibodies were ineffective in the same test. We conclude that the IL-1 released in vivo by malignant plasma cells has a major role in pathogenesis of lytic bone lesions of human MM. PMID- 2665840 TI - Erythropoietin alone induces erythroid burst formation by human embryonic but not adult BFU-E in unicellular serum-free culture. AB - Erythroid progenitors (BFU-E) from adult human peripheral blood generate erythroid bursts in semisolid culture supplemented with at least two growth factors, ie, erythropoietin (Ep) and interleukin-3 (IL-3) or granulocyte macrophage colony-stimulating factor (GM-CSF). We have analyzed the hematopoietin(s) requirement of human embryonic BFU-E, as compared to that of adult peripheral blood progenitors: This was basically evaluated in fetal calf serum-free (FCS-) methylcellulose culture of partially or highly purified progenitors treated with human recombinant hemopoietins. At a low seeding concentration (2 x 10(3) cells/dish) purified embryonic BFU-E generated erythroid bursts when treated only with Ep: Further addition of IL-3 or GM-CSF had no effect on BFU-E cloning efficiency, although the size of bursts was increased in a dose-dependent manner, particularly with IL-3. At a similar seeding concentration (ie, 10(3) cells/dish), purified adult BFU-E efficiently generated erythroid bursts in the presence of Ep and GM-CSF or IL-3, while only few small erythroid colonies were observed in the presence of Ep alone. In a final series of experiments, unicellular FCS-cultures of purified embryonic BFU-E gave rise to erythroid bursts in the presence of Ep alone. Furthermore, the cloning efficiency induced by Ep was unmodified by further addition of GM-CSF or IL-3. Unicellular FCS- cultures of highly purified adult peripheral blood progenitors generated no erythroid bursts in the presence of Ep alone. The addition of GM-CSF or IL-3 was required to generate BFU-E colonies. These studies indicate that in human embryonic life, BFU-E require only Ep for efficient erythroid burst formation, while IL-3 and GM-CSF essentially enhance the proliferation of early erythropoietic precursors. PMID- 2665839 TI - Growth and differentiation of a human megakaryoblastic cell line, CMK. AB - Recently, a human megakaryoblastic cell line, CMK, was established from the peripheral blood of a megakaryoblastic leukemia patient with Down syndrome. Using this cell line, we studied the proliferation and differentiation of megakaryocytic cells in the presence of highly purified human hematopoietic factors and phorbol 12-myristate-13-acetate (PMA). In a methylcellulose culture system, interleukin-3 (IL-3) and granulocyte-macrophage colony-stimulating factor (GM-CSF) facilitated colony formation by CMK cells in a dose-dependent manner. The maximum stimulating doses of these factors were 10 and 200 U/mL, respectively. These concentrations were comparable to those that stimulate activity in normal hematopoietic cells. In contrast, granulocyte-colony stimulating factor (G-CSF), macrophage-colony stimulating factor (M-CSF), and erythropoietin (EPO) had no effects on the colony formation of CMK cells. In a liquid culture system, 20% of the CMK cells expressed glycoprotein IIb/IIIa (GPIIb/IIIa) antigen without hematopoietic factors, whereas 40% of the cells expressed GPIIb/IIIa with the addition of IL-3 and GM-CSF. EPO also slightly enhanced expression of GPIIb/IIIa. On the other hand, PMA inhibited growth of CMK cells and induced most of them to express the GPIIb/IIIa antigen. Furthermore, PMA induced CMK cells to produce growth activity toward new inocula of CMK cells. This growth factor (GF) contained colony-stimulating activity (CSA) in normal bone marrow (BM) cells. The activity was believed to be attributable mainly to GM CSF, since 64% of this activity was neutralized by anti-GM-CSF antibodies and a transcript of GM-CSF was detected in mRNA from PMA-treated CMK cells by Northern blot analysis. These observations suggest that GM-CSF, as well as IL-3, should play an important role in megakaryocytopoiesis. PMID- 2665841 TI - NADPH production by the malarial parasite Plasmodium falciparum. AB - Two enzymes from Plasmodium falciparum that catalyze the formation of NADPH have been partially purified and characterized. Glutamate dehydrogenase (GDH), molecular mass 230 Kd, pH optimum 7.0, is capable of producing NADPH under optimum conditions at about 10% of the capacity of the host erythrocyte. This capacity increases slightly during the developmental cycle of the parasite. NADP specific isocitrate dehydrogenase (IDH), molecular mass 80 Kd, pH optimum 7.5, is capable of producing NADPH at 20% to 60% of the capacity of the host cell, depending on the developmental stage of the parasite. Increasing IDH activity is observed as the parasite matures. GDH and IDH provide the parasite with NADPH generating abilities that compare favorably with the host cell. PMID- 2665842 TI - Developmental regulation of erythropoiesis by hematopoietic growth factors: analysis on populations of BFU-E from bone marrow, peripheral blood, and fetal liver. AB - Fetal hematopoiesis is characterized by expanding erythropoiesis to support a continuously increasing RBC mass. To explore the basis for this anabolic, nonhomeostatic erythropoiesis, the proliferative effect of recombinant hematopoietic growth factors on highly enriched hematopoietic progenitor cells from fetal and adult tissues were compared. Fetal hepatic BFU-E, unlike adult bone marrow (BM) or peripheral blood (PB) BFU-E, were capable of proliferating in response to erythropoietin in the absence of added GM colony-stimulating factor (GM-CSF) or interleukin-3 (IL-3), and erythropoietin (Epo) directly stimulated the expansion of the fetal BFU-E pool in suspension culture. A murine monoclonal antibody (MoAb), Ep 3, was raised against enriched fetal liver progenitor cells, which detected all fetal BFU-E and which reacted with the erythropoietin responsive, GM-CSF/IL-3-independent fraction of adult BM BFU-E and CFU-E. All adult PB BFU-E were Ep 3- but became Ep 3+ after stimulation with GM-CSF or IL-3. These data indicate that Epo plays a unique role in fetal hepatic erythropoiesis, stimulating proliferation of immature BFU-E in addition to promoting terminal differentiation of later erythroid progenitor cells. In addition, these results demonstrate a MoAb which detects all erythropoietin-responsive progenitor cells and distinguishes the BFU-E compartments in adult BM and PB. PMID- 2665843 TI - Efficacy of ex vivo purging for autologous bone marrow transplantation in the treatment of acute nonlymphoblastic leukemia. AB - We used an in vitro measure of drug activity to predict the efficacy of ex vivo purging of leukemic cells from autologous bone marrow grafts. We previously found that the myeloid progenitor cell (CFU-GM) content of the marrow grafts after ex vivo purging with 4-hydroperoxycyclophosphamide (4-HC) correlates with time to hematologic recovery after autologous bone marrow transplantation in patients with acute nonlymphoblastic leukemia. We observed that variable red blood cell concentration of the bone marrow incubation mixture results in differential cytotoxic activity of 4-HC. The CFU-GM content of the graft after the ex vivo treatment is a measure of this 4-HC activity. We analyzed the disease-free survival of 45 patients with acute nonlymphoblastic leukemia undergoing autologous bone marrow transplantation with 4-HC purged grafts. Patients who relapsed after transplantation had 4.2 +/- 1.1% of graft CFU-GM surviving the ex vivo purge, compared with 1.1 +/- 0.4% for patients who achieved a sustained remission (P = .06). Twenty-three patients with a CFU-GM content after 4-HC purging of greater than 1% of the pretreatment value had an actuarial disease free survival of 12%, compared to 36% for 22 patients with a less than or equal to 1% CFU-GM content after purging (P = .006). Therefore, percent CFU-GM survival as a measure of 4-HC cytotoxicity identified a group of patients with insufficient purging. Although no randomized clinical trials have documented the need for ex vivo purging, our results suggest that effective bone marrow purging is important for the optimal application of autologous transplantation in the treatment of acute nonlymphoblastic leukemia. PMID- 2665844 TI - Successful HLA nonidentical bone marrow transplantation in three patients with the leukocyte adhesion deficiency. AB - Three consecutive patients with the severe phenotype of leukocyte adhesion deficiency characterized by a defective expression of LFA-1, Mac-1 (CR3), and p150.95 on leukocytes have received HLA partially incompatible bone marrow transplantation (BMT). The degree of HLA incompatibility between related donors and recipients was 2 HLA antigens in one and one full haplotype in the two others. Graft-v-host disease (GVHD) prophylaxis consisted in T-cell depletion of the bone marrow inoculum and a 60-day course of cyclosporin A. A first attempt led to autologous recovery in one patient. The second transplant in this patient and the first transplant in the two others led to stable partial engraftment of lymphocytes and phagocytic cells, as shown by expression of adhesion molecules (LFA-1, Mac-1) on leukocytes and by HLA typing and restriction fragment-length polymorphism studies using minisatellite probes. Although the level of mixed chimerism was lower in one patient (7% to 30% donor cells) and greater than 50% in the two others, recovery of lymphocyte and phagocytic cell functions was sufficient enough to allow the patient to lead a normal life, infection free in the three cases. These patients, now 57, 32, and 19 months post-transplant, are in good condition without any therapy. These results lead us to propose that the LFA-1 molecule plays a role in HLA-incompatible graft rejection, probably by mediating adhesion of cytotoxic T and non-T lymphocytes to their targets. PMID- 2665845 TI - Novel vitamin D analogs that modulate leukemic cell growth and differentiation with little effect on either intestinal calcium absorption or bone mobilization. AB - Induction of terminal differentiation of leukemic and preleukemic cells is a therapeutic approach to leukemia and preleukemia. The 1 alpha, 25 dihydroxyvitamin D3 [1,25(OH)2D3], the hormonally active form of vitamin D3, can induce differentiation and inhibit proliferation of leukemia cells, but concentrations required to achieve these effects cause life-threatening hypercalcemia. Seven new analogs of 1,25(OH)2D3 were discovered to be either equivalent or more potent than 1,25(OH)2D3 as assessed by: (a) inhibition of clonal proliferation of HL-60, EM-2, U937, and patients' myeloid leukemic cells: and (b) induction of differentiation of HL-60 promyelocytes. Furthermore, these analogs stimulated clonal growth of normal human myeloid stem cells. The most potent analog, 1,25-dihydroxy-16ene-23yne-vitamin D3, was about fourfold more potent than 1,25(OH)2D3. This analog decreased clonal growth and expression of c myc oncogene in HL-60 cells by 50% within ten hours of exposure. Effects on calcium metabolism of these novel analogs in vivo was assessed by intestinal calcium absorption (ICA) and bone calcium mobilization (BCM). Each of the analogs mediated markedly less (10 to 200-fold) ICA and BCM as compared with 1,25(OH)2D3. To gain insight into the possible mechanism of action of these new analogs, receptor binding studies were done with 1,25(OH)2-16ene-23yne-D3 and showed that it competed only about 60% as effectively as 1,25(OH)2D3 for 1,25(OH)2D3 receptors present in HL-60 cells and 98% as effective as 1,25(OH)2D3 for receptors present in chick intestinal cells. In summary, we have discovered seven novel vitamin D analogs that are more potent than the physiologic 1,25(OH)2D3 as measured by a variety of hematopoietic assays. In contrast, these compounds appear to have the potential to be markedly less toxic (induction of hypercalcemia). These novel vitamin D compounds may be superior to 1,25(OH)2D3 in a number of clinical situations including leukemia/preleukemia; they will provide a tool to dissect the mechanism of action of vitamin D seco-steroids in promoting cellular differentiation. PMID- 2665846 TI - The Rb gene and the negative regulation of cell growth. PMID- 2665847 TI - Malaria: the search for vaccine antigens and new chemotherapeutic strategies. PMID- 2665848 TI - Development of an asexual blood stage malaria vaccine. PMID- 2665849 TI - Interleukin-1 stimulates proliferation of acute myeloblastic leukemia cells by induction of granulocyte-macrophage colony-stimulating factor release. AB - In this study, we further established the role of interleukin-1 (IL-1) alpha and IL-1 beta as regulators of proliferation of acute myeloid leukemia (AML) cells. IL-1 stimulated tritiated thymidine (3H-TdR) uptake of AML cells in 13 of 28 cases. Cytogenetic analysis confirmed the leukemic clonality of the IL-1 stimulated cells. Most likely, IL-1 exerted these stimulative effects directly on AML blast cells because IL-1 effectively induced 3H-TdR uptake of CD34-positive AML blasts (separated following cell sorting). Furthermore, adherent cell depleted AML samples of three patients were more effectively stimulated than nondepleted AML fractions. Cluster and colony formation from adherent cell depleted AML samples could also be stimulated with IL-1, ie, in seven of ten cases analyzed. Subsequent experiments indicated that IL-1 stimulation depended on the release of GM-CSF because (1) induction of DNA synthesis of AML cells by IL-1 could be abrogated with antigranulocyte-macrophage colony-stimulating factor (GM-CSF) antibody, (2) conditioned media (CM) prepared from IL-1 stimulated AML blasts (adherent cell depleted) could stimulate the proliferation of purified normal bone marrow progenitors whereas supernatants from nonstimulated AML blasts did not, and (3) GM-CSF was demonstrated in IL-1/AML-CM with a specific radioimmunoassay, while GM-CSF was not detectable in nonstimulated supernatants. In one case of AML showing significant 3H-TdR uptake in the absence of CSFs, this spontaneous DNA synthesis was found to depend on autocrine IL-1 beta release as it could be suppressed with anti-IL-1 beta antibody or anti-GM-CSF. The blockade by anti-IL-1 beta could be overcome by the addition of high concentrations of IL 1 beta as well as GM-CSF. Thus, in this particular case, endogenously produced IL 1 beta had stimulated the release of GM-CSF which resulted in GM-CSF-dependent proliferation. The results indicate that GM-CSF production by AML blasts is often regulated by IL-1 rather than being constitutive. PMID- 2665850 TI - Detection of a human CFC with a high proliferative potential. AB - Colony forming cells (CFC) with high proliferative potential have been detected in nutrient agar cultures of human bone marrow cells containing recombinant human interleukin-3 (IL-3) and granulocyte macrophage colony stimulating factor (GM CSF). These CFC were detected by the formation of large colonies with diameters greater than 0.5 mm and containing approximately 50,000 cells after 28 days incubation. The incidence of these CFC was only two in 100,000 normal bone marrow cells; however, bone marrow from patients treated with 5-fluorouracil contained up to sevenfold higher numbers of these CFC. The characteristics of these CFC, multifactor-responsive progenitors with high proliferative potential, requiring a prolonged growth period in culture and showing a relative preservation in marrow from individuals pretreated with 5-fluorouracil, are consistent with a human cell type equivalent to the primitive murine progenitor termed HPP-CFC. PMID- 2665851 TI - The in vivo effects of recombinant human interleukin-3: demonstration of basophil differentiation factor, histamine-producing activity, and priming of GM-CSF responsive progenitors in nonhuman primates. AB - Recently human interleukin-3 (IL-3) produced by molecular cloning was characterized as a growth factor for basophils and eosinophils in human bone marrow cultures. Since we found a similar activity of the human factor on simian bone marrow cells, we investigated the in vivo effects of recombinant human (rh) IL-3 in healthy rhesus monkeys (n = 10). rh IL-3 was administered subcutaneously (SC) to monkeys at different doses (11, 33, and 100 micrograms/kg/d) for 14 days followed by subsequent rh GM-CSF administration (5.5 micrograms/kg/d SC) for another two weeks. During the second week of rh IL-3 administration monkeys responded with a twofold to threefold increase of WBCs caused by a dose-dependent elevation of basophils (up to 40% of WBCs) and eosinophils. rh IL-3 also induced a dose-dependent increase of histamine (up to 700-fold above normal values) in monkey blood cells. Administration of rh GM-CSF to rh IL-3 pretreated monkeys resulted in a twofold enhanced increase in WBCs (due mainly to eosinophils and neutrophils) compared with animals treated with rh GM-CSF alone. Simultaneous administration of both cytokines (100 micrograms/kg rh IL-3 + 5.5 micrograms/kg rh GM-CSF SC) to two separate monkeys for 14 days induced a WBC elevation similar to that observed in monkeys treated with rh GM-CSF alone. In conclusion, our results indicate that rh IL-3 is a differentiation factor for blood basophils and primes the hematopoietic system for subsequent rh GM-CSF actions. PMID- 2665852 TI - An antifibrin monoclonal antibody useful in immunoscintigraphic detection of thrombi. AB - Balb/c mice were immunized with human plasmin-generated fibrinogen degradation product Y. Spleen cells were fused with P3X63-Ag8.653 myeloma cells. A clone (Y22) was found that produces monoclonal antibodies (MoAbs) with a strong reactivity with human fibrin and only a weak reactivity with fibrinogen in an enzyme immunoassay (EIA). Y22 also reacts with fibrin of rabbits, rats, sheep, and dogs. The antibodies are of the IgG1 kappa-type and appear to be directed against a conformation-dependent epitope in the D-domain of fibrin. Experiments with 99mTc-labeled Y22 in vitro show that Y22 binds rapidly to forming clots. 99mTc-Y22 also binds to preformed plasma clots in a plasma milieu, even in the presence of high concentrations of heparin. Clot localization experiments in rabbits and rats confirm the high fibrin specificity and the potential of 99mTc Y22 for thrombus imaging in vivo. PMID- 2665853 TI - Megakaryocyte and hepatocyte origins of human fibrinogen biosynthesis exhibit hepatocyte-specific expression of gamma chain-variant polypeptides. AB - The gamma chain of human fibrinogen is heterogeneous in length at the C-terminus due to differential RNA processing of the gamma chain-gene primary transcript. We have produced two specific monoclonal antibodies (MoAbs) against the gamma-chain epitopes generated by this alternative processing event: anti-gamma 57.5(408-416) (L2B), which reacts with gamma 57.5 and gamma 55 chains, and anti-gamma 50(337 411) (H9B7), which reacts preferentially with gamma 50 chains. Using these MoAbs we have studied the expression of gamma-chain polypeptides by immunofluorescence microscopy in the tissues of fibrinogen biosynthesis and have determined that gamma 57.5 polypeptide is expressed in hepatocytes but is absent or present in significantly reduced amounts in megakaryocytes. Therefore the gamma 50 chain is found in plasma, platelet, and megakaryocyte fibrinogens, but the gamma 57.5 chain is found only in plasma fibrinogen. The C-terminal amino acid sequence of gamma 55 includes the L2B epitope 57.5(408-416). Using MoAb L2B we have determined that gamma 55, which is a post-translationally modified gamma 57.5 chain, is found only in plasma fibrinogen and is absent or present in markedly reduced amounts in platelet or megakaryocyte fibrinogen. In addition, the conformation of the L2B epitope is preserved in gamma 55, as determined by Western blot analysis. The hepatocyte-specific expression of the gamma 57.5-chain polypeptide and the post-translational modification to gamma 55 result in a compartmentalization of gamma-chain polypeptide expression. This is suggestive of different mechanisms regulating human fibrinogen gamma-chain gene expression in hepatocytes v megakaryocytes that may operate in a tissue-specific manner at the level of 3' RNA processing events. PMID- 2665854 TI - B-cell dysfunction following human bone marrow transplantation: functional phenotypic dissociation in the early posttransplant period. AB - We investigated the defect in humoral immunity that occurs following bone marrow transplantation (BMT). B cells from BMT recipients were tested for their ability to undergo the sequential steps of activation (RNA synthesis on stimulation with anti-mu or PMA), proliferation (DNA synthesis on stimulation with anti-mu plus B cell growth factor [BCGF], phorbol myristate acetate [PMA], or Staphylococcus aureus Cowan I [SAC] strain bacteria) and differentiation (Ig synthesis stimulated by T cell replacing factor [TRF]). B-cell maturation-associated cell surface markers were simultaneously investigated. "Early" (less than 10 months) posttransplant patients demonstrated defective B-cell activation and also failed to undergo normal proliferation and differentiation. Despite their functional impairment, the early patients' B cells displayed an "activated" phenotype with increased proportions of B cells displaying CD23 (a BCGF receptor) and decreased proportions of Leu 8+ B cells. Furthermore, these patients were uniquely distinguished by the fact that their B cells only weakly (if at all) expressed the CD19 antigen. In contrast, B cells from "late" patients (greater than or equal to 10 months post-BMT) activated and proliferated normally and displayed a normal cell surface phenotype, yet were unable to differentiate to high rate Ig secretion with TRF. Our results suggest a phenotype/function dissociation in early posttransplant period. With time, B cells in BMT patients acquire a normal surface phenotype and can activate and proliferate normally, yet still demonstrate a block in terminal differentiation. PMID- 2665855 TI - Down-modulation of neutrophil production by erythropoietin in human hematopoietic clones. AB - In clonogenic assays of hematopoietic progenitors, high concentrations (4 U/mL) of erythropoietin (epo) reduced the formation of granulocyte-macrophage (GM) colonies and diminished the number of granulocytes formed per culture plate. Fetal progenitors were more sensitive to these effects of epo than were progenitors from adults, displaying these reductions at greater than or equal to 1 U epo/mL. The mechanism was investigated by growing fetal progenitors stimulated by recombinant GM-CSF, in the absence of epo, and when eight-cell clones first appeared, mapping their location, then adding epo, and assessing its effect on the subsequent differentiation of the clones. In the absence of epo, the clones developed exclusively into GM colonies. However, if developing clones were presented with epo, 85% matured into GM colonies, but 15% became multilineage or normoblast colonies. In addition, developing clones that were presented with epo produced colonies that contained fewer neutrophils. These effects of epo on neutrophil generation were observed with each of three varieties of recombinant epo, and also with purified human epo, but were not observed using epo that had been neutralized with rabbit anti-epo antiserum. PMID- 2665856 TI - Characterization of a spontaneous mutation in beta-thalassemia associated with advanced paternal age. AB - We characterized the molecular defect in a Swiss patient with a spontaneous beta thalassemia mutation. Cloning and DNA sequencing of her beta-globin gene revealed a new frameshift mutation due to a single nucleotide deletion at codon 64 of the beta-globin gene. Restriction site polymorphism showed that the mutation arose on her paternal chromosome. Direct sequencing of a polymerase chain reaction amplified DNA segment showed absence of the lesion in both alleles of her father's beta-globin gene and confirmed the spontaneous nature of this mutation. PMID- 2665857 TI - Abnormalities in the mechanical properties of red blood cells caused by Plasmodium falciparum. AB - Although changes in the mechanical properties of infected red cells may contribute to the pathophysiology of malaria, such changes have not previously been described in detail. In this study, the physical properties of individual cells from both clinical and cultured samples infected with Plasmodium falciparum were tested using micropipette aspiration techniques. Cells containing ring forms took about 50% longer to enter 3 microns pipettes compared with nonparasitised cells, and there was a similar increase in the critical pressure required to induce cell entry. These abnormalities were similar in clinical and cultured samples. More mature cultured parasites (ie, trophozoites and schizonts containing pigment) caused much greater loss of deformability, with entry time and pressure increased four to sixfold. The decrease in deformability of the ring forms was attributable to a deficit in cell surface area/volume ratio (based on micropipette measurement of the surface area and volume of individual cells) and slight stiffening of the cell membrane (shear elastic modulus increased 13%, as measured by pipette aspiration of small membrane tongues). Measurement of the rate of cell shape recovery indicated that the membrane of parasitised cells was not more viscous. The main factor in the drastic loss of deformability of the trophozoites and schizonts was the presence of the large very resistant parasite itself. Otherwise, the cell surface area/volume deficit was slightly less and membrane rigidification slightly greater compared with ring forms. The above abnormalities should cause the trophozoites and schizonts to have great difficulty in traversing splenic or marrow sinuses and could contribute to microvascular occlusion and sequestration. On the other hand, the ring forms may be expected to circulate relatively unhindered. PMID- 2665858 TI - Marrow transplantation for acute lymphoblastic leukemia: factors affecting relapse and survival. AB - Transplant outcome was analyzed in 690 recipients of bone marrow transplants (BMTs) for acute lymphoblastic leukemia (ALL) in first (n = 299) or second remission (n = 391). Actuarial 5-year leukemia-free survival was 42% +/- 9% (95% confidence interval) and 26% +/- 6%, respectively; relapse rates were 29% +/- 9% and 52% +/- 8%, respectively. Five-year leukemia-free survival was 56% +/- 18% in children and 39% +/- 10% in adults (P less than .02) transplanted in first remission. In first-remission adults, non-T-cell phenotype, male to female donor recipient sex-match and graft-v-host disease (GVHD) were associated with decreased leukemia-free survival; inclusion of corticosteroids in the regimen to prevent GVHD was associated with increased leukemia-free survival. Variables associated with decreased leukemia-free survival after second-remission transplants were age greater than or equal to 16 years and relapse occurring while on therapy. Variables associated with increased probability of relapse were similar for first- and second-remission transplants and included GVHD prophylaxis without methotrexate and absence of GVHD. In first-remission transplants, leukocyte count greater than or equal to 50 x 10(9)/L at diagnosis was also associated with increased relapse; in second remission, relapse while receiving chemotherapy was also associated with increased posttransplant relapse. These data emphasize the importance of both disease- and transplant-related variables in predicting outcome after BMT. They may be used to explain differences between studies, design future trials, and identify persons most likely to benefit from BMT. PMID- 2665859 TI - Loss of hematopoietic stem cell self-renewal after bone marrow transplantation. AB - The quality of long-term hematopoietic engraftment after bone marrow transplantation (BMT) has not been well characterized. Clinical autologous BMT involves removal of less than 5% of the total content of the recipient marrow followed by ablation of the remaining marrow and reinfusion. To study long-term consequences of transplanting limited numbers of BM stem cells further, we evaluated the hematopoietic reserve in recipient animals after transplantation of varying quantities of BM. Recipient animals demonstrated a donor BM cell dose dependent decrease in stem cell content and self-renewal capacity that was not reflected in peripheral blood (PB) counts or BM cellularity. This decrease was observed after initial BM recovery and did not change with time after transplantation, demonstrating a permanent loss in BM self-renewal capacity. In addition, animals alive at 3 months, a time selected to allow BM recovery, also demonstrated a donor BM cell dose-dependent decrease in survival at 1 year. These results emphasize the importance of optimizing stem cell number in BMT. PMID- 2665860 TI - Detection of Philadelphia chromosome-positive cells by the polymerase chain reaction following bone marrow transplant for chronic myelogenous leukemia. AB - Sixteen patients treated by allogeneic bone marrow transplantation (BMT) for chronic myelogenous leukemia (CML) were evaluated by the polymerase chain reaction (PCR) for bcr/abl-specific RNA transcripts at various time points after BMT. In reconstitution experiments, one CML cell per million normal mononuclear cells could be detected by direct agarose gel visualization of a bcr/abl-specific band following PCR. Bcr/abl message was found in ten out of 16 patients post-BMT. PCR-positive bcr/abl was present only transiently in three patients and correlated with relapse in three. One patient died in clinical remission, while two patients remain in remission despite persistence of bcr/abl-positive abl positive cells at 180 days. Long-term follow-up of bcr/abl-positive patients in clinical remission may provide insight into the fate or residual Ph+ cells after BMT. This approach may aid in the identification of high-risk patients likely to relapse post-BMT. PMID- 2665861 TI - Cure of chronic myelogenous leukemia. PMID- 2665862 TI - The deamination of adenosine and adenosine monophosphate in Plasmodium falciparum infected human erythrocytes: in vitro use of 2'deoxycoformycin and AMP deaminase deficient red cells. AB - The role of enzymatic deamination of adenosine monophosphate (AMP) and adenosine in the in vitro growth of the malaria parasite Plasmodium falciparum was investigated by means of human red cells deficient in AMP deaminase to which the adenosine deaminase inhibitor 2'-deoxycoformycin was added. Malaria parasites grew normally in red cells lacking one or both of these enzyme activities. As a further probe of adenosine triphosphate (ATP) catabolism, both infected and uninfected RBCs were incubated with NaF (with and without 2'-deoxycoformycin) and the purine nucleotide/nucleoside content was analyzed by high-performance liquid chromatography (HPLC). Uninfected RBCs lacking either AMP or adenosine deaminase were able to bypass the enzyme block and degrade ATP to hypoxanthine. Uninfected RBCs with both deaminases blocked were unable to produce significant quantities of hypoxanthine. On the other hand, infected RBCs were able to bypass blockade of both deaminases and produce hypoxanthine and adenosine. These findings establish that deamination of adenosine and/or AMP are not essential for plasmodial growth. However, further work will be required to elucidate the pathways that permit the parasites to bypass these catabolic steps. PMID- 2665863 TI - Identification of an anti-A and anti-B blood group glycosyltransferase antibody after incompatible bone marrow transplant. AB - The occurrence of a potent antibody against plasmatic A and B glycosyltransferase activities has been characterized in a patient (blood group A1) transplanted with a bone marrow from a blood group O donor. A and B glycosyltransferases were purified to near homogeneity from plasma of A1 and B blood-group individuals. The half-maximal inhibition of both enzymes was obtained at 1 to 2 micrograms/mL of the post-transplant IgG fraction, prepared by protein A-sepharose chromatography. A and B glycosyltransferases were also recognized by the post-transplant IgG fraction after sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS PAGE) followed by electrophoretic transfer to nitrocellulose membranes. PMID- 2665864 TI - Comparison of fractionated to single-dose total body irradiation in conditioning canine littermates for DLA-identical marrow grafts. AB - We explored the ability of fractionated total body irradiation (TBI) given at a rate of 7 cGy/min from opposing dual 60Co sources at otherwise lethal doses of 450, 600, 700, 800, and 920 cGy to condition dogs for marrow grafts from DLA identical littermates. Results were compared with those of a previously reported study using single-dose TBI administered under otherwise identical conditions. Fractionated TBI was less immunosuppressive than single-dose TBI, as evidenced by a significantly higher rate of graft rejection (P = .001). Specifically, sustained allogeneic engraftment was observed in only two of 18 (11%) dogs that received 600 to 800 cGy fractionated TBI as compared with 11 of 17 (65%) dogs that received comparable doses of single-dose TBI. Only at 450 cGy (none of the ten dogs studied had sustained engraftment) and at 920 cGy (four of five dogs that received fractionated and 20 of 21 dogs that received single-dose TBI engrafted) were we unable to find differences between the two modes of radiation. Most dogs that rejected their graft survived with autologous recovery (13 of 22 that received fractionated and eight of 12 that received single-dose TBI; P = .49), presumably the result of extended support provided by the transient allogeneic grafts. We conclude that at equivalent doses fractionated TBI is significantly less effective than single-dose TBI to condition DLA-identical littermate dogs for marrow transplantation. These findings have implications for the design of conditioning programs in clinical transplantation, especially when T-cell-depleted marrow grafts are used. PMID- 2665865 TI - Autologous bone marrow transplantation with 4-hydroperoxycyclophosphamide purged marrows for acute nonlymphocytic leukemia in late remission or early relapse. AB - Twenty-four patients with acute nonlymphocytic leukemia (ANLL) were treated with high-dose chemotherapy or chemoradiotherapy followed by infusion of autologous marrow purged with 100 micrograms/mL of 4-hydroperoxycyclophosphamide (4HC). The marrow harvests were performed when there were less than 5% blasts in the marrow. Seven patients were transplanted in second complete remission (CR), eight in third CR, one in fourth CR, and eight in early relapse. The median time to achieve 500 neutrophils/microL or 1,000 leukocytes/microL was 30 days. A platelet count of 20,000/microL and 50,000/microL was achieved at a median of 67 and 91 days, respectively. One patient failed to engraft by day 58. There were five other transplant-related deaths: sepsis (one), intracerebral hemorrhage (one), veno-occlusive disease (one), and interstitial pneumonia (two). Four of seven evaluable patients transplanted in early relapse obtained a CR lasting 112, 143, 189, and greater than 615 days. Eight of 11 evaluable patients transplanted in CR have relapsed at a median of 153 days (range, 104 to 311). The actuarial survival for all patients was 19%. There was a trend toward improved relapse-free survival for patients transplanted in remission as opposed to those transplanted in relapse (P = .11). PMID- 2665866 TI - T-cell antigenic sites of the malaria circumsporozoite protein. PMID- 2665867 TI - Marrow transplantation in acute nonlymphocytic leukemia. PMID- 2665868 TI - Enhancement of colony-forming activity of granulocyte-macrophage colony stimulating factor by monocytes in vitro. AB - Human recombinant granulocyte-macrophage colony-stimulating factor (hrGM-CSF) stimulated granulocyte-macrophage (GM) colony formation from human marrow mononuclear cells (MMCs) in a dose-dependent manner in methylcellulose culture. When phagocytes were depleted from MMCs, GM colony formation from the phagocyte depleted (PD) MMCs by hrGM-CSF markedly decreased. Experiments in which PD-MMCs were cultured with hrGM-CSF and adherent cells showed that 94% (on day 7 and day 14) of the colonies from PD-MMCs were dependent on the presence of adherent cells. In contrast, the ability of granulocyte colony-stimulating factor (G-CSF) to form colonies was not affected by phagocyte depletion. To check for the presence or absence of progenitors that could form GM colonies in direct response to hrGM-CSF, single-cell culture of hematopoietic progenitor cell surface antigen (My-10)-positive PD-MMCs was carried out using a flow cytometer and an Autoclone System. In duplicate experiments, 0.7% and 3.5% (day 7) or 3.6% and 3.9% (day 14) of My-10-positive PD-MMCs formed GM colonies in response to hrGM-CSF and 5.1% and 6.0% (day 7) of My-10-positive PD-MMCs formed GM colonies in response to G-CSF. This was clear evidence for the presence of progenitors directly responding to hrGM-CSF. Also observed was a synergistic effect on GM colony formation in which more My-10-positive PD-MMCs stimulated by hrGM-CSF and G-CSF could form GM colonies than the sum of those stimulated by each separately. This enhancing effect of colony-forming activity of hrGM-CSF by adherent cells and the single cell culture experiment were reproduced in serum-free culture system. PMID- 2665869 TI - Enhanced proteolysis of plasma von Willebrand factor in thrombotic thrombocytopenic purpura and the hemolytic uremic syndrome. AB - To examine whether enhanced in vivo proteolysis of von Willebrand factor (vWF) would account for the reported loss of larger multimers in acute thrombotic thrombocytopenic purpura/hemolytic uremic syndrome (TTP/HUS), we studied eight patients with acute TTP/HUS whose blood samples were collected into an anticoagulant containing a cocktail of protease inhibitors to impede in vitro proteolysis. In all, enhanced proteolytic degradation of vWF was expressed as a relative decrease in the intact 225-Kd subunit of vWF and a relative increase in the 176-Kd fragment. However, instead of the loss of larger forms of normal multimers reported by other investigators, the plasma of all but one of our patients (whether they had TTP or HUS) contained a set of larger than normal (supranormal) multimers. Hence, although proteolytic fragmentation of vWF was enhanced during acute TTP/HUS, this phenomenon was not associated with the loss of larger multimers. In the five patients who survived the acute disease and underwent plasma exchange (three with HUS and two with chronic relapsing TTP), subunits and fragments returned to normal values, and supranormal multimers were no longer detected in plasma. In conclusion, even though vWF proteolysis is enhanced in acute TTP/HUS, it does not lead to loss of larger multimers. PMID- 2665870 TI - Platelet membrane glycoproteins and their function: an overview. AB - The membrane glycoproteins (GP) of human platelets act as receptors that mediate two important functions, adhesion to the subendothelial matrix and platelet platelet cohesion, or aggregation. Many of these glycoprotein receptors exist as noncovalently linked heterodimers, including those that belong to the supergene family of adhesion receptors called the integrins. Human platelets contain at least five members of this integrin family, including a collagen receptor (GP Ia IIa; alpha 2, beta 1), a fibronectin receptor (GP Ic-IIa; alpha 5, beta 1), a laminin receptor (GP Ic'-IIa; alpha 6, beta 1), a vitronectin receptor (VnR; alpha v, beta 3), and a promiscuous, activation-dependent receptor that is thought to be the receptor most responsible for fibrinogen-dependent, platelet platelet cohesion (GP IIb-IIIa; alpha IIb, beta 3). Some, but not all, of the integrins bind to a tripeptide sequence, arginine-glycine-aspartic acid (RGD), on the adhesive proteins. In addition to the integrins, platelets contain other membrane glyco-proteins: GP Ib-IX, a receptor for von Willebrand factor, which is thought to be the receptor most responsible for platelet adhesion to the subendothelial matrix in a flowing system; GP V, which may be associated with GP Ib-IX and whose function remains unknown; and GP IV (GP IIIb), which functions as a receptor for thrombospondin and collagen. PMID- 2665871 TI - Recent trends in platelet antigen/antibody detection. AB - The detection of platelet antigens and platelet antibodies has always been difficult. Recent technical achievements are due to the availability of more specific and sensitive reagents (i.e. F(ab)2 fragments; higher specific activity of labels; monoclonal antibodies directed against platelet membrane constituents etc.) and the application of advanced immunological assays to platelet immunology (i.e. blotting assays, "capture"-ELISA's and radioimmunoprecipitation in conjunction with SDS polyacrylamide gel electrophoresis). These techniques have permitted the definition and immuno-chemical characterization of new platelet allo- and autoantigens, have assisted in clinical diagnosis and promoted our understanding of pathogenic mechanisms. Illustrative examples are presented and discussed. PMID- 2665872 TI - Autoantibodies in chronic ITP. AB - Chronic ITP is a syndrome of destructive thrombocytopenia due in most cases to antiplatelet autoantibodies. In the present studies we have studied 74 patients with chronic ITP using a new immunobead assay. Of these, 59 (79.7%) had demonstrable platelet-associated autoantibodies: 48 against platelet glycoprotein IIb/IIIa and 11 against glycoprotein Ib/IX. Plasma autoantibodies were studied in all patients and 32 (43.2%) had positive results; in each case the patient also had platelet-associated autoantibodies directed to the same antigen. We conclude that the majority of patients with chronic ITP have autoantibodies against platelet membrane glycoproteins and that the immunobead assay is a sensitive and reproducible method for their detection which is applicable to the routine hospital laboratory. PMID- 2665873 TI - Laboratory workshop on the characterization of anti-platelet antibodies in immune thrombocytopenic purpura. AB - The aim of this laboratory workshop was to evaluate the state of knowledge concerning the demonstration of membrane glycoprotein specific anti-platelet antibodies. The main interest lay in investigating whether specific antibody detection offers possibilities to distinguish the chronic from the acute form of ITP. In five laboratories four different methods were applied to demonstrate such antibodies. These methods are briefly described and compared. In all, except two, of the 45 ITP samples anti-platelet antibodies could be detected by at least one participating laboratory, in 85% of the samples antibodies were found by two or more laboratories. For seven out of eight control samples no positive results were reported. The comparison of glycoprotein specific anti-platelet antibodies shows partly considerable differences which may be due to the different methods as well as the different antibodies used (monoclonal antibody against membrane glycoprotein and antihuman globulin sera). This laboratory workshop leads to the conclusion that by exchange of reagents and patient samples the different methods may be compared and evaluated. The results obtained allowed no further characterization of ITP. All participants agreed on the usefulness of further similar laboratory workshops. PMID- 2665874 TI - The serology and immunochemistry of HIV-induced platelet-bound immunoglobulin. AB - A study was carried out on the presence of platelet-bound immunoglobulins, platelet-bound complement and serum immunoglobulin reactive with platelets in the blood of persons infected with HIV and those at risk of HIV infection. Platelet bound immunoglobulins, predominantly IgG and IgM, but not complement, were demonstrated by immunofluorescence in 16 out of 16 patients with AIDS, in 5 out of 7 with AIDS-related complex/persistent generalized lymphadenopathy and in 7 out of 10 apparently healthy sexually active homosexual men, of whom 2 were anti HIV1 seropositive. There was no correlation between the presence of platelet bound immunoglobulins and either the platelet count or the level of circulating immune complexes. The specificity of the platelet-bound immunoglobulins and platelet-reactive immunoglobulins in the corresponding sera was studied. Platelet bound immunoglobulins were eluted and then investigated for cross-reactivity with HIV. Both sera and eluates were tested for reactivity with cardiolipin and reactivity with the major target antigen in classical autoimmune thrombocytopenia, the GP IIb/IIIa complex. Of 17 eluates containing platelet reactive immunoglobulins, 5 reacted with HIV-determinants but 2 out of 5 eluates that did not contain platelet-reactive immunoglobulins also reacted. Although anti-cardiolipin antibodies were detected in all sera, none of the 17 eluates reacted with cardiolipin. Moreover, sera and eluates, reactive with normal platelets, did not react with type-1-Glanzmann disease platelets. This indicates that the antibodies are directed against the glycoprotein IIb/IIIa complex of platelets. This could not be confirmed by immunoprecipitation or by immunoblotting, however. We conclude that the presence of platelet-bound immunoglobulins is common in HIV-infection but may also occur in persons at risk and that the nature of the auto-antibodies is not different from that of the auto antibodies observed in classical ITP. PMID- 2665875 TI - Overview of ITP treatment modalities in children. AB - Patients with idiopathic thrombocytopenia purpura (ITP) are frequently encountered by the pediatrician and pediatric hematologist. The clinical and laboratory features of ITP are quite uniform and facilitate prompt and accurate diagnosis. Bone marrow examination is not required in most cases since patients with alternative diagnoses (such as ALL) have greatly different presenting features. Acute ITP cannot be differentiated from the chronic form of the disease at presentation, nor can chronic disease be prevented by specific therapy administered for apparent acute ITP. Much controversy has revolved around whether an active interventionist (pharmacologic) or non-interventionist approach is preferred for management of ITP. The platelet count in both acute and chronic ITP often rises following treatment with prednisone and/or intravenous gamma globulin (IV GG), but such responses are transient and do not clearly provide protection against the rare complication of life-threatening hemorrhage. There are numerous disadvantages to an interventionist approach to therapy. Children with chronic ITP may require splenectomy if the disease is symptomatic enough to interfere with life-style, but the majority of these patients, too, require no specific therapy. PMID- 2665876 TI - [From oncogene to anti-oncogene. Recent findings apropos of the retinoblastoma susceptibility gene]. PMID- 2665877 TI - [Paraneoplastic hypercalcemia and ovarian seminoma. Review of the literature and etiological discussion apropos of a case]. AB - We report a case of hypercalcemia in a 20-year-old woman with an ovarian seminoma. She had neither evidence of bone metastasis nor hyperparathyroidism. Hypercalcemia was well controlled by corticotherapy and chemotherapy, and remained normal after remission was obtained. Different patterns in paraneoplastic hypercalcemia are detailed, with emphasis on PTH-related proteins and vitamin-D metabolites. Eleven cases of neoplasm with hypercalcemia and elevated calcitriol level are reported in the literature. One of them is a seminoma. These elevated levels could be related either to a PTH-like protein, either to 1 alpha-hydroxylase activity in some tumoral cells. Three other cases of seminoma associated with hypercalcemia without dosage of vitamin-D metabolites are reported. Dosage of calcitriol might be performed in paraneoplastic hypercalcemia of seminoma. PMID- 2665878 TI - [Conservative treatment of breast cancer. Carcinologic and cosmetic results of combination quadrantectomy and irradiation at the Centre Alexis-Vautrin]. AB - We studied the association of quadrantectomy and irradiation in 238 patients with a breast carcinoma treated from 1974 to 1984 in the Alexis-Vautrin Center. Five and ten year survival rate are respectively 89 and 77%. Local relapse rate at five and ten year are 2, and 9%. Local relapse rate is correlated with a young age, a high tumor grade and an internal site of tumor. We studied the cosmetic and functional results and compared objective results according to subjective self-evaluation by the patients. PMID- 2665879 TI - [Efficacy and toxicity of intrapleural mitoxantrone: apropos of 18 cases of pleural metastases of breast cancer]. AB - Mitoxantrone, an anthracenedione, has been shown to be as effective as doxorubicin, but with less local or systemic toxicity, when used for the treatment of advanced breast cancer. As the high molecular weight and hydrophilic property of this drug let us predict a slow intracavity resorption, we tested its use in the treatment of malignant effusions refractory to systemic chemotherapy. 18 women, 43 to 83 years old, with cytologically demonstrated metastatic pleural effusions, and with prominent clinical symptoms, were included in the study. All these patients were refractory to hormonotherapy and combination chemotherapy (previous regimens included anthracyclines in 17 patients but none had received systemic mitoxantrone). No previous local treatment had been attempted. During the study period, no other treatment has been given. Mitoxantrone (6 mg/m2) has been administrated after effusion aspiration. A complete response was seen in 8 patients, a partial response in 5, and no change in the 5 others but one had received only one injection on account of a transitory shock immediately after. No others side effects were reported (fever, local pain, alopecia, vomiting). No patient had evidence of myelosuppression. These results suggest that intracavity injection of mitoxantrone is feasible and generally safe in most patients. Some efficiency has been seen in previously heavily treated patients refractory to systemic chemotherapy. Local administration of mitoxantrone deserves further investigation. PMID- 2665880 TI - [Kaposi's sarcoma in Rwanda: clinico-pathological and epidemiological aspects]. AB - The clinico-pathological and epidemiological features of 119 cases of Kaposi's sarcoma diagnosed during the years 1979-1986 in the main pathology department of Rwanda are presented. Skin involvement (89%) was predominant with almost 70% of cutaneous lesions localised on the lower limbs; 11% of cases presented with extracutaneous localisations, 77% (10 cases out of 13) in the lymph nodes. Incidence rises progressively with age, and males are more affected than females with a sex ratio (m:f) of 6.4:1. The highest frequencies were observed in the western prefectures which border the province of Kivu in eastern Zaire. Histologically, three types were encountered: a mixed type (84%), a spindle cell predominant type (12.6%) and an anaplastic type (3.4%). The factor VIII-related antigen was present in all 40 cases tested by the PAP method. Antihuman immunodeficiency virus antibodies were looked for in 18 cases: 10 cases with localised Kaposi's sarcoma, all of whom were seronegative, and 8 cases with aggressive generalised Kaposi's sarcoma, all of whom were seropositive. The results are compared with those of other authors, and the histogenesis and pathogenesis, particularly the relationship with the acquired immunodeficiency syndrome, are discussed. PMID- 2665881 TI - Mixed silyl ether-perfluoroacyl ester derivatives for gas chromatography/mass spectrometry of oestrogens. Application to the quantitative determination of oestriol in human plasma. AB - The conversion of oestrogens into mixed derivatives comprising a phenolic silyl ether and one or more alcoholic perfluoroactyl ester(s) is described. They are easily formed in quantitative yield and have excellent gas chromatographic and mass spectrometric properties, making them suitable for analysis by selected ion monitoring. Reaction mechanisms are examined which propose explanations for the experimentally observed optimal reaction conditions. The 3-t-butyldimethylsilyl ether-16 alpha 17 beta-bis(pentafluoropropionate) has been used for the quantitative determination of oestriol in plasma by gas chromatography/mass spectrometry using a stable isotope internal standard. Comparison with the pertrimethylsilyl ether of oestriol indicates higher specificity and better precision for low-level (less than 0.5 ng ml-1) estimations. PMID- 2665882 TI - Alcohol and liver injury: dose-related or permissive effect? AB - The studies addressing the risk of development of cirrhosis of the liver in relation to alcohol consumption have been based on comparisons at the aggregate population level and at the individual level, on case-control studies and cohort studies, and on retrospective and prospective assessment of alcohol consumption. The ideal, but unfeasible, study design for estimation of the risk function is a prospective monitoring of alcohol consumption and recording of rate of development of cirrhosis per unit of time. Two recent studies, approaching this design, suggested that above a rather low, but not precisely determined, level of alcohol consumption, the risk of development of cirrhosis is not further influenced by the amount of alcohol consumed. A critical analysis of previous studies suggests that this risk function actually is compatible with their findings. The contention that alcohol abuse has a permissive rather than a dose dependent role in the development of alcoholic liver injury encourages research into the additional factors that must act before the liver injury occurs. PMID- 2665883 TI - Osteoporotic fracture space: an hypothesis. PMID- 2665884 TI - Treatment of postmenopausal osteoporosis: is the anabolic steroid nandrolone decanoate a candidate? AB - Thirty-nine postmenopausal women (aged 55-75 years) with at least one osteoporotic fracture were allocated to one year of treatment with the anabolic steroid nandrolone decanoate (50 mg i.m. every 3 weeks) or placebo injection. Both groups also received a daily intake of 500 mg calcium. Thirty-six women (92%) completed the study. In the nandrolone decanoate-treated group the fat corrected bone mineral content in the proximal part of the distal forearm (measured by single photon absorptiometry) showed a significant increase of 3% compared with placebo (P less than 0.01), and the same tendency was seen in the bone mineral content of the distal part of the distal forearm and density of the lumbar spine (measured by dual photon absorptiometry). However, this did not reach significance. In the placebo group all bone mineral measurements remained unchanged. The biochemical estimates of bone formation (plasma bone Gla protein (BGP), serum alkaline phosphatase) and whole body retention (WBR) of 99mTc diphosphonates were not statistically significantly changed by the nandrolone decanoate therapy. We conclude that treatment with nandrolone decanoate does increase the bone mineral content; however, this may not be due to a direct increase in bone formation. The mechanism may theoretically be a combination of decreased bone resorption and increased muscle mass, which both play a beneficial role in conserving bone. PMID- 2665885 TI - In vitro growth properties and PCR ras gene analysis of a murine embryonal carcinoma cell line harboring an amplified c-Ki-ras gene. AB - Ras proto-oncogenes are thought to be involved in both proliferation and malignant processes. We examined some growth properties of a murine embryonal carcinoma cell line (ECC), PCC4, that have been shown previously to be amplified for the c-KI-ras gene. Our results show that doubling time and plating efficiency are not significantly affected by such amplification. To examine the possible link between malignant behavior and c-Ki-ras alteration, we investigated activating mutations in this PCC4 cell line as well as in other ECC. Analysis of the in vitro amplified Ki-ras gene by PCR technology has not revealed point mutations in any of the ECC examined. PMID- 2665886 TI - Kurloff cell proteoglycans: presence of two main size-populations of intracellular protease-resistant proteochondroitin sulphate. Effect of D xyloside. AB - This paper reports that the Kurloff cell sulphated and chondroitinase AC sensitive material previously described filtered on Sepharose CL4B columns as 2 main populations with Kav of 0.25 and 0.44. Its alkaline treatment resulted in the elution of 2 peaks with Kav of 0.52 and 0.78. Their reduction in size observed after alkaline treatment and the 6-fold increase in the (35S) sulphate incorporation after addition of 0.1 mM xyloside to the incubation medium indicate that these intracellular sulphated glycosaminoglycans exist in the form of proteoglycans. They were characterized by their resistance to degradation by pronase, papain or cathepsin D, as assessed by gel filtration chromatography on Sepharose CL6B or CL4B. After the glycosaminoglycans were digested with chondroitinase AC, thin-layer chromatography analysis indicated the presence of delta di-4S and delta di-6S in a ratio of 7:1. The presence of such protease resistant proteochondroitin sulphate in intracytoplasmic granules of both Kurloff cells and other natural killer cell types is emphasized. PMID- 2665887 TI - Epithelial cell migration on small intestinal villi in the neonatal rat. Comparison between [3H] thymidine and cytoplasmic labelling after Pu-citrate ingestion. AB - This study compares, in 2-d-old rats, the migration rates of epithelial cells on villi of the small intestine, using two labelling methods: a single [3H] thymidine injection; and cytoplasmic labelling by a single ingestion of Pu citrate. Histoautoradiography showed negligible diffusion of Pu after the initial retention, which was mostly confined to the epithelial cells of the villi. However, after sloughing of labelled cells in the intestinal lumen, Pu was reabsorbed by the distal epithelial cells. In segments in which Pu reabsorption was negligible, the migration rates of Pu- and 3H-labelled cells were very close. These rates, expressed in micrometers, were almost constant along the length of the villus, and the Pu and 3H labelling edges reached the top of the villi in about 5 and 7 d, respectively. Once Pu retention had reached its maximum in 9 equal segments cut along the small intestine, tissue counting showed an exponential Pu release of 30-40%/d from each segment until the end of the experiment at d16. This constant release might reflect a constant cell migration rate during the period from Pu ingestion until d16. PMID- 2665888 TI - The real ear effect of adjusting the tone control and venting a hearing aid system. AB - The effect of modifying the frequency response of a hearing aid system has previously been reported only on 2 cc couplers. Although it is recognized that coupler measurements do not accurately reflect real ear measures, they are frequently quoted when describing the effect of modifying a hearing aid system. To investigate the correlation, the real ear effect was assessed in 43 ears by measuring the effect on the insertion gain of adjusting the tone control of a hearing aid and acoustically venting the mould with a 2 mm parallel vent, singly and in combination. The results were considerably different from those measured in couplers. By comparing insertion gain with 2 cc coupler gain measurements, it was found that: (1) adjusting the tone control had a lesser mean effect than predicted; (2) venting the earmould with a 2 mm parallel vent produced a mean reduction in the frequency response at 0.75 to 1 kHz of 8 dB SPL; (3) by combining a 2 mm earmould vent and adjusting the tone control, a mean reduction in the frequency response of 10 dB SPL was produced at 0.75 to 1 kHz. In addition, the range of acoustical effects was considerable, from virtually none to greater than those predicted in coupler experiments. This was presumably due to variation in the anatomy of normal canals. It is concluded that for both research and clinical purposes, the effect of modifying the frequency response of a hearing aid system should be measured by insertion gain rather than predicted from laboratory results. PMID- 2665889 TI - Criteria for establishing a physiological role for brain peptides. A case in point: the role of vasopressin in thermoregulation during fever and antipyresis. AB - This paper has attempted to present and discuss the criteria necessary for the evaluation of a specific physiological role for a peptide in the CNS. These criteria are based on many experimental approaches to the problem and conclusions must be supported by the weight of the evidence. These criteria were illustrated by examining the hypothesis that AVP is an antipyretic neurotransmitter involved in regulating febrile increases in Tb by release and action in the VSA of the brain. The weight of the evidence in this case implies that this hypothesis is essentially correct. The only serious conflicting evidence comes from the work with Brattleboro rats. It is hoped that further research will resolve these discrepancies or result in a suitably modified hypothesis. PMID- 2665890 TI - Mechanisms of recovery following unilateral labyrinthectomy: a review. AB - This paper reviews the literature on the mechanisms responsible for the behavioural recovery which occurs following unilateral labyrinthectomy (UL), UL causes a syndrome of ocular motor and postural disorders, which diminish over time in a process of behavioural recovery known as vestibular compensation. Electrophysiological studies show that the VIIIth nerve does not undergo a functional recovery, therefore vestibular compensation has been attributed to CNS plasticity. However, the nature of the plasticity responsible for vestibular compensation is not understood. Single-neuron studies have demonstrated that a significant recovery of resting activity has occurred in the vestibular nuclei (VN) ipsilateral to the UL by the time symptoms such as spontaneous nystagmus and roll head tilt (static symptoms) have largely disappeared. However, many of the deficits in the response of VN neurons to head acceleration persist and may be permanent. This lack of recovery in the response of neurons to head acceleration correlates with the incomplete and sometimes poor recovery of the vestibulo ocular and vestibulo-spinal reflex responses to head movement (dynamic symptoms). The major neuronal change in the VN during vestibular compensation appears to be the recovery of resting activity in the VN ipsilateral to the UL, although this recovery is more pronounced in the medial VN than in the lateral VN. The mechanism responsible for the regeneration of resting activity in VN neurons is unknown. In frogs, there is evidence to suggest that transcommissural synaptic input to the VN, from the contralateral (intact) labyrinth, increases in efficacy.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 2665892 TI - The technology of pulse oximetry. PMID- 2665891 TI - Molecular and cellular regulation of neuropeptide expression: the bag cell model system. AB - The bag cell neuroendocrine system of Aplysia californica has been under intensive investigation for nearly two decades. The favorable morphology and hardiness in organ culture of this preparation have permitted a wide range of electrophysiological, cellular, and molecular studies. In this review we have focused our attention on the biochemical and physiological processes that serve the principle function of the bag cells: the synthesis and secretion of the neuropeptide egg-laying hormone. Although these cells were at first considered a model system for the most elementary neuroendocrine mechanisms, increasing knowledge has disclosed a surprising degree of complexity in both neuropeptide biosynthesis and the electrophysiological processes responsible for secretion. Not only may various components of the prohormone be sorted into different classes of neurosecretory granules, which may in turn have different probabilities of secretion, but biosynthesis itself appears to be regulated by the same intracellular messengers that mediate the electrophysiological discharge cycle. Hence, the bag cells, and presumably other peptidergic neurons, appear to possess an array of regulatory processes that can modulate the amount and character of their secretory output. The interactions of these processes may confer a degree of plasticity to the functional expression of peptidergic neurons unanticipated in studies of other neuron types. PMID- 2665893 TI - The safety of cordocentesis. PMID- 2665894 TI - Temporary mechanical ventricular support: Part 2. AB - Temporary mechanical circulatory support is currently indicated in postcardiotomy cardiogenic shock and if necessary as a bridge to transplantation where no ventricular recovery is expected. Which mechanical support system to employ as a bridge to transplantation remains debatable. Implantable devices presently used are prototypes of proposed permanent devices for the treatment of severe heart failure in patients for whom transplantation is not suitable or available. PMID- 2665895 TI - Women and HIV disease. AB - Women are vulnerable to the acquired immunodeficiency syndrome (AIDS), and are now contracting the disease at a faster rate than men. However, many are ignorant of their potential risk of infection and it is only recently that the scientific community has begun to look at human immunovirus (HIV) infection in women. The media and statistical reporting still lag behind. PMID- 2665896 TI - Tumours of the pineal region. AB - Tumours arising in the region of the pineal gland provide a considerable challenge in treatment because of their diversity and location. In this article the anatomy and physiology of the pineal gland are considered, together with the pathology of its tumours, their presentation and management. PMID- 2665897 TI - Management of severe chest injuries. AB - Anoxia and haemorrhage are the causes of early death in patients with severe chest injuries. Early recognition with prompt resuscitation is the cornerstone of their management. Intensive care and a cohesive multidisciplinary approach to patients with associated multiple injuries are important. PMID- 2665898 TI - Computers and the diagnosis of acute abdominal pain. AB - One per cent of hospital admissions are for acute abdominal pain. The first doctor to see the patient is usually junior and his diagnostic accuracy is likely to be less than 50%. Computer-aided diagnostic accuracy rises to over 70% and thus unnecessary admissions and unnecessary operations are reduced. PMID- 2665899 TI - Persistent haematuria associated with renal pseudotumour. PMID- 2665900 TI - A urinary detergent and urolithiasis. PMID- 2665901 TI - Value of the gamma camera renogram in the differential diagnosis of acute tubular necrosis and rejection in the early post-transplant period. Comparison with biopsy findings. AB - A group of 128 consecutive patients was identified on whom renal isotope studies had been performed during the first 2 months after renal transplantation and within 7 days of transplant biopsy. The prospective renogram and biopsy reports were reviewed and graded into 4 categories: severe rejection, predominant rejection, predominant acute tubular necrosis (ATN) and pure ATN. Two extreme patterns of renogram were identified: a sharp rise with a fast decline in the first min, attributed to ATN, and a slowly rising curve with no early peak occurring in severe rejection although not specific to this condition. There was a continuous intermediate spectrum. There was no inter-observer variation in gradings at the 2 ends of the spectrum. In the middle part the difference between 2 independent observers never exceeded more than 1 grade. There was good correlation between the biopsy and renogram gradings, with a discrepancy of more than 1 grade in only 5 patients; 2 of these, with severe rejection on the renogram, showed predominant ATN on biopsy, but the final clinical diagnosis was severe rejection (false positive biopsies). Two patients with biopsies showing severe rejection had a sharp initial up-slope in the renograms but a slower down slope (over 4 min compared with 1 min in true ATN). With better definition of the criteria these renograms would not have been graded as ATN. There was 1 patient in whom no satisfactory explanation for the discrepancy was found (presumed false positive renogram). When properly defined criteria are used to interpret renograms, this simple test is at least as reliable as renal biopsy in differentiating ATN from rejection in the early post-transplant period, especially in the presence of anuria or severe oligurea. PMID- 2665902 TI - Clinical application of transrectal ultrasound for the investigation of the incontinent patient. AB - A transrectal ultrasound technique is described for imaging the bladder neck and urethra. A group of 25 continent female volunteers was examined initially; 59 incontinent women were then studied pre-operatively and again 6 months after either a Burch colposuspension, Pereyra operation or ox fascial sling to determine the ultrasonic characteristics of successful surgery. PMID- 2665903 TI - In vivo modulation of rat hypothalamic opioid peptide content by intracerebroventricular injection of guanidinoethylmercaptosuccinic acid (GEMSA): possible physiological role of enkephalin convertase. AB - Twice-daily intracerebroventricular (i.c.v.) injections for three days of increasing doses of guanidino-ethyl-mercapto-succinic acid (GEMSA) produced a dose-dependent decrease in methionine-enkephalin- and leucine-enkephalin levels in rat hypothalami. GEMSA is a specific and potent inhibitor of a carboxypeptidase B-like processing enzyme, referred to as enkephalin convertase (EC). The administration of GEMSA (0.1 microgram) resulted in more than 50% reduction in the levels of these two opioid peptides. However, no changes occurred in the hypothalamic content of beta-endorphin or dynorphin1-17. Moreover, in GEMSA-treated animals, hypothalamic luteinizing hormone-releasing hormone and serum luteinizing hormone levels were increased by 75%. Serum prolactin concentrations were decreased by 60% at the same time. Subcutaneous naloxone administration resulted in a 75% elevation of serum LH concentrations in control animals whereas GEMSA-treated animals showed a blunted response, most likely due to a decreased amount of opioid-active peptides. The present study is in agreement with the putative role of EC in the processing of the multivalent opioid precursor (proenkephalin A) in the rat hypothalamus. The enzyme inhibition by GEMSA may result in a reduced enkephalinergic tone, which is then accompanied by an altered endocrine status. PMID- 2665904 TI - Identification and characterization of D1 and D2 dopamine receptors in cultured neuroblastoma and retinoblastoma clonal cell lines. AB - The recent availability of high specific activity radiolabeled dopaminergic antagonists with specificity for dopamine receptor subtypes has allowed us to screen a wide variety of cultured mammalian cell lines for the presence of D1 and D2 dopamine receptors. Specific receptor binding of the D1 selective antagonists [3H]SCH 23390 and [125I]SCH 23982 was detected in membranes prepared from NS20Y cells, a clonal cell line derived from the C1300 murine neuroblastoma. Saturation analysis of [3H]SCH 23390 binding revealed the presence of saturable, high affinity binding sites with a dissociation constant (Kd) of 575 pM and a receptor density of 138 fmol/mg protein (approximately 9000 receptors/cell). Inhibition of [3H]SCH 23390 binding by a series of dopaminergic agonists and antagonists exhibited appropriate stereoselectivity and pharmacological specificity, verifying the D1 nature of this site. Dopamine inhibition of [3H]SCH 23390 binding revealed the presence of high and low affinity agonist binding sites which were converted to a homogeneous low affinity state by the addition of GppNHp. In membranes prepared from the WERI 27 human retinoblastoma cell line, specific receptor binding of the D2 antagonists [3H]methylspiperone and [125I]NAPS was observed. Saturation analysis of [3H]methylspiperone binding revealed the presence of a single class of high affinity, saturable binding sites with a Kd of 140 pM and a Bmax of 223 fmol/mg protein (approximately 2500 receptor sites/cell). Inhibition of [3H]methylspiperone binding by dopaminergic antagonists exhibited a rank order of potency consistent with the identification of a D2 dopamine receptor subtype. In addition, dopamine inhibition of [3H]methylspiperone binding exhibited both high and low affinity agonist binding sites which were converted to low affinity by the addition of GppNHp. These results represent the first direct demonstration of D1 and D2 dopamine receptors in cultured mammalian clonal cell lines. These cells should provide powerful model systems for investigating the molecular mechanisms involved in dopamine receptor/effector coupling and regulation. PMID- 2665905 TI - Prostaglandin effects after elimination of indirect hyperalgesic mechanisms in the skin of the rat. AB - In this study we eliminated known indirect hyperalgesic mechanisms by blocking the cyclooxygenase pathway of arachidonic acid metabolism with indomethacin, depleting sympathetic postganglionic neurons with 6-hydroxydopamine and depleting polymorphonuclear leukocytes with hydroxyurea. These treatments did not significantly affect the dose-dependence relationship for prostaglandin E2 (PGE2) and prostaglandin I2 (PGI2)-induced changes in the mechanical nociceptive threshold in the rat. These data are compatible with the hypothesis that PGE2 and PGI2 act directly on peripheral terminals of nociceptive afferents to produce hyperalgesia. PMID- 2665906 TI - TM: tension to tranquillity. PMID- 2665907 TI - Allergenic components of Candida albicans identified by immunoblot analysis. AB - Allergenic components of Candida albicans fractionated by SDS-polyacrylamide gel electrophoresis (PAGE) and transferred to nitrocellulose membranes were identified using sera from 30 asthmatic patients who showed positive skin test and RAST (radio-allergosorbent test) to C. albicans. The IgE-binding yeast components in the complex antigen preparation were then detected by reaction with enzyme-labelled anti-human IgE antibodies. They were confirmed by Coomassie blue R-250 staining of the membrane to visualize all protein bands after reaction with the enzyme substrate. The IgE-binding patterns of the sera tested were heterogeneous, displaying a total of 16 identifiable components with molecular weights ranging from 20 to 94 kD. A 40 kD component showed the highest IgE binding frequency, being recognized by 23 (77%) of the 30 sera examined. The other 15 allergenic components identified were recognized by less than 25% of the sera tested. Only two of the 30 serum samples contained IgE antibodies reactive with seven to eight allergenic components. Ten of the 30 sera reacted with only one allergenic component, and the remaining serum samples recognized two to five of the 16 identified allergens. Results described in this study are applicable to allergen standardization work and provide a basis for further study on the role of C. albicans in clinical allergy. PMID- 2665908 TI - The effect of brain hemisphere dominance on learning by computer assisted instruction and the traditional lecture method. AB - Brain hemisphere dominance is reported to effect learning style in that people who are classified as left brain-dominant are believed to be primarily auditory learners and those classified as right brain-dominant are believed to be primarily visual learners. The purpose of this study was to investigate the effect of brain hemisphere dominance on learning by computer assisted instruction (CAI) and the traditional lecture method. The Wagner Preference Inventory was used to determine brain hemisphere dominance. Content related to the use of Roman numerals was presented using both CAI and the lecture method. A two-way analysis of variance demonstrated an interaction effect between brain hemisphere dominance and teaching method. Subjects classified as right hemisphere-dominant scored higher on the posttest in the CAI group, and left hemisphere-dominant subjects scored higher in the lecture group. PMID- 2665910 TI - Sleep and depression in late life. AB - Depression is one of the most serious and prevalent neuropsychiatric disorders of old age. Despite its prevalence, depression in the aged is frequently unrecognized or is misdiagnosed. This article reviews the existing knowledge of several sleep-related areas and discusses possible future studies into sleep as a prognostic indicator for recurrent and bereavement-related depressions in late life. PMID- 2665909 TI - Urine citrate and renal stone disease. AB - Calcium stone disease is attributable to supersaturation of the urine with calcium and other salts, the presence of substances that promote crystallization and a deficiency of inhibitors of crystallization. Citrate is a potent inhibitor of calcium oxalate and calcium phosphate stone formation whose excretion is diminished in some patients with stone disease owing to idiopathic causes or secondary factors such as bowel disease and use of thiazides. The pH within the proximal tubule cells is an important determinant of citrate excretion. Multivariate analysis has shown that the urine concentrations of calcium and citrate are the most important factors in stone formation. In uncontrolled studies potassium citrate, which increases urinary citrate excretion, appears to be promising as a therapeutic agent for patients with stone disease and hypocitraturia refractory to other treatment. On the other hand, there are potential drawbacks to sodium alkali therapy, such as the precipitation of calcium phosphates. PMID- 2665911 TI - Age-related changes in sleep. AB - Within a wide range of individual differences, there are age-associated changes in the characteristics of sleep. There are shifts toward the extremities in sleep amounts, increased difficulties in initiating or maintaining sleep at night, and an emergence of naps. There are also changes in sleep structure. It is within these age-related changes that sleep disorders must be considered. PMID- 2665912 TI - Alzheimer's disease. Sleep and sleep/wake patterns. AB - Significant changes in sleep/wake patterns, particularly loss of SWS and increased amount and frequency of nighttime wakefulness, apparently occur even at an early stage of the AD process. These disruptions of nighttime sleep increase in magnitude with increasing severity of dementia. While the REM sleep of early stage AD patients is relatively unaffected by the disease process, later stages of AD are marked by significant losses of REM sleep and perhaps more importantly the breakdown of the sleep/wake circadian rhythm with significant amounts of sleep occurring during the day. This daytime sleep is of poor quality however, consisting almost exclusively of stages 1 and 2 sleep and does not compensate for the nighttime losses of SWS and REM sleep experienced by AD patients. These findings clearly support the clinical observations and anecdotal reports of sleep disturbance in AD patients. It is of interest to note that sleep is disrupted quite early in the disease process. In our study of early stage AD patients all were community dwelling and had relatively mild cognitive impairment (average MMS scores of 22.7). Despite this, significant increases in frequency and duration of awakening from sleep and reductions of SWS were observed in these patients. These findings indicate that when a patient is suspected of having AD it may be worthwhile as part of the evaluative and diagnostic process to caution both the patient and the patient's family that they might expect to see significant changes in sleep/wake patterns even though the patient's level of day-to-day functioning may still be high. It is also important to consider warning AD patients' families that as the disease progresses they should expect to see not only a worsening of nocturnal sleep quality but a breakdown of the circadian sleep/wake rhythm and an increase in daytime napping behavior by the patient. Families need to be encouraged to try and minimize the napping behavior of the patient in an effort to consolidate sleep into the night. This may have the effect of somewhat attenuating the amount of nocturnal disruption of sleep that accompanies progression of the disease. PMID- 2665913 TI - Impotence and aging. AB - Taking into account the normal changes that occur with aging and the large number of pathologies, pharmacologic agents, and social situations that the elderly are subject to, it is perhaps more surprising that 25 per cent of those over 80 years of age do report normal sexual functioning. Loss of erectile capability appears to be multifactorial in many patients, although the exact degree is uncertain due to unsystematic assessment in the majority of current studies. Unfortunately, impotence is often ignored by the patients' physicians. Physicians do not routinely ask about erectile functioning in their patients, perhaps because they do not know how to systematically evaluate and treat the complaint. Any follow through that might result from a complaint is often chaotic. And, rarely are treatment possibilities systematically and clearly presented to the patient. This is particularly true for the elderly patients whose physicians may be surprised that an elderly patient would still be interested in sexual behavior. No matter how subtle, this "dirty old man" response by the physician does not foster a good therapeutic environment. Inappropriate and unsystematic evaluations of impotent patients leads to a literature replete with contradictory statements. Because of the prevalence of impotence in the elderly, as a group they are hurt the most by unsystematic evaluation techniques and therefore have the most to gain from the application of systematic evaluation and treatment procedures. PMID- 2665914 TI - Sleep apnea in the elderly. AB - Sleep apnea is a common disorder in the elderly and is characterized by recurrent apneas which are associated with periodic oxyhemoglobin desaturations and arousals from sleep. In more severely affected individuals, it may result in marked sleep fragmentation, alterations in daytime function, and increased cardiovascular morbidity and mortality. In milder cases, however, physiologic abnormalities which are recognized may have a questionable impact on morbidity and mortality. Therefore, the decision to treat this disorder rests on accurately assessing the severity of physiologic disturbances in sleep and in breathing, and depends on determining whether daytime function is impaired. PMID- 2665915 TI - Sleep disorders in the elderly. Circadian rhythm. AB - Circadian rhythms are observable in almost every neuroendocrine, behavioral, and psychophysiologic function, in addition to the classic vital signs. This article discusses how the circadian system might change with advanced age, how these changes interact with behavior changes, and how the resultant effects might influence sleep and daytime functioning. PMID- 2665916 TI - Epidemiology of sleep disorders. AB - Sleep apnea and PLMS are extremely prevalent in the elderly. The subjective reports of poor sleep, insomnia, snoring, and excessive daytime sleepiness should not be taken lightly and should not be assumed to be a normal sign of aging. These problems may be interrelated and may be symptoms of the sleep disorders discussed above. Physicians and gerontologists need to become more sensitive to the special problems and needs related to sleep disorders in the geriatric population. PMID- 2665917 TI - Sleep and aging in animals. Relationships with circadian rhythms and memory. AB - In an earlier review, Ingram et al concluded that research on sleep and aging in animals was sparse and essentially in a formative stage. In the past several years, systematic research on age-related changes in sleep in animals has increased, along with a greater tendency to publish full-length reports with complete methodological details. Consequently, the status of research in the area may be upgraded to an intermediate level. Generally, recent findings confirm and extend earlier ones that a wide variety of age-related changes in sleep occur in several mammalian species. Inconsistencies still exist in regard to how selected parameters change in a particular species (for example, nonparadoxical sleep in aged cats). However, in contrast to the findings of Ingram et al, a larger number of age-related changes in sleep have been recently replicated in separate laboratories. Another area of congruence between earlier and more recent reports involves age-related alterations in circadian rhythms. Multiple changes in circadian function have been reported in many species, suggesting a widespread pattern of temporal disorganization in senescence. Among other changes, both the amplitude and the period of individual rhythms may be altered, often resulting in desynchronization both between rhythms and from environmental cycles. At present, no single animal model demonstrates the age-related changes that occur in human sleep. However, many of the age-related changes that humans exhibit in sleep and in circadian rhythms appear similar to those in other species. For example, rats show several changes in absolute levels of sleep, continuity of sleep, and circadian organization of sleep that approximate those in aged humans, while aged male cats show analogous changes in deep nonparadoxical sleep and in delta waves. These findings suggest that different species may be useful in modelling different aspects of sleep in aged humans. Relationships between sleep and memory in aged rats may also exhibit analogies to human aging. Deficits in paradoxical sleep, and more generally, in the continuity of sleep, have been related to cognitive deficits in aged humans. These similarities between rats and humans further enhance the potential usefulness of rats to model aspects of human aging. Many areas still require further study. The generality of age-related changes in sleep in animals cannot be determined until additional strains and species are evaluated. In addition, many sleep-related phenomena such as phasic events during paradoxical sleep have not yet been examined in old animals.(ABSTRACT TRUNCATED AT 400 WORDS) PMID- 2665918 TI - Neuropsychological function and sleep. AB - Neuropsychological function and sleep in the aged have been studied for more than 20 years. The elderly studies focused on psychometric correlates of sleep architecture (REM, SWS, and various measures of sleep disturbance). More recently, psychometrics have been related to breathing disturbance in sleep, but the interpretation of such deficits in terms of hypoxemia and sleepiness remains controversial. To a large extent, all such relationships may depend upon the medical risk factors and chronic conditions affecting both neuropsychological function and sleep in old age. PMID- 2665919 TI - Drugs, sleep disorders, and aging. PMID- 2665920 TI - Sleep loss in aging. AB - Tests of performance and alertness in normal older subjects undergoing sleep loss reveal loss of performance and alertness similar to that seen in younger individuals. Recovery of performance ability occurs with one night of normal sleep, even following periods of sleep loss up to 64 hours in length. Older individuals, including older individuals with primary insomnia, may tolerate sleep loss with less decrease in ability compared with their baseline than young adults and may recover function more quickly than young adults. While it has been frequently shown that older individuals perform more poorly than young adults on a broad range of tasks, these findings do not hold well for periods of nocturnal performance or performance during sleep loss. It is possible that these findings may be accounted for to some extent by the decrease in amplitude of the circadian body temperature curve in older individuals. It is unfortunate that Reynolds et al did not attempt to collect performance data in their depressed and demented patients to determine if the differential effects on mood and EEG would also be reflected in psychomotor performance. PMID- 2665922 TI - The developmental anatomy of pes valgo planus. AB - Pes planus or flatfoot becomes a medical problem only when symptoms develop. The mere absence of a well-formed medial longitudinal arch does not necessarily imply pathology. Many apparently "flat feet" demonstrate congruent joints, and the extremities function normally. The size and shape, as well as the angles of declination for the talus or astragulers and the calcaneus or os calcis, are most often determined at the moment of fertilization by the genes of the patients. The zygote or fertilized ovum is a first totipotent. Cell division normally occurs as development proceeds, but the embryo is vulnerable to alterations of the cell cycle. Teratogenic substances can induce death or substantial structural modifications to the developing fetus. The post-World War II tragedy of the medical use of the drug thalidomide in pregnant mothers resulting in amelia is testimony as to how the lower extremity can be adversely affected. Early chromosomal aberrations including duplication, deletion, breakage, inversion, translocation, and mosaicism have been shown to be involved in faulty development of the foot, and there is no reason not to implicate pes valgo planus to these events. Intrauterine development apart from the genetic considerations just mentioned place the fetus under additional jeopardy. Even extraembryonic membranes can form strands of tissue that can entangle the delicate developing foot plate, and calcaneovalgus deformities could conceivably be established. The developing embryo and fetus first demonstrate a blastema that forms limb buds on the ventral caudal aspect. Anlage of the scleroblastema and myoblastema of the prospective leg and foot develop in the presence of nerve trunks. Such nerves are related to the lumbosacral plexus and they are thought to exert inductive developmental influences. Interference with any of these events may be implicated in pedal deformities such as pes valgo planus. This is also true of subsequent morphogenetic events involving embryonic rotations, osteogenesis, and myogenesis. Many pedal deformities have congenital basis and it is clear that pes valgo planus is one of them. Post-natal structural changes further accentuate underlying etiologies. For example, the calcaneus normally exhibits a varus position at birth, but this feature diminishes until the cessation of bone growth. The adult talar neck-calcaneal angle is normally about 24 degrees, representing a 6-degrees reduction from that of 30 degrees, which is demonstrated at birth.(ABSTRACT TRUNCATED AT 400 WORDS) PMID- 2665921 TI - Flatfoot overview. AB - The pathologic condition pes planus has been noted in orthopedic and podiatric literature for a number of years. The many scientific and technical terms assigned to the condition have become synonymous, emerging in the vernacular as the common term "flatfoot." In the broadest sense, flatfoot refers to the weight bearing or nonweight-bearing foot that exhibits collapse of the medial column. A discussion of the history and attitudes toward flatfoot is presented. PMID- 2665923 TI - Abnormal biomechanics of flatfoot deformities and related theories of biomechanical development. AB - The flatfoot deformity has been investigated over this century by many leading authorities with regard to its etiologies and pathogenesis. A large number of articles in the early orthopedic literature concerning the flatfoot deformity defined the primary abnormalities of the structure without strong emphasis on its relationship to abnormal functional etiologies leading to the pathogenesis of the deformity. This article emphasizes abnormal biomechanics and theories of development. PMID- 2665924 TI - Conservative treatment of flatfoot in the newborn. AB - Excessive pronation of the feet is almost a universal condition among children, which is demonstrated as an abnormal weight-bearing position on hard, flat surfaces. Excessive pronation of the feet of children is closely associated with intrinsic and extrinsic skeletal deformity in adults; consequently, it must be neutralized as a basic necessity to most proper footcare, as the child grows. It must be a priority of podiatric medicine to develop a practical plan for supervision of foot health from the earliest weight bearing in infancy and to work in close cooperation with parents and pediatricians in doing so. PMID- 2665925 TI - Idiopathic flexible flatfoot in the adolescent. AB - In summary, factors to consider in treatment are (1) the patient's age; (2) the flexibility of the condition; (3) the severity of deformity; (4) the presence of equinus; (5) abnormal shoe wear; and (6) the symptoms. When a child presents with severe flexible flatfoot one should rule out an underlying neuromuscular disorder and perform a complete biomechanical evaluation to ascertain any rotational or angular conditions of the legs that might influence the treatment. If a child is in group 1 (ages 4 to 7), a Helfet heel seat with a medial plantar wedge is usually adequate treatment. In the group II (ages 8 to 12) adolescent with flexible flatfoot, more control of the calcaneal eversion is needed. This is obtained by using a device constructed from a plaster mold taken while the foot is in neutral position. This UCBL type of device must usually extend to the metatarsal heads and be elevated on the medial and lateral sides. The group III (ages 13 to 17) adolescent usually has the additional problem of a forefoot varus, which must be controlled using a forefoot post. It is also not unusual to have to add additional wedging inside the heel of the shoe to invert the heel. PMID- 2665926 TI - The conservative treatment of adult flexible flatfoot. AB - The purpose of this article is to attend to the nonsurgical treatment of adult symptomatic flexible flatfoot and its sequelae. Other articles in this issue thoroughly discuss the etiology, radiographic changes, and nonconservative treatment of the congenital and acquired flatfoot presented in children and adults. PMID- 2665927 TI - Criteria for combined procedure selection in the surgical correction of the acquired flatfoot. AB - Surgical correction of the flexible acquired flatfoot has long been subject to procedures based on an unsound understanding of the true pathomechanics of the deformity. With the advent of modern biomechanics and the concept of planal dominance, procedure selection can become a more exacting science. A classification system based on the progression of symptoms, used in concert with a firm understanding of the primary and compensatory deformities can simplify the process of selecting combined procedures to deal with a particular foot type. PMID- 2665928 TI - Correction of flexible pes planus deformity: medial column stabilization procedure. AB - A review of five distinct medial column stabilization procedures sets forth criteria specific to certain presentations of pes planus deformity. The importance of considering the manifestation of the condition and its implications with regard to the overall health of the particular patient cannot be overemphasized. The collective goal of all such corrective procedures is identical; it is the variable factors particular to a specific presentation that dictate the preferred corrective action. The course selected by a physician with respect to surgical correction of flexible pes planus must be determined by taking both the procedure and the presentation of the condition under advisement. PMID- 2665929 TI - A modified subtalar arthroereisis implant for the correction of flexible flatfoot in children. The STA Peg procedure. AB - The STA Peg procedure was developed to correct flexible flatfoot in young children prior to the age when secondary deformities are likely to develop. The procedure involves the implantation of a peg fashioned from ultra-high molecular weight polyethylene into the dorsal surface of the calcaneus, anterior to the posterior facet of the subtalar joint and fixed with polymethylmethacrylate. Smith has reported excellent overall results in the great majority of patients. The primary importance of the procedure is its rate of success, coupled with a relatively easy postoperative period, virtually no immobilization, its application for very young patients (beginning at 3 years of age), and its accommodation for the continued growth of the child. PMID- 2665930 TI - Triple arthrodesis as a salvage for end-stage flatfoot. AB - End-stage flatfoot is a challenging surgical deformity. It is most commonly rigid and painful, although it may be totally or partially reducible. Arthrosis may be a major feature causing pain, but not necessarily. The terminology "end-stage" means that the deformity and compensation has progressed as far as it will go and that salvage is required when disabling. The most dramatic and effective operation available to solve this problem is triple arthrodesis in its various modifications. The problems associated with this condition and the applied operation have been discussed. PMID- 2665931 TI - New and investigative procedures for flatfoot surgery. AB - For those patients who need it, surgical intervention for flatfoot at an early stage affords a better chance for favorable results. Various procedures that have stood the test of time and investigative procedures are presented. It is suggested that the podiatric surgeon concentrate on tested procedures and wait for further reports on investigative procedures. PMID- 2665932 TI - Biomechanics of the foot and ankle during gait. AB - Running is a very popular activity, whether for competition or fitness. Breakdown injuries related to training errors, shoe wear, or change in intensity are frequently seen by the sports medicine physician. In order to understand and treat the pathologic situation, a fundamental understanding of the biomechanics of walking and running is essential. The treating practitioner must appreciate the distinct differences between the walking and running gait. These differences transcend a simple increase in speed of gait and include distinct changes in joint range of motion and electromyographic activity. Armed with this knowledge, the practitioner treating a breakdown injury can work to a solution based on scientific understanding rather than anecdotal information. PMID- 2665933 TI - Rehabilitation of the injured ankle. AB - Stimulation of damaged sense receptors is essential to proper rehabilitation of the injured ankle. By performing exercises that induce movement and change tone and intra-articular pressure, especially in the weightbearing role, the ankle joint's periarticular structures are more likely to heal with functional strength and stability. PMID- 2665934 TI - Does formaldehyde cause nasopharyngeal cancer in man? AB - Formaldehyde is a widely used industrial chemical, which also has uses in consumer products, and hence large numbers of people are exposed to it. It is also an endogenous metabolite with measurable levels in body fluids and tissues. The reports of its carcinogenicity to rats have raised concern about its potential to cause a carcinogenic response in exposed populations. This letter reviews the information on the carcinogenicity of formaldehyde, particularly to the upper respiratory tract, in animals and man. PMID- 2665936 TI - [What is the reason for the increase in beta-2-microglobulin levels in the blood when using cuprophane dialysis membranes?]. AB - The authors discuss the question of whether the growing blood concentration of beta-2-microglobulin in the course of haemodialysis is due to the bioincompatibility of the cuprophane membrane or to changes in serum osmolality. x531p4cuprophane dialyzer was used for 20 acts of haemodialysis, a regenerated one for 12, a new one for 10 sequence ultrafiltrations. The serum concentration of beta-2-microglobulin was measured prior to and after haemodialysis, and so was serum osmolality. The changes in beta-2-microglobulin concentration during haemodialysis were compared with serum osmolality changes. The levels of beta-2 microglobulin rose during haemodialysis using a new as well as a regenerated dialyzer but remained unaltered during sequence ultrafiltration. They increased in the presence of serum hypoosmolality, remained unchanged in normal osmolality, and decreased in hyperosmolality. The results show that the cuprophane membrane is not the source of increased beta-2-microglobulin, but that serum hypoosmolality developing during haemodialysis is the factor responsible. PMID- 2665935 TI - Granulocyte-monocyte-colony-stimulating factor augments the cytotoxic capacity of lymphocytes and monocytes in antibody-dependent cellular cytotoxicity. AB - Human peripheral blood mononuclear cells (lymphocytes and monocytes) were preincubated for 0-24 h with human recombinant granulocyte-monocyte-colony stimulating factor (GM-CSF) and used as effector cells in an 18 h antibody dependent cellular cytotoxicity (ADCC) assay with SW948 (a human colorectal carcinoma cell line) as target cells and mAb 17-1A. A significant increase in the lytic capability was noted after 0.5-2 h of preactivation while longer preincubation times did not significantly increase the lytic potential. GM-CSF at 0.01 microgram/ml induced the best tumor cell lysis while higher concentrations were inhibitory. GM-CSF pretreatment induced a statistically significant increase in the lytic capacity of both monocytes and lymphocytes in ADCC as well as in the spontaneous cytotoxicity. PMID- 2665937 TI - [Detection of HLA-A and HLA-B antigens on thrombocytes. Comparison of 3 methods]. AB - HLA antigens A1, 2, 9, 10, B5, 7, 8, 12, 35 were determined on 28 samples of healthy persons' thrombocytes by means of three tests; the microabsorption and immunofluorescence tests and the ELISA technique. Identification with the ELISA test was exceptional. Unlike the microabsorption test, the immunofluorescence test was employed to identify HLA antigens with only some sera as a rule. Identical positive results of both the microabsorption and the immunofluorescence tests were rather infrequent. The authors could not corroborate literary reports on difficulties in the identification of the antigens HLA-B8 and HLA-B12, certain problems were encountered in the case of the HLA-B7 antigen only. A discussion is presented of the causes of the different results of each of the tests, and of the relevance of the results for transfusions of platelet concentrates chosen on the basis of lymphocytic cross-matching. PMID- 2665938 TI - [Cooperation between the volunteer bone marrow donor section at the Institute of Hematology and Blood Transfusion, Prague, and the Caitlin Raymond Registry of Bone Marrow Donor Banks. 1 year experience]. AB - The authors report on their one-year experience of co-operation with the Caitlin Raymond Registry of Bone Marrow Donor Banks in the selection of suitable bone marrow donors. Out of the 280 requirements received a total of seven donors were singled out - identical in HLA-AB antigens though unsuitable in the DR system. PMID- 2665939 TI - Immunoreactivity to gonadotropin-releasing hormone and gonadotropic hormone in the brain and pituitary of the rainbow trout Salmo gairdneri. AB - Immunoreactivity to gonadotropin-releasing hormone (GnRH) and gonadotropic hormone (GTH) was studied at the light-microscopical level in the brain and pituitary of rainbow trout at different stages of the first reproductive cycle using antisera against synthetic mammalian GnRH and salmon GTH. GnRH perikarya were localized exclusively in the preoptic nucleus, both in the pars parvicellularis and the pars magnocellularis. A few somata contacted the cerebrospinal fluid. Not all neurosecretory cells were GnRH-positive, indicating at least a bifunctionality of the preoptic nucleus. We recorded no differences between sexes or stages of gonadal development in the location of GnRH perikarya, whereas gradual changes were found in staining intensity during the reproductive cycle. GnRH fibres ran from the partes parvicellularis and magnocellularis through the hypothalamus and merged into a common tract at the transverse commissure before entering the pituitary. In the pituitary, GnRH was localized in the neural tissue of the neurointermediate lobe and, to a lesser extent, in the neural protrusions penetrating the proximal pars distalis. The bulk of GTH positive cells was situated in the proximal pars distalis. Some cells were found more rostrally amidst prolactin cells or in the neurointermediate lobe. Only a limited number of GTH cells appeared to be in close contact with GnRH-positive material. PMID- 2665940 TI - Modularity in promoters and enhancers. PMID- 2665941 TI - Directed expression of NGF to pancreatic beta cells in transgenic mice leads to selective hyperinnervation of the islets. AB - Nerve growth factor (NGF) is implicated in the differentiation of neurons in both the central and peripheral nervous systems. As a new approach to its role in neuronal development, we have used transgenic mice to selectively overexpress NGF in an innervated peripheral tissue, the islets of the pancreas. In two lines of mice, directed expression of NGF in the beta cells elicits a dramatic increase in the innervation of the islets, but not the surrounding exocrine tissue, by one class of sympathetic neurons. In contrast, the innervation by sensory and parasympathetic neurons appears unchanged. The results indicate that expression of NGF by a target tissue during neuronal development selectively influences the characteristics of its innervation. PMID- 2665942 TI - Transcriptional activation by the v-myb oncogene and its cellular progenitor, c myb. AB - The v-myb oncogene, like its cellular progenitor c-myb, encodes a short-lived nuclear protein involved in processes affecting growth and differentiation in a number of cell types. Fusion proteins, in which v-myb sequences are linked to the DNA binding domain of the yeast transcriptional activator GAL4, can activate transcription from a reporter gene linked in cis to a GAL4 binding site. The domain of v-myb responsible for transcriptional activation is located between residues 204 and 254, and is both necessary and sufficient for activation. Intact v-myb and c-myb proteins can also activate transcription, via a myb binding site linked in cis to a reporter gene. A v-myb protein bearing a deletion in the activator domain is no longer capable of stimulating transcription. PMID- 2665943 TI - NF-kappa B: a pleiotropic mediator of inducible and tissue-specific gene control. PMID- 2665944 TI - Regulation of p34cdc2 protein kinase during mitosis. AB - The cell-cycle timing of mitosis in fission yeast is determined by the cdc25+ gene product activating the p34cdc2 protein kinase leading to mitotic initiation. Protein kinase activity remains high in metaphase and then declines during anaphase. Activation of the protein kinase also requires the cyclin homolog p56cdc13, which also functions post activation at a later stage of mitosis. The continuing function of p56cdc13 during mitosis is consistent with its high level until the metaphase/anaphase transition. At anaphase the p56cdc13 level falls dramatically just before the decline in p34cdc2 protein kinase activity. The behavior of p56cdc13 is similar to that observed for cyclins in oocytes. p13suc1 interacts closely with p34cdc2; it is required during the process of mitosis and may play a role in the inactivation of the p34cdc2 protein kinase. Therefore, the cdc25+, cdc13+, and suc1+ gene products are important for regulating p34cdc2 protein kinase activity during entry into, progress through, and exit from mitosis. PMID- 2665945 TI - Regulation of lymphocyte motility by macrophages: characterization of a lymphocyte migration inhibitory factor derived from a macrophage-like cell line. AB - An inhibitory factor on lymphocyte migration was detected using a capillary random migration assay in the culture supernatant of peritoneal exudate macrophages cultured at concentrations greater than 8 x 10(6) cells/ml. After examining different macrophage-like cell lines, J774A.1 cells were found to produce this inhibitory factor, which was termed lymphocyte migration inhibitory factor (LMIF). The inhibitory effect of LMIF on the migration of spleen lymphocytes, thymocytes, and bone marrow cells was determined. The migration of thymocytes was more sensitive to LMIF than was the migration of spleen lymphocytes and bone marrow cells. Interestingly, when the effect of LMIF was tested on the migration of spleen T cells and B cells, T cells were more sensitive than B cells. When the thymocytes were separated by peanut agglutinin into mature and immature thymocytes, the migration of mature thymocytes was more sensitive than that of immature thymocytes, the migration of mature thymocytes was more sensitive than that of immature thymocytes to the effect of LMIF, suggesting that the greatest effect of LMIF was on the migration of mature T cells. Partial purification of LMIF by ion-exchange and gel-filtration chromatography revealed that it is approximately 14,000 in molecular weight and could exist in either monomeric or dimeric forms. The possible role of this factor in an immune response is discussed. PMID- 2665946 TI - Molecular mimicry between uveitopathogenic site of retinal S-antigen and Escherichia coli protein: induction of experimental autoimmune uveitis and lymphocyte cross-reaction. AB - Experimental autoimmune uveitis (EAU) is caused by the immunization of microgram amounts of a soluble retinal protein, known as S-antigen, in susceptible animal strains including primates. The disease serves as an animal model of ocular inflammation. We induced EAU and pinealitis in Lewis rats with small synthetic peptides, corresponding to the amino acid sequence in Escherichia coli protein, which contains six consecutive amino acids identical to a uveitopathogenic site in human S-antigen (peptide M). EAU and pinealitis induced in rats by synthetic peptide derived from E. coli was indistinguishable from those induced by native S antigen or other uveitopathogenic synthetic peptides corresponding to the amino acid sequence of S-antigen. Furthermore, lymph node cells from animals immunized with either peptide M or peptide derived from E. coli protein showed significant proliferation in the presence of either peptide when tested in vitro for lymphocyte mitogenesis using [3H]thymidine. Thus, molecular mimicry, a process by which an immune response directed against a nonself protein cross-reacts with a normal host protein, may play a role in autoimmunity. PMID- 2665947 TI - Physicochemical, physiological, and mathematical considerations in optimizing percutaneous absorption of drugs. AB - The percutaneous absorption or transdermal permeation of drugs has gained considerable prominence in recent years through the development of transdermal systemic delivery systems and the related interest in the design and use of topical products. The present review discusses the phenomenon of percutaneous absorption in drug delivery and its importance in regard to the anatomy of skin, its physiological function, and biomechanical properties, as well as the physicochemical properties of the skin and the drug. The mathematical relationships and models used to describe the phenomenon of percutaneous absorption are also reported. The importance of these factors in optimizing percutaneous absorption or transdermal permeation of drugs for local or systemic effect is also discussed. PMID- 2665948 TI - Gastrointestinal absorption of drugs. AB - In this paper, those subjects that are important to drug absorption in the gastrointestinal tract are reviewed. First the anatomy of the gastrointestinal system is discussed in some detail. This is followed by a general review of the some of the animal models that are used to study drug absorption. In later sections, the physiological factors that affect drug absorption (pH and bile fluid), different mechanisms of drug absorption (passive, facilitated, and active transport, peptide and macromolecule absorption, and lymphatic uptake), and adjuvants (promoters of drug absorption) are discussed. PMID- 2665949 TI - The skin compliance of transdermal drug delivery systems. AB - This review examines transdermal drug delivery systems (TDS) and focuses on the specific side effects they can have on the skin and how these may be avoided. After a general overview of the structure of skin and its functions, an outline is given of how TDS are composed and how they operate. Upon basic treatment of relevant skin irritation and sensitization phenomena, techniques are described for monitoring them. Subsequently, various specific skin reactions are dealt with; these can be evoked by TDS on both short- and long-term application. Suggestions are then put forward for improving the skin compliance of TDS. For example, it is proposed that hydrogel patches may prove to be a useful alternative for current systems in that they are suitable for long-term applications, having minimal side effects because they are less occlusive. PMID- 2665950 TI - Diagnosis of anterior knee pain. AB - A methodical approach to the evaluation of patients with anterior knee pain is extremely helpful. By exploring salient points from the patient's symptoms and history and adding important data from a comprehensive physical examination, the pieces of the puzzle can be fitted together and an accurate diagnosis can be made. This will allow the formulation of a specific plan of rehabilitation that is designed with a knowledge of patellofemoral biomechanics and that will expedite the recovery process and facilitate a return to full function. PMID- 2665951 TI - The role of radiography in the evaluation and treatment of common anarthrotic disorders of the patellofemoral joint. AB - Patellofemoral disorders are among the most common knee problems in the world. Although they are often considered as a group, pathologically the individual disorders are as variable as fingerprints. Treatment of resistant cases requires a detailed understanding of the disorder mechanism to be corrected. Many radiographic techniques, incorporating plain radiography, arthrography, CT, and MRI have been formulated to determine formats of chondromalacia, instability, and malalignment. Many of the techniques reviewed herein reveal distinct abnormalities but do not necessarily provide insight into the best treatment protocols. PMID- 2665952 TI - Conservative treatment of patellofemoral subluxation. AB - As pointed out in the preface of this book, patellofemoral subluxation is probably the most common knee problem seen in many orthopedists' offices today. Whereas the other authors have emphasized the anatomy and diagnosis, this article should serve as a dry but basic instruction on the exercise program that has been used in our clinic. We have had a success rate with this program of approximately 80 per cent. Certainly not all of the 20 per cent that fail require surgery. The classic exercises are quadricep sets, straight leg raises, hip abductors, hip adductors, hip flexors, and hamstring stretches, which have endured the test of time. The prevention of flexion extension activity, such as running the stadium stairs in order to strengthen the quadriceps of the patient with patellofemoral subluxation should be emphasized. Complications of conservative treatment, such as low back pain, iliopsoas tendinitis, and muscle soreness and the treatment of these is described. Finally, the importance of stretching the hamstring muscles is a cornerstone in the treatment of patellofemoral problems. Likewise, a tight IT band can put abnormal stress on the lateral aspect of the patella. In this article I have tried to point out our approach to conservative treatment of patellofemoral subluxation. PMID- 2665953 TI - Pitfalls of the lateral retinacular release. AB - The treatment of patellofemoral pain is fraught with pitfalls; however, most of these pitfalls can be recognized. Results of LRR in appropriate circumstances are reasonably good, and the complications are acceptably low. Risk factors for poor results are identifiable, and avoidance of the common complications are necessary to achieve reliable results. Cases of persistent pain after LRR must be approached in a thorough and orderly fashion. There should be clear indications and cautious expectations for the success of subsequent procedures. PMID- 2665954 TI - Formal extensor mechanism reconstruction. AB - The clinical syndrome of extensor mechanism malalignment can either be primary or secondary. The distinguishing feature of extensor mechanism malalignment is passive patellar hypermobility at 30 degrees of flexion, which yields apprehension. Formal extensor mechanism reconstruction requires multiple steps, which are described along with variations. PMID- 2665955 TI - Patellofemoral rehabilitation. AB - We have presented a brief overview of therapeutic exercise and patellofemoral biomechanics and their relation to a rehabilitation program of the nonoperative patient with patellofemoral dysfunction. This was followed by a specific protocol for extensor mechanism reconstruction, which can in part be applied to the nonoperative patient with a more vigorous lifestyle. Self-discipline and perseverance on the part of the patient are the only factors that cannot be controlled; yet, without these, no surgical procedure or rehabilitation program will ever succeed. PMID- 2665956 TI - Surgical complications of the patellofemoral articulation. AB - The complications associated with surgery on the extensor mechanism of the knee were reviewed. These complications may be avoided by being mindful of the importance of patient selection, establishing specific diagnoses, and then carrying out proper surgical procedures. Also reviewed were the complications associated with the extensor mechanism in total knee arthroplasty. Patellofemoral complications are the most common complications of total knee arthroplasty. The importance of precise surgical technique in aligning the extensor mechanism was emphasized. Caution is probably advisable in the use of metal-backed patellar components for the time being. Lastly, the relatively rare, but important, complications of reflex sympathetic dystrophy, infrapatellar contracture syndrome, and patella infra were reviewed. PMID- 2665957 TI - Stress injuries of the adolescent extensor mechanism. AB - Stress injury to the extensor mechanism is common, and we expect it to become more so as adolescent athletes train earlier and more vigorously. The clinical and radiographic findings of a number of these stress injuries are described. Our young athletes challenge us to continue studying these stress injuries with the goal of offering them more effective preventative programs. The success of our study will probably lie in the areas of stretching, cross training, and strength programs. PMID- 2665958 TI - [Selection of the dominant follicle. II]. PMID- 2665959 TI - Base substitutions in the 5' non-coding regions of two naturally occurring yeast invertase structural SUC genes cause strong differences in specific invertase activities. AB - Gene SUC4 produced about four fold more invertase activity than did gene SUC5. However, these genes differ in only three positions located in the 5' non-coding region. The difference in gene expression between SUC4 and SUC5 must be due to the G to A transition (position-497) and/or the C to T transition (position -460) in the upstream activator sequences. The sequence TACAAA present in SUC5 can play the same role than the TATAAA box of SUC4. PMID- 2665960 TI - A biologically active insulin analogue with modification in the A2 position. [2 Valine-A] sheep insulin. AB - The synthesis and biological evaluation of [2-Valine-A] insulin ([Val2-A]insulin) is reported. In this insulin, the isoleucine residue in position A2, invariant in the majority of mammalian insulins, is substituted by valine. The same substitution, along with four others, occurs naturally in the insulin produced by the owl monkey. Owl monkey insulin exhibits ca. 20% of the activity of porcine insulin in in vitro insulin assays using human cells in culture. [Val2-A]insulin displays 20-22% of the activity of bovine insulin in in vitro insulin assays using rat liver plasma membranes or isolated rat adipocytes. We suggest that the substitution of valine for isoleucine at position A2 is responsible for all or most of the diminution in potency of owl monkey insulin relative to porcine insulin. The data are discussed with regard to previous findings with insulin analogues in which isoleucine A2 was replaced with norleucine, glycine and alanine. PMID- 2665961 TI - Relapse of acetic acid-induced gastric ulcer and gastric mucosal prostaglandin I2 level in rats. AB - The healing process of acetic acid-induced gastric ulcer in rats was observed with an endoscope for 365 d after ulcer induction. The ulcers were induced by acetic acid solutions of various concentrations (2.5 (I), 5.0 (II), 10 (III) and 20% (IV); 0.05 ml). On day 3, a positive correlation was observed between the ulcer index (UI) and the concentration of acetic acid solution. On day 365, cumulative healing rates in groups I, II, III and IV amounted to 100, 100, 58.3 and 51.7%, respectively. The cumulative relapse rates in groups I, II, III and IV were 0, 13.6, 66.7 and 58.6%, respectively. Significant correlations were observed between initial UI values and cumulative healing or cumulative relapse rate. On day 365, rats were divided into two groups, a healed group and non healed group, and the gastric mucosal prostaglandin I2 (PGI2) level was measured by bioassay. The PGI2 level around ulcers in ulcer-induced rats was higher than in normal rats, and it was higher in non-healed rats than in healed rats. Moreover, the PGI2 level was higher in those groups which showed a higher cumulative relapse rates. The above results indicated that the initial ulcer size and the PGI2 level around the ulcer might correlate to ulcer healing or exacerbation. PMID- 2665962 TI - Protease-catalyzed semisynthesis of human neuropeptide Y. AB - Human neuropeptide Y was semisynthesized by enzymatic condensation of des-Tyr36 NH2 human neuropeptide Y and H-Tyr-NH2 using Pseudomonas aeruginosa elastase, a metalloenzyme possessing a hydrolytic specificity for the imino side of hydrophobic amino acids. The optimum pH for this enzymatic synthesis was judged to be around 7 in a high concentration of an organic solvent. PMID- 2665963 TI - Unexpected loss of immunoreactivity of a glucose oxidase-labeled antigen in a steroid enzyme immunoassay system. AB - Glucose oxidase-labeled 11-deoxycortisol was tested for immunoreactivity in an enzyme immunoassay system using a monoclonal antibody. The antigen was labeled by the N-succinimidyl ester method. It was found that the binding affinity of the label to the anti-steroid antibody markedly decreased during storage; the half life time was ca. 4.5 d. PMID- 2665964 TI - Genotoxicity of the food mutagen 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine (PhIP): formation of 2-hydroxamino-PhIP, a directly acting genotoxic metabolite. AB - Hepatocytes isolated from Aroclor 1254 (PCB) pretreated rats metabolized 2-amino 1-methyl-6-phenylimidazo[4,5-b]pyridine (PhIP) to a reactive metabolite that induced DNA damage measured by alkaline elution or as increased unscheduled DNA synthesis. PhIP induced mutations in Salmonella typhimurium TA98 and DNA strand breaks and sister chromatid exchange(s) in Chinese hamster V79 cells co-incubated with PCB-hepatocytes. No, or only minor genotoxic, effects were observed when hepatocytes from non-induced rats were used. The bacterial mutagenicity could be inhibited by alpha-naphthoflavone, indicating a role of P-450 in the activation of PhIP. At least eight different metabolites could be separated on HPLC after PhIP had been incubated with PCB-hepatocytes. All of the directly acting mutagenicity towards S.typhimurium TA98 co-eluted with one of the metabolites. The identity of this metabolite was concluded to be 2-hydroxamino-PhIP based on the following evidence: (i) it reduced ferric ion to ferrous ion as hydroxylamines do, (ii) it had an identical UV spectrum and chromatographic properties as a species formed upon reduction of 2-nitro-PhIP by NADPH P-450 reductase. This product displayed a major peak at m/z 241 during thermospray mass spectrometry in the positive-ion mode as would be expected from 2-hydroxamino PhIP. 2-Hydroxamino-PhIP was directly genotoxic both to TA98 and V79 cells. The genotoxic activity of the medium after removing the hepatocytes remained stable for several hours. Compared to 2-amino-3,4-dimethylimidazo[4,5-f]quinolone (MeIQ), PhIP caused a much larger increase in DNA damage in V79 cells (with hepatocyte activation), whereas MeIQ was more potent with respect to DNA damage induced in hepatocytes and bacteria. PMID- 2665965 TI - A rationale for the non-mutagenicity of 2- and 3-aminobiphenyls. AB - Of the three isomeric forms of aminobiphenyl, only 4-aminobiphenyl is an established carcinogen while the 2-isomer is considered as a non-carcinogen and 3 aminobiphenyl is at best described as a weak carcinogen. In the present studies we investigated the mutagenicity of these three compounds, their N-hydroxy derivatives and their nitrosoderivatives in the Ames test using the Salmonella typhimurium strains TA98 and TA100. The studies were performed both in the absence and presence of an activation system derived from the liver of rats pretreated with Aroclor 1254. Of the three isomers only 4-aminobiphenyl exhibited mutagenicity and only in the presence of an activation system. N-Hydroxy-4 aminobiphenyl was a potent direct mutagen in both bacterial strains, N-hydroxy-2 aminobiphenyl was mutagenic in only TA100 while N-hydroxy-3-aminobiphenyl displayed mutagenicity in neither strain. Both 2- and 3-nitrosobiphenyls were direct mutagens in strain TA100. These findings suggest that the weak carcinogenicity of 3-aminobiphenyl may be attributed to the lack of genotoxicity of its N-hydroxyderivative, whereas in the case of 2-aminobiphenyl it may be due to the inability of the hepatic preparations to catalyse its N-hydroxylation, which is in agreement with published in vivo metabolic studies. It is interesting that of the three isomers only 2-aminobiphenyl is non-planar, forming a dihedral angle of 40 degrees, and this may preclude it from acting as a substrate of the P 450I family of haemoproteins, which selectively catalyses the N-hydroxylation of many aromatic amines including 4-aminobiphenyl. PMID- 2665966 TI - Covalent binding of [2-14C]2-amino-3,8-dimethylimidazo[4,5-f]-quinoxaline (MeIQx) to mouse DNA in vivo. AB - Female BALB/c mice were administered intragastrically with equimolar amounts of either [2-14C]2-amino-3,8-dimethyl-[4,5-f]quinoxaline (MeIQx) or 2-acetylamino[9 14C]fluorene (2AAF). DNA was isolated from tissues of mice killed either 6 or 24 h after administration. Analysis of lvier DNA nucleotide digests by HPLC analysis revealed that all of the radioactivity was attributable to adduct formation. The specific activities of DNA samples were converted to covalent binding indices (CBI, mumol adduct per mol DNA nucleotides/mmol chemical applied per kg animal body weight). CBI values of 25 and 9 were determined for 2AAF and MeIQx in the livers of mice killed 6 h after dosing. The values were in general agreement with the moderate carcinogenic potency of these compounds. The specific activities of DNA preparations obtained from the kidneys, spleens, stomachs, small intestines and large intestines of mice treated with MeIQx and killed 6 h after dosing were 5- to 35-times less than those obtained with the liver. DNA isolated from the lungs (a target organ for MeIQx tumorigenicity) of MeIQx-treated mice was not radiolabelled at the limit of detection (CBI less than 0.3). With the exception of the gastrointestinal tract, the specific activities of DNA samples isolated from mice killed 6 h after administration were higher than those from mice killed after 24 h. PMID- 2665967 TI - Carcinogens induce intrachromosomal recombination in yeast. AB - To identify environmental carcinogens there is a need for inexpensive and reliable short-term tests that can be used to predict the carcinogenic potential of any given substance with high accuracy. The Ames assay, which is based on the induction of mutations in Salmonella typhimurium, is the most extensively used short-term test but certain human or animal carcinogens exist that are persistently undetectable as mutagens with the Ames assay or with other short term tests. There is a need for a short-term test to detect those carcinogens that are missed by the Ames assay. Carcinogenesis is in many cases associated with genome rearrangement. Because of this association a system screening for intrachromosomal recombination that results in genome rearrangement has been constructed for potential use as a short-term test in the yeast Saccharomyces cerevisiae. Evaluation of this recombination system shows that it is readily inducible by a variety of mutagenic as well as non-readily inducible by a variety of mutagenic as well as non-mutagenic carcinogens, including carcinogens that are not detectable by the Ames assay or by various other short-term tests, such as safrole, urethane, ethionine, auramine, methylene chloride, carbon tetrachloride, cadmium sulfate, aniline, dimethylhydrazine, aminotriazole, acetamide, thiourea and DDE. The present report shows the data for these as well as for additional agents, their response profiles with different concentrations of the agents and the protocol for the DEL system. PMID- 2665968 TI - The metabolism of 4,8-DiMeIQx in conventional and germ-free rats. AB - The aromatic amine mutagen, [14C]2-amino-3,4-8-trimethyl-imidazo[4,5 f]quinoxaline (4,8-DiMeIQx), which is derived from cooked food, was administered to conventional and germ-free AGUS rats previously fed either a semi-synthetic diet containing the cytochrome P-450 inducer beta-naphthoflavone (BNF) or a control diet without BNF. The germ-free animals had longer fecal transit times and lower induction of 7-ethoxyresorufin-O-deethylase activity than conventional rats. Induction with BNF caused a greater percentage of the radioactivity to be excreted in the feces of both germ-free and conventional rats. Feeding BNF also caused a 4-fold induction in germ-free and a 24-fold induction in conventional rat intestinal enzyme levels. Analysis of the urinary and fecal metabolites showed no consistent differences between conventional and germ-free rats in the metabolite profile. Major metabolites were identified as 8-hydroxymethyl-DiMeIQx, N-acetyl-8-hydroxymethyl-DiMeIQx, and 3-N-dimethyl-4-hydroxy-methyl-DiMeIQx. The data from this study indicate that intestinal microflora do not play a major role in the metabolism of 4,8-DiMeIQx, but the induction of intestinal enzymes does not affect the route and rate of excretion. PMID- 2665969 TI - Enzyme-mediated phosphorylation of polycyclic hydrocarbon metabolites: detection of non-adduct compounds in the 32P-postlabelling assay. AB - 32P-Postlabelling analysis is a sensitive method of detecting covalent modification of DNA by chemical carcinogens. We demonstrate that tetrol derivatives of the polycyclic aromatic hydrocarbons (PAHs) benzo[a]pyrene (BP) and chrysene become 32P-labelled in the assay in the absence of nucleic acids. The transfer of 32P from [gamma-32P]ATP to the PAH derivatives requires T4 polynucleotide kinase. Phosphorylated dihydrodiols, phenols, triols and parent hydrocarbons were not detected under standard TLC conditions. Labelling of the non-nucleotide substrates was at least 2000-fold less efficient than labelling of a synthetic BP - DNA adduct. Using 75 microCi[gamma-32P]ATP, the detection limit for BP tetrols was 100-200 pg. Labelling of non-adduct substrates is unlikely to interfere with the analysis of DNA isolated from mammalian tissues, but DNA modified by electrophiles in vitro may, if inadequately purified, give rise to spurious radioactive products. PMID- 2665970 TI - Cholinergic constriction in the general circulation and its role in coronary artery spasm. AB - The release of acetylcholine from autonomic nerves in those tissues that receive a cholinergic innervation is widely believed to dilate blood vessels. Exogenously administered acetylcholine in vivo does dilate vascular beds and produce hypotension; however, this latter effect is indirect and probably the result of liberation of endothelium-derived relaxing factor (EDRF) from endothelial cells. Some blood vessels contain a substantial population of medial constrictor receptors for acetylcholine, and the implications of this presence for vascular control systems has been largely ignored, although it needs to be considered. A survey of the evolution of vasomotor control systems indicates that acetylcholine serves principally as an excitatory transmitter to blood vessels. Neurally mediated cholinergic constriction and not dilation is found in fish, amphibians, reptiles, and birds, with responses initiated by medial muscarinic receptors. Acetylcholine constricts many vascular preparations from these lower animals, but some vessels relax, reflecting the emergence of an EDRF responsive to acetylcholine. An examination of cholinergic responses in mammalian vessels reveals that cholinergic (neurogenic) dilation is limited to a very few vascular beds and to only a few species. Both experimental evidence and evolutionary considerations support the likelihood that cholinergic (neural) constriction operates in some vascular regions in mammals and, in particular, in the coronary circulation of some species, including humans. In fact, constriction, and not dilation, may be the dominant vascular response to activation of the cholinergic axis in most mammals, including humans. The complications and contradictions introduced by the simultaneous presence of both EDRF and a cholinergic constrictor innervation involving medial muscarinic receptors are discussed. A variety of evidence is also presented that implicates cholinergic constriction in at least some instances of coronary artery spasm and sudden death. PMID- 2665971 TI - Attenuation of no-reflow phenomenon, neutrophil activation, and reperfusion injury in intestinal microcirculation by topical adenosine. AB - Small mesenteric arteries supplying partially isolated jejunal segments were totally occluded for 5 minutes and then released. With video microscopy, blood flow was calculated from measurements of submucosal arteriolar diameter and red blood cell velocity. For the first 30 minutes of reperfusion, the serosa was superfused with a Ringer's vehicle containing either adenosine (ADO; 10(-4) M), acetylcholine (ACh; 10(-5) M), or prostacyclin (PGI2; 3 x 10(-7) M). Thereafter, the substances were removed from the suffusate, and superfusion continued with vehicle alone for an additional 10-30 minutes. These concentrations were equieffective for causing vasodilation. During the first minute of reperfusion, blood flow increased more than 300% of baseline in all groups. Within the subsequent 30 minutes, blood flow fell to 45 +/- 3% of baseline with vehicle alone, which demonstrates the no-reflow phenomenon. While either ADO, ACh, or PGI2 was in the suffusate, vasodilation was persistent. After washout of these substances, the postocclusion blood flows were significantly higher with each treatment than with vehicle alone, which shows that each substance had a positive action. However, with ADO, blood flow was 121 +/- 7% of baseline after washout, whereas with ACh or PGI2, it was 64 +/- 10% or 69 +/- 5% of baseline after washout. This property of ADO was observed if the mucosa was superfused with a Ringer's solution or with a bile salt solution, which suggests that ADO might have similar properties in situ. After 60 minutes of reperfusion, the intestinal villi were short, thick, and edematous with epithelial necrosis and crypt degeneration. ADO attenuated most of these histological changes to a greater extent than either PGI2 or ACh. Furthermore, ADO reduced a biochemical index of neutrophil infiltration; tissue myeloperoxidase concentration was increased to 169 +/- 14% of baseline with vehicle but was increased to 120 +/- 8% with ADO. Overall, these observations suggest that ADO protects the intestine from ischemia reperfusion injury by causing vasodilation and by inhibiting neutrophil function. The vasodilatory effect probably is a minor component because other vasodilators (ACh and PGI2) had minimal protective effects in these conditions. PMID- 2665972 TI - Effects of recombinant human tumor necrosis factor alpha, lymphotoxin, and Escherichia coli lipopolysaccharide on hemodynamics, lung microvascular permeability, and eicosanoid synthesis in anesthetized sheep. AB - We infused recombinant human tumor necrosis factor alpha (rhTNF alpha), lymphotoxin (rhLT), and Escherichia coli 0111:B4 lipopolysaccharide (LPS) into anesthetized sheep with a lung lymph fistula to compare their effects on systemic and pulmonary hemodynamics, lung lymph dynamics, and eicosanoid release. rhTNF alpha (25-150 micrograms/kg, n = 6 sheep), but not rhLT (25 micrograms/kg, n = 3), rapidly increased lung lymph and plasma levels of 6-keto-prostaglandin F1 alpha (6-k-PGF1 alpha) and caused profound systemic vasodilation and hypotension. Meclofenamate pretreatment (10 mg/kg) of three other sheep given 25 micrograms/kg rhTNF alpha prevented the increase of lymph and plasma 6-k-PGF1 alpha levels, systemic vasodilation, and the early (less than 2 hrs) but not the late (4-6 hours) hypotension caused by rhTNF alpha. LPS (1 micrograms/kg, n = 11) induced a briefer increase of lymph 6-k-PGF1 alpha levels than did rhTNF alpha while plasma 6-k-PGF1 alpha levels did not increase. LPS induced more gradual hypotension than did rhTNF alpha but did not cause systemic vasodilation. LPS and rhTNF alpha, but not rhLT, increased lymph thromboxane B2 (TXB2) levels during the first hour of study, whereas only LPS acutely increased plasma TXB2 levels. LPS caused acute pulmonary vasoconstriction and greater acute pulmonary artery hypertension than did either rhTNF alpha or rhLT. Whereas LPS-treated sheep required less fluid transfusion than rhTNF alpha-treated sheep to maintain mean systemic arterial pressure greater than 50 mm Hg, LPS infusion caused a greater increase of lung lymph protein clearance. rhTNF alpha caused minimal alterations of lung microvascular permeability. We conclude that eicosanoid mediators contribute importantly to differences of systemic and pulmonary hemodynamics caused by these agents in sheep. rhTNF alpha cannot account for all of the LPS-induced hemodynamic, lung lymph, and eicosanoid responses in sheep. PMID- 2665973 TI - An overview of randomized trials of rehabilitation with exercise after myocardial infarction. AB - Of 22 randomized trials of rehabilitation with exercise after myocardial infarction (MI), one trial had results that achieved conventional statistical significance. To determine whether or not these studies, in the aggregate, show a significant benefit of rehabilitation after myocardial infarction, we performed an overview of all randomized trials, involving 4,554 patients; we evaluated total and cardiovascular mortality, sudden death, and fatal and nonfatal reinfarction. For each endpoint, we calculated an odds ratio (OR) and 95% confidence interval (95% CI) for the trials combined. After an average of 3 years of follow-up, the ORs were significantly lower in the rehabilitation than in the comparison group: specifically, total mortality (OR = 0.80 [0.66, 0.96]), cardiovascular mortality (OR = 0.78 [0.63, 0.96]), and fatal reinfarction (OR = 0.75 [0.59, 0.95]). The OR for sudden death was significantly lower in the rehabilitation than in the comparison group at 1 year (OR = 0.63 [0.41, 0.97]). The data were compatible with a benefit at 2 (OR = 0.76 [0.54, 1.06]) and 3 years (OR = 0.92 [0.69, 1.23]), but these findings were not statistically significant. For nonfatal reinfarction, there were no significant differences between the two groups after 1 (OR = 1.09 [0.76, 1.57]), 2 (OR = 1.10 [0.82, 1.47]), or 3 years (OR = 1.09 [0.88, 1.34]) of follow-up. The observed 20% reduction in overall mortality reflects a decreased risk of cardiovascular mortality and fatal reinfarction throughout at least 3 years and a reduction in sudden death during the 1st year after infarction and possibly for 2-3 years. With respect to the independent effects of the physical exercise component of cardiac rehabilitation, the relatively small number of "exercise only" trials, combined with the possibility that they may have had a formal or informal nonexercise component precludes the possibility of reaching any definitive conclusion. To do so would require a randomized trial of sufficient size to distinguish between no effect and the most plausible effect based on the results of this overview. PMID- 2665974 TI - Positive temporal sharp waves in neonatal EEG. AB - The clinical correlates and EEG characteristics of rolandic positive sharp waves in neonatal EEG have been studied systematically. Morphologically similar positive sharp waves have been reported to occur in the temporal areas (PTS). Their significance is, however, unclear. We reviewed fifty-two EEGs on patients from the Neonatal Intensive Care Unit of the University of Arkansas for Medical Sciences. Twenty-one of the EEGs which were reviewed had PTS. We correlated the PTS with the results of ultrasound of the head and with clinical evaluations. PTS are more strongly correlated with the occurrence of non-hemorrhagic than of hemorrhagic intracranial pathology. PMID- 2665975 TI - Studies of humoral and cell-mediated immunity to peptides shared by HLA-27.1 and Klebsiella pneumoniae nitrogenase in ankylosing spondylitis. AB - One-hundred and twenty-four patients with spondylarthropathies were studied for antibodies to the peptides from HLA-B27.1 and Klebsiella pneumoniae nitrogenase which share a QTDRED hexamer sequence. Of 60 male Norwegian ankylosing spondylitis (AS) patients 23.3% showed positive ELISA reactivity for B27.1 peptide compared with 4% of Norwegian male controls (P less than 0.10). This difference was not observed among patients and controls from New Mexico. All patients with anti-B27.1 antibody were HLA-B27+. Antibody to B27.1 peptide was present in 20% of normal female controls with at least one previous pregnancy. No female control without previous pregnancy showed positive anti-B27.1 peptide reactivity. Anti-Klebsiella peptide antibody was neither significantly elevated in AS nor correlated with anti-B27.1 peptide antibody. Significant migration inhibition by these peptides was not observed in AS or normal controls. The possible influence of epitope conformation, rather than sequence homology, in potentially cross-reacting determinants shared by bacterial antigens and human Class I molecules requires further study. PMID- 2665977 TI - In vitro suppression of interleukin 2 production by Mycobacterium leprae antigen. AB - The suppressive activity of three different lots and sources of Mycobacterium leprae (M. leprae) was studied by measuring the inhibitory effect on interleukin 2 (IL-2) production in normal subjects. All three M. leprae preparations had suppressive activity on IL-2 production when peripheral blood mononuclear leucocytes (PBML) were stimulated with the mitogens PHA-P or Con A in a dose response. M. leprae also had suppressive activity on IL-2 production when PBML were stimulated with the specific antigen, PPD. The inhibitory activity of M. leprae on IL-2 was not due to the direct interaction of M. leprae and IL-2 because direct mixing of IL-2 with different concentrations of M. leprae did not alter the activity of IL-2. Incorporation of M. leprae for 0, 6 and 12 h in PHA-P and PBML cultures had no inhibitory effect on IL-2 production; however, after 14, 16 and 18 h of M. leprae incorporation, significant inhibitory effects were noted on IL-2 production. The suppressive mechanism of M. leprae was studied by incorporating M. leprae into PBML or adherent cells. The suppressive activity could be detected in both M. leprae-stimulated PBML and M. leprae-stimulated monocyte supernatant fluids. The suppressive mechanism of M. leprae was further evaluated by incorporating 1 and 2 micrograms/ml of indomethacin in PBML containing PHA-P and M. leprae. The suppressive activity of M. leprae was significantly diminished by indomethacin, suggesting that the inhibitory effect of M. leprae may result from the induction of PBML and adherent cells to produce the immunosuppressive activity of prostaglandin(s). PMID- 2665978 TI - Gastrointestinal hemorrhage and the skin. AB - Cutaneous manifestations are often associated with disorders in which gastrointestinal hemorrhage is a major feature. These manifestations include vascular abnormalities, connective tissue disorders, gastrointestinal polyposis, vasculitis and its variants, Kaposi's sarcoma, and inflammatory bowel disease. Because such skin lesions often develop prior to gastrointestinal hemorrhage, they may prove helpful in making a definitive diagnosis before gastrointestinal blood loss becomes a major clinical problem. PMID- 2665976 TI - Antibodies against Ku protein in sera from patients with autoimmune diseases. AB - Immunoaffinity-purified Ku protein was used to screen sera from patients with systemic lupus erythematosus (SLE), scleroderma, myositis and Sjogren's syndrome for anti-Ku antibodies in a quantitative immunoblot assay. Sixteen percent of the 159 studied sera were reactive with the Ku protein; significantly increased frequencies of anti-Ku antibodies were found in SLE (19%) and scleroderma (14%) sera. Patients with myositis and Sjogren's syndrome showed similar frequencies. All positive sera had antibodies to the 86 kD subunit of Ku protein; only one serum did not react with 70 kD subunit. Frequencies of other autoantibodies were compared in anti-Ku positive and negative patients. Only anti-Sm antibodies, especially in the absence of anti-nRNP, appear to be associated with the presence of anti-Ku antibodies. A strong correlation between anti-Ku antibodies and the class II HLA antigen DQw1 (89% of the positive sera) was observed, suggesting participation of MHC genes in the mounting of the anti-Ku immune response. PMID- 2665979 TI - Gastrointestinal polyposis syndromes. AB - Well recognized cutaneointestinal syndromes in which colonic polyps are a constant and defining feature include Gardner's syndrome (familial adenomatous polyposis), Peutz-Jeghers syndrome, and Cronkhite-Canada syndrome. Colonic polyps are also found with increased frequency in Cowden's disease, the Muir-Torre syndrome, and neurofibromatosis. The Ruvalcaba-Myhre-Smith syndrome is a newly defined entity in this category. The relationship between acrochordons and colonic polyps remains a controversial issue, awaiting additional studies. PMID- 2665980 TI - Hepatic disease and the skin. AB - There are numerous cutaneous findings associated with liver diseases. Although most of these changes are nonspecific and therefore are of limited value in the actual diagnosis of hepatic disease, recognition of the association may be useful for diagnosis and for monitoring the patient's response to treatment. PMID- 2665981 TI - An approach to cutaneous changes caused by hematologic malignancies. AB - Most hematologic malignancies can present with or later develop cutaneous lesions. The proper diagnosis of such patients through the evaluation of their cutaneous lesions is complicated both by the confusing variety of clinical findings and by the shifting classifications of hematologic malignancies in the face of evolving knowledge. The spectrum of T-cell malignancies continues to increase and now includes several disorders formerly attributed to B-cells or macrophages. The cutaneous findings of malignant and malignant behaving hematologic disorders are grouped by the presumed cellular etiology and by the clinical subset of tumor. Clinical and histopathologic features unique to individual disorders are emphasized, as well as those features that may be shared by otherwise quite dissimilar malignancies. PMID- 2665982 TI - Purpura. AB - Purpura is a cutaneous manifestation of a wide variety of diseases. These include such diverse entities as platelet defects, vasculitides, and disorders of connective tissue. Uncovering the underlying disorder in a patient with purpura is a stimulating challenge to the clinician's diagnostic abilities. PMID- 2665983 TI - Sarcoidosis. AB - Sarcoidosis is characterized by noncaseating granuloma that can occur in any organ of the body. The lymph nodes, lungs, skin, liver, spleen, phalangeal bones, parotid glands, and eyes are the most common sites of involvement. Although sarcoidosis rarely causes death, its course is highly variable, and its treatment can be challenging to the clinician. This article presents an updated review of the clinical manifestations of sarcoidosis as well as discussions of the diagnostic evaluation and treatment of this idiopathic disease. PMID- 2665984 TI - Disorders affecting the skin and the heart. AB - Numerous disorders affect both the skin and the heart. These include inherited and metabolic disorders, rheumatologic diseases, infectious diseases, and a variety of others. In many instances, awareness of this association allows the dermatologist to assist in identifying potentially life-threatening cardiac conditions. PMID- 2665985 TI - Cutaneous manifestations of diabetes mellitus. AB - Diabetes mellitus is a common condition, and persons who have this ailment are commonly encountered by dermatologists and primary care physicians. Because glucose attaches to long-lived proteins, it may have a profound effect on the tertiary structure of the protein. Chronic hyperglycemia may be responsible for the pathogenesis of many diabetic complications. It has been suggested that increased cross-linking of collagen in diabetic patients is responsible for the fact that their skin is generally thicker than that of nondiabetics. Advanced glycosylation end-products are probably responsible for yellowing of skin and nails. Increased viscosity of blood caused by stiff red blood cell membranes results in engorgement of the postcapillary venules in the papillary dermis, which is detected as erythema of the face or as periungual erythema. It is suggested that these skin changes may eventually be used as a reflection of the patient's current (as well as past) metabolic status. PMID- 2665986 TI - The thyroid. AB - The integument contains many components whose function is influenced by thyroid hormone. Thus, an increase or decrease in hormone levels results in a variety of cutaneous, hair, and nail changes. These changes are important to recognize, as they may aid in the early diagnosis of thyroid disorders. Other cutaneous disorders are more prevalent in patients with thyroid disease, and their recognition may likewise be helpful. Finally, several syndrome complexes occur with which thyroid disorders are regularly associated. PMID- 2665987 TI - Cutaneous manifestations of nutritional disorders. AB - Although the frequency of nutritional disorders is diminishing in developed countries, it is imperative that the clinician know the cutaneous clues to diagnoses of these conditions. Settings in which nutritional disorders occur include cogenital or postsurgical alterations in bowel anatomy, chronic wasting states, psychiatric diseases, and metabolic alterations. PMID- 2665988 TI - Cutaneous manifestations of bacterial infections. AB - A thorough history, physical examination, and appropriate laboratory and radiologic evaluation are mandatory in the febrile patient with a rash. Many infections have characteristic cutaneous findings that facilitate an accurate clinical diagnosis prior to isolation of the organism from culture of body fluids. A skin biopsy can be a valuable aid, since many organisms can be cultured directly from the specimen or seen on histologic examination. PMID- 2665989 TI - Rickettsial diseases. AB - The rickettsioses have several unifying features. Arthropod vectors are the common means of transmission. Fever, headache, myalgias, and the characteristic eruption (except in Q fever and ehrlichioses) are the hallmarks of the clinical presentation. The diseases share a common pathogenesis, namely, vasculitis, and treatment uniformly consists of tetracycline or chloramphenicol. Distinguishing aspects of these processes include the multitude of different reservoirs, the progression of the rash, and the nonspecific antigen test (Weil-Felix) results. PMID- 2665990 TI - Immunoperoxidase identification of nucleated cells in urine in glomerular and acute tubular disorders. AB - Nucleated nonsquamous cells in urine of patients with crescentic glomerulonephritis (CN), noncrescentic glomerulonephritis (NCN), acute tubular necrosis (ATN) and drug related acute interstitial nephritis (AIN) were identified using monoclonal antibodies and immunoperoxidase stain. Cell viability was determined by trypan blue permeability. CN was distinguishable from NCN by total cell numbers exceeding 30,000/ml (p less than 0.001) and counts of granulocytes exceeding 10,000/ml (p less than 0.05), monocytes exceeding 3,000/ml (p less than 0.001), T4 lymphocytes exceeding 1,500/ml (p less than 0.001), T8 lymphocytes exceeding 1,500/ml (p less than 0.001), glomerular epithelial cells exceeding 4,000/ml (p less than 0.001), proximal tubular cells exceeding 8,000/ml (p less than 0.001), loop of Henle cells exceeding 1,500/ml (p less than 0.01) and urothelial cells exceeding 1,500/ml (p less than 0.05). AIN was distinguishable from ATN by total cell numbers exceeding 75,000/ml (p less than 0.001) and counts of granulocytes exceeding 150,000/ml (p less than 0.001), monocytes exceeding 5000/ml (p less than 0.001), T4 lymphocytes exceeding 3,000/ml (p less than 0.01), T8 lymphocytes exceeding 2,500/ml (p less than 0.01) and cell viability exceeding 60% (p less than 0.05). Proximal tubular, loop of Henle, distal tubular/collecting duct and urothelial cells were present in high numbers in CN, ATN and AIN. CN can be distinguished from NCN, and ATN can be distinguished from AIN by identifying and quantifying the nucleated cells present in the urine. PMID- 2665991 TI - Evaluation of change with time of glomerular morphology in membranoproliferative glomerulonephritis: a serial biopsy study of 33 cases. AB - The evolution of renal glomerular lesions was examined in biopsies taken from 33 patients with membranoproliferative glomerulonephritis (MPGN). 25 patients had a diffuse form of MPGN in the first biopsy (group A). Twenty-four of them still showed diffuse MPGN in subsequent biopsies, but one patient improved clinically and histologically 19 years after the initial biopsy. Out of 6 patients with focal MPGN in the first biopsy (group B), 4 developed diffuse MPGN, one remained with focal MPGN in the repeat biopsy, and another one was found in remission, as determined by both histological and clinical features. Group C represents two patients who had no histological findings of MPGN on initial biopsy but later showed evidence of a diffuse form of MPGN on subsequent biopsies. Thus, the focal form of MPGN may be found either in the development of diffuse MPGN or in its healing stage, and the prognosis will vary accordingly. PMID- 2665992 TI - Idiopathic acute interstitial nephritis associated with anterior uveitis in adults. AB - Concomitant renal and ocular lesions have been described in a few systemic diseases. The association of acute interstitial nephritis (AIN) and anterior uveitis without determined cause was first described in children. Recently, the same clinical association has been reported in adults. We report 3 cases of this association and present a review of the literature. Including our 3 patients, 7 cases of this association have been reported in adults. All patients were females aged 27-74 years. Initial symptoms were either ocular, or pseudoviral (fever, myalgia and fatigue). Histological renal studies revealed acute interstitial nephritis with tubular lesions. Immunofluorescence and electron microscopy were not contributive. Ocular prognosis was always good. In 5 patients, the evolution of renal function was excellent with complete resolution of acute renal failure within a few weeks. Chronic renal failure developed in two of the four patients who did not receive systemic steroid therapy (with evolution towards terminal renal failure in one patient). Three of the patients received 60 mg per day of prednisone and none of them developed chronic renal failure. Despite the small number of patients reported and the possibility of spontaneous regression, these data suggest a beneficial effect of systemic steroid therapy to prevent or reduce interstitial inflammation and subsequent fibrosis. PMID- 2665993 TI - Serum osteocalcin and bone mineral metabolism following successful renal transplantation. AB - Serum osteocalcin (bone gla protein, BGP), a vitamin K-dependent non-collagenous bone protein and its relationship to other markers of bone and mineral metabolism were studied cross-sectionally in varying numbers of patients before and over 240 days following renal transplantation. Marked elevation of serum creatinine (11.9 +/- 0.76 mg/dl), osteocalcin (216.9 +/- 7 ng/ml), parathyroid hormone (PTH, mid molecule fragment) (24.5 +/- 3.6 ng/ml), alkaline phosphatase (255.2 +/- 54.7 IU/l) and phosphorus (5.6 +/- 0.3 mg/dl) were noted preoperatively. Serum calcium levels remained normal throughout the study period while phosphate levels normalized within one week after transplantation. PTH levels progressively decreased postoperatively over the study period but were still elevated well above normal. Serum osteocalcin decreased to near normal values at 60-90 days after surgery. Both PTH and alkaline phosphatase correlated significantly with osteocalcin preoperatively and postoperatively. The relatively depressed values of osteocalcin in the face of still elevated PTH levels post-transplantation was attributed to the effect of immunosuppressive corticosteroid therapy. The significant correlation between PTH and osteocalcin suggests that osteocalcin may be as or more sensitive a measurement of bone turnover than alkaline phosphatase pre- and post-transplantation. PMID- 2665994 TI - Hip fracture in a heart transplant patient. AB - The considerable risks of osteonecroses and fractures after renal transplantation are well described. Whether or not these transplantation risks are unique to those with renal failure is uncertain. A 56-year-old man developed multiple spontaneous fractures, including a fracture of the femoral neck, following cardiac transplantation. PMID- 2665995 TI - Roentgenographic measurement of pedicle screw penetration. AB - Potential complications due to pedicle screw penetration of the anterior cortex include injury to vascular, visceral, ureteral, sympathetic, and neural structures. This study examined the accuracy of lateral roentgenographic techniques in determining actual screw penetration in vertebral levels T12 through S1 of ten unilateral sets of pedicles in five anatomic specimens. A true lateral roentgenogram alone was inaccurate for determining the penetration of the anterior cortex by a pedicle screw. The greatest discrepancy between roentgenographically apparent and actual screw penetration was found at the L4 and L5 levels. Deviation from a true lateral roentgenographic axis resulted in the most pronounced change in roentgenographically apparent screw penetration at L4 and L5. The roentgenographic axes resulting in the closest approximation of actual screw penetrations were 5 degrees and 10 degrees above the true lateral axis for the T12-L3 and the L4-S1 levels, respectively. At 50% apparent penetration, the screw may be safely assumed to not be penetrating the anterior cortex using a true lateral roentgenogram. At 80% apparent penetration, 30% and 10% probabilities of actual screw penetration of the anterior cortex exist at L4 and L5, respectively. At 100% apparent penetration, there is an almost 100% probability that the screw is actually protruding through the anterior cortex. PMID- 2665996 TI - Coagulopathies associated with major spinal surgery. AB - Coagulation disorders occurring during major spinal surgery may be more common than previously thought. Patients who develop clinical disseminated intravascular coagulation (DIC) during spinal surgery represent one extreme of this process. The etiology of the coagulopathy seems to be unrelated to age, gender, or etiology of the spinal deformity, e.g., idiopathic, congenital, neuromuscular, or degenerative. Acute bleeding diathesis may occur during or shortly after surgery and may be difficult to control. The consumptive coagulopathy is not a self limiting process. Preoperative, intraoperative, and postoperative monitoring of coagulation studies in patients with prolonged spinal procedures may help to identify those patients at risk for fulminant DIC and allow for prompt therapeutic intervention. In the presence of active hemorrhage or in those patients who cannot tolerate large volume transfusion, cryoprecipitate is the replacement product of choice for fibrinogen replacement. PMID- 2665997 TI - [Concurrence of acute autonomic and sensory neuropathy and myasthenia gravis--a case report and pathogenetic considerations]. AB - A 22-year-old woman admitted to the hospital on Mar. 19, 1985 because of syncopal attacks and numbness on the limbs. Examination revealed peripheral sympathetic as well as parasympathetic dysfunctions and loss of myelinated as well as unmyelinated fibers in a biopsied sural nerve. A diagnosis of acute autonomic and sensory neuropathy (AASN) was made. She was treated with prednisolone but did not respond to the therapy. Only L-DOPS was effective on orthostatic hypotension. Recovery of the neurological conditions was insufficient till May 1987, when she complained of easy fatigability when speaking and chewing. Pharmacological and electrodiagnostic tests showed typical myasthenic phenomenon. At this time, serum anti-ACh receptor antibody was 741nmol/l and a diagnosis of myasthenia gravis was confirmed. Anti-ACh receptor antibody was proven to be elevated in the serum collected on April 1985 when the initial symptom of AASN had appeared. A thymectomy resulted in prompt and complete remission of semiologies of both myasthenia gravis and AASN. These suggest that immunological abnormality might play an important role in the pathogenesis of AASN in this case. PMID- 2665998 TI - [Idiopathic hypokalemic periodic paralysis presenting peculiar insulin secretion]. AB - A 24-year-old male was admitted to our hospital because of the paralytic attack. He was well until he went to bed the day before, and he found his limbs unmovable in the morning. The initial attack occurred at age 11 and subsequently he had two episodes of the reversible generalized weakness which always appeared in the morning and continued for about one day at age 14 and 21, respectively. The provocative factors were uncertain. There was no family history of paralytic attacks nor thyroid diseases. On the neurologic examination he presented flaccid tetraparesis without the facial and respiratory involvements. The laboratory studies showed that the serum potassium was 2.4 mEq/l and the thyroid function was normal. The oral and intravenous potassium chloride was given and within two days the serum potassium turned back to the normal level, and he has recovered completely from the paralysis. An oral 75g glucose load was performed. The serum immunoreactive insulin (IRI) was elevated from the basal level to 289 microU/l, showing the prominent peak response at 30 min after the load, and both the serum potassium and the grasping power decreased significantly, although the blood glucose fluctuated within the normal level. After the prophylactic treatment with acetazolamide 2,000 mg daily for 7 days, this markedly elevated initial insulin response has disappeared and moreover the weakness of grip was milder, however, the serum potassium decreased notedly. This case revealed that in the idiopathic hypokalemic periodic paralysis the attack was possibly induced by the extraordinarily secreted insulin which was supported by the acetazolamide treatment. PMID- 2665999 TI - Biochemistry of nonheme iron in man. I. Iron proteins and cellular iron metabolism. AB - Total plasma iron turnover in man is about 36 mg/day. Transferrin is the iron transport protein of plasma, which can bind 2 atoms of iron per protein molecule, and which interacts with various cell types to provide them with the iron required for their metabolic and proliferative processes. All tissues contain transferrin receptors on their plasma membrane surfaces, which interact preferentially with diferric transferrin. In erythroid cells as well as certain laboratory cell lines, the removal of iron from transferrin apparently proceeds via the receptor-mediated endocytosis process. Transferrin and its receptor are recycled to the cell surface, whereas the iron remains in the cell. The mode of iron uptake in the hepatocyte, the main iron storage tissue, is less certain. The release of iron by hepatocytes, as well as by the reticuloendothelial cells, apparently proceeds nonspecifically. All tissues contain the iron storage protein ferritin, which stores iron in the ferric state, though iron must be in the ferrous state to enter and exit the ferritin molecule. Cellular cytosol also contains a small-molecular-weight ferrous iron pool, which may interact with protoporphyrin to form heme, and which apparently is the form of iron exported by hepatocytes and macrophages. In plasma, the ferrous iron is converted into the ferric form via the action of ceruloplasmin. PMID- 2666000 TI - [Physical and biological effects of ultrasound in diagnostic conditions--a review]. AB - Ultrasound waves spread in the body in changing the acoustic pressure in a high frequency causing heat production or acoustic cavitation. There are many adverse effects known in cell cultures or in animals. Epidemiologic studies showed no evidence at the present time that ultrasound causes any biological effects in human subjects. Therefore further observations, especially of new applications are necessary. PMID- 2666001 TI - Detection and management of the dilated fetal urinary tract. PMID- 2666002 TI - Bone scintigraphy--an update. PMID- 2666003 TI - Management of bone tumours--the radiologist's role. PMID- 2666004 TI - The stilette sign: the appearance of dilated bile ducts in the fatty liver. AB - The appearances of hepatic steatosis and of dilated intrahepatic bile ducts occurring independently are well described. When both conditions occur simultaneously a major sign of biliary obstruction, a double lumen with echogenic walls (the double-barrelled shotgun sign), is modified by the abnormally echogenic liver. The combined appearance is of a tubular structure with no echogenic interface with the liver, containing an echogenic structure at its centre representing echoes from the adjacent bile duct and portal vein walls. We have named this appearance the 'stilette' sign because of its resemblance to a fine needle within a tube. Its importance lies in the fact that it makes dilated intrahepatic bile ducts difficult to recognise by ultrasound. PMID- 2666005 TI - Are multiple examinations of the gall-bladder helpful? AB - The pattern of use of the oral cholecystogram and ultrasonocholecystography in the investigation of 1014 patients prior to cholecystectomy was analysed. Three hundred and sixty-eight (36.3%) of our patients had both an oral cholecystogram and an ultrasound examination of the gallbladder. In 193 (52.4%) of these the initial investigation was positive: the second test in this group was rarely helpful and sometimes confusing. Overall the predictive value of a positive first study was 98.5%. We conclude that the use of further investigation following an initially positive result is not justified. By these criteria 18.5% of patients had an unnecessary second investigation. PMID- 2666006 TI - Pyeloduodenal fistulae. A report of two cases and review of the literature. AB - Two cases of pyeloduodenal fistula are described. Previously reported cases are reviewed with discussion of clinical aspects and the role of various radiological investigations. Conservative management with internal ureteric stenting (intraoperative or percutaneous) is suggested as an alternative to nephrectomy. PMID- 2666007 TI - Diastematomyelia: prenatal ultrasonic appearances. AB - Four cases of in-utero diastematomyelia are presented and the ultrasonic features described. Characteristic findings are localised widening of the posterior ossification centres with a central echogenic focus at the point of widening, visible on coronal scanning, and absence of a posterior defect or soft tissue mass on transverse scanning. The aetiology and management of the condition is discussed. The cases illustrate that widening of the posterior ossification centres can occur in the absence of overt spina bifida and the prenatal detection of diastematomyelia will allow for early postnatal investigation and treatment. PMID- 2666008 TI - Free intraperitoneal fluid in patients with intestinal obstruction without clinical or radiological evidence of perforation. AB - Two patients with clinical evidence of intestinal obstruction underwent abdominal ultrasound examination; in both, free intraperitoneal fluid was noted. There was no clinical or radiographic evidence of perforation. PMID- 2666009 TI - Digital subtraction angiography. PMID- 2666010 TI - 1989 Physician's Directory. Colorado Medical Society. PMID- 2666011 TI - Pharmacotherapy of allergic rhinitis. AB - The pathophysiology, clinical manifestations and diagnosis, and pharmacotherapy of allergic rhinitis are reviewed. Allergic rhinitis is an immunologically mediated disease initiated by an antigen-antibody reaction in sensitized persons. Clinical manifestations include nasal obstruction, rhinorrhea, itching of the nose and eyes, coughing, and sneezing and may be perennial or seasonal. Diagnosis is confirmed by challenging the patient with suspected allergens in skin-prick tests. Avoidance of offending allergens is the cornerstone of therapy. Antihistamines and decongestants provides only minimal relief when used alone and are more effective when combined with other agents. Two newer antihistamines, astemizole and terfenadine, lack the sedative and anticholinergic properties of older antihistamines. Intranasal corticosteroids are particularly effective in relieving symptoms; beclomethasone diproprionate and flunisolide do so without producing systemic adverse effects. Cromolyn sodium is effective in relieving nasal symptoms and is the prototype of a new noncorticosteroidal class of compounds termed antiallergy drugs. Drugs under investigation for the treatment of allergic rhinitis include histamine H2-receptor antagonists, nonsteroidal anti inflammatory agents, anticholinergic agents, and beta-adrenergic receptor agonists. Immunotherapy is a helpful adjunctive treatment. Treatment with drugs may be necessary for those patients with allergic rhinitis who find it difficult or impossible to avoid the offending allergen. The severity of symptoms and the adverse effects of agents should be considered when individual therapeutic plans are being established. PMID- 2666012 TI - Pharmacologic management of Paget's disease. AB - The pathogenesis, clinical features, indications for therapy, and current pharamacologic management of Paget's disease are reviewed. Paget's disease is a bone disorder of unknown etiology primarily affecting the elderly. Overactive bone resorption leads to the accelerated formation of disorganized, weak bone. Pain and fractures are common clinical features. Neurologic, cardiovascular, metabolic, and neoplastic complications are also reported. Because most patients are asymptomatic, the disease is often detected during routine roentgenography or laboratory tests. Primary indications for pharmacologic intervention include bone pain, neural compression, immobilization hypercalcemia or hypercalciuria, cardiac failure, and orthopedic surgery. Recurrent or non-healing fractures and rapidly progressing complications are additional indications. Drugs used in the management of Paget's disease include calcitonin, etidronate disodium, and plicamycin. Although these agents are efficacious, each has disadvantages. Clinical resistance to animal calcitonins may develop, and the cost of therapy may be prohibitive. Etidronate may induce ostemalacia. The use of plicamycin is limited by potentially severe toxicities. Dichloromethylene and aminohydroxypropylidene are promising diphosphonate compounds but are still investigational In those patients who are unresponsive to single-agent regimens, combination therapy may prove effective. Although many patients with Paget's disease do not require pharmacologic therapy, calcitonin and etidronate are the agents of choice when it is indicated. PMID- 2666013 TI - Ciprofloxacin-induced interstitial nephritis. PMID- 2666014 TI - In vitro activity of Ro 23-9424, ceftazidime, and eight other newer beta-lactams against 100 gram-positive blood culture isolates. AB - One hundred Gram-positive bacteremia organisms from five important genus groups were tested against 10 newer beta-lactams. Ceftazidime was significantly less active (50% of strains at less than or equal to 8 micrograms/ml) compared to other cephalosporins. The penems (FCE-22101 and HRE-664) and imipenem were each superior to the cephalosporins with 92-93% inhibition of strains. A novel fused co-drug of fleroxacin and desacetyl-cefotaxime, Ro 23-9424, was 100% effective against these Gram-positive pathogens at less than or equal to 8 micrograms/ml. Several of these compounds should receive consideration for clinical trials for empiric therapy among neutropenic patient infections where Gram-positive pathogens may be more prevalent. PMID- 2666015 TI - Effects of Escherichia coli spheroplast formation on assays of H2 and adenosine triphosphate based ampicillin susceptibility tests. AB - The present study examined the effects of ampicillin on one strain of Escherichia coli in lactose peptone broth with an osmolality of 342 mosm/L under anaerobic conditions. Spheroplast formation occurred at 10 X MIC of ampicillin. The metabolic changes that took place during spheroplast formation disfavored the production of molecular hydrogen. The intracellular bacterial adenosine triphosphate (ATP) level remained normal or slightly elevated during spheroplast formation while viability (cfu/ml) decreased. Thus spheroplast formation did not interfere significantly with ampicillin susceptibility as interpreted by assaying molecular hydrogen and viability. The effect on the ATP assay was, however, pronounced. It was found that the reversion of spheroplasts to bacterial cells for this particular strain (as recorded by cfu/ml) did not occur in quantitative numbers. The ATP assay thus indicated an approximate of the density of cells, while viability studies reported a lower cell density. When using a broth with lower osmolality (50 mosm/L) no spheroplast formation occurred and a close relation between viability and intracellular ATP was observed. PMID- 2666016 TI - Mycoplasma hominis septic thrombophlebitis in a patient with multiple trauma: a case report and literature review. AB - Mycoplasma hominis was recovered from the site of a septic thrombophlebitis on the left cephalic veins of a patient with pelvic and other multiple trauma. The organisms were initially isolated from routine cultures in conventional blood agar media incubated anaerobically. The absence of other demonstrable pathogens and the patient's serologic response to the isolate support the role of the organism as the cause of this previously unreported mycoplasmal infection. M. hominis should be considered a possible cause of sepsis in selected cases of infections following pelvic trauma or manipulations of the genitourinary tract. PMID- 2666017 TI - Isolation and characterization of shrew (Suncus murinus) liver alcohol dehydrogenases. AB - 1. Starch gel electrophoresis of adult shrew (Suncus murinus) liver extracts revealed five forms of alcohol dehydrogenase (ADH 1-5) and four of them were purified. 2. ADH-4 and ADH-5 resemble human class I ADH in terms of electrophoretic mobility, substrate specificity and sensitivity to pyrazole inhibition. 3. ADH-2 does not belong to any of the three classes of human ADHs but rather with catalytic properties similar to those of the class B ADH found in guinea pig liver. 4. ADH-1 prefers secondary alcohol over primary alcohol substrates and between the enantiomers tested, the enzyme favors the S isomers. PMID- 2666018 TI - Performance of the copper T-380A intrauterine device in breastfeeding women. AB - The effect of breastfeeding on performance of the TCu-380A IUD was evaluated using data derived from multicenter clinical trials. Insertion events for breastfeeding women (N = 559) and non-breastfeeding women (N = 590) were compared as well as discontinuations of IUD use through six months following insertion. Results indicate that breastfeeding women inserted with a TCu-380A are more likely than non-breastfeeding women to have a smooth, pain-free insertion, few postinsertion bleeding and pain problems, and a high rate of continuation of IUD use. There were no uterine perforations reported from either group of women. PMID- 2666020 TI - Inhibition of Chlamydia trachomatis growth in endometrial cells by copper: possible relevance for the use of the copper IUD. AB - There is agreement that the relative risk of developing pelvic inflammatory disease (PID) increases among women who use the intrauterine contraceptive device (IUD). The role of Chlamydia in causing PID among IUD users is not clear. The present study demonstrates that Chlamydia trachomatis growth can be inhibited in cultured human endometrial cells by copper ions at concentrations known to be released by the copper IUDs. More than 98% inhibition was produced with 10(-5) and 10(-6) M of copper. Both C. trachomatis serovar E and a lymphogranuloma venereum Chlamydia serovar L2 (LGV) were inhibited by the copper ions. Although the mechanism of the inhibition is not known, the continuous presence of the copper ions during and after adherence appeared to be necessary for maximal effect. If such inhibition occurs in vivo, it is possible that copper ions released from the copper-containing IUD may partially protect against chlamydial infection. PMID- 2666019 TI - Clinical evaluation of two monthly injectable contraceptives and their effects on some metabolic parameters. AB - One-hundred-and-thirty normally menstruating females were subgrouped equally and enrolled from the family planning clinic to study the clinical performance of the monthly injectable contraceptives medroxyprogesterone acetate 25 mg + estradiol cypionate 5 mg (Cycloprovera) and norethisterone enanthate 50 mg + estradiol valerate 5 mg (HRP-102) and their effects on some metabolic parameters. The contraceptive efficacy after 6 months of use for both drugs was 100%. No change in menstrual pattern occurred in 74% of Cycloprovera users and 67.3% of HRP-102 users. A statistically significant decrease (P less than 0.01) occurred in HDL cholesterol and total serum protein values and a statistically significant increase (P less than 0.01) was observed in hematocrit value of Cycloprovera users only. Body weight and blood pressure values after 6 months of drug use showed no statistically significant changes in both groups. Also, no statistically significant changes were noticed in both groups for hemoglobin, post-prandial blood glucose, cholesterol, A/G ratio, SGPT and SGPT values following 6 months of injectable contraceptive use. None of the injectable users developed cervical dysplastic changes cytologically. PMID- 2666021 TI - Prevention of Potomac horse fever. PMID- 2666022 TI - Replacement therapy for inherited enzyme deficiencies. PMID- 2666023 TI - The effect of immunity to core lipopolysaccharides (LPS) on the production of thromboxane and prostacyclin by equine peritoneal macrophages. AB - An experiment was designed to determine whether a change in the ability of macrophages to respond to lipopolysaccharides (LPS) of gram-negative bacteria was involved in the development of cross-reactive immunity to endotoxemia. The endotoxin-induced production of thromboxane A2(TxA2) and prostacyclin (PGI2) by peritoneal macrophages from horses which were hyperimmunized against the common core region of LPS were compared to those in unimmunized horses. Bacterins used for induction of core LPS immunity were prepared from the J-5 mutant of Escherichia coli 0111:B4, and the R 595 mutant of Salmonella minnesota. Serum antibody titers to core LPS were determined by an indirect enzyme-linked immunosorbent assay. Immunized horses had a marked increase in titer to core LPS (p less than 0.05), while there was no change in titer in unimmunized control horses. The only significant difference in the in vitro LPS-induced production of TxA2 and PGI2 by peritoneal macrophages between immunized and control horses was a greater production of TxA2 by macrophages from immunized horses in response to 10 ng/ml LPS (p less than 0.05). Results of this experiment do not support the concept that cross-reactive immunity to LPS is attended by reduced production of TxA2 and PGI2 by equine peritoneal macrophages. PMID- 2666024 TI - The Skin Cancer Prevention Study: design of a clinical trial of beta-carotene among persons at high risk for nonmelanoma skin cancer. AB - We describe a randomized clinical trial of oral beta-carotene (50 mg/day) for preventing nonmelanoma skin cancer. It is a multicenter study conducted at sites in California, Minnesota, and New Hampshire. This report describes the design of the study, baseline characteristics of the 1805 randomized patients, changes in their plasma beta-carotene and retinol levels after 1 year of treatment, and plans for statistical analyses. Important features of this study are (1) a high proportion of potential subjects were found to be ineligible or chose not to enter the study, (2) the study agent is readily available over the counter and in common foods, and (3) nonmelanoma skin cancer is a relatively minor health concern for most patients. These considerations necessitated intensive efforts to encourage compliance with the study regimen. There are also some unusual statistical features of the study. One is that the study outcome is routinely assessed only at annual examinations, so the precise time of failure cannot be identified. Also, a secondary goal of the study is to determine whether beta carotene decreases the average number of new skin cancers per patient per year, and there are no established statistical methods for analysis of data in this situation. Alternative approaches to the analysis are discussed. PMID- 2666025 TI - Comparisons of cause of death verification methods and costs in the lipid research clinics program mortality follow-up study. AB - Classification of causes of death by a nosologist is standardized and relatively inexpensive, although the quality of the data recorded on death certificates has been subjected to criticism and the level of detail may not allow examination of specific circumstances of the death. A costly alternative is classification by a panel of physicians reviewing additional clinical information. The costs associated with both methods of classification as utilized by the Lipid Research Clinics Program Mortality Follow-up Study are presented along with their advantages and disadvantages. For deaths among the elderly (65 years or older), determination of the underlying cause of death may be difficult, especially as regards cardiovascular disease causes of death using only the death certificate, and impossible for classifying sudden death. Both classification methods are compared for 268 deaths among the elderly and 155 deaths among the nonelderly males and females participating in the study. The kappa statistics for observer agreement indicate moderate agreement (k = 0.58) and were not significantly different between the two age-groups (p greater than 0.10). Thus, the agreement between the methods was not affected significantly by the age of the deaths being classified. However, examination of the agreement chart showed a preference by the nosological classification for cardiovascular classification in the elderly population. The effect of the different classifications upon the analysis of the predictive value of high-density lipoprotein cholesterol on coronary heart disease mortality showed little difference between both methods of classification. PMID- 2666026 TI - Meta-analysis and evidence. AB - Meta-analysis is the science of combining evidence from different studies, but traditional statistical techniques contain neither a formal definition nor a measure of evidence. It is argued in this paper that the log-likelihood ratio, as a measure of the "weight of evidence," can be a very useful tool in the meta analysis. The mathematics and the philosophy behind the use of this index are introduced. The construction and interpretation of "support curves" in fixed and random-effects models are presented. The application of evidential techniques is illustrated on six trials of aspirin therapy previously presented by Canner. The possible dangers of focusing on statistical error rates instead of evidence are discussed. PMID- 2666027 TI - The likelihood ratio versus the p value in meta-analysis: where is the evidence? Comment on the paper by S. N. Goodman. PMID- 2666028 TI - Perusing the literature. PMID- 2666029 TI - Assessing new cancer treatments: regarding T. M. Morgan's "Analysis of Duration of Response". PMID- 2666030 TI - Radiographically subtle soft tissue injuries of the cervical spine. PMID- 2666031 TI - Cystadenocarcinoma versus pseudocyst of the pancreas: a difficult differential diagnosis. AB - Cystadenocarcinoma of the pancreas is a rare malignant tumor. It may appear as a typical pseudocyst on US and CT. Percutaneous drainage of a presumed pancreatic pseudocyst not only may have complications but also may miss the correct diagnosis. In such patients, only a total excision of the cystic mass and complete pathologic examination can distinguish between inflammatory, benign, or malignant neoplastic lesions. PMID- 2666032 TI - A vendor protests. PMID- 2666033 TI - Amelanotic lentigo maligna melanoma: a unique case and review of the literature. AB - It has been estimated that 2 percent of all melanomas are clinically amelanotic, with amelanotic lentigo maligna melanoma being an even rarer presentation. These neoplasms have presented clinically as neurodermatitis, eczema, and erythema. Given the lack of clinical markers and subsequent delay in diagnosis of these lesions, they are potentially more dangerous than pigmented lentigo maligna melanomas. We report a case of an amelanotic lentigo maligna melanoma presenting as an ill-defined edematous area on the left cheek of an elderly woman. PMID- 2666034 TI - Baroreflex control of the circulation in patients with congestive heart failure. AB - Vagal and glossopharyngeal afferents from cardiopulmonary and arterial baroreceptors exert supraspinal tonic restraint on sympathetic efferent outflow. The baroreceptor inhibitory influence is directly related to physiological changes in cardiac filling and arterial pressures. Increased cardiac pressures and dimensions during CHF may provide chronic stimulation that reduces responsiveness of these receptors and thereby influence the neurohumoral control of the circulation. Patients with chronic and severe CHF of ischemic cause were compared with control subjects whose ischemic heart disease did not affect cardiac performance. Orthostatic pooling of blood with use of upright tilt (45 degree), provided an apparently sufficient stimulus to unload baroreceptors in patients like controls. In contrast to peripheral vasoconstriction in controls, the patients dilated their resistance vessels during upright tilt. This abnormal vasodilation was systemic and uniform in skeletal muscle and subcutaneous tissue of the forearm remaining at heart level. Such an inability to vasoconstrict in the patients, could not be attributed to depression of local vasoconstrictor reflex or autoregulatory responsiveness of forearm vascular beds. Neural blockade carried out separately or in combination with blockades of forearm vascular effector receptors revealed; increased neural efferent activity to the forearm during tilting the patients which mediated beta-adrenergic vasodilation in both vascular beds. The patients had augmented circulating catecholamine levels, those for epinephrine increased in venous effluents but were maintained in brachial arterial inflow, and those for norepinephrine increased in arterial rather than venous plasma in the forearm. Following the patients during a course of therapy with a selective vasodilator calcium antagonist, the beta-adrenergic reflex vasodilation became substantially attenuated but was preserved during a placebo course of therapy. The beta-adrenergic reflex effect evidenced in the studied patients is most probably a manifestation of reduced baroreceptor afferent restraint and it could subsequently relate to the severity of depression of baroreceptor sensitivity during the course of CHF. PMID- 2666035 TI - In vitro fertilization treatment using ultrasonic guided puncture. PMID- 2666036 TI - Cyclosporin A nephrotoxicity. PMID- 2666037 TI - Minor mullerian anomalies and oligomenorrhea in infertile women. A syndrome. Gynecologic and obstetric implications. PMID- 2666038 TI - Immunological aspects of anaesthesia and surgery--with special reference to NK cells. PMID- 2666039 TI - Individual variation in response to thiopentone. AB - The purpose of this study was twofold. The first one was to quantify differences in dose requirements for thiopentone in different patient groups and the second one was to point out and elucidate possible explanations for the observed differences. Pharmacodynamic aspects were studied by comparisons of doses and serum concentrations associated with the achievement of obtundance of the eyelash reflex. Also the effect of thiopentone on cardiovascular system was studied in vivo and in vitro. For the study of the in vitro effect rings of the rabbit pulmonary artery were used in vivo the cardiac effect of thiopentone was assessed by impedance cardiography. Classical compartmental analysis of serum concentration/time relationship after administration of anaesthetic doses of thiopentone was performed to establish comparable pharmacokinetic data. Furthermore unbound and protein-bound levels of thiopentone were measured and assessed. The analysis of thiopentone was based on high pressure liquid chromatography and separation between bound and unbound drug was done by ultrafiltration as well as equilibrium dialysis. The binding of thiopentone in human serum and in a physiological saline solution (PSS) with 45 g albumin per litre was 85% and remarkably constant over the concentration range between 4 and 80 micrograms/ml. At lower drug concentration the binding increases and was 87% at 0.4 micrograms/ml. The increase was more pronounced at pH 6 and 6.8 than at pH 7.4 while no increase was observed at pH 9.0. The percentage binding increases with increasing pH from approximate 75% at pH 6.0 to a maximum value of 95% at pH 9.0. This increase in binding with increasing pH might be explained by the simultaneous transition of N-albumin to B-albumin. The albumin binding was at a higher level after reduction of the temperature from 37 degrees C to 2 degrees C. The partition coefficient between olivaoil and PSS also showed an increase by this change in temperature. The very moderate changes in binding over long ranges of drug concentration made it difficult to obtain reliable expressions for thermodynamic parameters which could characterize the nature of the binding. It was suggested that the nature of the protein binding could be characterized best as a solution of the drug in hydrophobic areas of the albumin molecule. The average percentual binding on serum has been shown reduced in patients with deteriorated kidney and liver function and also in elderly subjects, in pregnant women and in newborns. The reduced binding may explain the increased values for total body clearance and for volumes of distribution found in patients with kidney failure.(ABSTRACT TRUNCATED AT 400 WORDS) PMID- 2666040 TI - Oral acyclovir suppressive therapy in severe recurrent genital herpes. A double blind, placebo-controlled cross-over study. AB - A randomised, double-blind, placebo-controlled cross-over study was conducted in 24 patients, nine females and 15 males, with a history of more than eight recurrences of genital herpes in the past year. The patients received a first treatment course with 400 mg acyclovir or matching placebo by mouth, twice daily, for 12 weeks. After cross-over patients received alternative medication for another 12 weeks. The patients were followed without treatment for a further three-month period. During acyclovir therapy, recurrences were completely prevented in 17 patients (71%) and the remaining seven patients had nine recurrences as compared to 18 recurrences while receiving placebo. The placebo treatment did not reduce the recurrence rate. No adverse effects were attributable to the acyclovir treatment period. All virus isolates tested after treatment remained sensitive to acyclovir. Acyclovir prophylaxis of recurrent genital herpes is effective and safe. A continuous suppressive therapy with acyclovir offers a basis for a normal sexual life to those patients severely incapacitated by their disease, but once medication is stopped, patients shed virus as before suppression. PMID- 2666041 TI - Bronchial hyperresponsiveness to inhaled methacholine in subjects with chronic left heart failure at a time of exacerbation and after increasing diuretic therapy. AB - Cough and wheezing are common findings in left heart failure. However, it is still questionable whether nonallergic bronchial hyperresponsiveness, the hallmark of asthma, is also associated with this condition. In 12 subjects with acute decompensation of chronic postischemic LV failure, we assessed the PC20 methacholine during an episode of acute LV failure and after five to 15 days of intensive diuretic therapy. Weight, arterial blood gases, plethysmographic lung volumes, and expiratory flows were also measured on both visits. Extravascular lung water was estimated indirectly with a radiologic score. During acute decompensation, six subjects had significant airway obstruction and eight had a PC20 less than or equal to 16 mg/ml (significant bronchial hyperresponsiveness). After diuretic therapy, subjects improved significantly, losing an average of 2.2 kg, but they still had chronic LV failure and evidence of an obstructive breathing defect. Although mean PC20 was unchanged, three subjects had significantly improved PC20 after treatment. We conclude that: (1) left ventricular failure is often associated with mild bronchial hyperresponsiveness, although it is not excluded that smoking and the resulting possibility of bronchial obstruction can also play some role; and (2) acute treatment does not generally alter bronchial responsiveness to methacholine, suggesting that chronic LV failure can cause chronic changes to the airways. PMID- 2666042 TI - Bronchial responsiveness to exercise after human cardiopulmonary transplantation. AB - Heart-lung transplant (HLT) recipients characteristically display marked bronchial hyperresponsiveness (BHR) to inhaled methacholine, but their bronchial responsiveness (BR) to exercise has not been reported. We measured BR to exercise in 13 stable HLT recipients, 13 normal control (NC) subjects and 13 asthmatic patients (AS). All subjects exercised for eight minutes on a bicycle ergometer at a work level designed to obtain and maintain 80 percent maximum heart rate, or to tolerance. The postexercise fall in FEV1 was equivalent in the HLT group and the NC group (0 +/- 0.2 L vs 0 +/- 0.2 L:p = NS) in contrast to the AS group (-0.6 +/ 0.5 L:p less than 0.01). Stable HLT recipients do not exhibit BHR to exercise at tolerable work loads. This observation supports the hypothesis that BHR to methacholine after HLT is due to denervation hypersensitivity of muscarinic receptors rather than other causes. PMID- 2666043 TI - Irritant-induced occupational asthma. AB - A retrospective review was performed on the files of 154 consecutive workers assessed for occupational asthma to clarify the relative frequency of asthma induced by irritants in the workplace and to determine whether such asthma was clearly distinguishable from other forms of occupational asthma. Fifty-nine workers were considered to have occupational asthma. A subset of ten had a history consistent with asthma initiated by exposure to high concentrations of an irritant, had persistent symptoms for an average of five years when seen, demonstrated increased reactivity to methacholine, and gave no prior history of pulmonary complaints. These ten had a lower incidence of atopy (20 percent vs 58 percent) and a more frequent history of smoking (80 percent vs 38 percent) than the other subjects with occupational asthma but did not differ in average latency (5.9 years vs 5.7 years). Our findings suggest that irritant-induced asthma is not uncommon, and those affected may have different baseline characteristics from others with occupational asthma. PMID- 2666044 TI - Longitudinal changes in pulmonary function following bone marrow transplantation. AB - We prospectively followed a well characterized cohort of patients post-bone marrow transplantation for changes in pulmonary function. Thirty-four recipients without respiratory symptoms were available for follow up with a mean of two years. Spirometry and other measures of lung volume were well preserved following bone marrow transplantation. A progressive 11.9 percent decline in percent predicted diffusing capacity per year occurred. Age, cigarette smoking, type of cytoreductive therapy, type of GVHD prophylaxis, and the occurrence of AGVHD did not affect longitudinal changes in pulmonary function. Patients receiving transplants for CML developed a highly significant fall in diffusing capacity. Asymptomatic patients with CGVHD developed evidence of progressive obstructive ventilatory impairment. This suggests a subclinical spectrum of patients who may progress to the development of bronchiolitis obliterans and respiratory failure post-bone marrow transplantation. PMID- 2666045 TI - Wegener's granulomatosis presenting as acute respiratory failure with anti neutrophil-cytoplasm antibodies. AB - Anti-neutrophil-cytoplasm antibodies recently have been reported as serologic markers of Wegener's granulomatosis. We describe two cases in which this test appeared to be of great value in the diagnosis of Wegener's granulomatosis presenting as acute respiratory failure, a clinical setting in which it may be the only diagnostic test that can be safely and easily performed. PMID- 2666047 TI - Dyspnea in pregnancy. PMID- 2666046 TI - A prospective comparison of IMV and T-piece weaning from mechanical ventilation. AB - Two hundred (200) consecutive medical and surgical patients requiring mechanical ventilation were entered into a prospective randomized trial of weaning by either intermittent mandatory ventilation (IMV) or T-piece. Patients in these groups were of similar age and sex and had the same total ventilation time (TVT). The study design provided equal time for each weaning mode after specific criteria for oxygenation and ventilation were satisfied (PaO2 greater than 55 mm Hg on FIO2 less than 0.5; VE less than 12 L/min and two of the following four parameters: MVV greater than 2 VE, VT greater than 5 ml/kg, FVC greater than 10 ml/kg, NIF less than or equal to -20 cm H2O). Of the original 200 patients 165 were entered into the weaning phase; 35 patients were withdrawn prior to weaning due to the discretion of the attending physician or protocol error. Weaning time was not different between the IMV (5.3 +/- 1.2 h, mean +/- SEM) and T-piece groups (5.9 +/- 1.4 h, p = NS). Of the 165 patients, 155 (93 percent) were weaned successfully by protocol, 79 in the IMV and 76 in the T-piece group. Of 155 patients, 136 (88 percent) were weaned on the first attempt by protocol. Of the 19 who were not weaned, 11 were weaned successfully on the second and five on the third trial; three patients required three-day weans. We conclude that clinically stable patients who require short-term mechanical ventilation and meet standard bedside weaning criteria can be weaned efficiently by protocol using either IMV or T-piece techniques. PMID- 2666048 TI - Reversible hyperinflation in emphysema. AB - Pulmonary emphysema results in hyperinflation of the lungs and concomitant changes in the configuration of the thoracic cavity. We describe a patient who underwent bilateral lung transplantation for emphysema due to alpha 1 antitrypsin deficiency. Dramatic changes in chest dimensions and configuration occurred following transplantation, demonstrating the dynamic and reversible nature of the thoracic cavity abnormalities of emphysema. PMID- 2666050 TI - Latchkey children: a review of the literature. AB - Professional interest in the latchkey phenomenon has increased in the past 20 years. This article gives background information and reviews empirical research. PMID- 2666049 TI - Pet-associated injuries: the trouble with children's best friends. PMID- 2666051 TI - Detection of ras gene alterations and ras proteins in colorectal cancer. AB - DNA extracted from 31 primary colorectal carcinomas was analyzed for the presence of ras gene amplification and mutations. Nine carcinomas had Ha-ras amplification and seven Ki-ras amplification. Nine carcinomas had codon 12 Ki-ras mutations. Immunohistochemical staining for ras proteins revealed a normal membrane association in normal mucosa and benign polyps but an abnormal cytoplasmic distribution in carcinomas. Amplification, mutations, and immunohistochemical staining were independent of histologic differentiation, Dukes' stage, or DNA ploidy status. This study demonstrates that abnormalities of ras genes are a common finding in colorectal carcinomas. They are potentially important biologic changes associated with malignancy, although they do not appear to be related to clinical behavior. PMID- 2666052 TI - Ras oncogene and the acquisition of metastasizing properties by rectal adenocarcinoma. AB - To gain a better understanding of the biologic development of rectal adenocarcinomas, the authors evaluated the level of ras gene protein product (p21) in the available material of 74 Dukes' B adenocarcinomas, 64 Dukes' C adenocarcinomas, and 60 lymph-node metastases resected at the University of Chicago Medical Center between 1965 and 1981. Pathologic slides and archival paraffin blocks were retrieved for confirmation of the original diagnosis and measurement of p21 content. P21 titers were obtained using the RAP-5 monoclonal antibody in a semiquantitative immunohistochemical assay. Titer was expressed as the highest dilution giving definitive staining using the avidin-biotin peroxidase method. The analysis indicated that a higher percentage of Dukes' stage C rectal adenocarcinomas had high (greater than or equal to 1:40,000) p21 titers than Dukes' B adenocarcinomas (68.8 vs. 51.4 percent, respectively, P less than 0.05). In view of recent data suggesting that ras oncogene expression confers invasive and metastatic capabilities to NIH 3T3 cells, the authors believe this study offers evidence that overexpression of ras oncogene with overproduction of p21 protein product may be an important prerequisite for the acquisition of metastatic capabilities in the early stages of colon cancer. PMID- 2666053 TI - Adenosquamous carcinoma of the colon--an immunocytochemical and ultrastructural study. Report of two cases and review of the literature. AB - This paper presents two cases of adenosquamous carcinoma of the colon and brings to 39 the total number documented in medical literature. The concurrent glandular and squamous differentiation of the tumor cells was demonstrated by immunocytochemistry and electron microscopy. Evaluation of the biologic characteristics of all the reported cases suggests that malignant squamous elements in colonic carcinomas behave more aggressively than their glandular counterparts. In contradistinction from the pure squamous-cell carcinoma of the colon, adenosquamous carcinoma does not show the same predilection for the right colon. PMID- 2666054 TI - Absence of luminal intrinsic factor after gastric bypass surgery for morbid obesity. AB - Abnormally low serum cobalamin levels (less than 180 pg/ml) have been observed in 154 of 429 patients (36%) at an average of 22 months (range 3-64 months) after gastric bypass surgery for morbid obesity. Twenty-four patients underwent a Schilling test and retrograde endoscopy of the bypassed gastric segment to determine the presence of intrinsic factor (IF) in gastric aspirates and in mucosal biopsies at 22 +/- 4 months after surgery. Five patients had a normal cobalamin level (405 +/- 44 pg/ml), and gastric juice intrinsic factor was present in three of them (11 +/- 7 ng/ml). Nineteen patients had a low cobalamin level (113 +/- 8 pg/ml), and gastric juice IF was found in only two subjects of this group (10 ng/ml each). Basal gastric juice IF concentration of healthy control subjects was 24 +/- 5 ng/ml. Schilling test results were normal in all five patients of the first group and in only nine patients of the group with cobalamin deficiency after surgery. To assess whether IF was present within the parietal cells of subjects with absent luminal IF, we studied gastric biopsy material of 14 patients using a well-characterized indirect immunoperoxidase method. IF was identified in fundic mucosal biopsy specimens of all 14 patients with absent gastric juice IF. We conclude that cobalamin deficiency occurs in a significant number of patients after gastric bypass and is associated with absence of gastric juice IF. We propose that this abnormality might be caused by inadequate secretion of IF from the bypassed stomach. PMID- 2666055 TI - Definition and investigation of dyspepsia. Consensus of an international ad hoc working party. PMID- 2666057 TI - Insulin--therapeutic trends for the 90s. Proceedings of a satellite symposium held at the 24th annual meeting of the European Association for the Study of Diabetes (EASD). Paris, 6 September 1988. PMID- 2666056 TI - Cardiolipin-fluorescent (M1) antimitochondrial antibody and cholestatic hepatitis in secondary syphilis. AB - A 27-year-old black male with secondary syphilis and cholestatic jaundice is presented. The liver biopsy was believed to be most consistent with large bile duct obstruction, but both the ultrasound and endoscopic retrograde cholangiography were normal. Prior to treatment with penicillin, his serum was positive for antimitochondrial antibody. After treatment, the antibody was no longer detectable and the jaundice gradually resolved. The patient's pretreatment serum was, after further analysis, found to be positive for the antibody to the M1 antimitochondrial antigen subtype, which is identical to cardiolipin, the antigen in both the VDRL and Wasserman tests. A review of hepatic involvement in secondary syphilis is presented. PMID- 2666059 TI - Towards more physiological insulin therapy in the 1990s. A comment. PMID- 2666058 TI - Circadian rhythms of insulin needs and actions. AB - Circadian rhythms of insulin needs and action are a frequently discussed issue that is both of considerable physiological interest and of clinical importance in case of insulin substitution in type 1 diabetes. Basally, insulin is released in a pulsatile fashion which seemingly is erratic but at close analysis displays 'free-running' cyclical rhythmicity of 8-30 min duration that possibly guarantees optimal insulin action. This basal mode of insulin secretion is subject to a multitude of endogenous control systems that act on the B-cell both in a stimulatory (e.g., beta-agonists, glucagon as well as glucose and amino acids) and an inhibitory fashion (e.g., alpha-agonists, somatostatin). Since impairment of target cell sensitivity to insulin action and hyperglycemia may be caused by the stress hormones, cortisol, epinephrine and growth hormone included, with in part intrinsic rhythmicity, as well as by dehydration and by prolonged insulin withdrawal, a secondary feed-back signal on insulin release may easily be induced by rising blood glucose levels. In that modulators of insulin release and action are themselves secreted in a circadian fashion they tend to secondarily imprint the mode of insulin release. Therefore, any difference between a daily maximum and minimum in plasma insulin concentration besides its free-running short-term rhythmicity has to be regarded as a composite secondary circadian rhythm. It is in particular due to variable secondary early-morning and late-afternoon insulin resistance. PMID- 2666060 TI - The pharmacokinetic basis of insulin therapy in diabetes mellitus. PMID- 2666061 TI - Insulin versus insulin plus sulfonylureas in type 2 diabetic patients with secondary failure to sulfonylureas. AB - According to the modern pathophysiological understanding of type 2 diabetes and the mechanisms of sulfonylurea action, combined insulin-sulfonylurea therapy appears to be an interesting alternative for treating diabetic patients with secondary failure to sulfonylureas. From its revival in the early 1980s, combination therapy has been shown to have a positive effect on blood glucose control although initially published clinical studies, generally open and uncontrolled, have been widely criticized. Several recent well-designed studies confirmed these favorable results, with better glucose profiles and/or decreased insulin needs, which were shown to persist after 1 year or more. Most of the studies investigating the mechanism of action indicate that the effect is mainly due to stimulation of the residual insulin secretion with minimal or no effect on insulin sensitivity. The risk of hypoglycemic episodes is rather small when insulin doses are adapted at the beginning of the combined therapy. Effects on lipid metabolism are minimal and controversial. Thus, insulin-sulfonylurea treatment may be a safe and effective solution in type 2 diabetic patients with secondary failure to sulfonylureas, particularly in those with significant residual endogenous insulin secretion. The additional cost of such combined therapy should be weighed against the potential advantages of better metabolic control. PMID- 2666062 TI - Effect of cooling rate on insulin release from frozen-thawed dispersed rat islet cells. AB - Rat islet cells, dissociated with EDTA-Dispase, were immersed in 10% dimethyl sulfoxide at 20 degrees C for 15 min and frozen to -40 degrees C at a cooling rate of 0.5 or 1.0 degree C/min and subsequently further to -80 degrees C at 3 degrees C/min by a programmable freezer. After being maintained at -80 degrees C for 10 min, they were rapidly thawed in a water bath at 37 degrees C. They were cultured for 12 h and preincubated in 3.3 mM glucose-containing Krebs-Henseleit bicarbonate buffer (KHBB) for 1 h. Groups of 10(4) cells were then incubated in 3.3 or 16.7 mM glucose-containing KHBB for another hour. As a control, non-frozen thawed cultured islet cells were incubated similarly. The non-frozen rat islet cells released 1.29 pg insulin/cell.60 min in the presence of 3.3 mM glucose and this release level was significantly elevated to 1.64 pg insulin/cell.60 min in the presence of 16.7 mM glucose. The cells frozen at 0.5 degree C/min releasing 1.55 pg insulin/cell.60 min in the presence of 3.3 mM glucose also responded to 16.7 mM glucose and released the significantly high level of 1.87 pg insulin/cell.60 min. However, the islet cells frozen at a cooling rate of 1 degree C/min secreted 1.74 and 1.92 pg insulin/cell.60 min in the presence of 3.3 mM and 16.7 mM glucose respectively. There was no significant difference between these levels. These results indicate that cryopreservation at a cooling rate of 0.5 degree C/min may be adequate for the preservation of dispersed pancreatic endocrine cells. PMID- 2666063 TI - Cellular differentiation in the embryonic rat pancreas, with special reference to the co-existence of substances immunoreactive to both insulin and glucagon antibodies in the same cells. AB - We used light and electron microscopy and immunohistochemistry to examine the pancreas primordium in 11- to-20-day-old rat embryos. Cells that were immunoreactive to glucagon-like antibodies (G-like cells) first appeared under light microscopy on day 11, and those immunoreactive to insulin-like antibodies (I-like cells) appeared on day 13. All the I-like cells also reacted to G-like substance antibody. From the 13th to the 17th day of gestation, the G-like cells proliferated rapidly while the I-like cells increased in number very slowly. All the I-like cells continued to react with G-like substance antibody as well. The I like cells began increasing rapidly on the 18th day and soon occupied about half of the islet-constituting cells. They no longer reacted with G-like substance antibody. Using double-label immunostaining with protein A-colloidal gold, the pancreatic endocrine cells became visible in 15-day-old embryos as large polygonal cells containing numerous secretion granules 180-200 nm in diameter. Some of these cells reacted to both I-like and G-like substance antibodies. These findings show the co-existence of G-like and I-like substances in rat embryo pancreatic endocrine cells between the 13th and 17th days of gestation, after which the I-like cells proliferate rapidly, and undergo definitive differentiation from the G-like cells. PMID- 2666064 TI - Blood rheology during an intensified conventional insulin treatment (ICIT) in insulin-dependent diabetes. AB - Fifteen insulin-dependent diabetes mellitus (IDDM) patients with minor diabetic complications underwent an intensified conventional insulin treatment (ICIT) program consisting of multiple daily insulin injections with an insulin pen. Blood viscosity parameters were measured before the start, after 6 weeks, 1 and 2 years with a Contraves LS30 viscosimeter. At the start several rheological parameters were disturbed in the diabetic subjects. Mean total hemoglobin A1 (HbA1) significantly (at least P less than 0.05) decreased while the plasma free insulin level significantly increased (at least P less than 0.05) under ICIT. During the first 6 weeks hematocrit (P less than 0.01), plasma (P less than 0.05), whole blood (P less than 0.05) and erythrocyte (P less than 0.01) viscosities significantly decreased but they increased again at 1 year of ICIT. Only plasma viscosity (P less than 0.05) remained below the starting value after 1 and 2 years. Normalization of the blood sugar level improved plasma and whole blood viscosity by an insulin-induced dilution phenomenon after 6 weeks. The persisting decrease in plasma viscosity was accompanied by a significant alteration of the plasma protein profile. These findings suggest that metabolic status influences blood rheology in IDDM patients but by different mechanisms on a short- or long-term basis. PMID- 2666065 TI - Non-human primate pancreas as a substrate for the detection of islet-cell antibodies in human sera. AB - In an effort to find out if the use of non-human primate pancreas may improve the sensitivity of the islet cell antibody (ICA) test, the sera from patients with type 1 diabetes (insulin-dependent IDDM) and controls were investigated by indirect immunofluorescence (IFL) on both human and baboon substrates. The mean titers of positives were insignificantly higher (1:24.9) on baboon as compared to human tissue (1:22.3). Of 50 sera from IDDM patients positive for ICA on human tissue, 47 were also positive on baboon pancreas. Of 40 ICA-negative IDDM sera two were judged positive on baboon substrate. ICA were positive on human/baboon pancreas in 3/4 out of 50 first-degree relatives of IDDM patients, 2/2 of 50 sera from patients with autoimmune diseases, 0/0 of 50 sera from type 2 diabetics and 2/1 of 100 mixed hospital controls. A disadvantage of baboon pancreas for ICA testing by IFL is the high background fluorescence given by the exocrine pancreas. With baboon tissue, three highly positive results would have been missed with undiluted sera which are usually used in this assay. It is therefore suggested that human pancreas should still be preferentially used for ICA determination, but baboon tissue may be a valuable substitute. PMID- 2666066 TI - Receptor binding and biologic activity of biosynthetic human insulin and mini proinsulin produced by recombinant gene technology. AB - Human insulin and its precursor, mini-proinsulin, made with a new biosynthetic method, were tested for their receptor binding, biologic action, and antibody binding ability. The structure of mini-proinsulin is similar to that of proinsulin with a shortened C-peptide, B(1-29)-Ala-Ala-Lys-A(1-21) insulin. The ability of biosynthetic human insulin to bind to receptors, to stimulate 2 deoxyglucose uptake in isolated adipocytes, and to bind to insulin antibody was comparable to that of semisynthetic human insulin. The ability of mini-proinsulin to bind to insulin receptors and to stimulate 2-deoxyglucose uptake in adipocytes was 0.5 and 0.2% that of human insulin, whereas the corresponding abilities of proinsulin were 5 and 3%, respectively. Despite having less receptor binding and biologic activity, mini-proinsulin demonstrated higher affinity for the insulin antibody than did proinsulin. These results suggest that biosynthetic human insulin behaves similarly to semisynthetic human insulin in its receptor binding and biologic activity, and that the shortened C-peptide region reduces receptor binding by fixing or covering the N-terminal region of the A chain, which is important for receptor binding. PMID- 2666067 TI - IgE antibodies to insulin and related peptides, a result of insulin treatment? AB - Anti-insulin immunoglobulin E (IgE) antibodies in sera of insulin-treated diabetic patients were characterized by affinity and concentration, and by binding to proinsulin and insulin A and B chains. The affinities of IgE to insulin scattered between less than 10(7) and 0.6 x 10(9) l/mol, the concentrations between 0.3 and 3.5 ng/ml. All positive sera of type 1 and few of type 2 patients recognized proinsulin, A chain, and B chain with comparable affinities and concentrations. Elevated concentrations of total serum IgE in 12 of the 16 anti-insulin IgE-positive sera from insulin-treated patients indicate that these patients are predisposed to allergies. The incidence of elevated levels of total serum IgE in type 1 (17.7%) and in type 2 (7.8%) diabetic patients did not differ from the general population. Reagins to insulin and related antigens were also observed in sera of non-diabetic allergic persons without previous contact with exogenous insulin. The natural occurrence of insulin-specific reagins makes the use of IgE as a marker of antigenicity of insulin questionable. Discrepancies between the insulin-positive radioallergosorbent test (RAST) or skin test and clinical manifestations of insulin allergy exist, because IgE antibodies with low affinities require high concentrations of insulin for binding. Such amounts of insulin may occur at the injection site, but not in the circulation. PMID- 2666068 TI - The use of multiple insulin injection therapy using 'NovoPen' in a routine out patient setting. AB - Multiple injection therapy using self-contained cartridge devices such as NovoPen has become a standard option for the treatment of insulin-requiring diabetes in recent years. Such treatment was previously viewed as impractical by the majority of patients and their physicians. Many small pilot studies have suggested that the use of such therapy leads to improvements in glycaemic control. We have many (greater than 200) patients in our clinic who use this form of treatment in the context of a routine out-patient department, where intensive supervision, which characterises all studies involving small numbers, is not practical. We have carried out a questionnaire survey of these patients to ascertain their attitudes to this form of therapy, and made some assessment of its impact on glycaemic control. Multiple injection therapy is a very popular form of therapy, leading to improvements in lifestyle and reduction in frequency of hypoglycaemic symptoms. However, its lack of impact on glycaemic control as estimated by measurement of haemoglobin A1 is disappointing. PMID- 2666070 TI - [Methotrexate resistance of rat clonogenic hemopoietic cells with an inserted bacterial dihydrofolate reductase gene]. PMID- 2666069 TI - Effects of very-low-calorie diet weight reduction on glucose tolerance, insulin secretion, and insulin resistance in obese non-insulin-dependent diabetics. AB - We put 12 obese subjects on a very-low-calorie diet (VLCD) and observed how their weight loss affected their glucose tolerance. Seven had non-insulin-dependent diabetes and five did not. They consumed 1000 kcal/day for at least 1 week, then 420 kcal/day for 4 weeks, and 1000 kcal/day thereafter. VLCD improved glucose tolerance and insulin response to a glucose load in the diabetics and did not affect these parameters in the non-diabetics. It did not change insulin responsiveness to intravenous glucagon in either group. Both groups showed improved insulin resistance, as measured by an insulin suppression test. Regression analysis showed that insulin resistance correlates well with obesity and glycemic control. Weight reduction did not change hepatic insulin extraction. Thus, the improvement in glucose tolerance by some of the diabetics seems to have arisen from improvements in their insulin resistance and insulin response to a glucose load. Insulin resistance improved because of weight reduction and subsequent improvements in glycemic control. PMID- 2666071 TI - [Homogeneous immunoenzyme analysis in reverse micelle systems of surface-active compounds in organic solvents]. PMID- 2666072 TI - [Obtaining of transgenic pigs containing and expressing the surface antigen of the human hepatitis B virus]. PMID- 2666073 TI - Dactimicin: a most interesting member of a new class of aminoglycosides. PMID- 2666074 TI - The Committee on Problems of Drug Dependence: a legacy of the National Academy of Sciences. A historical account. AB - The history of The Committee on Problems of Drug Dependence is traced from its beginning (1929) as The Committee on Drug Addiction to 1989, its sixtieth anniversary. A brief account of the etiology of The Committee from The Bureau of Social Hygiene, established in New York City by John D. Rockefeller, Jr. in 1913 is also given. PMID- 2666075 TI - Alcohol use among Nigerian youths: the need for drug education and alcohol policy. AB - The recent national heightened interest in drug abuse, involving social campaigns by political leaders, has provided an opportune time for interested workers to articulate and advocate a drug and alcohol education programme. Education in this case means the intentional giving of assistance or advice (by an educator or change agent) in a process of decision making on the use of alcohol and drugs. It should be integrated into the school curriculum, be multidisciplinary in approach, and in particular the parents of youths from elite homes should be involved. There are elements of drug education in developed countries that can be creatively adapted to countries like Nigeria. The programme will take into cognisance the religious differences between the North and South of the country, the literacy level and availability of Community resources. A national drug and alcohol policy will enhance the effectiveness of such a programme. PMID- 2666076 TI - [Sonographic findings in silicone-induced granulomas and lymphadenopathy following mammaplastic surgery]. AB - Ultrasound examination of the breast and its lymphatic drainage was undertaken in 78 patients who--after mammoplasty with silicone implants--had palpable lymph nodes, pain and sensation of tension in the area surrounding the implant. Five patients had space-occupying echo-dense inner structures and dense echos from structures dorsal to the space-occupying ones. In this way silicone granuloma could be demonstrated even preoperatively in tissues, musculature or lymph nodes, although the changes were palpable in only two of the five patients. Ultrasonography can thus be of great importance not only in the diagnosis but also in the preoperative localization of silicone-induced granulomas. PMID- 2666077 TI - [Fever in HIV-1 infection]. PMID- 2666078 TI - [Positron-emission tomography: the potentials and prospects for cardiologic diagnosis]. PMID- 2666079 TI - [The conditioning of drug effects. A pathway for research on placebo effects?]. PMID- 2666080 TI - [Oral iron therapy. Bioavailability and therapeutic effectiveness of ferrous iron in effervescent tablets in posthemorrhagic iron deficiency anemia]. AB - Bio-availability and therapeutic efficacy of two oral ferrous preparations in the form of effervescent tablets (A and A*) were compared. In a randomly controlled trial, postabsorption rise of serum iron was compared intraindividually after oral intake of the effervescent tablets and of an optimally bio-available ferrous ascorbate standard solution (80.5 mg). Afterwards the therapeutic efficacy of both preparations (161 mg daily) was compared with a proprietary iron preparation (B: 150 mg daily) for three months. The trial was conducted on 24 male subjects (aged 20-38 years) who underwent weekly phlebotomies of 500 ml until exhaustion of body iron reserves and development of a mild iron-deficiency anaemia (standard phlebotomy protocol). Relative bioavailability, related to the standard iron solution, was 89% and 104%, respectively, for tablets A and A*. The rise in haemoglobin and ferritin during the three-months treatment was relatively the same for all three preparations: the average daily haemoglobin rise (means +/- SD) was 1.4 +/- 0.5 g/l (A), 1.5 +/- 0.4 g/l (A*) and 1.2 +/- 0.5 g/l (B), respectively, the differences not being statistically significant. PMID- 2666082 TI - [Present-day diagnosis of microbial enterocolitis]. PMID- 2666081 TI - [Hypercalcemia in coexistent parathyroid adenoma and multiple myeloma. Problems of differential diagnosis]. AB - In a chance observation, a 74-year-old woman was found to have hypercalcaemia (3.0 mmol/l) and multiple skeletal osteolyses. A diagnosis of multiple myeloma was made after the demonstration of paraproteins in serum (IgG-kappa) and a 10% proportion of plasma cells in a pelvic crest biopsy. Oral chemotherapy with melphalan and prednisone failed to alter the calcium level. Simultaneous increase in alkaline phosphatase and reduction in serum phosphate concentration led to further tests: determination of peripheral venous parathormone concentration, ultrasound examination of the neck, thallium-technetium subtraction scintigraphy and selective venous parathormone measurements. The results demonstrated the coexistence of primary hyperparathyroidism. The calcium level became normal after surgical removal of a parathyroid adenoma. PMID- 2666083 TI - [Radiotherapy of endocrine orbital disease]. PMID- 2666084 TI - [Regression of fatty liver]. PMID- 2666085 TI - Use of pharmacokinetics when dealing with the drug residue problem in food producing animals. AB - If the principal pharmacokinetic parameters of a veterinary drug-such as its elimination half-life from blood plasma, volume of distribution, plasma protein binding and metabolism-are known, then the presence and concentration of residues in animal tissue after administration of the drug can be predicted. This makes it possible to reduce the number of animals required by conventional residue testing and satisfies a legitimate demand of animal welfare groups. Using radioactively labelled drugs, the ratio of the parent substance to its metabolites can be established. Thus as a rule the determination of parent substance is sufficient for the routine determination of residues in foodstuffs. This is true in particular of sulfonamides. The pharmacokinetics of this class of substances are such that their main metabolites are eliminated from the animal's body faster than the parent substance. Other examples given are ceftriaxone, carprofen und climazolam. PMID- 2666086 TI - [Secondary leukemias]. PMID- 2666087 TI - [Spectrum of lymphoproliferative diseases]. PMID- 2666088 TI - [Research methods in lymphoma classification]. PMID- 2666089 TI - [Management of Hodgkin's disease]. PMID- 2666090 TI - [Clinical diagnosis and treatment of non-Hodgkin's lymphoma]. PMID- 2666091 TI - [Chronic lymphatic leukemia]. PMID- 2666092 TI - [Malignant blood diseases in childhood]. PMID- 2666093 TI - [Chromosome and gene abnormalities in malignant blood diseases]. PMID- 2666094 TI - [Cytostatic-sensitive and cytostatic-resistant leukemias]. PMID- 2666095 TI - [Allogeneic and autologous bone marrow transplantation in managing malignant blood diseases]. PMID- 2666096 TI - [Stability of blood cell preparations for malignant blood diseases]. PMID- 2666097 TI - [What other treatments resemble cytostatics and radiation for malignant blood diseases?]. PMID- 2666098 TI - [The morphological and immunological classification of acute leukemias]. PMID- 2666099 TI - [Management of acute leukemia in adults]. PMID- 2666100 TI - [Myelodysplastic syndromes]. PMID- 2666101 TI - Auditory and somatosensory evoked potentials in a case of "locked-in" syndrome: a clinical and pathological study. AB - Brainstem auditory evoked potentials were bilaterally normal, and somatosensory evoked potentials were unilaterally abnormal in a patient with a large pontine infarct causing a "locked-in" syndrome. In the post mortem examination, the lesion extended unilaterally into the pontine tegmentum, partially involving the left medial lemniscus. The P14 potential was absent and the N20 potential was diminished in amplitude with right median nerve stimulation. The origin of the P14 potential has been debated in the literature. This case provides evidence for the P14 generator being located at the pontine level, in relation to a lemniscal area above the decussation of the somatosensory pathway. Evoked potentials can help to determine the tegmental extension of the pontine infarcts in the "locked in" syndrome, especially in patients unable to cooperate with clinical examination. PMID- 2666102 TI - [Bulimic behaviors. Clinical, biochemical, pharmacologic data]. AB - Bulimia nervosa has been recently identified. DSM III-R gives more restrictive criteria for the trouble than DSM III. One may doubt it allows to better understand the probable psychopathological heterogeneity of this eating disorder. Biological indexes up to now only led to partial results. Their interpretation is made more difficult because of the small size of the samples of patients, studied in conditions which are often ill-defined. The biological parameters which are investigated are similar to those studied in depression: monoamines, hypothalamic pituitary-adrenal axis, hypothalamic-pituitary-thyroid axis, hypothalamic pituitary-gonadal axis, Growth Hormone, prolactin , melatonin, beta-endorphin, EEG mapping. Antidepressants and anticonvulsants remain the most often mentioned drugs. Tryptophane, lithium, opiate antagonists, amphetamines, serotoninergic drugs are currently being studied. PMID- 2666103 TI - [Negative symptoms and schizophrenia. A concise review of clinical and pharmacotherapeutic data]. AB - A historical review is given of the origins of the concepts of negative symptoms. An outline is given of the conceptual difficulties inherent to the negative syndrome, especially influences related to post psychotic depressed patients, neuroleptic treatment and institutionalization are critically reviewed. Subsequently pathophysiological and etiological theories of negative symptoms are reviewed and discussed. The last part of this article contains a discussion of therapeutical strategies in the treatment of negative symptoms. Firstly dopamine agonist strategies are discussed, secondly the role of neuropeptides (vasopressin and TRH) in the treatment of negative symptoms is discussed and a putative therapeutic role for these peptides is suggested. PMID- 2666104 TI - [Lithium, pregnancy and breast feeding]. AB - Due to its teratogenic potential and its passage in the maternal milk, the administration of lithium during pregnancy and post-partum, if breast-feeding is contemplated, raises specific issues. The kinetics of lithium during pregnancy is reviewed, as well as its influence on the foetus during this period and during breast-feeding. Its teratogenicity affects particularly the cardiovascular system, the Ebstein's anomaly being the most typical and frequent malformation. As a general rule, the administration of lithium should be avoided during pregnancy, at least during the first trimester. However, pregnancy and breast feeding do not represent an absolute contraindication for the continuation of lithium therapy if it is deemed necessary, in spite of the risks that can be incurred and of which the patient should be informed. PMID- 2666105 TI - Fusion proteins containing androgen receptor sequences and their use in the production of poly- and monoclonal anti-androgen receptor antibodies. AB - Complementary DNA segments that encode different domains of human and rat androgen receptors were fused to the Escherichia coli trpE gene using pATH expression vectors. Fusion proteins expressed by the bacteria were used to immunize rats and rabbits to obtain polyclonal antibodies to androgen receptors. Spleen cells of immunized rats were fused with myeloma cells to obtain stable hybridomas that produced monoclonal antibodies. Gradient centrifugation and immuno-precipitation assays indicated that the antibodies interacted with androgen receptors specifically. PMID- 2666106 TI - Differential sensitivity to beta-cell secretagogues in cultured rat pancreatic islets exposed to human interleukin-1 beta. AB - The early stages of insulin-dependent diabetes mellitus are characterized by a selective inability to secrete insulin in response to glucose, coupled to a better response to nonnutrient secretagogues. The deficient glucose response may be a result of the autoimmune process directed toward the beta-cells. Interleukin 1 (IL-1) has been suggested to be one possible mediator of immunological damage of the beta-cells. In the present study we characterized the sensitivity of beta cells to different secretagogues after human recombinant IL-1 beta (rIL-1 beta) exposure. Furthermore, experiments were performed to clarify the biochemical mechanisms behind the defective insulin response observed in these islets. Rat pancreatic islets were isolated and kept in tissue culture (medium RPMI-1640 plus 10% calf serum) for 5 days. The islets were subsequently exposed to 60 pM human recombinant IL-1 beta during 48 h in the same culture conditions as above and examined immediately after IL-1 exposure. The rIL-1 beta-treated islets showed a marked reduction of glucose-stimulated insulin release. Stimulation with arginine plus different glucose concentrations, and leucine plus glutamine partially counteracted the rIL-1 beta-induced reduction of insulin release. The activities of the glycolytic enzymes hexokinase, glucokinase, and glyceraldehyde 3-phosphate dehydrogenase, were similar in control and IL-1-exposed islets. Treatment with IL 1 also did not impair the activities of NADH+- and NADPH+-dependent glutamate dehydrogenase, glutamate-aspartate transaminase, glutamate-alanine transaminase, citrate synthase, and NAD+-linked isocitrate dehydrogenase. The oxidation of D-[6 14C]glucose and L-[U-14C]leucine were decreased by 50% in IL-1-treated islets. Furthermore, there was a significant decrease in the ratios of [2-14C]pyruvate oxidation/[1-14C]pyruvate decarboxylation and L-[U-14C]leucine oxidation/L-[1 14C]leucine decarboxylation, indicating that IL-1 decreases the proportion of generated acetyl-coenzyme-A residues undergoing oxidation. However, in the presence of IL-1 there was a significant increase in L-[U-14C]glutamate oxidation. These combined observations suggest that exposure to IL-1 induces a preferential decrease in glucose-mediated insulin release and mitochondrial glucose metabolism. This mitochondrial dysfunction seems to reflect an impairment in proximal steps of the Krebs cycle. It is conceivable that the IL-1-induced suppression and shift in islet metabolism can be an explanation for the beta-cell insensitivity to glucose observed in the early phases of human and experimental insulin-dependent diabetes mellitus. PMID- 2666107 TI - Immunofluorescent analysis of estrogen induction of progesterone receptor in the rhesus uterus. AB - Estrogen (E) has been shown to induce an increase in progesterone (P) receptor (PR) concentration in uterine tissue of both rodents and primates. Because of the presence of different cell types within the uterus, we were interested in determining whether estrogen-induced PR were cell type specific in the nonhuman primate uterus (rhesus monkey). Immunofluorescent analyses of E receptor (ER) and PR were performed on fresh frozen cryostat sections (6 microns) of uterine tissue from ovariectomized (3 months) and estradiol (E2)-treated (peak level of E2 during an artificial menstrual cycle) rhesus monkeys. Antibodies to ER and PR were obtained from Abbott Laboratories (H222) and Transbio (MPR1). The avidin biotin complex technique was used with streptavidin-conjugated Texas red for fluorescent detection. Ovariectomized monkeys showed positive fluorescence for ER in luminal and glandular epithelia, stromal cells, and smooth muscle cells of the myometrium. In contrast, positive fluorescence for PR was observed primarily in glandular epithelia, with little or no fluorescent detection in luminal epithelium, stromal cells, or myometrial smooth muscle cells. After E2 treatment strong positive fluorescence for PR was observed in luminal and glandular epithelia, stromal cells, and myometrial smooth muscle cells. Strong positive fluorescence for ER was also observed in the same cell types. Fluorescent detection of ER and PR was restricted to the nuclei of these cell types. These studies show that ER are present constitutively in all cell types of the E withdrawn (ovariectomized) nonhuman primate uterus, whereas PR are primarily restricted to glandular epithelia. E2 treatment, which simulated the follicular phase and E2 surge, resulted in the appearance of immunofluorescent PR in luminal epithelia, stromal cells, and myometrial smooth muscle cells. These studies serve to define the cellular pattern of E2-induced PR in the primate uterus. PMID- 2666108 TI - In vivo evidence for a direct effect of naloxone on testicular steroidogenesis in the male rat. AB - It has been suggested that endogenous opioid peptides (EOP) exert paracrine or autocrine effects in the testes. To assess this hypothesis, we examined whether naloxone, by blocking the effects of EOP, influenced serum testosterone levels, apart from its effects on LHRH/LH, in the intact male rat. We found that naloxone increased serum LH and testosterone levels over essentially the same time course and produced dose-dependent increases in serum testosterone levels even though LH levels were maximally elevated at all doses. These data are not consistent with the view that naloxone exerts its effects on testosterone exclusively by altering LHRH/LH release. Additional, perhaps more definitive, evidence of a direct effect of naloxone on testosterone's biosynthesis was provided by our observations that 1) naloxone generated increases in serum testosterone levels in male rats in which the naloxone-induced surge in LH was blocked by nembutal; and 2) intratesticular injections of naloxone increased serum testosterone levels without increasing LH. Although these data suggest that naloxone influences steroidogenesis independently of its effects on LH, we found that the antagonist failed to increase serum testosterone levels in hypophysectomized animals or when serum LH levels were allowed to reach undetectable levels in nembutal-blocked animals. Consequently, our data are consistent with the hypothesis that naloxone facilitates the effects of LH on testosterone's biosynthesis rather than exerting an independent effect of its own. Whether the effects observed in these studies represent a negative autocrine effect of EOP on Leydig cells or a paracrine effect on Sertoli cells remains to be determined. Nevertheless, our results provide, to our knowledge, the first in vivo evidence that EOP modulate testicular steroidogenesis in the intact animal. PMID- 2666109 TI - On the structure of the luteinizing hormone/chorionic gonadotropin receptor. AB - In this review we have tried to argue that the evidence indicating that the LH/CG receptor is composed of a single polypeptide is stronger than the evidence indicating that the LH/CG receptor is a more complex structure composed of several subunits. Clearly, however, this issue has not been resolved and probably will not be resolved by performing additional experiments similar to those summarized here. It is our opinion that this issue will be resolved only by 1) reconstitution experiments in which the ability of the purified LH/CG receptor to bind hCG and activate adenylyl cyclase activity is tested; and/or 2) isolation and expression of a full length complementary DNA (cDNA) for the LH/CG receptor and the demonstration of hCG binding and adenylyl cyclase activation by the expressed receptor. Similar experiments will also clarify the proposed structures for the FSH and TSH receptors. As the second decade of work on the LH/CG receptor draws to an end it appears that these experiments are now possible, and hopefully a resolution of the existing controversy will be forthcoming in the near future. PMID- 2666110 TI - Vitamin D-dependent calcium binding proteins: chemistry, distribution, functional considerations, and molecular biology. PMID- 2666111 TI - Autosomal dominant osteopetrosis: bone metabolism and epidemiological, clinical, and hormonal aspects. PMID- 2666112 TI - Insulin-like growth factors I and II. Peptide, messenger ribonucleic acid and gene structures, serum, and tissue concentrations. AB - There is currently widespread interest in the IGFs (IGF-I and IGF-II) and their roles in the regulation of growth and differentiation of an ever increasing number of tissues are being reported. This selective review focused on the current state of our knowledge about the structure of mammalian IGFs and the multiple forms of mRNAs which arise from alternative splicing and promoter sites which arise from gene transcription. Current progress in the immunological measurement of the IGF is reviewed including different strategies for avoiding binding protein interference. The results of measurements of serum IGF-I and IGF II in fetus and mother and at various stages of postnatal life are described. Existing knowledge of the concentration of these peptides in body fluids and tissues are considered. Last, an attempt is made to indicate circumstances in which the IGFs are exerting their actions in an autocrine/paracrine mode and when endocrine actions predominate. In the latter context it was concluded that an important role for GH action on skeletal tissues via hepatic production of IGF-I and endocrine action of IGF-I on growth cartilage is likely. PMID- 2666113 TI - The immune-hypothalamic-pituitary-adrenal axis. PMID- 2666114 TI - Thyrotoxicosis due to ingestion of excess thyroid hormone. PMID- 2666115 TI - Natural heterogeneity of thyroid cells: the basis for understanding thyroid function and nodular goiter growth. PMID- 2666116 TI - Regulation of estrogen biosynthesis by human adipose cells. PMID- 2666118 TI - Hormonal regulation of pulmonary surfactant. PMID- 2666117 TI - Stimulation and suppression of the mineralocorticoid hormones in normal subjects and adrenocortical disorders. AB - In summary, maneuvers that affect the RAS stimulate or suppress solely aldosterone and 18-OHB and have little, if any, effect on DOC, 18-OHDOC, B, or cortisol. The magnitude of aldosterone response seems to be of equal magnitude for all stimulatory or suppressive maneuvers as used in the present protocols. Although primarily originating in the ZG, some secretion of 18-OHB from the ZF is evident by its disproportionate responses (in relation to aldosterone) to maneuvers challenging ACTH. The prompt and marked increases the 18-OHDOC and B after ACTH make them the most sensitive "markers" of the ZF steroid activity. The application of those maneuvers and MCH measurements to adrenal disorders should help to further characterize their pathophysiology. PMID- 2666119 TI - On the occasion of the 80th anniversary of the founding of the ILAE. PMID- 2666120 TI - Double-blind, placebo-controlled evaluation of cinromide in patients with the Lennox-Gastaut Syndrome. The Group for the Evaluation of Cinromide in the Lennox Gastaut Syndrome. AB - This study evaluated the effects of cinromide in patients with Lennox-Gastaut Syndrome. No difference between cinromide and placebo was shown in terms of seizure reduction or global evaluations. This study is important, however, because it represents an effort to overcome methodologic difficulties inherent in evaluating this population, and because a substantial placebo response was demonstrated. The need for well-designed, placebo-controlled clinical studies of potential antiepileptic drugs, even in an especially refractory and mentally impaired population, is underscored by the study's outcome. PMID- 2666121 TI - Reduction in T lymphocyte subpopulations following acute exposure to 4 ppm nitrogen dioxide. AB - The effect of acute exposure to nitrogen dioxide (NO2) on splenic T lymphocyte subpopulations was studied in C57BL/6cum mice. The mice were exposed to 4 ppm NO2 for 8 hr. Monoclonal antibodies to T lymphocyte differentiation antigens and fluorescence-activated cell sorter (FACS) analysis were used to detect changes in T lymphocyte subpopulations. Percentages of total T lymphocytes (Thy-1.2 positive), T-helper/inducer lymphocytes (L3T4-positive), and T cytotoxic/suppressor lymphocytes (Lyt-2-positive) were significantly lower in NO2 exposed animals than in filtered-air-breathing controls. Large T cytotoxic/suppressor cells were found to be the most susceptible subpopulation. Spleen and body weights of the mice were also determined. There were no differences between body weights of control and exposed animals; however, exposed mice had significantly lower spleen weights. This is the first report providing evidence linking alterations in T lymphocyte subpopulations to acute NO2 exposure at occupational levels. T lymphocytes play a central role in regulatory and effector immunological functions such as mediating delayed hypersensitivity, regulating immunoglobulin production, and lysing virus-infected and neoplastic cells. The biological significance of these findings remains to be established, but it is very likely that functional impairment occurs since an optimal immune response depends upon a proper balance of the T lymphocyte subpopulations. Detection of alterations in T lymphocyte subpopulations using monoclonal antibodies and FACS analysis may provide an extremely sensitive means of demonstrating NO2-induced changes in the immune system. PMID- 2666122 TI - Mutagenic activity of ultraviolet-irradiated mixtures of nitrogen dioxide and propene or butadiene. AB - The mutagenic activities of mixtures of nitrogen dioxide and 1,3-butadiene or propene were investigated after uv-irradiation in a small, laboratory-bench scale flow-through gas exposure system. The tester organism was Salmonella typhimurium, principally strain TA100. The photoreaction products from 1,3-butadiene and nitrogen dioxide were more mutagenic than those from propene and nitrogen dioxide. Approximately 0.25 ppm butadiene, compared to 100 ppm propene, was needed to give a significant mutagenic effect with 0.25 ppm NO2 after 6 hr exposure. The influence of different experimental conditions on mutagenic activity was studied using propene plus nitrogen dioxide. Increasing the mean reaction time from 40 min to 1 hr 20 min or 3 hr 20 min by reduction of the flow rate through the 20-liter reaction vessel did not appreciably increase the sensitivity of the system, nor did humidification of the air, omission of the metabolic system (S9 mix), or spreading of the bacteria on the agar surface. Prolongation of the exposure time from 6 to 16 or 24 hr did, however, give an increased mutagenic response. With prolonged exposure, a slight mutagenic effect could also be detected with ethene + NO2 + uv. Ozone addition did not appreciably enhance the mutagenic response. PMID- 2666123 TI - Evaluation of dextromethorphan and carbetapentane as anticonvulsants and N-methyl D-aspartic acid antagonists in mice. AB - Two antitussives, dextromethorphan and carbetapentane, which have been reported to bind to a common binding site in brain tissue and produce anticonvulsant effects in rats, were evaluated for their anticonvulsant effects against maximal electroshock-induced seizures, for their neurological impairing effects on the horizontal screen test, and their protective effects against N-methyl-D-aspartic acid (NMDA)-induced lethality in mice. Both compounds protected animals against maximal electroshock-induced seizures in a dose-related fashion after either intraperitoneal or oral administration. The neurologically impairing doses were approximately 1.5 times the anticonvulsant doses. As a function of dose, dextromethorphan, but not carbetapentane, protected mice from NMDA-induced lethality. Since carbetapentane had an anticonvulsant action without protecting against NMDA-induced lethality, these data support the hypothesis that dextromethorphan and carbetapentane may have a common anticonvulsant action separate from the phencyclidine-like, NMDA-antagonist action which only dextromethorphan exhibits. PMID- 2666124 TI - The past and the future in the study of radiation-induced mutation in the germ line of mice and humans. PMID- 2666125 TI - Colonization of pregnant women and their newborn infants with group B streptococci in the Gondar College of Medical Sciences. AB - In a study of Group B streptococcal carriage, 200 postpartum women and 80 newborn infants were investigated in the Gondar College of Medical Sciences from January to April 1987, using swabs from the vagina and rectum, and from the throat and external ear, respectively. We found a colonization rate of 9% (18/200) in the mothers and 5% (4/80) in the neonates. The serological typing of the 25 isolated strains showed 60% (15/25) to be Type Ib/c and 16% (4/25) to be Type Ia strains. Therefore, in newborn infants with infections, diagnostic and bacteriological procedures should include a search for Group B Streptococci. PMID- 2666126 TI - Testicular feminization syndrome. Four case reports with a brief review of the literature. AB - Four cases of testicular feminization syndrome in Ethiopian patients are described. All four patients had normal female breasts, scanty pubic and axillary hair and absent internal genital organs. Three had bilateral inguinal or labial masses. The main features of their clinical presentation and histological studies are briefly discussed with a review of the literature. PMID- 2666127 TI - Kellersberger memorial lecture, 1988. Technology for leprosy control--progress and prospects. PMID- 2666128 TI - Nucleo-mitochondrial interactions in yeast mitochondrial biogenesis. PMID- 2666129 TI - Alternative occupancy of a dual ribosomal binding site by mRNA affected by translation initiation factors. AB - The interaction between Escherichia coli 30S ribosomal subunits and mRNAs, and the effect of the initiation factors on this process, have been studied using MS2 RNA, polyribonucleotides and model mRNAs encoded by synthetic genes. The interactions were analyzed by gel filtration, by sucrose gradient centrifugation and by competition for ribosome binding between the various mRNAs and a Shine Dalgarno deoxyoctanucleotide. It was found that the initiation factors do not significantly affect the Shine-Dalgarno interaction nor the apparent Ka values of the 30S-subunit-mRNA binary complexes, but influence the positioning of the mRNAs on the 30S subunit with respect to the Shine-Dalgarno octanucleotide. The results suggest that, in the absence of initiation factors, the mRNA occupies a ribosomal "stand-by" site which is close to or includes the region where the Shine-Dalgarno interaction takes place; in the presence of the factors, the mRNA is shifted away from the stand-by site, towards another ribosomal site with similar affinity for the mRNA. This shift does not require the presence of fMet-tRNA and, depending upon the type of mRNA, is mediated by IF-2 and/or IF-3. PMID- 2666130 TI - Sequence and characterization of the sperm-specific protein phi 3 from Mytilus californianus. AB - We have shown that the sperm-specific protein phi 3 from Mytilus californianus (Conrad) exhibits compositional microheterogeneity. For the first time, we have isolated and characterized the three major components of this protein. These fractions display different electrophoretic mobilities on Triton/urea/acetic acid polycrylamide gels. However, they have a very similar molecular mass of 5 +/- 0.1 kDa as measured by sedimentation equilibrium in the analytical ultracentrifuge. All of them show a marked trend toward aggregation. We have also established the sequence for each of these three fractions. The sequencing data suggest an even greater extent of microheterogeneity for this protein. The predicted secondary structure from the sequences, as well as infrared analyzes carried out on the native protein, suggest a structure organization into an alpha helix. PMID- 2666131 TI - Mathematical modelling of metabolic pathways affected by an enzyme deficiency. Energy and redox metabolism of glucose-6-phosphate-dehydrogenase-deficient erythrocytes. AB - The effects of various forms of glucose-6-phosphate dehydrogenase deficiency on erythrocyte metabolism have been studied on the basis of a complex mathematical model which comprises the main pathways of this cell: glycolysis, pentose pathway, reactions of the glutathione and adenine nucleotide metabolism. The calculated flux rates through the oxidative pentose pathway with and without methylene blue are in good accord with experimental results. The degree of deficiency as predicted by the model on the basis of calculated upper oxidative load boundaries, as well as of maximal methylene blue stimulation, correlates with the individual clinical manifestation of the metabolic disease. Therefore, the model allows one to judge the degree of metabolic disorder in the presence of glucose-6-phosphate dehydrogenase enzymopathies if the kinetic properties of the defect enzyme are known. Experimentally accessible parameters for an assessment of the oxidative load capacity of cells in vivo are proposed. It is pointed out that the threshold of tolerance as to energetic load is drastically reduced in the case of severe glucose-6-phosphate dehydrogenase deficiency. PMID- 2666132 TI - Molecular cloning of the nuclear gene for mitochondrial ribosomal protein YmL31 from Saccharomyces cerevisiae. AB - The nuclear gene for mitochondrial ribosomal protein YmL31 (MRP-L31) of Saccharomyces cerevisiae was cloned using synthetic oligonucleotide mixtures which correspond to the N-terminal amino acid sequence of the mature YmL31. The gene MRP-L31 codes for a basic protein with a calculated molecular mass of 15.5 kDa and resides on chromosome XI. A comparison of the amino acid sequence deduced from the nucleotide sequence of the MRP-L31 gene and the N-terminal sequence of the isolated protein revealed the existence of a leader peptide sequence of 12 amino acid residues. No significant similarity to known ribosomal protein sequences of other organisms was found. PMID- 2666133 TI - Subunit association defects in Escherichia coli ribosome mutants lacking proteins S20 and L11. AB - The subunit association capacity of 30S and 50S ribosomal subunits from Escherichia coli mutants lacking protein S20 or L11 as well as of 50S subunits depleted of L7/L12 was tested by sucrose gradient centrifugation and by a nitrocellulose filtration method based on the protection from hydrolysis with peptidyl-tRNA hydrolase of ribosome-bound AcPhe-tRNA. It was found that the subunits lacking either S20 or L11 display an altered association capacity, while the 50S subunits lacking L7/L12 have normal association behavior. The association of S20-lacking 30S subunits is quantitatively reduced, especially at low Mg2+ concentrations (5-12 mM), and produces loosely interacting particles which dissociate during sucrose gradient centrifugation. The association of L11-lacking 50S subunits is quantitatively near-normal at all Mg2+ concentrations and produces loosely associating particles only at low Mg2+ concentrations (5-8 mM); the mechanism of their association with 30S subunits, however, or the structure of the resulting 30S-50S couples is altered in such a way as to cause the ejection of an AcPhe-tRNA molecule pre-bound to the 30S subunits in response to poly(U). PMID- 2666134 TI - Human phosvitin/casein kinase type II. Molecular cloning and sequencing of full length cDNA encoding subunit beta. AB - Phosvitin/casein kinase type II is an ubiquitous, highly conserved enzyme consisting of subunits alpha, alpha' and beta. Subunit beta, presumably serving regulatory functions, was prepared from human placenta and the amino acid sequence of a protease digestion peptide was determined. The deduced nucleotide sequence was employed for the synthesis of a mixture of 20mers as a hybridization probe to screen a lambda gt10 HeLa cell cDNA library for clones encoding subunit beta. A full-length clone consisting of 1013 bp was isolated and the sequence of both strands determined. The deduced amino acid sequence of the largest open reading frame encodes 215 amino acid residues predicting a maximum Mr of 24925. The nucleotide sequence of the human beta subunit shows a similarity of 75% to that of Drosophila melanogaster and the deduced amino acid sequence a similarity of 88% and 97% to that of D. melanogaster and bovine lung, respectively. No further protein sequence currently known exhibits any notable similarity. Using a 537-bp restriction fragment of the cDNA clone representing 80% of the coding region, a 1-kb subunit-beta transcript was detected by Northern hybridization in total RNA prepared from human epithelial cells and placenta as well as from bovine heart suggesting a single transcript of the beta-subunit gene and also demonstrating high similarity also between the human and bovine nucleotide sequences. The same restriction fragment was used as the probe to indicate in Southern hybridizations that the corresponding genomic DNA contains at least one intron of roughly 2.5 kb in length and presumably is a single copy gene. PMID- 2666135 TI - NMR analysis of site-specific mutants of yeast phosphoglycerate kinase. An investigation of the triose-binding site. AB - Site-specific mutants of yeast phosphoglycerate kinase have been produced in order to investigate the roles of the 'basic-patch' residues, arginine 168 and histidine 170. The fully-conserved residue, arginine 168, has been replaced with a lysine (R168K) and a methionine (R168M) residue, while the non-conserved histidine 170 has been replaced with an aspartate (H170D). Comparison of the 500 MHz 1H-NMR spectra of the mutant proteins with that of wild-type phosphoglycerate kinase shows that the overall fold of the mutants remains essentially unaltered from that of the native enzyme. Results of NOE experiments indicate that there are only very minor changes in structure in the vicinity of the mutations. These mutations have also led to firm sequence-specific resonance assignments to histidines 62, 167 and 170. NMR studies of 3-phosphoglycerate binding show that decreasing the positive charge in the sequence 168-170 reduces the binding of this substrate (by about 15-fold and 4-fold for mutants R168M and H170D respectively). Mutant R168K binds 3-phosphoglycerate with an affinity about twofold less than that of the native enzyme. Significantly, the activity of mutant H170D, measured at saturating substrate concentrations, is unchanged from that of the wild-type enzyme. This indicates that this residue is not of major importance in the binding or reaction of 3-phosphoglycerate. The observation is in agreement with results obtained for the wild-type enzyme, which indicate that 3-phosphoglycerate interacts most strongly with histidine 62 and least strongly with histidine 170, as would be predicted from the X-ray crystal structure. Substitution of positively charged arginine 168 with neutral methionine (or positively charged lysine) does not cause a detectable change in the pKa values of the neighbouring histidine groups, in as much as they remain below 3. The results reported here indicate that the observed reduction in catalytic efficiency relates less to direct electrostatic effects than to the mutants' inability to undergo 3-phosphoglycerate-induced conformational changes. PMID- 2666136 TI - Assessment of liver circulation by quantitative scintiangiography: evaluation of the relative contribution of the hepatic arterial and portal venous blood flows to liver perfusion. AB - Quantitative hepatic scintiangiography was previously used for evaluating the relative contribution of hepatic arterial and portal venous blood flows to the hepatic circulation. The present study compares 3 different procedures (automatic and manual integration, and slope fitting methods) for analyzing the hepatic time activity curves obtained after bolus i.v. injection of 370 MBq 99mTc diethylentriaminopentacetic acid. Twenty five subjects were studied: five controls, ten cirrhotics, and ten portal hypertensive patients previously submitted to side to side portacaval anastomosis. The correspondence between results given by the different methods was satisfactory only in shunted patients, and the reproducibility of computed parameters was quite poor for all procedures. Accordingly, none of the methods can be considered as supporting reliable quantitative pathophysiological evaluations. However, the hepatic arterial/portal venous flow ratio was found to be increased in liver cirrhosis and in shunted patients and therefore, in spite of the limitations underlined before and of the absence of data on the reproducibility of consecutive injections, hepatic scintiangiography may be of some clinical utility. PMID- 2666137 TI - Classical external indwelling central venous catheter versus totally implanted venous access systems for chemotherapy administration: a randomized trial in 100 patients with solid tumors. AB - A prospective randomized trial was organized at the Institut Gustave-Roussy to assess the reliability of classical external catheters (CE) versus totally implanted access systems (TI) for delivering intravenous chemotherapy for a duration of at least 6 months. The analysis was performed on the 96 patients whose implantation succeeded (CE 46, TI 50). Failure was defined as loss of ability to function (followed by removal) within the 6-month period of the survey. Patients dying with functional catheters were considered as censored (15 cases) at the time of death. Twenty-four access systems were removed. The removal free curves differ significantly (P less than 0.001), favoring the TI access systems. The main reasons for removal were: catheter fall (CE6, (TI 0), migration (CE 1, TI 1), infection (CE 5, TI 1), thrombotic occlusion (CE 1, TI 0) and venous complications (CE 1 thrombosis plus 1 pulmonary embolism, TI 1 thrombosis). In addition, a survey by questionnaire demonstrated a significantly better patient activity rate (P = 0.02) and hygiene (P less than 0.001) in the TI group. This prospective randomized study demonstrates that totally implanted access systems are more reliable, safer and better tolerated than classical external catheters for solid tumor patients undergoing intravenous chemotherapy for longer than 6 months. PMID- 2666138 TI - Multiple publication of reports of drug trials. AB - Fourty-four multiple publications of 31 comparative trials of nonsteroidal anti inflammatory drugs in rheumatoid arthritis were examined for mutual agreement. Thirty-two of the papers were published in the same language as the primary version. Important discrepancies were seen in 14 trials, involving description of the study design in two, exclusion of protocol violators in two, inconsistency in the number of effect variables in five, in the number of side-effects in five, and in the significance level in one. In three articles the conclusion became more favourable for the new drug with time. Only half of the trials had the same first author and number of authors. For six trials, multiple publication was difficult to detect. Adherence to the manuscript guidelines published by the International Committee of Medical Journal Editors should diminish the risk of inflated meta-analyses, reference lists and curricula vitae, and inexplicable discrepancies in articles based on the same data. PMID- 2666139 TI - Antihypertensive effect of slow-release nicardipine. A placebo-controlled cross over study. AB - The magnitude and duration of the antihypertensive effect of slow-release nicardipine (SR-Nicardipine) have been compared with placebo in 36 uncomplicated essential hypertensives (diastolic BP 95 to 115 mm Hg after 1-month placebo washout). According to a double-blind, randomized, cross-over design they received SR-Nicardipine 40 mg b.d. and placebo for 1 month. At the end of each treatment period, blood pressure and heart rate were measured 12 h after the evening dose and 1, 2, 3 and 4 h after the morning dose. SR-Nicardipine significantly reduced systolic (SBP) and diastolic (DBP) blood pressure at each time after dosing. The absolute decrements peaked 4 h after dosing (-18.3 and 11.7 mm Hg, respectively) and more than 90% of the peak effect persisted 12 h after dosing, both for SBP and DBP. The heart rate was slightly increased by SR Ni-cardipine. Adverse effects monitored with a check-list occurred in 31% of patients during SR-Nicardipine treatment and in 28% on placebo. Thus, SR Nicardipine 40 mg b.d. has a maintained and significant antihypertensive effect lasting up to 12 h in essential hypertension. PMID- 2666140 TI - Stimulation of renin secretion by potassium-channel activation with cromakalim. AB - The cardiovascular and endocrine profile of cromakalim has been studied in 8 healthy men (age 25 +/- 2 years: means SEM) and its influence on renin release from cultured rat juxtaglomerular cells in vitro has also been examined. According to a double-blind, randomized sequence the subjects received placebo or cromakalim 1 mg as a single daily oral dose for 5 days. Compared to placebo, cromakalim significantly increased plasma renin activity (+ 122%; from 1.73 to 3.87 ng AI.ml-1.h-1), angiotensin II (+ 105%; from 5.1 to 10.5 pg.ml-1), and norepinephrine (+ 61%) levels, and heart rate (+ 8%). Plasma aldosterone, blood pressure and indices of the electrolyte-fluid volume state were unchanged. Cromakalim in vitro stimulated renin release, from 9.9 to 36.5 ng AI.h-1.30 min.mg cell protein, from juxtaglomerular cells. It appears that the presumed K+ channel activator cromakalim increases renin release in vivo at least in part by direct stimulation of renal juxtaglomerular cells. PMID- 2666142 TI - Monoclonal antibody 5.5 reacts with p8,14, a myeloid molecule associated with some vascular endothelium. AB - The movement of mononuclear phagocytes and neutrophils from the circulation into tissues is a process which is not completely understood. Monoclonal antibody 5.5 is specific for an 8/14-kDa molecule known variously as the CF antigen, L1 molecule or MRP8 and 14. We show that this molecule, which will be named p8,14 in this study, is expressed in all circulating monocytes and neutrophils as an intracellular product (as well as some types of epithelium). Tissue staining patterns suggest that when monocytes and neutrophils adhere to vascular endothelium, they release this molecule onto the associated endothelium. This process occurs with single monocytes and when monocytes form part of an inflammatory infiltrate. Monoclonal antibody 5.5 does not react with cultured endothelial cells even when stimulated with phorbol ester, tumor necrosis factor, interferon-gamma or interleukin 1 alpha providing further evidence that myeloid cells are the source of the p8,14 in this interactive process. Monocytes which have moved further into such tissues and tissue macrophages in general are monoclonal antibody 5.5 negative, suggesting that the ability to synthesize this molecule may be lost when monocytes leave the circulation and enter tissues. These results indicate that p8,14 plays a role in the interaction between myeloid cells and the vascular endothelium to which they adhere prior to leaving the circulation. PMID- 2666141 TI - Effect of zolpidem on sleep in insomniac patients. AB - The effect of zolpidem 10 mg p.o. on sleep in patients with persistent psychophysiological insomnia was assessed by polysomnographic recordings. An improvement in sleep with no rebound insomnia was observed during treatment for two weeks. Time awake after the onset of sleep was reduced after one week and increased after two weeks, whereas sleep latency remained reduced. Zolpidem markedly increased the duration of Stage 2 sleep without affecting either slow wave sleep or REM sleep. Subjective evaluation of improvement in sleep was well correlated with sleep laboratory findings. Zolpidem did not impair the immediate memory or psychomotor performance of patients on the morning after its administration. Side-effects during the period of drug administration included drowsiness, fatigue, headache, anxiety and irritability. They were mild or moderate and wore off soon after awakening. PMID- 2666143 TI - Characterization of C3a receptor-proteins on guinea pig platelets and human polymorphonuclear leukocytes. AB - The expression of specific membrane receptors for C3a was determined on guinea pig C3a-sensitive (gp R+) platelets and human polymorphonuclear leukocytes (hu PMNL). Binding studies with 125I-labeled C3a from gp or hu sources and Scatchard analysis applied to the binding data revealed the existence of two receptor classes on gp R+ platelets; a high-affinity class with about 200 binding sites/cell and Kd = 1.7 x 10(-9) M, and a relatively low-affinity class with Kd = 10(-8) M and about 500 sites/cell. Hu PMNL express a homogeneous receptor class with Kd = 3 x 10(-8) M and 40,000 sites/cell. Molecular characterization of the C3a receptor on gp R+ platelets was achieved by (a) cross-linking photoaffinity labeled receptors to bound 125I-labeled C3a; (b) photoaffinity labeling receptors with a 13-amino acid residue C3a analogue 125I-Nap-Ahx-13; and (c) use of chemical cross-linkers like disuccinimidylsuberate to cross-link receptors with 125I-C3a. All three techniques gave rise to very similar labeling patterns. With the photoaffinity labeling methods, a diffuse band pattern was observed with an apparent molecular mass of 95-123 kDa with 125I-C3a as label, and 85-105 kDa with 125I-Nap-Ahx-13 as label. Chemical cross-linking of 125I-C3a revealed three distinct bands with molecular masses of approximately 123, 108 and 95 kDa. Subtracting the contribution of the cross-linked ligands, the C3a receptor on gp R+ platelets appears to be a protein complex, consisting of one to three components with estimated molecular masses between 83-114 kDa. PMID- 2666144 TI - Pgp-1hi T lymphocytes accumulate with age in mice and respond poorly to concanavalin A. AB - Aging is associated with an accumulation of T cells functionally hyporesponsive to the effects of mitogens such as concanavalin A. Recent studies in mice and human have identified surface markers useful for distinguishing antigen stimulated memory T cells from virgin T cells. In mice, memory T cells within the CD8+ cell population have been shown to express relatively high levels of the cell surface glycoprotein Pgp-1. On the theory that aging might diminish the supply of virgin thymic emigrants without compromising the production of memory T cells, we examined the proportion of Pgp-1hiCD4+ and CD8+ cells in the spleen, blood and lymph nodes of mice of varying age. We found a dramatic (2.5-fold) age associated increase in the percentage of cells with the Pgp-1hi phenotype. By limiting dilution methods, the frequency of concanavalin A-responsive T cells was found to be significantly reduced in the Pgp-1hi cell pool, whether measured by interleukin 2-dependent proliferation, interleukin 2 production or generation of cytotoxic effectors. Pgp-1hi and Pgp-1lo T cells from young mice proliferate equally well when stimulated by optimal doses of phorbol myristate acetate and ionomycin suggesting that the poor responses to concanavalin A do not simply reflect low viability. Aging leads both to an increase in mitogen-hyporesponsive Pgp-1hi T cells, and also to lower responsiveness of cells in the Pgp-1hi subset. PMID- 2666145 TI - A sensitive technique to monitor gene transfer and expression in bone marrow stem cells. AB - The polymerase chain reaction technique (PCR), a primer-mediated enzymatic amplification of specific target sequences, was used to monitor gene transfer into hematopoietic progenitor stem cells. A gene coding for human interleukin 1 alpha (IL-1 alpha) was cotransfected with the rous sarcoma virus (RSV) CAT plasmid into mouse bone marrow cells by electroporation. Individual chloramphenicol (CAM)-resistant bone marrow progenitor colonies (granulocyte macrophage colony-forming units; CFU-GM) containing 50-100 cells were analyzed by PCR for the presence and expression of IL-1 alpha and CAT sequences. Amplified IL 1 alpha DNA sequences were detected from a 50-cell CFU-GM colony. CAT and IL-1 alpha RNA expression was demonstrated from the CAM-resistant CFU-GM colonies. PMID- 2666146 TI - On the late seeding of CFU-S to the spleen: 8- vs 12-day CFU-S. AB - Marrow from 5-fluorouracil- or cyclophosphamide-treated mice, injected into lethally irradiated recipients, gives an increasing number of spleen colonies between days 7 and 14. It has been suggested that the later-forming colonies result from the more primitive spleen colony-forming units (CFU-S), which first seed into the marrow, only later to be recirculated and form colonies in the spleen. Strontium 89 (89Sr), a bone-seeking radionuclide, was injected into recipient mice to block such putative recirculation. A dose of 89Sr, which killed at least 99.8% of CFU-S in, or entering, the bone cavities, was incapable of preventing the increase in spleen colony numbers. Similarly, the splenic environment, modified by the presence of spleen colonies and able to provide a better bed for trapping CFU-S from the peripheral circulation, yielded the same number of further CFU-S, whether or not the animal had received 89Sr. Thus, it was concluded that the 12-day CFU-S does not seed initially into the marrow spaces. Direct observation of the quality of CFU-S initially seeding into the bone marrow and spleen showed, by retransplantation into secondary irradiated mice, that a similar spectrum of CFU-S types had seeded both organs. PMID- 2666147 TI - Cyclophosphamide-induced enhancement of stem cell recovery from whole-body irradiation is radiation dose-dependent. AB - Although the enhancement of CFU-S recovery by CY pretreatment has been described for combinations of TBI greater than 4 Gy, no information exists as to whether such enhancement is operative at lower TBI doses (less than 3 Gy). B6D2F1 mice received intraperitoneal injections of CY (2 and 5 mg/mouse) at various time intervals prior to 2, 5 or 9 Gy TBI. The control group received the same dose of TBI without CY pretreatment. Six days after TBI, we determined the femoral content of CFU-S. Administration of 5 mg CY per mouse 3 days prior to 5 or 9 Gy TBI enhanced recovery of CFU-S with a substantial increase in CFU-S of 3- and 30 fold over control, respectively. In contrast, the administration of CY prior to 2 Gy TBI delayed recovery with CFU-S remaining at only 10 to 40% of control. This prolongation in CFU-S recovery was similar for CY doses of either 2 or 5 mg per mouse at all the time intervals tested (2, 3, 4 and 7 days prior to TBI). Our results demonstrate an enhancement of CFU-S recovery by pretreatment with CY for high doses of TBI that is reversed if the subsequent TBI dose is too low. PMID- 2666148 TI - Estradiol-concentrating cells in the brains of hypogonadal female mice and in their intraventricular preoptic area implants. AB - Estradiol-concentrating cells were evaluated in the brains of hypogonadal female mice and in their intraventricular preoptic area brain grafts using autoradiography for [3H]estradiol. Normal distribution of estradiol-concentrating cells was observed in the brains of the hypogonadal mice with dense collections of these cells in the lateral septum; the medial preoptic area; the medial anterior hypothalamus; the ventromedial, arcuate, and periventricular nuclei of the hypothalamus; and the medial and cortical nuclei of the amygdala. In addition, estradiol-concentrating cells were present in all the transplants, with the estimated number of such cells in the transplants ranging from 390 to 2600. There was no correlation between numbers of estradiol-concentrating cells within the transplants and degree of reproductive recovery in the hypogonadal mice. Gonadotropin-releasing hormone (GnRH) immunocytochemistry of alternate sections revealed GnRH-immunoreactive material within the grafts and immunoreactive fibers exiting the grafts and entering the hosts' median eminence. No specific relationship between GnRH cells and estradiol-concentrating cells was evident within the grafts, nor was there any indication of identity of estrogen concentrating cells with GnRH cells. PMID- 2666149 TI - Regional voltage map of the hippocampus during seizures. AB - The hallmark of brain tissue is its electrical activity. However, few techniques are available to directly monitor voltage changes in neural tissue, especially in whole brain preparation. A technique has been developed using a fluorescent voltage-sensitive dye and digital image analysis to produce a high spatial resolution map of the voltage changes induced by seizures in the hippocampus. Eight different anatomical regions within the septal hippocampus of the rat were analyzed. Seizures were produced in vivo by methods which use entirely different mechanisms and produce electrographically and behaviorally different types of seizures. Kainic acid produced depolarization during the seizure, whereas bicuculline produced hyperpolarization. The results provide experimental evidence that all seizures do not induce a depolarized state in the brain. PMID- 2666150 TI - The karyotype of Trypanosoma cruzi Dm 28c: comparison with other T. cruzi strains and trypanosomatids. AB - Chromosome-sized DNA molecules from Trypanosoma cruzi clone Dm 28c were analyzed and compared with other T. cruzi strains and monogenetic trypanosomatids by orthogonal field alteration gel electrophoresis. The results showed that T. cruzi Dm 28c displays at least 18 chromosomes ranging from 550 to more than 1500 kb and that in general the trypanosomatids have smaller chromosomes distributed in the size range from 300 to 1500 kb. With the exception of T. cruzi strain G49, there is no evidence of minichromosomes, suggesting they are not widely distributed among different isolates of the parasite. The hybridization of T. cruzi chromosomal Southern blots with probes for T. cruzi-specific genes showed that their location can change from one strain to another, supporting the idea of the plasticity of the parasite genome. Furthermore, the chromosome pattern is strictly conserved during the transformation of T. cruzi Dm 28c epimastigotes to metacyclic trypomastigotes, suggesting that extensive chromosomal rearrangements do not occur during at least part of the life cycle of the parasite. PMID- 2666151 TI - Plasmodium falciparum: inhibitor sensitivity of the endogenous superoxide dismutase. AB - Plasmodium falciparum, unlike P. berghei, contains two superoxide dismutases (SOD). We have previously found that the major isozyme is cyanide sensitive and appears, like the P. berghei SOD, to be adopted from its host, whereas the minor isozyme was found to be cyanide insensitive. We now report that the minor parasite-associated enzyme is peroxide insensitive, suggesting that it is manganese containing. PMID- 2666152 TI - Plasmodium falciparum: an abundant stage-specific protein expressed during early gametocyte development. AB - A stage-specific protein has been identified in gametocytes of Plasmodium falciparum. The protein is represented on two-dimensional electrophoresis by peptides of two apparent Mr of 27,000 and 25,000, each of which has at least four different isoelectric points between pH 6.0 and 5.0. The protein is designated Pfg 27/25 (P. falciparum gametocyte-specific antigen of 27 and 25 kDa). By indirect immunofluorescence with a monoclonal antibody 1H12 specific for Pfg 27/25, this protein is present in gametocytes within 30 to 40 hr after invasion of a red blood cell by a merozoite and is present throughout subsequent maturation of the gametocyte; Pfg 27/25 is not detectable on the surface of extracellular gametes by immunofluorescence with Mab 1H12. Pfg 27/25 is absent from asexual stages of P. falciparum at any stage in their development. Pfg 27/25 is an abundant protein in gametocytes and represents between 5 and 10% of total protein of these stages. Pfg 27/25 is also a major immunogen in man during P. falciparum infection. Antibodies to this protein were readily detected in human sera from an area of holoendemic P. falciparum and also from an individual following a primary attack of P. falciparum. PMID- 2666153 TI - Plasmodium falciparum: cytoadherence of a knobless clone. AB - Sequestration of Plasmodium falciparum-infected erythrocytes is crucial to parasite survival as it prevents destruction in the liver and spleen. Knobs have been considered necessary but not sufficient for cytoadherence to vascular endothelial cells in vivo and to melanoma or umbilical vein endothelial cells in vitro. We describe here a knobless clone that cytoadheres strongly to C32 melanoma cells. This clone cannot express the knob-associated histidine-rich protein (KAHRP) due to the deletion of the KAHRP gene. Our results raise the possibility of an alternative mechanism for in vitro cytoadherence and suggest that the use of long term cultured isolates and melanoma cells as a model for cytoadherence in vivo may be misleading. PMID- 2666154 TI - Cloning and expression of a functional fucose-specific lectin from an orange peel mushroom, Aleuria aurantia. AB - Aleuria aurantia lectin (AAL) shows sugar-binding specificity for L-fucose. A lambda gt11 expression library was constructed from A. aurantia poly(A) RNA and screened with a polyclonal antiserum directed against AAL. An immunopositive clone carrying 1.3-kb EcoRI fragment was obtained. The fragment encoded AAL, but lacked a nucleotide sequence corresponding to the two amino-terminal amino acids. The 5'-terminal part of the fragment was replaced with a chemically synthesized DNA fragment and inserted into an expression vector to yield a plasmid pKA-1. Escherichia coli carrying pKA-1 expressed functional AAL and the recombinant AAL showed the same immunological properties as those of natural AAL. PMID- 2666156 TI - Protein phosphorylation is required for diazoxide to open ATP-sensitive potassium channels in insulin (RINm5F) secreting cells. AB - The patch-clamp open-cell recording configuration has been used to investigate the effects of non-hydrolyzable analogues of ATP on the diazoxide-activation of KATP channels in the insulin-secreting cell line RINm5F. K+ channels inhibited by 0.1, 0.5 and 1.0 mM ATP were consistently activated by 200 microM diazoxide. During sustained activation of channels, exchange of ATP for either AMP-PNP, AMP PCP or ATP gamma S abolished the effects of diazoxide. If diazoxide was added to the membrane in the continued presence of AMP-PNP, AMP-PCP or ATP gamma S either no effects were observed or alternatively a small transient activation of channels occurred. This study suggests that protein phosphorylation is necessary for diazoxide to activate ATP-sensitive potassium channels in insulin-secreting cells. PMID- 2666155 TI - Production and purification of a recombinant human 14 kDa beta-galactoside binding lectin. AB - The cDNA for a 14 kDa human beta-galactoside-binding lectin was inserted into a plasmid carrying a taq promoter, and the lectin protein was expressed in E. coli cells. The recombinant lectin was extracted from the cells and purified to apparent homogeneity by a single-step chromatography on an asialofetuin-agarose column. Subunit molecular mass (14 kDa), hemagglutinating activity and antigenicity were indistinguishable from those of the human placental lectin. Though the N-terminal of the placental lectin is blocked with an acetyl group, the recombinant lectin was found to have a free amino group. However, the N terminal amino acid sequences were identical. The recombinant lectin was considered to have the same three-dimensional structure as the placental lectin. PMID- 2666157 TI - Kinetic beta-deuterium isotope effects suggest a covalent mechanism for the protein folding enzyme peptidylprolyl cis/trans-isomerase. AB - The cis/trans interconversion of Glt-Ala-Ala-Pro-Phe-4-nitroanilide and Glt-Ala Gly-Pro-Phe-4-nitroanilide was studied both enzymatically and nonenzymatically by measuring kinetic beta-deuterium isotope effects. The hydrogen atom at the alpha carbon atom of the Xaa residue within the Xaa-Pro moiety was substituted by deuterium. In the nonenzymatic case the transition state of rotation is reflected by kH/kD greater than 1. When catalysed by 17 kDa PPIase the same bond rotation is characterized by kH/kD less than 1. This suggests a covalent mechanism of catalysis which involves an approximately tetravalent carbon of the prolyl imidic bond for the transition state of reaction. PMID- 2666158 TI - Processing of transcripts of a dimeric tRNA gene in yeast uses the nuclease responsible for maturation of the 3' termini upon 5 S and 37 S precursor rRNAs. AB - The rna82 mutation of Saccharomyces cerevisiae inactivates an RNA processing activity responsible for maturation of 3'-terminal sequences upon 5 S and 37 S ribosomal RNA precursors. This study describes a difference in the processing of transcripts of an S. cerevisiae dimeric tRNA gene (tRNA(arg)-tRNA(Asp) in RNA polymerase III in vitro transcription extracts prepared from rna82 and wild-type cells. The mutant extract accumulated additional processing intermediates containing tRNA(Arg) sequences as compared to the extract from wild-type cells. The structure of these intermediates revealed a defect in removal of the 10 nucleotides left 3' to the tRNA(Arg) sequence by the RNase P cleavage immediately 5' to tRNA(Asp). This is the first demonstration of a mutational defect affecting maturation of 3' sequences upon a eukaryotic tRNA precursor. PMID- 2666159 TI - Production of plasmids giving high expression of recombinant DNA-derived ovine growth hormone variants in Escherichia coli. AB - A method for the production of plasmids giving different levels of expression of ovine growth hormone (oGH) variants in E. coli is described. The cDNA sequence coding for mature oGH was inserted into the multiple cloning site of plasmid pUC8 and random deletions were then introduced 3' to the initiation codon. Clones producing GH (with varying N-terminal extensions) were identified by immunological screening. Levels of expression of GH-related protein, measured by immunoassay or on SDS-polyacrylamide gels, varied from over 20% to less than 0.05% of total cell protein. The coding sequence of plasmid pOGHe101, giving very high expression of variant oGH1, was determined. PMID- 2666160 TI - Effect of starvation and insulin in vivo on the activity of the pyruvate dehydrogenase complex in rat skeletal muscles. AB - The in vivo responses of pyruvate dehydrogenase (PDH) complex to starvation and insulin was assessed in heart, diaphragm and red quadriceps muscle. PDH complex activity was decreased by starvation (3.4-10.2-fold), the magnitude of change depending on muscle type. Insulin increased PDH activity in all muscle types. In fed rats, this effect was relatively small (1.25-1.29-fold). In starved rats there were effects in heart (4.3-fold) and red quadriceps (1.7-fold) but no effect in diaphragm. These results demonstrate that PDH complex in different groups of muscle has different insulin sensitivity (particularly in tissues from starved animals). PMID- 2666161 TI - Alpha- and beta-tubulin mRNAs of Trypanosoma cruzi originate from a single multicistronic transcript. AB - The cluster of alternated alpha- and beta-tubulin genes in the genome of Trypanosoma cruzi was shown to be transcribed into a single RNA molecule which upon processing gives rise to the mature alpha- and beta-tubulin mRNAs. This conclusion was based on: (i) nuclear RNA species with the same molecular mass hybridize to both alpha- and beta-tubulin cDNA probes; (ii) S1 nuclease assay of the clustered tubulin genes has shown protected DNA fragments of the same size and of greater molecular mass than that corresponding to the mRNAs, hybridizable to both alpha- and beta-tubulin cDNA probes; (iii) beta-tubulin hybrid selected RNA is still able to hybridize to alpha-tubulin probe. PMID- 2666162 TI - A cDNA clone encoding the precursor for a 10.2 kDa photosystem I polypeptide of barley. AB - Two cDNA clones for the barley photosystem I polypeptide which migrates with an apparent molecular mass of 9.5 kDa on SDS-polyacrylamide gels have been isolated using antibodies and an oligonucleotide probe. The determined N-terminal amino acid sequence for the mature polypeptide confirms the identification of the clones. The 644 base-pair sequence of one of the clones contains one large open reading frame coding for a 14,882 Da precursor polypeptide. The molecular mass of the mature polypeptide is 10 193 Da. The hydropathy plot of the polypeptide shows one membranespanning region with a predicted alpha-helix secondary structure. The gene for the 9.5 kDa polypeptide has been designated PsaH. PMID- 2666163 TI - Regulation of tetrahydrobiopterin synthesis during lectin stimulation of human peripheral blood lymphocytes. AB - Lectin stimulation of human T lymphocytes causes a 7-fold increase in the specific activities of GTP-cyclohydrolase and a 4-fold increase in the specific activities of sepiapterin reductase. GTP-cyclohydrolase activities are maximal after 48 h and subsequently decline, whereas sepiapterin reductase activities continue to increase during the 72 h period measured. The specific activities of 6-pyruvoyltetrahydropterin synthase remain unchanged upon stimulation. Tetrahydrobiopterin synthesis during blast transformation is thus directed by both GTP-cyclohydrolase and sepiapterin reductase. PMID- 2666164 TI - EGF-like domains in extracellular matrix proteins: localized signals for growth and differentiation? AB - Multidomain proteins of the extracellular matrix (ECM) play an important role in development and maintenance of cellular organization and in tissue repair. Several ECM proteins such as laminin, tenascin and thrombospondin contain domains with homology to epidermal growth factor (EGF) and exhibit growth promoting activity. The mitogenic activity of laminin is restricted to a fragment which consists of about 25 repeating domains with partial homology to EGF and comprises the rod-like inner regions of the three short arms of the four armed molecule. The mitogenic activity does not correlate with promotion of cell attachment and neurite outgrowth for which major functional sites have been found in other regions of the laminin molecule. It is suggested that EGF-like domains in laminin, in other ECM proteins and in the extracellular portions of some membrane proteins are signals for cellular growth and differentiation. Because they are integral parts of large molecules and often of supramolecular assemblies these domains are well suited to stimulate neighboring cells in a specific and vectorial way. This concept of localized growth or differentiation signals offers an attractive mechanism for the regulation of cellular development. PMID- 2666165 TI - Remarks on the supramolecular organization of the glycolytic system in vivo. AB - The great latent catalytic capacity, manifested at the extremely high intracellular concentrations and in large apparent kcat/Km values, of the glycolytic enzymes on the one hand and their tendency in experiments in vitro to form functionally-specific flux-enhancing (channeling) complexes on the other, is considered and discussed as an apparent discrepancy. A random association of glycolytic enzymes in vivo is probable. PMID- 2666166 TI - Synthesis and secretion of bacterial alpha-amylase by the yeast Saccharomyces cerevisiae. AB - Alpha-amylase from Bacillus amyloliquefaciens, synthesized in yeast Saccharomyces cerevisiae without substitution of the signal sequence, is efficiently secreted from yeast cells: 60-70% of the overall amount of the enzyme is found in the culture fluid. In contrast to many yeast secretory proteins, which accumulate in the periplasmic space and in the cell wall, intracellular alpha-amylase is localized mainly in the cytoplasm. Obviously, transfer across the cell wall is not a rate-limiting step in alpha-amylase export from the cell. The glycosylated forms of proteins are predominantly found both inside the cell and in the culture medium. PMID- 2666167 TI - Analysis of 3'-untranslated regions of seven c-myc genes reveals conserved elements prevalent in post-transcriptionally regulated genes. AB - We have characterized the complete sequence of two c-myc cDNAs from the amphibian Xenopus laevis, and could thus compare the 3'-non-coding sequences of 7 myc cDNAs from 6 species spread over 350 million years of evolution. Although the size of these sequences is heterogeneous, we identified three completely conserved sequences of 10, 11 and 12 contiguous nucleotides. We observed that two of these elements may be contained in conserved stem-loop structures previously implicated in mRNA turnover. The length of these motifs, their existence in conserved predicted structures, and their presence in regulated eukaryote mRNA with a frequency greater than predicted by chance, suggest that they are functionally important. PMID- 2666168 TI - Synthesis of human endothelin-1 precursors in Escherichia coli. AB - Endothelin, the most potent vasoconstrictor found in nature, is thought to be important in the regulation of blood pressure and/or local blood distribution. Human placenta cDNA fragment encoding preproendothelin-1 (preproET-1) and its carboxyl terminal mature precursor (C-matured precursor) was expressed in E. coli. These products were characterized by both enzyme immunoassay and Western blot analysis. PMID- 2666169 TI - Sequence divergence in a specific region of islet amyloid polypeptide (IAPP) explains differences in islet amyloid formation between species. AB - Amyloid deposits in the islets of Langerhans occur in association with type 2 diabetes mellitus (DM) in humans and cats and consist of a 37-amino-acid polypeptide known as islet amyloid polypeptide (IAPP). In order to find an explanation for the situation that islet amyloid (IA) does not develop in common rodent species, we have deduced the amino acid sequence of the IAPP molecule in mouse, rat and hamster. We find that a specific region of the molecule diverges to a high degree. Synthetic peptides corresponding to this region of human and hamster IAPP were compared for their ability to form amyloid fibrils in vitro. Whereas the human peptide readily formed fibrils with amyloid character, the hamster peptide completely lacked this property. We suggest this to be a likely explanation for the differences in IA formation between humans and rodents and discuss our findings in relation to the type 2 DM syndrome. PMID- 2666171 TI - The interaction of beta-N-methylamino-L-alanine with bicarbonate: an 1H-NMR study. AB - The mode of action of the neurotoxic, non-protein amino acid beta-N-methylamino-L alanine (L-BMAA) is unknown. We have shown, using 1H-NMR spectroscopy, that L BMAA forms a stable adduct with bicarbonate (probably a carbamate). The properties of this adduct may explain the observation that L-BMAA and N-methyl-D aspartic acid appear to act at the same central nervous system receptors. PMID- 2666170 TI - Tumor promoter 12-O-tetradecanoylphorbol 13-acetate inhibits mas/angiotensin receptor-stimulated inositol phosphate production and intracellular Ca2+ elevation in the 401L-C3 neuronal cell line. AB - Stimulation of mas-oncogene transfected 401L-C3 cells by angiotensins leads to the production of inositol phosphates. This response shows dose dependence, and has an apparent rank order of potency angiotensin III greater than or equal to angiotensin II much greater than angiotensin I. Preincubation with 12-O tetradecanoylphorbol 13-acetate, for 5 min, significantly diminishes both inositol phosphate and intracellular [Ca2+] responses to angiotensins, without affecting those stimulated by the endogenous bradykinin receptor. Incubation of 401L-C3 cells with either phorbol ester or angiotensins leads to elevation of intracellular pH, implying that mas/angiotensin receptor stimulation itself leads to protein kinase C activation. These results suggest the operation of a negative feedback loop specific for the mas/angiotensin receptor signalling pathway, and which may be essential in defining the final biological output response to this receptor stimulation. PMID- 2666172 TI - Substrate structural requirements of Schizosaccharomyces pombe RNase P. AB - RNase P from Schizosaccharomyces pombe has been purified over 2000-fold. The apparent Km for two S. pombe tRNA precursors derived from the supS1 and sup3-e tRNA(Ser) genes is 20 nM; the apparent Vmax is 2.5 nM/min (supS1) and 1.1 nM/min (sup3-e). Processing studies with precursors of other mutants show that the structures of the acceptor stem and anticodon/intron loop of tRNA are crucial for S. pombe RNase P action. PMID- 2666173 TI - Cervical incompetence. AB - In the early 1950s, when treatment of cervical incompetence was first described, diagnosis seemed relatively simple and management favorable, but after more than 35 years of trying multiple variations of procedures and treatment regimens, no advances have been made. In 1959, Neser questioned the very existence of cervical incompetence as an entity, and concluded that, in the final analysis, the problem is a diagnostic one. Liberal use of cerclage in situations of moderate risk of preterm delivery or as a prophylactic measure for multiple gestation does not appear to improve outcome, as judged by prematurity or survival. Because of advances in neonatal care in the last decade, fetal survival has improved tremendously. It is hoped that, in the future, more objective and accurate criteria for the diagnosis of cervical incompetence will emerge, and that outcome of treatment will be measured not by fetal survival, but by prolongation of pregnancy and by birth weight. At present, making an unequivocal diagnosis of cervical incompetence remains an elusive, challenging, and unsolved problem. PMID- 2666174 TI - Menstrual cyclicity has a profound effect on glucose homeostasis. AB - Results from oral glucose tolerance tests have frequently demonstrated a deterioration in glucose metabolism during the luteal phase of the menstrual cycle. To examine this issue further, eight women underwent both midfollicular (days 3 to 10) and midluteal (days 20 to 25) phase hyperglycemic clamp studies (+125 mg glucose/dl) after an overnight fast. Glucose levels rose from 83 +/- 1 to 207 +/- 2 and 87 +/- 1 to 207 +/- 2 mg/dl, respectively, during the follicular and luteal phases. The basal (6 +/- 1 versus 7 +/- 1 microU/ml) and glucose stimulated (42 +/- 5 versus 43 +/- 6 microU/ml) insulin responses were similar in the follicular and luteal studies. However, glucose uptake was significantly higher during the follicular versus the luteal phase (10.99 +/- 0.97 versus 6.93 +/- 0.37 mg/kg-min; P less than 0.01), as was the ratio of glucose uptake to insulin concentration (30.0 +/- 5.5 versus 19.7 +/- 3.7, P less than 0.01). The authors conclude that: (1) Glucose metabolism is impaired in the luteal phase of the menstrual cycle; (2) This defect cannot be explained by differences in the plasma insulin response; and (3) This impairment in the ability to promote glucose uptake under hyperglycemic conditions suggests a defect in the mass action effect of glucose per se. PMID- 2666175 TI - Immunoradiometric assays of total renin and gonadotropins in serum during the menstrual cycle. AB - The contribution of the ovary to the circulating total renin pool is linked to its secretory activity in relation with its reproductive function. In a longitudinal study of 13 normal women, total renin levels measured in serum by an immunoradiometric assay were lower in the midfollicular phase (180 +/- 59 pg/ml) than in the midluteal phase (291 +/- 100 pg/ml). Peak levels were encountered 1 day after the luteinizing hormone (LH) surge (375 +/- 97 pg/ml). Rapid circhoral fluctuations were observed in all periods of the cycle, unrelated to the LH pulses. In case of ovarian function inhibition (induced by gonadotropin-releasing hormone agonists), total renin levels were lower than in the midfollicular phase (126 +/- 56 pg/ml). Low levels also were encountered in the prepubertal period (153 +/- 89 pg/ml). Very high levels (17,600 +/- 11,400 pg/ml) were found in follicular fluids from stimulated cycles. These results show that circulating total renin levels follow a complex pattern in which LH, but possibly also follicle-stimulating hormone and gonadal steroid hormones (estradiol and progesterone), may play a role. PMID- 2666176 TI - Zygote intrafallopian transfer as a successful treatment for unexplained infertility. AB - This study describes the zygote intrafallopian transfer treatment in patients with unexplained infertility. After retrieval, the oocytes were inseminated with 80,000 progressive motile sperm cells per milliliter. If fertilization occurred, a maximum of three zygotes were replaced by laparoscopy in the fimbrial end of one healthy fallopian tube. A pregnancy rate of 48.1% per zygote intrafallopian transfer replacement was obtained. Seventeen pregnancies are actually ongoing, two patients delivered, and seven patients miscarried. Even after replacing a maximum of three zygotes, there were 6 twin and 2 triplet pregnancies. PMID- 2666177 TI - Automated semen analysis. PMID- 2666178 TI - Anne Bader--thank you. PMID- 2666179 TI - The tonsil and adenoid controversy. AB - This paper will review the anatomy, histology, immunology, bacteriology, indications, complications, and trends in modern tonsil and adenoid surgery. Information on tonsils and adenoids, both in their normal and abnormal states, has proliferated over the last two decades. A considerable variation in opinion remains on the subject. Historical fluctuations in the indications for tonsil and adenoid surgery have resulted in swings in the quantity of surgery performed. This paper will attempt to bring contemporary information together to provide reasonable guidelines for management of disease tonsils and adenoids. PMID- 2666180 TI - Feto-placental haemodynamics in growth retardation: a pulsed Doppler study. AB - 69 singleton pregnancies, with a diagnosis of intra-uterine growth retardation (IUGR) at ultrasound, were followed until delivery by pulsed Doppler evaluations in fetal thoracic descending aorta (DA) and umbilical artery (UA). Three haemodynamic groups were described according to flow characteristics expressed as the pulsatility index (PI) of the vessel under study. In each group the relative incidence of fetal distress, diagnosed according to CTG monitoring, was evaluated. Fetal distress occurred in 75% of the cases with a raised PI both in DA and UA, in 40% of the cases with a raised PI only in DA and in 21% of the cases with 'normal' PI values in both vessels. It can be said that Doppler flow measurements can be useful in defining the actual haemodynamic situation of the fetus with possible clarifications concerning its 'stressed' or 'distressed' condition and residual capacities to substain hypoxia. PMID- 2666181 TI - Chlorhexidine for prevention of neonatal colonization with group B streptococci. V. Chlorhexidine concentrations in blood following vaginal washing during delivery. AB - Chlorhexidine 2 g/l was applied to the vagina of 96 women during delivery, whereas 28 served as controls. Both groups were given a shower using a chlorhexidine soap, and outer washing of the outer anogenital tract was also performed in all patients using chlorhexidine 2 g/l. Using a gas chromatographic method with a detection limit of 10 ng chlorhexidine per ml blood, 10-83 ng/ml was demonstrated in 34 (35%) of the study group patients, whereas the remaining study group patients and controls showed no detectable chlorhexidine. Performing the washing a second time after 6 hours in 14 patients and a third time in 3 patients after a further 6 hours did not result in increased serum levels. It was concluded that small amounts of chlorhexidine are absorbed through the vaginal mucosa and that chlorhexidine is not accumulated in the blood on repeated usage with 6 hour intervals during delivery. PMID- 2666182 TI - Teratogenicity of caffeine; a review. PMID- 2666183 TI - Torsion of the pregnant uterus with a change in placental localization on ultrasound; a case report. AB - An unexpected uterine torsion at term was found during Caesarean section. In retrospect, a changing placental localization on ultrasound from the left to the right side was recorded just before the operation. This may be a useful sign to diagnose uterine torsion earlier. PMID- 2666184 TI - Functionally constrained codon usage in histone genes. PMID- 2666185 TI - Why the L-type pentose pathway does not function in liver. AB - 1. The classical pentose and not the L-type pathway functions in liver (Rognstad et al., 1982; Landau and Wood, 1983a; Landau, 1985; Scofield et al., 1985b). 2. It seems necessary to summarize again the reasons for this conclusion because of a recent review by Williams and his coworkers in this Journal (Williams et al., 1987). PMID- 2666186 TI - Professor R. H. S. Thompson. PMID- 2666187 TI - Structure and regulation of Escherichia coli isocitrate dehydrogenase. PMID- 2666188 TI - NADPH-dependent disulphide reductases. PMID- 2666189 TI - ADP-ribosylation of proteins: a ubiquitous cellular control mechanism. PMID- 2666190 TI - Secretion of Escherichia coli haemolysin. PMID- 2666191 TI - Signal recognition in protein translocation across the endoplasmic reticulum membrane. PMID- 2666192 TI - Periplasmic secretion of human growth hormone by Escherichia coli. AB - The gene coding for human growth hormone (hGH) was fused to the coding sequence for the signal peptide of a secreted Escherichia coli protein. STII heat-stable enterotoxin. This hybrid gene was expressed in E. coli. The signal peptide is properly processed and hGH is secreted in to the periplasmic space. In E. coli, some of the material made is proteolytically clipped or deamidated. The effect of culture conditions on the expression and secretion of hGH was studied and several important parameters were identified, including culture temperature and duration, cultivation pH, K+ levels, plasmid structure, and nutrient supplements. Alteration of culture conditions significantly improves the recovery yield and product quality of human growth hormone. PMID- 2666193 TI - Secretion of recombinant proteins into the culture medium by Escherichia coli and Staphylococcus aureus. AB - The ability of staphylococcal protein A (SPA) to bind to the Fc part of IgG has been used for the purification of a number of heterologous gene products as fusion proteins. Both the SPA promoter and signal sequence function in Escherichia coli, as well as in a number of Gram-positive bacteria, which facilitates comparisons of the expressed specific products in different hosts. The expression system developed for E. coli yields excretion of the fusion protein to the growth medium, which makes E. coli a competitive alternative to Gram-positive bacteria for the expression of secreted products. The human peptide hormones insulin-like growth factors (IGF) I and II were expressed using the protein A system in E. coli and Staphylococcus aureus. Despite a high degree of structural homology, large differences in the yields were observed in the two hosts. This underlines the importance of investigating different bacterial hosts for a particular protein product. PMID- 2666194 TI - Side-specific photolabelling of the hexose transporter. PMID- 2666195 TI - Structures and functions of mammalian nucleoside transporters. PMID- 2666196 TI - Structure of bacterial surfaces. PMID- 2666197 TI - Bacterial capsules and interactions with complement and phagocytes. PMID- 2666198 TI - Regulation of gene expression by insulin in adipose cells: opposite effects on adipsin and glycerophosphate dehydrogenase genes. AB - Insulin is known to play the role of a positive effector both in vitro on the adipose conversion process and in vivo on the fatty acid synthesis and esterification processes in adipose tissue. The effects of insulin on the expression of two genes activated during adipose conversion, glycerol-3-phosphate dehydrogenase (GPDH) and adipsin genes, have been investigated in 3T3 F442A adipose cells. Within a physiological range of concentrations, insulin exerts opposite effects on the levels of GPDH (EC50 approximately 0.2 nM) and adipsin (EC50 approximately 1 nM) mRNAs. Its negative effect on the abundance of adipsin mRNA involves primarily a rapid inhibition of the transcriptional rate (less than 2 h). Its positive effect on the abundance of GPDH mRNA is due to a stimulation of the transcriptional rate accompanied by a delayed stabilization of GPDH mRNA. In addition, insulin exerts a specific effect on the length of the poly(A) tract of the adipsin mRNA. These results show that a single mechanism for the regulation of adipose-related genes by insulin can be excluded but rather suggest a complex phenomenon in which various levels of regulation take place. PMID- 2666199 TI - Localization of beta II subspecies of protein kinase C in beta-cells. AB - Protein kinase C (PKC) has been generally accepted to play a key role in stimulus response coupling in various secretory cells, including pancreatic islets and pancreatic acini. The enzyme exists as a large family of multiple subspecies with highly related structures (alpha-, beta I-, beta II-, gamma-, delta-, epsilon-, and zeta-PKC). With an immunocytochemical procedure with subspecies-specific antibodies, beta II-PKC-like immunoreactivity was identified to localize in the beta-cells of the rat pancreatic islets. Neither beta I- nor gamma-PKC-like immunoreactivity was found in both islets and acini. Biochemical analysis confirmed that the rat whole pancreatic tissues contain a significant amount of alpha-PKC and a minute amount of beta II-PKC but neither beta I- nor gamma-PKC. On the other hand, beta II-PKC-like immunoreactivity was not detected in rat insulinoma cells, in which insulin secretion was induced in response to 12-O tetradecanoylphorbol-13-acetate and carbachol but not in response to glucose. These findings suggest that beta II-PKC is the major, if not the sole, subspecies of PKC in beta-cells of rat pancreatic islets and a possible candidate for involvement in glucose-induced insulin secretion. PMID- 2666201 TI - Lack of teratogenic effect of brief maternal insulin-induced hypoglycemia in rats during late neurulation. AB - We have previously shown that 1 h of maternal insulin-induced hypoglycemia is teratogenic to rat embryos during the initial stages of neurulation, when they are dependent on uninterrupted glycolysis (day 9.5-9.7 of development). To determine whether this vulnerability persists in later stages of neural tube and cardiac development, we infused insulin into 16 conscious pregnant rats for 1 h beginning after embryos had developed the capacity for aerobic glucose metabolism (day 10.6 of development). Half of the pregnant animals were allowed to become hypoglycemic (44 +/- 2 mg/dl) during the insulin infusions. The other half received glucose infusions to maintain normoglycemia (130 +/- 3 mg/dl). Normal plasma glucose levels were maintained in all animals after the insulin infusions. Embryos were examined on day 11.5 of development. At that time, 1 of 111 embryos from the normoglycemic group and 1 of 109 embryos from the hypoglycemic group were grossly malformed (P greater than .5). Means of embryo crown-rump length (4.15 +/- 0.03 vs. 4.14 +/- 0.03 mm), somite number (29.7 +/- 0.1 vs. 29.8 +/- 0.2), and total protein content (320 +/- 5 vs. 326 +/- 6 micrograms) were also similar in the two groups (P greater than .5). Thus, we could not detect an embryotoxic effect of 1 h of maternal insulin-induced hypoglycemia beginning at day 10.6 of development. This finding is in contrast to our prior demonstration that a similar period of hypoglycemia occurring earlier in neurulation (day 9.7) caused growth retardation and developmental anomalies in embryos.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 2666200 TI - Ganglioside treatment and improved axonal regeneration capacity in experimental diabetic neuropathy. AB - The efficacy of gangliosides in enhancing axonal regeneration and maturation in the early stages of diabetic neuropathy was assessed by quantitative analysis of immunostained serial sections of the sciatic nerve. Sprague-Dawley rats were made diabetic with a single injection of alloxan (100 mg/kg). One week later they were injected daily intraperitoneally with either a highly purified ganglioside mixture (10 mg/kg) or sterile saline for 4 wk. At the end of the treatment, sciatic nerves were crushed and allowed to regenerate for 1 wk without ganglioside treatment. The animals were then killed, and the nerves were frozen and processed for immunohistochemistry and electron microscopy. The number of regrowing axons was counted with a computerized image-analysis system on cross sections taken at predefined distances along the regenerating stump and stained with monoclonal antibody iC8 specific for the 145,000-Mr subunit of the neurofilaments. In untreated diabetic animals the number of axons able to regenerate and sustain elongation for greater than or equal to 13 mm from the crush point was reduced by 40% with respect to control rats. Ganglioside treatment was effective in compensating almost completely for this dramatic reduction. Electron microscopy confirmed that the immunofluorescence counts corresponded to regenerating axons containing neurofilaments. These results suggest that gangliosides are able to compensate for the derangements of axonal transport of cytoskeletal proteins reported in experimental diabetic neuropathy. PMID- 2666202 TI - Neuraminidase treatment of isolated rat adipocytes and differential regulation of basal and insulin-stimulated glucose transport. AB - The role of membrane carbohydrate in the function of insulin receptors and glucose transporters was investigated with neuraminidase to release sialic acid from isolated rat adipocytes. Pretreatment of adipocytes with neuraminidase resulted in an increase in basal glucose transport. At the same time, insulin stimulated glucose transport was reduced by an average of 30%. The enzyme action on glucose transport was not due to a nonspecific membrane perturbation because neuraminidase caused only a nonsignificant decrease in the uptake of the amino acid analog alpha-(methylamino)isobutyric acid and had no effect on basal or insulin-stimulated protein synthesis. Insulin binding was slightly increased in neuraminidase-treated cells, yet the shapes of the dose-response curves for insulin stimulation of glucose transport were similar (EC50 = 0.087 +/- 0.010 and 0.082 +/- 0.008 nM for control and treated cells, respectively). The neuraminidase-induced increase in basal transport was the result of an increase in the affinity of the glucose-transport system (Km = 7.3 +/- 1.4 and 3.6 +/- 0.7 mM before and after treatment, respectively) with no change in Vmax. Conversely, enzyme treatment decreased the Vmax of insulin-stimulated 3-O-methylglucose transport from 87.8 +/- 13.2 to 41.3 +/- 4.9 pmol.2 x 10(5) cells-1.s-1 while not altering the Km. These changes in glucose-transport activity resulting from enzyme treatment were not due to alterations in glucose-transporter concentration on the plasma membrane as measured by the D-glucose-inhibitable binding of [3H]cytochalasin B. Thus, sialic acid plays multiple roles in the control of glucose-transport activity.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 2666203 TI - Peptide-based radioimmunoassay for insulin receptor. Detection of insulin stimulated downregulation in IM-9 lymphocytes. AB - To overcome the difficulties encountered in quantifying the insulin receptor number by Scatchard analysis, a radioimmunoassay (RIA) for the human insulin receptor (hIR) has been developed that uses an antibody raised against a synthetic peptide (Gly-Lys-Lys-Asn-Gly-Arg-Ile-Leu-Thr-Leu-Pro-Arg-Ser-Asn-Pro Ser) corresponding to the carboxyl terminal of the hIR. A second peptide (Tyr-Gly Arg-Ile-Leu-Thr-Leu-Pro-Arg-Ser-Asn-Pro-Ser) was used as a standard and allowed preparation of monoiodinated derivative of theoretical specific activity for use as the radioactive ligand. The assay is specific, highly reproducible, and sensitive, with a detection limit of 10 fmol of receptor. One mole of purified receptor, measured by Scatchard analysis or amino acid analysis, is read as one mole of receptor in the RIA with peptide being the standard. The assay is effective with receptor from multiple sources and could determine the decrease in number of insulin receptors seen in IM-9 lymphocytes after treatment with insulin (downregulation). PMID- 2666204 TI - Decreased activation rate of insulin-stimulated glucose transport in adipocytes from obese subjects. AB - Recent studies from our laboratory have shown that the rate at which insulin activates glucose disposal in vivo is much slower in obese subjects compared with lean controls. To determine if this was caused by an abnormality in activation of insulin-stimulated glucose transport at the cellular level, we measured the rate at which insulin stimulated glucose transport in human adipocytes from obese volunteers. Basal rates of 3-O-methylglucose transport in the absence of insulin were lower (0.20 +/- 0.04 vs. 0.40 +/- 0.11 pmol.10(-5) cells.10 s-1, P less than .25) in adipocytes from obese subjects (n = 10) than in lean control subjects (n = 5), but this did not achieve statistical significance. Maximal insulin stimulated (4300 pM insulin) glucose transport rates were significantly decreased in obesity (2.81 +/- 0.81 vs. 1.15 +/- 0.20 pmol.10(-5) cells.10 s-1, P less than .005). It took longer for adipocytes from obese subjects to achieve half-maximal activation of insulin-stimulated glucose transport than those from lean subjects (15 +/- 2 vs. 9.4 +/- 1.2 min, P less than .05). The slower overall rates of activation of maximal insulin-stimulated glucose transport observed in adipocytes from obese subjects mirror the slower rates of stimulation of glucose disposal in vivo, which suggests that the in vivo findings are caused by a cellular abnormality in insulin action at a step beyond the binding of insulin to its receptor.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 2666205 TI - Efficacy of benztropine therapy for drooling. AB - This study assessed the efficacy of synthetic anticholinergic benztropine and incidence of side-effects in 20 developmentally-disabled patients with severe drooling. The double-blind, placebo-controlled, crossover protocol included one week baseline, two-week placebo and two-week benztropine conditions (mean dose 3.8 mg). A significant decrease in drooling during the benztropine condition relative to placebo was demonstrated and conservative response rates (calculated by deleting placebo responders), ranged up to 65 to 70 per cent. For patients completing the protocol the incidence of side-effects did not differ across conditions and minor problems such as a dry mouth were eliminated by small dose adjustments. More serious cholinergic side-effects, which resolved within 24 to 48 hours, necessitated discontinuation of the drug in three patients. This study demonstrates that synthetic anticholinergics can provide an important therapeutic alternative to surgical and behavioral therapies for drooling. PMID- 2666206 TI - Long-term effects of meningitis. PMID- 2666207 TI - Thyroid disturbances in cytogenetic diseases. PMID- 2666208 TI - Feeding disorders in children with multiple handicaps. PMID- 2666209 TI - In vivo insulin resistance in streptozotocin-diabetic rats--evidence for reversal following oral vanadate treatment. AB - Hepatic glucose production and peripheral glucose utilisation were measured in vivo with the euglycaemic-hyper-insulinaemic clamp technique in rats rendered severely diabetic with streptozotocin (45 mg/kg) and in control rats. The rats were studied in the post-absorptive state while anaesthetised. The basal glucose production and glucose utilisation were significantly higher (p less than 0.001) in diabetic rats 9 days after streptozotocin administration. During the clamp studies, suppression of glucose production by the liver induced by submaximal or maximal insulin levels was significantly less (p less than 0.01 and p less than 0.001 respectively) effective in diabetic rats as compared to control rats. Glucose utilisation was significantly lower following both submaximal (p less than 0.01) or maximal (p less than 0.001) hyperinsulinaemia as compared to control rats. Oral administration of vanadate (0.2 mg/ml in drinking water) for a 20-day period in diabetic rats lowered their plasma glucose levels to normal near values within 4 days, normalised plasma insulin levels, and increased pancreatic insulin stores. The rate of glucose disappearance (K value) and in vivo glucose induced insulin secretion as estimated during an i.v. glucose tolerance test were not significantly improved. In control rats, vanadate treatment did not significantly affect any of the above parameters. In vanadate treated diabetic rats, basal glucose production was normalised. Following submaximal or maximal hyperinsulinaemia, glucose production was suppressed normally. Basal glucose utilisation was restored and returned to normal values during submaximal hyperinsulinaemia. However, during maximal hyperinsulinaemia, glucose utilisation still remained significantly lower (p less than 0.05) as compared to vanadate treated control rats. (ABSTRACT TRUNCATED AT 250 WORDS) PMID- 2666210 TI - Growth hormone regulation of DNA replication, but not insulin production, is partly mediated by somatomedin-C/insulin-like growth factor I in isolated pancreatic islets from adult rats. AB - We have investigated whether the previously demonstrated stimulatory actions of growth hormone on DNA synthesis and (pro)insulin biosynthesis and release of isolated adult rat islets of Langerhans are mediated by an autocrine release of somatomedin-C/insulin-like growth factor I (SM-C/IGF I). In medium containing 1% fetal calf serum, the presence of 16.7 mmol/l glucose, or 2.7 mmol/l glucose supplemented with a concentrate of essential amino acids, caused a significant increase in 3H-thymidine incorporation and insulin release compared to 2.7 mmol/l glucose alone but no increase in SM-C/IGF I release. Further supplementation with 1 microgram/ml growth hormone increased 3H-thymidine incorporation and SM-C/IGF I release within all groups, and insulin release in the 16.7 mmol/l glucose and 2.7 mmol/l plus amino acid groups. The ability of growth hormone to increase 3H thymidine incorporation in the presence of 16.7 mmol/l glucose, but not its action on insulin release, was partly inhibited by a monoclonal antibody against SM-C/IGF I (control cultures 100%; growth hormone alone 261 +/- 27%, mean +/- SEM; growth hormone + anti-SM-C/IGF I 179 +/- 21%; p less than 0.05, n = 18). Growth hormone, but not 100 ng/ml SM-C/IGF I, increased insulin biosynthesis assessed as immunoprecipitable 3H-labelled insulin by 45%, but this was accompanied by a similar increase in overall protein synthesis. Similarly growth hormone, but not SM-C/IGF I caused a 75% increase in glucose oxidation by islets. Both growth hormone and SM-C/IGF I failed to increase the cellular uptake of alpha-aminoisobutyric acid or 3-O-methyl glucose over a 90 min period.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 2666212 TI - In vivo molecular sensing in diabetes mellitus: an implantable glucose sensor with direct electron transfer. AB - Miniature, amperometric glucose sensors were constructed for implantation in the subcutaneous tissue of normal and insulin-dependent diabetic subjects. To minimise dependence on fluctuating tissue oxygen tension, we employed the technology of mediated electron transfer, with 1,1'-dimethylferrocene acting as the redox shuttle between immobilized glucose oxidase and a platinum base electrode. In 6 normal subjects, the subcutaneous sensor responses mirrored the simultaneously-measured changes in blood glucose concentration after a 75 g oral glucose load and after intravenous injection of 0.15 U/kg short-acting insulin, though increases and decreases in the sensor output were slower than the glycaemic changes. The mean peak delay in sensor response after the oral glucose was 40 min (range 0-45 min) and the delay in the hypoglycaemic nadir was 4 min (range 0-15 min). In 5 insulin-dependent diabetic subjects, spontaneous and induced hypoglycaemia was detectable by the implanted sensor. In addition, marked and frequent oscillations in the sensor current occurred in several normal and diabetic individuals as the blood glucose fell below about 1.9 mmol/l. These oscillations were present in a diabetic subject who had lost adrenergic warning symptoms to hypoglycaemia. Continuous metabolic monitoring in diabetes, particularly the detection of hypoglycaemia, may be possible with implanted sensors based on this technology. PMID- 2666211 TI - Insulin stimulates skeletal growth in vivo and in vitro--comparison with growth hormone in rats. AB - The effect of insulin on skeletal growth was examined by (1) systemic injection, (2) local administration into the tibia growth plate and (3) in vitro by use of chondrocytes in culture. (1) Male rats, body weight 60-75 g, were hypophysectomised. One week after the operation, the animals were divided into three groups. Group A received intraperitoneally saline, group B insulin (5-30 U.kg-1.day-1) and group C human growth hormone (250 micrograms/kg/day) for the following 10 days. In addition, on day 10 the rats were injected with 10 mu-Ci 35 S-sulfate intraperitoneally. Twenty-four h later in the non-fasting state plasma glucose, insulin, somatomedin activity (porcine assay), body weight, nose-rump length, width of the tibia growth plate, and the 35-S-sulfate incorporation into rib cartilage were determined. Compared to saline, growth hormone and insulin treatment significantly enhanced body weights, nose-rump lengths, the widths of the proximal tibia growth plates and the incorporation of sulfate into rib cartilage. For the three skeletal growth parameters, growth hormone was more effective than insulin, while body weights did not differ after insulin or growth hormone treatment. Somatomedin activity (U/ml) was low in group A (0.39 +/- 0.04, n = 9, Mean +/- SEM) and group B (0.34 +/- 0.08, n = 8) and high in the growth hormone treated group C (0.90 +/- 0.09, n = 7; p less than 0.002). (2) To test the possibility that insulin might directly augment skeletal growth, insulin (80 mU) was injected into the proximal tibia growth plate of one leg and saline into the cartilage zone of the other leg.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 2666213 TI - The natural history of lymphocyte subsets infiltrating the pancreas of NOD mice. AB - A longitudinal study of lymphocytic infiltration in the endocrine pancreas of non obese diabetic mice was performed to investigate the role of different lymphocyte subsets in the pathogenesis of diabetes. The incidence of insulitis and the percentage of mononuclear cell subsets in the pancreas were evaluated in non obese diabetic mice of various ages (5, 9, 13, 17, 22, 29 and 36 weeks). Cryostat sections of pancreas were stained with heamatoxilin-eosin or with different monoclonal antibodies against total T lymphocytes, helper T lymphocytes, cytotoxic/suppressor T lymphocytes, activated interleukin 2 receptor positive lymphocytes and B lymphocytes. A monoclonal antibody against Class-II antigens was also used. Positive cells were revealed by the immunoperoxidase technique. Insulitis was found in 5 weeks old mice but to a lesser extent than in adult animals. No significant variation between infiltrating cell subsets was found in different age groups. T lymphocytes ranged between 20.4% and 28.1%, B lymphocytes between 28.8% and 30.8% and Class-II positive cells between 22.8% and 32.2%. Interleukin 2 receptor positive cells ranged between 5.5% and 8.5% as detected with AMT-13 monoclonal antibody which recognise the interleukin 2 binding site. A higher percentage of activated cells was observed using another monoclonal antibody (7D4) directed against a different epitope of the interleukin 2 receptor, suggesting the presence of activated lymphocytes with interleukin 2 receptors saturated by interleukin 2. No insulin-containing cells were found to express Class-II molecules as demonstrated by a double immunofluorescence technique. Most infiltrating mononuclear cells were found to be positive for Class-II and L3T4 antigens or to be Class-II positive and express surface immunoglobulins.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 2666214 TI - Mechanism for increased insulin-stimulated glucose metabolism in adipocytes from 13-week-old obese Zucker rats. AB - A study was made on the mechanism of increased glucose metabolism in enlarged adipocytes from 13-week-old obese Zucker rats showing hyperinsulinaemia and hyperglycaemia. Glucose metabolism was assessed by measuring CO2 production from glucose and the concentration of glucose transporters was estimated by immunoblotting. In comparing adipocytes from obese rats with those from lean rats, the basal rates of glucose oxidation at 0.02 mmol/l glucose increased 2.6 fold per unit cellular surface area and the transporters in the plasma membrane increased 1.4-fold per protein, while that in low-density microsome was 67% of the value in lean rats. The increase of glucose oxidation rates observed in basal cells from obese rats could be partly explained by translocation of the transporters from the intracellular site to the plasma membrane. In the presence of insulin, as the basal rates of glucose oxidation increased in obese rats, maximally insulin-stimulated oxidation increased 4-fold in lean rats and 1.7-fold in obese rats. Thus, the rates of insulin-stimulated oxidation on a per unit cellular surface area as well as the transporters on a per protein basis in the plasma membrane became almost similar in cells from both groups of rats. Since protein content per cell increased with cell enlargement, increased glucose metabolism per cell which was observed in adipocytes from the obese rats was mainly due to an increase of glucose transporters accompanied by a similar degree of cellular protein increase. PMID- 2666215 TI - Effect of a phospho-oligosaccharidic putative insulin messenger on insulin release in rats. AB - The phospho-oligosaccharide extracted from rat liver and supposed to act as the insulin second messenger inhibits glucose-stimulated insulin release. In the present study, this phospho-oligosaccharide was found not to affect D-[U 14C]glucose oxidation and 45Ca net uptake, but to inhibit insulin release evoked by either D-glucose or 2-ketoisocaproate in isolated rat islets. The relative extent of the latter inhibition was unaffected by either the concentration of D glucose or the presence of dibutyryl-cyclic AMP, forskolin or glucagon in the incubation medium. At variance with the inhibitory effect of clonidine, that of the phospho-oligosaccharide was resistant to both blockade of alpha 2-adrenergic receptors or pre-treatment with the toxin of Bordetella pertussis. It is speculated, therefore, that such a phospho-oligosaccharide might interfere with a distal event in the insulin secretory sequence. PMID- 2666216 TI - Hypertriglyceridaemia as a risk factor of coronary heart disease mortality in subjects with impaired glucose tolerance or diabetes. Results from the 11-year follow-up of the Paris Prospective Study. AB - The Paris Prospective Study is a long-term investigation of the incidence of coronary heart disease in a large population of working men. The first follow-up examination involved 7,038 men, aged 43-54 years. Subjects with impaired glucose tolerance or diabetes (n = 943) were selected from the total population for a separate analysis of coronary heart disease mortality risk factors. During a mean follow-up of 11 years, 26 of these 943 subjects with abnormal glucose tolerance died from coronary heart disease. Univariate analysis showed that plasma triglyceride level (p less than 0.006), plasma cholesterol level (p less than 0.02), and plasma insulin level both fasting and 2-h post-glucose load (p less than 0.02), were significantly higher in subjects who died from coronary heart disease compared to those who did not. In multivariate regression analysis using the Cox model, plasma triglyceride level was the only factor positively and significantly associated with coronary death. The distribution of plasma triglyceride levels was clearly higher for the subjects who died from coronary heart disease compared to those who did not die from this cause or were alive at the end of the follow-up. This new epidemiological evidence that hypertriglyceridaemia is an important predictor of coronary heart disease mortality in subjects with impaired glucose tolerance or diabetes suggests a possible role of dyslipidaemia in the excessive occurrence of atherosclerotic vascular disease in this category of subjects. PMID- 2666217 TI - Fasting plasma C-peptide, glucagon stimulated plasma C-peptide, and urinary C peptide in relation to clinical type of diabetes. AB - Many patients with Type 2 (non-insulin-dependent) diabetes mellitus are treated with insulin in order to control hyperglycaemia. We studied fasting plasma C peptide, glucagon stimulated plasma C-peptide, and 24 h urinary C-peptide in relation to clinical type of diabetes in 132 insulin treated diabetic subjects. Patients were classified clinically as Type 1 (insulin-dependent) diabetic subjects in the presence of at least two of the following criteria: 1) significant ketonuria, 2) insulin treatment started within one year after diagnosis, 3) age of diagnosis less than or equal to 40 years, and 4) weight below 110% of ideal weight of the same age and sex. Eighty patients were classified as Type 1 and 52 as Type 2 diabetic subjects. A second classification of patients into 6 C-peptide classes was then performed. Class I consisted of patients without islet B-cell function. Class II-VI had preserved islet B-cell function and were separated according to the 20%, 40%, 60% and 80% C-peptide percentiles. The two classifications of patients were compared by calculating the prevalence of clinical Type 1 and Type 2 diabetes in each of the C-peptide classes. This analysis showed that patients with a fasting plasma C-peptide value less than 0.20 nmol/l, a glucagon stimulated plasma C-peptide value less than 0.32 nmol/l, and a urinary C-peptide value less than 3.1 nmol/l, or less than 0.54 nmol/mmol creatinine/24 h, or less than 5.4 nmol/24 h mainly were Type 1 diabetic patients; while patients with C-peptide levels above these values mainly were Type 2.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 2666218 TI - Type 1 (insulin-dependent) diabetes in Japanese children is not a uniform disease. AB - The initial course of Type 1 (insulin-dependent) diabetes mellitus was studied in two groups of Japanese children, i.e. 21 patients with abrupt onset (Group A) and 19 patients detected by urine glucose screening at school with minimal or no symptoms (Group B). There was no statistical difference in mean age at diagnosis between Group A and B (11 +/- 3 years vs 11 +/- 3 years). Group A patients revealed a rapid deterioration of pancreatic B-cell function, but there was evident recovery of the B-cell function from 3 to 9 months following initial treatment. The B-cell capacity in Group B was self maintained until 24 months after diagnosis. Thereafter, even these patients exhibited a progressive decline in the B-cell function. The two groups had a similar incidence of islet cell antibodies at diagnosis (58% vs 69%). However, human leukocyte antigen studies revealed that patients in Group A had a significantly higher prevalence of DR4 and DRW9 than those in Group B (p less than 0.01). These results suggest that in Japanese children there are two forms of diabetes, an abrupt and a slow onset form, which are clinically different and which also seemed to be genetically independent types, or possibly the same disease diagnosed at different stages. PMID- 2666219 TI - Limitations of capillary plasma immunoreactive insulin assay as an epidemiological tool. PMID- 2666220 TI - The challenge of caring for the underserved. PMID- 2666221 TI - [Eosinophils and eosinophilia]. PMID- 2666222 TI - [Recent acquisitions concerning acute cerebral ischemia]. PMID- 2666223 TI - [Metabolic treatment of acute myocardial infarct]. PMID- 2666224 TI - [Evaluation of beta cell function in non-insulin-dependent diabetes mellitus (NIDDM) and its correlations with clinico-metabolic parameters]. AB - Authors studied plasma C-peptide in basal period and after stimulation with one mg of glucagon intravenous in 73 patients with NIDDM. The results have confirmed initial clinical diagnosis of NIDDM. Significative correlations were obtained between basal C-peptide and C-peptide response to glucagon (r = 0.861; p less than 0.01); delta C-peptide (difference between C-peptide basal and after response to glucagon) (r = 0.361; p less than 0.01); body mass index (r = 0.423; p less than 0.01). The significant correlations between basal C-peptide, C peptide response to glucagon and delta C-peptide show that basal C-peptide measurement is a sufficient test for beta-cell secretory capacity, even though do not give indicative signs for therapy choice of NIDDM for its multifactorial pathogenesis. PMID- 2666225 TI - [The diagnostic and therapeutic importance of esophago-gastro-duodenoscopy]. PMID- 2666226 TI - [Etiopathogenetic role of metabolic, circulatory, sex factors and type and duration of diabetes in diabetic retinopathy. Investigation with vitreofluorophotometry]. AB - We have studied metabolic, circulatory and vascular parameters in a group of 57 diabetics (37 affected by IDDM, 20 affected by NIDDM; 35 were males, 22 were females). Goals of present study were: 1) quantitative evaluation of the blood retinal barrier; 2) influence of the metabolic state, blood pressure, sex, type and duration of the diabetes on the ocular conditions; 3) relationship between ophthalmoscopic appearance of the retina and vitreous fluorophotometric recordings. We concluded that: a) ocular alterations depend by lipidic metabolism, blood pressure, sex, type and duration of the diabetes; b) vitreous fluorophotometry has proved a good device for early detection of retinal damages in the diabetic retinopathy. PMID- 2666227 TI - [Diagnosis and treatment of water-electrolyte depletion]. PMID- 2666228 TI - [Acid phosphatase]. PMID- 2666229 TI - [Naltrexone]. PMID- 2666230 TI - Developmentally regulated conversion of mesenchyme to epithelium. AB - Polarized epithelial cells perform many critical physiological functions in multicellular organisms. Recent embryological studies of the conversion of nonpolar mesenchymal cells to epithelium in the developing mouse kidney have provided vital information on the molecular mechanisms that initiate epithelial cell polarization. To become polar, the cells first attach to the basement membrane that is produced by the developing epithelial cells themselves. Of the basement membrane components, laminin has a key role in the development of epithelial cell polarity. Laminin is a multidomain glycoprotein composed of three subunits: A, B1, and B2. One binding site for epithelial cells is found in the carboxyl-terminal part of the A chain of laminin. Antibodies reacting with this part of laminin inhibit polarization of developing epithelial cells in organ cultures of embryonic kidneys. Expression studies also suggest that the A chain of laminin is important for epithelial cell polarization; the A chain appears when the cells begin to polarize, whereas B chains are expressed at an earlier stage of development. The studies of conversion of mesenchyme to epithelium suggest that morphogenesis can be controlled by differential expression of laminin chains. PMID- 2666231 TI - Structural and functional properties of ras proteins. AB - The ras proteins belong to a family of related polypeptides that are present in all eukaryotic organisms from yeast to human. Their extraordinary evolutionary conservation suggests that they have essential cellular functions, although their exact role remains unknown. Mutations in specific amino acids and overexpression of normal proteins have been linked to altered proliferation and/or differentiation and, particularly, to neoplastic processes. Mature ras proteins are located on the inner side of the plasma membrane, and their biochemical properties include binding and exchange of guanine nucleotides and GTPase activity. The favored hypothesis for ras function is that these proteins exist in an equilibrium between an inactive conformation (p21.GDP) and an active conformation (p21. GTP) in which they are able to interact with their as yet unknown cellular target or targets. Similarities in cellular location, structure, and biochemistry with other known regulatory (G) proteins suggest that they play a role in transduction of signals from the cell surface. The elucidation of the crystal structure of normal and transforming ras proteins and the identification of cellular proteins that interact directly with them (GAP, CDC25) or suppress some of their biological effects (Krev-1) have opened new avenues in the search for their elusive cellular targets and in the elucidation of the functional role of ras gene products. PMID- 2666232 TI - Role of glucocorticoids in the regulation of lipogenesis. AB - Traditionally, the glucocorticoids have been viewed as catabolic hormones. However, with the present knowledge about how the glucocorticoid receptor protein functions in the stimulation of mRNA synthesis, a new view must be accepted: These steroids also have an anabolic function. They are anabolic because they stimulate the de novo synthesis of enzymes of anabolic pathways. In the liver, stimulation of lipogenic enzymes has been shown. These findings suggest that glucocorticoids can increase feed efficiency and thereby play a role in the etiology of obesity. PMID- 2666234 TI - [The anaerobic threshold: interpretation and clinical usefulness]. PMID- 2666233 TI - Cooperative binding of two antibodies to independent antigens by an Fc-dependent mechanism. AB - Binding of a murine N-acetylglucosamine (GlcNAc)-specific IgG3 monoclonal antibody to a solid phase expressing GlcNAc determinants and phosphocholine (PC) determinants is enhanced by IgG3, but not IgG2b, PC-specific monoclonal antibody. The cooperative binding requires an intact Fc region on the GlcNAc-specific monoclonal antibody and is hypothesized to result from Fc-Fc association. Although the in vivo relevance of this phenomenon requires further study, intermolecular cooperativity in binding of antibody to multivalent antigens, such as bacterial cell wall antigens, could represent an adaptive mechanism for antibodies expressing low intrinsic affinities for highly repeated epitopes. Furthermore, the ability of antibodies of distinct specificity to participate in cooperative binding offers, at least in principle, new approaches to optimizing antibody targeting. PMID- 2666235 TI - [Acoustic, mechanical and electric alternans in heart tamponade. Clinical case and review of the literature]. AB - The uncommon observation of alternation of the first heart sound in intensity, associated with mechanical and electric alternans is reported in a patient with cardiac tamponade due to large hemorrhagic pericardial effusion. Following pericardiocentesis and removal of 400 millilitres of fluid, all alternation phenomena disappeared. The combination of three alternation phenomena may be a helpful physical diagnostic sign of cardiac tamponade. The possible mechanisms of the "alternans" are discussed. It is suggested that variations in ventricular filling and emptying are the relevant pathogenetic factors. PMID- 2666236 TI - [Prospective study of the function of the anal sphincter before and after hemorrhoidectomy]. AB - A prospective study was carried out on the anorectal function in patients with hemorrhoids (group H, n = 25) versus normal controls (group T, n = 22) and on the effect at three months of hemorrhoidectomy on sphincter function and anal continence. Hemorrhoidectomy was performed by the same surgeon using the standard Milligan Morgan procedure in all cases. All patients and controls underwent an anal manometry, a measure of the length of the anal sphincter and a saline continence test. Anal resting pressure was higher in group H as compared to group T before hemorrhoidectomy (136 +/- 32 cm H2O vs 98 +/- 19 p less than 0.001). After hemorrhoidectomy, and resting pressure was significantly lower (141 +/- 21 cm H2O vs 106 +/- 25 p less than 0.01). Anal length was similar in group H and in group T (50.2 +/- 6.6 mm vs 45 +/- 5.5 NS) but decreased significantly after hemorrhoidectomy (41.9 +/- 7.6 vs 50.3 +/- 7.3 p less than 0.01). Ultraslow waves were more often observed in patients with piles (60 p. 100 vs 9 p. 100 of normal controls). After hemorrhoidectomy ultraslow waves were less commonly encountered (25 p. 100 p less than 0.05). Anal leakage during the saline continence test was observed in 12 and 82 p. 100 of patients before and after hemorrhoidectomy, respectively (p less than 0.001). No anal leakage was observed in the control groups. After hemorrhoidectomy the mean volume of anal leakage was of 190 ml. In 35 p. 100 of the patients, anal leakage occurred before the anal infusion of 500 ml.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 2666237 TI - [Omeprazole (20 mg daily) compared to ranitidine (150 mg twice daily) in the treatment of esophagitis caused by reflux. Results of a double-blind randomized multicenter trial in France and Belgium]. AB - We report the results of a trial of omeprazole 20 mg daily versus ranitidine 150 mg b.i.d. in the short-term management of erosive or ulcerative esophagitis. The principal aim of the trial was to assess the healing rates of the esophageal lesions. The trial was conducted in 19 centers (16 in France and 3 in Belgium). The lesions of the esophageal mucosa were defined as follows: grade 2 (n = 112), round or linear erosions; grade 3 (n = 33), confluent erosions affecting the total esophageal circumference; or grade 4 (n = 11), erosions as described above plus deep ulcerations or peptic stenosis which did not need endoscopic dilatation. The main criterion was the complete healing of esophageal lesions after 4 weeks of treatment. Patients were randomly allocated to double-blind treatment with omeprazole or ranitidine. Clinical and endoscopic examinations were done on inclusion in the trial and at day 29 +/- 6, and again at day 57 +/- 6 if esophagitis was unhealed. No patient was excluded from the analysis on an "intention-to-treat" basis, and 25 patients were excluded from the "per protocol" analysis, mainly because of poor compliance with the trial protocol. The healing rate at weak 4 was 50 of 62 patients (81 p. 100) treated with omeprazole and 31 of 69 patients (45 p. 100) with ranitidine (p less than 0.001). The corresponding figures at week 8 were 58 of 61 (95 p. 100) and 40 of 61 (65 p. 100) (p less than 0.001). PMID- 2666239 TI - [M cell and lymphoid follicle associated epithelium of the digestive tract]. PMID- 2666238 TI - [Double-blind controlled study of the efficacy of nifuroxazide versus placebo in the treatment of acute diarrhea in adults]. AB - In a double-blind, controlled randomized trial, 88 adult patients with acute diarrhea (more than three watery stools per day) received either 400 mg of nifuroxazide twice daily or placebo for 5 days. The mean duration of diarrhea in the nifuroxazide group was 2.09 days versus 3.26 days in the placebo group (p less than 0.004). The number of bowel movements per day diminished and mucus disappeared more quickly in patients treated by nifuroxazide than in patients of the placebo group. Nifuroxazide was well tolerated and no side effects were observed. Nifuroxazide is an effective therapy for acute diarrhea and can be prescribed from the onset of diarrhea without waiting for stool culture results which can be late or negative. PMID- 2666240 TI - [Viral hepatitis in patients over 60 years of age. Clinical, etiologic and developmental aspects]. AB - The authors report a retrospective study of 78 cases of acute viral hepatitis observed from 1971 to 1985 in patients over 60. Viral hepatitis involved males as often as females. A, B, delta and non-A, non-B viruses were responsible for 11.5, 23.1, 5.1 and 60.3 p. cent of cases, respectively. From 1975 on, the frequency of non-A non-B viral hepatitis has reached 85 p. cent while blood transfusions appeared as the most important route of transmission. Outcome was severe in 10.3 p. cent of cases. Early in the course of disease, the risk of progression to cirrhosis was obvious and concerned 12 patients (1 out of 18 with B hepatitis, 3 out of 4 with D hepatitis, 8 out of 47 non-A non-B hepatitis). The long term prognosis (from three to five years) was not as poor as stated in previous studies. PMID- 2666242 TI - [Influence of malnutrition on insulin resistance in cirrhotic patients, studied with the euglycemic clamp]. PMID- 2666241 TI - [Hepatobiliary actinomycosis. Apropos of 3 cases with pseudocancerous aspects]. AB - Three cases of hepatobiliary actinomycosis are reported. In all cases, carcinoma was initially suspected. One patient underwent cytoaspiration under sonographic guidance. Diagnosis was obtained by autopsy in one case, laparotomy and biopsy in the other cases. Confusion with cancer is frequent in actinomycosis, especially in hepatic lesions. PMID- 2666243 TI - [Hepatic cytoprotection (1). Morphologic aspects of cell death]. PMID- 2666244 TI - [Hepatic cytoprotection (2). Mechanisms of toxicity of phagocytic cells. Protective systems]. PMID- 2666245 TI - [Hepatic cytoprotection (3). Mechanisms of protection against the hepatotoxicity of drugs]. PMID- 2666246 TI - [Esophageal cinescintigraphy and esophageal motor disorders]. PMID- 2666247 TI - [Surgical treatment of gastroesophageal reflux in adults. Towards a simplification of therapeutic choices]. PMID- 2666248 TI - [Cystic dystrophy on aberrant pancreas. Contribution of ultrasound-endoscopy]. AB - Cystic dystrophy of aberrant pancreatic tissue without chronic pancreatitis is a rare disease described by Potet and Duclert in 1970. Clinical diagnosis is possible by endoscopy and intraluminalsonography; we report the first case diagnosed by intraluminalsonography. PMID- 2666249 TI - Placebo-controlled trial with the somatostatin analogue SMS 201-995 in peptic ulcer bleeding. AB - A 5-day, double-blind, placebo-controlled, multicenter trial in 23 centers with a total of 273 patients [241 evaluable patients; 126 on placebo and 115 on a long acting somatostatin analogue (SMS 201-995, octreotide, Sandostatin)] resulted in no difference in stopping bleeding and preventing rebleeding between placebo (70.6%) and SMS 201-995 (69.6%). Surgery rates, blood transfusion requirements, and time required before bleeding stopped were also not significantly different between the two groups. A retrospective subgroup analysis according to age, sex, localization of the ulcers, severity of the bleeding, and arterial spurting vs. oozing showed homogeneity and did not allow identification of a subgroup that might benefit from treatment with SMS 201-995. The tolerability of SMS 201-995 was very good. No difference was found between placebo and SMS 201-995 with regard to the side-effect profile. PMID- 2666250 TI - Mast cells are closely apposed to nerves in the human gastrointestinal mucosa. AB - Mast cell/nerve associations have been recorded in several publications; however, the human gastrointestinal tract has received little attention. Accordingly, mucosal samples from small bowel, appendix, and large bowel were studied. Combined histochemical/immunocytochemical techniques revealed that the proportion of mast cells apposed to nerves ranged from 47.08% +/- 6.10% to 77.66% +/- 4.26%. The highest incidence of contact was observed in the appendix; where the apparent nerve density was also greater than in the large or small bowel. Electron microscopic studies revealed many mast cells adjacent to nerve fibers and membrane-to-membrane contact between axonlike processes and mast cells. Often, these processes were dilated, as were axons in adjacent nerve fibers. These data provide a microanatomic basis for potential communication between nerves and mast cells in the human gastrointestinal mucosa. This may be of physiologic significance in the normal individual and important in disease processes, such as inflammation and fibrosis. PMID- 2666251 TI - Sensitivity, specificity, and positive predictivity of the Hemoccult test in screening for colorectal cancers. The University of Minnesota's Colon Cancer Control Study. AB - Data are presented on the sensitivity, specificity, and positive predictivity of the Hemoccult test based on the experience of the Minnesota Colon Cancer Control Study, a randomized clinical trial to determine whether the use of the Hemoccult test can reduce mortality from colorectal cancer. Rehydrating the slides with a drop of water before processing resulted in an increase in positivity (2.4% to 9.8%), and sensitivity (80.8% to 92.2%) but a decrease in specificity (97.7% to 90.4%) and positive predictivity (5.6% to 2.2%). The effects of age and sex were also evaluated. The test was less specific for men than women (p = 0.03). Specificity was highest for those less than 60 yr of age and decreased with increasing age (p = 0.05). The positive predictivity increased with age from 1.6% for those under 60 yr to 3.6% for those over 70 yr (p = 0.0004). PMID- 2666252 TI - Ultrasonography in the diagnosis of acute appendicitis: a prospective study. AB - The diagnostic accuracy and practical impact of high-resolution sonography were prospectively studied in 523 consecutive patients admitted to the hospital with suspected appendicitis. The criteria for ultrasound diagnosis of acute appendicitis included visualization of a noncompressible aperistaltic appendix, with a targetlike appearance in transverse view and a diameter greater than or equal to 7 mm. In 115 of 130 patients with proven appendicitis the inflamed appendix or appendiceal abscess could be visualized, giving a sensitivity of 88.5%. The mean diameter of ultrasonically visible appendices was 11.4 +/- 3.2 mm. The overall accuracy and specificity of sonography in the diagnosis of acute appendicitis were 95.7% and 98%, respectively. The predictive value of a positive test was 94.5% and that of a negative result 96.3%. In a separate analysis of the results in 121 women of childbearing age, who have a high risk of preoperative misdiagnosis, the overall accuracy was found to be 96.7%, with 82.6% sensitivity and 100% specificity. Twenty-four (89%) of the 27 patients with appendiceal rupture (incidence 20.8%) were correctly diagnosed with ultrasound. The other 3 cases (11%) were missed. Routine use of ultrasonography has significantly improved the diagnostic accuracy in patients with suspected appendicitis and has reduced the negative laparotomy rate from 22.9% to 13.2%. PMID- 2666253 TI - Evidence for disease recurrence after liver transplantation for primary biliary cirrhosis. Clinical and histologic follow-up studies. AB - Twenty three patients with primary biliary cirrhosis surviving for greater than 1 yr after liver transplantation were studied. All reported marked symptomatic improvement, and had significant falls in serum bilirubin, alkaline phosphatase (p less than 0.0001), immunoglobulin M, and antimitochondrial antibody levels (p less than 0.005). Beyond 1 yr, liver biopsies showed features compatible with disease recurrence in 9 of 10 patients, and a further 4 patients developed pruritus or associated abnormalities. Immunoglobulin M levels were raised in 80%, with elevated antimitochondrial antibody titers in all those tested. Cyclosporine treatment in some patients initially given prednisone and azathioprine was followed by regression of histologic abnormalities. Of 102 patients with nonprimary biliary cirrhosis followed similarly, 50 underwent biopsy, and although 12 showed features of bile duct damage, all had additional histologic and clinical changes supporting an alternative diagnosis. These findings are consistent with previous reports that primary biliary cirrhosis can recur after transplantation, possibly modified by the use of cyclosporine. PMID- 2666254 TI - Arachidonic acid metabolites in hepatobiliary physiology and disease. AB - Arachidonic acid metabolites are involved in a wide spectrum of hepatobiliary physiologic functions and disease. Prostanoids alter hepatic bile flow. Prostaglandins with a C9 ketooxygen stimulate a bicarbonate-rich choleresis and those with a C9 hydroxyloxygen produce a chloride-rich choleresis. Prostaglandin F2 alpha stimulates the release of the potent choleretic glucagon and the stimulatory effect of prostaglandin F2 alpha on bile flow is inhibited by cyclooxygenase inhibitors, suggesting that prostaglandins play a role in the release of choleretic hormones as well as in their action. Prostanoids are involved in gallbladder contraction and water absorption. Prostaglandins produce gallbladder contraction in various species and cause gallbladder relaxation in other species. Prostaglandins also may be mediators of cholecystokinetic hormone action; however, cyclooxygenase inhibitors do not inhibit the effect of cholecystokinetic hormones in all species. Prostanoids alter the normal process of water absorption by gallbladder mucosa and induce net water secretion. The inflamed gallbladder secretes rather than absorbs fluid. The demonstration that prostaglandin E2 inhibits gallbladder fluid absorption has led to subsequent studies that demonstrated that the secretion of fluid into the inflamed gallbladder lumen may be mediated by prostanoids. In cholecystitis, the prostanoids may mediate the distention produced by mucosal fluid secretion and the contraction of the diseased gallbladder. The inflammatory changes produced in various experimental models of cholecystitis can be prevented by cyclooxygenase inhibitors. Cyclooxygenase inhibitors decrease gallbladder prostaglandin formation and are effective in producing relief of the symptoms of gallbladder disease. In experimental cholesterol gallstone formation, prostaglandins are involved in the production of mucin, which acts as a nidus for stone formation, and cyclooxygenase inhibitors prevent the formation of experimental cholesterol gallstones. Prostaglandins have been shown to be cytoprotective in various types of experimental hepatic injury and leukotrienes have been shown to be injurious to hepatocytes and biliary tract tissues. Specific prostanoids and lipoxygenase inhibitors may be valuable in treating patients with various acute hepatic inflammatory disease processes. Continued evaluation of the role of arachidonic acid metabolites in hepatobiliary physiology and disease may lead to important new therapeutic modalities. PMID- 2666255 TI - Pharmacotherapy of bleeding peptic ulcer--is it time to give up the search? PMID- 2666256 TI - Insulin action on different smooth muscle preparations. AB - 1. The importance of insulin in diabetic gastro-intestinal complications has been postulated. The present study was designed to investigate short-term effect of insulin on different smooth muscles isolated from non-diabetic animals. 2. The contractile responses of isolated guinea-pig ileum to acetylcholine and histamine and the serotonin-induced contractions of rat stomach fundus strips were inhibited by insulin in a non-competitive manner. The contractions of rat vas deferens elicited by noradrenaline and tyramine were also inhibited in the presence of insulin. 3. Insulin caused dose-dependent relaxation on the isolated rat duodenum. The relaxing response to insulin was not affected in the presence of atropine, phentolamine, propranolol, nicotinic acid, tetrodotoxin, tetraethylammonium, ouabain and nifedipine. The relaxing effect of insulin on the isolated rat duodenum was inhibited by sodium orthovanadate, trifluoperazine, verapamil, aspirin and dexamethasone, non-competitively. 4. The above results strongly suggest that the relaxing or inhibitory effect of insulin on the smooth muscles is closely related with prostanoid metabolism. Furthermore, it is concluded that this effect of insulin on the smooth muscles may be due to activation of Ca2+-pump ATPase(s). PMID- 2666257 TI - Patrick A.P. Moran, 1917-1988: in memoriam. PMID- 2666258 TI - The third cellulase of alkalophilic Bacillus sp. strain N-4: evolutionary relationships within the cel gene family. AB - The third cellulase gene (celC) of Bacillus sp. strain N-4 was cloned in plasmid pBR322 and was located within a 5.5-kb HindIII fragment. The cellulase encoded by this fragment had an Mr of about 100,000 and showed optimum activity around pH 9. These properties were different from those of the enzymes encoded by the celA and celB genes of the same organism. The amino acid sequence deduced from the nucleotide sequence was found to be highly homologous to the CEL-F enzyme from Bacillus sp. strain No. 1139 [Fukumori et al., J. Gen. Microbiol. 132 (1986) 2329 2335]. An evolutionary relationship observed among the four cellulases of alkalophilic Bacillus strains and that of Bacillus subtilis endoglucanase suggested that ancestral genes for alkaline and neutral cellulases diverged early in the evolution of these enzymes. PMID- 2666259 TI - Cloning of ara, a putative Arabidopsis thaliana gene homologous to the ras related gene family. AB - A putative Arabidopsis thaliana gene, ara, homologous to the ras-related gene family was isolated from a genomic library by low-stringency hybridization with a v-Ha-ras probe. The putative gene has a coding frame for a 218-residue protein (Mr 24,210), which is interrupted by one intron. The amino acid residues conserved in proteins of the ras gene family, which are important for GTP binding, GTP hydrolysis and membrane attachment, are also present in the ara protein. An unusually long homopyrimidine-homopurine tract was found about 100 bp upstream from the methionine start codon. A unique sequence, 5' AACAAAACCAAAGTGATATGC-3', was found three times in the 5'-noncoding region and once in the intron. PMID- 2666260 TI - Participation of the hup gene product in site-specific DNA inversion in Escherichia coli. AB - The closely related Escherichia coli genes hupA and hupB each encode a bacterial histone-like protein HU. We report here that DNA inversion mediated by hin, gin, pin and rci but not by cin is blocked in a hupA hupB double mutant, although inversions in these systems occur in the hupA or hupB single mutant as efficiently as in the wild-type strain. These findings show that HU protein participates in site-specific DNA inversion in E. coli and that only one subunit, either HU-1 or HU-2, is sufficient for this inversion. PMID- 2666261 TI - Participation of hup gene product in replicative transposition of Mu phage in Escherichia coli. AB - The closely related Escherichia coli genes hupA and hupB each encode a bacterial histone-like protein HU. We report here that mutator phage Mucts62 was unable to replicate in a hupA hupB double mutant, although it could replicate in hupA or hupB single mutant as efficiently as in the wild-type strain. Mucts62 was able to lysogenize the double mutant at 30 degrees C; cell killing occurred when the lysogen was incubated at 42 degrees C, but did not result in phage production. High-frequency non-replicative integration of Mu into host genomic DNA soon after infection could not be detected in the hupAB double mutant. These results provide the evidence that HU protein is essential for replicative transposition of Mu phage in E. coli, and also participates in high-frequency conservative integration. PMID- 2666262 TI - Molecular analysis of one of multiple protease-encoding genes from the prototype virulent strain of Bacteroides nodosus. AB - The aim of these studies was to examine the organization of the Bacteroides nodosus protease-encoding gene(s). The extracellular serine proteases (38 kDa) from the prototype virulent strain of B. nodosus were purified and used to raise a specific antiserum in rabbits. This antiserum was used in a colony immunoassay to screen a genomic DNA library constructed in Escherichia coli using BamHI digested B. nodosus DNA and the plasmid pBR322. An E. coli clone expressing a 50 kDa immunoreactive polypeptide was identified. No protease activity was detected in the culture media, or in crude soluble and membrane fractions prepared from this clone. Restriction mapping and deletion analysis of the recombinant plasmid, pEKM2, was used to locate the coding region to a 1.4-kb EcoRI-BamHI fragment which was subsequently sequenced. A large open reading frame was found to extend through the BamHI site from a putative start codon just downstream from the EcoRI site, which indicated that the complete gene was not isolated. Southern blotting demonstrated that there were at least three B. nodosus BamHI fragments which were homologous to the 0.4-kb PstI-BamHI fragment of pEKM2. Based on these results the existence of multiple protease genes in B. nodosus was postulated. PMID- 2666263 TI - The expression in Escherichia coli of a synthetic gene coding for the precursor of papain is prevented by its own putative signal sequence. AB - A 1048-bp gene coding for prepropapain was assembled from chemically synthesized oligodeoxyribonucleotides and cloned into a variety of Escherichia coli expression plasmids. We observed loss of plasmid when the preproP gene was expressed in E. coli either as the native precursor or fused at the C terminus of the first 592 amino acids (aa) of beta-galactosidase (beta Gal). Deletion of the putative 26-aa signal peptide (pre-region) increased plasmid stability. The level of maintenance for the different plasmid constructs correlated with the level of expression detected by immunoblotting. Constitutive expression of the beta Gal propapain fusion generated insoluble granules in a protease-deficient E. coli host. The fusion protein was easily purified to near homogeneity by differential solubilization of the granules. PMID- 2666264 TI - Cloning and nucleotide sequence of the phosphoenolpyruvate carboxylase-coding gene of Corynebacterium glutamicum ATCC13032. AB - As a first step in determining the importance of the anaplerotic function of phosphoenolpyruvate carboxylase (PEPC) in amino acid biosynthesis, the ppc gene coding for PEPC of Corynebacterium glutamicum ATCC13032 has been cloned by complementation of an Escherichia coli ppc mutant strain. PEPC activity encoded by the cloned gene is not affected by acetyl-CoA under conditions where the E. coli enzyme is strongly activated, whereas acetyl-CoA is able to relieve inhibition by L-aspartate used singly or in combination with alpha-ketoglutarate. Amplification of the ppc gene in a C. glutamicum lysine-excreting strain resulted in increased PEPC-specific activity and lysine productivity. The nucleotide sequence of a DNA fragment of 4885 bp encompassing the ppc gene has been determined. At the amino acid level, PEPC from C. glutamicum presents overall a high degree of similarity with corresponding enzymes from three different organisms. The location of some strictly conserved regions may have important implications for PEPC activity and allostery. PMID- 2666265 TI - Cloning and nucleotide sequence of ovine prolactin cDNA. AB - A cDNA expression library was constructed in the lambda gt 11 phage vector using ovine (o) pituitary mRNA. The clone, pOP1, carrying a 934-bp insert contains an open reading frame beginning with the first nucleotide (nt) and ending with the stop codon TAA at nt position 781. Two potential translation start codons (ATGs) are present in the 5' region of this cDNA. Translation initiation could occur at the 5' proximal ATG at nt position 61. The nucleotide sequence around this ATG (TCCATGG), resembles the optimum sequence context for translation initiation by the eukaryotic ribosomes, as defined by mutational analysis [Kozak, Cell 44 (1986) 283-292)], with its substitution of the A at -3 of the consensus sequence by a T residue in this clone. Translation initiated at this codon could potentially code for the entire pre-prolactin (pre-PRL) molecule. The 3' untranslated region is 154 nt long and contains a polyadenylation signal AATAAA. The deduced amino acid sequence agrees in totality with the published amino acid sequence of the mature hormone. The present study reports on the nucleotide sequence of o-PRL mRNA and the deduced amino acid sequence in the signal peptide of the hormone. PMID- 2666266 TI - Acute decompensation in dementia: recognition and management. AB - Dementing illnesses are chronic disorders causing global impairment of intellectual function. The most common cause is Alzheimer's disease, and this, together with most other forms of dementing illness, is relentlessly progressive. Frequently, however, there is an abrupt deterioration in physical, behavioral, or cognitive function in someone who is known to suffer from a dementing illness. This article outlines an approach to the many factors capable of producing such acute decompensation. PMID- 2666267 TI - True anemia: incidence and significance in the elderly. AB - The incidence of anemia increases as humans age, but in healthy aging individuals followed longitudinally, significant anemia does not develop in the absence of disease. Mild lymphopenia, as well as abnormal platelet function tests and increased coagulability when measured in vitro, also tend to develop in aging individuals. Hematologic neoplasia in the elderly behaves very similarly to the way it does in young individuals, but elderly individuals with hematologic neoplasms have a poor response to therapy. PMID- 2666268 TI - Managing diabetes-related infections in the elderly. AB - The elevated serum glucose levels of diabetics affect traditional host defenses, predisposing these individuals to infectious processes. The elderly diabetic patient is also faced with senescence of the immune system which can alter host defense mechanisms and increase the risk of infection. Infections in elderly diabetics can be severe and life-threatening, and only through the prompt recognition and treatment of these disorders can morbidity and mortality be avoided. Broad-spectrum antimicrobial agents, in conjunction with surgical intervention, are often necessary to eradicate these infections. Common sites of involvement include the skin, biliary tract, urinary tract, and the soft tissues and bones of the feet. PMID- 2666269 TI - NSAID-induced gastropathy in the elderly: understanding and avoidance. AB - Nonsteroidal anti-inflammatory drugs (NSAIDs) are a significant cause of gastric mucosal injury and bleeding, particularly in elderly patients. The mechanism of this injury appears to be, at least in part, a disruption of normal cytoprotective mechanisms by the inhibition of prostaglandin production. Acute injury results from the local effect of some drugs and may resolve with time. Chronic injury may occur with any NSAID and may often be asymptomatic until a complication occurs. Treatment of either lesion centers around NSAID withdrawal and standard ulcer therapy. Although routine prophylaxis of all patients is not indicated, those patients with a history of NSAID injury or other risk factors may need preventive measures if they are treated with NSAIDs. Oral prostaglandins, such as misoprostol, are effective in the prevention of NSAID induced injury. The efficacy of sucralfate and H2-blockers in this setting appears promising but requires further study. PMID- 2666270 TI - Preventive care: what it's worth in geriatrics. AB - Though aging is a lifelong process, many persons think of their aging only late in their lives. By this time many have in fact accelerated their aging or developed diseases that may otherwise never have occurred. This article focuses on measures that, if followed throughout one's lifetime, may improve functional status during one's later years. Environmental factors and diet are a few of the areas discussed. PMID- 2666271 TI - Practice guidelines for Medicare: needed or a nuisance? PMID- 2666272 TI - In memory of Claude Pepper, a friend to medical progress. PMID- 2666273 TI - Gold in gray: reflections on business' discovery of the elderly market. AB - Changes in the business sector's stereotype of the elderly population from a negligible consumer group to a $500 billion market are examined, with attention to both the positive and the problematic aspects of the new targeting of older consumers. Privatization, consumerism, and the rise of a geriatric social industrial complex are among the concepts used to understand recent trends. Questions are raised concerning the extensive targeting of the new elderly population market and the ethical dilemmas it may pose in a heavily consumer oriented society. PMID- 2666274 TI - The home care crisis of the nineties. AB - The supply of acceptable quality, paid custodial home care is threatened by the increasingly precarious financial condition of providers. Examined were the trends of the publicly-owned, for-profit providers. Restrictive public payments and the lack of private insurance coverage have contributed to the financial woes. Changes are urgently needed which address the financing of home care. PMID- 2666275 TI - A community-wide effort to reduce hospital utilization by patients requiring nursing home placement. AB - Described is an effort by health care providers to reduce hospital utilization by increasing admissions to skilled nursing facilities from hospitals. For a 6-month period, there were increased admissions from hospitals to nursing homes and a reduced number of hospital nonacute patients who required long-term care placement. Eventually, however, the nursing homes shifted their admission patterns to accept more persons from non-hospital settings. As a result, admissions from hospitals declined and the number of nonacute patients in hospitals increased. PMID- 2666276 TI - Perceptions and attitudes toward sexuality of the elderly during the Middle Ages. AB - Major historical themes from the European Middle Ages regarding the sexuality of the elderly were identified in literature, art, and historical works. It is proposed that thoughts on the ages of life excluded the elderly from having normal sex lives. Also proposed is that the church of the Middle Ages defined sexual behavior by the elderly as immoral. PMID- 2666277 TI - Differential effects of family-based strategies on Alzheimer's disease. AB - Assessed was the efficacy of a home-based program of cognitive stimulation for the functional status of patients with Alzheimer's disease, as well as the well being of caregivers. Ten family dyads (caregiver and patient) participated in the intervention and six family dyads formed the comparison group. Patients in the program maintained their levels of cognitive and behavioral functioning while improving emotionally, whereas the comparison group patients deteriorated. Similarly, the caregivers in the program maintained well-being and enhanced their coping resources. PMID- 2666278 TI - Oxidative influence on development and differentiation: an overview of a free radical theory of development. AB - Metabolic gradients exist in developing organisms and are believed to influence development. It has been postulated that the effects of these gradients on development result from differential oxygen supplies to tissues. Oxygen has been found to influence the course of development. Cells and tissues in various stages of differentiation exhibit discrete changes in their antioxidant defenses and in parameters of oxidation. Metabolically generated oxidants have been implicated as one factor that directs the initiation of certain developmental events. Also implicated as factors that modulate developmental processes are the cellular distribution of ions and the cytoskeleton both of which can be influenced by oxidants. The interaction of oxidants with ion balance and cytoskeleton is discussed. PMID- 2666279 TI - Oxygen radical chemistry of polyunsaturated fatty acids. AB - Polyunsaturated fatty acids (PUFA) are readily susceptible to autoxidation. A chain oxidation of PUFA is initiated by hydrogen abstraction from allylic or bis allylic positions leading to oxygenation and subsequent formation of peroxyl radicals. In media of low hydrogen-donating capacity the peroxyl radical is free to react further by competitive pathways resulting in cyclic peroxides, double bond isomerization and formation of dimers and oligomers. In the presence of good hydrogen donators, such as alpha-tocopherol or PUFA themselves, the peroxyl radical abstracts hydrogen to furnish PUFA hydroperoxides. Given the proper conditions or catalysts, the hydroperoxides are prone to further transformations by free radical routes. Homolytic cleavage of the hydroperoxy group can afford either a peroxyl radical or an alkoxyl radical. The products of peroxyl radicals are identical to those obtained during autoxidation of PUFA; that is, it makes no difference whether the peroxyl radical is generated in the process of autoxidation or from a performed hydroperoxide. Of particular interest is the intramolecular rearrangement of peroxyl radicals to furnish cyclic peroxides and prostaglandin-like bicyclo endoperoxides. Other principal peroxyl radical reactions are the beta-scission of O2, intermolecular addition and self combination. Alkoxyl radicals of PUFA, contrary to popular belief, do not significantly abstract hydrogens, but rather are channeled into epoxide formation through intramolecular rearrangement. Other significant reactions of PUFA alkoxyl radicals are beta-scission of the fatty chain and possibly the formation of ether linked dimers and oligomers. Although homolytic reactions of PUFA hydroperoxides have received the most attention, hydroperoxides are also susceptible to heterolytic transformations, such as nucleophilic displacement and acid-catalyzed rearrangement. PMID- 2666280 TI - Oxygen toxicity and reactive oxygen metabolites in mammals. AB - The current hypothesis for the damage caused to mammalian tissues by hyperoxia is that oxygen radicals and related reactive oxygen metabolites are formed at rates which exceed the ability of the cells' natural antioxidant defense mechanisms to detoxify these deleterious products. In this review a very brief description of oxygen pathology is given together with data on the relevance of in vivo tissue pO2 levels. After a short historical account of the biochemistry of oxygen toxicity in the pre-radical days. the evidence for the current status of the radical theory is reviewed. This covers the probable sources of excess reactive oxygen metabolite generation under conditions of increased oxygen tension, and the measurement of the reactive species thought to be important in causing this damage. The large volume of circumstantial evidence, including the production of tolerance, raising or lowering antioxidant defenses and the administration of exogenously produced radicals is considered. PMID- 2666281 TI - What is sphincter of Oddi dysfunction? AB - Ever since its description approximately 100 years ago, the sphincter of Oddi has been surrounded by controversy. First, whether it indeed existed, second, whether it had a significant physiological role in man and more recently whether abnormalities in its function give rise to a clinical syndrome. Data from animal and human studies, using sensitive techniques, have helped define the physiological role of the sphincter of Oddi, and more recent studies are determining the factors which control sphincter of Oddi function. These studies support Oddi's original description that the sphincter has a major role in the control of flow of bile and pancreatic juice into the duodenum, and equally importantly helps prevent the reflux of duodenal contents into the biliary and pancreatic ductal systems. The controversy of whether abnormalities in sphincter of Oddi motility result in clinical syndromes has not been totally resolved. Part of the difficulty has been inability to document normal and hence abnormal function of the sphincter. With the emergence of endoscopic biliary manometry as a sensitive and reproducible technique, however, the motility of the human sphincter of Oddi has come under closer scrutiny and allowed definition of possible disorders. We have used the term sphincter of Oddi dysfunction to define manometric abnormalities in patients who present with signs and symptoms consistent with a biliary or pancreatic ductal origin. Based on the manometry, we have subdivided the dysfunction into two groups; a group characterised by a stenotic pattern - that is, raised sphincter basal pressure - and a second group having a dyskinetic pattern - that is, paradoxical response to cholecystokinin injection, rapid contraction frequency, high percentage of retrograde contractions, or short periods of raised basal percentage of retrograde contractions, or short periods of raised basal pressure. It is apparent from the mamometry but also from the clinical data that the patients are a heterogeneous group and thus any therapy would need to be tailored for each patient and abnormality. The most recent therapeutic data suggest that patients with the stenotic pattern on manometry respond to division of the sphincter, however, those patients with the dyskinetic manometric pattern show no significant effect after sphincterotomy. Further prospective trials evaluating therapeutic options are under way and their results are eagerly awaited. PMID- 2666282 TI - Prophylactic endoscopic sclerotherapy of oesophageal varices in liver cirrhosis. A multicentre prospective controlled randomised trial in Vienna. AB - The effect of prophylactic treatment of oesophageal varices by endoscopic injection sclerotherapy before the first episode of variceal haemorrhage was studied in patients with cirrhosis in a prospective, randomised and controlled multicentre trial. From February 1984 to March 1987 patients with liver cirrhosis and large varices (stage III-IV according to Paquet) were treated and followed up. The sample comprised 87 patients: 45 in the prophylactic treatment and 42 in the control group. After excluding drop outs, 41 patients were treated in each group. Twenty nine per cent of patients in the sclerotherapy group and 34% in the control group had a variceal haemorrhage during the period of observation. There was no significant difference in the distributions of the bleeding free intervals between the sclerotherapy and the control groups. During the follow up period 24% of patients in the sclerotherapy group and 46% in the control group died. The distribution of survival times indicates a tendency towards longer survival of patients with prophylactic sclerotherapy, particularly in those with alcoholic cirrhosis. PMID- 2666283 TI - Human monoclonal antibodies directed against ovarian carcinoma. AB - In order to obtain human monoclonal antibodies for immunodetection or treatment of ovarian carcinoma, we generated hybridomas by fusing peripheral blood lymphocytes of patients with ovarian carcinoma and the mouse myeloma cell line X63.Ag8.653. The patients were immunized prior to collection of peripheral blood lymphocytes with autologous tumor cells admixed with New Castle Disease Virus. Immunocytologic studies of hybridoma supernatant with tumor cells fixed with methanol and air-dried tumor cells indicated that all 14 antibodies reactive with tumor cells were directed against cytoplasmic or nuclear antigens. One hybridoma designated as 1B3 was very stable and secreted a specific IgM antibody. This cell line expanded in nude mice and the monoclonal antibody 1B3 was effectively purified from ascites or supernatant fluid. In experiments with tissue sections partly derived from the patient whose peripheral blood lymphocytes were used for fusion, biotinylated 1B3 recognized ovarian tumor cells. There was no significant cross-reaction against normal tissue from stomach, small intestine, colon, lung, kidney, endometrium, placenta, or lymph node. Mammary carcinoma preparations were also stained by 1B3 while normal breast tissue was negative. PMID- 2666284 TI - Preoperative assessment of myometrial invasion of endometrial adenocarcinoma by sonography (US) and magnetic resonance imaging (MRI). AB - The presence and/or depth of myometrial invasion of endometrial adenocarcinoma has important prognostic and therapeutic implications. Fifteen patients with histologically proven endometrial cancer underwent preoperative evaluation with sonography (US) and magnetic resonance imaging (MRI) to assess depth of invasion. Using criteria of greater than or equal to 50% of myometrial wall involvement as representing deep invasion, and less than 50% as superficial invasion, US was more accurate than MRI in five cases; in three MRI was more accurate than US; both MRI and US were equally accurate in four; neither was accurate in three. Polypoid lesions caused the greatest number of false positive reports of deep invasion with both MRI and US. Preliminary results indicate that US and MRI have promise as preoperative tests to assess the extent of myometrial invasion. PMID- 2666285 TI - Vaginal endometrioid adenocarcinoma arising in vaginal endometriosis: a case report and literature review. AB - Presented here is the seventh reported case of vaginal endometrioid adenocarcinoma arising in vaginal endometriosis. This case has unique features. There is no evidence of endometriosis elsewhere, and the only metastasis is seen in one obturator lymph node. Thorough preoperative and intraoperative evaluation is stressed. PMID- 2666286 TI - Primary squamous carcinoma of the ovary: a case report and review of the literature. AB - Only three cases of primary squamous carcinoma of the ovary have been reported to date. This fourth case serves to illustrate similarities between all known cases of this tumor. This tumor presents primarily as a simple cyst or has a major cystic component. Three of the reported cases (including the present one) had a prior diagnosis of carcinoma in situ of the uterine cervix. Accurate surgical staging and complete tumor excision appear to be optimal therapy for squamous carcinoma of the ovary. PMID- 2666287 TI - Stage IV endometrial carcinoma in a 25-year-old woman: a case report and review of the literature. AB - Presented is a case of endometrial adenocarcinoma FIGO stage IV grade III in a 25 year-old woman with no evidence of any associated disease or known risk factors. To the best of the authors' knowledge this association has not been reported previously. PMID- 2666288 TI - Susceptibility of multidrug-resistant isolates of Klebsiella pneumoniae to silver nitrate. AB - Multidrug-resistant (MDR) clinical isolates of Klebsiella pneumoniae were checked for their sensitivity toward silver nitrate by the tube-dilution method. Nearly 75% of MDR strains could be successfully inhibited by 5 mg/L of silver nitrate. A significant correlation was observed between incidence of silver and trimoxazole resistance and silver and kanamycin resistance in these isolates. The genetic linkage of these two properties could not be proved since simultaneous curing and co-transfer studies gave negative results. PMID- 2666290 TI - [The effect of cytokines on myelopoiesis. Origin, regulation of secretion and biological activity]. AB - Recombinant DNA technology has been central in answering some of the most relevant questions in research of the regulation of the functional status of hematopoietic progenitor cells and their progney. This article focuses on recent results that have emerged from studies utilizing recombinant growth factor molecules regulating hemopoietic blood cell development and activation. The following points are considered: biological characteristics of hemopoietic growth factors and synergizing factors, their role in the regulation of hemopoiesis and activation of normal and leukemic cells, their cellular origin, and regulation of production. PMID- 2666289 TI - Effect of medium on the bacteriocin production by Klebsiella pneumoniae. AB - The influence of growth media and media constituents on bacteriocin production by Klebsiella pneumoniae was studied. Among the standard laboratory media used trypticase soy broth (TSB) showed the maximum production and poor yields resulted from growth in peptone water and nutrient broth. A number of peptones differed in their bacteriocin production. Best yields were observed in tryptone and proteose peptone water. Addition of 1% yeast extract to TSB further stimulated bacteriocin production. However, activity was low when glucose, glycine, sodium mercaptoacetate or bile salt mixture were added to the medium. Suppression of synthesis by certain agents as well as inhibition of formed bacteriocin by the others appears to affect the bacteriocin yield. No proteinase activity was detected during the entire incubation period. PMID- 2666291 TI - [The historical development of local treatment of burns]. PMID- 2666292 TI - [Computerized electrocardiography: some references for comparison]. PMID- 2666293 TI - A multicenter, randomized, double-blind study comparing once-daily bedtime administration of famotidine and ranitidine in the short-term treatment of active duodenal ulcer. AB - The efficacy and safety of famotidine and ranitidine in the treatment of active duodenal ulcer were compared in a multicenter, randomized double-blind study. The study was carried out at 5 centers and involved a total of 143 patients with endoscopically documented active duodenal ulcer. The patients received either famotidine (1 40 mg tablet at night) or ranitidine 2 150 mg tablets at night). Endoscopic examinations were performed at 4 and 6 weeks of active treatment. Day and nocturnal pain were also monitored, and the laboratory and clinical profiles evaluated. One hundred and thirty-three patients fulfilled the evaluation criteria (66 patients in the famotidine group and 67 in the ranitidine group). Healing rates at weeks 4 or 6 of treatment showed no significant differences between the famotidine group and the ranitidine group. The healing rates were 78% at week 4 and 96% at week 6 in the famotidine group, and 76% at week 4 and 95% at week 6 in the ranitidine group. Similar results were observed in both treatment groups with regard to pain resolution, decrease in antacid intake and safety profile. PMID- 2666294 TI - Impaired insulin-mediated inhibition of lipolysis and glucose transport with aging. AB - Regulation of hormone action with aging has been extensively studied; adipocytes provide an interesting model for some of these questions. We have compared the ability of insulin to stimulate glucose uptake and suppress lipolysis in adipocytes isolated from two month and twelve month-old rats. The ability of insulin to stimulate maximal glucose transport was decreased in adipocytes from the older rats (P less than 0.001); as well, insulin's EC50 was also higher (P less than 0.01) in these cells. Furthermore, these defects were present when insulin-stimulated glucose transport was measured in the presence or absence of adenosine deaminase which metabolizes endogenously released adenosine. Endogenously released adenosine is a stimulator of glucose transport and an inhibitor of lipolysis. Maximal suppression of isoproterenol-induced lipolysis by insulin was similar when adipocytes isolated from the two age groups were incubated in the absence of adenosine deaminase. However, maximal insulin mediated suppression of lipolysis was found to be significantly decreased (P less than 0.001) in adipocytes isolated from older rats when the experiments were done in the presence of adenosine deaminase; also, insulin's EC50 was increased in these cells under these conditions (P less than 0.001). These results emphasize the importance of the adenosine receptor in modulating the response of isolated adipocytes to insulin, particularly for lipolysis, and document the presence of age-associated defects in insulin regulation of both glucose transport and lipolysis. PMID- 2666295 TI - Dissociation between insulin binding and glucose utilization after intense exercise in mouse skeletal muscles. AB - Since there are data to indicate that heavy exercise decreases insulin binding to skeletal muscle at a point when glucose uptake is known to be augmented, we tested the hypothesis that insulin-stimulated glucose uptake and metabolism are dissociated from insulin binding after exercise. Therefore, insulin binding, 2 deoxy-d-glucose (2-DOG) uptake and glucose incorporation into glycogen and glycolysis were compared in soleus and EDL muscles of intensively exercised (2-3 h) mice and non-exercised mice. Basal 2-DOG uptake was increased in the exercised EDL (P less than 0.05) but not in the exercised soleus (P greater than 0.05). However, in both muscles intense exercise increased insulin-stimulated (0.1-16 nM) 2-DOG uptake (P less than 0.05). The rates of glycogenesis were increased in both the exercised muscles (P less than 0.05) as was the rate of glycolysis in the exercise soleus (P less than 0.05). Glycolysis was not altered in the EDL (P greater than 0.05). In the face of the increased 2-DOG uptake and glucose metabolism in the exercised muscles, insulin binding was not altered in the exercised soleus muscle (P greater than 0.05) and was decreased in the exercised EDL (P less than 0.05). These results indicate that after intense exercise there is a dissociation of insulin binding from insulin action on glucose uptake and metabolism in skeletal muscles. PMID- 2666296 TI - Impact of human growth hormone on plasma lipoprotein concentrations. AB - To evaluate whether the moderately elevated human growth hormone concentration, seen in insulin dependent diabetic patients, has any impact on lipoproteins, human growth hormone was given to nondiabetic persons in doses which would bring their plasma human growth hormone concentration up in the same level as seen in insulin dependent diabetic patients. After one week of treatment with human growth hormone we found total plasma triglyceride to be significantly raised (0.98 mmol/l +/- 0.28 mmol/l (mean +/- SD) before versus 1.27 mmol/l +/- 0.38 mmol/l (mean +/- SD) after treatment). Very low density lipoprotein (VLDL) was separated into two fractions (VLDL-1 and VLDL-2) of which VLDL-2 is regarded as a VLDL-remnant which is suggested to be of importance for development of atherosclerosis. After one week of human growth hormone treatment there were no changes in VLDL-1 concentrations whereas a significant raise in VLDL-2 triglyceride and VLDL-2 cholesterol was seen. PMID- 2666297 TI - Hospitals poised to offer in-home i.v. therapy. PMID- 2666298 TI - Medicare margins in the 1990s face a policy battle. PMID- 2666299 TI - Power politics decides who writes Medicare policy. PMID- 2666300 TI - Expand home care and mental health. Interview by Jeff Finn. PMID- 2666301 TI - Detecting Chlamydia trachomatis by direct immunofluorescence using a Cytobrush sampling technique. PMID- 2666302 TI - Screening for treponemal infection by a new enzyme immunoassay. AB - A new enzyme immunoassay (EIA, Captia Syphilis-G) for detecting IgG antibodies against Treponema pallidum was evaluated as a screening test for syphilis. When serum samples were tested at a dilution of 1 in 20 (EIA20), the overall agreement between the IgG EIA and serological status based on the T pallidum haemagglutination assay (TPHA) and the fluorescent treponemal antibody absorption (FTA-ABS) test was 99.2% (1310/1321). The sensitivity of the EIA20 was 98.4% (60/61) and the specificity 99.3% (1251/1260). Discrimination between patients with and without treponemal infection was good: the mean EIA20 absorbance ratios (patient/mean low titre positive control results) were 0.49 for antibody negative patients, 3.30 for patients with positive Venereal Diseases Research Laboratory (VDRL) test and TPHA results, and 1.77 for patients with negative VDRL but positive TPHA results. The cut off point for excluding treponemal infection was taken as 0.9. Specimens with ratios of more than 0.9 should be confirmed by the FTA-ABS test and evaluated for specific IgM antibodies to treponemes. When serum samples were tested at a 1 in 50 dilution (EIA50) the sensitivity was lower (80.3%) but the specificity was absolute. The reduction in sensitivity correlated with low absorbance ratios in the patients who were VDRL negative and TPHA positive. The screening performance of the IgG EIA20 is thus comparable with that provided by a combination of the VDRL test and TPHA. The potential for automation makes the EIA an attractive alternative, particularly in larger centres. Alternatively, the test can be performed at a 1 in 50 dilution (EIA50), at which level it is ideally suited for confirming the treponemal status of antibodies in serum samples preselected by positive cardiolipin antigen screening test results. PMID- 2666303 TI - An IgM capture enzyme linked immunosorbent assay to detect IgM antibodies to treponemes in patients with syphilis. AB - A new IgM capture enzyme linked immunosorbent assay (ELISA) was compared with the 19S(IgM) fluorescent treponemal antibody absorption (19S(IgM)FTA-ABS) test for detecting IgM antibodies to treponemes. Serum samples from 180 people, 109 with various stages of untreated syphilis, 45 with treated syphilis, and 26 non infected, were investigated. In all diagnostic groups of syphilis the reactivity of the IgM capture ELISA was similar to that of the 19S(IgM)FTA-ABS test except in untreated neurosyphilis, for which the IgM capture ELISA was significantly less sensitive. The IgM capture ELISA was very sensitive in congenital (100%, 5/5) and primary (82%, 18/22) syphilis, but less sensitive in secondary (60%, 12/20), latent (53%, 16/30), neurosyphilis (34%, 11/32), and treated (11%, 5/45) syphilis. False positive IgM capture ELISA results were not found in five people who gave false positive Venereal Disease Research Laboratory (VDRL) reactions or in 21 neonates born to mothers adequately treated for syphilis before or during pregnancy. This indicated that the IgM capture ELISA was very specific. The course of antitreponemal IgM reactivity after treatment of early infectious syphilis was followed up in six patients. The quantity of IgM antibody declined in nearly all patients after treatment, but still remained detectable in five patients up to six months after treatment. In contrast, non-treponemal antibodies measured by the VDRL test disappeared in four out of six patients within five months from starting treatment. In conclusion, the IgM capture ELISA may be useful for easy and sensitive detection of IgM antibodies to treponemes in patients with congenital and primary syphilis. A positive test result in these cases indicates that patients should receive treatment if they have not been treated recently. The test is not, however, recommended to replace the VDRL test to monitor patients treated for syphilis. PMID- 2666304 TI - Influence of storing urogenital specimens at -20 degrees C before testing by enzyme amplified immunoassay (IDEIA) to detect Chlamydia trachomatis antigen. AB - Urogenital specimens from 445 patients, 174 women and 271 men, were tested for antigen to Chlamydia trachomatis by an enzyme amplified immunoassay, IDEIA. The test results for specimens stored at -20 degrees C for means of 9.6 weeks (from each of the first 376 patients) and eight months (from the remaining 69) were compared with results for specimens stored at 4 degrees C and tested within five days. Of 617 specimens (one from the urethra of each patient and one from the cervices of 172 women) cultured for C trachomatis, 90 (15%) gave positive results. The IDEIA results for specimens stored at -20 degrees C were identical with those of specimens analysed without such storage in 96.4% (595/617) of all cases. No difference was seen between urethral specimens from men or women or cervical specimens or between specimens stored for 9.6 weeks compared with those stored for eight months. In 22 cases in which the IDEIA results differed, culture positive results were missed in stored as well as unstored specimens. The median absorbance value above the cut off point for a positive IDEIA result in stored specimens was no lower than in those not stored. The few differences noted probably depended on the sampling technique rather than on the way of storing the specimens. PMID- 2666305 TI - Nutritional regulation of immunity and risk of infection in old age. PMID- 2666307 TI - Acute inflammatory effects of a monocyte-derived neutrophil-activating peptide in rabbit skin. AB - The inflammatory effects of a monocyte-derived neutrophil-activating peptide (MONAP), purified to homogeneity from lipopolysaccharide-stimulated human peripheral blood monocytes, have been evaluated in rabbit skin. Intradermal injection of MONAP alone caused a mild infiltration of polymorphonuclear leucocytes (PMNL) but did not induce any change in plasma extravasation. When combined with prostaglandin E2(PGE2), MONAP caused a marked and synergistic increase in PMNL infiltration and plasma extravasation into the injected skin sites. The increase in vascular permeability induced by MONAP depended on the presence of circulating PMNL. MONAP is a novel cytokine with pro-inflammatory properties and may have physiological and pathophysiological roles in health and disease. PMID- 2666306 TI - Chemical composition and tissue distribution of the human CDw44 glycoprotein. AB - The CDw44 glycoprotein was purified from 2.3 x 10(11) CD3+ CD4+ CD8- T-chronic lymphocytic leukaemia (CLL) cells using F10-44-2 monoclonal antibody affinity chromatography, DEAE-Sepharose anion-exchange chromatography, passage down carboxymethyl (CM)-Sepharose cation-exchange columns, wheat germ lectin affinity chromatography and gel-permeation chromatography. On elution in non-ionic detergents from the DEAE column, two distinct peaks of antigen activity were obtained. The CDw44 glycoprotein in each peak was a glycoprotein of 85,000 MW, but the amino acid composition of the peaks was noticeably different. Carbohydrate compositions showed that each peak contained approximately 30% (w/w) carbohydrate, the composition suggesting both O-linked and complex N-linked glycans. Modulation studies with the F10-44-2 antibody on normal peripheral blood mononuclear cells (PBMC) demonstrated that the CDw44 glycoprotein of T cells consisted of one fraction that was readily modulated, and the other which was resistant to modulation. Detailed tissue distribution studies for CDw44 were performed using the F10-44-2 antibody on frozen sections of human tissues. CDw44 has a restricted tissue distribution, but is found on many highly diverse cell types (e.g. T lymphocytes, smooth muscle cells, some secretory glands, skin epithelial cells). PMID- 2666308 TI - Elevated levels of GM-CSF and IL-1 in the serum, peritoneal and pleural cavities of GM-CSF transgenic mice. AB - Levels of granulocyte-macrophage colony-stimulating factor (GM-CSF) in the peritoneal and pleural cavity fluid of two lines of GM-CSF transgenic mice were abnormally high (up to 120,000 U/ml), often exceeded the elevated serum GM-CSF levels in these mice and correlated with the increased number of macrophages present. In the peritoneal fluid, the only significant elevations of IL-1 levels were seen in moribund male-line transgenic mice. In contrast, IL-1 levels in pleural cavity fluid of male-line transgenic mice were clearly higher than those in littermate control mice or female-line transgenic mice. In male-line transgenic mice, IL-1 levels in both peritoneal and pleural cavities correlated with local macrophage numbers. Endotoxin was detectable in the peritoneal cavity fluid from some mice of all types but did not correlate with elevated IL-1 levels. No correlation was observed between levels of GM-CSF or IL-1 in the peritoneal cavity and the development of fibrotic nodules in the peritoneal cavity or gut congestion, two lesions common in male-line GM-CSF transgenic mice. The data suggest that the elevated levels of IL-1 in GM-CSF transgenic mice may be the consequence of stimulation by GM-CSF of IL-1 production by the elevated numbers of macrophages in these mice. PMID- 2666309 TI - Patterns of IL-2 production and utilization in mice heavily infected with Mycobacterium bovis BCG reflect the phase of protective immunity being expressed. AB - The results shown here demonstrate that in mice heavily infected with Mycobacterium bovis BCG Pasteur, mitogen-induced levels of interleukin-2 (IL-2) correlate temporally with the state of immunity that is being expressed in the animal during the course of the infection. Active immunity, which is conferred by populations of both CD4+ (L3T4) and CD8+ (Lyt-2) T lymphocytes, and memory immunity, which is mediated by a population of CD4+ T lymphocytes, were identified and distinguished in terms of their sensitivity to cyclophosphamide therapy, their ability to passively transfer specific resistance to infection with virulent Mycobacterium tuberculosis, and their capacity to produce and/or absorb IL-2. In this regard, concanavalin A (Con A)-stimulated L3T4+ and Lyt-2+ enriched splenocytes exhibited an apparent depression in measurable levels of IL 2 when harvested during the first 40 days of the infection, which could be explained by the subsequent observation that these T cells were capable of rapidly absorbing a known quantity of recombinant IL-2 in vitro. Detectable levels of IL-2 in these mitogen-stimulated supernatants began to rise after Day 25, which was temporally associated with a gradual shift from active immunity, to immunity mediated by cyclophosphamide-resistant memory T cells, which did not absorb IL-2 in vitro. These data indicate that fluctuations in apparent IL-2 production reflect changes in the type of immunity being expressed, rather than than some form of defect in IL-2 production. PMID- 2666310 TI - Rapid diagnosis of neonatal septicemia. PMID- 2666311 TI - Pertussis vaccine. PMID- 2666312 TI - Biological determinants in implant design. AB - This paper considers whether fibro-osseous integration is a feasible outcome for dental implants and whether the mucosal-implant junction is a crucial factor for implant success. It is argued that the periodontal ligament is a connective tissue with specific origin determined early in development. Further, it is argued that fibroblasts of the ligament exhibit unique functional characteristics associated with tooth support and that these characteristics cannot, as yet, be duplicated in other fibroblasts. These specific attributes argue against the feasibility of fibro-osseous integration unless cells of the periodontal ligament are available to develop a fibrous attachment. With respect to the dentogingival junction, it is argued that this structure does not provide a functional seal around the normally functioning tooth and therefore a minor degree of inflammation in the connective tissue adjacent to an implant is acceptable. It is also argued that inflammation associated with fibro-osseous integrated implants is not the result of a deficiency in the epithelial attachment but rather is due to the inability of the connective tissue to withstand the forces applied to it. PMID- 2666313 TI - Oral health promotion at worksites. AB - Many workplace-based health promotion programmes have been reported but only a few include or focus specifically on oral health. Although certain obstacles to oral health promotion in the workplace exist from the management side, from the dental profession and from the employees, these seem to be of a scale that can easily be overcome: moreover, numerous potential benefits exist. From the employer's point of view, the main arguments in favour are reduced health care costs, increased productivity and reduced absenteeism. The benefits to the dental profession are possible increases in utilization of services and less restraint from fee payment structures and physical environments. The immediate benefit to the employees is easy access to dental services. In addition, work-related dental hazards can be compensated for or prevented and screening activities can be more easily organized. The literature is at present sparse and there are few guidelines to actual strategies for effective oral health promotion. However, elements of strategies that have been successful in various geographical and economic environments include: active involvement of the work force, the use of dental auxiliaries, voluntary daily mouthrinsing, screening activities, use of mass media, oral hygiene instruction and prophylaxis and paraprofessional training. It is recommended that future research concentrates on these elements to build up a meaningful and relevant data base upon which effective oral health promotion programmes can be formulated. PMID- 2666314 TI - Taking the mystique out of the diagnosis and treatment of craniomandibular (TMJ) disorders. AB - The temporomandibular joint (TMJ) is of great importance in the assessment, diagnosis and treatment of many craniofacial disorders. Frequently overlooked by medical practitioners as a source of patient discomfort, the key to understanding the joint and its role in abnormal conditions is the complex nature of its structure. Returning to biological fundamentals provides an essential foundation on which to build techniques for diagnosis and ultimately treatment regimens. In considering the aetiology of craniomandibular disorders many factors have to be sifted. These include predisposing factors such as size, shape and interrelation of the parts of the stomatognathic system. Precipitating causes may include trauma to the head and neck as well as stress to the individual, while perpetuating influences are manifested in the myospasm-pain-myospasm cycle. The complexity of the joint system is reflected in the range and diversity of the thorough examination which the clinician is required to perform. Listening to the patient's description of their symptoms is of crucial importance in the initial stages to provide guidance for the ensuing examination procedures. Relief of pain, generally caused by muscle spasm, is the primary treatment objective. Many modes of treatment are available in the long-term resolution of the disorders and these range from medicinal, nutritional and psychological therapies to occlusal equilibration and physiotherapy. PMID- 2666315 TI - Caring for the dentate elderly. AB - The proportional increase of elderly persons in most communities and increasing tooth retention among them betoken considerable change in gerodontic needs. Servicing dentate older patients will occupy progressively more practising time. This committment requires the development of somewhat different skills, knowledge and philosophy from those customarily propounded in dental teaching to date which has concentrated mostly on matters relevant to young and middle-aged persons. Dentists must become proficient in managing clinical entities of prevalence in the elderly. Xerostomia, a frequent, but often neglected symptom can have distressing consequences. Practitioners have a responsibility to detect it, analyse its likely cause or causes and select appropriate therapy. Root caries is re-emerging as a common finding. Its aetiology must be understood in order to institute effective preventive measures and treatment. Dentate elderly persons typically have heavily restored teeth subject to various iatrogenic problems. Some of the restorative work required can be provided exactly as for younger patients. However, optimum care is not necessarily the most elaborate. It is often desirable, when health or financial considerations dictate, to adopt expedients which reduce treatment extent and/or expense. Adhesive materials are extremely useful. The 'sandwich technique' for bonding composite resin to dentine via glass ionomer cement often facilitates the provision of extensive restorations in a minimally invasive fashion. Adhesive procedures can also be applied to treat attrition, mend fatigue fractures, splint teeth deficient in periodontal support, and provide simplified cosmetic treatment for elderly patients. PMID- 2666316 TI - Reducing barriers to older persons' use of dental services. AB - In the United States elderly persons are the least likely of any age group to utilize dental services. With the increase in the elderly population and expansion of interest in their dental care, our understanding of the barriers to that care is particularly important. Studies have indicated that cost of treatment, fear of dentistry, functional independence and poor general health are of little significance in explaining the low utilization patterns of this age group. Perceived need seems to be the strongest predictor in deciding whether dental services are sought by an individual. Two programmes established by The University of Washington aimed to enhance the utilization of dental services by the elderly. One provided free screenings for over 65's on low incomes, coupled with a low cost dental care scheme. Although it was found that the convenient location of a dental clinic was a valuable incentive for the increased uptake of services, the difficulty remained one of patient perception of need. The second programme sought to overcome this latter problem by providing information on the importance of oral health to the independent elderly. This included a weekly class for small groups conducted by a health educator over a 6-week period together with a self-monitoring chart for each participant. It is anticipated that the heightened awareness aroused by this education programme will translate into perceived need and thus greater dental service utilization by the participants. PMID- 2666317 TI - The politics of employment-based insurance in the United States. AB - Analyses of the corporatization of U.S. health care typically focus on the political struggle between corporations and traditional health care providers, e.g., physicians. A neglected area of study is the struggle between corporations and their employees over the employment-based health insurance system. Yet, since this system is currently the primary mechanism for financing health care in the United States, an analysis of its historical development is critical to any understanding of the corporatization of U.S. health care. It is argued here that the employment-based health insurance system was a part of a political compromise between capital and labor that emerged after World War II. In exchange for control over production and increased worker productivity, corporations agreed to provide workers with steady wage increases and an expanded system of fringe benefits, or "corporate welfare." But, by the late 1970s, rising health care costs created a corporate health care financing crisis that has prompted corporations to cut back employee health insurance coverage. The relative inability of workers to resist such cutbacks reveals the extent to which, by linking health care to wage labor, the "corporate welfare" system has made the U.S. working class more vulnerable to corporate power. PMID- 2666318 TI - The political implications of psychosocial work redesign: a model of the psychosocial class structure. AB - The goal of this article is to further illuminate the poorly understood distribution of psychosocial well-being at the national population level (the distribution of conventional economic well-being is, of course, well understood). After reviewing psychosocial phenomena that cannot be predicted by the "conventional" class structure, the author introduces a new definition of production output value (New Value), more closely related to psychosocial well being. A psychosocial class structure model is presented based on nine occupational subgroups in four status levels, representing both conventional and New Value-based status differences. An empirical analysis of 38 occupations in the U.S. work force (U.S. Quality of Employment Surveys 1969, 1972, 1977) uses psychosocial job dimensions of decision latitude, psychological demands, physical exertion, and social support. The author reviews job redesign strategies for three New Value "impoverished" groups with routinized, bureaucratized, and commercialized jobs, and the conditions for economic stability and political participation related to the psychosocial class structure model. Conflicts arising between conventional and New Value-based policies are discussed. PMID- 2666319 TI - Foreign nations, international organizations, and their impact on health conditions in Nicaragua since 1979. AB - In July 1979, a coalition of social forces in Nicaragua, under the leadership of the Sandinistas, toppled the discredited 43-year Somoza dictatorship. In addition to revolutionary Nicaragua's own substantial efforts, since 1979 international forces and developments have had profound impacts on the nation's ambitious social programs. This article investigates the impact of foreign nations and international organizations on Nicaragua's health conditions since 1979. Given or pledged assistance, for health and other social needs, has been forthcoming, for example, from Latin America, Western Europe, socialist countries, the United Nations, the Organization of American States, and the European Economic Community. International forces, however, have also had a negative impact on Nicaragua's health conditions. Since 1981, counter-revolutionary guerilla forces, known as contras, have fought the Nicaraguan government troops in a disastrous conflict, involving substantial international assistance for each side. The United States and several other nations have provided some form of aid to the contras. The war in Nicaragua has resulted in enormous human and material losses, and, of course, has adversely affected health conditions. PMID- 2666320 TI - Clinical manifestations of the Marfan syndrome. PMID- 2666321 TI - Griseofulvin and ketoconazole in the treatment of dermatophyte infections. PMID- 2666322 TI - The use of zidovudine. PMID- 2666323 TI - Vibrio vulnificus infection in Hawaii. AB - A life-threatening Vibrio vulnificus infection occurred in a 52-year-old Korean woman with hepatic cirrhosis. Four days after ingesting raw crab, the patient presented to the hospital with nausea, vomiting, fever, hypotension, and hemorrhagic blistering of the left foot. Vibrio vulnificus was recovered from both her blood and a foot wound. PMID- 2666325 TI - Erythema nodosum as the presenting symptom of gastric centrofollicular lymphoma. PMID- 2666324 TI - Bullous systemic lupus erythematosus. AB - Two patients with bullous systemic lupus erythematosus are reported. In one, the disease appears to have been caused by hydralazine. The cutaneous lesions of bullous SLE have not been previously reported in drug-induced lupus. PMID- 2666326 TI - Use of phenytoin in healing of war and non-war wounds. A pilot study of 25 cases. AB - Nineteen patients with war-related missile wounds and six with refractory civilian ulcers were treated with topical phenytoin sodium powder daily for up to 4 weeks. The mean healing time was 2 weeks for missile wounds, compared to historical controls requiring 6-8 weeks. Healing time was 4 weeks for civilian ulcers that had been unresponsive to any treatment over the previous 5 months. Twenty-two patients had complete healing, three required skin grafts. Wider use of this safe, inexpensive, readily available and easy-to-use agent is suggested because of its positive effect on wound healing and rapid pain relief. PMID- 2666327 TI - Human urinary kallikrein. Complete amino acid sequence and sites of glycosylation. AB - Human glandular kallikrein was purified from urine and subjected to detailed structural characterization. The protein was carboxymethylated with iodoacetic acid and digested with TPCK-trypsin, Staphylococcal aureus V-8 protease and endo LysC peptidase. The resulting peptide fragments were separated by reverse-phase HPLC using C-4 columns and acetonitrile-trifluoroacetic acid gradient elution. The complete amino acid sequence of the carboxymethylated derivative was elucidated by sequence analysis and alignment of peptides derived from different proteolytic cleavages. A procedure using in situ CNBr cleavage of a large endo LysC peptidase-derived peptide followed by direct sequencing was carried out to provide overlap for two glycosylation sites at residues 78 and 84. Three Asn linked glycosylation sites were confirmed by the direct sequence analysis of the isolated glycopeptides. However, the third glycosylation at Asn-144 occurs only in 60% of kallikrein molecules. Reverse-phase HPLC effectively separates two species of HUK which correspond to molecules glycosylated and non-glycosylated at Asn-144, respectively. The human urinary kallikrein contains 238 amino acid residues with Ile and Ser as N- and C-terminal amino acids, respectively. The primary structure is completely identical to that deduced from a human genomic DNA sequence (F.K. Lin et al., manuscript in preparation) and is different in one amino acid (Lys-162 vs. Glu-162) from that deduced from pancreatic or kidney cDNA sequence. PMID- 2666328 TI - Action theory within the structural view. AB - This paper presents a summary of a cohesive theme coursing through a group of selected papers written by the author over four decades. Purpose, intention, choice and decision are seen as firmly anchored within structural metapsychological theory. These constitute a cohesive and operative psychoanalytic theory of action, which Hartmann stated did not exist within psychoanalytic theory. The exposure and inclusion of this unconscious series of intrapsychic events obviates the need for many alternative theories which have been erected to give a place to these very functions. Unconscious decision, ego will and volition, the unconscious initiation and execution of action, operate during waking life, with as complete and complex secondary process mentation as secondary revision organizes the final shape and contents of a dream during sleep. These conceptual changes and advances have important psychosociolegal implications. Man not only does not know why he acts; he also does not always know that he acts. The mainstream itself is not monolithic and has also resisted the development of many of these advances. Factors responsible for this lag or block are adduced, which include anti-scientism or intellectuality, as well as, most importantly, a resistance to an increase of responsibility and accountability. PMID- 2666329 TI - Drug-induced ocular cicatrization. PMID- 2666330 TI - Complications of contact lens solutions. PMID- 2666331 TI - Complications of topical ocular anesthetics. PMID- 2666332 TI - Complications of antimalarial therapy. PMID- 2666333 TI - Complications of intraocular antimicrobial agents. PMID- 2666334 TI - Ocular anesthetic properties and adverse reactions. PMID- 2666335 TI - Prophylaxis against post-appendicectomy wound infection. A controlled clinical trial of intravenous (i.v.) metronidazole versus i.v. metronidazole-ampicillin gentamicin. AB - A controlled clinical trial has been conducted on three doses of intravenous (I.V.) metronidazole alone and of I.V. metronidazole-gentamicin-ampicillin combined in wound infection following appendicectomy for non-perforated appendicitis. Of the 205 patients entered, 154 were evaluable. There were 118 males and 36 females (3.3:1), their mean age was 24 +/- 9.8 years, and mean Quetelet index was 23 +/- 5. The two groups were comparable in terms of seven potential risk factors: age, sex, Quetelet index, mean duration of operation, wound contamination, nasal carriage of S. aureus, and operating surgeon's rank. The over-all wound infection rate was 10.4%. There were two delayed infections in each treatment group. We found no difference between the two treatment groups in terms of wound infection and delayed wound infection. No adverse drug reaction was seen. We conclude that the two regimens are equally convenient, safe, effective, and reliable. But, metronidazole alone is the less expensive of the two. PMID- 2666336 TI - Quantitative ultrasonic detection and classification of diffuse liver disease. Comparison with human observer performance. AB - A multiparameter ultrasonic tissue characterization system has been developed and tested on several types of diffuse liver disease. The four tissue characterization parameters used are based on the first and second order statistics of the B-scan image. Performance of the system was evaluated using receiver operating characteristic (ROC) analysis and was compared with the performance of experienced human observers viewing B-scan images. The machine based multiparameter system achieved an area under the ROC curve (Az) of 0.88 for detection of chronic hepatitis in more than 100 proven cases of the disease. This was dramatically better than the performance of human observers (Az = .64, P less than .05) and compares favorably to the performance of other accepted diagnostic tests such as head CT and the PAP smear. For detection of Gaucher's disease, the Az for the system was .92, whereas for separating hepatitis from Gaucher's disease Az was .84. Human observers also did well at these tasks (P greater than .8) using organomegaly as their major criterion for diagnosing Gaucher's disease. For primary biliary cirrhosis the system Az was .80, for glycogen storage disease Az was .94. These results suggest that use of multiparameter tissue characterization can significantly increase the usefulness of ultrasound for evaluation of diffuse liver disease. PMID- 2666337 TI - Needle tip echogenicity. A study with real time ultrasound. AB - During ultrasound-controlled biopsy, the visualization of the needle tip is essential for its exact guidance. We constructed a testing device to simultaneously measure the needle tip echo (NTE) intensity of several needles. The following needle parameters were studied: the angle of incidence, the needle diameter, the needle tip bevel angle, and the orientation of the needle tip opening to the transducer. Measurements were made in A-mode using the highest amplitude peak of the NTE and in B-mode using the gray level histogram map from a fixed area around the NTE. There was a positive linear correlation between the intensity of the NTE and the angle of incidence in A-mode as well as B-mode. In A mode a similar linearity was found between the NTE and the needle diameter, which in B-mode was exponential. However, the needle tip bevel angle did not affect the NTE. Rotating the needle around its longitudinal axis rendered the highest echo at an orientation of 180 degrees from the transducer in A-mode as well as B-mode. PMID- 2666338 TI - Treatment of head and neck cancer with combined modalities. AB - Patients with advanced epidermoid carcinoma of the head and neck are often treated with combinations of radiation therapy and surgery. Patients with more advanced malignancies may also receive adjuvant chemotherapy. Prospective randomized protocols provide the most effective means of determining the value of combined modalities versus a single modality only. Preoperative assessment includes direct visualization, palpation, endoscopy and, in selected incidents, CT or MRI scanning. CT scan may provide objective evidence of tumor response when preoperative adjuvant treatment, either as radiation or chemotherapy, is given. PMID- 2666339 TI - Short course chemotherapy for pulmonary tuberculosis. A randomised controlled trial of a six month versus a nine month oral regimen. AB - We report on the first trial in the Republic of Ireland to look at chemotherapy for TB. This management trial, carried out in single unit, which treats a third of all TB cases in the Republic of Ireland compared to effectiveness of a three drug/nine month regimen (Rifampicin (R), Isoniazed (R), supplemented with Ethambutol (E) for the first two months = RHE9) with a four drug six months regimen (R, H supplemented with E and Pyrazinamide (Z) for the first two months = RHEZ6). Two hundred and eighty eight patients (288) were entered into the study. A total of 143, (76 were in the RHE9 group and 67 in the RHEZ6 group) completed the trial as planned. At the end of the third month, significantly more patients in the RHEZ6 regimen (98%) were culture negative compared to the RHE9 regimen (88%). All were culture negative at the end of chemotherapy. Drug intolerance was seen in 35 (12%) patients with no significant difference in hepatitis between the two regimens. Toxicity from Pyrazinamide was minimal. One hundred and forty five (145) patients were invalid for analysis for the following reason:- bacteriologically negative TB (41), drug intolerance (35), death (23), non compliance (19), diagnosis not TB (10), drug resistance (7), extrapulmonary disease (4), consent withdrawn (3), Mycobacteria other than tuberculosis (3). All patients are being followed to monitor relapse rates. PMID- 2666340 TI - Direct immunofluorescence testing of skin biopsies--an under-utilised diagnostic aid. AB - Direct immunofluorescence testing of skin biopsies is a simple inexpensive and relatively non-invasive diagnostic procedure currently widely used in dermatological practice for the investigation and diagnosis of dermatological and immunological disorders. This paper reviews the value and applicability of the procedure in a variety of disease states. The sensitivity and specificity of the test to a spectrum of clinical conditions should encourage its more widespread use in general medical and rheumatology practice. PMID- 2666341 TI - Biliary tract complications in orthotopic liver transplantation: an experimental study in the pig. AB - The results of 56 consecutive orthotopic liver transplants in the pig were reviewed to determine the incidence of primary biliary tract complications. There were 8 biliary tract complications in 56 grafts (14.2%) directly responsible for death. End-to-end choledochocholedochostomy (ee-CC) was the most frequently used technique (40 cases) with 4 technical failures (10.0%). Choledochojejunostomy with a Roux-en-Y jejunal loop (RYCJ) was used in 9 cases with 2 technical failures (22.2%). Side-to-side choledochocholedochostomy (ss-CC) was used in 7 cases with 2 technical failures (28.5%). Biliary leak and stenosis were the most common complications. End-to-end choledochocholedocostomy appears to be the most suitable and easy biliary reconstruction in the pig but possible gross disparity in the sizes of the donor and recipient ducts may represent and adverse factor. PMID- 2666342 TI - Endoscopic papillosphincterotomy and surgical sphincteroplasty for the treatment of bile duct stones: a comparative analysis. AB - One hundred and ten subjects with cholelithiasis entered this retrospective study. Early and late results of 73 patients treated by endoscopic papillosphincterotomy (EPST) were compared to those of 37 patients who had surgical transduodenal papillo-sphincteroplasty (SST). The comparative analysis was made in terms of clinical, biochemical and ultrasonographic findings. The follow-up period ranged from 1 to 5 years in the first group and from 1 to 15 years in the second group. EPST and SST proved to be comparable in regard to operative mortality and morbidity. EPST failed in removing large or impacted bile duct stones in 47% of cases, while SST was uniformly successful. Long-term results were good in most patients, either when treated by EPST or SST. The 5 year failure rate was 8% after EPST and 0% after SST. In the surgical group, the 15-year failure rate was 5%. Serum alkaline phosphatase levels were higher after EPST than after SST, suggesting the persistence of some degree of biliary stasis in endoscopically managed patients. Pneumobilia was detected more often in surgical patients, indicating that SST does create a wide and permanent communication between the duodenum and the biliary system. IN CONCLUSION: 1) EPST may achieve acceptable success rates with low mortality and morbidity, even in high risk patients; 2) the high number of long-term good clinical results seems to indicate that sphincter re-stenosis after EPST is rare, at least for the first 5 years from operation; 3) SST is an effective and safe procedure, ensuring excellent long-term results, provided that the technique of and the indication for are correct (including Wirsung assessment); 4) the wide and permanent stoma created by SST is not associated with recurrent cholangitis, if bile duct re stenosis does not occur. PMID- 2666343 TI - Medicaid recipients and psychiatric treatment. AB - This is a report of an analysis of data collected on 7,000 Medicaid outpatients in psychotherapy and 2,500 psychiatric inpatients. The data were collected over an 18-month period, from December 1986 to May 1988, from patients on Oahu, Hawaii, Maui and Kauai. PMID- 2666344 TI - [Lymph node sonography in the after care of malignant melanoma]. AB - Sonographic and palpatory lymph node findings were compared with the results of surgery or regular examination in a retrospective study of 167 melanoma patients. Sonography proved highly advantageous for diagnosis: whereas palpation indicated tumors at 83 of 277 lymph node locations, sonography showed 36 of the 83 to be false-positive. Moreover, sonography allowed the correct diagnosis of 6 non palpable lymph node metastases. Sonographic diagnosis was initially uncertain in only 15 cases. Differential diagnoses and the limitations of lymph node sonography are described, and suggestions made for the application of this method in the postoperative care of melanoma patients. PMID- 2666345 TI - [Necrobiotic xanthogranuloma in paraproteinemia]. AB - Necrobiotic xanthogranuloma is a rare generalized dermatosis occurring exclusively in association with paraproteinemia. Clinically it is characterized by large, ulcerating, nodular and plaque-like tumors of the dermis and subcutis. Histologically the lesions are composed of a nonspecific, lymphocytic and plasmacellular infiltrate and highly characteristic granulomas with giant cells of the Touton and foreign body type. Ultrastructurally, tubular cystic organelles with a central lamella and a few ribosomes at their outer membranes are found. By means of histochemical studies we excluded the skin infiltrates as the site of the paraprotein release. The pathogenesis of the disease remains unclear; it is suggested that the paraprotein has functional features of a lipoprotein, which may bind to lipoprotein receptors of the histiocytes, thereby inducing xanthoma formation. PMID- 2666346 TI - [Perspectives and new contributions in urology: the machines]. AB - The evolution of urology tended to an important diversification. The endoscopy got an access to the ureter and the kidney with rigid or flexible scopes. The treatment of the stone disease has been modified by the extracorporeal shock wave devices. The open surgery has almost disappeared and the percutaneous techniques were relegated to secondary or complementary procedures. Concerning the urologic surgery the bladder replacement with intestines has been reactualized. The problems of resorption and high pressures have been solved by a detubulation and reconfiguration of the intestinal segments. The initial enthusiasm for penile and sphincteric prosthesis has diminished, but these procedures continue to have limited indications with good results. The urologist is used to control personally his tumor patients which enables him to criticize his results and to design new adjuvant protocols in collaboration with the oncologists, e.g. for the treatment of infiltrating bladder cancer. The evident danger of diversification is a dispersion, and a solution of this problem has to be found for the future of our specialty. PMID- 2666347 TI - [Arthroscopic surgery--current status and perspectives]. AB - The morbidity after arthroscopic surgery is low; a hospitalization is not necessary in most patients. The possible operations of the knee joint include removal of loose bodies, resections on meniscus, plicae and synovium as well as more complicated procedures as suturing of a meniscus, total synovectomy and operations in patients with osteoarthritis. The advantage of the arthroscopic operation compared with arthrotomy is well documented in meniscal resection (shorter treatment, stay in the hospital and sick leave, reduced costs, and nevertheless excellent results) whereas the indication and clinical value of other arthroscopic procedures (i.e. suturing of a meniscal tear, lateral release, abrasion-arthroplasty) still are discussed. Diagnostic and operative arthroscopy of the shoulder joint has found its place and will certainly improve our knowledge on significance and treatment of disorders and injuries of this joint. In selected cases, an arthroscopy of the elbow, the hip, the ankle, the wrist or the temporomandibular joint offers important diagnostic information and may allow operative treatment. Arthroscopic surgery is technically difficult and not without problems. However, the rate of complications is extremely low (0.56%). Infections occur in significantly less than 1% of the cases. In veterinary medicine, therapeutic arthroscopy is used mainly in horses, but arthroscopies have been performed in the ox, the cow, the pig, the dog, the cat, and the rabbit. Modern joint surgery includes arthroscopic techniques; the training of trauma surgeons and orthopedic surgeons in arthroscopy is therefore mandatory. PMID- 2666348 TI - [Recent technologic developments facilitating the diagnosis of surgical endocrine lesions]. PMID- 2666349 TI - [Recent technologic developments facilitating the treatment of surgical endocrine lesions]. PMID- 2666350 TI - [Progress in thoracic surgery since 1980]. AB - Modern thoracic surgery was born at about the time the Swiss Surgical Society was founded. Tuffier, Rehn, Lilienthal, Thorek were some of the pioneers. Today the important developments are esophagectomy without thoracotomy, the routine performance of cardiac transplantation and the emergence of lung transplantation. The past, present and future of these developments are outlined. PMID- 2666351 TI - [Modern radiologic imaging in the diagnosis of abdominal diseases. Magnetic resonance imaging and spectroscopy]. AB - The diagnostic value of magnet resonance imaging for the diagnosis of pathological abdominal conditions has been limited sofar because of artefacts due to movement susceptibility. The current indications comprise: liver: differential diagnosis of metastases, cysts and hemangiomas, identification of small metastases, demonstration of malignant vascular invasion, evaluation of hemochromatosis; kidneys: evaluation of transplant rejection, analysis of complex cysts, demonstration of malignant tumoral invasion. The application of magnetic resonance will be greatly extended by the introduction of rapid image sequences and the application of specific contrast media. PMID- 2666352 TI - [Diagnosis and therapy of gastrointestinal hemorrhage]. AB - In the upper gastrointestinal tract endoscopic hemostasis has not replaced surgery, but reduced it to a necessary minimum. Active bleeding can be stanched by the injection method during emergency endoscopy. For bleeding esophageal varices we use polidocanol, in other lesions in the upper gastrointestinal tract we apply thrombin and in the lower intestinal tract adrenalin. If endoscopic hemostasis is successful in small bleeding vessels, the efficiency of hemostatic injections can be trusted. Large visible vessels need to be operated early electively. After the introduction of this therapeutic concept, for example the operation frequency in bleeding gastroduodenal ulcers could be reduced from 51% in 1982 to 28% in 1988. Mortality was improved from 22.1% to 4.7%. In gastrointestinal bleeding diagnostic problems occur especially with angio dysplasia in the small intestine and colon. This is due to impaired accessibility in the small intestine and problematic cleaning of the colon. In the intestine surgical therapy of bleeding lesions has very few alternatives, for example palliative embolization of infusion of vasoconstrictiva. PMID- 2666353 TI - [Pathologic-anatomic parameters for the prognosis of invasive breast cancer following amputation or saving the breast]. AB - The axillary lymph-node-status is the most important prognostic factor in breast cancer patients without distant metastases. The proportion of node positive axillae depends on the number of histologically documented nodes (at least 6 according to TNM recommendations). The prognostic significance of solitary micro metastases and of metastases detected only by serial sectioning or by immunocytochemistry is not yet established. An important prerequisite for successful conserving breast-cancer treatment is patient selection. Selection leads to a high proportion of patients with favourable prognosis: primary tumors less than 3 cm in diameter, at least 2/3 without axillary lymph-node-metastases, at least 1/3 less than 50 years old. That means attribution of prognostically less favourable patients to mastectomy. Tumor diameter and grading are established prognostic parameters of the primary. The significance of grading is independent of the system used and also independent of the reproducibility by different investigators. Measurement of tumor cell ploidy, proliferation and of epidermal growth factor-receptor content may add to the safety of prognosis prediction. Steroid hormone receptor content, eventually also Somatostatin receptor and Aromatase activity in the tumor tissue can influence the therapeutic decisions. PMID- 2666354 TI - Conservative surgery and radiation in the treatment of early (stages I and II) breast cancer. Long-term results. AB - Multiple nonrandomized series as well as prospective randomized trials have demonstrated that the long-term results of conservative surgery and appropriate radiation are equal to those of mastectomy for the treatment of early breast cancer. Moderate doses of radiation combined with surgical excision result in optimal local-regional control, good to excellent cosmetic results in the majority of patients and minimal complications. The long-term potential carcinogenic effects of radiation have not materialized in the clinical setting and the incidence of contralateral breast cancer and second non-breast malignancy is comparable to that reported after mastectomy. Based on this data, conservative surgery and radiation continues to represent a valid alternative to mastectomy for the treatment of early breast cancer. PMID- 2666355 TI - [The significance and treatment of late distant metastasis in breast cancer]. AB - More than half of the patients relapsing with breast cancer will do so after 3 years. Disease free survival is negatively influenced by tumor size and increasing numbers of positive axillary lymph nodes. Small primaries, negative nodes and positive estrogen receptors predict long overall survival. Many additional prognostic factors exist, however, they are not yet in general use. Similarly to early relapses, patients with late relapses do better with skeletal than with visceral metastases. Women with liver metastases should therefore be treated with chemotherapy, whereas bone disease may respond for prolonged periods to hormonal manipulation. PMID- 2666356 TI - [Long-term results following breast reconstruction]. AB - A ten-year experience of breast reconstruction (BR) at the Gustave-Roussy Institute (Paris) provides material for a long-term analysis of carcinologic and cosmetic results. Carcinologic results have been studied in a group of 120 breast reconstructions which was matched to a group of 120 mastectomies without BR. No statistical difference was observed both for the overall survival and the disease free survival in both groups. The percentage of local recurrences in the reconstructed breast was inferior, but not statistically, to the percentage observed in the controls providing a good argument in favour of the BR inocuity. Cosmetic results were analyzed on photographs according to a previously defined scale. They show a 55% percentage of satisfactory results when all the techniques of BR are mixed. A comparison between the cosmetic results according to the technique of BR demonstrates the superiority of the rectus abdominis flap which provides a higher rate of satisfactory results (63%) as compared to the results observed after simple reconstruction (53%) or latissimus dorsi (44%). A psychologic study of 150 BR shows that every patient underwent a specific psychological process called mourning work. The degree of satisfaction is not linked to objective results. Overall, 93% of the groups were satisfied, would do it again and would advise it for others; 7% were dissatisfied for surgical or emotional reasons. PMID- 2666357 TI - [Imaging methods in breast diagnosis--value and choice of methods in general practice]. AB - X-ray mammography continues to represent the most efficient imaging method for the diagnosis of breast disease and ultimately reduce mortality from breast cancer. Ultrasound is the most valuable supplementary method and is particularly useful to differentiate cystic from solid lesions. Today it is used mostly in the dense breast, as e.g. in young patients. All other imaging methods as thermography, diaphanoscopy, computed tomography and magnetic resonance imaging have not gained any importance and are particularly not useful for screening a large number of patients. In this paper all these imaging methods and our personal experience with them are briefly discussed. The importance of implementing mammographic screening programs to detect breast cancer is stressed, particularly considering the high incidence of breast cancer in all industrialized countries. PMID- 2666358 TI - [Breast pain: differential diagnosis and therapy]. AB - Mastodynia is the most frequent symptom of all breast symptoms which is experienced by a large number of women at some stage in their lives. At least 6 patterns of mastodynia can be distinguished clinically. Hormones, steroids, prolactin-inhibitors, vitamins, antioestrogen, diuretics, alternative drugs and surgery are used in therapy. But only controlled studies allow to demonstrate the effects of a therapy in comparison to a placebo response rate. Several investigators tried to find parameters to predict the response to the different therapies. The management options from the literature are discussed and evaluated. PMID- 2666359 TI - Association of Hb S [beta 6(A3)Glu----Val] and Hb I-interlaken [alpha 15(A13)Gly- --Asp] in a Sicilian man; review of the occurrence of Hb I-interlaken in Sicily. PMID- 2666360 TI - A functional new experimental biventricular model of heterotopic cardiac transplantation. AB - A heterotopic cardiac transplantation model in which the donor heart was able to maintain the systemic and pulmonary circulation of the recipient was devised, which did not require extracorporeal circulation or heparinization. All donor hearts in five pairs of adult mongrel dogs were resuscitated, and the systemic and pulmonary circulations maintained by the donor hearts alone were studied hemodynamically up to 3 hr after resuscitation, although long-term survival was not achieved. PMID- 2666361 TI - Aneurysm of the anterior inferior cerebellar artery at the internal auditory meatus: case report and review of the literature. AB - The authors present a case of a ruptured aneurysm of the anterior inferior cerebellar artery at the right internal auditory meatus, of which incidence is thought to be very rare. The patient experienced a sudden onset of headache, vomiting and tinnitus in the right side. Moderate peripheral facial palsy and hearing disturbance in the right appeared 2 weeks after the onset with diplopia. These symptoms improved to some extent after the successful neck clipping of this aneurysm. PMID- 2666362 TI - The odyssey and outlook of graduate medical education. AB - The healthcare needs of our society are changing from hospital-based, disease oriented services to community-based, prevention-oriented primary care. Medical educators must prepare the next generation of physicians for this transformation. Allopathic academic medical centers tend to be infatuated with technology, while osteopathic medicine always has been more oriented toward primary care. Osteopathic medicine is therefore in a better position to adjust its graduate medical education to meet society's need for primary physicians. Osteopathic medicine has a golden opportunity to create a new type of residency that will produce a genuine primary physician and give allopathic medicine a model to emulate. PMID- 2666363 TI - Adjuvant chemotherapy (CMF) for stage III breast cancer: a randomized trial. AB - A randomized trial of the effect of adjuvant CMF chemotherapy in patients with Stage III breast cancer receiving primary local radiation or local radiation plus surgery, failed to reveal a survival benefit from early systemic treatment. The subset of premenopausal patients receiving chemotherapy did, however, show a significant prolongation of disease-free survival from 23 to 55 months. Overall survival of this subgroup was not increased. The study included the use of two dose levels of CMF to assess whether higher chemotherapy doses would be more effective. No dose effect was observed. Initial local control with radiation therapy or radiation plus surgery was achieved in the majority (90.9%). Distal recurrence and death from metastatic disease were the major causes of treatment failure. Treatment benefit among premenopausal patients was mainly delayed onset of distal metastatic disease. Among premenopausal patients, salvage therapy for metastatic disease appeared more effective in those not previously exposed to systemic treatment. PMID- 2666364 TI - Technical modifications in hyperfractionated total body irradiation for T lymphocyte deplete bone marrow transplant. AB - The Medical College of Wisconsin implemented a major bone marrow transplant (BMT) program in July 1985. The type of transplants to be focused on were allogeneic T lymphocyte deplete. Total body irradiation (TBI) was initially patterned after the Memorial method. Patients received total body irradiation in a sitting position at a dose rate of 20-25 cGy/minute with 50% attenuation lung blocks used both anterior/posterior and posterior/anterior. Electron boosting was utilized for the ribs beneath the lung blocks. Occasionally, lower extremity boosting was required because of the sitting position. A dose of 14 Gy was chosen since T lymphocyte deplete bone marrow transplant data suggest the need for higher total doses to consistently obtain engraftment. This dose was given in 3 equal daily fractions over 3 days following conditioning chemotherapy. Six of 11 patients treated in this manner developed lethal pulmonary events. In response to the pulmonary toxicity, partial lung shielding was increased to 60% attenuation. In the next 107 patients receiving this program of total body irradiation there was a reduced incidence of fatal pulmonary events (10 cases of fatal idiopathic interstitial pneumonitis and 12 cases of fatal pulmonary infections) after a median follow-up of 9 months. This was an obvious improvement over the initial group. A significant level of hepato-renal toxicity was also observed with 14 Gy total body irradiation when no liver or kidney blocking was used. Of the first 20 patients treated, three cases of fatal veno-occlusive disease resulted. Subsequently, a 10% attenuation right sided liver block was added. Five of 98 patients treated with this block have developed fatal hepatic dysfunction, (median follow-up of 7.2 months). This incidence is not statistically different from the initial group but favors the use of the liver block. Some renal toxicity was also detected with the earlier regimen, especially in pediatric patients. Partial kidney blocking has been implemented to minimize this toxicity. Our current dose rate has been reduced to 8 cGy/minute in a further attempt to reduce organ toxicity. To date, this selective blocking has not adversely affected the excellent rate (96%) of first time engraftments. PMID- 2666365 TI - Recombinant murine GM-CSF increases resistance of some factor dependent hematopoietic progenitor cells to low-dose-rate gamma irradiation. AB - The effects of murine recombinant IL-3 (multi-CSF) and murine recombinant GM-CSF (granulocyte-macrophage colony stimulating factor) on the radiation biology of clonal hematopoietic progenitor cell lines were evaluated. Four clonal cell lines with growth response to either IL-3 or GM-CSF (FDCP-1JL26, and bg/bg d64) or exclusively dependent on IL-3 (32D cl 3 and B6SUtA), were pre-incubated in IL-3, or GM-CSF, for 7 days prior to gamma irradiation, then washed and irradiated at 5 cGy/min, or 116 cGy/min, and transferred to semisolid medium supplemented with either IL-3, or GM-CSF, for assay of 7 day greater than or equal to 50 cell colonies. The cell lines demonstrated similar radiosensitivity and lack of a detectable dose-rate effect when grown in IL-3 (FDCP-1JL26: D0 154, n 1.05 at 5 cGy/min, and D0 138, n 1.16 at 116 cGy/min; bg/bg d64: D0 95.7, n 1.16 at 5 cGy/min, and D0 97.7 n .993 at 116 cGy/min; B6SUtA: D0 101, n 1.29 at 5 cGy/min, D0 100, n 1.27 at 116 cGy/min; and cell line 32D cl 3: D0 123, n 1.65 at 5 cGy/min, and D0 126, n 1.17 at 116 cGy/min). In contrast, FDCP-1JL26 cells demonstrated a significant relative radioresistance at low-dose-rate when grown in recombinant GM-CSF, (D0 217, n 1.27 at 5 cGy/min, D0 138, n 1.34 at 116 cGy/min, p less than .005). The increase in radioresistance of FDCP-1 cells at low-dose-rate was induced either by preincubation in GM-CSF with transfer to IL 3, or by preincubation in IL-3 and transfer to recombinant GM-CSF. Growth factor independent malignant subclones of lines B6SUtA and FDCP-1JL26 demonstrated a significant increase in radioresistance at low-dose-rate (B6SUtA EL4JL: D0 187, n 1.39 at 5 cGy/min, and D0 133, n 1.73 at 116 cGy/min (p. less than .05); and FDCP 1JL26 F7 cl 2: D0 191, n 1.17 at 5 cGy/min, and D0 150, n 1.31 at 116 cGy/min [p less than .05]). Thus, some hematopoietic progenitor cell lines are induced by GM CSF to grow after irradiation at low-dose-rate similar to the growth of clonal malignant cell lines. The data may have implications for the radiation biology of normal hematopoietic progenitor cells in two circumstances: (a) selective survival of GM-CSF responsive cells after total body irradiation, and (b) selective survival of some hematopoietic progenitors in vivo during clinical recombinant GM-CSF infusion. PMID- 2666366 TI - Carboplatin (CBDCA) and radiotherapy for stage IV carcinoma of the head and neck: a phase I-II study. AB - The prognosis of patients with squamous cell carcinoma (SQC) of the head and neck (H&N) depends on the primary site and anatomical extent of the disease. Recurrence rates after conventional surgery (S) and/or radiotherapy (RT) remain low for localized tumors, whereas in advanced loco-regional disease they occur in over 60% of all cases. Several combinations of treatment modalities have been attempted in order to improve local control in Stages III and IV. Unfortunately, the recurrence rate remains high with added morbidity when conventional surgery is combined with pre or post-operative radiotherapy. Induction chemotherapy (CT) with Cisplatinum and Bleomycin has resulted in severe toxicities when combined with radiotherapy. To evaluate the toxicity of Carboplatin (CBDCA), a second generation platinum analog, when given simultaneously with conventional doses of radiotherapy, 26 patients with Stage IV SQC of the head and neck were treated at the University of Maryland Medical Systems. There were 23 males and 3 females; median age was 59 years and median Karnofski performance status was 60. Twenty patients had received no prior therapy; six had surgical exploration and excision with measurable residual disease. Anatomically, six patients had tumors of the oral cavity, twelve in the pharynx, one in the nasopharynx, four in the larynx, one in the hypopharynx, one in the maxillary antrum, and one was an unknown primary. These patients were treated as out-patients with weekly injections of Carboplatin. The dose was escalated: two patients received 60 mg/M2, seven received 75 mg/M2, thirteen were treated with 100 mg/M2, and four with 400 mg/M2. The radiotherapy was given daily with conventional fractions of 180 cGy and total tumor doses of 60-75 Gy. Toxicities were mainly hematological with median nadirs decreasing with increasing doses of Carboplatin. Mucositis was seen in over 80% of the patients, but interestingly enough, it has never been more severe than that observed with radiotherapy alone. So far, there has not been any kidney, ear, or neurotoxicities. Of 25 evaluable patients, 19 (76%) responded with 13 (52%) showing complete response. The overall median survival time is 266+ days (324+ for responders and 179+ for non-responders). The follow-up is still short, 10-14 months, but 9 of 13 patients with complete response have not yet progressed. PMID- 2666367 TI - Digital subtraction angiography (IV DSA) in treatment planning of subdiaphragmatic Hodgkin's disease. AB - In subdiaphragmatic Hodgkin's disease the most common sites of involvement include the para-aortic region, in particular the celiac trunk, the splenic pedicle, and the spleen. In treatment planning, no imaging modalities (i.e. lymphography, CT, US) have so far been able to realize the need for direct imaging of any of these areas on a simulation film, necessary for individual beam shaping. With intravenous digital subtraction angiography (IV DSA) a new imaging method is available that allows direct imaging of these regions in a frontal view. The way and extent the splenic artery crosses the left kidney can exactly be delineated. By using a subtrascope (as common in angiography) the DSA can exactly be superimposed and documented on a simulation film. The DSA drawn onto the simulation film serves as a base for defining an individual target volume in the upper abdominal region (splenic pedicle etc.). The kidney can be shielded in a highly individualized way by individual beamshaping blocks. From December 1985 to December 1986, we treated 35 patients by using this technique for treatment planning. In 32 evaluable patients the imaging accuracy for all sites was judged as "excellent" in 74%, "reasonable" in 19%, and "poor" in 7%. The course of the splenic artery in relation to the left kidney revealed 78% within or above the upper third. By DSA assisted localization the target volume could be accurately defined in every case with shielding of the kidney as much as possible. Compared to nonindividualized standard definitions ("including L1" and "including upper third of the kidney") DSA assisted individual target volume definition was more precise: "including L1" overestimates in 63%, "including upper third" underestimates in 53%. Compared to the standard definition ("including L1") reduction of up to 25% kidney volume to be irradiated could be achieved in 63%. DSA could be performed on an outpatient basis. The median duration of DSA performance was 20 minutes; superimposing and drawing at the subtrascope took median 20 minutes. There were no severe side effects. PMID- 2666368 TI - Heavy charged-particle stereotactic radiosurgery: cerebral angiography and CT in the treatment of intracranial vascular malformations. AB - A method is described for stereotactic localization of intracranial arteriovenous malformations (AVM) and for calculating treatment plans for heavy charged particle Bragg peak radiosurgery. A stereotactic frame and head immobilization system is used to correlate the images of multivessel cerebral angiography and computed tomography. The AVM is imaged by angiography, and the frame provides the stereotactic coordinates for transfer of this target to CT images for the calculation of treatment plans. The CT data are used to calculate the residual ranges and compensation for the charged-particle beam required for each treatment port. Three-dimensional coordinates for the patient positioner are calculated, and stereotactic radiosurgery is performed. Verification of the accuracy of the stereotactic positioning is obtained with computer-generated overlays of the vascular malformation, stereotactic fiducial markers, and bony landmarks on orthogonal radiographs immediately prior to treatment. Using these procedures, the accuracy of the repositioning of the patient at each of a series of imaging and treatment procedures is typically within 1 mm in each of three orthogonal planes. PMID- 2666369 TI - Combined total body X-ray irradiation and total skin electron beam radiotherapy with an improved technique for mycosis fungoides. AB - Twelve consecutive patients with advanced stage mycosis fungoides (MF) were treated with combined total body X ray irradiation (TBI) and total skin electron beam radiotherapy (EBRT). Six had generalized plaque disease and dermatopathic nodes, three had tumor stage disease and node biopsy positive for mycosis fungoides, and three had erythroderma/Sezary syndrome. The treatment regimen consisted of split course total body X ray irradiation, given in twice weekly 15 cGy fractions to 75 cGy, then total skin electron beam radiation therapy given in once weekly 400 cGy fractions to a total dose of 2400 cGy. Underdosed areas and areas of greatest initial involvement were boosted 400 cGy twice weekly for an additional 1200 cGy. This was followed by a second course of total body X ray irradiation, to a total dose of 150 cGy. The total skin electron beam radiotherapy technique is a modification of an established six position EBRT technique for mycosis fungoides. Measurements to characterize the beam with and without a lexan scattering plate, demonstrated that the combination of no-plate beams produced better dose uniformity with a much higher dose rate. This improved technique is particularly advantageous for elderly and/or frail patients. Nine (75%) of the 12 patients achieved complete response (CR). The other three had significant improvement with greater than 80% clearing of their disease and resolution of symptoms. All six patients with generalized plaque disease achieved complete response and remained free of disease from 2 to 16 months. Two of three node positive patients also achieved complete response; one, with massive biopsy documented mycosis fungoides nodal disease and deep open tumors, remained relapse free over 2 years. Only one of the three patients with erythroderma/Sezary syndrome achieved a complete response, which was short lived. Therapy was well tolerated. No significant hematological toxicity occurred. Although total body X ray irradiation and total skin electron beam radiotherapy produced excellent palliation of patients with advanced stage mycosis fungoides, new strategies to provide more effective systemic treatment are needed. PMID- 2666370 TI - Taking a hard look at Borrelia burgdorferi. PMID- 2666371 TI - Veterinary perestroika. PMID- 2666372 TI - Titers, tests, and truisms: rational interpretation of diagnostic serologic testing. PMID- 2666373 TI - Evaluation of full cortical allografts in 25 dogs. AB - Twenty-five dogs received 26 cortical allografts from Apr 9, 1976 through Jan 31, 1982. Cortical allografts were used to reconstruct fractures of the femur, humerus, tibia, radius, and ulna. These grafts were used to replace comminuted fragments; to lengthen bones; to correct malunions, delayed unions, and nonunions; and in one case, to replace bone lost to sequestrum formation in an infected fracture site. All fractures were stabilized by use of standard ASIF techniques and dynamic compression plates. Frozen bone allografts were used in all cases. These were harvested aseptically and stored in a household freezer for 3 days to one year before use. Clinically normal function was achieved in 96% of the dogs. PMID- 2666374 TI - American Indians and their horses' health. PMID- 2666375 TI - Distribution of virginiae butanolides in antibiotic-producing actinomycetes, and identification of the inducing factor from Streptomyces antibioticus as virginiae butanolide A. PMID- 2666376 TI - Rapid photometric assay of growth of Mycoplasma mycoides subsp. capri. AB - A new spectrophotometric technique for evaluation of early growth in liquid culture of Mycoplasma mycoides subsp. capri has been developed. As turbidity does not appear until after incubation to 18 h the method utilizes the change in absorbance of the medium at 550 nm to monitor growth. The change in absorbance of the medium (which contains phenol red) occurs when the pH changes due to microbial growth. For measurement of growth at later stages when turbidity is proportional to number of colony forming units, two other wavelengths (450 nm and 700 nm) have been suggested. PMID- 2666377 TI - Partial purification and characterization of phospholipase C from Yersinia enterocolitica. AB - About 34% of the strains of Yersinia enterocolitica isolated from raw milk were found to produce lecithinase. A selected strain produced phospholipase C at 22 degrees C and 37 degrees C; production was optimum at 37 degrees C in the stationary phase (14-16 h). A decrease in phospholipase C activity at various storage temperatures (-5 degrees C, 4 degrees C, 37 degrees C) was also observed, although the enzyme was active over a wide range of temperature (5-65 degrees C) and pH (3.5-7.5). The phospholipase C was partially purified by ammonium sulphate precipitation and Sephadex column chromatography, and characterized. PMID- 2666378 TI - Probiotics in man and animals. AB - There is good evidence that the complex microbial flora present in the gastrointestinal tract of all warm-blooded animals is effective in providing resistance to disease. However, the composition of this protective flora can be altered by dietary and environmental influences, making the host animal susceptible to disease and/or reducing its efficiency of food utilization. What we are doing with the probiotic treatments is re-establishing the natural condition which exists in the wild animal but which has been disrupted by modern trends in conditions used for rearing young animals, including human babies, and in modern approaches to nutrition and disease therapy. These are all areas where the gut flora can be altered for the worse and where, by the administration of probiotics, the natural balance of the gut microflora can be restored and the animal returned to its normal nutrition, growth and health status. PMID- 2666379 TI - Influence of mucin on glycosidase, protease and arylamidase activities of human gut bacteria grown in a 3-stage continuous culture system. AB - Human intestinal bacteria were grown in a 3-stage continuous culture system on a medium containing complex polysaccharides and proteins as carbon and nitrogen sources. Selected bacterial populations were enumerated and glycosidase, protease and arylamidase activities measured. Comparison of arylamidase and glycosidase activities in the multichamber system (MCS) and faeces showed that the predominant faecal enzymes were also produced by bacteria growing in the MCS. After 48 d operation, porcine gastric mucin (5.8 g/d) was independently fed to vessel 1. Elevated levels of volatile fatty acid (VFA) formation showed that the glycoprotein was actively fermented. The increase in carbohydrate availability as a result of breakdown of the mucin oligosaccharides stimulated bacterial growth and activities. The enzymological measurements showed that mucin increased production of both cell-bound and extracellular glycosidases, such as beta galactosidase, alpha-glucosidase and N-acetyl-beta-glucosaminidase. Protease activities were profoundly influenced by mucin. These were largely cell-bound in non-mucin cultures but were predominantly extracellular and collagenolytic when mucin was present. Experiments with protease inhibitors showed that cysteine proteases were the major cell-bound and extracellular enzymes in both mucin and non-mucin cultures, but that serine and metalloproteases were also present. The effect of mucin on arylamidase formation was less marked, although there was increased production of these enzymes in vessels 1 and 2 of the MCS. These results suggest that host-produced substances such as mucin glycoprotein may play a role in modulating the growth and activity of bacteria growing in the human large intestine. PMID- 2666380 TI - Studies on antagonism between porcine skin bacteria. AB - Strains of Staphylococcus warneri, Staph. epidermidis and Aerococcus viridans isolated from porcine skin were shown to produce substances that inhibited the growth of Staph. hyicus. Studies of interactions between the inhibitor-producing bacteria and Staph. hyicus on cellulose acetate membranes demonstrated a significant reduction (P less than 0.001) of the Staph. hyicus population at various stages of its growth cycle, depending on the inhibitor used. Inhibitor production profiles in batch culture showed a change in production with culture growth. Trypsin and an extracellular substance from Staph. hyicus had similar effects in reducing inhibitor production. Staphylococcus hyicus was shown to produce varying amounts of a proteolytic enzyme during growth in batch culture. Such in vitro models of bacterial interaction enable potential mechanisms of disease control using inhibitor-producing organisms to be investigated and provide a basis for studies in vivo. PMID- 2666381 TI - Comparison of properties of collected cells and cells from the culture vessel during continuous culture of Streptococcus mutans Ingbritt. AB - In continuous-culture studies chemostat effluents are usually collected into a receiving flask in an ice bath to obtain enough cells for an experiment. It is assumed that the properties of these are not significantly different from those of the culture in the chemostat vessel. This assumption has been tested for the dental pathogen Streptococcus mutans Ingbritt. Collected supernatant fluid and cells were compared with supernatant fluid and cells taken directly from the culture vessel, for four major groups of culture properties: viability and biomass, concentrations of metabolites and nutrients, activities of selected enzymes, and glycolytic rates. The assumption held true except for glycolytic rate during endogenous metabolism. It is suggested that comparison of collected and culture vessel cells is an important control which should be done in all continuous culture studies of microbial physiology and biochemistry, but that the properties of Strep. mutans cells collected on ice up to 16 h do reflect those of cells actively growing in the chemostat. PMID- 2666382 TI - The effects of nutrients on the survival of Escherichia coli in lake water. AB - Escherichia coli was shown to survive without decline in viable counts for at least 12 d in filtered-autoclaved lake water. In unfiltered lake water there was a rapid decline in the viable count of E. coli. The addition of synthetic sewage to filtered-autoclaved lake water led to an increase in the viable count of E. coli at 15 degrees C and 37 degrees C and to an increase in the survival time of the E. coli in unfiltered water. The addition of phosphate and carbon sources (glucose, glycerol, succinate, acetate and lactose) did not significantly increase the survival time of E. coli in unfiltered water over the controls. The addition of ammonium sulphate and some amino acids (as nitrogen sources) to the unfiltered lake water did lead to an increase in the survival times for E. coli and this increase was proportional to the concentration of the added nitrogen source. PMID- 2666383 TI - Serum-free, chemically defined medium to evaluate the direct effects of growth factors and inhibitors on proliferation and function of neonatal rat cardiac muscle cells in culture. AB - Neonatal rat cardiac myocytes were isolated and cultured to evaluate the effects of growth factors and inhibitors on proliferation, survival, and functions in a serum-free medium. Insulin and transferrin in MCDB 107 nutrient medium elicited DNA and protein synthesis in cells on a fibronectin-coated culture surface in serum-free medium. Insulin was most effective on both DNA and protein synthesis in serum-free culture conditions. The serum-free, hormone-supplemented medium eliminated the contamination of noncardiac myocytes and supported the long-term survival (over 18 d) of cardiac myocytes. Dexamethasone was required to induce optimal contractility with or without insulin and transferrin. Serum contained both negative and positive effectors of DNA and protein synthesis of the cardiac myocytes. Concentrations of serum (above 5%) inhibited DNA and protein synthesis. Low density lipoprotein (LDL) accounted in part for the inhibitory activity. The serum-free culture system provides a useful model to elucidate the role of hormones, growth factors, and drugs in heart cell regeneration and function. PMID- 2666384 TI - Characterization of a new spontaneously developed murine mammary adenocarcinoma in syngeneic BALB/c hosts. AB - A mouse mammary tumor cell line, designated JC, has been established from a spontaneously developed primary adenocarcinoma of an aged virgin female BALB/c mouse. Isoenzyme analyses including glucose-6-phosphate dehydrogenase, lactate dehydrogenase, and peptidase proved that this cell line is of murine origin and devoid of contamination from other species. Karyotyping revealed that the number of chromosome ranged from 26 to 100, with a modal number of 40. Electron microscopic examination detected the presence of tonofilament and desmosomes confirming its epithelial nature. In addition, no type B or C virus particle was detected, although intracysternal A particle was observed occasionally. Tumorigenicity in immunocompetent syngeneic hosts was easily established by s.c., i.p., and i.v. injection of viable JC tumor cells. A very weak immunogenicity of the JC tumor was demonstrated through its immunization-challenging on syngeneic immunocompetent hosts. Although no rejection of JC tumor was noted, a significant prolongation for the incubation period before an obvious and palpable tumor growth was detected between the experimental and the control animals. Development of a concomitant immunity was also detected. The JC tumor represents a valuable murine mammary tumor model which is different from other available models because of its unique origin, absence of virus particles, very weak immunogenicity, and high tumorigenicity in syngeneic hosts. The cell line has been maintained for more than 5 yr and has been used for experimental immunotherapy in our laboratory. PMID- 2666385 TI - Transferrin is an autocrine growth factor secreted by Reuber H-35 cells in serum free culture. AB - We have previously reported that Reuber H-35 rat hepatoma cells secrete an autocrine growth-stimulating activity in serum-free culture. To characterize this activity, conditioned serum-free medium from dense H-35 donor cultures was collected in the absence and presence of [35S]methionine. A 1:4 dilution of conditioned medium into fresh serum-free medium resulted in an increase in mean H 35 cell numbers per assay dish from 1.59 +/- 0.12 X 10(5) to 3.35 +/- 0.34 X 10(5) after 44 h of incubation. Control, unconditioned medium, resulted in significantly (P less than 0.05) less growth (2.14 +/- 0.41 X 10(5) cells per dish). Trypsin digestion eliminated the growth-promoting effect of conditioned medium but had no effect on unconditioned medium. Dialysis did not diminish the growth-promoting activity of conditioned medium. The immunoprecipitate of [35S]methionine-containing conditioned medium with antisera against rat serum transferrin contained a dominant radioactive doublet of molecular weight equal to purified rat serum transferrin. A rat transferrin radioimmunoassay was devised and used to quantitate that 29.1 +/- 1.2 ng of transferrin was secreted per 10(6) cells per hour in serum-free culture. Addition of antitransferrin antibody resulted in a significant (P less than 0.025) decrease in H-35 cell growth after 48 h. Thus, a portion of the autocrine growth-promoting activity secreted by H-35 cells into serum-free culture is due to transferrin. PMID- 2666386 TI - Expression of the human chondrocyte phenotype in vitro. AB - We report a culture scheme in which human epiphyseal chondrocytes lose their differentiated phenotype in monolayer and subsequently reexpress the phenotype in an agarose gel. The scheme is based on a method using rabbit chondrocytes. Culture in monolayer allowed small quantities of cells to be amplified and provided a starting point to study expression of the differentiated human chondrocyte phenotype. The cells cultured in monolayer produced type I procollagen, fibronectin, and small noncartilaginous proteoglycans. Subsequent culture in agarose was associated with the acquisition of typical chondrocyte ultrastructural features and the synthesis of type II collagen and cartilage specific proteoglycans. The switch from the nonchondrocyte to the differentiated chondrocyte phenotype occurred under these conditions between 1 and 2 wk of agarose culture and was not necessarily homogeneous throughout a culture. This culture technique will facilitate direct investigation of human disorders of cartilage that have been addressed in the past by alternative approaches. PMID- 2666387 TI - Stabilization of the 3' one-third of Escherichia coli ribosomal protein S20 mRNA in mutants lacking polynucleotide phosphorylase. AB - Mutations which largely inactivate polynucleotide phosphorylase and which render RNase II thermolabile exert two effects on the metabolism of the two nested mRNAs which encode ribosomal protein S20. (i) The lifetime of both mRNA species is extended 2.5-fold at 38 degrees C in a strain harboring both mutations. (ii) A relatively stable truncated fragment of these mRNAs accumulates to significant levels in strains lacking polynucleotide phosphorylase. The truncated RNA (Po RNA) is 147 to 148 residues long and is coterminal with the 3' ends of intact S20 mRNAs. Its 5' end appears to be generated by endonucleolytic cleavage to the 5' side of a G residue in the sequence AACCGAUC. The data are consistent with the hypothesis that S20 mRNAs can be degraded by alternative pathways. The normal pathway depends on functional polynucleotide phosphorylase and is concerted, since S20 mRNAs disappear without accumulation of detectable intermediates in the decay process. The slower alternative pathway is followed when polynucleotide phosphorylase is inactivated by mutation. This pathway is distinguished by segmental rather than concerted degradation of S20 mRNAs and involves at least one endonucleolytic cleavage. The 5' two-thirds of S20 mRNAs decays significantly more quickly than the 3' third in this latter mode of mRNA turnover. PMID- 2666388 TI - Separation of the SOS-dependent and SOS-independent components of alkylating agent mutagenesis. AB - Escherichia coli plasmids containing the rpsL+ gene (Strs phenotype) as the target for mutation were treated in vitro with N-methyl-N-nitrosourea. Following fixation of mutations in E. coli MM294A cells (recA+ Strs), an unselected population of mutant and wild-type plasmids was isolated and transferred into a second host, E. coli 6451 (recA Strr). Strains carrying plasmid-encoded forward mutations were then selected as Strr isolates, while rpsL+ plasmids conferred the dominant Strs phenotype in the second host. Mutation induction and reduced survival of N-methyl-N-nitrosourea-treated plasmids were shown to be dose dependent. Because this system permitted analysis and manipulation of the levels of certain methylated bases produced in vitro by N-methyl-N-nitrosourea, it afforded the opportunity to assess directly the relative roles of these bases and of SOS functions in mutagenesis. The methylated plasmid DNA gave a mutation frequency of 6 X 10(-5) (a 40-fold increase over background) in physiologically normal cells. When the same methylated plasmid was repaired in vitro by using purified O6-methylguanine DNA methyltransferase (to correct O6-methylguanine and O4-methylthymine), no mutations were detected above background levels. In contrast, when the methylated plasmid DNA was introduced into host cells induced by UV light for the SOS functions, rpsL mutagenesis was enhanced eightfold over the level seen without SOS induction. This enhancement of mutagenesis by SOS was unaffected by prior treatment of the DNA with O6-methylguanine DNA methyltransferase. These results demonstrate a predominant mutagenic role for alkylation lesions other than O6-methylguanine or O4-methylthymine when SOS functions are induced. The mutation spectrum of N-methyl-N-nitrosourea under conditions of induced SOS functions revealed a majority of mutagenic events at A . T base pairs. PMID- 2666389 TI - Cloning and sequencing of the gene encoding a 125-kilodalton surface-layer protein from Bacillus sphaericus 2362 and of a related cryptic gene. AB - Using the vector pGEM-4-blue, a 4,251-base-pair DNA fragment containing the gene for the surface (S)-layer protein of Bacillus sphaericus 2362 was cloned into Escherichia coli. Determination of the nucleotide sequence indicated an open reading frame (ORF) coding for a protein of 1,176 amino acids with a molecular size of 125 kilodaltons (kDa). A protein of this size which reacted with antibody to the 122-kDa S-layer protein of B. sphaericus was detected in cells of E. coli containing the recombinant plasmid. Analysis of the deduced amino acid sequence indicated a highly hydrophobic N-terminal region which had the characteristics of a leader peptide. The first amino acid of the N-terminal sequence of the 122-kDa S-layer protein followed the predicted cleavage site of the leader peptide in the 125-kDa protein. A sequence characteristic of promoters expressed during vegetative growth was found within a 177-base-pair region upstream from the ORF coding for the 125-kDa protein. This putative promoter may account for the expression of this gene during the vegetative growth of B. sphaericus and E. coli. The gene for the 125-kDa protein was followed by an inverted repeat characteristic of terminators. Downstream from this gene (11.2 kilobases) was an ORF coding for a putative 80-kDa protein having a high sequence similarity to the 125-kDa protein. Evidence was presented indicating that this gene is cryptic. PMID- 2666390 TI - Identification of multiple repressor recognition sites in the hut system of Pseudomonas putida. AB - The hutC gene in Pseudomonas putida encodes a repressor protein that negatively regulates the expression of all hut genes. We have overexpressed this cloned hutC gene in Escherichia coli to identify P. putida hut regions that could specifically bind the repressor. Ten restriction fragments, some of which were partially overlapping and spanned the coding portions of the P. putida hut region, were labeled and tested for their ability to recognize repressor in a filter binding assay. This procedure identified three binding sites, thus supporting previous indications that there were multiple operons. A 1.0-kilobase pair SalI restriction fragment contained the operator region for the hutUHIG operon, whereas a 1.9-kilobase-pair SmaI fragment contained the hutF operator. A 2.9-kilobase-pair XhoI segment appeared to contain the third operator, corresponding to a separate and perhaps little used control region for hutG expression only. The addition of urocanate, the normal inducer, caused dissociation of all operator-repressor complexes, whereas N-formylglutamate, capable of specifically inducing expression of the hutG gene, inhibited binding only of repressor to fragments containing that gene. Formylglutamate did not affect the action of urocanate on the repressor-hutUHIG operator complex, indicating that it binds to a site separate from urocanate on the repressor. DNA footprinting and gel retardation analyses were used to locate more precisely the operator for the hutUHIG operon. A roughly 40-base-pair portion was identified which contained a 16-base-pair region of dyad symmetry located near the transcription initiation site for this operon. PMID- 2666391 TI - Transcription mapping of the Escherichia coli chromosome by electron microscopy. AB - The distinctive double Christmas tree morphology of rRNA operons as visualized by electron microscopy makes them easy to recognize in chromatin spreads from Escherichia coli. On the basis of the pattern of nascent transcripts on nearby transcription units and the relative distances of the operons from one another and the replication origin, we are now able to specifically identify five of the seven rRNA operons in E. coli. The use of rRNA operons as markers of both position and distance has resulted in the morphological mapping of a significant portion of the E. coli chromosome; over 600 kilobase pairs in the 84- to 90-min and 72-min regions can now be recognized. Since individual rRNA operons could be identified, direct comparisons could be made of their transcriptional activities. As judged by the densities of RNA polymerases along the operons, rrnA, rrnB, rrnC, rrnD, and rrnE were all transcribed at similar levels, with one RNA polymerase every 85 base pairs. The ability to recognize individual operons and specific regions of the chromosome allows direct comparisons of various genetic parameters. PMID- 2666392 TI - Lytic response of Escherichia coli cells to inhibitors of penicillin-binding proteins 1a and 1b as a timed event related to cell division. AB - In growing cultures of Escherichia coli, simultaneous inhibition of penicillin binding proteins 1a and 1b (PBPs 1) by a beta-lactam efficiently induces cell lysis. However, the lytic behavior of cultures initiating growth in the presence of beta-lactams specifically inhibiting PBPs 1 suggested that the triggering of cell lysis was a cell division-related event, at least in the first cell cycle after the resumption of growth (F. Garcia del Portillo, A. G. Pisabarro, E. J. de la Rosa, and M. A. de Pedro, J. Bacteriol. 169:2410-2416, 1987). To investigate whether this apparent correlation would hold true in actively growing cells, we studied the lytic behavior of cultures of E. coli aligned for cell division which were challenged with beta-lactams at different times after alignment. Cell division was aligned either by nutritional shift up or by chromosome replication alignment. Specific inhibition of PBPs 1 with the beta-lactam cefsulodin resulted in a delayed onset of lysis which was coincident in time with the resumption of cell division. The apparent correlation between the initiation of lysis and cell division was abolished when cefsulodin was used in combination with the PBP 2 specific inhibitor mecillinam, leading to the onset of lysis at a constant time after the addition of the beta-lactams. The results presented clearly argue in favor of the hypothesis that the triggering of cell lysis after inhibition of PBPs 1 is a cell division-correlated event dependent on the activity of PBP 2. PMID- 2666393 TI - Mercury operon regulation by the merR gene of the organomercurial resistance system of plasmid pDU1358. AB - The structural basis for induction of the mercury resistance operon with inorganic mercury and with the organomercurial compound phenylmercuric acetate was addressed by DNA sequencing analysis and by lac fusion transcription experiments regulated by merR in trans from broad-spectrum-resistance plasmid pDU1358 (Hg2+ and phenylmercury responding). The lac fusion results were compared with those from a narrow-spectrum-resistance (Hg2+ responding but not phenylmercuric responding) operon and the pDU1358 merR deleted at the 3' end. The nucleotide sequence of the beginning region of the broad-spectrum mer operon of plasmid pDU1358 was determined, including that of the merR gene, the operator promoter region, the merT and merP genes, and the first 60% of the merA gene. Comparison of this sequence with DNA sequences of narrow-spectrum mer operons from transposon Tn501 and plasmid R100 showed that a major difference occurred in the 3' 29 base pairs of the merR gene, resulting in unrelated C-terminal 10 amino acids. A hybrid mer operon consisting of the merR gene from pDU1358, a hybrid merA gene (determining mercuric reductase enzyme), and lacking the merB gene (determining phenylmercury lyase activity) was inducible by both phenylmercury and inorganic Hg2+. This shows that organomercurial lyase is not needed for induction by organomercurial compounds. A mutant form of pDU1358 merR missing the C-terminal 17 amino acids responded to inorganic Hg2+ but not to phenylmercury. Thus, the C-terminal region of the MerR protein of the pDU1358 mer operon is involved in the recognition of phenylmercury. PMID- 2666394 TI - Actively replicating nucleoids influence positioning of division sites in Escherichia coli filaments forming cells lacking DNA. AB - The positioning of constrictions in Escherichia coli filaments pinching off anucleate cells was analyzed by fluorescence microscopy of dnaX(Ts), dnaX(Ts) sfiA, dnaA46(Ts), gyrA(Am) supF(Ts), and gyrB(Ts) mutants. In filaments with actively replicating nucleoids, constrictions were positioned close to the nucleoid, whereas in nonreplicating filaments, positioning of constrictions within the anucleate region was nearly random. We conclude that constriction positioning depends in an unknown way on nucleoid replication activity. PMID- 2666395 TI - Isolation and mapping of Escherichia coli mutations conferring resistance to division inhibition protein DicB. AB - Temperature-sensitive dicA mutants of Escherichia coli, dicA1(Ts), are blocked for cell division, owing to derepressed expression of a division inhibition gene, dicB. We isolated mutants which survived a high temperature in the dicA1 background and which survived induced expression of dicB carried by a high-copy number plasmid. Most of the mutations conferred very slow growth on the cells. Two were mapped to the 90-min cluster of genes involved in translation and transcription, in or very close to gene rpoB. The majority of the other mutations were found to cause variable degrees of minicell formation and to map within or very close to the minB locus. Contrary to these mutations, the canonical min-1 mutation did not confer resistance to DicB. PMID- 2666396 TI - Involvement of Pseudomonas putida RpoN sigma factor in regulation of various metabolic functions. AB - The RpoN protein was originally identified in Escherichia coli as a sigma (sigma) factor essential for the expression of nitrogen regulons. In the present study we cloned the Pseudomonas putida rpoN gene and identified its gene product as a protein with an apparent molecular weight of 78,000. A mutant rpoN gene was constructed by in vitro insertion mutagenesis with a kanamycin cassette. A P. putida rpoN mutant was then isolated by replacement of the intact chromosomal rpoN gene by the mutant rpoN gene through homologous recombination. Examination of the phenotypes of the P. putida rpoN mutant thus obtained allowed the identification of a series of metabolic functions whose expression depends upon the RpoN sigma factor. The rpoN mutation in P. putida affected the utilization by this organism of nitrate, urea, and uncharged amino acids, namely, alanine, glycine, isoleucine, leucine, and serine, as nitrogen sources. The mutation also affected the utilization of the above-mentioned amino acids, as well as lysine, C4-dicarboxylates (succinate, fumarate), and alpha-ketoglutarate, as carbon sources. In contrast to the P. putida wild-type strain, the rpoN mutant was nonmotile. The colony morphology of the mutant strain was different from that of the wild-type strain. Studies on the expression of the TOL plasmid catabolic operons in the mutant strain demonstrated that transcription from the upper operon promoter and from the xylS gene promoter requires the RpoN sigma factor. PMID- 2666397 TI - Sequence and overexpression of the menD gene from Escherichia coli. AB - The menD gene of Escherichia coli codes for the first enzyme of menaquinone biosynthesis, 2-succinyl-6-hydroxy-2,4-cyclohexadiene-1-carboxylate (SHCHC) synthase. DNA sequence analysis of menD shows an open reading frame encoding a 52 kilodalton protein. Possible promoter and ribosome binding sites are present. Insertion of the menD gene into a tac promoter expression vector leads to nearly a 100-fold increase in the level of SHCHC synthase activity upon induction with isopropyl-beta-D-thiogalactoside (IPTG). Sodium dodecyl sulfate-polyacrylamide gel electrophoresis of [35S]methionine-labeled proteins shows a 61-kilodalton protein produced upon induction of the menD-containing expression vector. This is the first reported sequence analysis of a men gene and the first significant amplification of any of the menaquinone biosynthetic enzymes. PMID- 2666398 TI - Gene transfer system for Rhodopseudomonas viridis. AB - A gene transfer system for Rhodopseudomonas viridis was established which uses conjugation with Escherichia coli S17-I as the donor and mobilizable plasmids as vectors. Initially, plasmids of the incompatibility group P1 (pRK290 and pRK404) were used. The more effective shuttle vectors between E. coli and R. viridis, pKV1 and pKVS1, were derived from plasmid pBR322 and showed the highest conjugation frequency (10(-2] thus far demonstrated in purple bacteria. It was also demonstrated that Rhizobium meliloti can be used as a donor for conjugation with R. viridis. From a genomic cosmid library of R. viridis constructed in the vector pHC79, clones that coded for subunits H (puh operon), L, M and cytochrome c (puf operon) of the photosynthetic reaction center were isolated and characterized. For linkage of the two operons on the genome, cosmids that overlapped with the operon-carrying clones were identified. The relative positions of the two operons could not be determined, but the operons must be more than 100 kilobase pairs apart. Thus, the genomic organization of the reaction center in R. viridis is different from that of Rhodobacter capsulatus, for which a distance of about 39 kilobase pairs was determined. From a spontaneous mutant of R. viridis that is resistant to the herbicide terbutryn, the puf operon was cloned in pKVS1 and transferred by conjugation into R. viridis wild-type cells. The resulting exconjugants were resistant to the herbicide, which demonstrated that the puf operon on pKVS1 constructions was functionally expressed in R. viridis. PMID- 2666399 TI - Genetic regulation of the tricarboxylate transport operon (tctI) of Salmonella typhimurium. AB - Tricarboxylates are transported into Salmonella typhimurium by a binding protein dependent transport system known as TctI. Genetically, it comprises three structural genes, tctCBA, as well as a fourth gene of unknown function (tctD), which is transcribed divergently from tctC (K. A. Widenhorn, J. M. Somers, and W. W. Kay, J. Bacteriol. 170:3223-3227, 1988). Deletions in tctD strongly reduced expression of tctC or of tctC-lacZ transcriptional fusions; however, expression was restored when tctD was present in trans. Expression of tctD-lacZ transcriptional fusions was strongly repressed in the presence of D-glucose but could be alleviated by the addition of cyclic AMP. Furthermore, transcription of tctD was found not to be autogenously regulated. Thus, tctD is considered to be regulated by catabolite repression and encodes a transcriptional activator of tctCBA expression. From the DNA sequence of tctD, the predicted gene product was hydrophilic and shared distinct homologies with other globally regulated transcriptional activators such as OmpR and NtrC. PMID- 2666400 TI - Initial cloning and sequencing of hydHG, an operon homologous to ntrBC and regulating the labile hydrogenase activity in Escherichia coli K-12. AB - To isolate genes from Escherichia coli which regulate the labile hydrogenase activity, a plasmid library was used to transform hydL mutants lacking the labile hydrogenase. A single type of gene, designated hydG, was isolated. This gene also partially restored the hydrogenase activity in hydF mutants (which are defective in all hydrogenase isoenzymes), although the low hydrogenase 1 and 2 levels were not induced. Therefore, hydG apparently regulates, specifically, the labile hydrogenase activity. Restoration of this latter activity in hydF mutants was accompanied by a proportional increase of the H2 uptake activity, suggesting a functional relationship. H2:fumarate oxidoreductase activity was not restored in complemented hydL mutants. These latter strains may therefore lack, in addition to the labile hydrogenase, a second component (provisionally designated component R), possibly an electron carrier coupling H2 oxidation to the anerobic respiratory chain. Sequence analysis showed an open reading frame of 1,314 base pairs for hydG. It was preceded by a ribosome-binding site but apparently lacked a promoter. Minicell experiments revealed a single polypeptide of approximately 50 kilodaltons. Comparison of the predicted amino acid sequence with a protein sequence data base revealed strong homology to NtrC from Klebsiella pneumoniae, a DNA-binding transcriptional activator. The 411 base pairs upstream from pHG40 contained a second open reading frame overlapping hydG by four bases. The deduced amino acid sequence showed considerable homology with the C-terminal part of NtrB. This sequence was therefore assumed to be part of a second gene, encoding the NtrB-like component, and was designated hydH. The labile hydrogenase activity in E. coli is apparently regulated by a multicomponent system analogous to the NtrB-NtrC system. This conclusion is in agreement with the results of Birkmann et al. (A. Birkmann, R. G. Sawers, and A. Bock, Mol. Gen. Genet. 210:535-542, 1987), who demonstrated ntrA dependence for the labile hydrogenase activity. PMID- 2666401 TI - Spermidine biosynthesis in Escherichia coli: promoter and termination regions of the speED operon. AB - Two enzymes, S-adenosylmethionine decarboxylase and spermidine synthase, are essential for the biosynthesis of spermidine in Escherichia coli. We have previously shown that the genes encoding these enzymes (speD and speE) form an operon and that the area immediately upstream from the speE gene is necessary for the expression of both the speE and speD genes. We have now studied the upstream promoter and the downstream terminator regions of this operon more completely. We have shown that the major mRNA initiation site (Ia) of the operon is located 475 base pairs (bp) upstream from the speE gene and that there is an open reading frame that encodes for a polypeptide of 115 amino acids between the Ia site and the ATG start codon for the speE gene. Downstream from the stop codon for the speD gene is a potential hairpin structure immediately followed by an mRNA termination site, t. An additional mRNA termination site, t', is present about 110 bp downstream from t and is stronger than t. By comparing our DNA fragments with those prepared from this region of the E. coli chromosome by Kohara et al., we have located the speED operon on the physical map of the E. coli chromosome. We have shown that the orientation of the speED operon is counterclockwise and that the operon is located 137.5 to 140 kbp (2.9 minutes) clockwise from the zero position of the E. coli chromosomal map. PMID- 2666402 TI - Features of the rho-dependent transcription termination polar element within the hisG cistron of Salmonella typhimurium. AB - Previous genetic analysis showed that the polar effects of mutations in the hisG cistron of Salmonella typhimurium are dependent on the presence of a single putative transcription termination element within the hisG gene. In fact, all proximal mutations causing translation termination are strongly polar, whereas distal ones are not. The element was mapped by isolating mutations able to relieve the polar phenotype, and they were found to be small deletions in the region downstream of the translational stop codon (M. S. Ciampi and J. R. Roth, Genetics 118:193-202, 1988). In this study, we analyzed the his-specific RNAs synthesized in vivo in different strains harboring the polar frameshift hisG2148 mutation. The nature of the polarity effects is clearly transcriptional, since shorter RNA molecules were produced. When the hisG2148 mutation was transferred in a rho background or in strains harboring the small distal deletions, an increase in readthrough transcription was observed. The transcriptional termination element was characterized in more detail by performing high resolution S1 nuclease mapping experiments. This analysis showed that (i) termination or exonucleolytic degradation following termination produced transcripts with heterogeneous 3' ends; (ii) this process is dependent on the transcription termination factor Rho, since relief of termination occurs in a rho background; and (iii) the element appears to function as a transcription terminator, at least to some extent, even in the course of active translation of the hisG cistron. PMID- 2666403 TI - Mutations in the glnG gene of Escherichia coli that result in increased activity of nitrogen regulator I. AB - Mutations in the glnG gene of Escherichia coli that result in increased activity of nitrogen regulator I (NRI), the product of glnG, were obtained by two different selection procedures. The mutant proteins were purified and characterized. The concentrations of mutant proteins needed to activate transcription at the glnAp2 promoter were three to four times lower than that of the wild-type NRI. The rate of phosphorylation of these proteins and the stability of mutant NRI phosphate were found to be similar to those of the wild type NRI. In one of the mutants, the site of the mutation was localized in the DNA region specifying the central domain of NRI. PMID- 2666404 TI - Sequence and structure of the yeast galactose transporter. AB - The previously cloned GAL2 gene of the Saccharomyces cerevisiae galactose transporter has been sequenced. The nucleotide sequence predicts a protein with 574 amino acids (Mr, 63,789). Hydropathy plots suggest that there are 12 membrane spanning segments. The galactose transporter shows both sequence and structural homology with a superfamily of sugar transporters which includes the human HepG2 erythrocyte and fetal muscle glucose transporters, the rat brain and liver glucose transporters, the Escherichia coli xylose and arabinose permeases, and the S. cerevisiae glucose, maltose, and galactose transporters. Sequence and structural motifs at the N-terminal and C-terminal regions of the proteins support the view that the genes of this superfamily arose by duplication of a common ancestral gene. In addition to the sequence homology and the presence of the 12 membrane-spanning segments, the members of the superfamily show characteristic lengths and distributions of the charged, hydrophilic connecting loops. There is indirect evidence that the transporter is an N-glycoprotein. However, its only N-glycosylation site occurs in a charged, hydrophilic segment. This could mean that this segment is part of a hydrophilic channel in the membrane. The transporter has a substrate site for the cyclic AMP-dependent protein kinase which may be a target of catabolite inactivation. The transporter lacks a strong sequence enriched for proline (P), glutamate (E), aspartate, serine (S), and threonine (T) and flanked by basic amino acids (PEST sequence) even though it has a short half-life. Mechanisms for converting the poor PEST to a possible PEST sequence are considered. Like the other members of the superfamily, the galactose transporter lacks a signal sequence. PMID- 2666405 TI - Saturation of mismatch repair in the mutD5 mutator strain of Escherichia coli. AB - The mutD (dnaQ) gene of Escherichia coli codes for the proofreading activity of DNA polymerase III. The very strong mutator phenotype of mutD5 strains seems to indicate that their postreplicational mismatch repair activity is also impaired. We show that the mismatch repair system of mutD5 strains is functional but saturated, presumably by the excess of DNA replication errors, since it is recovered by inhibiting chromosomal DNA replication. This recovery depends on de novo protein synthesis. PMID- 2666406 TI - Crystallization and preliminary X-ray characterization of branched-chain amino acid aminotransferase from Escherichia coli. AB - The branched-chain amino acid aminotransferase of Escherichia coli was crystallized in two crystal systems, monoclinic and tetragonal, from polyethylene glycol and ammonium sulfate solutions, pH 7.0, respectively. The crystals were of good quality, with diffractions extending beyond 2.8 A. The space group and unit cell dimensions of the monoclinic system crystals were determined from precession photographs to be C2, and a = 93.9, b = 143.6, c = 143.9 A and beta = 134.3 degrees. For the tetragonal system crystals, the possible space group P422 or P4122, and cell dimensions of a = b = 101 A and c = 249 A were determined. Three identical subunits exist per an asymmetric unit in both types of crystals. PMID- 2666407 TI - Binding site of cerulenin in fatty acid synthetase. AB - An antibiotic cerulenin, (2R, 3S)-2,3-epoxy-4-oxo-7,10-trans,trans- dodecadienamide, irreversibly inhibits fatty acid synthetase from Saccharomyces cerevisiae. Three moles of cerulenin were bound to 1 mol of the enzyme with concomitant loss of its activity. Pretreatment of the enzyme with iodoacetamide reduced the amount of cerulenin bound to the enzyme. Since iodoacetamide is known to specifically bind to the cysteine residue on the condensing reaction domain, cerulenin is considered to bind to the same domain. Tryptic digestion of the [3H] cerulenin-treated enzyme gave a radioactive peptide; its amino acid composition was Asx 1, Thr 1, Ser 1, Glx 2, Pro 1, Gly 1, Ala 1, Val 1, Ile 1, and Leu 2. This composition included all the amino acids of the condensing reaction site (Thr-Pro-Val-Gly-Ala-Cys) previously reported by Kresze et al. (Eur. J. Biochem., 79, 181 [1977] except for Cys. When the enzyme was treated with [3H]cerulenin and digested successively with trypsin and carboxypeptidase P, a [3H] cerulenin cysteine adduct was isolated as the sole product. This was identified with the adduct chemically synthesized from non-labeled cerulenin and cysteine, and its structure was elucidated by 1H-, 13C-NMR, and fast atom bombardment mass spectrometry. These results indicate that cerulenin, forming a hydroxylactam ring, reacts at its epoxide carbon (C-2 position) with the SH-group of the cysteine residue in the condensing reaction domain of yeast fatty acid synthetase. PMID- 2666408 TI - Properties of electroporation-mediated DNA transfer in Escherichia coli. AB - Efficient and reproducible DNA-transfection was attained in E. coli, by electroporation. The yield of the transfectants was affected by pretreatment of the recipient cells as well as by the composition of the electroporation medium. Using a single pulse procedure, relationships among the electrical parameters, the transfection efficiency, and the cellular viability were investigated in 10 mM Tris-HCl buffer (pH 7.5) containing 5% sucrose. Certain sodium salts (e.g., citrate, phosphate, and sulfate) were promotive, whereas Mg2+, DEAE-dextran, and polyvinylpyrrolidone were inhibitory to the transfection. Heterologous nucleic acids (native DNA, denatured DNA, and tRNA) exerted only a marginal effect on transfection with a viral replicative-form DNA. The efficiency of DNA transfer was affected by culture conditions, and bacteria grown at a higher temperature were more competent. The electroporation system was more efficient than an improved CaCl2 method, not only in transfection with viral single- and double stranded DNAs, but also in transformation with plasmid DNAs. PMID- 2666409 TI - Triadic proteins of skeletal muscle. AB - Biochemical approaches toward understanding the mechanism of muscle excitation have in recent years been directed to identification and isolation of proteins of the triad junction. The principal protein described--the junctional foot protein (JFP)2--was initially identified by morphological criteria and isolated using antibody-affinity chromatography. Subsequently this protein was described as the ryanodine receptor. It has been isolated and incorporated into lipid bilayers as a cation channel. This in its turn has directed attention toward the transverse (T)-tubular junctional constituents. Three approaches employing the JFP as a probe toward identifying these moieties on the T-tubule are described here. The binding of the JFP to the dihydropyridine receptor, which has been hypothesized to be the voltage sensor in excitation-contraction coupling, is also discussed. The detailed architecture and function of T-tubular proteins remain to be resolved. PMID- 2666410 TI - Kinetic analysis of excitation-contraction coupling. AB - Recent studies of isolated muscle membrane have enabled induction and monitoring of rapid Ca2+ release from sarcoplasmic reticulum (SR)5 in vitro by a variety of methods. On the other hand, various proteins that may be directly or indirectly involved in the Ca2+ release mechanism have begun to be unveiled. In this mini review, we attempt to deduce the molecular mechanism by which Ca2+ release is induced, regulated, and performed, by combining the updated information of the Ca2+ release kinetics with the accumulated knowledge about the key molecular components. PMID- 2666412 TI - Crystallization and preliminary x-ray characterization of thioredoxin reductase from Escherichia coli. AB - Single crystals of thioredoxin reductase, suitable for x-ray diffraction studies, have been obtained at room temperature by vapor diffusion of 10-20 mg/ml protein solution against 35% polyethylene glycol containing 200 mM ammonium sulfate. Good quality crystals appear spontaneously only from a protein solution that had been stored for more than a year at 4 degrees C, although large single crystals are reproducibly obtained from fresh protein solutions by micro-seeding. The space group is P6(3)22 (a = b = 123.8 A, c = 81.6 A), with one monomer of the enzyme (34.5 kDa) in the crystallographic asymmetric unit. The crystals are well ordered and diffract to beyond 2 A resolution. PMID- 2666411 TI - Critical sulfhydryls regulate calcium release from sarcoplasmic reticulum. AB - Rapid Ca2+ release from the sarcoplasmic reticulum (SR)3 can be triggered by either binding of heavy metals to a sulfhydryl (SH) group or by catalyzing the oxidation of endogenous groups to a disulfide. Ca2+ release has been monitored directly using isolated vesicle preparations or indirectly by monitoring phasic contractions in a skinned fiber preparation. SH oxidation triggered by addition of Cu2+/mercaptans, phthalocyanine dyes, reactive disulfides, and various anthraquinones appears to involve a direct interaction with the Ca2+ release protein from the SR. A model is presented in which reversible oxidation and reduction of endogenous SH groups results in the opening and closing of the Ca2+ release channel from the SR. PMID- 2666413 TI - Cytosolic free calcium in adipocytes. Distinct mechanisms of regulation and effects on insulin action. AB - It has been proposed that an elevation in cytosolic free Ca2+ may play a role in either mediating or antagonizing the ability of insulin to stimulate glucose uptake in adipocytes. This question has been addressed in the present studies using isolated fura-2-loaded rat adipocytes stimulated with a variety of agonists. The effects of insulin, oxytocin, norepinephrine, ATP, and ionomycin on cytosolic free Ca2+ levels were assessed and compared with their effects on transport-limited glucose oxidation. Oxytocin and ionomycin at concentrations which caused 3-5-fold increases in cytosolic Ca2+, by releasing Ca2+ from internal stores, had no effect on insulin-stimulated glucose oxidation. ATP and norepinephrine which caused more modest increases in Ca2+, by mechanisms at least partially dependent on external stores, inhibited insulin-stimulated glucose oxidation. Insulin had no effect on basal Ca2+ levels nor did it modulate the Ca2+ elevation caused by other agonists. These data suggest that insulin stimulated glucose transport is not associated with an increase in cytosolic Ca2+. In addition, although there appears to be a correlation between inhibition of insulin-stimulated glucose transport and the effect of certain agonists to promote Ca2+ influx, there is not a general obligatory relationship between an elevation in cytosolic Ca2+ and antagonism of this insulin action. PMID- 2666414 TI - Inositol trisphosphate production in squid photoreceptors. Activation by light, aluminum fluoride, and guanine nucleotides. AB - The light-stimulated production of inositol triphosphate (IP3), via hydrolysis of phosphatidylinositol bisphosphate (PIP2), can be demonstrated in an in vitro preparation of isolated distal segments of squid photoreceptors. The retina is labeled with [3H]inositol (Szuts, E. Z., Wood, S. F., Reid, M. S., and Fein, A. (1986) Biochem. J. 240, 929-932), and the rhodopsin-containing distal segments are isolated in artificial cytosol. Within 2 s after a flash, IP3 levels increase 200% (corresponding to an intracellular increase of approximately 5 microM), and the lipid precursor PIP2 decreases by 50%. Inositol bisphosphate (IP2) levels increase later, as a breakdown product of IP3. IP3 response is light-dependent, saturating when 0.5% of the rhodopsin is photoactivated. Guanosine-5'-O-(3 thiotriphosphate (GTP gamma S) binding demonstrates that the plasma membrane of most of the photoreceptor distal segments is intact or only transiently permeable. Membrane permeabilization enhances light-activated GTP gamma S binding but abolishes the light-activated IP3 production. Receptor-mediated production of IP3 is believed to be the result of a receptor-G-protein-phospholipase C cascade (i.e. Cockcroft, S., and Gomperts, B. D. (1985) Nature 314, 534-536). To test for G-proteins, we incubated the photoreceptors in AlF4- (an activator of G-proteins) in the dark. IP3 and IP2 were produced with a corresponding decrease in PIP2. Incubation with GTP or GTP gamma S, in hypotonic buffer, which causes transient leakiness, increased dark levels by IP3 by 50%. Addition of GTP in isotonic buffer enhanced the light-induced increase of IP3. These results localize the light-stimulated phospholipase C activity to the distal segments and suggest that a G-protein couples rhodopsin to phospholipase C. PMID- 2666415 TI - Translational frameshifts induced by mutant species of the polypeptide chain elongation factor Tu of Escherichia coli. AB - Translational frameshifts, both +1 and -1, are promoted by mutations in tufA and tufB, the two genes encoding the polypeptide chain elongation factor (EF) Tu of Escherichia coli. Strains harboring the mutant EF-Tu(Ala375----Thr) encoded by either tufA or tufB or by both, display a linear relationship between the frequency of frameshifting and the concentration of mutant EF-Tu, relative to the total amount of EF-Tu. A second mutant species, EF-TuB(Gly222----Asp), also promotes frameshifting. The frequency is strikingly enhanced by the combined action of EF-TuA(Ala375----Thr) and EF-TuB(Gly222----Asp) and exceeds by far the total contribution of the two mutant EF-Tus studied separately. These observations raise the question whether the formation of each peptide bond under conditions that no frameshifting occurs also requires the combined action of two EF-Tu molecules, in this case not differing functionally. PMID- 2666416 TI - Binding of Vibrio cholera toxin and the heat-labile enterotoxin of Escherichia coli to GM1, derivatives of GM1, and nonlipid oligosaccharide polyvalent ligands. AB - Vibrio cholera toxin and the heat-labile enterotoxin of Escherichia coli have been shown to differ somewhat in their ligand specificity and in the antigenicity of their binding sites. Therefore, the components of the oligosaccharide portion of GM1 bound by cholera toxin and the heat-labile enterotoxin of E. coli were identified by determining the concentration of GM1, derivatives of GM1, oligosaccharide isolated from GM1, or clustered oligosaccharide needed to inhibit toxin binding to GM1-coated plastic wells. The KIs for GM1, the C(7) sialosyl alcohol [corrected] of GM1, and ethanolamine-sialosyl-GM1 were similar (approximately 30-50 nM) for both toxins. N-Deacetylation of GM1 resulted in a small increase in KI; formation of the sialosyl methyl ester increased the KI 2-5 fold; loss of the terminal galactosyl residue (GM2) increased the KI by 10-15 fold; and removal of the sialosyl moiety (asialo-GM1) resulted in loss of inhibition of both toxins. Oligosaccharide isolated from GM1 had a KI for both toxins that was approximately 100-fold greater than that obtained for GM1 and approximately 1000-fold greater than that for a clustered oligosaccharide derivative having an average of 8 oligosaccharide residues (isolated from GM1) per molecule of poly-L-lysine. These results indicate that both toxins are functionally quite similar in their recognition of GM1 as a ligand in that each requires the free carboxyl group of sialic acid for optimum binding, does not need carbons 8 and 9 of the sialosyl moiety nor the acetyl groups associated with the sialic acid and galactosamine residues, and can have its binding to GM1 blocked by a nonlipid compound, i.e. oligo-GM1-poly-L-lysine. PMID- 2666417 TI - Proteoglycan biosynthesis in murine monocytic leukemic (M1) cells before and after differentiation. AB - Murine monocytic leukemic (M1) cells were cultured in the presence of [3H]glucosamine and [35S]sulfate. Labeled proteoglycans were purified by anion exchange chromatography and characterized by gel filtration and sodium dodecyl sulfate-polyacrylamide gel electrophoresis in combination with chemical and enzymatic degradation. M1 cells synthesize a single predominant species of proteoglycan which distributes almost equally between the cell and medium after 17 h labeling. The cell-associated proteoglycan has an overall size of about 135 kDa and contains three to five chondroitin sulfate chains (28-31 kDa each) attached to a chondroitinase-generated core protein of 28 kDa. The synthesis and subsequent secretion of this proteoglycan was enhanced 4-5-fold in cells induced to differentiate into macrophages. This was not a phenomenon of arrest in the G0/G1 stage of the cell cycle, since density inhibited undifferentiated cells arrested at this stage did not increase proteoglycan synthesis. The chondroitin sulfate chains contained exclusively chondroitin 4- and 6-sulfate; however, the ratio of these two disaccharides differed between the medium- and cell-associated proteoglycans, and changed during progression of the cells into a fully differentiated phenotype. Pulse-chase kinetics indicate the presence of two distinct pools of proteoglycan; one that is secreted very rapidly from the cell after a approximately 1-h lag, and a second pool that is turned over in the cell with a half-time of approximately 3.5 h. Subtle differences in the glycosylation patterns of the medium- and cell-associated species are consistent with synthesis of two pools. Papain digestion suggests that the chondroitin sulfate chains are clustered on a small protease resistant peptide. The data suggest that this proteoglycan is similar to the serglycin proteoglycan family. PMID- 2666418 TI - Maternal schooling and childhood mortality. PMID- 2666419 TI - HIV infection in developing countries. PMID- 2666420 TI - Maternal mortality: levels, causes and promising interventions. PMID- 2666421 TI - Community-based intervention trials. PMID- 2666422 TI - Expression of myc and ras oncogenes in two newly established neuroblastoma cell lines. AB - Two new neuroblastoma cell lines, KG-MH and KM-YH have been established from fresh tumour samples. In vitro growth characteristics are presented together with a karyological analysis. Northern and Southern blot experiments have been performed using molecularly cloned probes for c-myc, N-myc, c-Ha-ras, c-Ki-ras, and N-ras oncogenes. Both cell lines showed expression for N-myc, while c-myc expression was not detected. Cell line KM-YH, with a rather long population doubling time of 78 h, showed additional expression for the three ras genes. PMID- 2666423 TI - Purification of the decomposing enzyme from Nepenthes alata against glycophorin B of human red blood cells by high-performance liquid chromatography. PMID- 2666424 TI - Fractionation of human gastric proteinases by immobilized metal chelate (Fe3+) affinity chromatography. PMID- 2666425 TI - Determination of beta-methyldigoxin and its metabolites by high-performance liquid chromatography and fluorescence polarization immunoassay. PMID- 2666426 TI - Growth hormone treatment of children with short stature increases insulin secretion but does not impair glucose disposal. AB - Pediatricians willing to administer GH to non-GH-deficient children with short stature are concerned about the potential adverse effects of this hormone on glucose homeostasis and insulin action. This study was designed to determine the effects of GH therapy on carbohydrate metabolism in 10 prepubertal non-GH deficient children with short stature. After 12 months of treatment with 0.3 U GH/kg BW.day, which resulted in an increase in height velocity from 4.0 +/- 0.3 (+/- SE) to 11.0 +/- 0.4 cm/yr, glucose tolerance was not impaired in these children. Not only were their fasting and postprandial plasma glucose concentrations unchanged from the pretreatment values, but basal glucose turnover did not vary; it was 0.53 +/- 0.04 before and 0.64 +/- 0.06 mmol/m2.min after GH treatment. Using the euglycemic clamp technique, the dose-response curves describing the effects of insulin on glucose disposal were comparable before and after GH treatment. There was a consistent 1.5- to 2-fold increase in plasma insulin and C-peptide concentrations during GH treatment, in both the basal and postprandial states, and after oral glucose or iv glucagon stimulation. We conclude that the GH regimen employed was remarkably effective in increasing growth velocity and devoid of detectable diabetogenic effects during a 1-yr treatment period in these non-GH-deficient children. (glucose, 1 mmol/L = 18 mg/dL; insulin, 1 pmol/L = 0.139 microU/mL; C-peptide, 1 pmol/L = 0.003 ng/ml). PMID- 2666427 TI - Obesity in male and female rhesus monkeys: fat distribution, glucoregulation, and serum androgen levels. AB - Obese (n = 8) and nonobese (n = 6) adult rhesus monkeys (Macaca mulatta) were assessed in terms of body size and distribution of body fat, glucose tolerance, and serum lipid, insulin, and androgen levels. The weights of the obese monkeys were more than 2 SD above the mean for their sex, while the nonobese monkeys averaged less than 0.25 SD from the mean. Obese males and females had excess body fat located predominantly in the abdominal region; abdominal circumference was highly correlated with total body fat, as estimated by the isotope dilution method (r = 0.98; P less than 0.001). Obese monkeys of both sexes had fasting hyperinsulinemia, greater insulin response to iv glucose administration, and marginally impaired glucose tolerance. Obese males had delayed maximal insulin response to glucose administration. Fasting serum triglycerides also were elevated in the obese monkeys (0.95 +/- 0.08 vs. 0.47 +/- 0.05 mmol/L; P less than 0.001). Obese males had lower serum dihydrotestosterone levels than nonobese males (3.1 +/- 0.7 vs. 5.6 +/- 0.4 nmol/L; P less than 0.01). Nonobese females had approximately 2-fold higher serum dehydroepiandrosterone sulfate levels than the other groups. We conclude that obese male and female rhesus monkeys have patterns of fat distribution and glucoregulatory abnormalities similar to those of humans with upper body obesity. The contribution of differences in androgen metabolism to the development of obesity and its complications in rhesus monkeys remain to be defined. PMID- 2666428 TI - Severity, duration, and mechanisms of insulin resistance during acute infections. AB - Acute infections provoke insulin resistance. These experiments were designed to study the severity, duration, and mechanisms of insulin resistance caused by acute infections. First, we studied eight patients [mean age, 29 +/- 11 (+/- SD) yr; body mass index, 23 +/- 2 kg/m2] with acute viral or bacterial infections during the acute stage of their infection and 1-3 months after recovery. The rate of glucose infusion required to maintain normoglycemia during hyperinsulinemia (approximately 500 pmol/L) was used as a measure of insulin action. During infection, the glucose requirements in the patients [21 +/- 2 (+/- SE) mumol/kg.min] were 52% less than those in weight- and age-matched normal subjects (44 +/- 2 mumol/kg.min; P less than 0.001). Compared to data from a large group of normal subjects, the resistance to insulin during infection corresponded to that predicted for a weight-matched 84-yr-old normal person or an age-matched obese person with a body mass index of 37 kg/m2. One to 3 months after recovery, the patients' glucose requirements were still significantly lower (37 +/- 3 mumol/kg.min; P less than 0.02) than those in matched normal subjects. To assess the mechanism of insulin resistance, seven additional patients were studied during the acute stage of infection using a low dose insulin infusion (plasma insulin, 215 pmol/L) combined with a [3-3H]glucose infusion and indirect calorimetry. Again, the glucose requirements were 59% lower in the patients (14 +/- 2 mumol/kg.min) than in matched normal subjects (34 +/- 2 mumol/kg.min; P less than 0.001). This decrease was due to a defect in glucose utilization (18 +/ 2 vs. 37 +/- 1 mumol/kg.min; P less than 0.001, patients vs. normal subjects) rather than impaired suppression of glucose production (4 +/- 1 vs. 3 +/- 1 mumol/kg.min, respectively). Total carbohydrate oxidation rates were similar in both groups (16 +/- 2 vs. 14 +/- 1 mumol/kg.min, respectively), whereas the apparent glucose storage was neglible in the patients (2 +/- 1 mumol/kg.min) compared to that in normal subjects (22 +/- 2 mumol/kg.min; P less than 0.001). We conclude that acute infections induce severe and long-lasting insulin resistance, which is localized to glucose-utilizing pathways. The rate of carbohydrate oxidation is normal during infections, whereas the rate of nonoxidative glucose disposal, as determined by indirect calorimetry, is nearly zero. The apparent blockade in glucose storage could result from diminished glycogen synthesis, accelerated glycogenolysis, or both. PMID- 2666429 TI - Insulin resistance and hypertriglyceridemia in nondiabetic relatives of patients with noninsulin-dependent diabetes mellitus. AB - Plasma glucose, FFA, and insulin responses to an oral glucose challenge, plasma lipid and lipoprotein concentrations, and the ability of insulin to stimulate glucose disposal were measured in 35 nondiabetic sedentary and overweight subjects. The subjects were divided into 2 groups on the basis of the presence (n = 19) or absence (n = 16) of a history of a first degree relative with noninsulin dependent diabetes. The 2 groups were similar in age, body mass index, waist to hip ratio, and maximal aerobic capacity. The results demonstrated that the ability of insulin to stimulate disposal of a glucose load was significantly reduced in the subjects with a positive family history of noninsulin-dependent diabetes. In addition, these individuals had significantly higher plasma triglyceride and very low density lipoprotein cholesterol concentrations. Since all environmental factors known to modify insulin action and very low density lipoprotein metabolism were equal in the 2 groups, these data suggest that the metabolic differences noted are likely to be genetic in origin. PMID- 2666430 TI - Early morning hyperglycemia in insulin-dependent diabetes: acute and sustained effects of cholinergic blockade. AB - Nocturnal release of GH has been shown to be related to the early morning rise in plasma glucose (PG) seen in insulin-dependent diabetes mellitus (IDDM). We have studied the effects of suppression of nocturnal GH release during a single night (acute study) and after nightly suppression for 1 week (chronic study). Changes in plasma glucose and counter-regulatory hormone concentrations were monitored in six IDDM patients during a constant overnight insulin infusion alone, after addition of the anticholinergic agent pirenzepine to cause acute GH suppression, and again on the seventh night of such treatment. In control experiments (infusion of insulin alone; 0.075 mU/kg.min) PG increased from (mean +/- SEM) 5.6 +/- 0.6 mmol/L at 2400 h to 11.1 +/- 1.3 mmol/L at 0900 h (P = 0.0024). Addition of pirenzepine (100 mg at 2200 h and again at 2400 h) in the acute study resulted in a PG change from 5.6 +/- 0.3 mmol/L at 2400 h to 8.4 +/- 1.4 mmol/L at 0900 h (P = 0.17). After pirenzepine administration at the same dose for 7 nights, PG increased from 4.7 +/- 0.6 mmol/L at 2400 h to 6.8 +/- 1.2 mmol/L at 0900 h (P = 0.11). Increases in PG during the study period were significantly less after chronic treatment than after acute treatment compared with changes on control nights. The nocturnal release of GH, which was demonstrated in all patients during the control nights, was suppressed in all patients during the acute study and in four of six patients during the chronic studies. We conclude that initial reduction of the early morning rise of PG in IDDM is associated with acute suppression of nocturnal GH release, and that the more significant sustained effect of anticholinergic GH suppression on the rise of PG may be associated with additional indirect effects on insulin clearance. PMID- 2666431 TI - [Long-term interaction of nerve and muscle, and trophic substance]. PMID- 2666432 TI - The 24 h-urinary excretions of albumin, beta 2-microglobulin and N-acetyl-beta-D glucosaminidase activity in children with IDDM. AB - Microalbuminuria in diabetics is considered to be a sensitive indicator of early diabetic nephropathy. In this paper, 24 h-urinary excretions of albumin, BMG and NAG activity were measured in forty-one children with insulin-dependent diabetes mellitus. Moreover, the relationships between the urinary excretions of these substances and various clinical parameters of diabetes were analyzed. The mean values (mean +/- SD) of 24 h-urinary albumin, BMG and NAG activity in the diabetic children were 8.0 +/- 10.6 mg/day, 61.2 +/- 69.0 micrograms/day and 1.87 +/- 1.30 U/day, respectively. No significant differences were found between diabetic children and normal controls for these mean values. Nor were significant correlations between the various clinical parameters of diabetes and the urinary excretions of any of these substances found. However, nine of the forty-one diabetic children (22.0%) had higher levels of these urinary substances than those (mean + 2SD) in normal controls. Screening of the 24 h-urinary albumin, BMG and NAG activity should be performed routinely in young patients with diabetes. PMID- 2666433 TI - Rapid method to detect shiga toxin and shiga-like toxin I based on binding to globotriosyl ceramide (Gb3), their natural receptor. AB - Shiga toxin and the closely related Shiga-like toxins produced by Escherichia coli represent a group of very similar cytotoxins that may play an important role in diarrheal disease and hemolytic uremic syndrome. These toxins have the same biologic activities and according to recent studies also share the same binding receptor, globotriosyl ceramide (Gb3). They are currently detected, on the basis of their ability to damage several cell lines, by using expensive and tedious assays that require facilities for and experience with tissue cultures and are therefore most suitable for research laboratories. We have developed a rapid method to detect Shiga toxin and Shiga-like toxin I based on specific binding to their Gb3 natural receptor, which was coated onto microdilution plates. Bound toxin was then detected by enzyme-linked immunosorbent assay (ELISA) with monoclonal antibodies. The sensitivity of the Gb3 ELISA was 0.2 ng (2 ng/ml) of purified toxin. The assay was positive with sonic extracts of Shigella dysenteriae serotype 1 strain 6OR (a Shiga toxin producer), E. coli serotype O26:H11 strain H30, and E. coli serotype O157:H7 (both Shiga-like toxin I producers). The assay was very specific in that no cross-reactivity was noted with purified cholera toxin, E. coli heat-labile and heat-stable enterotoxins, and Clostridium difficile cytotoxin, or sonic extracts of other cytotoxin producing organisms, such as other shigellae, pathogenic and nonpathogenic E. coli, Salmonella spp., Campylobacter spp., and Aeromonas spp. These results were in complete agreement with a [3H]thymidine-labeled HeLa cell cytotoxicity assay and with detection of the structural genes by DNA hybridization studies with a Shiga-like toxin I probe. Quantitative analysis showed a high correlation between Gb3 ELISA and HeLa cell assay when fractions obtained at various stages of toxin purification were examined by both methods (r = 0.99, P < 0.01). This rapid Gb3 ELISA is sensitive and specific and may be diagnostically useful in cytotoxin related infections. PMID- 2666434 TI - Evaluation of the Abbott TESTPACK RSV enzyme immunoassay for detection of respiratory syncytial virus in nasopharyngeal swab specimens. AB - The Abbott TESTPACK RSV assay (Abbott Laboratories, North Chicago, Ill.), a rapid (20-min) enzyme immunoassay, was compared with culture and direct immunofluorescence (DFA) of nasopharyngeal cells for the detection of respiratory syncytial virus (RSV) in nasopharyngeal swab specimens. Nasopharyngeal swab specimens, collected from 234 infants, were placed in viral transport medium. Portions of specimen in transport medium were used for each test. Of 234 specimens, 70 (30%) were culture positive, 103 (44%) were DFA positive, 107 (46%) were culture or DFA positive, and 112 (48%) were TESTPACK RSV positive. Of 19 specimens positive by TESTPACK RSV but negative by culture or DFA, 15 were positive by the blocking assay. A total of 122 specimens were culture, DFA, or blocking assay positive; TESTPACK RSV detected 108 specimens (sensitivity, 89%). The specificity, positive predictive value, and negative predictive value of TESTPACK RSV as compared with those of culture, DFA, and the blocking assay were 96, 96, and 89%, respectively. By comparison, the sensitivity, specificity, positive predictive value, and negative predictive value of combined culture and DFA were 88, 100, 100, and 88%, respectively. TESTPACK RSV is a rapid and reliable enzyme immunoassay for the direct detection of RSV antigen in nasopharyngeal swab specimens. PMID- 2666435 TI - Use of monoclonal antibodies to type Shigella flexneri in Bangladesh. AB - A panel of 10 mouse and rat monoclonal antibodies specific for different type- and group-specific O-antigenic determinants of Shigella flexneri lipopolysaccharide was used to serotype 240 isolates of S. flexneri from Bangladesh. Three immunoglobulin M antibodies were used in a direct slide agglutination test; seven immunoglobulin G antibodies were absorbed to Staphylococcus aureus and used in a coagglutination assay. All but 13 of the isolates could be serotyped by using the monclonal antibodies. The six most common serotypes were (in descending order) 2a, 2b, Y (E1037), 1a, 3a, and 1b and accounted for more than 80% of all isolates. Two of the nontypable strains were found to be of a new provisional serotype of S. flexneri (T. Wehler and N.I.A. Carlin, Eur. J. Biochem. 176:471-476, 1988). The 11 remaining strains were found to be rough and therefore nontypable. The serotyping scheme based on the panel of monoclonal antibodies is specific and holds the potential to be developed into a useful tool for epidemiological investigation. The study also demonstrates that the recently described E1037 antigen is commonly found among at least four serotypes (4a, 6, X, and Y) of S. flexneri. PMID- 2666436 TI - Evaluation of oligonucleotide probes for identification of shiga-like-toxin producing Escherichia coli. AB - Four synthetic oligonucleotide probes representing different regions of the Shiga like toxin I (SLT-I) structural genes and one oligonucleotide derived from the SLT-II gene of Escherichia coli serotype O157:H7 strain 933 were examined for the identification of E. coli strains that produce cytotoxins for Vero or HeLa cells. E. coli strains that synthesize SLT-I alone or O157:H7 isolates that coexpress SLT-I and SLT-II hybridized with all four probes that were complementary to the SLT-I genes, suggesting that they have toxin genes with great homology in all the regions examined. In colony hybridization tests, these oligonucleotide probes did not react with E. coli strains that were nontoxigenic for Vero cells or that produced cytotoxins belonging to the SLT-II family. The probe derived from the slt-IIA gene distinguished E. coli strains that produced SLT-II alone from SLT-I producing strains and hybridized to all E. coli O157:H7 strains that produced both SLT-I and SLT-II. Using two of these oligonucleotide probes that were complementary to slt-IA or slt-IIA sequences, we identified 50 of 52 cytotoxin producing strains, whereas none of 416 nontoxigenic E. coli strains was reactive. The colony blot hybridization with the oligonucleotide probes described here can serve as a specific and sensitive test with potential diagnostic value. PMID- 2666437 TI - Etiology of childhood diarrhea in Korea. AB - To assess the role of recently recognized enteropathogens in childhood diarrhea in Korea, 231 children with diarrhea admitted to and 104 children without diarrhea seen at the well-baby clinic or the outpatient department of Hanyang University Hospital in Seoul, Korea, were evaluated during a 14-month period. Stools were cultured for bacterial pathogens, including enterotoxigenic (heat labile and heat-stable enterotoxin-producing) and enteroadherent organisms. Only those stools obtained from patients with diarrhea were examined for rotavirus. All Escherichia coli isolates were screened for Shiga-like toxin (SLT) I, SLT-II, enterohemorrhagic E. coli fimbriae, and enteroinvasiveness by colony hybridization. One or more pathogens were identified in 75.8% of the children with diarrhea. Rotavirus was the most frequently identified pathogen, accounting for 47% of the cases. Other major enteropathogens were enterotoxigenic E. coli (22%), Clostridium difficile (16%), enteroadherent E. coli (15%), and enteropathogenic E. coli (6%). Shigella spp., Campylobacter jejuni, Salmonella spp., SLT-I-and enterohemorrhagic-E. coli-fimbria-probe-positive E. coli serotype O26:H11 and enteroinvasive E. coli were isolated from only a few patients. Aeromonas hydrophila and E. coli O157 were not isolated. Compared with those of the controls, the isolation rates of heat-stable-enterotoxin-producing E. coli (P less than 0.05), C. difficile (P less than 0.025), and enteroadherent E. coli (P less than 0.05) were significantly higher in the patients with diarrhea. The greatest number of rotavirus, enterotoxigenic E. coli, and C. difficile cases were identified during the cool, dry months of October and November. PMID- 2666438 TI - Agreement study between two laboratories of immunofluorescence as a confirmatory test for human immunodeficiency virus type 1 antibody screening. AB - A total of 114 serum specimens from 76 blood donors, 21 patients with acquired immune deficiency syndrome or acquired immune deficiency syndrome-related complex, 7 multiply transfused patients, 3 hemophiliacs, and 7 others were tested for anti-human immunodeficiency virus type 1 (HIV-1) antibody by enzyme immunoassay (EIA) and Western blot (WB) and then blindly tested by immunofluorescence (IF), independently, in two separate laboratories. The IF technique used acetone-fixed HIV-1-infected E cells and uninfected HUT-78 cells mixed at a 1:3 ratio in one spot on a glass slide and uninfected HUT-78 cells (to assess nonspecific fluorescence) alone in a second spot. Of 114 serum specimens, 85 were repeat EIA positive, and 21 of these were WB positive. A total of 129 of 134 of the IF results (included were 20 duplicates) were identical between laboratories, for a Kappa agreement statistic of 0.93. All five IF results discordant between laboratories were EIA repeat positive and WB negative. Included in the study were eight WB-indeterminate sera, of which five blood donor serum specimens and one hemophiliac serum specimen were IF negative and two acquired immune deficiency syndrome serum specimens were IF positive. As a confirmatory test for HIV-1 antibodies, IF provided a faster alternative or supplementary test for confirming EIA results. PMID- 2666439 TI - Development and evaluation of enzyme-linked immunosorbent assays for detection of shiga-like toxin I and shiga-like toxin II. AB - Shiga-like toxin (SLT)-producing Escherichia coli has been associated with a spectrum of human illnesses, including hemorrhagic colitis and hemolytic uremic syndrome. It produces at least two antigenically distinct toxins designated SLT-I and SLT-II, which have been implicated in disease. Currently available toxin assays, however, are not suitable for most clinical or public health laboratories. In this study, we have developed two sandwich enzyme-linked immunosorbent assays (ELISAs) based on toxin-specific murine monoclonal capture antibodies and rabbit polyclonal second antibodies which are specific for SLT-I and SLT-II. The SLT-I ELISA detected 200 pg of purified SLT-I, and the SLT-II ELISA detected 75 pg of purified SLT-II. The types of SLT produced by 166 human and 54 animal isolates of E. coli that produced moderate to high levels of toxin were determined by the ELISA, and results were confirmed by cytotoxin neutralization assays. With the exception of results from three strains, the tests agreed on the types of toxin present. DNA probe assays of 86 of 87 isolates also agreed with the ELISA and neutralization results. Although the SLT-II ELISA was specific for the SLT-II variant produced by porcine edema strains, most of the isolates examined produced levels of toxin (less than 50 50% cytotoxic doses [CD50] per ml) below the detection limit of the test. The ELISAs were not sufficiently sensitive to consistently detect low levels of toxin (less than 50 CD50 per ml) found in fecal extracts. On the basis of these findings, both ELISAs appeared to detect significant levels of SLT-I ( > 100 CD50 per ml) and SLT-II ( > 50 CD50 per ml) in E. coli culture extracts and should be useful diagnostic tools in many microbiology laboratories. PMID- 2666440 TI - Antibody response to low-molecular-weight antigens of Aspergillus fumigatus in allergic bronchopulmonary aspergillosis. AB - Sera from patients with allergic bronchopulmonary aspergillosis (ABPA) or aspergilloma and normal sera were analyzed for specific antibodies by Western (immuno-) blotting with Aspergillus fumigatus antigens transferred electrophoretically onto polyvinylidene difluoride membranes. Western blot analysis demonstrated consistent reactivity of low-molecular-weight A. fumigatus antigens against ABPA sera but not against uncomplicated aspergilloma or normal sera. None of these low-molecular-weight components had any lectin-binding activity. Sera from patients with aspergilloma, however, frequently reacted with high-molecular-weight components of A. fumigatus. The majority of these high molecular-weight antigenic components demonstrated concanavalin A-binding activity. The low-molecular-weight bands were discernible in Western blots with sera from all ABPA patients irrespective of disease activities, such as relapse, flare, or treatment. Antibodies detected by methods such as immunodiffusion or enzyme-linked immunosorbent assays demonstrated total antibody responses to most or all antigenic components, while Western blots demonstrated the reactivities of the individual components with the specific antibodies. Western blot analysis thus provided more information for immunodiagnosis of ABPA than other methods, especially when only crude antigens were available. PMID- 2666441 TI - Incidence of catheter-associated gram-negative bacteremia in children with short bowel syndrome. AB - Children with catheter-associated bacteremia were evaluated for the type of bacteria recovered and the relationship of the bacteria to the predisposing disease. A previously unrecognized observation was that gram-negative isolates, namely, Escherichia coli and Klebsiella sp., were almost exclusively recovered (11 of 12 isolates [92%]) from children with short bowel syndrome (SBS) compared with those from children with other underlying diseases, such as inflammatory bowel disease, malignancies, and other disorders (P less than 0.001). Furthermore, children with SBS had a higher frequency of repeated infection (3.1 catheter-associated infections compared with 1.3 catheter-associated infections in children with other disorders during the same period). Only gram-positive bacteria were isolated from children with malignancies and other predisposing disorders. The very high frequency of catheter-associated gram-negative bacteremia in children with SBS compared with that in children with other bowel disorders, malignancies, and other predisposing diseases requires attention by the clinician in the management of patients in this group. PMID- 2666442 TI - Oral Candida albicans isolates from nonhospitalized normal carriers, immunocompetent hospitalized patients, and immunocompromised patients with or without acquired immunodeficiency syndrome. AB - A total of 128 human oral isolates of Candida albicans were collected from asymptomatic healthy carriers (64 isolates); asymptomatic, nonimmunosuppressed, hospitalized patients (25 isolates); immunosuppressed transplant patients (19 isolates); and human immunodeficiency virus-infected patients with symptoms of acquired immunodeficiency syndrome and oral candidiasis (20 isolates). Isolates were serotyped as A or B and tested for reactivity with an agglutinating immunoglobulin M monoclonal antibody (H9). Immunocompetent individuals colonized by oral C. albicans were almost equally likely to carry serotype A as serotype B cells, while immunocompromised individuals were at least twice as likely to be infected by serotype B than serotype A strains. The reactivity of isolates with H9 antibody followed a similar but more distinctive pattern. Approximately half of the strains from immunocompetent individuals reacted strongly with H9, and the remainder reacted weakly. However, up to 75% of the isolates from immunocompromised patients reacted weakly with H9, while the remainder reacted strongly. A correlation between H9 reactivity and the serotypes of these isolates existed (P = 0.16). The correlation between H9 reactivity and immune status was even stronger (P = 0.025). The monoclonal antibody activities described above were determined by agglutination tests during defined phases of C. albicans growth. Expression of antigen at various times during growth of several isolates was confirmed at the cellular level by analysis using fluorescence-activated cell sorting. Despite the correlation between serotype A and H9 reactivity, H9 antigen was not identical to the serotype A antigen because four serotype A strains reacted only weakly with H9 antibody, and one strain reacted strongly with H9 but was serotype B. These data indicate that oral strains of C. albicans from immunocompetent individuals differ as a group from C. albicans isolated from those who are immunosuppressed. PMID- 2666443 TI - Differential antibody responses to Plasmodium falciparum and P. vivax circumsporozoite proteins in a human population. AB - Papua New Guineans exposed to hyperendemic malaria in the Madang area showed different antibody responses to Plasmodium falciparum and Plasmodium vivax sporozoites despite comparable entomological inoculation rates. Although there was a significant trend of increasing prevalence of anti-P. falciparum circumsporozoite (CS) protein immunoglobulin G (IgG) with age, there was no significant increase in the antibody units of IgG recognizing P. falciparum CS proteins. Antibodies recognizing P. vivax CS proteins steadily increased in prevalence and antibody units with age. Significant trends of increasing prevalence of antibody responders (both IgG and IgM) with increasing splenic enlargement were found in the younger age groups for P. falciparum CS proteins but not for P. vivax CS proteins. When antibody responders were analyzed by quartiles, there was a trend of increasing antibody response with age against P. vivax CS peptide, but not for P. falciparum CS protein. There was no evidence for increasing protection against blood-stage infections with increasing antibody levels for either P. falciparum or P. vivax. Neither were any significant relationships found between entomological inoculation rates and either CS antibody prevalence or concentration among the villages studied. PMID- 2666444 TI - Restriction endonuclease analysis of human and bovine group B streptococci for epidemiologic study. AB - Group B streptococci, a frequent cause of neonatal sepsis and meningitis, postpartum endometritis, and bovine mastitis, may be acquired by several modes of transmission. Detailed epidemiologic study is hampered by the lack of a sufficiently discriminatory typing system, especially for type III and nontypable strains. We examined 54 epidemiologically well-characterized strains by restriction endonuclease analysis (REA) and compared the results with those obtained by serotyping. REA patterns were inspected without knowledge of the epidemiological or serotyping data. Among 21 type Ia, Ia/c, and Ib/c isolates, we found 10 REA patterns; among 5 type II and IIc isolates, we found 5 REA patterns; among 13 type III isolates, we found 6 REA patterns; and among 15 nontypable human and animal isolates, we found 7 different REA patterns. Double digestion of type III isolates with EcoRI and BglII helped us to distinguish the isolates. In total, 28 REA patterns were found in six serotype groups and one nontypable group. Some geographically and epidemiologically separate isolates had identical REA patterns, suggesting dissemination of a limited number of clones. We conclude that REA is a promising tool for detailed epidemiological study of group B streptococci. PMID- 2666445 TI - Evaluation of blood collected on filter paper for detection of antibodies to human immunodeficiency virus type 1. AB - This study was undertaken to evaluate the sensitivity and specificity of a commercial enzyme immunoassay in detecting antibody to human immunodeficiency virus type 1 using whole-blood specimens collected onto filter paper. Results obtained with specimens collected onto filter paper were comparable with those obtained with the corresponding serum or plasma specimens. PMID- 2666446 TI - Nasopharyngeal swabs and nasopharyngeal aspirates equally effective for the diagnosis of viral respiratory disease in hospitalized children. AB - Paired nasopharyngeal swab and nasopharyngeal aspirate specimens from 125 patients were compared for viral diagnosis. The viral isolation rates were comparable for the two types of specimens. There was a high level of agreement between the two specimens in overall positivity rate by immunofluorescence and positivity in culture-confirmed patients. PMID- 2666447 TI - Modifications of a Candida albicans biotyping system. AB - Methods of preparing and plating inocula onto media for the Odds and Abbott Candida albicans biotyping system (F. C. Odds and A. B. Abbott, Sabouraudia 18:301-317, 1980; Odds and Abbott, Sabouraudia 21:79-81, 1983) were altered to utilize inexpensive and commercially available supplies and equipment. The modified system correlates well with the reference system. PMID- 2666448 TI - Aeromonas hydrophila infection associated with the use of medicinal leeches. AB - The use of medicinal leeches (Hiruda medicinalis) is becoming more common after plastic surgery to control venous congestion of skin grafts. We describe a patient with Aeromonas hydrophila infection whose graft was treated with medicinal leeches. The infection required systemic antibiotic therapy. A. hydrophila is the predominant bacterial flora in the gut of the leech, where it plays an essential role for the animal in the digestion of blood. The potential for A. hydrophila wound infection, and appropriate antibiotic prophylaxis of the leech or patient, should be considered when medicinal leeches are used. PMID- 2666449 TI - New therapeutic modalities in hypertension: focus on a new calcium antagonist nicardipine. AB - A new generation of dihydropyridine calcium antagonists which are related structurally to nifedipine is undergoing clinical investigation. Among these newer agents. nicardipine and nimodipine have become available for clinical use. In controlled trials, nicardipine is superior to placebo and equal to other antihypertensive agents for the treatment of systemic hypertension. Nicardipine is associated with a low incidence of adverse effects that are related primarily to its peripheral vasodilatory actions. In addition, nicardipine appears to have little if any negative effects on myocardial contractility or conduction. PMID- 2666450 TI - Pharmacokinetics of capacity-limited systems. AB - Nonlinearities are commonplace in pharmacokinetics and most frequently occur because of a limited concentration of biological material available for interaction with relatively high concentrations of drugs. The Michaelis-Menten type function can be applied to metabolism, transport, and binding phenomena that display capacity-limitation. Nonlinear systems can be handled with differential equations (directly or converted to linear form), integrated equations (in non closed form) or with relatively new area/moment or MRT relationships. Drug disposition studies should include several dose levels and recommendations are provided for detecting the presence of one or more nonlinear absorption or disposition processes in typical experimental data. PMID- 2666451 TI - Labetalol compared with propranolol in patients with both angina pectoris and systemic hypertension: a double-blind study. AB - Labetalol is a non-selective beta-adrenoceptor antagonist agent with added alpha 1-adrenergic blocking properties, beta 2-stimulating action, and direct vasodilatory activity. A multi-center, double-blind, parallel group study compared the safety and efficacy of labetalol to propranolol in the treatment of patients with both exertional angina and mild to moderate systemic hypertension. An initial 4 to 5 week placebo washout phase was followed by a five week titration phase and a four month maintenance phase. Labetalol and propranolol had similar effects in reducing supine and standing blood pressures, except for a greater reduction in standing systolic blood pressure seen in the labetalol group. There were comparable effects by both treatments on angina attacks, nitroglycerin use, and exercise tolerance. Adverse effects were frequent with both drugs, but were generally minor. Thus, labetalol appears to be an effective alternative to propranolol in the treatment of patients with coexisting angina pectoris and hypertension, with the choice of agent dependent on the clinical situation. PMID- 2666452 TI - Lack of interaction between sulindac or naproxen and propranolol in hypertensive patients. AB - Seventeen patients with hypertension and osteoarthritis participated in a single blind crossover study comparing the effects of sulindac 200 mg twice daily, naproxen 500 mg twice daily, and placebo on blood pressure. All patients were treated for hypertension with propranolol monotherapy. Blood pressures were back titrated to achieve a baseline diastolic blood pressure of 90 to 100 mm Hg while taking naproxen. There were no significant differences in mean sitting or standing blood pressures among the patients receiving naproxen, sulindac, or placebo treatments. There was no change in pulse, weight, or any of the laboratory measurements at the end of each treatment phase. These results suggest that neither sulindac nor naproxen interferes with propranolol therapy for uncomplicated hypertension. PMID- 2666453 TI - The monoamine oxidase inhibitor-tyramine interaction. AB - Reports of hypertensive reactions from monoamine oxidase inhibitors (MAOI) began to proliferate in the early 1960s. Asatoor did extensive research and found that the combination of an MAOI and a food containing tyramine resulted in the hypertensive interaction ("the cheese reaction"). Because of the risk of intracerebral hemorrhage and death, clinicians were hesitant to use the MAOIs. Although progress on the metabolic effects of MAOIs has been slow, use of clinical information in addition to analysis of bioactive amine content of foods has allowed the formulation of dietary recommendations, which are thought to be useful clinically in the administration of MAOIs. This has resulted in the gradual return to use of these psychotropic compounds. PMID- 2666454 TI - Sustained-release diltiazem: duration of antihypertensive effect. AB - The antihypertensive activity of a sustained-release preparation of diltiazem (given each 12 hours) was assessed in 96 patients with supine diastolic blood pressure (BP) between 95 and 110 mm Hg in a multicenter, randomized, double blind, placebo run-in, parallel-group trial comparing optimally titrated doses of diltiazem and placebo. The aim was to assess the onset of action as well as the extent and variability of BP control of this formulation during the 12-hour interval. Diltiazem was titrated from 120 mg bid to 180 mg bid as necessary to lower BP. At baseline, on the first day of titration, and at the end of 8 weeks, BP was evaluated at 0, 1, 2, 3, 4, 5, 6, 8, 10, and 12 hours after dosing. The onset of action was within 2 hours, and the effect was maintained throughout the 12-hour period. Mean BP for the diltiazem group at baseline was 154/101 mm Hg. At week 8, BP was 148/93 mm Hg at hour "0" (P less than .02 and P = .0001 for systolic and diastolic BP vs. placebo), 139/84 mm Hg at the nadir at hour 5 (P = .0001), and 149/91 mm Hg at the end of the 12-hour period (P less than .02 and P = .0001 for systolic and diastolic BP). Diltiazem was significantly more effective than placebo (P = .0001) with 50% of patients controlled to a diastolic pressure of less than 90 mm Hg at 7 of the 10 evaluation points, including the evaluation point of 12 hours post-dose.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 2666455 TI - Ibuprofen and acetaminophen in the relief of postpartum episiotomy pain. AB - A single-dose, double-blind, randomized clinical trial was conducted to examine the relative analgesic efficacy of ibuprofen 400 mg (n = 36), acetaminophen 1000 mg (n = 37), and placebo (n = 38) in postpartum patients who had moderate to severe pain after episiotomy. At regular intervals over 4 hours, patients evaluated pain severity and relief on categorical scales and completed a categorical overall evaluation at the end of the trial. Both active agents were effective compared with placebo (P less than .05). Ibuprofen 400 mg was more effective than acetaminophen 1000 mg for the sum of pain intensity difference, total pain relief, and reduction of pain by more than 50% (P less than .05), suggesting a more rapid onset of action and a more prolonged effect by ibuprofen 400 mg. No adverse effects were reported. Based on the results of this conventional postpartum episiotomy pain model, both agents are considered efficacious and ibuprofen 400 mg is a more effective analgesic for the relief of acute pain than acetaminophen 1000 mg. PMID- 2666456 TI - Starburst amacrine cells of the primate retina. AB - A group of readily recognized amacrine cells were observed in Golgi-impregnated and flat-mounted macaque, baboon, and human retinas. These cells had roughly circular or oval dendritic fields that were narrowly stratified within the inner plexiform layer (IPL). Most of these cells stratified in the inner half (sublamina b) of the IPL, and they had their somata in the ganglion-cell layer; a few stratified in the outer half (sublamina a) of the IPL and had their somata in the amacrine-cell layer. Typically, a single dendrite issued from the soma, and, after passing for 10 microns or so, gave rise to five or more radiate processes. As these processes neared the edge of the dendritic field they branched, turned, and became varicose. Most showed no evidence of an axon, although a few had a short process extending inward, toward the optic-fiber layer. Dendritic-field diameters were about 100 microns near the fovea and increased to about 350 microns in the peripheral retina. Mean somal diameter also increased slightly from near the fovea (7.8 microns) to the periphery (8.7 microns). Although the primate cells are smaller, and there are some minor differences in the form of the dendritic fields, these cells appear to be morphologically equivalent to the starburst amacrines of the rabbit retina, whose counterparts have also been observed in the retinas of rats and cats. Presuming that these cells correspond to the choline acetyltransferase immunoreactive primate cells described by Mariani and Hersh (J. Comp. Neurol. 267:269-280, '87), their overlap factor is about ten for the type whose somata lay in the ganglion-cell layer and about 0.25 for those whose somata lay in the amacrine-cell layer. PMID- 2666457 TI - White fibrous papulosis of the neck: a new clinicopathologic entity? AB - A clinical, histologic, and ultrastructural study of 32 cases of white fibrous papulosis of the neck was undertaken. Clinically, this condition is characterized by asymptomatic white papules that appear mainly around the neck in elderly persons. The papules are approximately 2 to 3 mm in diameter, round to oval, clearly marginated, and unrelated to the hair follicles. The major pathologic change revealed by light microscopic examination is a relatively circumscribed area of thickened collagen bundles in the papillary to mid dermis. Ultrastructurally, no remarkable morphologic change is seen in either the collagen or the elastic fibers, except for a variation in the diameters of collagen fibrils within the lesion compared with perilesional normal skin. White fibrous papulosis of the neck appears to be a new clinicopathologic entity, cases of which to date have been reported only in Japan. PMID- 2666458 TI - Penile basal cell carcinoma. Report of a case and review of the literature. AB - We describe a 69-year-old man with penile basal cell carcinoma and review the literature on this condition. Basal cell carcinomas of the penis are rare, and there are only 26 other reported cases. There is no documented case of metastatic penile basal cell carcinoma. The one reported case of metastatic penile basal cell carcinoma actually represents urethral transitional cell carcinoma. Therefore conservative therapy with local removal is adequate treatment, and more extensive procedures are unnecessary. Ultraviolet light exposure may be an important etiologic factor for basal cell carcinomas located on sun-exposed areas. The occurrence of basal cell carcinomas on non-sun-exposed areas raises the possibility of other, not yet defined, etiologic agents. PMID- 2666459 TI - Cutis marmorata telangiectatica congenita: report of 22 cases. AB - Twenty-two cases of cutis marmorata telangiectatica congenita were evaluated during an 8-year period. All but two patients were examined in the first year of life; 14 of the 22 (64%) were female infants. Four patients had focal cutaneous atrophy associated with the reticulated vascular pattern, and eight had ulcerations of involved skin. Six (27%) had additional anomalies. Of these, three patients had a nevus flammeus, and one had congenital generalized fibromatosis and hemiatrophy. Two of the infants had glaucoma; one also had a facial nevus flammeus and the other had cutis marmorata telangiectatica congenita of the face. A congenital pigmented nevus and a localized venous malformation constituted the remaining associated defects. This disease is an uncommon cutaneous vascular anomaly that is most often solitary but occasionally may be associated with other developmental defects. PMID- 2666460 TI - Eosinophilic pustular folliculitis (Ofuji's disease): response to dapsone but not to isotretinoin therapy. PMID- 2666461 TI - Pemphigoid en cocarde. PMID- 2666462 TI - Atypical herpes simplex infection in patients with acute myelogenous leukemia recovering from chemotherapy. PMID- 2666463 TI - Well's syndrome (eosinophilic cellulitis): additional cases in the literature. PMID- 2666464 TI - Opportunistic fungal infections in immunocompromised hosts. AB - Fungal infections in immunocompromised hosts cause major morbidity and mortality. The Candida and Aspergillus species are the most common causes, but many rarer organisms, once considered "contaminants," are being reported. The number of patients who receive immunosuppressive agents for the treatment of malignancy or for organ transplantation is increasing as well as the potential for local or disseminated fungal infections. The diagnosis of these infections is often difficult and the existing methods for treatment are often ineffective. A high degree of suspicion to identify fungal infections and to prompt initiation of treatment must be maintained if the survival rate of these patients is expected to improve. PMID- 2666465 TI - Brunsting-Perry pemphigoid simulating basal cell carcinoma. AB - The cases of three patients whose initial clinical presentations suggested superficial multicentric basal cell carcinoma are reported. Although routine histologic examinations were nonspecific, direct immunofluorescence studies showed immunoglobin and/or complement deposition patterns diagnostic of Brunsting Perry variant pemphigoid. There is a wide spectrum of clinical presentation of Brunsting-Perry pemphigoid. In cases in which there is a minimum of blistering activity, the use of direct immunofluorescence is invaluable for definitive diagnosis. PMID- 2666466 TI - Hereditary mucoepithelial dysplasia. Case report and review of the literature. AB - Hereditary mucoepithelial dysplasia, a dyshesive, dyskeratotic epithelial syndrome caused by an abnormality in desmosomes and gap junctions, involves the mucosae, skin, hair, eyes, and lungs. A 16-year-old patient had nontender, fire red mucosae; keratosis pilaris; diffuse, nonscarring alopecia; cataracts; photophobia; corneal vascularization; and decreased visual acuity. Histologic examination of gingival sections showed a dyshesive epithelium with atrophy, dyskeratosis, lack of keratinization, and unusual cytoplasmic inclusions. Results of electron microscopic studies showed a reduced number of desmosomes, amorphous intercellular material, and cytoplasmic inclusions resembling tonofilaments and gap junction material. The patient described in this report represents an apparently sporadic case of hereditary mucoepithelial dysplasia. Other cases described previously in the literature are reviewed. We believe this disorder should be brought to the attention of dermatologists because patients with hereditary mucoepithelial dysplasia have numerous skin problems and are susceptible to recurrent infection and potentially fatal bullous lung disease. Also, misinterpreted abnormal results from cervical Pap smears could lead to hysterectomy being performed unnecessarily on these patients. PMID- 2666467 TI - Herpes simplex mimicking leukemia cutis. AB - We present a patient with chronic lymphocytic leukemia who developed a painful penile ulcer that was initially diagnosed as leukemia cutis, as evidenced by an atypical leukemic infiltrate on biopsy. A Tzanck preparation was positive for multinucleated giant cells, and the diagnosis of herpes genitalis was confirmed by viral culture. In patients with hematologic malignancies, herpes simplex virus must be included in the differential diagnosis of ulcerative lesions. The histopathologic findings of inflammatory dermatoses in these patients may include an atypical infiltrate, because of the predominance of atypical inflammatory cells in the peripheral circulation. PMID- 2666469 TI - Pyostomatitis vegetans. Report of a case and review of the literature. AB - This report describes a 39-year-old woman with pyostomatitis vegetans and ulcerative colitis. Pyostomatitis vegetans is a rare eruption of the oral cavity characterized by tiny yellow pustules coating the surface of the friable eroded mucosa. It is considered a marker for inflammatory bowel disease. In a review of the literature, 19 of 26 cases (73%) reported were associated with gastrointestinal disturbances, predominantly inflammatory bowel disease. PMID- 2666468 TI - Rowell's syndrome. Report of a case. AB - We describe a patient with discoid lupus erythematosus who developed annular lesions of the thigh and chilblainlike lesions of the fingers matching those described in the original reports of Rowell's syndrome. The patient also had circulating anti-Ro(SS-A) antibodies whose similarity to the anti-Sj-T antibodies found in the original Rowell's syndrome cases has been recently claimed. A review of the literature suggests that most of the cases of Rowell's syndrome described thus far in fact may be cases of coincidental association of lupus erythematosus and erythema multiforme. PMID- 2666470 TI - Subcutaneous myospherulosis. AB - Myospherulosis is an uncommon subcutaneous disorder believed initially to be caused by an endosporulating fungus. Recently investigators have disproved an infectious cause and have shown that the disease represents an alteration in red blood cells, usually produced by petrolatum or lanolin, with an accompanying foreign-body-type response. We report the case of a 57-year-old woman who had received a penicillin injection approximately 40 years before she developed a cystic mass in the right buttock. Examination of the mass revealed the classic histologic findings of this disease. PMID- 2666471 TI - Reducing the costs of computer literacy through resource sharing. PMID- 2666472 TI - Reusable loop stitches for inspection of grafts. AB - Reusable loop stitches are a good method of securing the stent in skin grafts. Two suture methods are presented: the free-loop and the loose-loop suture technique. Their main advantage is that they provide a loop of suture that can be repeatedly rethreaded with suture, thereby permitting reexaminations and re stentings of the graft site without additional anesthesia. PMID- 2666473 TI - Long-term safety and efficacy with Fibrel in the treatment of cutaneous scars- results of a multicenter study. Multicenter study group. AB - Three hundred patients were treated with Fibrel (Serono Laboratories, Randolph, MA) for the correction of cutaneous scars. Fibrel treatment was restricted to four scars with one or two treatments following a negative skin test. The scar corrections were evaluated by the physician, the patient, and also via an objective photogrammetric method. At the end of 1 year, the percentages of scars with moderate, marked, or complete correction were 65.0%, 63.3%, and 85.8% according to physician, patient, and photogrammetric evaluations, respectively. A cohort of 111 patients from the 1-year study were followed for up to 2 years postimplantation to evaluate safety and efficacy. These patients had similar demographic and scar characteristics as the total patient population in the initial study. The efficacy evaluation at the end of 24 months indicated that successful correction was maintained in 64.4%, 58.9%, and 78.9% of scars for physician, patient, and photogrammetric evaluations, respectively. There were no severe hypersensitivity reactions following treatment with Fibrel. The data from these patients demonstrate that one or two Fibrel treatments are effective in maintaining the correction of depressed cutaneous scars for up to 2 years with negligible adverse sequelae. PMID- 2666474 TI - Effect of the pulse length of ultrasound on cell membrane damage in vitro. AB - Suspended cells of a human lymphoblastic cell line were exposed to pulsed ultrasound of 775 kHz. The pulse lengths were varied between 16 and 1000 microseconds. The mark/space ratio was always kept at 1:1. Two ultrasound intensity levels were used: 3.6 and 6.4 W/cm2 spatial peak and temporal peak. After an exposure time of 5 min, cell membrane damage was measured cytometrically by a dye exclusion test. No membrane damage was observable at 16 microseconds, whereas, at pulse lengths of 1000 microseconds, about one-third of the cells were damaged. PMID- 2666475 TI - Self-paced learning in children with attention deficit disorder with hyperactivity. AB - Attention deficit (ADDH) children self-paced the delivery of response pairs for paired-associate learning at about the rate previously shown to be conducive to relatively good learning in attention deficit. The self-pacing opportunity did not seem either to impair or to enhance the learning performance. On methylphenidate they paced themselves at about the same rate but learned much more. Stimulant therapy does not help by "slowing the child down" but permits more effective memorizing at the same presentation rate. PMID- 2666477 TI - Cardiac surgery: a glimpse into the future. PMID- 2666476 TI - Sugar consumption, locomotion, task orientation, and learning in preschool children. AB - A challenge design was employed to investigate the effect of sucrose consumption on the behavior of 12 preschool children. On separate experimental days, subjects were tested individually with either a challenge sucrose drink (2 gm/kg body weight) or a placebo drink sweetened with aspartame. Fifteen-minute observations of each child during free play were made at 15, 45, and 75 minutes after ingestion of the drink. Assessment with a paired-associate learning task was made before ingestion and at 30, 60, and 90 minutes after ingestion. This study was a partial replication and extension of one of the few studies in the literature that has found an effect of sucrose on the behavior of normal children. On all dependent measures (locomotion, task orientation, and learning), the study failed to obtain significant differences between the two conditions. PMID- 2666479 TI - Theories of cardiovascular causes in sudden infant death syndrome. PMID- 2666478 TI - Mechanism of the attenuated peak heart rate response to exercise after orthotopic cardiac transplantation. AB - The mechanism responsible for attenuation of the peak heart rate response to exercise in patients after cardiac transplantation was studied. Because the donor heart is believed to be surgically denervated, the peak heart rate response to exercise is dependent primarily on 1) an increase in the circulating levels of the catecholamines norepinephrine and epinephrine at peak exercise, and 2) the end-organ responsiveness of the sinoatrial (SA) node to beta-adrenergic stimulation. To assess the former mechanism, the levels of plasma nonepinephrine and epinephrine were measured at rest and at peak exercise on a cycle ergometer in 23 transplant recipients an average of 7 +/- 1 months after transplantation and in 23 normal subjects matched for age. To assess the latter mechanism, the heart rate response to a graded infusion of isoproterenol was determined in six normal subjects with and without atropine pretreatment and in eight transplant recipients. In transplant recipients, both the absolute plasma levels of nonepinephrine and epinephrine at peak exercise and the increments from baseline to peak exercise were comparable with or greater than those in normal subjects. In transplant recipients, the isoproterenol dose that increased heart rate by 25 beats/min over baseline was not different from that in atropine-treated normal subjects (normal subjects 9 +/- 2 ng/kg per min; transplant recipients 11 +/- 1 ng/kg per min; p = NS). These data show that after cardiac transplantation, there is a normal or slight elevation of circulating catecholamines at peak exercise, and that the responsiveness of the SA node to beta-adrenergic stimulation is normal.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 2666480 TI - Alexander Filipovich Samojloff and Paul Dudley White: electrocardiography and a Russian-American friendship. PMID- 2666481 TI - Immunoglobulins and hypersensitivity in human immunodeficiency virus (HIV) infection. PMID- 2666482 TI - Cross sensitivity with acetaminophen in aspirin-sensitive subjects with asthma. AB - Drugs inhibiting cyclooxygenase regularly cross-react with aspirin (ASA). Although some experiments suggest that acetaminophen (ACETM) is a weak inhibitor of cyclooxygenase in certain tissues, it has not been studied in human lung tissue, and controversy exists whether or not true cross-reactivity occurs between ASA and ACETM. Three ASA-sensitive subjects with asthma, who gave a history of reactions to ACETM, underwent double-blind, placebo-controlled challenges and reacted to 1000 mg of ACETM with a greater than 20% fall in FEV1. Two patients were desensitized to ASA and then were rechallenged with 1000 mg of ACETM without reaction. Two patients were desensitized to increasing doses of ACETM, achieving refractoriness to 1500 mg, but not 2000 mg. Thus, cross sensitivity between ASA and ACETM was documented when large challenge doses (1000 mg) of ACETM were used. Furthermore, cross desensitization suggests that in ASA sensitive subjects with asthma, similar mechanisms are likely to be responsible for reactions to ASA, nonsteroidal anti-inflammatory drugs, and ACETM. PMID- 2666483 TI - Quality assurance and standardization of allergy extracts in allergy practice. PMID- 2666484 TI - Transdermal scopolamine attenuates methacholine-induced bronchospasm. AB - Anticholinergic agents have been widely used in the management of asthma. The use of scopolamine has been limited by significant side effects. Transdermal delivery of scopolamine (TS) has, however, been used successfully for the prevention of motion sickness. The purpose of this study was to determine if TS would decrease methacholine-induced bronchospasm in a group of subjects with mild asthma. Bronchoprovocational challenges with inhaled methacholine were performed on three separate occasions in 10 male subjects who each had a past history of asthma. After a baseline challenge, each subject received, in a double-blinded fashion, either a placebo patch or TS patch. The challenge was then repeated after at least 36 hours, and the alternate patch was then dispensed. The provocative dose producing a fall in FEV1 by 20% from baseline was then calculated by linear regression analysis. No significant change in baseline pulmonary function was noted with placebo patch or TS. With the use of TS, there was a small but significant increase in the provocative dose producing a fall in FEV1 by 20% from baseline for the group (p less than 0.05). In conclusion, we were able to demonstrate that a TS patch worn for a short period of time, can significantly decrease airway reactivity to methacholine in some patients with hyperactive airways. PMID- 2666485 TI - Effect of age on glucose tolerance and glucose uptake in healthy individuals. AB - Plasma glucose and insulin responses and basal and insulin-stimulated glucose uptake were determined in 24 non-obese, healthy, physically active individuals, divided into two groups on the basis of age. The mean (+/- SEM) age of the younger group was 33 +/- 3 years, in contrast to an age of 64 +/- 2 years for the older group. Plasma glucose concentrations were significantly higher (two-way ANOVA, P less than .001) for three hours after a 75 g oral glucose challenge in the older group, as was the plasma insulin response (two-way ANOVA, P less than .001). Furthermore, there was a significant correlation between age and total plasma glucose (r = 0.63, P less than .001) and insulin (r = 0.44, P less than .01) during the glucose tolerance test. However, the magnitude of the decrease in glucose tolerance with age was relatively modest. For example, total plasma glucose response was only 11% higher in the older group, and the plasma glucose concentration 120 minutes after the oral glucose load only increased approximately 2 mg/dL per decade. Glucose uptake during euglycemic clamp studies was also reduced in the older group, and this was true if the clamps were performed at plasma insulin concentration of approximately 10 microU/mL (P less than .05) or 60 microU/mL (P less than .10). However the differences were relatively modest in magnitude, ie, 10-25%. The fact that the increase in glucose uptake when plasma insulin was raised six-fold was similar in both groups suggests that insulin sensitivity does not decline with age.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 2666486 TI - Mechanisms of hypertension in the elderly. AB - It has long been recognized that, with advancing age, basal systolic blood pressure increases within the clinically "normal" range in many individuals. Likewise, the prevalence of clinical hypertension, either systolic plus diastolic or isolated systolic, also increases with age. This report reviews the purported mechanisms underlying these types of hypertension and discusses age-associated changes in the cardiovascular system of normotensive individuals that could plausibly interact with these pathophysiologic mechanisms of hypertension. PMID- 2666487 TI - Renal function in aging. AB - A variety of age-related anatomic and functional alterations in the kidney have been described. Anatomic abnormalities in the aging kidney include a decrease in kidney size, increased glomerular sclerosis, altered tubular structure, and an altered pattern of vascular flow. These anatomic abnormalities are associated with renal functional abnormalities, including decreased renal blood flow, and glomerular filtration rate. Altered renal tubular function, including impaired handling of water, sodium, acid, and glucose, may also be present. Impaired "endocrinologic" functioning manifested by changes in the renin-angiotensin system, vitamin D metabolism, and antidiuretic hormone responsiveness have been reported. The kidney is constantly exposed to the effects of a variety of potentially toxic processes. These range from environmental toxins and drugs, to a variety of chronic medical illnesses including hypertension, diabetes, and atherosclerotic disease. In this context, differentiation of "aging" effects from nephrotoxic effects resulting from these other processes is difficult. It has been argued that hypertension is an important factor in the development and progression of renal insufficiency in the elderly. The relationship between hypertension, glomerular hyperfiltration, atherosclerosis, and progressive renal dysfunction needs further study. Further research may allow the rational recommendation of interventions designed to control age-associated changes in renal function. PMID- 2666488 TI - The renin-angiotensin system. Normal physiology and changes in older hypertensives. AB - The long-term effects of angiotensin (ANGII) on arterial pressure regulation appear to be closely linked to volume homeostasis, via the renal-pressure natriuresis mechanism, both in normal humans and in older hypertensives. In response to disturbances such as increased sodium intake, suppression of ANGII and aldosterone formation greatly amplifies the effectiveness of the pressure natriuresis mechanism, thereby preventing large increases in body fluid volumes and minimizing the rise in blood pressure needed to maintain sodium balance. When ANGII levels are inappropriately elevated, the antinatriuretic effects of ANGII cause increased arterial pressure, which then serves to maintain sodium and water balance via the pressure natriuresis mechanism. The primary intrarenal and extrarenal mechanisms by which ANGII controls renal excretion and arterial pressure include: (1) a direct effect of ANGII on tubular sodium transport; (2) a preferential constrictor action of ANGII on efferent arterioles, which increases sodium reabsorption by altering peritubular capillary physical forces (efferent arteriolar constriction also prevents excessive decreases in glomerular filtration rate when renal perfusion is compromised, such as in renal artery stenosis); and (3) extrarenal effects of ANGII, including stimulation of aldosterone secretion. Current evidence suggests that the direct effects of ANGII on the kidney are quantitatively more important than indirect effects mediated by aldosterone. In older hypertensives, plasma renin activity and aldosterone concentration are often suppressed, perhaps due to loss of functional nephrons and increased sodium chloride delivery to the macula densa of the remaining nephrons.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 2666489 TI - Proper scoring of the geriatric depression scale. PMID- 2666490 TI - Normotension in conscious rats after placement of bilateral electrolytic lesions in the rostral ventrolateral medulla. AB - The effects of bilateral electrolytic lesions of the rostral ventrolateral medulla (RVLM) on mean arterial pressure (MAP) and heart rate (HR) were examined in 8 rats at one and 5 days after placement of the lesions. The MAP (111 +/- 2 mm Hg) and HR (393 +/- 17 bpm) of the lesion group were similar to the values recorded in the control group (117 +/- 3 mm Hg, 405 +/- 11 bpm; n = 18). Blockade of the synthesis of angiotensin II with captopril in the lesion group significantly decreased MAP to 93 +/- 2 mm Hg on the first postlesion day. In contrast, the MAP of the control group after captopril fell slightly to 111 +/- 4 mm Hg. Captopril did not alter MAP or HR on postlesion day 5 in either group. Administration of chlorisondamine, an autonomic ganglionic blocking agent, reduced MAP in the lesion and control groups to similar values of 59 +/- 2 mm Hg and 64 +/- 2 mm Hg, respectively. Baroreflex-mediated tachycardia to a decrease in MAP was abolished in the lesion group at one day postlesion and attenuated at 5 days postlesion. In contrast, the baroreflex-mediated bradycardia to an increase in MAP was unaffected by the lesions. Plasma renin activity (PRA) in the lesion group was elevated by nearly 50% as compared to the control group on the first postlesion day (7.3 +/- 0.8 and 4.9 +/- 0.5 ng AI/ml/h, respectively). A 90% elevation in plasma norepinephrine (NE) concentration was also observed in the lesion group as compared to the control group (437 +/- 80 pg/ml and 228 +/- 22 pg/ml, respectively) on postlesion day one. By postlesion day 5, the PRA of the lesion and control groups were nearly identical (4.4 +/- 0.7 and 4.0 +/- 1.0 ng AI/ml/h, respectively), and the plasma NE concentrations were also very similar (201 +/- 41 pg/ml and 175 +/- 22 pg/ml, respectively). We conclude that bilateral destruction of the RVLM does not cause hypotension or bradycardia in conscious rats. Therefore, areas other than the RVLM are capable of maintaining MAP and HR. Sympathetic vasomotor and cardiomotor tone appears unaffected by the lesions. However, increased activity of the renin-angiotensin system may contribute transiently to the maintenance of vasomotor tone and, consequently, MAP after lesion of the RVLM. The RVLM may be important in mediating baroreflex increase in HR. PMID- 2666492 TI - Triangular fibrocartilage complex lesions: a classification. AB - Based on anatomic and biomechanical studies and review of our clinical experience of the past 10 years, a classification of injuries to the triangular fibrocartilage complex is presented. This classification is based on the clinical examination, routine x-ray films, wrist arthrograms, wrist arthroscopy, and wrist arthrotomy. The classification recognizes both traumatic and degenerative lesions. Traumatic lesions are classified according to their location. Degenerative lesions are classified by the location and severity of degenerative changes of the triangular fibrocartilage complex, ulnar head, ulnocarpal bones and lunotriquetral ligament. PMID- 2666493 TI - Palmar dislocation of the radiocarpal joint. AB - Radiocarpal dislocation, with or without damage to the radial styloid process or to the distal radial rim, is extremely rare. Review of the literature reveals much confusion on the proper classification of radiocarpal dislocations or fracture-dislocations. A case of radiocarpal dislocation is reported, the classification is discussed, and a critical review of earlier reports is presented. PMID- 2666494 TI - Repair of the proximal interphalangeal joint with a homograft. AB - We describe the delayed reconstruction of a destroyed proximal interphalangeal joint by implantation of a partial articular homograft in a 17-year-old boy. One year after the operation the joint is painless and has a normal range of motion. PMID- 2666495 TI - Noninvasive assessment of microvessels with the duplex scanner. AB - This study was undertaken to determine if a duplex scanner equipped with a new 10 MHz probe could accurately evaluate microvascular anastomotic patency. The overall predictive accuracy of the duplex scanner was 90% (p less than 0.0001) with no difference noted among the three main anastomotic groups examined--acute artery, acute vein, and long-term artery. There was, however, a statistically significant difference (p less than 0.05) in the ability to interpret vessels that were patent (100%) versus those that were partially occluded (73%) or occluded (88%). It is believed that the duplex scanner has potential applications to preoperatively and intraoperatively study microvessels and postoperatively to supplement other techniques in monitoring acute and long-term anastomotic patency. PMID- 2666491 TI - Appetite regulation: the role of peptides and hormones. PMID- 2666496 TI - Review of treatment results for ulnar nerve entrapment at the elbow. AB - A review of 50 published reports between 1898 and 1988, comprising more than 2000 patients treated for ulnar nerve compression at the elbow, demonstrated that little more than personal bias is available for guidance in selecting treatment. To provide uniform data, the degree of nerve compression of the patients from these articles was staged using a sensory plus motor classification based on contemporary concepts of the pathophysiology of chronic nerve compression. The results of these studies are reinterpreted in light of this staging system. This analysis suggests that for a minimal degree of compression, excellent results can be achieved in 50% of the patients by nonoperative techniques and in almost 100% of patients by any of five surgical techniques. For a moderate degree of compression, the anterior submuscular technique yields the most excellent results with the fewest recurrences. For a severe degree of compression, the anterior intramuscular transposition yielded the fewest excellent and the most recurrent results. This review suggests that an internal neurolysis, combined with an anterior submuscular transposition, may be the best approach when the ulnar nerve is severely compressed. PMID- 2666497 TI - A fixation technique for the Steindler flexorplasty. A technique for fixation of the flexor pronator group to the anterior surface of the humerus is described. PMID- 2666498 TI - Endoscopic injection therapy for nonvariceal bleeding lesions of the upper gastrointestinal tract. AB - A number of techniques have been developed to control active upper gastrointestinal tract bleeding. These include thermal devices such as the laser, heater probe, and bipolar circumactive probe (BICAP). Although these devices have proved effective, they vary in cost and at times are cumbersome to use. A simple, inexpensive, readily available means of treating active bleeding from the gastrointestinal tract is injection of the lesion with a sclerosing substance. This method has proved helpful in stopping variceal hemorrhage, and the simplicity of the equipment and procedure makes it an outstanding candidate therapy for treating other causes of hemorrhage. Although the method is not well known in the United States, it has been applied in Japan and Europe. Most studies so far have been uncontrolled, but in over 700 patients reported in the world literature, effective initial hemostasis has been achieved in about 90% of patients overall. Success rates have been somewhat dependent on the site and rate of bleeding. No deaths have been reported from the procedure. We review the current status, techniques, and types of sclerosing agents and provide a detailed analysis of results of injection sclerotherapy. We propose that although the technique is simple, the effectiveness and routine application to the patient with upper gastrointestinal hemorrhage await careful controlled studies and comparison with other available hemostatic methods. PMID- 2666499 TI - Extended esophageal pH monitoring. An analysis of the literature and assessment of its role in the diagnosis and management of gastroesophageal reflux. AB - In this review article we examine several facets of extended pH monitoring of the esophagus. The different types of instrumentation and the technical difficulties of obtaining and interpreting tests are discussed. The wide variations among different laboratories in the duration and timing of pH monitoring sessions are summarized. We outline the problems in interpretation and reproducibility such as normal control values, criteria for separation of abnormal from normal subjects, correlation of pH events with symptoms and with esophageal injury. Comparison of extended with short-term monitoring of esophageal pH are drawn, as well as comparisons between results of extended monitoring and other tests of reflux. Cost considerations are listed. Finally, we present a proposed scheme for the use of extended pH monitoring as well as a cautious note about accepting extended pH monitoring as a routine clinical test at present. PMID- 2666500 TI - Cruveilhier-Baumgarten syndrome without esophageal varices: ultrasonographic diagnosis and echo-Doppler study. AB - Two cases of Cruveilhier-Baumgarten syndrome not clinically evident and without esophageal varices in patients with liver cirrhosis and portal hypertension are presented. The diagnosis was made by real-time ultrasonography, which showed echographic caput medusae with large afferent umbilical veins and efferent inferior superficial epigastric veins. Doppler flowmetry documented high blood flow rates in these collateral portal-systemic circulations, and this explained the absence of large varices at endoscopy. The role of massive spontaneous portal systemic shunts in preventing the formation of other shunts and particularly esophageal variceal bleeding is discussed. PMID- 2666501 TI - A review of the literature relating to touch and its use in intensive care. AB - This literature review is an exploration of the available literature on and surrounding the subject of touch in order to help nurses to understand this subject and use touch effectively in nursing care. The study is focused particularly on the use of touch in intensive care as this is the area of interest of the author, and several writers have suggested touch is of great importance in this area. The literature on communication in all its forms and particularly in intensive care is discussed first as this explains the framework in which touch occurs and how it fits into nursing care. Theories about touch and studies of the use of touch are linked to try to show the human need, and taboos about touch. This is related to the use of touch by nurses and other health care workers particularly in intensive care. Recommendations are made, from the information gained from the literature, about how nurses' use of touch as part of nursing care can be improved. PMID- 2666502 TI - Effective management of urinary drainage systems in critical care areas. AB - Many invasive procedures are used in the care of critically ill people. These potentially increase the risks of infection which may be fatal, as such patients usually have reduced efficiency of normal defence mechanisms. Urethral catheterisation and continuous urinary drainage is one such procedure which is commonly necessary and is known to carry a considerable risk of urinary tract infections. Effective management should reduce the incidence of these. In some units no rationally-based protocols are available to guide nursing management of urinary drainage and thus minimise this risk. This paper is based on a time limited literature search undertaken as a basis for producing the guidelines recommended, which are research-based where possible though there is as yet no experimental evidence on some aspects of care. PMID- 2666503 TI - Cochlear implants. Summary of NIH consensus development conference. PMID- 2666504 TI - A physician's nightmare. PMID- 2666505 TI - Medical museum notes. PMID- 2666506 TI - Splenic and liver trauma in children. AB - These data indicate that most children with blunt injury to the liver and spleen can be treated conservatively. The fact that nonoperative management is a successful method of therapy limits the usefulness of DPL in most stable pediatric patients with abdominal trauma. Recovery of blood by DPL will neither influence the decision to operate nor yield information concerning which organ is injured. The abdominal CT scan is the most sensitive diagnostic method. In patients with associated head trauma, the head CT and abdominal CT both can be obtained during the same visit to the radiology suite. DPL may be useful in the unstable patient to be sure the abdomen is the site of bleeding before starting an emergency laparotomy and occasionally, in more stable patients with ongoing abdominal pain, to rule out an associated bowel injury with perforation (e.g., recovery of bilious or feculant material). Insight into the contemporary management of splenic and liver injuries in children is important. In the 1980s, a laparotomy safely can be avoided in many cases with reduction of patient morbidity, length of hospital stay and cost of hospitalization. PMID- 2666507 TI - Wolfram syndrome: a tribute to Don J. Wolfram, M.D. [corrected]. PMID- 2666508 TI - Identification of a novel protein (G210) specific to the Golgi apparatus. AB - A monoclonal antibody, 3C9, has enabled the detection of a novel Golgi-specific protein in bovine tissues. Immunohistochemical studies at the light microscopic level have detected the 3C9 antigen only in certain cells: exocrine pancreas, gut epithelium, and thymus epithelium. Examination of gut and pancreas by immunoelectron microscopy showed a localization exclusive to the Golgi apparatus. The relative molecular weight of the antigen detected by immunoblotting is 210,000 daltons. The antigen is not extracted from microsomal membranes of bovine gut epithelium by sodium carbonate solutions. Furthermore, the 3C9 antigen enters into the detergent phase when Triton X-114 partitioning methods are used. These data strongly suggest that this novel antigen is an intrinsic membrane protein, resident in the Golgi apparatus of certain cells. Moreover, they enhance the hypothesis that the distribution of enzymes and polypeptides in the Golgi apparatus is cell specific. PMID- 2666509 TI - Immunohistochemical localization of relaxin in human prostate. AB - We identified relaxin in human male prostate by use of an anti-human relaxin analogue polyclonal antibody and the avidin-biotin-immunoperoxidase method. The antibody was obtained by immunizing a rabbit with a synthetic human relaxin analogue which has 95% sequence homology with native human relaxin. Human prostate tissues incubated with the anti-human relaxin analogue exhibited positive immunostaining up to an antibody dilution of 1:3200. Inhibition of immunostaining with this antibody by excess relaxin analogue demonstrated specificity of the antibody. The exact role of relaxin in human male reproductive physiology remains to be fully elucidated. PMID- 2666510 TI - Quantitative evaluation of congo red binding to amyloid-like proteins with a beta pleated sheet conformation. AB - The binding of Congo red to several purified amyloid-like peptides having a beta pleated sheet conformation was quantitatively examined. Congo red binds preferentially to the beta-pleated sheet conformation of both insulin fibrils and poly-L-lysine. Congo red does not bind nearly so well to poly-L-serine or polyglycine, despite the fact that these peptides also have a beta-pleated sheet conformation. Binding to insulin fibrils was saturable with an apparent Bmax of 2 moles of Congo red per mole of insulin fibrils and an apparent KD of 1.75 x 10( 7) M. Binding to beta-poly-L-lysine was similar but had a much higher apparent Bmax of 43. Binding of Congo red to beta-poly-L-lysine was pH dependent and appeared to be determined by the number of protonated lysine residues in the 250 amino acid peptide. We present a new hypothesis in which Congo red binds to amyloid-like proteins via bonds between the two negatively charged sulfonic acid groups of Congo red and two positively charged amino acid residues of two separate protein molecules which are properly oriented by virtue of the beta pleated sheet conformation of the peptide backbone. PMID- 2666511 TI - A double-label pre-embedding immunoperoxidase technique for electron microscopy using diaminobenzidine and tetramethylbenzidine as markers. AB - Techniques for correlative double-label immunocytochemistry (ICC) at light and electron microscopic (EM) level are useful for determining the neurotransmitter phenotype of inputs onto immunocytochemically identified neurons. Tetramethylbenzidine (TMB) has been used as a chromogen at the EM level for horseradish peroxidase tract tracing. We have found that TMB, in combination with diaminobenzidine (DAB), can be used in a double-label immunocytochemical protocol to examine neuropeptide Y inputs onto luteinizing hormone-releasing hormone cells in the sheep preoptic area. At both light and EM levels, TMB reaction product is visibly distinct from DAB reaction product. The ultrastructural preservation we have been able to obtain with our technique is better than that obtained with techniques that use TMB at a lower pH. Furthermore, this technique allows the demonstration of synaptic contacts between neurochemically identified terminals and cells with different neurotransmitter phenotypes. PMID- 2666512 TI - Two simple methods for quantifying low-affinity dye-substrate binding. AB - Binding with low-affinity ligands, such as histological dyes, can be difficult to quantitate owing to the dissociation of bound ligand with washing or the retention of nonspecifically bound ligand because of incomplete washing. The present report describes two simple, rapid methods of discriminating bound from free ligand without the need for washing steps. One method is based on the spectral changes induced in a dye ligand, Congo red, on binding to the "receptor" insulin fibrils. This method discriminates spectrophotometrically between bound and free ligand without requiring any physical separation of the two forms. No radioactive ligands are necessary, and, by using disposable cuvettes, the entire binding assay can be done in a single container without the need for transfers. The second method employs a non-traditional filtration approach that avoids the need for a washing step by measuring the decrease in concentration of the dye ligand in the filtrate rather than by applying the usual approach of measuring the absolute amount of ligand bound to the precipitated "receptor." Both methods show saturation of binding sites and give similar values for the KD and Bmax. PMID- 2666513 TI - Immunodetection of human tumour-associated cell-bound antigens by human monoclonal antibodies. AB - A novel cellular enzyme-linked immunoassay has been developed to detect specific binding of human monoclonal antibodies to target tumour cells obtained by enzymatic disaggregation of surgically resected human colorectal carcinomas. Cell preparations derived from human tissues contain endogenous immunoglobulin. The method described is designed to detect specific binding of a human monoclonal antibody while minimising extraneous background signals caused by the presence of endogenous immunoglobulins in the preparation. This is achieved by first generating immune complexes, which are then incubated with the target cells. The assay is well suited for rapid screening of large numbers of tissue culture supernatants and could be adapted for cells of other tumours. Small quantities of target cells and supernatant are used and the assay can be completed within 5 h. PMID- 2666514 TI - Characterization of bullous pemphigoid antigen synthesized by cultured human squamous cell carcinoma cells. AB - This report concerns the characterization of bullous pemphigoid antigen (BPA) in cultured cells derived from a human squamous cell carcinoma (SCC cells) as identified by sera of 9 patients with bullous pemphigoid (BP). Immunoglobulin G from 5 of 9 BP sera bound the cell surfaces of SCC cells with a punctate staining pattern by immunofluorescence. The other four BP sera and all 12 controls sera showed no specific staining. To characterize the antigen for pemphigoid antibody, we immunoprecipitated NP-40 extracts of cells labeled with [14C] amino acids using nine BP sera and 12 controls sera. These immunoprecipitates were analyzed by sodium dodecyl sulfate polyacrylamide gel electrophoresis and by fluorography. The five BP sera that gave positive immunofluorescence results also precipitated a protein with molecular weight (mol wt) of 110 kD, whereas the other four BP sera negative by immunofluorescence and all 12 controls sera did not precipitate this protein. These results indicate that the sera of patients with BP contain antibodies against the protein with mol wt 110 kD in the SCC cells used in this study. With use of four BP sera, two of which were positive to this mol wt 110 kD BPA and two of which were negative, immunoprecipitation was carried out in Pam cells. One 110 kD-positive serum and two 110 kD-negative sera, precipitated a BPA of mol wt 220 kD from Pam cells labeled with [35S] methionine. These results suggest that BP sera may recognize more than one antigen, in addition to possible BPA heterogeneity in different individuals. PMID- 2666515 TI - Development of human embryonic and fetal dermal vasculature. AB - This report summarizes recent advances in the understanding of the structure and organization of the microvasculature in developing human skin. Previous observations suggested that the skin contains no blood vessels as late as eight weeks estimated gestational age (EGA). Computer reconstructions, in conjunction with light and transmission electron microscopy (TEM), however, demonstrated that specimens as young as 35-45 d show a level of vascular complexity previously unknown. The computer reconstructions showed that the vasculature was organized in one or two planes parallel to the epidermis. A simple, single plane was evident in specimens 40-50 d EGA, whereas specimens 50-75 d EGA showed two planes. Fewer vessels were continuous throughout the tissue sample in the younger specimens compared with the older specimens. Superior views highlighted the continuities and connections of vessels. The younger specimens showed more discontinuous segments of vessels when compared with the network established in the older specimens. In the earliest specimens examined morphologically (35-40 d), simple, capillarylike vessels were morphologically identifiable in presumptive dermis. The samples studied by TEM revealed detailed structure of the vessel wall including extreme attenuations and projections, plasmalemmal vesicles, and junctions similar to adult endothelial cells. Little or no basal lamina surrounded the vessel. The basal lamina first appeared in the form of amorphous deposits and eventually thickened and became continuous. By the end of the first trimester, the basal lamina still lacked the organization of adult cutaneous arterial and venous segments. These findings suggest that the major vascular organization of the dermis is defined in the first trimester of development. PMID- 2666516 TI - The vascular effects of omega-3 fatty acids. AB - Much has been learned in the past two decades about the impact of omega-3 fatty acids on human biology. These distinctive fatty acids are derived principally from marine sources such as fish and fish oil. They are rapidly incorporated into cell membranes after their ingestion in the diet and subsequently may alter a myriad of cellular functions. For example, eicosapentaenoic acid and docosahexaenoic acid may inhibit the synthesis of several prostaglandins and leukotrienes, as well as reduce the cellular production of cytokines or growth factors such as interleukin-1 or platelet-derived growth factor. Some of these functional changes found after fish-oil ingestion may have therapeutic implications in the treatment of human disease. Studies are now underway to investigate the effect of fish-oil preparations or more-purified omega-3 fatty acids on arterial injury, thrombosis or atherosclerosis, as well as to study their effects in certain inflammatory or cutaneous disorders, such as psoriasis. This paper will review the current body of research on marine oils and will focus specifically on the effects of omega-3 fatty acids in vascular biology and associated disease states. The potential toxicity of these fatty acids will be discussed, as well as current indications (or lack of them) for their therapeutic use in humans. PMID- 2666517 TI - Histogenesis of Kaposi's sarcoma and angiosarcoma of the face and the scalp. AB - This study reviews data on the histogenesis of Kaposi's sarcoma and angiosarcoma derived from clinical features, histology, electron microscopy, enzyme histochemistry, and immunochemistry of both diseases. Their hemorrhagic clinical appearance contrasts the predominantly lymphatic histologic features of vessels in early lesions. Investigations performed to resolve the debate whether these tumors arise from blood vessel or lymphatic endothelium show remarkably similar results for both conditions. Electron microscopy reveals Weibel - Palade bodies in a minority of cases, but features consistent with less well-differentiated blood vessel endothelium may be seen in a greater proportion of tumors. Enzyme histochemistry generally shows absence of adenosine triphosphatase and alkaline phosphatase in tumor cells; a pattern of enzymes similar to that found in normal lymphatic endothelium. Conflicting data arises from the large number of immunohistochemical studies performed on both conditions. Factor VIII-related antigen and Ulex europaeus agglutinin-I have been most frequently employed, but the specificity of these agents for blood vessel endothelium is debatable. Panendothelial markers show consistent labeling of both tumors, but marker studies employing a wide range of monoclonal antibodies specific for blood vessel endothelium have shown occasional positive labeling of tumor cells. A number of studies have claimed absence of labeling with specific blood vessel monoclonal antibodies, but at present no study employing a specific marker for lymphatic endothelium has been reported. Although the demonstration of specific markers for blood vessel endothelium in these tumors has been variable, the data would be compatible with lesions arising from undifferentiated stem cells that proliferate with varying degrees of differentiation toward blood vessel endothelium. An alternative hypothesis for the histogenesis of Kaposi's sarcoma would be one of multicentric hyperplasia containing lymphatic venular anastamoses with elements of both lymphatic and blood vessel endothelium. PMID- 2666518 TI - Structure and function of lymphatics. AB - Lymphatics are large vessels with a lumen potentially ten times wider than blood vessels and have a mean mesh diameter in the upper dermis of approximately 504 +/ 88 microns. The plexus lies just deep to the subpapillary venous plexus and when functioning well it is difficult to identify because of the attenuated endothelium and collapsed lumen. The role of the lymphatic as a pathway for the Langerhans cell and as an exit for macromolecules such as lipid and protein make it an essential organ for normal skin biology. When this system fails, impaired immunity, fibrosis, and recurrent infections are inevitable. Even vasculitis may be a consequence of failure of clearance of immune complexes from the interstitium. The adipose tissue and deep dermis are especially vulnerable in this respect. Elastin fibers support cutaneous lymphatics and may be low resistance pathways through the connective tissues into the lymphatic. Identification of lymphatics by special markers is a concept that currently fails to take into account that changing roles in disease may be associated with a change in the specificity of markers. The anatomy of lymphatic vessels in the skin is described and the role of the lymphatic is emphasized. PMID- 2666519 TI - Ultrastructure and organization of the cutaneous microvasculature in normal and pathologic states. AB - The cutaneous microvasculature is organized into upper and lower horizontal plexuses with the dermal capillary loops arising from the upper plexus. The arteriolar and venular sides of the microvasculature can be identified by the ultrastructure of the mural basement membrane material. Collecting venules present in the lower dermis contain valves. Periadventitial cells (veil cells) are present around all microvessels. Their size and number appear to correlate with the quantity of mural basement membrane material found in cutaneous vessels in diabetes, actinic damage, and chronological aging. The contractile cells of the vascular wall surround the endothelial cell tube in a manner suggesting specific functions. The smooth muscle cells in the arteriolar segment form a sleeve, whereas each pericyte in the postcapillary venular simultaneously makes many contacts with several underlying endothelial cells. The common telangiectases can be explained by abnormalities in this organization and ultrastructure rather than by neovascularization or random anastomoses. The macular telangiectases seen in scleroderma, generalized essential telangiectasia, and nevus flammeus are produced by dilatation of the postcapillary venules of the upper horizontal plexus. Cherry angiomas are produced by spherical and tubular dilatations of capillary loops in dermal papillae with tortuous cross-connections between individual loops. Angiokeratomas of Fabry and Fordyce have the ultrastructure of collecting venules that contain valves, and appear to represent the ectopic development or placement of small valve-containing collecting veins. The cutaneous lesions of hereditary hemorrhagic telangiectasia represent arteriovenous communications. PMID- 2666520 TI - Monoclonal antibody-defined human endothelial antigens as vascular markers. AB - A review is given of human endothelial antigens recognized by monoclonal antibodies and used as vascular markers. These antigens can be classified tentatively into two categories that partly overlap: 1) differentiation markers and 2) antigens involved in specific cellular functions. Monoclonal antibodies recognizing endothelial differentiation markers reacting with all types of human endothelium can be regarded as constitutive endothelial markers. Other differentiation markers have a restricted distribution that is associated with a subtype of endothelium. Although sensitivity of the markers is high in general, specificity for endothelium is not absolute, based on distribution studies in tissues or in cell lines. With the exception of PAL-E and EN-3/EN-4, it is not clear from the literature whether the antibodies also react with lymphatic endothelium. Immunohistochemical examination of other species indicate that only BW 200 is restricted to humans. Immunoelectron microscopy of microvascular cells in tissue specimens has revealed that the monoclonal antibodies recognizing differentiation antigens show different subcellular distribution patterns. PAL-E and BW 200 react with the luminal endothelial surface, in a local and diffuse pattern, respectively. Anti-Von Willebrand factor (i.e., Factor VIII-related ag) antibodies react with Weibel-Palade bodies but also with subendothelial structures. Applications of immunohistochemistry using monoclonal antibodies in diagnostic pathology include assessment of vascular invasion by cancer cells, and identification of endothelial neoplasms and related disorders. Because anti Factor VIII-related antigen and BW 200 are applicable on formaldehyde-fixed and paraplast-embedded tissue, they are most suitable for histodiagnostic application. Immunohistochemistry using monoclonal antibodies recognizing endothelial antigens involved in specific cellular functions also may contribute to pathobiologic research on the characterization of blood-tissue barriers, e.g., in the tumor vascular bed. PMID- 2666521 TI - Microvascular endothelial cell culture. AB - Microvascular endothelial cells play a central role in inflammation, tumor metastasis, and wound healing. Methods to study these processes in vitro using cells isolated from adult skin, from the inner and the outer segments of the neontal foreskin, and from experimental animals are reviewed. A new modified Iscove's medium supplemented with 2% pre-partum maternal serum, dibutyryl cyclic AMP, isobutyl methylxanthine, thymidine, and hypoxanthine is described. This modified medium supports growth of both adult and neonatal endothelial cells up to seven passages with retention of cytologic markers closely identified with endothelial cells (Weibel-Palade bodies, Factor VIII-associated antigen). Several functions associated with the microvasculature in situ are expressed by microvascular endothelial cells in cell culture. Such functions include the formation of a basement membrane, angiogenesis, intercelluar gap formation in response to vasoactive agents, and the attachment and migration of lymphocytes through endothelial monolayers. PMID- 2666522 TI - Human vascular endothelial cells, granulopoiesis, and the inflammatory response. AB - We have carried out a series of in vitro studies designed to characterize the role of mononuclear phagocytes as regulators of hematopoiesis. The results of these studies have demonstrated that mononuclear phagocytes produce factors, including interleukin-1 (IL-1), that induce the expression of multilineage hematopoietic growth factors by human vascular endothelial cells. In more recent studies we and others have identified these induced factors as G-CSF, GM-CSF, IL 6, and IL-1. Interleukin 1 stimulates expression of these genes by inducing the accumulation of gene transcripts. Moreover, transcript accumulation, at least with GM-CSF, results from prolongation of mRNA half-life. Based on preliminary studies in a cell-free system, we propose that the inductive capacity of IL-1 results from its activation of ribonuclease inhibitors in the cytoplasm of IL-1 induced cells and hypothesize that this may be a general mechanism by which IL-1 induces gene expression. PMID- 2666523 TI - Neutrophil-endothelial cell interactions: mechanisms of neutrophil adherence to vascular endothelium. AB - Adherence of circulating neutrophils to the microvascular endothelium is the initial step in diapedesis, the process by which leukocytes migrate through blood vessels to accumulate at sites of cutaneous disease or injury. The mechanisms underlying neutrophil-endothelial cell interactions are currently under intense investigation. It has now been clearly shown that human neutrophil adherence in vitro to cultured human endothelial cell monolayers can be enhanced by a variety of mediators of inflammation, that both the neutrophil and the endothelial cell may actively contribute to the adhesive interaction depending on the stimuli involved, and that the Mac-1, LFA-1, p150,95 glycoprotein family (CD11/CD18) plays a critical role. Chemotactic peptides (FMLP, C5a) and lipid mediators (LTB4, PAF) act primarily on the neutrophil to enhance its adherence to endothelium. The effect occurs quickly (maximal response within 2 min), can be rapidly modulated, and is dependent on the expression of CD11/CD18 on the neutrophil surface. In contrast, the cytokines, interleukin-1 (IL-1) and tumor necrosis factor (TNF), as well as bacterial lipopolysaccharide (LPS), induce cultured human endothelial cells to increase their adhesivity for human neutrophils by a process that is time-dependent, requiring 4 to 6 h for maximal response, and involves de novo RNA and protein synthesis. Two adhesion molecules are induced on the surface of endothelium in response to cytokine activation: endothelial-leukocyte adhesion molecule-1 (ELAM-1) and intercellular adhesion molecule-1 (ICAM-1). ICAM-1 is a ligand for LFA-1 (CD11a/CD18). Thus, CD11/CD18 plays a central role in neutrophil adherence to endothelium stimulated by chemotactic factors or cytokines. However, much still remains to be explored to further understanding of the fascinating but complex interaction of circulating neutrophils and the microvascular endothelium during acute inflammatory reactions in the skin. PMID- 2666524 TI - Complement-mediated endothelial cell damage in immune complex vasculitis of the skin: ultrastructural localization of the membrane attack complex. AB - Activation of the complement system is an important element in our concept of the pathomechanism of immune complex (IC) vasculitis. Both deposition of IC and attraction of polymorphonuclear leukocytes (PMN) are effected by products of complement activation. Actual tissue damage, however, is believed to be caused by PMN penetrating the vessel wall. Our former finding that deposits of membrane attack complex of complement (MAC) are found predominantly in skin lesions of patients with IC vasculitis and not in perilesional skin, has raised the question whether the complement system itself (by way of the MAC) contributes to tissue damage. Our present study shows the ultrastructural localization of MAC in lesional and clinically uninvolved skin in two patients with a cutaneous IC vasculitis. Lesional skin deposits of MAC were found on endothelial cells (EC) of upper dermal vessels and on infiltrating PMN. Uninvolved skin deposits of MAC were found on some EC, but clearly to a lesser extent than on EC of the lesional skin. In the skin of two healthy controls MAC was only found sporadically on EC. Deposits of MAC on EC in the lesional skin were often associated with a typical form of local cell swelling. This local form of endothelial cell swelling was incidentally seen in vessels of clinically uninvolved skin, but not in the skin of the two controls. The association of the endothelial cell swelling with deposits of MAC suggests that the complement system can have a direct damaging effect on EC in IC vasculitis by the assembly of MAC on the endothelial cell membrane. PMID- 2666525 TI - Development of immune complexes in the skin. AB - Complement activation by immune complexes induces inflammation, but during this process the nature of the complexes is altered. Once immune complexes have attained sufficient lattice to activate complement, further increase of the lattice and immune precipitation are limited by the incorporation of complement components. The presence of complement components in immune complexes facilitates their disposal from circulation by complement receptors on red cells in humans. Without complement activation the disposal of immune complexes of sufficient lattice is mediated by Fc receptors. The development of immune deposits in tissues can arise by several mechanisms. Circulating immune complexes may be deposited in a number of vascular beds. Immune deposits in tissues may also arise by local formation. This process may involve structural antigens in tissues, cell surface antigens that are shed after interaction with specific antibodies or antigens that have become planted in tissues and then combine with antibodies. Charge-charge interactions enhance deposition of immune complexes in several organs, involving fixed negative charges in tissues and positive charges on antigens or antibodies in immune complexes. Successful detection of immune deposits in dermal vessels requires the examination of fresh lesions. Local vascular changes contribute significantly to deposition of immune complexes in dermal vessels. Charge-charge interactions enhance this deposition and contribute to the development of deposits at the dermal-epidermal junction in experimental animals. PMID- 2666526 TI - Hypersensitivity angiitis. AB - Hypersensitivity angiitis is a disease in which patients present with palpable purpura dominant on the lower legs. As lesions evolve they become confluent, and sometimes hemorrhagic and ulcerate. Other organ systems may be involved, particularly the joints, gastrointestinal tract, and kidneys. Current evidence supports an immune complex pathogenesis in which a variety of antigens including bacteria, viruses, drugs, or chemicals are involved. Therapy consists of identifying the potential offending agent and administration of antiinflammatory drugs. PMID- 2666527 TI - Lymphocyte adhesion to endothelial cells in vitro: models for the study of normal lymphocyte recirculation and lymphocyte emigration into chronic inflammatory lesions. AB - Lymphocytes preferentially leave the bloodstream to enter secondary lymphoid organs or sites of inflammation by first adhering to, and then migrating through, the walls of specialized postcapillary venules known as high endothelial venules. To study the initial adhesion event between lymphocytes and endothelial cells, two different in vitro assays have been developed. In the first, lymphocytes are incubated on frozen sections of lymphoid organs or other tissues. Under certain conditions, lymphocytes specifically bind to the endothelial cells of high endothelial venules in such sections. The results of monoclonal antibody inhibition studies have suggested that endothelial cells at various lymphoid organs, and at certain inflammatory lesions, may express organ-specific ligands on their surface, which bind to corresponding organ-specific "homing receptors" on the lymphocytes. The second assay measures the adhesion of lymphocytes to confluent monolayers of viable, cultured endothelial cells. Because pretreatment of such cell monolayers with a number of cytokines produced at inflammatory sites stimulates an increase in the adhesiveness of the cells for lymphocytes, it has been suggested that such cytokine-induced increases in endothelial cell adhesiveness may be important in the induction of lymphocyte traffic into such lesions. Unlike the homing receptor type of binding described above, the cytokine induced increase in lymphocyte-endothelial cell adhesion is presumably non-tissue specific. Results of monoclonal antibody inhibition studies in this system have suggested that at least two ligand-receptor interactions may be involved. Monoclonal antibodies to the lymphocyte function-associated antigen-1 greatly inhibited the adhesion of T cells to untreated endothelial cells, but had little or no inhibitory effect on T-cell adhesion to cytokine-treated endothelial cells. PMID- 2666528 TI - Perivascular dendritic macrophages as immunobiological constituents of the human dermal microvascular unit. AB - We have recently observed a previously uncharacterized population of class II (Ia) antigen-positive dendritic cells that is intimately associated with the dermal microvessels of normal human adult and newborn skin. Immunofluorescence and immunoelectron microscopy studies have indicated that this cell is a perivascular macrophage. This dermal perivascular dendritic macrophage was seen in greatest density in the superficial vascular plexus and appears to constitute a large percentage of the total dermal macrophage population. Because tissue macrophages do not always share the same immunologic repertoire as circulating monocytes/macrophages, we became interested in examining the functional immunologic capabilities of this dermal dendritic macrophage. A procedure was developed to isolate and partially purify these cells from normal human newborn foreskin. Preliminary findings are compatible with the possibility that these cells possess the capacity to present alloantigens to CD4+ T cells. The potential immunologic function of this dermal perivascular macrophage is discussed in the context of its possible interactions with the other cellular components of the dermal microvascular unit (i.e., microvascular endothelial cells, perivascular T cells, and mast cells). PMID- 2666529 TI - A novel group of interferons associated with the early ovine and bovine embryo. PMID- 2666530 TI - [Early diagnosis of the cervical incompetency by the ultrasonography]. AB - To establish a reliable method for diagnosing cervical incompetency, we observed changes in the cervix by ultrasonography and tried to settle the criteria for early diagnosis. The ultrasonographic evaluation of the cervix was performed by real time B mode scanning (Aloka Echo camera SSD 650 with attached sector scanner using 3.5 MHZ transducers). The cervical length was defined as the distance from the lower edge of the fetal membranes to the edge of the portio vaginalis. In the case of normal pregnancy, the cervical length increased gradually from 14 to 24 weeks of gestation and then decreased gradually. In the case of patients who delivered before 33 weeks of gestation, the cervical length was less than -ISD. 78 of 79 cases in whom bulging of the membranes was not seen delivered at term, but 9 of 33 cases with bulging membranes delivered preterm (chi2, p less than 0.001). The criteria of cervical incompetency based on ultrasonographic findings are as follows: 1. Bulging of the fetal membranes into the endocervical canal 2. Shortening of the cervix a. the cervical length less than -ISD of the mean value b. the decrease in cervical length before 24 weeks of gestation PMID- 2666531 TI - [Successful conservative treatment of cervical pregnancy]. PMID- 2666532 TI - Prospective, randomized trial of oral piroxicam in the prophylaxis of postoperative cystoid macular edema. AB - One hundred and seventy-eight patients undergoing uncomplicated cataract extraction with posterior chamber intraocular lens insertion completed a prospective, randomized, controlled trial of oral piroxicam in the prophylaxis of postoperative cystoid macular edema (CME), with a 1-year follow up. The incidence of "visually significant" CME, the mean interval to onset following surgery, clinical severity, recurrence rate, and the time to achieve best corrected visual result were unaffected by a 17-day piroxicam course. Oral steroid CME treatment produced a rapid response, but could not be shown to change the ultimate visual results. High-performance liquid chromatography analysis of aqueous humor obtained at cataract surgery suggested that piroxicam's pharmacokinetics might be a factor in this lack of response; the large number of potential inflammatory mediators uninfluenced by cyclo-oxygenase inhibition also may implicate piroxicam pharmacodynamics. PMID- 2666533 TI - Review: pharmacologic control of wound healing in glaucoma filtration surgery. AB - An integrated understanding of the wound healing process, pharmacological agents, and surgical techniques are required for comprehensive treatment of wound healing in glaucoma filtration surgery. More well controlled basic and clinical studies are required to clarify the existing ambiguities in the selection of proper pharmacological agents, dosage, timing, and method of delivery. The most promising treatment modalities may be combination drug therapy and the use of bioerodible compounds for a sustained and localized delivery system. PMID- 2666534 TI - Chronic pyelonephritis: modulation of host defenses by cyclosporin A. AB - Chronic experimental pyelonephritis is characterized by a stable level of infection, which persists for many months. Administration of cyclosporin A (CsA) reactivated previously healed renal lesions and caused a marked increase in bacterial numbers in the kidney. Studies were then carried out to compare the effects of CsA, and the nonselective cytodepletive agents irradiation and cyclophosphamide, on both host defenses and the bacteriologic status of chronically infected kidneys. Two different responses were observed. In animals treated with CsA, bacterial numbers increased markedly, although circulating neutrophil numbers were relatively unaffected. This observation was in contrast to the severe ablation of leukocyte numbers and competence needed to achieve an equivalent effect when irradiation and cyclophosphamide were used. One possible explanation for the adverse effect of CsA on the host-parasite balance in chronic pyelonephritis is that CsA affects mediators that control the inflammatory response or induces a qualitative change in a critical cellular defense compartment. PMID- 2666535 TI - Paracelsus. PMID- 2666536 TI - The mechanism of the inspiratory expansion of the rib cage. PMID- 2666537 TI - Alzheimer's disease--a mini review. PMID- 2666538 TI - Cryosurgical treatment of endolymphatic hydrops. AB - Cryosurgery of the labyrinth, as a treatment of endolymphatic hydrops, was initially greeted with considerable enthusiasm, but has lately received little publicity. That it still has a valuable role is demonstrated by this study of 69 patients who underwent labyrinthine cryosurgery over a 16 year period. Complete relief from vertigo has been achieved in 71 per cent of cases and morbidity has been minimized by the precautions outlined. The literature is reviewed to demonstrate the superiority of the transmastoid approach, the evolution of the technique and experimental evidence for the supposed mode of action. PMID- 2666539 TI - Neuroendocrine carcinoma of the lip (Merkel cell tumour) examined by electron microscopy and immunohistochemistry. AB - A definite diagnosis of neuroendocrine carcinoma of the skin is seldom made on initial histological examination; the tumour is usually reported as a poorly differentiated or anaplastic carcinoma. By applying electron microscopy and immunohistochemistry, a correct diagnosis can be made. The ultrastructural examination shows dense-core membrane-bound granules, intermediate perinuclear filaments and desmosome-like junctions. Immunohistochemistry reveals positive staining for neuron-specific enolase and keratin, the latter in a characteristic paranuclear distribution. Confronted with an unusual clinical picture or indefinite histological diagnosis, tissue specimens should be secured for the above mentioned ancillary procedures. PMID- 2666540 TI - Malignant melanoma of the larynx. AB - Malignant melanoma of the larynx is a rare tumour. Only 31 cases of primary laryngeal melanoma have been reported in the literature. Cady et al., (1968) found only four cases in a group of 2,500 cases of laryngeal cancer seen over a 25-year period. A case of primary malignant melanoma of the larynx is presented along with a review of the literature. Problems associated with histological diagnosis are discussed. This patient was regarded as a poor risk for laryngectomy and appears to have control of local disease following application of Carbon dioxide laser. PMID- 2666542 TI - [Doppler ultrasound and sexual impotence]. PMID- 2666541 TI - Plasma lipoproteins in fish. PMID- 2666543 TI - [Ultrasonic examination of impotence]. PMID- 2666544 TI - [List of new members admitted to the French College of Vascular Pathology in 1988]. PMID- 2666545 TI - [What is new about determining thrombo-embolic risk?]. PMID- 2666546 TI - [The evolution of ideas in preventive treatment of thrombo-embolic disease. Hemodilution]. PMID- 2666547 TI - [Detection of acute venous thromboses using plethysmography. Possibilities and limitations]. AB - The combined use of careful clinical examination and venous occlusion plethysmography has good diagnostic reliability. The clinical examination provides an estimated percentage "clinical probability"; in the event of negativity, complementary plethysmography enables confirmation of a negative clinical diagnosis; positive plethysmography confirms a probable clinical diagnosis or establishes the probability of thrombosis in patients with poor clinical signs. Thus false negative or false positive cases may be easily eliminated. In the remaining dubious cases complementary investigations are necessary. PMID- 2666548 TI - [Pitfalls of echo-Doppler in recent venous thromboses]. PMID- 2666549 TI - [Conditions for good phlebographic interpretation or several primary facts on phlebography in venous thromboses of the legs]. PMID- 2666550 TI - [Duration of treatment with heparin in deep venous thromboses of the legs]. PMID- 2666551 TI - [Role of compression and ambulation in the treatment of recent deep venous thromboses]. PMID- 2666552 TI - [Role of thrombolytics in the treatment of deep venous thromboses of the legs]. PMID- 2666553 TI - [Indications for venous thrombectomy]. AB - Thrombectomy has a place in the treatment of acute venous thrombosis. However, this is only the case in certain conditions. Its use is indisputable in true blue venous thrombosis which is a rarely occurring pathology. It may be proposed and discussed for recent thrombosis, of a known and correctable cause, blocking one or several important venous channels in a patient likely to develop an invalidating postthrombotic syndrome. PMID- 2666554 TI - [Results of a multicenter survey on the diagnosis and treatment of recent deep vein thromboses of the legs. March 1988]. PMID- 2666555 TI - Impairment of glucose tolerance in hyperthyroid cats. AB - Intravenous glucose tolerance tests were performed in eight adult cats before and after a 4-week treatment with thyroxine. The untreated cats had a mean fasting blood glucose concentration of 7.7 +/- 0.3 mmol/l and a mean fasting insulin concentration of 88 +/- 31 pmol/l which were not significantly different from mean fasting glucose and insulin concentrations after 4 weeks of thyroxine administration (6.9 +/- 0.2 mmol/l and 101 +/- 28 pmol/l respectively). At 120 min after glucose injection, the glucose concentration in untreated cats returned to baseline concentrations as did the insulin concentration. However, in the hyperthyroid cats both glucose and insulin concentrations were significantly (P less than 0.001) higher (13.6 +/- 0.8 mmol/l and 245 +/- 17 pmol/l respectively) in comparison with the baseline and untreated cats. The t1/2 for glucose disappearance was significantly higher in the cats rendered hyperthyroid, and the glucose disposal rate constant (K) was significantly lower in this group. It is concluded that hyperthyroidism in cats leads to impairment of glucose tolerance possibly due to peripheral insulin resistance. PMID- 2666556 TI - Cyclical changes in plasma renin during the oestrous cycle in the rat: synchronized effect of oestrogen and progesterone. AB - The aim of the present work was to study the relationship between sex hormones and plasma renin levels during the oestrous cycle in a Wistar-derived rat strain. Plasma renin activity (PRA) as well as a plasma renin concentration (PRC) were increased during the day of oestrus in rats with controlled 4-day oestrous cycles. This increase in PRA and PRC was not found when rats were ovariectomized on dioestrus day 2 and samples measured on the expected day of oestrus. The increase in PRA and PRC was not found when normal cyclic rats were treated with either tamoxifen or the progesterone receptor blocker RU 38486. Treatment with progesterone at pro-oestrus after ovariectomy on dioestrus day 2 partially increased the PRA and PRC when compared with the values found during the day of oestrus in control rats. The combined treatment of ovariectomized rats on dioestrus day 2 with oestrogen and progesterone restored the normal increase in PRA and PRC values on the expected day of oestrus. We therefore postulate that the sodium diuresis promoted by progesterone may be modulated by the previous peak of oestrogen. However, stimulation of extrarenal sources of renin cannot be excluded nor can an involvement of inactive precursors of renin in the fluctuations of active renin that occur during the oestrous cycle. No important change in plasma renin substrate (PRC) was observed during the oestrous cycle. PRA, PRC and PRS were determined every 4 h during the 4-day oestrous cycle. Our results clearly show a rhythmic variation in PRA and PRC which increases during the day of oestrus with a peak at 06.00 h.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 2666557 TI - Production of insulin-like growth factor-II by human fetal pancreas in culture. AB - Insulin-like growth factor-II (IGF-II) is a polypeptide hormone thought to be involved in fetal development because of its wide distribution in fetal tissues and its presence in the fetal circulation. We have developed a highly sensitive radioreceptor assay for IGF-II using rat liver microsomal membranes and have used this assay to test for the presence of IGF-II in the human fetal pancreas and the release of IGF-II by the human fetal pancreas in organ culture. IGF-II was present in extracts of pancreatic tissue (0.056 +/- 0.012 pmol/mg tissue, n = 5) and was released in culture at the rate of 0.027-0.134 pmol/mg tissue per day with release being maintained for at least 3 weeks in culture. The rate of release was not affected by the gestational age of the fetus over 14 to 20 weeks but was significantly related to the rate of insulin release (r = 0.712, P less than 0.001, n = 34). Chronic exposure to 12-0-tetradecanoylphorbol-13-acetate (TPA), which inhibits insulin release in the human fetal pancreas, caused an 85% drop in IGF-II production, which was reversed when TPA was removed. These studies demonstrate that IGF-II is produced by the human fetal pancreas in a pattern similar to that of insulin. We suggest that control of IGF-II release, like that of insulin, may involve protein-kinase C and that IGF-II may have a paracrine or autocrine role in the development of fetal pancreatic function. PMID- 2666558 TI - In defence of the anecdotal. PMID- 2666559 TI - Addition of non-pharmacological methods of treatment in patients on antihypertensive drugs: results of previous medication, laboratory tests and life quality. AB - Four hundred patients from eight health centres were recruited for this 2-year study on the possible replacement of antihypertensive drugs by non pharmacological therapy. All the patients were given a device to measure their blood pressure at home and had monthly checks at a health centre. Two hundred patients on antihypertensive drugs (G1) started additional non-pharmacological therapy after 1 year in the study, while the rest (G2) had used it from the beginning. Antihypertensive drugs were withdrawn according to predetermined criteria. The drop-out rate was 1.5% each year. Medication was withdrawn completely from 42.7% of G1, and in 21.5% it was withheld for at least 18 months. The corresponding figures for G2 were 46.4% and 25.5% respectively. Most of the medication withdrawal in G1 occurred during the first year, when the group's management consisted solely of blood pressure measurements at home and frequent visits to the health centre. Serum triglycerides decreased on non-pharmacological treatment in both sexes in both groups. Life quality improved, particularly for the group (n = 173) that had the drugs withdrawn. PMID- 2666560 TI - Plasma zinc concentrations during the first 2 years after diagnosis of insulin dependent diabetes mellitus: a prospective study. AB - Studies of zinc status in insulin-dependent diabetes mellitus (IDDM) have shown contradictory results. Zinc is essential for many enzymes involved in the human metabolism and may play a role in the biosynthesis and storage of insulin in the B-cell. We therefore prospectively followed 26 patients (14 males and 12 females) with newly diagnosed IDDM in order to determine the plasma zinc variation at the time of diagnosis and after 1, 3, 6, 12 and 24 months. Seventy-two healthy persons (36 males and 36 females) served as controls. Only minor differences in plasma zinc were demonstrated during the first 2 years of IDDM. A sex difference was found in healthy controls but only after 24 months in the diabetics. Quantitative changes of the B-cell function, development of insulin antibodies, age, body weight and serum albumin did not correlate with the course of plasma zinc. PMID- 2666561 TI - A human endothelial cell-restricted, externally disposed plasmalemmal protein enriched in intercellular junctions. AB - We have raised an mAb to a previously undescribed 135-kD externally disposed integral membrane protein that is enriched in the intercellular junctional domain of cultured human umbilical vein endothelial cells. This protein localizes at the appositional surfaces of cells as they become confluent and is stably expressed in the junctional zones of confluent monolayers. This protein is expressed in situ on continuous endothelia of all blood vessels in all human tissues examined. Moreover, this protein, as determined by mAb immunocytochemistry, is not expressed by any other cell type. This protein may mediate endothelial-specific functions restricted to the intercellular domain. It may also serve as a unique cell surface marker for the identification and purification of human endothelial cells. PMID- 2666562 TI - Analysis of the first two waves of thymus homing stem cells and their T cell progeny in chick-quail chimeras. AB - Chick-quail chimeras were used to study precursor/progeny relationships of hemopoietic stem cells (SC) that enter the embryonic thymus in waves to give rise sequentially to the TCR-1+, TCR-2+, and TCR-3+ lineages of T cells. The first wave of SC and their progeny were examined by grafting thymus from 9-d chick embryos (E9) into E3 quails. mAbs specific for chick T cell antigens were used to trace the development of T cells in the recipients. All three lineages of TCR bearing cells were generated from the first wave of SC. The cortico-medullary transit time was several day shorter for the TCR-1 subpopulation than for the TCR 2 subpopulation, and the peripheral seeding of TCR-2 cells also occurred later in development. The duration of thymocyte production from the first wave of SC that entered the thymus was approximately 3 wk, during which gradual cortical to medullary replacement by second wave SC progeny occurred. When the latter was examined, after transplantation of E7 quail thymus into E3 chick embryos, a sequential generation pattern for the TCR-1 and TCR-2 cell progeny was not evident. Finally, recirculation of T cells to the thymus medulla was defined in this avian model. PMID- 2666563 TI - Inhibition of human macrophage colony formation by interleukin 4. AB - We investigated the effects of human rIL-4 on in vitro hematopoiesis. A profound inhibition of macrophage colony formation by IL-4 was observed, whereas colony growth of other lineages was not affected. Inhibition of macrophage colony growth was not restricted to GM-CSF-induced colony growth but was also present in cultures stimulated with M-CSF. This inhibition was not only observed in cultures of light density bone marrow cells, but also in cultures of monocyte- and T lymphocyte-depleted bone marrow cells. Since a similar inhibition was observed in cultures of CD34+HLA-DR+-enriched bone marrow cells, a direct action of IL-4 on monocyte-committed progenitor cells is suggested. PMID- 2666564 TI - European multicentre evaluation of the ABBOTT Spectrum clinical chemistry analyzer. AB - The analytical performance of the selective multitest ABBOTT Spectrum analyser was studied according to the ECCLS guidelines and partly the CERMAB protocol in a multicentre evaluation involving laboratories from six European countries. Fifteen analytes, including the electrolytes sodium, potassium and chloride, were measured each in at least 3 laboratories, all at 37 degrees C, except the electrolytes, which are measured at room temperature. The trial lasted approximately three months and involved the collection of over 60,000 data points. It yielded the following results: 1. The precision was at least as good as the precision obtained with the comparison instruments. The majority of the coefficients of variation were between 1 and 4%. 2. The recovery for method assigned control sera values was, with few exceptions, within 10%. 3. Good agreement with respect to the method assigned values of control materials and method comparison with patient specimens to different instruments (e.g. SMAC, Hitachi 737, RA 1000) was found. 4. No drift was observed. 5. Reagent-related carry-over was not found. Specimen-related carry-over was detected in some cases, the deviation being of little or no clinical significance. 6. The manufacturer's claims regarding method linearity were as stated or exceeded. 7. The open system capability was tested and rated as very convenient. 8. The practicability of the instrument was very good. PMID- 2666566 TI - Cocaine abuse and addiction. AB - The National Institute on Drug Abuse now considers cocaine the "drug of greatest national public health concern." Lower prices and a new administration route, cocaine smoking, have increased the potential for addiction. An estimated 2 million individuals in the United States may be addicted to cocaine, or four times the number addicted to heroin. Contrary to population representations of the intractable power of cocaine addiction, cocaine dependence is a treatable disorder. The primary care physician must become familiar with signs of dependence and with therapeutic approaches to cocaine abuse, with particular attention to emerging advances in both psychotherapy and pharmacotherapy. PMID- 2666565 TI - Efficacy of transdermal clonidine for headache prophylaxis and reduction of narcotic use in migraine patients. A randomized crossover trial. AB - Thirty patients completed a double-blind, randomized crossover study utilizing transdermal clonidine and an identical-appearing placebo. Crossover occurred at 6 weeks, with a total study time of 12 weeks. Subjects were asked to record daily in a special diary (1) the presence or absence of headache, (2) duration of headache, (3) severity of headache, and (4) use of pain medication for headache relief. The severity of the headaches was rated from 1 (very mild) to 5 (very severe). Although the subjects reported a decrease in frequency, duration, and intensity of headaches while using the medicated patch, these differences did not reach statistical significance. Nineteen patients subjectively preferred the medicated patch, while five preferred the placebo (P less than .01). During use of the medicated patch, a significant reduction (P = .039) occurred in use of class II narcotics. Three doses of these substances were used by the patients when treated with clonidine, while 34 doses were taken during placebo use. These findings suggest that clonidine might have a role in reduction of parenteral narcotic use in acute pain syndromes. PMID- 2666567 TI - Penicillinase-type of beta-lactamase responsible for the ampicillin resistance in Escherichia coli NTUH 9501-1. AB - beta-Lactamases which hydrolyze the amide bonds of beta-lactam rings of penicillins and cephalosporins are widely distributed among microorganisms and play an important role in microbial resistance to beta-lactam antibiotics. These enzymes have been classified into penicillinase-type and cephalosporinase-type on the basis of their substrate specificity. Several clinical isolates of Escherichia coli from National Taiwan University Hospital (NTUH) were shown to be ampicillin-resistant and found to contain the penicillinase-type of beta lactamase. Escherichia coli NTUH 9501-1 was chosen for further genetic analysis by recombinant DNA technology. DNAs from NTUH 9501-1 were isolated and digested with Pst I. The cellular DNA fragments were then joined with the vector DNA fragments derived from pHC 79 cosmid by Pst I digestion and followed by calf intestine alkaline phosphatase treatment. The recombinant cosmid DNAs were transfected and propagated in the wild type of E. coli DH 5. The transduced cells were selected on the basis of growth on LB plates containing ampicillin. The recombinant cosmid DNAs were re-isolated from the transductant cells and digested with Pst I. The cellular DNA fragments isolated by gel electrophoresis were able to transform DH 5 (amp(s)) to amp(r) cells. The results suggested that transposon like DNA sequences coding for the ampicillinase-type of beta-lactamases were responsible for the penicillin resistance in E. coli NTUH 9501-1. PMID- 2666568 TI - Treatment of childhood acute lymphoblastic leukemia with protocol TCL821: a report of Taiwan Children's Cancer Study Group. AB - Of 110 previously untreated patients who had entered the study of protocol TCL821, 96 were evaluable. The patients were divided into a standard risk group (Group I) and a high risk group (Group II) depending on their age and leukocyte count at the time of diagnosis. Treatment consisted of a 5-week induction therapy course with prednisolone (PRED), vincristine (VCR) and adriamycin (ADM) followed by central nervous system (CNS) prophylaxis. Maintenance therapy consisted of 6 mercaptopurine (6-MP) plus methotrexate (MTX) for 3 years and 6-MP alone for another 2 years, reinforced with dexamethasone, VCR and ADM or cytosine arabinoside (Ara-C) or cyclophosphamide (CTX) every 16 weeks for Group I and 8 weeks for Group II for 3 years. Immunologic typing was done in 74 cases which revealed 60.9% of the common acute lymphoblastic leukemia (ALL) type, 14.9% null cell type, 4.0% undifferentiated type, 4.0% Pre-B cell type, 4.0% B cell type, 10.8% Pre-T cell type and 1.4% T cell type. In Group I the complete remission rate (CR) was 100% and the continuous complete remission rate (CCR) was 72.2% with a follow-up duration of 40-73 months. In Group II, both CR and CCR were 92.9% and 45.8% respectively. The incidence of patients with Pre-T cell type was higher in this study than in most other reports, and these patients responded favorably to treatment. PMID- 2666569 TI - [Reappraisal of T1-Tc scanning in the preoperative localization of hyperfunctioning parathyroid glands]. AB - Preoperative localization for hyperfunctioning parathyroid glands remains a problem in clinical parathyroid surgery. From January 1984 to August 1986, a total of 16 patients with the diagnosis of primary hyperparathyroidism (14) or secondary hyperparathyroidism (2) received preoperative T1-Tc image studies to localize the hyperfunctioning parathyroid glands. All the patients underwent surgery as soon as the diagnoses had been confirmed, and were cured. During surgery, bilateral neck explorations and parathyroid biopsies were routinely performed. All the adenomas were removed, and half of the hyperplastic parathyroid gland was preserved in patients with 4 enlarged hyperplastic glands (3 1/2 hyperplastic glands were removed). The results of the T1-Tc scans correlated with the pathological and operative findings. A hyperfunctioning parathyroid gland with a positive scan was considered as a true positive; a hyperfunctioning parathyroid gland with a negative scan was considered a false negative; normal parathyroid glands with negative scans were considered true negatives; while positive scans without hyperfunctioning parathyroids were counted as false positives. The sensitivity, specificity and accuracy of this localization tool were thereby calculated. On at least 6 months of follow-up, all the patients remained normocalcemic. T1-Tc scanning showed a total of 20 positive images: 6 images were proved to be enlarged parathyroid adenomas, 13 images to be hyperplastic glands and the other one to be thyroid nodule. Also, 2 adenomas, 19 hyperplastic glands and 22 normal parathyroid glands not visualized by T1-Tc scanning were found on exploration. Eight of the 14 patients with primary hyperparathyroidism included 1 adenoma in each patient, 3 normal glands in 6 patients and 2 normal glands in the other 2 patients.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 2666570 TI - Development of cell-mediated cytotoxic immunity to respiratory syncytial virus in human infants following naturally acquired infection. AB - With virus-infected autologous and allogenic mononuclear cells as specific targets, the development of cell-mediated cytotoxic reactivity to respiratory syncytial virus (RSV) was studied in peripheral blood lymphocytes (PBL) in groups of infants with acute RSV infection and in other control groups of subjects during a community outbreak of RSV infection. No RSV-specific cellular cytotoxicity was observed in cord blood lymphocytes and in other uninfected controls. The PBL of infants with acute RSV infection exhibited significant cellular cytotoxic response. The activity peaked early, usually within 1 week after infection. The response appeared to be age-dependent. Over 65% of infants 6 24 months of age and about 35-38% of infants under 5 months of age exhibited cellular cytotoxicity to RSV. Cellular cytotoxic reactivity was observed against autologous and less frequently against allogenic RSV-infected target cells. These findings suggest the appearance of virus-specific cell-mediated cytotoxic immune response after acute RSV infection. The development of cellular cytotoxic responses may play a role in the mechanisms of protection against or the pathogenesis of RSV infection in man. PMID- 2666571 TI - Electron microscopy of ribonucleic acid in nuclear particulate aggregates of hepatitis D using nuclease-gold complexes. AB - The ultrastructural localization of hepatitis delta antigen (HDAg) and ribonucleic acid (RNA) was investigated by immunoperoxidase electron microscopy and by enzyme electron microscopy of RNase-gold complexes on liver biopsies from seven patients with hepatitis D. HDAg was localized mainly in the nucleus and sometimes in the cytoplasm of hepatocytes. Ultrastructurally, intranuclear HDAg was found on nuclear particulate structures measuring 20 to 30 nm in diameter. Intranuclear RNA visualized with gold particles was found in high amounts in the nucleolus, to a small extent in the chromatin area, and also on nuclear particulate structures. These findings suggest that intranuclear aggregates of irregular granular particulate structures in hepatitis D are the internal component of hepatitis delta virus (HDV) particles in blood. PMID- 2666572 TI - Special supplement. A commemorative edition in honor of C. D. Marsden. PMID- 2666573 TI - Did parkinsonism occur before 1817? PMID- 2666574 TI - Current theories on the cause of Parkinson's disease. PMID- 2666575 TI - Is "Parkinson's disease" one disease? AB - Consideration is given to how and why categories of ill health are divided into diseases. Aetiology is a fundamental criterion for the delineation of individual diseases. The same clinical and pathological picture may have many different causes; for example meningococcal meningitis and pneumococcal meningitis are distinct diseases that may display the same symptoms and signs. On the other hand, a single aetiology may lead to quite separate clinical and pathological phenomena; for example, neurosyphilis is a disorder that can present with general paresis or tabes dorsalis (or any combination of the two). In attempting to find a nosological placement for Parkinson's disease, we must take into account the extensive overlap with idiopathic dementia (Alzheimer's disease). Present evidence raises the possibility of several causes for Parkinson's disease, some of which may also be responsible for idiopathic dementia. A classification in accord with its position is desirable, and as a first step it would be helpful to replace "Parkinson's disease" with a term that is not saddled with implications of a single causal mechanism. "Idiopathic Parkinsonism" is suitable nomenclature for what is really a syndrome of unknown origin. PMID- 2666576 TI - Clues to the mechanism underlying dopamine cell death in Parkinson's disease. AB - The primary pathological change in Parkinson's disease is the destruction of dopamine containing cells in the zona compacta of substantia nigra. The cause of nigral cell death and the underlying mechanism remains elusive. However, the discovery of the selective nigral neurotoxin MPTP and its ability to inhibit mitochondrial energy metabolism via its metabolite MPP+ and to generate superoxide radicals suggests processes by which nigral cell death might occur. Recent postmortem evidence in brain tissue from patients dying with Parkinson's disease also suggests the occurrence of some on-going toxic mechanism. This may be a free radical process stimulated by an excess of iron within substantia nigra coupled to a generalised decrease in brain ferritin content. These data suggest altered iron handling occurs in Parkinson's disease which may lead to the generation of toxic oxygen species such as superoxide radicals. There is also evidence for an inhibition of mitochondrial function in the substantia nigra in patients with Parkinson's disease. So there may be a close association between the actions of the synthetic neurotoxin MPTP and the underlying cause of idiopathic Parkinson's disease. PMID- 2666577 TI - The on-off phenomenon. AB - The on-off phenomenon is an almost invariable consequence of sustained levodopa treatment in patients with Parkinson's disease. Phases of immobility and incapacity associated with depression alternate with jubilant thaws. Both pharmacokinetic and pharmacodynamic factors are involved in its pathogenesis, but evidence is presented to indicate that the importance of levodopa handling has been underestimated and that progressive reduction in the storage capacity of surviving nigrostriatal dopamine terminals is not a critical factor. Re distribution of levodopa dosage which may mean smaller, more frequent doses, or larger less frequent increments, may be helpful in controlling oscillations in some patients. Dietary protein restriction, the use of selegiline hydrochloride and bromocriptine may also temporarily improve motor fluctuations. New approaches to management include the use of subcutaneous apomorphine, controlled-release preparations of levodopa with a peripheral dopa decarboxylase inhibitor and the continuous intra-duodenal administration of levodopa. PMID- 2666579 TI - Aspects of the history of Parkinson's disease. PMID- 2666578 TI - Transplantation into the human brain: present status and future possibilities. PMID- 2666580 TI - PET and movement disorders. AB - In this paper the use of PET for determining the patterns of disruption of both regional cerebral metabolism, and the pre- and post-synaptic dopaminergic systems, associated with movement disorders is reviewed. That the various akinetic-rigid syndromes result in distinctive PET findings is shown, making functional imaging valuable in their differential diagnosis. PET may also be useful for detecting the presence of sub-clinical disease in Huntington's disease and other inherited movement disorders. PMID- 2666581 TI - Multiple system atrophy--the nature of the beast. AB - Multiple system atrophy (MSA) is generally considered a rare disease, but may account for up to 10% of patients with Parkinsonism. The profusion of names for this disease, which may present to general physicians, psychiatrists, cardiologists, autonomic specialists, general neurologists and those with a special interest in Parkinsonism (this author's own perspective) or cerebellar disorders, together with ignorance of its protean manifestations, may account for its underrecognition and misdiagnosis. In this article, the history and nosology of the condition are considered, and provisional diagnostic criteria are advanced. The usefulness (or otherwise) of ancillary investigations is addressed, and the shortcomings of current methods of treatment are stressed. As with idiopathic Parkinson's disease, the ultimate goal of eradicating the disease entails better diagnosis in order to establish the cause, and thence to develop a radical treatment capable of preventing or arresting the disease process. PMID- 2666582 TI - Psychopathology and movement disorders: a new perspective on the Gilles de la Tourette syndrome. AB - Attention is drawn to associations between movement disorders and psychopathology. The historical background of this is briefly reviewed, and then some recent research findings with regards to the Gilles de la Tourette syndrome are presented. In particular, associations between aggressive and obsessive compulsive disorder and Gilles de la Tourette movements are reported. Further there are associations between a family history of tics and obsessive compulsive disorder in the subsequent generation. It is concluded that the Gilles de la Tourette syndrome should not be viewed as a tic disorder, but a far more complex condition in which the tics form but one aspect. PMID- 2666583 TI - Clinical variants of idiopathic torsion dystonia. AB - Some patients with dystonic movements and postures not known to be caused by environmental or degenerative disorders can be segregated from classical appearing idiopathic torsion dystonia on the basis of distinctive clinical and pharmacologic features. Many of them should be considered within the family of dystonia, as clinical variants of idiopathic torsion dystonia, while others are better classified as being part of other families of dyskinesias. In the former group are paradoxical dystonia, myoclonic dystonia, diurnal dystonia, and dopa responsive dystonia. The latter group consists of dystonic tics and the various entities comprising paroxysmal dystonia, namely kinesigenic, nonkinesigenic and hypnogenic dystonia. PMID- 2666584 TI - Oncogene expression and cytotoxic activity of tumor necrosis factor against human cancer cells. AB - We studied the effect of recombinant tumor necrosis factor (TNF) on selected leukemic and breast cancer cell lines. Based on their sensitivity to TNF in the presence or absence of cycloheximide (CHX), these cell lines could be categorized into three phenotypes: SS, cells that are spontaneously sensitive to TNF; RS, cells that are normally resistant to TNF but are killed in the presence of CHX; and RR, cells that are resistant to TNF irrespective of the presence of CHX. The effect of TNF on expression of c-myc, N-ras, and Ha-ras oncogenes was also studied in these cell lines. Transient, minimal suppression of c-myc was observed in one cell line (Raji), and an inconsistent stimulation of c-myc in another (MCF 7.OCI). No correlation was observed between the effect on oncogene expression and TNF sensitivity. PMID- 2666585 TI - Exacerbation of epidemic Kaposi's sarcoma with a combination of interleukin-2 and beta-interferon: results of a phase 2 study. AB - Epidemic Kaposi's sarcoma (EKS) is the most common neoplastic manifestation of acquired immune deficiency syndrome (AIDS). The underlying immune deficiency can be partially reversed in vitro with interleukin-2 (IL-2). The type 1 interferons (IFN), alpha and beta, inhibit the growth of the etiologic agent of AIDS, the human immunodeficiency virus, have antitumor activity against Kaposi's sarcoma, and are synergistic with IL-2 in stimulating natural killer cell activity. Four patients with EKS were treated three times weekly with simultaneous intravenous injections of recombinant IL-2 (5 X 10(6) Cetus units/m2) and recombinant IFN beta (6 X 10(6) units/m2). All patients had generalized disease, were without systemic symptoms, had no prior opportunistic infection, and had stable disease at the initiation of therapy. No patient had an objective response. Three patients exhibited rapid disease progression within 2-4 weeks of starting treatment, necessitating discontinuation of therapy and early closure of the study. This adverse result may have resulted from the significant levels of gamma interferon (IFN-gamma) that can be generated with this dose and schedule of IL-2. Investigators using IL-2 should monitor IFN-gamma levels and avoid intermediate to high-dose bolus IL-2 therapy in patients with EKS. PMID- 2666586 TI - Recombinant interleukin-2 therapy of systemic lupus erythematosus in the New Zealand black/New Zealand white mouse. AB - New Zealand Black/New Zealand White (NZB/W) mice, a model of systemic lupus erythematosus (SLE), have age-dependent loss of interleukin-2 (IL-2) production. To determine if replacement therapy would influence the course of autoimmune disease, we injected groups of NZB/W mice with low-dose (1,500 units/day) or high dose (15,000 units/day) purified human recombinant IL-2. Parameters of active SLE and populations of splenocytes were not altered consistently by long-term treatment with either dose of IL-2. PMID- 2666587 TI - Modulation of murine hematopoiesis in vivo with recombinant murine interleukin-1. AB - Interleukin-1 (IL-1), a cytokine, primarily produced by monocytes, is the molecule involved in mediating many of the body's responses associated with infection and inflammation. More recently, IL-1 has been shown to sustain elevated levels of circulating granulocytes, stimulate the production of granulocyte-macrophage colony stimulating factors (CSFs) in vitro, increase plasma levels of CSF, and act synergistically with CSFs to increase the number of granulocyte-macrophage progenitors (colony-forming units) (CFU-GM) in vitro. The purpose of this study was to investigate the effect of murine IL-1 on steady state hematopoiesis in vivo. C3H/HeJ or its normal littermate C3H/HeN male mice were administered either murine recombinant IL-1 at 45, 50, 200, 225, or 900 units (0.0125-0.25 micrograms)/animal, or 200 units (0.05 micrograms) of semipurified IL-1 derived from P388D1 cell culture supernatants. Because one of the responses to IL-1 is increased prostaglandin (PG) production and with the known activity of PGs on hematopoiesis, additional studies incorporated the cyclooxygenase inhibitor indomethacin (IM) (10 mg/kg body weight). In order to study the effect of IL-1 in vivo on pluripotential progenitors (CFU-S), IL-1 was compared with recombinant murine GM-CSF (50, 200, and 900 units; 0.0125, 0.05, and 0.25 micrograms). Control groups consisted of animals receiving either lipopolysaccharide (0.5 mg/kg body weight) or phosphate-buffered saline where appropriate. After 24 h, animals were sacrificed, and their peripheral blood indices and stem cell content of both bone marrow and spleen were evaluated for various committed hematopoietic progenitors: CFU-GM, CFU-Meg, CFU-E, BFU-E, and CFU-DG. Circulating neutrophils were increased following IL-1; however, this increase was reduced following IM. IL-1 marrow-derived CFU-GM, CFU-E, BFU-E, and CFU-Meg were below controls. In contrast, splenic CFU-GM and CFU-Meg were significantly elevated with increasing IL-1 concentrations. Erythroid progenitors were increased following low IL-1 concentrations and reduced in animals receiving IM, thus indicating a role for prostaglandins in the mechanism of IL-1 for influencing hematopoiesis. CFU-DG were increased, however, only when animals were pretreated with IL-1 and their cells implanted into normal hosts, not when normal cells were implanted into animals pretreated with IL-1, indicating a potential target cell effect rather than an indirect, factor-related response.(ABSTRACT TRUNCATED AT 400 WORDS) PMID- 2666588 TI - Treatment of refractory non-Hodgkin's lymphoma with radiolabeled MB-1 (anti-CD37) antibody. AB - The biodistribution, toxicity, and therapeutic potential of anti-CD37 monoclonal antibody (MoAb) MB-1 labeled with iodine 131 (131I) was evaluated in ten patients with advanced-, low- or intermediate-grade non-Hodgkin's lymphomas who failed conventional treatment. Sequential dosimetric studies were performed with escalating amounts of antibody MB-1 (0.5, 2.5, 10 mg/kg) trace-labeled with 5 to 10 mCi 131I. Serial tumor biopsies and gamma camera imaging showed that the 10 mg/kg MoAb dose yielded the best MoAb biodistribution in the ten patients studied. Biodistribution studies in the five patients with splenomegaly and tumor burdens greater than 1 kg indicated that not all tumor sites would receive more radiation than normal organs, and these patients were therefore not treated with high-dose radioimmunotherapy. The other five patients did not have splenomegaly and had tumor burdens less than 0.5 kg; all five patients in this group showed preferential localization and retention of MoAb at tumor sites. Four of these patients have been treated with 131I (232 to 608 mCi) conjugated to anti-CD37 MoAb MB-1, delivering 850 to 4,260 Gy to tumor sites. Each of these four patients attained a complete tumor remission (lasting 4, 6, 11+, and 8+ months). A fifth patient, whose tumor did not express the CD37 antigen, was treated with 131I labeled anti-CD20 MoAb 1F5 and achieved a partial response. Myelosuppression occurred 3 to 5 weeks after treatment in all cases, but there were no other significant acute toxicities. Normal B cells were transiently depleted from the bloodstream, but immunoglobulin (Ig) levels were not affected, and no serious infections occurred. Two patients required reinfusion of previously stored autologous, purged bone marrow. Two patients developed asymptomatic hypothyroidism 1 year after therapy. The tolerable toxicity and encouraging efficacy warrant further dose escalation in this phase I trial. PMID- 2666589 TI - Childhood non-Hodgkin's lymphoma involving the testis: clinical features and treatment outcome. AB - Among 131 boys with advanced (stage III or IV) non-Hodgkin's lymphoma (NHL) consecutively treated at St. Jude Children's Research Hospital, testicular involvement was present at the time of diagnosis in six and as an isolated site of relapse in three. Testicular involvement was not seen in any patient with localized (stage I or II) disease. Four of the six patients with involvement at presentation are free of disease 2.9+ to 8.3+ years after diagnosis, following chemotherapy alone (three patients) or chemotherapy plus orchiectomy. Overt testicular relapse while on therapy resulted in death from progressive disease in two patients; the third relapsed after completing therapy for Burkitt's lymphoma and is in second remission after chemotherapy, orchiectomy, and scrotal irradiation. The prolonged remissions seen in children with testicular involvement at diagnosis suggest that scrotal irradiation may not be necessary in chemosensitive disease. By contrast, testicular relapse on therapy appears to indicate drug-resistant disease and a poor prognosis, despite testicular irradiation and chemotherapy. PMID- 2666590 TI - Response to salvage therapy and survival after relapse in acute myelogenous leukemia. AB - The response to and survival following first salvage therapy regimens for 243 patients with acute myelogenous leukemia (AML) treated between 1974 and 1985 were evaluated. Eighty (33%) patients obtained a complete remission (CR), 24% died prior to achieving a response, and 43% were resistant on their first salvage regimen. The median survival was 18 weeks. Five percent overall and 16% of the CR patients are predicted to survive for more than 5 years. The factor most strongly associated with response and survival was the duration of the initial remission with 49 of 82 (60%) patients whose initial CR duration was at least 1 year in duration obtaining a second CR v 31 of 161 (19%) for patients with a shorter remission (P less than .01). Age, liver function, serum lactic dehydrogenase (LDH), karyotype, and the proportion of blasts plus promyelocytes present at the time of starting salvage therapy were strongly associated with probability of response and survival. Multivariate analysis was used to develop logistic regression and proportional hazard models to predict probability of response and survival, respectively. The major regimens used were conventional-dose cytarabine (ara-C) (combined with anthracyclines or amsacrine), high-dose ara-C, rubidazone, amsacrine (AMSA), other anthracyclines, and autologous or allogeneic transplant programs. After allowing for the prognostic factors in the models, specific treatment regimens were not strongly associated with prognosis. PMID- 2666591 TI - Simple nontoxic treatment of advanced metastatic seminoma with carboplatin. AB - Between 1982 and 1986, 34 patients with advanced metastatic seminoma were treated with four to six courses of single-agent carboplatin administered at 400 mg/m2 every 4 weeks either on an outpatient basis or during 24-hour admissions. Patients with raised serum alphafetoprotein (AFP) or with multiple (more than three) lung metastases were excluded since these features may indicate a nonseminomatous component. In this series 20 patients were previously untreated except for orchiectomy, and 14 patients had received prior radiotherapy restricted to infradiaphragmatic nodal areas. Treatment was extremely well tolerated. No patient suffered renal damage, neurotoxicity, or ototoxicity, and there were no episodes of neutropenic septicemia, thrombocytopenic hemorrhage, or bruising. The actuarial 2-year survival was 94% (95% confidence intervals, 83% to 100%) with follow-up of 12 to 46 months from completion of carboplatin (mean, 26 months). The actuarial chance of remaining alive and free from progressive disease at 2 years was 80% (95% confidence intervals, 66% to 94%). Of six patients who relapsed, five are currently in remission 9 to 18 months after completion of salvage treatment. This level of antitumor activity is equivalent to that seen with aggressive combination regimens. Single-agent carboplatin should be considered the treatment of choice for advanced stages of malignant seminoma when limitation of toxicity is considered important; however, the rarity, especially of extranodal metastases from seminoma, leads to the need for further investigation using this approach. PMID- 2666592 TI - Diffuse malignant mesothelioma of the pleura in Ontario and Quebec: a retrospective study of 332 patients. AB - Three-hundred thirty-two cases of pleural diffuse malignant mesothelioma (DMM) seen at large centers in Ontario and Quebec from 1965 to 1984 were reviewed retrospectively. Previous asbestos exposure was found in 44% of patients. Diagnosis was most often made by exploratory thoracotomy; pleural biopsy or cytology were rarely contributory. The delay in diagnosis was often long (median time, 3.5 months) and thrombocytosis (platelets greater than or equal to 400,000/microL) was common (41% of cases). The median survival (MS) was only 9 months. Eleven clinical variables were analyzed for prognostic significance. The three most important prognostic factors using a univariate analysis were stage, weight loss, and histologic type. For 118 patients with complete data, multivariate analysis showed that the stage of disease, high platelet count, and asbestos exposure were the most important prognostic factors. There was no cure of DMM, and we did not find any drastic differences in survival among groups of patients subjected to the different therapeutic measures. Radical surgery and radiotherapy were ineffective and we confirmed the low response rate to chemotherapeutic agents. This large retrospective trial can serve as a baseline for future studies in this field. In particular, it provides the basis for appropriate stratification variables to be used in future therapeutic trials. PMID- 2666594 TI - Serial lumbar and ventricular cerebrospinal fluid biochemical marker measurements in patients with leptomeningeal metastases from solid and hematological tumors. AB - This study presents results of investigations of lumbar and ventricular cerebrospinal fluid (CSF) biochemical markers (Beta-glucuronidase (B-gluc), Beta 2-microglobulin (B2-m), and carcinoembrionic antigen (CEA] in 28 patients with five different tumor types with leptomeningeal metastasis diagnosed by CSF cytology and/or autopsy. All received methotrexate and radiotherapy at some stage. Decadron or other symptomatic treatments were not used. Measurements of the concentrations of B-gluc, B2-m and CEA were evaluated with the aim of correlating the results of these measurements to site of disease, of monitoring response and early relapse of leptomeningeal disease, and of establishing the duration of survival. In almost all our patients the results of ventricular CSF B gluc, B2-m and CEA measurements were lower than those obtained from lumbar CSF. The markers did not correlate with site of disease or CSF cytology. A clear relationship was found between pretreatment lumbar CSF B2-m and CEA levels, response to therapy and survival. The markers are also useful for monitoring response. The findings of this study indicate that B2-m and CEA levels have a prognostic value with regard to response to therapy and time of survival. PMID- 2666595 TI - The role of the skin in nosocomial infection: a review. AB - This paper reviews the role that skin plays in nosocomial infection. Skin is heavily colonised with a variety of commensal and potentially pathogenic bacteria and poses an important source of hospital acquired infection. Several outbreaks of skin infection are described in which the source and route of infection have been identified. Some of the factors implicated in the survival and dispersal of skin pathogens are described. PMID- 2666593 TI - The potential role of lonidamine (LND) in the treatment of malignant glioma. Phase II study. AB - Up-to-date unsatisfactory results obtained in multimodality treatments of malignant glioma have prompted the research of new therapeutic modalities with 'unconventional' modes of action. Lonidamine (LND) is a drug which reduces aerobic glycolytic activity in both human and experimental tumors. This effect mainly depends on the inhibition of mitochondrially-bound hexokinase (HK) which is present in large amounts in malignant cells. A Phase II study was conducted on patients with recurrent glioma; 12 patients were admitted to the study. Clinical side effects were moderate, necessitating a reduction of the dosage in only 1 case. The objective results were evaluated according to the indications of Levin. 2 responders and 3 cases of stable disease were observed out of 10 evaluable patients. The potential value of this new drug is discussed. PMID- 2666596 TI - Effect of PEEP on regional ventilation and perfusion in the mechanically ventilated preterm lamb. AB - Improvement of gas exchange through closer matching of regional ventilation (V) and lung perfusion (Q) with the application of positive end-expiratory pressure (PEEP) was evaluated in vivo in six mechanically ventilated preterm lambs (107 126 days/145 days gestation). Changes in V and Q were determined from in vivo scintigraphic measurements in four lung regions with inhaled radioactive 81mKr, and infused 81mKr/dextrose and/or [99mTc]MAA as PEEP was applied at 2, 4, and 6 cm H2O in each animal. Dynamic compliance varied between 0.02 and 0.40 ml/cm H2O, which was consistent with surfactant deficiency. As PEEP was increased, the regional distribution of Q shifted from the rostral to the caudal lung regions (p less than 0.02 to less than 0.05), while that of V remained unchanged. Regional V/Q matching improved together with a trend towards improvement of arterial blood gases as PEEP was increased from 2 to 4 cm H2O. Pulmonary scintigraphy offers a noninvasive methodology for the quantitative assessment of regional V and Q matching in preterm lambs and may be clinically applicable to ventilated neonates. PMID- 2666597 TI - Klebsiella pneumoniae osteomyelitis: demonstration by three-phase radionuclide bone imaging. AB - The Klebsiella pneumoniae bacillus is a rare cause of acute hematogenous osteomyelitis of long bones. Bony involvement usually develops from a bacteremia associated with a Klebsiella pulmonary or urinary tract infection. Diabetes mellitus, alcoholism, or cirrhosis are predisposing conditions to the development of this form of osteomyelitis. A case report follows in which two sites of Klebsiella osteomyelitis were demonstrated by three-phase bone imaging in a patient with both diabetes and alcoholism. PMID- 2666598 TI - Cationic complexes of technetium for myocardial imaging. AB - Over the past 15 years a major goal of research in cardiovascular nuclear medicine has been the development of 99mTc complexes that could replace 201Tl and thus enhance the utility of myocardial perfusion imaging. This paper presents an overview of the current state-of-art of the development of cationic 99mTc complexes for this purpose. Cationic 99mTc complexes that have been evaluated as myocardial perfusion imaging agents in human volunteers and/or animals are discussed and classified on the basis of the oxidation state of the technetium center. PMID- 2666599 TI - Captopril test in screening hypertensive patients. PMID- 2666600 TI - Recent developments in trace element metabolism and function: newer roles of selenium in nutrition. AB - Until recently, studies of the function of selenium focused on the selenoenzyme, glutathione peroxidase. However, the recognition that several metabolic effects of selenium are not associated with glutathione peroxidase has forced a re evaluation of the function of this enzyme and the element. Hepatic glutathione peroxidase contains a significant percentage of the regulated selenium in the rat and is more sensitive to selenium deficiency than other selenoproteins. Thus, in addition to its enzymatic activity, it might have a storage function for the element. Another selenoprotein, designated selenoprotein P, has been found in rat plasma and has been quantitated. Its function is not yet known, but it has been postulated to be a transport protein for selenium and a defense against oxidant stress. Understanding the nutritional effects of selenium will require better characterization of glutathione peroxidase, selenoprotein P and other selenoproteins. PMID- 2666601 TI - Recent developments in trace element metabolism and function: trace elements, disease resistance and immune responsiveness in ruminants. AB - Evidence for the influence of trace elements on disease resistance in ruminants is reviewed with emphasis on susceptibility to infection in vivo during the more common deficiencies (copper, selenium and cobalt). Copper deficiency associated with increases in pasture molybdenum increased the susceptibility of lambs to microbial infections. Under experimental conditions, dietary molybdenum decreased the establishment of abomasal and intestinal nematodes but not their pathogenicity to lambs. Molybdenum may enhance inflammatory responses leading to parasite rejection by the host. Decreased incidence of metritis in selenium treated dairy cows provides a rare example of an association between selenium deficiency and decreased disease resistance. Improved antibody responses following selenium administration have also been found in sheep. Cobalt deficiency has reduced lamb survival and increased susceptibility to parasitic infection transiently in cattle and lastingly in sheep. In copper-, selenium- or cobalt-deficient sheep and cattle, there are many reports of impaired leucocyte and lymphocyte responses to in vitro challenges, but their relevance to disease resistance in vivo is unproven. Disease resistance may have priority for limited micronutrient supplies, leaving other processes vulnerable. PMID- 2666602 TI - Recent developments in trace element metabolism and function: role of metallothionein in copper and zinc metabolism. AB - Metallothionein is a copper- and zinc-binding protein present in most, if not all, tissues of higher eukaryotic species of animals. This review focuses on what is currently known about the characteristics, detection, occurrence, synthesis and turnover of metallothionein, specifically in livestock animals. The function of metallothionein in copper and zinc metabolism, though widely acknowledged, remains controversial. Current evidence in support of a role in the detoxification as well as in the homeostasis of copper and zinc is presented, along with a proposed model summarizing the involvement of metallothionein in basic cellular metabolism of copper and zinc. Also discussed are potential implications of metallothionein in animal agriculture. PMID- 2666603 TI - The future direction of nutrition research: "And a little cell (child) shall lead them". PMID- 2666604 TI - Molecular biology and nutrition research. AB - The important advances that have occurred in molecular and cell biology have great potential for metabolic and nutritional research. This review will focus on the application of genetic manipulation to metabolism and nutrition, with special emphasis on the tissue-specific expression and regulation of the newly introduced genes. PMID- 2666606 TI - Renin inhibitors: present and future. Satellite symposium of the 12th scientific meeting of the International Society of Hypertension. 28 May 1988, Osaka, Japan. PMID- 2666605 TI - Role of vitamin A degradation in the control of hepatic levels in the rat. AB - The relationship between excess vitamin A intake and accumulation in various tissues, including the liver, was studied in rats fed for 45 d four levels of vitamin A: 1, 6, 30 and 100 IU/kcal. As vitamin A intake increased, progressively smaller fractions of the administered vitamin A were recovered in tissue. The decrease in fractional recovery in the tissues examined was calculated from the differences between intake, tissue level and excretion, and was found to increase after administration of high vitamin A diets. This could be explained, at least in part, on the basis of an enhanced rate of vitamin A degradation as a function of the increased concentration of retinol in the liver. At high tissue retinol concentrations, calculated rates of retinol metabolism via the hepatic cytosolic retinol dehydrogenase (EC 1.1.1.1) and the recently discovered microsomal retinol dehydrogenase and oxidase vastly exceeded the decrease in fractional recovery of vitamin A accumulation in the tissues. This calculated rise in metabolic rate was verified by a corresponding increase in urinary polar metabolites derived from labeled retinol. Thus, accelerated catabolism as a function of increased hepatic vitamin A concentration may provide a homeostatic mechanism which offsets in part excessive vitamin A accumulation. PMID- 2666607 TI - Pharmacology of novel imidazole alcohol inhibitors of primate renin. AB - SQ 30,774 and SQ 31,844 are representatives of a novel class of renin inhibitors, the imidazole alcohols. These compounds, which contain an imidazole ring as part of their active site binding group are potent in vitro inhibitors of primate renin, but not rat, hog of dog renin. In conscious, sodium-depleted cynomolgus monkeys both compounds produced a dose-related inhibition of plasma renin activity (PRA) at doses ranging between 0.001 and 1.0 mumol/kg, intravenously, and total inhibition was observed after the highest dose. However, a reduction in blood pressure was observed only after an intravenous dose of 10 mumol/kg or when the compounds were administered by infusion. In sodium-replete monkeys, SQ 30,774 inhibited the rise in arterial pressure and PRA following administration of exogenous monkey renin. When the compounds were administered orally at 50 mumol/kg, only SQ 31,844 significantly inhibited PRA (80%). It is concluded that representatives of the imidazole alcohol class of renin inhibitors are potent inhibitors of renin in vitro and inhibit PRA and lower arterial pressure in vivo. PMID- 2666608 TI - Renin inhibitory peptides: a study of structural modifications in the peptide backbone. AB - We studied the peptide backbone modifications that improve the metabolic stability of the resulting peptides and yet retain high inhibitory activity against human plasma renin. A systematic investigation of N-alpha-methyl and C alpha-methyl modifications at the P2 and P3 sites of renin-inhibitory peptides that contain part of the human angiotensinogen sequence led to the discovery of N alpha-methyl amino acids at the P2 site as a useful structural modification. U 71,038 (11) inhibited human plasma renin with an in vitro potency (IC50) of 2.6 x 10(-10) mol/l. It is highly selective for renin and, as anticipated, resistant to proteolytic degradation. Additional study based on molecular graphic modelling has led us to propose a gamma-lactam conformational constraint at the P2-P3 site. This pseudo-dipeptide has proved useful in the preparation of active renin inhibitors. Compound 18a inhibited human plasma renin with an in vitro potency (IC50) of 2.1 x 10(-9) mol/l. This class of compounds also offers structural features for the study of enzyme-bound conformers. PMID- 2666609 TI - An orally active renin inhibitor: cyclohexylnorstatine-containing dipeptide (KRI 1314). AB - In our continuing search for low molecular weight, human renin inhibitors, a dipeptide derivative, morpholino-naphthyl-acyl-histidyl-cyclohexyl-norstatine (KRI-1314), was newly synthesized and estimated for oral effectiveness. This compound inhibited plasma renin from humans and from Japanese monkeys in vitro, with 50% inhibitory concentrations (IC50) of 4.7 x 10(-9) and 2.4 x 10(-8) mol/l, respectively. The mean blood pressure of sodium-depleted Japanese monkeys was lowered significantly after intravenous injection or oral administration of KRI 1314. The maximum reduction was attained 3 h after oral administration at a dose of 10 mg/kg. Plasma renin activity (PRA) was halved 1 h after oral administration of KRI-1314, and this inhibition persisted for more than 5 h. results suggest that KRI-1314, a potent, orally effective and long-lasting renin inhibitor, may become one of a new class of antihypertensive agent. PMID- 2666610 TI - Effects of renin inhibitors on the expression of kidney renin gene and tissue renin-like activity. AB - The effect of renin inhibitor ES-1005 on renin gene expression was investigated in sodium-depleted marmosets. The kidneys were removed after continuous infusion of ES-1005 (12 mg/kg per h) for 2 h. The relative amount of kidney renin messenger (m)RNA was measured by densitometric Northern blot analysis using an alpha-32P-labelled human renin complementary (c)DNA fragment as a hybridization probe. Plasma renin activity was completely inhibited by ES-1005. The level of kidney renin mRNA decreased significantly to about one-third of the normal control value. We also investigated the inhibitory potency of the renin inhibitor ES-6864 on the renin-like activity in dog tissues (adrenal glands, aorta and brainstem). ES-6864 inhibited the tissue renin-like activity with an IC50 of 10( 7) to 10(-8) mol/l in vitro. Renin inhibitors not only inhibit the activity of plasma and tissue renin, but also suppress the synthesis of renin in the kidney. PMID- 2666611 TI - Structure and function of renin. AB - Purification and determination of the primary structure of renin laid the foundation for determining the complete structure and function. Identification of the functional groups in the active site and demonstration of the sequence homology of renin and aspartyl proteins have been the most important steps to date in characterizing the general properties of renin. The demonstration of a long subsite structure in the active site of renin and other aspartyl proteases was another important step. The lack of immuno-crossreactivity and substrate specificity between human and non-primate renin suggests that the active site of human renin is unique. This has been clearly demonstrated by the synthesis of an inhibitor peptide specific for human renin. PMID- 2666612 TI - Effects of a renin inhibitor, SR 43845, and of captopril on blood pressure and plasma active renin in conscious sodium-replete macaca. AB - The effects of the renin inhibitor, SR 43845 (IC50 = 10(-11) mol/l human and primate plasma renin) and of the angiotensin converting enzyme (ACE) inhibitor captopril on blood pressure and plasma active renin were investigated in conscious, chronically instrumented, sodium-replete macaca (cynomolgus monkeys). Perfusion of SR 43845 at 0.33, 3.3, 33, 100 and 200 micrograms/kg per min for 30 min elicited a dose-related decrease in blood pressure with a notable effect on plasma renin activity (PRA; 90% inhibition), beginning at a dose of 0.33 micrograms/kg per min. The maximal reduction in blood pressure of 22 +/- 2 mmHg (from 110 +/- 5 mmHg) was achieved at 100 micrograms/kg per min and a higher dose (200 micrograms/kg per min) induced no further reduction. Plasma levels of active renin were also significantly increased (to 104%, from 102 +/- 14 pg/ml) at the lower dose. Captopril, tested at 33 micrograms/kg per min under the same experimental conditions, lowered blood pressure in a similar manner and with the same intensity as the renin inhibitor at an equal dose (by 14 +/- 1 mmHg, from 114 +/- 4 mmHg). However, a dose six times as high only influenced the decrease of blood pressure slightly (by 16 +/- 2 mmHg, from 103 +/- 5 mmHg). For the same hypotensive effect, the plasma renin concentration was significantly higher with the renin than with the ACE inhibitor. The recovery of pre-infusion blood pressure was both time- and dose-dependent, the basal value being almost restored after 5 h with both inhibitors, although the initial plasma renin levels were not completely recovered. A comparison of the maximal hypotensive effects and the plasma active renin concentrations elicited by the renin and the ACE inhibitors suggests that there are no major differences between the two types of inhibition and that renin inhibition is slightly more efficient. PMID- 2666613 TI - Systemic and renal haemodynamic effects of renin or angiotensin converting enzyme inhibition in non-human primates. AB - The cardiovascular actions of a renin inhibitor, U-71038 (Boc-Pro-Phe-N-MeHis-Leu psi [CHOHCH2]Val-Ile-Amp), and of an angiotensin converting enzyme (ACE) inhibitor, captopril, were determined in conscious sodium-depleted cynomolgus monkeys. Cardiac output was measured with a thermodilution technique. The hypotension induced by U-71038 was associated with a significant reduction in total peripheral resistance without alteration in cardiac output or the heart rate. A similar reduction in total peripheral resistance was observed after captopril at a dose which caused hypotension equivalent to that elicited by U 71038. The latter effects were not accompanied by significant alterations in cardiac output or the heart rate. The glomerular filtration rate was measured by the plasma disappearance of 125I-sodium iothalamate. Renin or ACE inhibition adequate to cause equivalent hypotensive responses did not change the glomerular filtration rate to a significantly different degree. The systemic and renal haemodynamic profiles of U-71038 and captopril appear to be similar, suggesting that renin and ACE inhibition elicit fundamentally similar cardiovascular effects in conscious sodium-depleted cynomolgus monkeys via a decreased formation of angiotensin II (Ang II). PMID- 2666614 TI - Characteristics of the blood pressure lowering action of renin inhibition and comparison with angiotensin converting enzyme inhibition. AB - Mean arterial blood pressure (MAP) was 100 +/- 4 mmHg in a group (n = 3) of conscious sodium-deficient dogs. A 3-day infusion of the renin inhibitor isovaleryl -His-Pro-Phe-His-Sta-Leu-Phe-NH2 (SCRIP) lowered MAP to an average of 79 +/- 4 mmHg. Termination of the infusion resulted in a prompt rise in MAP to 100 +/- 5 mmHg but plasma renin activity (PRA), which was 22 +/- 2 ng angiotensin (Ang) l/ml per h before the infusion, recovered only to 5 +/- 1 ng Ang l/ml per h during the same time (4 h after infusion). In other experiments in sodium deficient dogs, a direct comparison was made between inhibition of PRA and the reduction of blood pressure. Over the dose range 0.1-2 micrograms/kg per min, PRA was inhibited in a dose-related manner, but MAP was not reduced. At dose levels beginning an order of magnitude higher (e.g. 20-160 g/kg per min), PRA was completely inhibited and there was a dose-related fall in MAP. These data suggest that there is no correlation between inhibition of PRA and the reduction in blood pressure in chronically sodium-deficient dogs. In other studies comparing renin inhibition with angiotensin converting enzyme (ACE) inhibition, there was evidence for greater efficacy of ACE inhibition in conscious sodium-deficient dogs, but no evidence of any difference in one-kidney, one clip hypertensive dogs. PMID- 2666615 TI - Effects of the renin inhibitor H77 on angiotensin II, arterial pressure and cardiac function in conscious dogs: comparison with captopril. AB - The renin inhibitor H77 and the angiotensin I converting enzyme (ACE) inhibitor captopril were compared in separate experiments with infusion of 5% dextrose as a control for the effects on plasma angiotensin II (Ang II) concentration, arterial pressure and cardiac function, measured by Swan-Ganz catheter, in conscious dogs. The effects of a high dose of H77 (10 mg/kg per h) were similar to those of high dose captopril (6 mg/kg per h). Both reduced plasma Ang II concentration, systemic vascular resistance and arterial pressure; both increased the heart rate; both increased cardiac output but the change was significant only with captopril; neither affected stroke volume, pulmonary artery pressure or pulmonary vascular resistance; both reduced left and right atrial pressures. The similar pattern of effects for the two inhibitors suggests that the mechanism by which they act is the same--reduction in Ang II--and that the cardiovascular effects of H77 are not a specific action of the peptide that is unrelated to the reduction in plasma Ang II concentrations. PMID- 2666616 TI - Immunological approach to blockade of the renin-substrate reaction. AB - To block the renin-substrate reaction by immunological tools is a long-standing dream. Since 1951 active immunization and the passive transfer of antirenin antisera have been successfully carried out in different species and in different experimental models of hypertension and normotension. These studies indicated that renin is a powerful immunogenic protein, capable of breaking down self tolerance in different species. In this initial period the most significant results were obtained with hog renin. Passive transfer of antisera raised against hog renin or active immunization with hog renin was able to decrease blood pressure in renovascular or essential hypertension in dogs. Renin was semipurified and injected without adjuvant, however, since there was no method for determining plasma renin activity. Recently, complete purification of murine and human renin has allowed an extension of this approach, using the passive transfer of antirenin polyclonal antisera or monoclonal antibodies. Active immunization against pure human renin was successful in normotensive marmosets. This immunization with a nearly homologous renin in a primate model induced a significant decrease in blood pressure, associated with a complete disappearance of plasma renin activity. Unfortunately this powerful immunization was associated with an autoimmune disease that is specific for the kidney, related to self recognition of the production site of renin by antibodies and lymphocytes. Similar results were reported with the use of mouse submandibular gland renin as an immunogen in spontaneously hypertensive rats (SHR). This manipulation decreased blood pressure in SHR to a level near that of normotensive Wistar-Kyoto control rats. However, again the animals showed a severe autoimmune disease of the kidney.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 2666617 TI - Synthetic peptide inhibitors of prorenin activation. AB - In studying potential inhibitors of prorenin activation, we synthesized stereoisomers of a nonapeptide which spans the putative prorenin cleavage site. Peptide 67 has a D-Leu substitution on the amino side of the sessile bond and peptide 68 has a D-Arg substitution on the carboxy side. Both peptides equally inhibited human urinary kallikrein activity with an IC50 of 5 x 10(-4) mol/l. However, peptide 67 inhibited tryptic prorenin activation more effectively, with an IC50 of 5 x 10(-3) mol/l, than did peptide 68 with an IC50 of 10(-2) mol/l. Although the inhibitory properties of these peptides are weak, our data suggest that peptide analogue inhibitors of prorenin activation can be developed, and that prorenin activating enzyme(s) may be another potential target of renin angiotensin inhibition. PMID- 2666618 TI - Angiotensin converting enzyme inhibition and renin inhibition. AB - Over a period of several years, methods of measuring circulating angiotensin II have been progressively improved and it has now become possible to measure circulating angiotensin II with a high degree of accuracy. The main ingredients in this new methodology are bonded-phase silica for quantitative angiotensin extraction from biological fluids and antibodies with a high affinity to angiotensin II to provide for the sensitivity of the radio-immunoassay, high performance liquid chromatography to guarantee the specificity for the angiotensin-(1-8)octapeptide, and a renin inhibitor in the blood sampling tube to prevent any in vitro angiotensin II generation. With this new methodology it can be demonstrated that after the first administration of a full dose of an angiotensin converting enzyme (ACE) inhibitor, plasma angiotensin II virtually disappears from the circulation, whereas with chronic administration which induces a marked increase in renin secretion and thereby in angiotensin I levels, angiotensin II clearly remains present in plasma at peak inhibition, though at a much lower level than before ACE inhibition. Plasma angiotensin II levels were decreased equally and dose-dependently by the administration of two renin inhibitors, CGP 38560A and A64662. However, in man these compounds have so far only been tested with single administration. In conclusion, the measurement of plasma angiotensin II equally reflects the degree of ACE and renin inhibition, and is therefore the only logical approach to evaluation of the efficacy and potency of ACE inhibitors and renin antagonists. PMID- 2666619 TI - Why renin inhibitors? AB - Angiotensin converting enzyme inhibitors are widely used in the treatment of hypertension and congestive heart failure. They are potent drugs and have few side effects. The search for potent and orally absorbable agents that either block the angiotensin II receptor or inhibit the catalytic action of renin has not been so successful. This paper reviews present efforts to develop renin inhibitors. Most of the work has been based on the design of peptide analogues of angiotensinogen, many of which contain the unusual amino acid statine (or one of its variants) in place of the scissile bond (the peptide bond that renin cleaves in angiotensinogen). Substitutions at other sites in the molecule determine potency and species selectivity; for example, substitutions at the carboxyl terminus permit the construction of potent renin inhibitors that contain fewer amino acid residues. Peptide analogues of the prorenin segment of the enzyme, however, are but weak inhibitors and show little promise. Progress has also been slow in efforts to understand the principles required in the synthesis of potent renin inhibitors with significant bioavailability after oral administration. Finally, the question of whether renin inhibitors will offer a clinical advantage over converting enzyme inhibitors has not been answered. PMID- 2666620 TI - Human renin protein and gene structures: present and future targets for renin blockade in treatment of hypertension. AB - The cloning of the gene for human renin has permitted remarkable advances to be made in understanding the structure of this aspartyl protease. From computer models and the determination of the actual co-ordinates of expressed recombinant human renin at 3 nm, a considerable amount of information has emerged concerning the molecular mechanism of renin activity, thus permitting the logical design and analysis of renin inhibitors suitable for use in antihypertensive medication. In addition, many of the properties of renin can now be explained in molecular terms, including the species specificity of its reaction with angiotensinogen. From the production of renin inhibitors, the next avenue of research is likely to be the design of drugs that will reduce the activity of the human renin gene and thereby curtail renin production. This may involve a 'new pharmacology' based on transacting factors. Thus cloning of the renin gene has led to elucidation of the tertiary structure of human renin for inhibitor design, and will similarly permit studies of gene-regulatory factors that may be future targets for blockade of the renin system in antihypertensive therapy. PMID- 2666621 TI - AIDS: current implications and impact on nursing. AB - The pandemic proportions of human immunodeficiency virus (HIV) have already begun impacting health care in the United States. It is safe to say that in the near future nursing will have to formulate an aggressive response to this situation. This article addresses the origins of HIV and the resulting acquired immunodeficiency syndrome (AIDS) and discusses the impact on nursing. It also suggests ways in which nursing as a profession can respond to the epidemic of HIV and the fear which surrounds it. PMID- 2666622 TI - Intractable pain management with intravenous narcotic administration at home. AB - Administration of intravenous narcotics in a patient's home is a relatively new therapeutic method of controlling excruciating cancer-related pain. As with any new therapy, there are many questions and concerns related to administration and management. This article presents information derived from a literature review designed to improve understanding and technique. PMID- 2666623 TI - Sickle cell anemia: an i.v. nursing challenge. AB - Patients with sickle cell anemia present a true challenge to an I.V. nurse's skill, but what is the reason for their difficult venous access? Is it the disease, its treatment, or both? The author will attempt to arrive at an answer to this perplexing situation. A review of the disease itself, the genetics involved, the pathophysiology, treatment modalities in the most frequently seen manifestations, and some possible answers to the problem are addressed. PMID- 2666624 TI - Pemphigoid gestationis: a unique mechanism of initiation of an autoimmune response by MHC class II molecules? PMID- 2666625 TI - Hypocholesterolemia in childhood. PMID- 2666626 TI - Congenital malformations and psychosocial development in children conceived by in vitro fertilization. AB - To determine whether in vitro fertilization (IVF) as a method of conception is associated with an increased risk for congenital malformations or developmental dysfunction, we performed a general physical examination for malformations, neurologic examination, developmental examination (Bayley Scales), echocardiography, electrocardiography, abdominal ultrasound study, and, when possible, cranial ultrasound examination on a cohort of 83 IVF children and 93 matched non-IVF children. Major malformations were found in two IVF and one non IVF subject; the rates were not significantly different. The mean Mental Development Index scores for IVF subjects and the comparison group were 115 +/- 13 and 111 +/- 13, respectively (p = 0.12). The mean Psychomotor Development Index scores were 114 +/- 14 and 108 +/- 15 (p = 0.04). Based on these small numbers but extensive evaluation, we found no association between conception by IVF and an increased risk for congenital malformations. Likewise, children conceived by IVF showed no evidence of developmental delay. Their high average achievement on the Bayley tests probably resulted from the exceptional motivation of their parents ("wantedness") and their generally high socioeconomic status. PMID- 2666627 TI - Sjogren-Larsson syndrome: inherited defect in the fatty alcohol cycle. AB - We investigated fatty alcohol metabolism in eight patients with Sjogren-Larsson syndrome, and in nine obligate heterozygotes. Fatty alcohol: nicotinamide-adenine dinucleotide oxidoreductase (FAO) activity was deficient in cultured skin fibroblasts (mean 18% of normal, n = 8) and peripheral blood leukocytes (mean 22% of normal, n = 3) from patients with Sjogren-Larsson syndrome. The palmitoyl coenzyme A-inhibitable component of FAO activity was decreased to 10% and 15% of normal in fibroblasts and leukocytes, respectively, of patients with Sjogren Larsson syndrome. Most affected patients accumulated long-chain fatty alcohol in plasma, with a greater relative accumulation of octadecanol (mean threefold greater than normal) than hexadecanol (mean twofold greater than normal). Erythrocyte lipid alkyl ether linkages derived from hexadecanol were slightly increased in three of four patients. Fibroblasts and leukocytes from heterozygotes with Sjogren-Larsson syndrome showed mean FAO activities that were intermediate between those seen in homozygotes and in normal control subjects. The heterozygotes had normal fatty alcohol concentrations in plasma. These studies demonstrate FAO deficiency in patients with Sjogren-Larsson syndrome, and suggest that accumulation of fatty alcohol or its metabolic products may be important in the pathogenesis of this disorder. PMID- 2666628 TI - Favorable outcome of neonatal aortic thrombosis and renovascular hypertension. AB - Fifteen children with renovascular hypertension as a result of aortic thrombosis were followed for a mean of 26 months (range 5 to 58 months) to determine outcome. As neonates, all patients had hypertension and elevated plasma renin activity. Of 11 patients studied with radionuclide renography and scintigraphy, 10 had abnormal renal blood flow; three had complete absence of unilateral perfusion. On follow-up examination all children were normotensive; five children ages 5 to 24 months required antihypertensive medication. Of 15 children, 14 had normal statural growth; all had normal serum creatinine, plasma renin activity, and calculated glomerular filtration rate values. Patients with complete absence of renal perfusion unilaterally remained functionally anephric; children with less severe perfusion deficits had improved perfusion as shown by radionuclide renography and scintigraphy. We believe that many patients with aortic thrombosis and renovascular hypertension who have had aggressive antihypertensive therapy in the neonatal period will have good renal function and increased perfusion to the affected kidney 2 years later. PMID- 2666629 TI - Relationships among life stress, perceived family environment, and the psychological distress of spina bifida adolescents. AB - Fifty-three teen-agers with spina bifida participated in a mail survey and completed measures of recent life events, perceived family environment, and psychological distress. Low levels of perceived family conflict and control served as life stress buffers in the prediction of distress, whereas a high level of perceived independence served as a life stress exacerbator. These interaction effects differ from those obtained for a normal sample of adolescents in the lone previous study (Burt, Cohen, & Bjorck, 1988) that reported comparable analyses. The results suggest that the process by which family environments moderate stress adjustment differs for able-bodied vs. spina bifida adolescents. PMID- 2666630 TI - Family context in pediatric psychology: a transactional perspective. AB - The degree to which the family is seen as a significant contributor to child health conditions impacts directly on the successful functioning of the pediatric psychologist. A transactional model of family functioning is proposed for pediatric psychology. Development is considered to be the result of a three-part process that starts with child behavior that triggers family interpretation that produces a parental response. Family interpretation is presented as part of a regulatory system that includes family paradigms, family stories, and family rituals. Corresponding to the proposed three-part regulation model, three forms of intervention are discussed: remediation, redefinition, and reeducation. Clinical decision making based on this model is outlined with examples given from different treatment approaches. Implications for the treatment of families in pediatric psychology are discussed. PMID- 2666631 TI - Inhibitory effect of a new mycotic agent, piritetrate on ergosterol biosynthesis in pathogenic fungi. AB - A new antimycotic agent piritetrate, a thiocarbamate derivative, was found to interfere with fungal sterol biosynthesis. Sterol biosynthesis was measured by means of incorporation of radioactivity from [14C]acetate into individual sterol fractions and their precursor compounds extracted from cells of Candida albicans, Cryptococcus neoformans, and Trichophyton mentagrophytes. Piritetrate was a much more potent inhibitor of fungal squalene epoxidation than a related drug, naphthiomate. The greater antifungal efficacy of the former was reflected in its greater inhibitory action on sterol biosynthesis than the latter. Such inhibitory effects were also demonstrated in in vitro labelling experiments with [14C]mevalonate on the S10 fraction (10,000 g supernatant of homogenate) of C. albicans cells. At 5 x 10(-7) M concentration, piritetrate gave almost 90% inhibition of ergosterol biosynthesis in the S10 fraction of C. albicans cells. Furthermore, this agent was highly specific for fungal enzymes involved in ergosterol biosynthesis, with no detectable effects on mammalian cholesterol biosynthesis in rat liver at the therapeutic concentration. PMID- 2666632 TI - Invasive aspergillosis: clinical and pathological features of a new animal model. AB - A new animal model of invasive aspergillosis is described in which female New Zealand White rabbits were immunosuppressed with corticosteroids and cyclophosphamide and were given an intratracheal inoculation of 4 x 10(4) conidia of Aspergillus fumigatus. Thirteen of 15 animals survived during a 10-day-period of observation. Most had clinical signs of a respiratory infection (dyspnoea) and at autopsy there was macroscopic and microscopic evidence of invasive pulmonary aspergillosis. Six control animals (infected but not immunosuppressed) showed no such signs. The extent of hyphal invasion was assessed histologically and quantified by calculating the number of colony forming units (c.f.u.) g-1 of tissue: in the experimental group the mean c.f.u. value for the lungs was 1.25 x 10(3) compared to 73.3 c.f.u. g-1 of lung for the control group (P = 0.003). The infection was also quantified by a whole lung chitin assay: in the experimental group the mean chitin content (expressed as a glucosamine equivalent) was 3.05 micrograms g-1 lung tissue compared to a 0.53 micrograms g-1 lung tissue for the control group (P = 0.01). We conclude that this model of invasive aspergillosis in rabbits reflects closely the pathological features of the disease in man and that it may prove useful for studies of the pathogenesis and the treatment of invasive aspergillosis. PMID- 2666633 TI - Systemic candidosis in beige mice. AB - Systemic spread of Candida albicans after intravenous inoculation was compared in beige mice and their functionally normal littermates. The number of colony forming units (c.f.u.) recovered from the kidneys, livers, and spleens of beige mice was substantially greater (100 to 1000-fold) than the number cultured from the respective organs of their functionally normal littermates. Pre-treatment with silica did not alter the number of c.f.u. recovered from the organs of either beige mice or their normal littermates. These results are consistent with the hypothesis that normally functioning polymorphonuclear leukocytes are crucial to the innate defenses that control the proliferation of this fungus. PMID- 2666634 TI - Vaginal eosinophils and IgE antibodies to Candida albicans in women with recurrent vaginitis. AB - Eosinophils were identified in 31 of 121 (25.6%) vaginal smears obtained from women with recurrent vaginitis. The presence of eosinophils correlated (p less than 0.005) with the occurrence of IgE antibodies to Candida albicans in vaginal fluid. Localized allergic responses to C. albicans or other allergens may contribute to the pathogenesis of recurrent vaginitis in sensitized women. PMID- 2666635 TI - Fetal diaphragmatic hernia: ultrasound diagnosis and clinical outcome in 38 cases. AB - A previously published survey has evaluated the natural history and clinical outcome of fetal diaphragmatic hernia (CDH) in 94 cases. This study showed that the prenatal diagnosis is accurate, the mortality is high (80%), and polyhydramnios is a prenatal predictor of poor clinical outcome. As a follow-up study, 38 consecutive cases of CDH diagnosed in utero were evaluated and treated by the same surgical team. This permitted detailed assessment of prognostic factors and evaluation of the impact of extracorporeal membrane oxygenation (ECMO) on outcome. We found the following. (1) Survival is poor despite optimal postnatal therapy including ECMO. (2) Polyhydramnios is both a common prenatal marker for CDH (present in 69% of fetuses) and a predictor for poor clinical outcome (only 18% survival), but tends to occur after the second trimester. (3) Amniocentesis is indicated to rule out chromosomal abnormalities that were present in 16% of fetuses. (4) All 14 fetuses diagnosed prior to 25 weeks' gestation died. Improved postnatal therapy or surgical intervention before birth will be necessary to salvage the CDH fetus with an early gestational diagnosis or associated polyhydramnios. PMID- 2666636 TI - Accuracy of diagnostic imaging as determined by delayed operative intervention for advanced neuroblastoma. AB - Current treatment of newly diagnosed widespread neuroblastoma may include chemotherapy, delayed surgical resection, marrow ablative chemoradiotherapy, and bone marrow transplantation. Diagnostic imaging (DI) with computerized tomography (CT) or magnetic resonance imaging (MRI) has been used to determine response to therapy and timing of delayed resection. We assessed the accuracy of DI in 25 patients (26 total cases) treated over 21 months. Tumor size and location were estimated prior to surgical resection by DI, and the sensitivity and specificity of these studies were determined from operative findings. DI consisted of CT (15), MRI (8), and MRI and CT (3). Discordance between DI and operative findings was found in ten patients (38%). This included three errors of sensitivity (12%), including two false-positives and one false-negative. Seven errors of specificity were noted; they included a positive scan with no viable tumor identified (3), much more extensive disease (3), or less extensive disease (1). Viable tumor was identified in 18 cases, and in 11 patients, complete resection of macroscopic tumor at the primary site was carried out. Ten of 13 patients operated on within 5 months of beginning chemotherapy were rendered grossly free of neuroblastoma at the primary site after surgery. Eight of 12 patients operated on 6 months or longer after starting chemotherapy were rendered grossly free of tumor at the primary site. Bone marrow transplantation was performed in 21 patients, ten of whom are alive with a median follow up of 20 months. Survival was similar for patients who underwent surgical resection at less than or equal to 5 v greater than 6 months after starting chemotherapy.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 2666637 TI - Androgenic-anabolic steroid use in adolescents. AB - Use of androgenic-anabolic steroids is increasing in the adolescent population. Information necessary for the health care professional to deal effectively with this problem is reviewed. Clinical effects, both positive and negative, as well as methods for recognition of the androgen-anabolic steroid user, are presented. Discussion of various forms of intervention is included. PMID- 2666638 TI - Development of antiviral drugs for the treatment of AIDS: strategies and prospects. AB - This review makes it clear that there are numerous possibilities for the development of antiviral drugs for the treatment of AIDS. Drug design based on a profound understanding of specific enzymatic regulatory proteins and structural requirements for virus replication is possible. Information regulating these specific processes is increasing rapidly and will further speed preclinical drug design. Over time, this concerted effort to develop anti-AIDS drugs will radically alter the approach to the design of drugs for the treatment of other diseases. PMID- 2666639 TI - AIDS drug discovery and development. PMID- 2666640 TI - Zidovudine-induced fever. AB - Zidovudine (3'-azido-3'deoxythymidine, AZT, Retrovir) is the first antiretroviral drug to demonstrate clinical efficacy for symptomatic human immunodeficiency virus infection. In a large, placebo-controlled trial, nausea and hematologic toxicity, but not fever, occurred more frequently in zidovudine- than in placebo treated patients. However, in an open label study, fever severe enough to halt zidovudine administration occurred in 10% of 70 acquired immune deficiency syndrome (AIDS) patients receiving the drug. We now describe three AIDS patients with severe zidovudine-induced fever in whom other causes of fever were excluded. Zidovudine-induced fever was confirmed in each case by drug rechallenge. Using an enzyme immunoassay, we detected IgM antibodies directed against a zidovudine serum protein conformational determinant in one of these three patients. Neither IgG nor IgM anti-zidovudine antibodies were present in sera from the other two patients with zidovudine fever, from four AIDS patients who discontinued zidovudine for reasons other than fever, or from five AIDS patients who never received zidovudine. Zidovudine may cause fever as a severe adverse effect in patients with AIDS. Either type III or type IV hypersensitivity may mediate this reaction. PMID- 2666641 TI - Condom failure among homosexual men. AB - Following a postal questionnaire survey of 262 homosexual men carried out to investigate condom use during sexual activity, a sample of 97 men who used condoms during anogenital sex was identified. Thirty-one percent of those who had used a condom during anal intercourse reported at least one incident of condom breakage. When looked at in terms of frequency of individual condom use, it was found that 1 in 27 condoms break during this activity. Examination of the reasons for breakage and a review of the literature indicated that physical stress on the condom is likely to be a major factor in these incidents. PMID- 2666642 TI - Prevalence of foot pathology and lower extremity complications in a diabetic outpatient clinic. AB - Multiple risk factors interplay in the formation of foot ulceration and/or limb amputation in the diabetic patient. This study defines the prevalence of foot pathology, lower extremity complications, and known risk factors for ulceration in a cross-sectional analysis of 92 diabetic patients in a Veterans Affairs Metabolic Clinic. Sixteen percent of patients had a history of lower extremity complications including pedal ulceration and/or amputation, previously requiring 1480 hospital days of care. Sixty-eight percent of patients had structural pathology in the foot, including: 51 percent callus, 32 percent hammertoes, 8 percent bunions, and 1 percent Charcot foot. Thirty-four percent of patients were insensate, while 25 percent had autonomic neuropathy. Twenty-two percent of patients had atherosclerosis obliterans as defined by an ankle brachial index less than 0.9; 13 percent suffered from intermittent claudication. The following pathologies were significantly more prevalent in diabetic patients with a history of ulceration and/or amputation compared to those patients without ulceration or amputation: hammertoe deformity (p less than .0001), abnormal cutaneous pressure sensation (p less than .05), abnormal R-R interval (p less than .05), intermittent claudication (p less than .05), and abnormal ankle brachial index (p less than .05). An important finding was that 41 percent of insensate patients were not aware of their sensory deficit. In addition, two-thirds of the patients with vascular disease had palpable pulses. All patients with diabetes should be entered into a basic foot education program. The high prevalence of lower extremity pathology coupled with the inadequacy of history and physical examination in detecting neuropathy and vascular disease emphasize the need for vigorous screening to determine whether patients are at high risk of ulceration/amputation. These patients should be entered into aggressive prophylactic treatment programs. PMID- 2666643 TI - Noninvasive measurement of the stiffness of tissue in the above-knee amputation limb. AB - In order to characterize the mechanical properties of the soft tissue in above knee amputations, nine subjects were measured with a Doppler ultrasound system. Measurements were made at four locations: anterior, posterior, lateral, and medial. The characterizations included tissues up to 2.5 cm deep. The average posterior moduli are significantly greater than the anterior and lateral parameters. No significant difference was found among moduli from the medial zone compared to other areas. Superficial tissue had a significantly higher modulus than the tissue beneath. A simple method for transducer placement produced repeatable results. The present technique proved to be useful with patients in good health, and with no severe residual limb complications. The information generated with the ultrasonic device may aid in prosthesis fitting and will be used in a Computer-Aided Design (CAD) system as well as in other clinical applications. PMID- 2666644 TI - Extended physiologic taction: design and evaluation of a proportional force feedback system. AB - In both robot teleoperation and prosthetics, the feeding back of touch information to the human operator in a physiologically compatible manner is an important problem. Most research in feedback systems for prosthetic devices has concentrated on electrotactile or vibrotactile stimulation of the skin. While these techniques can transmit information to the user, the user does not have the same sensation as if he were grasping an object in his natural hand. The present research investigates a third method of stimulation using direct force. In the sense of Simpson's Extended Physiologic Proprioception (EPP), it is called: Extended Physiologic Taction (EPT). The EPT system produces a one-to-one correspondence of touch sensation to user stimulation. The EPT system applies a force on the surface of the skin of the operator proportional to the grip force applied at the terminal device, or applies a vibration to the operator proportional to the vibration at the terminal device. A method of quantifying grip controllability has also been developed. A prototype was built and tested using a myoelectrically-controlled prosthetic terminal device as the remote gripping device. Quantifiable comparisons can be made between different feedback and gripping systems as well as comparisons between artificial terminal devices and the natural hand. Results are reported of improved grip control and of improved ability to manipulate objects when using the EPT system. PMID- 2666645 TI - Sutureless nerve repair at the fascicular level using a nerve coupler. AB - Peripheral nerves are transected in many traumatic injuries of the extremities. Satisfactory functional regeneration of such nerves often fails to occur after repair with sutures. Possible reasons for these failures include poor alignment of nerves or fascicles, intrusion of scar tissue into the nerve junction, and outgrowth of nerve tissue from the repair site. This animal study describes an experimental method of sutureless, monofascicular peripheral nerve repair using a resorbable nerve coupler in the rat model. The first version of this coupler shows approximately equal performance to suture repair. Histology and electrophysiology assessments after regeneration showed that the polyglycolic acid (PGA) tube repairs were functionally equal to monofascicular suture junctions as well as being quicker and simpler to perform. Modified coupler designs based on this and other work show greater promise. Collateral studies are using similar versions of the nerve coupler as a vehicle for the insertion of chemical and neuro-electronic factors that may enhance nerve regeneration. PMID- 2666646 TI - Problems with the differentiation of anxiety and depression. AB - This paper discusses the problems of differentiating anxiety and depression. Assessment of these two clinical states is particularly difficult since they are typically intermingled. Theoretical analysis of the current use of the constructs and a sound psychometric approach can disentangle them. Unfortunately, the most widely used assessment methods do not measure anxiety and depression independently. PMID- 2666647 TI - The reliability and validity of the Mini-Mental State in a British community survey. AB - The Mini-Mental State (MMSE) was administered to 2302 general practice patients aged 75 yr and over. Those scoring 23 or less and a sample of those scoring 24 or 25 were selected for further investigation using the Cambridge Mental Disorders of the Elderly Examination. Inter-observer reliability was high with a mean kappa value of 0.97. Eighty-six per cent of respondents judged to have organic mental disorders scored 23 or less on the MMSE and 92% of those judged to be cognitively intact scored 24 or more. However, only 55% of respondents who scored 23 or less were demented or delirious while a number of relatively well educated, mildly demented subjects scored 24 and 25. The customary cut-off point of 23/24 may need to be revised in future community studies. MMSE scores cannot be used to make even tentative psychiatric diagnoses; more detailed investigation of low scorers is essential. PMID- 2666648 TI - Study of LH response to GnRH in the young male as a criterion of genetic merit for female reproduction in sheep. AB - A high and a low response line in sheep were selected on the basis of the mean concentration of LH in 10-week-old Finn-Dorset ram lambs after an i.v. injection of 5 micrograms GnRH. After 8 male generations the mean LH response of the high line was more than 5-fold that of the low line and the heritability of the selected trait was estimated at 0.44 +/- 0.015. Highly significant line differences in mean LH response to GnRH were also found in males at 20 weeks of age and females at 10 and 20 weeks of age and the genetic correlations between the four LH response traits appear to be close to unity. Large line differences in the mean FSH response to GnRH were also found in both males and females at 10 and 20 weeks of age. Selection had little effect on the physical characteristics of lambs. High-response line ewes entering their first breeding season at about 7 months of age showed oestrus earlier in the season and had higher ovulation rates and numbers of lambs born per ewe lambing than did low-response line ewes. In the second breeding season, at about 19 months of age, the only line difference was a higher ovulation rate early in the breeding season in high-line ewes. It is suggested that these changes may be mediated by a more rapid response in high line ewes to increased GnRH stimulation at puberty or at the beginning of the breeding season. PMID- 2666649 TI - Immunofluorescent localization, by use of anti-idiotypic antibody, of monoclonal anti-progesterone antibody in the mouse uterus before implantation. AB - Mouse monoclonal anti-progesterone IgG1 antibody designated DB3 has an anti fertility effect when injected into female mice shortly after mating. In BALB/c mice, pregnancy is blocked, probably as a result of progesterone withdrawal with inhibition of implantation. Rabbit polyclonal anti-idiotype raised against DB3 has been used in an indirect immunofluorescence method on frozen tissue sections to demonstrate the presence of DB3 on the surface of uterine luminal and glandular epithelia before implantation. DB3 was only detectable 30-60 h after a single parenteral injection (9 nmol antibody per mouse i.p. or i.v. at 32 h post coitum). Immunolocalization was both pregnancy-dependent and anti-progesterone antibody-specific, as it was not seen in pseudopregnant mice or mice treated with P3 (mouse myeloma IgG1 protein, using polyclonal anti-P3 anti-idiotype as a probe) or saline. The immunofluorescent reaction was completely blocked by addition of DB3 idiotype in vitro. The results indicate that anti-progesterone antibody binds to an antigen associated with luminal and glandular epithelia which may locally inhibit the uterine uptake of progesterone and disrupt the process of implantation. PMID- 2666650 TI - Cellular localization of inhibin mRNA in the bovine ovary by in-situ hybridization. AB - Hybridization histochemistry has been used to detect the presence of mRNA for the alpha and beta A subunit of inhibin in tissue sections of the ovary of cows. 32P labelled cDNAs, complementary to the bovine alpha or beta A subunit of inhibin or to a control segment of plasmid DNA (pBR 322), were used. The alpha subunit mRNA was located in the granulosa layer of antral follicles greater than 0.36 mm in diameter while the alpha and beta A subunit mRNA were both present in follicles of greater than 0.8 mm. In these latter follicles, the thecal layer hybridized with only the alpha subunit mRNA. No hybridization of the alpha or beta A subunit probe was found in the cells of the corpus luteum. Hybridization of both probes was abolished when the tissue sections were pretreated with ribonuclease (RNAse). The plasmid cDNA did not hybridize to any of the tissue sections. This study demonstrates that mRNA for the alpha inhibin subunit can be detected in granulosa and theca cells whereas the beta A inhibin subunit mRNA is restricted to the granulosa cells. These results provide evidence for an independent regulation of expression for the two subunits of inhibin. PMID- 2666651 TI - Monoclonal antibody localization of sperm surface antigen secreted by the epididymis of the baboon (Papio cynocephalus). AB - A monoclonal antibody (BSA6) was generated against an antigenic determinant secreted by the epididymis of the baboon and present on the acrosomal surface of the spermatozoa. This determinant was first secreted by the principal cells of the proximal corpus region, as determined by fluorescent microscopy performed on Bouin-fixed epididymal tissue sections. The secretory product subsequently bound on the lateral acrosomal surfaces in the distal corpus region, but became uniformly distributed over the acrosomal region in the cauda epididymidis. The antigenic determinant had a molecular weight of 82,000 (western blot technique). The testis, caput and other somatic tissues were devoid of the antigen, indicating the restriction of the antigen to spermatozoa and epithelial cells of the corpus epididymidis. Examination of similar tissue from immature baboons indicated that the secretion of this antigen was age-dependent, secretion beginning at about 4 years of age. PMID- 2666652 TI - Presence of platelet glycoproteins Ib and IIb-IIIa in inflammatory and noninflammatory synovium. AB - Rheumatoid synovial tissue and noninflammatory synovial tissue from patients with meniscus lesions were stained using monoclonal antibodies against platelet 150 kDa Ib glycoprotein (gp Ib) and against 140/110 kDa IIb-IIIa glycoprotein complex (gp IIb-IIIa) applied with the avidin-biotin-peroxidase complex method. Gp Ib and gp IIb-IIIa positive intravascular platelet aggregates were not seen, except locally in the capillary blood vessels of one rheumatoid synovial sample. This suggests that the platelets and the clotting sequence are not activated in inflamed synovial tissue. However, in many of the synovial capillaries endothelial immunoreactivity was seen. This reaction could have been due to cross reaction, since the vitronectin receptor beta chain is structurally identical to platelet gp IIIa. The gp IIb-IIIa member of the integrin receptor family plays a role in the transmembrane linkage between its extracellular ligands and intracellular microfibers. Gp IIb-IIIa may thus contribute to normal synovial physiology and to the pathogenesis of chronic synovitis. PMID- 2666653 TI - Fibrinopeptide A reactive peptides and procoagulant activity in bronchoalveolar lavage: relationship to rheumatoid interstitial lung disease. AB - Extravascular, primarily, alveolar fibrin deposition is commonly associated with the alveolitis of many interstitial lung diseases including the interstitial lung disease associated with rheumatoid arthritis (RA). We therefore hypothesized that coagulation pathways, which promote fibrin formation, would be activated in the alveolar lining fluids of patients with rheumatoid interstitial lung disease. To test this hypothesis, we studied the bronchoalveolar lavage (BAL) fluids from patients with rheumatoid interstitial lung disease (n = 7) and patients with RA unassociated with interstitial lung disease (n = 10) to characterize and quantitatively compare the BAL procoagulant material and levels of fibrinopeptide A (FPA), which is cleaved from fibrinogen by thrombin. FPA reactive peptide concentrations were significantly greater in rheumatoid interstitial lung disease than RA when normalized per ml of concentrated BAL fluid (p = 0.02), per mg BAL total protein (p = 0.01) or BAL albumin content (p = 0.03) and correlated with BAL antigenic neutrophil elastase concentrations (r = 0.87). Procoagulant activity was present in similar concentration of BAL of patients with RA and rheumatoid interstitial lung disease and was mainly attributable to tissue factor associated with factor VII (or VIIa). Our results demonstrate that tissue factor and factor VII are endogenous in the alveoli of subjects with RA and interstitial lung disease and could interact with distal coagulation substrates which may enter the alveoli in interstitial lung disease to locally promote fibrin deposition.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 2666654 TI - Aseptic necrosis and glucocorticosteroids in systemic lupus erythematosus: a reevaluation. AB - To reassess predisposing factors in patients with systemic lupus erythematosus (SLE) who develop aseptic necrosis of bone, we studied 172 patients with SLE seen at our institution between 1975 and 1987 followed for longer than 1 year. Twenty eight (16.3%) of these patients developed clinically apparent aseptic necrosis. In 12 of these 28 the continuous glucocorticosteroid dose was known. These 12 patients were compared to 15 controls with SLE followed for a minimum of 4.5 years for whom continuous glucocorticosteroid dosage was also known. We were unable to find any significant differences between patients with aseptic necrosis and controls in prevalence of specific lupus organ system involvement, Raynaud's phenomenon, or abnormal serological or hematological variables. Overall disease activity at the time of maximal glucocorticosteroid dosage did not differ significantly between the 2 groups but was slightly greater at the time SLE was diagnosed in the group with aseptic necrosis. Glucocorticosteroid intake during the first 1.5 years after diagnosis of SLE and during the third year after diagnosis was significantly greater for the patients with aseptic necrosis than for the control patients, as was glucocorticosteroid intake during the maximal 1, 3 and 6 months of therapy. We conclude that glucocorticosteroid intake is the major factor predisposing to aseptic necrosis in patients with SLE. PMID- 2666655 TI - Antidouble stranded DNA antibody assays in systemic lupus erythematosus: correlations of longitudinal antibody measurements. AB - To determine whether different assays of antidouble stranded DNA (anti-dsDNA) antibodies provide comparable information in quantitative antibody assessment over time, longitudinal correlations between 3 anti-dsDNA antibody methods were derived. Determinations of anti-dsDNA antibody levels on serial samples from 9 patients with systemic lupus erythematosus (SLE) were performed by filter binding radioimmunoassay, enzyme linked immunosorbent assay, and Crithidia indirect immunofluorescence. Substantial pairwise correlations among assay methods were found (r = 0.544 to 0.804; p less than 0.001). In addition, anti-dsDNA antibody levels as measured by each assay were inversely correlated with levels of the 3rd component of complement. Our results indicate that changes in antibody levels as determined by these 3 methods closely parallel each other over time, and suggest that the array of anti-dsDNA antibodies detected in patient sera remains relatively constant over time. PMID- 2666656 TI - Comparison of a 550,000 dalton cartilage matrix glycoprotein in cartilage from immature and mature dogs. AB - Cartilage matrix glycoprotein is a disulfide bonded 550,000 dalton protein found in cartilage and in the vitreous of the eye. Immunofluorescence studies using a specific antiserum to this glycoprotein have previously demonstrated a difference between the topographic distribution of staining for cartilage matrix glycoprotein in cartilage from immature and mature animals. Using a polyclonal antiserum to cartilage matrix glycoprotein, we studied this protein in cartilage from normal immature and mature dogs to determine if it changes with maturation. Cartilage matrix glycoprotein from immature canine cartilage migrates as a doublet, with apparent molecular weights of 100-116,000, regardless of its state of reduction, and is immunologically cross reactive with cartilage matrix glycoprotein from adult canine cartilage. Cartilage matrix glycoprotein from mature canine cartilage is disulfide bonded before reduction with 2 mercaptoethanol and its 116,000 Da subunit migrates as a single band after reduction. PMID- 2666657 TI - Axillar ultrasound of the glenohumeral joint. AB - A new ultrasonographic method for detection of intraarticular effusion in the glenohumeral joint was developed. The distance between the humerus and the joint capsule is measured at the axilla with the humerus in 90 degrees abduction. Effusion was detected by ultrasonography in 10 of 11 joints in which effusion was confirmed by intraarticular puncture. Intraarticular injection of physiological NaC1 solution could be seen as a change in the scan. The mean ultrasonographic distance between the head of humerus and the joint capsule was 2.4 mm (SD 0.5 mm) in 80 shoulder joints of 40 healthy adults. Thus, intrasynovial effusion can be suspected if the distance is 3.5 mm (mean + 2 SD) or more, or the difference between both sides is 1 mm or more. PMID- 2666658 TI - Robert Adams' rheumatic arthritis of the shoulder: "Milwaukee shoulder" revisited. PMID- 2666659 TI - Coexistence of adult onset Still's disease and polymyositis with rhabdomyolysis successfully treated with methotrexate and corticosteroids. AB - Adult onset Still's disease is a disorder characterized by spiking fevers, rash, arthritis, serositis and myalgia. Erosive arthritis is a well recognized feature, however, myositis is not. We describe a patient with adult onset Still's disease, polymyositis (PM) and rhabdomyolysis successfully treated with methotrexate (MTX) and corticosteroids. This occurrence has previously been reported, however without the presence of rhabdomyolysis or treatment with MTX. Suppression of disease activity was followed by marked radiographic improvement of the arthritis. MTX and corticosteroids in combination may be indicated for the treatment of adult onset Still's disease when PM and erosive arthritis occur. PMID- 2666660 TI - Scleroderma renal crisis without hypertension. PMID- 2666661 TI - Twenty-five years of developments in carcinogen hazard assessment. PMID- 2666663 TI - Future applications of lasers in surgery and medicine: a review. AB - The experimental use of lasers in surgery and medicine began only shortly after the development of the first working laser system. However, the development of practical, effective, and safe surgical lasers has been lengthy with many obstacles and delays. Today the laser is used for a wide variety of surgical operations. The fundamental limits and potential for future applications of lasers in surgery and medicine are discussed. PMID- 2666662 TI - Acupuncture prophylaxis of cancer chemotherapy-induced sickness. AB - In a multi-facet study we evaluated the efficacy of P6 electroacupuncture (10 Hz applied for 5 min) as an antiemetic in patients receiving a variety of cancer chemotherapy drugs. The study involved 130 (15 in an open pilot study, 10 in a randomized placebo controlled crossover study and 105 in a definitive study) patients who had a history of distressing sickness after previous treatment, and who, on the basis of a previous survey, would be expected to have a 96% chance of this with subsequent therapy. Sickness was either completely absent or reduced considerably in 97% of patients and no side effects were encountered. The limited crossover study, using a 'dummy' acupuncture (ACP) point showed that the beneficial effects were limited to the P6 point. Logistic and ethical considerations excluded the possibility of carrying out a larger placebo controlled study. While in our hands P6 ACP was an effective antiemetic in patients having cancer chemotherapy, because of the time involved and the brevity of the action (8 h) an alternative approach to electro-ACP is required before this technique is adopted clinically. PMID- 2666664 TI - Benjamin Collins Brodie 1783-1862. PMID- 2666665 TI - Antimalarials. 16. Synthesis of 2-substituted analogues of 8-[(4-amino-1 methylbutyl)amino]-6-methoxy-4-methyl-5-[3- (trifluoromethyl)phenoxy]quinoline as candidate antimalarials. AB - A series of 2-substituted analogues of the exceptional drug 8-[(4-amino-1 methylbutyl)amino]-6-methoxy-4-methyl-5-[3- (trifluoromethyl)phenoxy]quinoline (I) were prepared and evaluated for both suppressive and prophylactic antimalarial activity. The preparation of analogues of compound I was of interest due to the high level of both blood and tissue schizonticidal activity demonstrated by this compound. One analogue, 8a, was found to be both more active and less toxic than the parent compound I. In addition, three analogues of example 8a were prepared. Although two of the three analogues showed significant antimalarial activity, both were inferior to compound 8a. PMID- 2666666 TI - Synthesis of acyclonucleoside hydroxamic acids as inhibitors of ribonucleotide reductase. AB - N-Hydroxy-alpha-(2-hydroxyethoxy)-1(2H)-pyrimidineacetamides 1-3 were synthesized as potential antitumor agents whose mechanism of action would involve inhibition of ribonucleoside diphosphate reductase (RDPR, EC 1.17.4.1). Acyclonucleoside esters 6-8 were prepared by the stannic chloride catalyzed reaction of methyl chloro[2-(phenylmethoxy)ethoxy]acetate (5) with various silylated pyrimidines, generated in situ from the bases and bis(trimethylsilyl)acetamide. Catalytic didebenzylation of hydroxamate 11 gave 1, while 2 and 3 were synthesized by the reaction of lactones 14 and 22, respectively, with hydroxylamine. In vitro acyclonucleoside hydroxamic acids 1-3 were 3-10-fold less potent than hydroxyurea against calf thymus cytidine diphosphate reductase. 5-Fluorouracil derivative 2 is nearly equipotent with hydroxyurea in inhibiting the growth of HeLa cells, while 1 is a much weaker inhibitor and cytidine derivative 3 is devoid of activity at 200 micrograms/mL. PMID- 2666667 TI - Synthesis and receptor affinities of some conformationally restricted analogues of the dopamine D1 selective ligand (5R)-8-chloro-2,3,4,5-tetrahydro-3-methyl-5 phenyl- 1H-3-benzazepin-7-ol. AB - The synthesis of a structurally novel series of 6,6a,7,8,9,13b-hexahydro-5H benzo[d]naphtho[2,1-b]azepines (2), conformationally restricted analogues of the dopamine D1 antagonist (5R)-8-chloro-2,3,4,5-tetrahydro-3-methyl-5-phenyl-1H-3 benzazepin -7-ol (SCH 23390, 1c), is described. Affinity for D1 receptors was determined by competition for rat striatal binding sites labeled by [3H]SCH 23390; affinity for D2 receptors was similarly determined by competition experiments using [3H]spiperone. Compounds in this series having the B/C-trans ring junction (2b and related analogues), where the D ring is unequivocally fixed in an equatorial orientation, possess considerably more D1 receptor affinity and selectivity vs the D2 receptor than the conformationally mobile cis stereoisomers (2a), thus leading to the conclusion that axial substituents at the 4- or 5 positions of the benzazepine nucleus are detrimental to D1 receptor affinity. Resolution and X-ray analysis demonstrated that D1 receptor affinity was preferentially associated with the (-)-6aS,13bR enantiomer of 2b. PMID- 2666668 TI - 2,4-Diamino-5-benzylpyrimidines and analogues as antibacterial agents. 12. 1,2 Dihydroquinolylmethyl analogues with high activity and specificity for bacterial dihydrofolate reductase. AB - Twelve 2,4-diamino-5-[(1,2-dihydro-6-quinolyl)methyl]pyrimidines containing gem dimethyl or fluoromethyl substituents at the 2-position of the dihydroquinoline ring were prepared by condensations of dihydroquinolines with 2,4-diamino-5 (hydroxymethyl)pyrimidine. The dihydroquinolines were produced from the reaction of anilines with mesityl oxide or fluoroacetone. In some cases, 1-aryl-2,4 dimethylpyrroles were obtained as byproducts. Most of these pyrimidines were highly inhibitory to Escherichia coli dihydrofolate reductase (DHFR) and also had high specificity for the bacterial enzyme. 2,4-Diamino-5-[[1,2-dihydro-2,4 dimethyl-3-fluoro-2-(fluoromethyl)-8- methoxy-6(1H)quinolyl]methyl]pyrimidine had an apparent Ki value for E. coli DHFR 13 times lower than that of the control, trimethoprim (1), and was 1 order of magnitude more selective for the bacterial enzyme. It had outstanding activity against Gram-positive organisms in vitro, as well as broad-spectrum antibacterial activity equivalent to that of 1. The results of in vivo testing will be reported elsewhere. The gem-dimethyl substituents of the dihydroquinoline derivatives are considered to be responsible for the high selectivity, as well as contributing to potent bacterial DHFR inhibition. Molecular models are presented which suggest the probable interactions with the bacterial enzyme. PMID- 2666669 TI - Synthesis and biological activity of novel carbacyclins having bicyclic substituents on the omega-chain. AB - A number of carbacyclins having bicyclic substituents on the omega-chain have been synthesized and tested for antiplatelet aggregation activity in vitro (against collagen-induced aggregation of rat platelet), for reduction of systemic blood pressure in vivo (ability to reduce the blood pressure in anesthetized rat by iv injection), and for cytoprotective activity (protection against ethanol induced rat gastric lesion). The most effective compound for each activity was [3aS-[2E,3a alpha,4 alpha (3R),5 beta,6a alpha]]-5-[hexahydro-5- hydroxy-4-[3 hydroxy-3-(2-indanyl)-1-propynyl]-2(1H)-pentalenylidene+ ++] pentanoic acid (compound 11a), while some 1,4-benzodioxan analogues had selectivity for organ protective activity, and indan analogues showed selectivity in their antiaggregation activity. PMID- 2666670 TI - A behavioural intervention for Gilles de la Tourette syndrome in a severely mentally handicapped girl. AB - This paper describes an attempt to treat Gilles de la Tourette syndrome (GTS) in a severely mentally handicapped girl, using a cue-controlled relaxation technique. Response to treatment followed a pattern frequently found in the general clinical literature. Namely tic frequency decreased during relaxation sessions but there was no generalization of effects outside of relaxation sessions. Pharmacological intervention, using clonidine, also did not reduce tic frequency. However, pimozide proved immediately effective in suppressing tics and this improvement was maintained at follow-up. Medication side effects were noted and implications for long-term treatment of GTS are discussed. PMID- 2666671 TI - The Miller-Dieker syndrome: a case report and review of the literature. AB - A case of Miller-Dieker syndrome is reported. A 6-month-old baby girl has the characteristics of the syndrome. Post natal growth deficiency: microcephaly, profound mental retardation. Craniofacial defects: micrognathia, ear abnormalities, anteverted nares, wrinkling of forehead, bitemporal growing of high forehead. Neurological abnormalities: opisthotonos, epilepsy, initial hypotonia. The literature is reviewed. PMID- 2666672 TI - Transcranial Doppler arteriography--a technical note. AB - Transcranial Doppler (TCD) evaluation of the intracranial vessels was performed in sixty-six patients, 51 of whom received conventional angiography either prior to or subsequent to the ultrasonic arteriogram. Of the 14 patients evaluated for arteriovenous malformations (AVMs), TCD indicated the existence of the AVM in 10 cases. Of those 10 cases, 9 correlated with angiography. Twenty-one patients with aneurysms were evaluated with TCD and only 2 were detected. Twenty-three patients suspected of having ischemic disease were evaluated with TCD, which indicated the presence of stenosis in 21 patients. Twenty of those patients received conventional angiography, with 18 demonstrating significant stenosis. PMID- 2666673 TI - Consensus methods for finding and ranking DNA binding sites. Application to Escherichia coli promoters. AB - There have been many different approaches employed to define the "consensus" sequence of various DNA binding sites and to use the definition obtained to locate and rank members of a given sequence family. The analysis presented here enlists two of these approaches, each in modified form, to develop a highly efficient search protocol for Escherichia coli promoters and to provide a relative ranking of these sites showing good agreement with in vitro measurements of promoter strength. Schneider et al. have applied Shannon's index of information content to evaluate the significance of each position within the consensus of a family of aligned sequences. In a formal sense, this index is only applicable to a group of sequences, providing at each position a negative entropy value between zero (random) and two bits (total conservation of a single base) for sequences in which all bases are equally represented. A method for evaluating how well an individual sequence conforms to the information content pattern of the consensus is described. A function is derived, by analogy to the information content of the sequence family, for application to individual sequences. Since this function is a measure of conformity, it can be used in a search protocol to identify new members of the family represented by the consensus. A protocol for locating E. coli promoters is presented. The Berg-von Hippel statistical mechanical function is also tested in a similar application. While the information content function provides a superior search protocol, the Berg-von Hippel function, when scaled at each position by the information content, does well at ranking promoters according to their strength as measured in vitro. PMID- 2666674 TI - Polymerase-specific differences in the DNA intermediates of frameshift mutagenesis. In vitro synthesis errors of Escherichia coli DNA polymerase I and its large fragment derivative. AB - The sequences of more than 600 frameshift mutations produced as a consequence of in vitro DNA replication on an oligonucleotide-primed, single-stranded DNA template by the Escherichia coli polymerase I enzyme (PolI) or its large fragment derivative (PolLF) were compared. Four categories of mutants were found: (1) single-base deletions, (2) base substitutions, (3) multiple-base deletions and (4) complex frameshift mutations that change both the base sequence and the number of bases in a concerted mutational process. The template sequence 5'-Py-T G-3', previously identified as a PolLF hotspot for single-base deletions opposite G, is also a hotspot for PolI. A PolI-specific warm spot for single-base deletions was identified. Among base substitutions, transitions were more frequent than transversions. Transversions were mediated by (template)G.G, (template)G.A, and (template)C.T mispairs. Multiple-base deletions were found only after PolI replication. Although each of these deletions can be explained by a misalignment mediated by directly repeated DNA sequences, deletion frequencies were often different for repeats of the same length. Both PolI and PolLF produced many complex frameshift mutants. The new sequences at the mutant sites are exactly complementary to nearby DNA sequences in the newly synthesized DNA strand. In each case, palindromic complementarity could mediate the misalignment needed to initiate the mutational process. The misaligned DNA synthesis accounts for the nucleotide changes at the mutant site and for homology that could direct realignment of the DNA onto the template. Most of the complex mutant sequences could be initiated by either intramolecular misalignments involving fold-back structures in newly synthesized DNA or by strand-switching during strand displacement synthesis. The striking differences between the specificities of complex frameshift mutations and multiple-base deletions by PolI and PolLF identify the existence of polymerase-specific determinants that influence the frequency and specificity of misalignment-mediated frameshifts and deletions. PMID- 2666675 TI - Restorative neurology of head injury. AB - This article outlines the clinical characteristics of head injuries and describes their outcome. It emphasizes that some of the clinical characteristics and patterns of recovery can be explained by temporary or long-term failure in connection between different regions of the brain by specialized white matter pathways, which results in so-called dysconnection syndromes. It points out that the ability to assess these dysconnection syndromes leads to the prevention of disuse of the uninjured part of the brain and suppression of secondary brain dysfunctions. The second part of this article describes restorative neurology and then discusses how it is becoming possible to breach the existing gap between cellular and human holistic neurobiology. It concludes that restorative neurology research programs will be used routinely in the treatment of patients with acute and chronic head injury. PMID- 2666676 TI - Combination iron depletion therapy. AB - Iron (Fe) depletion with anti-transferrin (Tf) receptor monoclonal antibodies (MAbs), Fe chelators, or gallium (Ga) salts inhibits in vitro and in vivo growth of tumor cells. The present studies examined the cytotoxic effects of an IgA anti human Tf receptor MAb, 42/6, combined with parabactin, a powerful Fe chelator, or Ga nitrate. Parabactin inhibited in vitro growth of human hematopoietic and solid tumor cells, and the rank order of their sensitivities to the Fe chelator was identical to their relative sensitivity to MAb 42/6 as demonstrated in previous studies. When the most parabactin and MAb 42/6-sensitive (HL60 leukemia) and resistant (KB carcinoma) cells were incubated with various concentrations of parabactin, cell killing was time and dose dependent over the first 24 hours. Little additional cytotoxicity occurred, however, when cells were exposed to parabactin for 48 hours. HL60 cells were slightly more sensitive than KB cells to parabactin cytotoxicity. Addition of optimally effective concentrations of anti Tf receptor MAb 42/6 to parabactin increased cytotoxicity to HL60 cells over a narrow parabactin dose range but had little effect on cytotoxicity to KB cells. Cell cycle analysis of cells treated with parabactin for 24 hours showed that doses causing variable cytotoxicity increased the percentage of cells in S phase, but higher parabactin concentrations consistently arrested cells in G1 phase or at the G1/S interface. MAb 42/6 also increased toxicity of parabactin to granulocyte/macrophage colony-stimulating factors and normal marrow granulocyte/macrophage progenitors. When HL60 or KB cells were treated with MAb 42/6 combined with Ga nitrate, MAb 42/6 increased cytotoxicity of Ga for HL60 cells but had little or no effect on Ga cytotoxicity to KB cells. In contrast, MAb 42/6 had minimal effects on cytotoxicity of the ribonucleotide reductase inhibitor, isoquinaldehyde thiosemicarbazone, to either HL60 or KB cells. Both hematopoietic and solid tumors were killed by Fe depletion, but the present studies suggested that hematopoietic cells are more sensitive than solid tumor cells to cytotoxic effects of Fe depletion. Combined Fe depletion therapy by the use of MAb 42/6 with an Fe chelator or Ga salt increased toxicity to MAb 42/6 sensitive cells, such as HL60, but was not more effective against MAb 42/6 resistant solid tumor cells. Combination Fe depletion therapy of hematopoietic cell tumors merits evaluation in experimental in vivo tumor systems. PMID- 2666677 TI - Recent advances in the surgical management of pheochromocytoma. AB - Improvements in biochemical assays, radiographic imaging, and perioperative monitoring; the availability of selective adrenergic blockers; and a better understanding of the pathophysiology of the disease have all contributed to the reduction in mortality and morbidity in patients with pheochromocytomas. Twenty four-hour urinary catecholamines are more reliable than blood levels in detecting pheochromocytomas. The diagnosis may be confirmed by elevated epinephrine fractions when total catecholamine levels are normal. Computerized tomography is the preferred imaging tool, although ultrasound and magnetic resonance are preferred during pregnancy. 131I iobenguane scanning is useful in locating extra adrenal disease and may have a role in the treatment of metastases. Total alpha adrenergic blockade with phenoxybenzamine versus selective (alpha 1) blockage with prazosin are equally effective preoperatively. Invasive monitoring is necessary in all patients, and agents to control arrhythmias, hypertension, hypotension, and cardiac arrest are prepared in advance. Patients with benign lesions have an excellent cure rate, and those with malignancies have effective palliation of their symptoms. PMID- 2666678 TI - Parathyroid adenocarcinoma. AB - Parathyroid adenocarcinoma is a very rare carcinoma with an equal male-female incidence. The clinical picture that adenocarcinoma of the parathyroid presents is the same as that of hyperparathyroidism due to adenoma. Onset of parathyroid adenocarcinoma occurs primarily in the fourth decade of life. It is not incompatible with long-term survival provided that the entire gland is removed at the initial operation without rupture of the capsule. If the carcinoma recurs, it grows slowly and any spread tends to be local. Distant metastasis is rare. Calcium levels above 13 mg/100 mL should alert the clinician to the possibility of adenocarcinoma of the parathyroid. Increased mitotic figures, increased fibrosis of the gland, and invasion of the vessels and surrounding tissues are the features indicative of malignancy. A review of the literature reveals that fewer than 150 cases of this entity have been reported. The authors present two case reports and discuss the epidemiology, clinical picture, pathology, and therapy of parathyroid adenocarcinoma. PMID- 2666679 TI - Blood transfusion: uses, abuses, and hazards. AB - Homologous blood transfusion without risk is an unobtainable goal. Infection with human immunodeficiency virus continues to occur at an average rate of one infection per 100,000 transfusions, in spite of the most sensitive and specific testing available. In the past 30 years, the number of red cell antigens identified have increased from primarily ABO and Rh to some 400 antigens, which has also contributed to the hazards of blood transfusion. These risks can be minimized by the judicious use of homologous blood in conjunction with technological advances in transfusion medicine therapy and changes in attitudes of transfusionists. In the operating theater, there has been a resurgence in intraoperative autologous transfusion therapy, and patients are individualized rather than held to an arbitrary hemoglobin standard prior to anesthesia. In the preoperative period, elective surgical candidates may predeposit autologous blood or select directed donors. The prospective recipient or the directed donor may be candidate for recombinant erythropoietin therapy as a prelude to blood donation. This article discusses the uses of blood and blood products, the hazards of blood transfusion, and precautions that can be taken to minimize risks to the patient. PMID- 2666680 TI - Less well known parameters of in vitro radiosensitivity. AB - In addition to well known parameters used for measuring in vitro cellular radiosensitivity (mean lethal dose, extrapolation number, quasithreshold dose), there are other, less well known measures that may be more important. The authors recently surveyed the literature and found that mean activation dose (D) has been neglected in the analyses. Among 70 articles published in the radiation oncology and biology literature that used cell survival curves or parameters to measure radiosensitivity, only two used the values of D in their analysis. By recalculating D from published survival curves, different conclusions may be drawn. The authors see a definite need for more prospective application of D and surviving fraction at 2 Gy. PMID- 2666681 TI - From the Congressional Office of Technology Assessment. PMID- 2666682 TI - Increasing rates of depression. PMID- 2666683 TI - Transforming growth factor-beta. Multiple actions and potential clinical applications. PMID- 2666684 TI - Diagnostic and therapeutic technology assessment. Chemonucleolysis for herniated lumbar disk. AB - The DATTA panelists did not achieve a definitive consensus on the use of chymopapain chemonucleolysis for a protruding lumbar disk contained by the annulus. Concerns about safety, especially the risk of anaphylaxis and the risk of damage to the spinal cord, were frequent. The effectiveness of this procedure for this indication was also questioned by many of the panelists. The panel did agree that chemonucleolysis is unacceptable as either safe or effective for use in patients with a herniated lumbar disk that is extruding nucleus pulposus through the annulus. Accordingly, diagnostic imaging of any suspect disk must be performed before chemonucleolysis can be deemed appropriate for any individual patient. Current imaging techniques are not infallible and cannot confer an absolute sense of security when seeming to indicate a nonextruded protruding disk. PMID- 2666685 TI - Meet Vic Cohn--dean of American science writers. PMID- 2666686 TI - [Comparative evaluation of D-dimer assays]. PMID- 2666687 TI - [Thrombin/antithrombin III complex (TAT)--a new parameter for detection of thrombotic states]. PMID- 2666688 TI - [Ultrasonography-guided cobalt-60 brachytherapy of malignant glioma]. AB - Brachytherapy with cobalt-60 source is reported. In this method it is characterized that the source is inserted interstitially with remote control system by after-loading method via outer catheter (using tandem tube), which was established in the center of residual tumor, using ultrasonography guide with trepanation, or intraoperatively put within the dead space after tumor resection. Six cases of deep-seated and recurrent malignant glioma, were treated with this method. A total dose of 20 to 45 Gy (10 to 15 Gy/day for 2 to 3 days) was delivered to the target. Additionally conventional external irradiation was followed. The effect of cobalt-60 brachytherapy on such tumors were favorable especially for well-circumscribed glioma less than 3 cm on CT scan. PMID- 2666689 TI - [Percutaneous ethanol injection of parathyroid adenoma under US guidance]. AB - A patient with post-operative recurrent parathyroid adenoma was treated with percutaneous injection of absolute ethanol under ultrasonographic guidance. Serum calcium and PTH level were both successfully normalized, while recurrent nerve palsy was encountered as side effect. Six months later, she was suffered from hyperparathyroidism again, because of local tumor recurrence. Her recurrent nerve palsy was cured at that time. This technic could be a simple and non-invasive alternative for the conventional surgical procedure, but the indication for larger adenomas like this case should be carefully considered. PMID- 2666690 TI - [Report of a case of iatrogenic pseudoaneurysm of right subclavian artery]. AB - A case of iatrogenic right subclavian artery pseudoaneurysm which had disappeared spontaneously without surgical procedure, was presented. Among several diagnostic imaging modalities, ultrasonic color doppler method was considered most useful to visualize the anatomy and hemodynamics of the artery and the aneurysm. PMID- 2666691 TI - [A case of abdominal actinomycosis following foreign body in the stomach wall]. AB - Recently abdominal actinomycosis is rare. Its diagnosis is difficult because it resembles malignant diseases. We reported a case of abdominal actinomycosis considered to be of the stomach origin and attempted to correlate the radiological findings with the pathological features referring to the previous reports. PMID- 2666692 TI - [A case report of intrahepatic portal vein aneurysm; diagnostic usefulness of MRI]. AB - A very rare case of portal vein aneurysm in 62 year old female was revealed by various modern imaging modalities including MRI. Diagnostic usefulness of MRI was first demonstrated because of it's high sensitivity to the blood flow as compared with other conventional imaging modalities. PMID- 2666693 TI - [Arterial-portal shunting in hepatic cavernous hemangioma; a case report]. AB - A 60-year-old woman had a small hepatic tumor in the right lobe detected by CT scan. Angiography showed a hypervascular lesion with shunting of dense contrast material into portal vein radicles. Resected specimen revealed a cavernous hemangioma. The angiographic differentiation between small hemangiomas and malignant hypervascular neoplasms of the liver can be difficult. PMID- 2666694 TI - [A case of focal nodular hyperplasia in the liver]. AB - A case of focal nodular hyperplasia of the liver was reported, in which various diagnostic imaging modalities were performed. Hepatic colloid scan (SPECT) in this case shows typical focal accumulation in the lesion. Ultrasonic image shows a sharply demarcated hypoechoic lesion in the left lobe. But no significant informations of this tumor were obtained in the plain CT, CE-CT and angiography. Echo-guided biopsy was performed and focal cirrhotic finding in the lesion without liver cirrhosis was obtained. PMID- 2666695 TI - [Distribution of T cell subsets and DR antigen positive T cells in peripheral blood and in intestinal mucosa of inflammatory bowel disease]. AB - The absolute number of T cell subsets and the rate of T cell DR antigen expression in the peripheral blood and the intestinal mucosa in IBD patients were compared with those in healthy normal controls by two color analysis. The methods used here were flow cytometry for the peripheral blood and immunohistological fluorescent staining for the intestinal mucosa. In peripheral blood lymphocyte (PBL), helper (CD4+ Leu8-) T cells increased in ulcerative colitis (UC), whereas suppressor (CD8+ CD11+) T cells decreased in Crohn's disease (CRD). In lamina propria lymphocyte (LPL) of intestinal mucosa, there were no changes in the proportion of T cell subsets in UC, whereas suppressor (CD8+ CD11+) T cells increased in inflamed mucosa of CRD. DR antigen positive T cells did not increase in PBL, but they increased in LPL of both UC and CRD. In conclusion, there are some differences in distribution of T cell subsets and DR antigen positive T cells between the peripheral blood and the intestinal mucosa in IBD patients. Moreover, the heterogeneity of the distribution of T cell subsets is observed between UC and CRD. PMID- 2666696 TI - [An immunohistochemical study of endogenous estradiol and testosterone in human colo-rectal cancer tissues]. AB - An immunohistochemical method (peroxidase antiperoxidase method) was carried out to examine the distribution of endogenous estradiol (E2) and testosterone (Te). One hundred and twenty four (48.2%) of 257 colo-rectal cancer cases, and 36.7% of male cases and 58.4% of female cases revealed E2-immunostain. This immunohistochemical reaction for E2 was found more frequently in female patients than in male patients, while Te-immunostain was found in 15 (17.6%) of 85 colo rectal cancer cases. E2 and Te were demonstrated mainly in the cytoplasms and occasionally in the nuclei of cancer cells. Since E2 or Te-positive cancer cells were mainly distributed in the deeper or invasive portion of tissue sections, it might deserve further investigation to elucidate a certain relationship between cancer growth and endogenous sex-hormones. PMID- 2666697 TI - [Treatment of endotoxin shock due to gram-negative bacteremia using extracorporeal circulation]. AB - The effectiveness and significance of the various therapeutic methods of extracorporeal circulation were assessed in an experimental model of septic endotoxin shock. After sepsis was produced in 30 puppies by intravenously injecting 5 X 10(9) CFU/ml/kg of E. coli, on-line plasma exchange, conventional plasma exchange, charcoal plasma perfusion, hemofiltration, and sham perfusion were performed for 2 hr. As a result, 4 of the 5 puppies in the on-line plasma exchange group and one of the 5 in the conventional plasma exchange group survived; the others all died. In the on-line plasma exchange group, the number of E. coli decreased to 2.5 X 10 CFU/ml at the end of the treatment, while it was 1.3 X 10(3) CFU/ml in the sham perfusion group. The endotoxin concentration was also reduced significantly, while plasma opsonin activity was remarkably elevated. These results suggest the significance of achieving the elimination of endotoxin in blood and an increase in plasma opsonin activity simultaneously in the treatment of septic endotoxin shock. PMID- 2666698 TI - [A case of acute emphysematous cholecystitis with infiltration of giant cells and eosinophils in the gallbladder wall]. PMID- 2666699 TI - [Progress in cancer chemotherapy]. PMID- 2666700 TI - [Blood group isoantigen and lectin binding studies in the human bladder cancer]. AB - The purpose of this study is to investigate changes of glycoconjugates in the cancer cells of the urinary bladder by means of immunohistochemical methods. The normal bladder epithelium, cancerous lesions, and non-malignant epithelia of the tumor bearing bladder were examined by staining by avidin-biotin-peroxidase complex methods using blood group isoantigens (BGA) and lectins. The materials were obtained from 48 cystectomy specimens in our hospital in these seven years. Anti-A, B and H monoclonal antibodies were used for detecting BGA. GSI-A4, UEA-1, LTA-M, BPA, DBA and PNA were used as probes for lectins. The changes of glycoconjugates in the cancer cells of the bladder and in non-malignant epithelia of the tumor bearing bladder were studied by using six kinds of lectins. Each lectin binding rates of the primary lesions and the metastasized lesions was comparatively investigated. Positive rates for BGA of the high grade tumor was lower than that of the low grade. In the high grade tumor, GSI-A4, PNA and BPA showed high binding rates, while the DBA binding rate was low. The correlation between the histopathological grading of bladder tumor and the changes of glycoconjugates in the cells was suggestive of cancerous process. PMID- 2666701 TI - [A case of malakoplakia of the testis and epididymis]. AB - A forty-two year-old man with left epididymo-testicular malakoplakia was reported. Thirty-two cases of testicular malakoplakia with (5 cases) and without (27 cases) epididymal malakoplakia were reviewed. The mean age was 48. 2 year old. Two-thirds of the cases suffered from right side involvement. All cases except a few cases received orchiectomy within 2.6 months on average from the onset of the symptoms. Diabetes mellitus, malignant diseases, or chronic renal failure seem to have a causal relation to the development of testicular malakoplakia. Six cases of epididymal malakoplakia were also reviewed. PMID- 2666702 TI - [Status of the pressor and depressor systems of the blood in circulatory insufficiency in patients with hypertension]. PMID- 2666703 TI - [Clinical pharmacology and therapeutic use of cordarone]. PMID- 2666704 TI - [Study of the relation of various genetic and pathophysiologic factors participating in the regulation of blood pressure in patients with hypertension]. AB - A study of 35 patients with uncomplicated essential hypertension (EH) (labile hypertension, stages IB-IIA or stable hypertension, stage IIB) demonstrated a higher rate of Na+-Li+ countertransport in patients with hypertensive hereditary predisposition to EH (group 1), as compared to those with unaggravated heredity (group 2). A suppression of plasma renin activity (53%), and a higher rate of hyperlipoproteinemia (55%) were observed in group 1, as opposed to group 2 where Na+-Li+ countertransport was lower, plasma renin activity was normal, and hyperlipoproteinemia occurred in 33%. There was a direct correlation between Na+ Li+ countertransport and renin-angiotensin-aldosterone components in group 2. A conclusion is made that aggravated heredity, RAAS components and hyperlipoproteinemia should be taken into account in the assessment of Na+-Li+ countertransport in hypertensive patients. PMID- 2666705 TI - [Effect of vasodilator agents on the effectiveness of the complex treatment of patients with ischemic heart disease and congestive heart failure]. AB - A total of 153 coronary patients with congestive heart failure, stage IIA and IIB, were investigated. Thirty patients underwent a three-week course of treatment with cardiac glycosides, plus diuretics and potassium preparations where necessary. In addition to conventional treatment, 123 patients were treated with vasodilating agents (2% nitroglycerin ointment, nitrosorbide or molsidomin) with the doses adjusted individually on the basis of acute drug testing. Those patients with congestive heart failure who received combined treatment with cardiac glycosides and vasodilators demonstrated a more obvious improvement of clinical parameters and instrumental findings as compared to the patients, treated with cardiac glycosides alone. PMID- 2666706 TI - [Characteristics of hormonal regulation in patients with ischemic heart disease after the insulin test combined with physical load]. AB - Nine normal subjects and 6 coronary patients (aged 26 to 53 years) who had survived myocardial infarction more than 3 years before and showed no clinical signs of heart failure, obesity, hypertension and diabetes mellitus, while having normal glucose tolerance test values, were exposed to the insulin test in combination with physical stress in the presence of clinically manifest hypoglycemia. Plasma and erythrocyte glucose and immunoreactive insulin, and urinary excretion of catecholamines were measured. Coronary patients showed considerably increased erythrocyte immunoreactive insulin levels, recorded immediately upon discontinuation of exercise, while their sympathoadrenal hormonal activation was less significant, as compared to normal subjects. The combination of the insulin test and exercise in coronary patients with normal glucose tolerance values helps to detect disturbances of regulatory mechanisms at the erythrocyte level and can be used as an adjuvant method for the assessment of latent carbohydrate metabolic disorders. PMID- 2666707 TI - [Comparative evaluation of the anti-anginal effects of dilzem and corinfar in patients with ischemic heart disease and exertion-induced stenocardia]. AB - Antianginal efficiency of dilzem, as compared to placebo, was assessed in 53 patients with angina of effort, functional class II-IV. Repeated bicycle ergometry and 24-hour ECG monitoring were used as objective methods for the assessment of treatment efficiency. Antianginal effect of dilzem (180-300 mg/daily) was compared to that of corinfar (30-60 mg/daily) in 16 patients by a simple blind cross procedure, using placebo. The duration of continuous bicycle ergometric exercise increased by 163 sec. In the presence of dilzem, and by 152 sec. in the presence of corinfar, as compared to the placebo, while the performance volume increased by 1296 and 1188 kgm, respectively (p less than 0.001). Unlike corinfar, dilzem produced a significant drop in heart rate and double product both at rest and during exercise. Both dilzem and corinfar considerably reduced average rate and total duration of painless episodes of myocardial ischemia (p less than 0.05), as evidenced by Holter's monitoring. PMID- 2666708 TI - [Hemodynamic effects of the treatment of hypertension with the calcium channel blocker diltiazem]. AB - The 1.5-benzotthazepine derivative diltiazem, which blocks slow calcium channels, is an effective hypotensive agent, used for the treatment of moderate hypertension. Treatment with diltiazem alone, its dose adjusted on an individual basis, controlled arterial blood pressure in 58% of the patients. With a 240 mg daily dose, blood pressure was controlled in 12 of 52 patients; when the daily dose was increased to 360 mg, blood pressure was controlled in another 18 patients. In the remaining 22 patients, blood pressure was only controlled after captopril was added in a daily dose of at least 50 mg. The drop of arterial blood pressure was associated with falling total peripheral resistance and end diastolic blood volume, and was accompanied by an increase in left-ventricular ejection fraction and myocardial oxygen want. PMID- 2666709 TI - [Use of digoxin in patients with paroxysmal supraventricular tachycardia]. AB - The effectiveness and electrophysiologic mechanisms of antiarrhythmic effect of digoxin were examined in 27 patients with paroxysmal atrioventricular nodal reciprocal tachycardia (PAVNRT) and supraventricular tachycardia (SVT) due to latent complementary conductive pathways, i. e. latent Wolff-Parkinson-White (WPW) syndrome. To assess antiarrhythmic action of digoxin, transesophageal pacing and plasma digoxin radioimmonoassays were used. Preventive antiarrhythmic efficiency of digoxin was 53% in PAVNRT patients, and 25% in SVT patients with latent WPW syndrome. Antegrade atrioventricular conduction block seems to be the mechanism of oral digoxin preventive effect. There was no relationship between antiarrhythmic efficiency of digoxin and its plasma level. PMID- 2666710 TI - [Comparative effectiveness of finoptin and phosphobion in treating attacks of supraventricular tachycardia]. AB - Forty-seven cases of supraventricular reciprocal paroxysmal tachycardia in patients with a complementary atrioventricular junction, with retrograde flow only, were studied. An attack of tachycardia was induced by frequent transesophageal stimulation of the left atrium. Records from the esophageal lead were taken in addition to external ECG leads. An attack of supraventricular paroxysmal tachycardia could be controlled in 22 (88.0%) cases following a 10 mg intravenous dose of finoptin, and in 15 (68.2%) cases following a 10 mg phosphobion dose. The electrophysiological mechanism of the control of tachycardia by finoptin was the antegrade block of impulse conduction through the atrioventricular node in 21 (95.5%) patients, and retrograde block of the complementary atrioventricular pathway in 1 (4.5%) patient. Under the effect of phosphobion, antegrade atrioventricular block was seen in all cases. The time needed to arrest an attack by the drugs examined ranged from a few seconds to 5 minutes. The use of phosphobion was associated with more marked changes of atrioventricular conductivity and more pronounced subjective sensations. PMID- 2666711 TI - [Acute appendicitis in patients with diabetes mellitus]. AB - The peculiarities of clinical picture, preoperative preparation and postoperative course in 157 patients with acute appendicitis, who suffered from diabetes mellitus, are shown. The direct dependence of pathomorphologic changes in the vermiform process on the severity degree and the state of diabetes compensation is noted. For correction of carbohydrate metabolism in the patients' contingent considered, it is the most expedient to use the fractional injection of common (crystalline) insulin at low doses. PMID- 2666712 TI - [Penetrating wounds of the abdominal cavity]. AB - The first experience with diagnosis and treatment of open injuries to the abdomen in the specialized department of polytrauma is summarized. Surgical tactics stipulates early diagnosis of the possible injuries to the internal organs, and emergency operative intervention with the volume depending on the character of an injury, severity of the state of a patient. PMID- 2666713 TI - [Subcutaneous rupture of the duodenum]. AB - The results of the treatment of 7 patients with subcutaneous rupture of the duodenum are analysed. The correct diagnosis before the operation was established in 1 case only. At operation, a retroperitoneal hematoma with a dash of bile, and a retroperitoneal emphysema as well were revealed in all the patients. The closure of the rupture, drainage of the subhepatic and retroperitoneal space, duodenal decompression in 3 patients by means of intubation with the two-lumen probe, in 2--creation of gastroduodenoanastomosis were performed. One patient underwent Roux-en-Y duodenostomy. Two patients died. PMID- 2666714 TI - [Clinical manifestations and diagnosis of combined injuries of the abdominal organs]. PMID- 2666715 TI - [Yersinia infection simulating acute appendicitis]. PMID- 2666716 TI - [A method of appendectomy with layer-by-layer suturing of the appendiceal stump]. PMID- 2666717 TI - [A method of invagination of the appendiceal stump]. PMID- 2666718 TI - [Radical treatment of patients with deep wound suppuration after appendectomy]. PMID- 2666719 TI - [A method of performing choledochoduodenoanastomosis]. PMID- 2666720 TI - [Potentialities of ultrasonic diagnosis of tumors of the stomach]. AB - On the basis of examination of 15 patients, the possibilities of ultrasound diagnosis of gastric cancer are shown. PMID- 2666721 TI - [Lymphosarcoma of the shoulder]. PMID- 2666722 TI - [The use of perforated foil in free autodermoplasty]. PMID- 2666723 TI - [A method of increasing the resources of skin for autoplasty of granulating wounds in burn patients]. PMID- 2666724 TI - [Rectal prolapse]. AB - A variety of pathogenetic mechanisms underly rectal prolapse. Treatment is predominantly operative. Some of the basic surgical techniques are reviewed. The modification of posterior rectopexy with ampoxen, implicated at the Department of Surgery of the Medical Academy in Sofia, is presented. After exposure of the rectum at the side of the sacrum, the intestine is fixed to the presacral fascia. The aim is to create adhesions. Septic complications are avoided, which otherwise, with applications of other synthetic implants are quite common. Experience is recorded with the application of the method in three patients, who were followed up over a period of 2 years. PMID- 2666725 TI - [Priapism]. PMID- 2666726 TI - [A method for the local application of cytostatics under ultrasonic control in patients with inoperable liver metastases]. PMID- 2666727 TI - [Absence of nocturnal decrease in blood pressure in 24-hour blood pressure monitoring: an indication of secondary hypertension]. AB - Non invasive 24 hours ambulatory blood pressure monitoring was performed in 81 patients with secondary hypertension (renoparenchymatous nephropathy n = 15, diabetic nephropathy n = 10, Conn's disease n = 4, renal artery stenosis n = 15, pheochromocytoma n = 2, hemodialysis patients n = 15 and patients after kidney transplantation n = 20). The results were compared to 201 patients with essential hypertension. The results showed that 98.5% of patients with essential hypertension have a nightly decline in blood pressure of at least 15 mmHg (systolic + diastolic), whereas 69% of patients with secondary hypertension showed either an attenuated circadian rhythm or no circadian rhythm. Patients with pheochromocytoma who had a night time increase in blood pressure demonstrated the greatest difference to the essential hypertension collective followed by patients with diabetic nephropathy, Conn's disease and the group of patients after kidney transplantation. After successful treatment of the condition leading to hypertension circadian periodicity returned in some patients. In summary these results suggest that the absence of a night time decline in blood pressure during 24-hour-ambulatory monitoring is an indication of secondary hypertension. PMID- 2666728 TI - [Treatment of patients with gonarthrosis by intra-articular administration of drugs]. AB - The effectiveness of intra-articular administration of kenalog, hydrocortisone, gordox and polyvinylpyrrolidone to patients with gonarthrosis and concurrent synovitis was studied. Kenalog and hydrocortisone were more effective than placebo, while gordox, polyvinylpyrrolidone and placebo had similar effect. Kenalog and hydrocortisone had nearly the same favourable effect in synovitis. Only one patient treated with gordox had side effects. Signs of synovitis were analysed and its most typical symptoms specified. PMID- 2666729 TI - [The medical center of Dr. A.P. Chekhov in Kriukov]. PMID- 2666730 TI - [The history of the illness of I.A. Krylov]. PMID- 2666731 TI - [Valentin Ivanovich Pokrovskii (on his 60th birthday)]. PMID- 2666732 TI - [Problems of the diagnosis and treatment of glomerulonephritis]. PMID- 2666733 TI - [Lenin and science]. PMID- 2666734 TI - [Unsolved problems of peptic ulcer]. PMID- 2666735 TI - [Current problems of tuberculosis]. PMID- 2666737 TI - [Comparative evaluation of various methods of treating patients with esophageal candidiasis]. AB - The effectiveness of treatment of candidiasis of the esophagus by different methods and preparations (nystatin, amphotericin B, donor leukocytic mass) was compared in 34 patients. Local application of amphotericin B and donor leukocytic mass was found the most effective in the combined treatment of candidiasis of the esophagus. PMID- 2666736 TI - [Effectiveness of phenobarbital, ziksorin and cordiamine in the treatment of non conjugated hyperbilirubinemia]. AB - The effectiveness of phenobarbital, ziscorine, cordiamine and the combination of phenobarbital and pyrogenal was studied in 48 patients with non-conjugated hyperbilirubinemia. In effectiveness the agents were distributed in the following order: cordiamine, phenobarbital, ziscorine. The combination of phenobarbital and pyrogenal has proved to be inexpedient. PMID- 2666738 TI - [Intestinal microbiocenosis in patients receiving immunosuppressive drugs]. PMID- 2666739 TI - [Syndrome of chronic overdose of insulin and hypoglycemic sulfanilamide drugs]. AB - Clinical features, pathogenesis and treatment of the syndrome of chronic overdosage of insulin and hypoglycemic sulpha drugs are discussed. The typical features of this syndrome were found not only in type I and II diabetes mellitus patients who were treated with insulin but also in those who were given large dosages of hypoglycemic sulpha drugs. Treatment of this syndrome has been recommended. PMID- 2666740 TI - [Holistic nursing. Breathing--expression of our soul. From breath to breath]. PMID- 2666741 TI - [Pathophysiology of nutrient absorption]. PMID- 2666742 TI - DNA repair and its pathogenetic implications. PMID- 2666743 TI - Detection of altered H-ras proteins in human tumors using western blot analysis. AB - H-ras p21 protein expression was investigated in bladder and colonic tumor tissues using an H-ras specific antibody in Western blot analysis. The specificity of this antibody to H-ras proteins was established using NIH/3T3 transfectants expressing oncogenic counterparts of the different ras gene family members. Use of this antibody to detect altered H-ras proteins was demonstrated using a panel of transfectants bearing different mutated H-ras genes and established cell lines previously characterized in transfection assays. Extension of this technique to direct analysis of human tumor material confirmed previous observations of H-ras activation within a group of bladder tumors and identified three more urothelial tumors expressing altered H-ras proteins. The altered migrational properties of these three were suggestive of point mutational events in 12 (1 case) and 61 (2 cases) codon hot spots. This study extends previous observations on the preferential activation of H-ras in urinary tract tumors and provides a rapid technique for evaluating the status of H-ras proteins in human tumor tissue. PMID- 2666744 TI - N-acetyl-beta-D-glucosaminidase assay in urine: urea inhibition. AB - Urea inhibition of urinary N-acetyl-beta-D-glucosaminidase (NAG) was examined with human isoenzymes and total enzyme in urine. The fluorometric substrate 4 methylumbelliferyl-N-acetyl-beta-D-glucosaminide (MUNAG) and the colorimetric substrate m-cresolsulfonphthaleinyl-N-acetyl-beta-D-glucosaminide (MCPNAG) were used to determine substrate kinetics and apparent urea inhibition kinetics. Apparent KmS of 0.47 (MUNAG) and 0.35 mmol/L (MCPNAG) for human NAG isoenzyme A and 0.46 (MUNAG) and 0.30 mmol/L (MCPNAG) for human NAG isoenzyme B were determined. Apparent Kis of approximately 100 mmol/L for urea inhibition of both isoenzymes in either substrate and apparent Kis of 79 (MUNAG) and 91 mmol/L (MCPNAG) for NAG in dilute urine samples were found. The potential for urea inhibition at physiological concentrations of urea and at normal assay dilutions therefore exists. Inhibition at these dilutions was minimal when substrate concentrations of 2 x Km or greater were used, but the substrate MUNAG at 1/2 x Km gave the highest sensitivity and lower blanks and allowed better quantitation of low activity samples. Within-run CVs of 3.2% with MUNAG and 10% with MCPNAG were found for low activity samples. PMID- 2666745 TI - Home treatment for aphasic patients by trained nonprofessionals. AB - Thirty-seven aphasic men received 8-10 hr of individual treatment each week for 12 weeks from a home therapist (wife, friend, relative) who was trained and directed by a speech pathologist. Treatment was followed by 12 weeks of no treatment. Patients were evaluated at entry and at 6, 12, 18, and 24 weeks after entry with a battery of speech and language measures. The group made substantial progress on all measures during the 12 weeks of treatment and ceased to progress when treatment was discontinued. Progress for the home treatment patients did not differ significantly from that of patients who received 12 weeks of individual treatment from speech pathologists or from that of patients for whom treatment was deferred for 12 weeks. Patient selection, training of the home therapists, and other methodological aspects are described to assist speech pathologists in making decisions about the use of trained volunteers in aphasia treatment. PMID- 2666746 TI - A review of the biomechanical properties of bone as a material. AB - Experimental studies on bone all reveal important difficulties in data interpretation. This paper proposes an analysis of experimental studies performed so far, with particular attention to the anisotropic characteristics of bone, its behaviour in the post-elastic phase, and its dependence on viscoelastic phenomena. Mechanical properties are also correlated with variables such as moisture, deformation rate during testing, density, variations in different regions of the bone, and the most relevant strength criteria are recalled. The investigation performed is also intended to provide an evaluation of the degree of refinement of biomechanical experimental data for use in a numerical approach to bone mechanics. PMID- 2666747 TI - Is callus calcium content an indicator of the mechanical strength of healing fractures? An experimental study in rat metatarsals. AB - Changes in the mechanical properties and the calcium content of healing fracture callus were followed, using rat metatarsals. By 24 weeks post-fracture the mean ultimate tensile stress and elastic modulus were still less than half that of the contralateral unfractured bone, whereas the mean torsional modulus had almost reached that of the unfractured bone. The calcium content of the callus formed immediately between the fractured ends of the bone showed changes which coincided with the increases in mechanical strength and the moduli, thus measurement of callus calcium content would enable the prediction of the strength of a healing fracture. PMID- 2666748 TI - The implementation of an autoregressive model with exogenous input in a single sweep visual evoked potential analysis. AB - Based on a model of signal-noise interaction, we present a method for single sweep analysis of Visual Evoked Potentials. The EEG is represented as an autoregressive process and the single-sweep VEP as a filtered version of a reference signal taken as the running average of 20 consecutive sweeps. The algorithm for model identification and filtering is an ARX (AutoRegressive with eXogenous input) which provides a fast and efficient solution by means of a least squares approach. The choice of reference signal, as well as the complexity of the model, is also discussed. A further advantage of this approach is parameter reduction: all the single-sweep information is contained in 18 model coefficients and the reference signal. PMID- 2666749 TI - In vivo transillumination of the hand using near infrared laser pulses and differential spectroscopy. AB - In vivo dual wavelength differential spectrography was performed on the hand of an adult male, using a collimated transillumination device. A pulsed laser with sufficiently high peak power and sufficiently low energy was employed so that transillumination could be realized without thermal damage. Spectrochemical analysis based on the absorbance of oxygen transporting molecules (OTM), i.e. haemoglobin in blood vessels and myoglobin in muscles, was performed along a 70 mm scanning line within the near-red infrared range. The two wavelengths used (675 and 800 nm) were chosen on the basis of the absorption spectrum of haemoglobin. The profiles computed with differential spectrography data related to the oxygen saturation of OTM are closely correlated with X-ray densitometry of the most vascularized tissues in the hand along the scanning line. In addition, at 675 nm, the profiles are rapidly modified as a function of the oxygen supply to the hand. Considering the accuracy obtained for the spatial localization of the OTM redox state, it is expected that these results could be applied to imaging. PMID- 2666750 TI - Computer-aided interpretation of ECG signals using polynomial regression methods. AB - Using polynomial regression methods this paper introduces a new approach to computer-aided interpretation of the ECG. An algorithm is presented for the identification and separation of ECG segments. The method of interpretation is efficient and its results are consistent and reliable. PMID- 2666751 TI - Electrical muscle stimulation in combination with a reciprocating gait orthosis for ambulation by paraplegics. AB - Commercially available electrical muscle stimulators (EMS) provide functional electrical stimulation and are interfaced with reciprocating gait orthosis (RGO). The system which has been developed is described here as an EMS-RGO. Advantages of the system include: medically prescriptable subsystems available from manufacturers, and commercially recommended subsystems for applications such as gait training. The system itself employs four EMS units worn on a belt. It is controlled by remote switches and is interfaced to electrodes placed over the quadriceps, hamstring and gluteal muscle groups of each leg. Two EMS units (for quadriceps stimulation) function primarily for stand-up and sit-down. Two other EMS units (for stimulation of the hip extensors) function primarily for ambulation. Each EMS unit is powered by a nine volt alkaline transistor battery which provides about 36 stand-uphs and sit-down's and approximately 3.1 km of walking before replacement is necessary. The system has been evaluated on a T-5 level paraplegic individual who sustained a motor complete lesion (Frankel Class B) of the spinal cord over seven years ago. It is emphasized that successful EMS RGO walking exercise must be preceded by a physical conditioning programme of active physical therapy. New battery technology (such as lithium batteries) may improve the useful lifespan of the system, and new electrode technology (such as TTGs) may improve patient acceptance of the system. PMID- 2666753 TI - Operative factors, not hemodynamics, modify hormones in repair of coarctation. AB - This study was designed to evaluate separately the influence of restoration of distal pulse pressure and the influence of factors related to operation upon hemodynamic and hormonal alterations accompanying repair of canine aortic coarctation. Eight normal adult dogs underwent a sham operation and served as controls. In 10 dogs the thoracic aorta was transfected and reanastomosed. In 10 dogs aortic coarctation was created within 1 week of birth by banding the aorta just proximal to the ductus ligament, thereby fixing lumenal diameter at 1 to 2 mm. Studies were performed in the latter animals 18 months after operation. These dogs were subdivided into two groups: one (n = 6) underwent surgical repair of the coarctation; in the other (n = 4), the coarctation was repaired and an occluder was placed on the aorta to maintain distal aortic pulse pressure at its diminished preoperative level. Normal distal pulse pressure was restored in these animals by releasing the occluder 1 week after recovery from the repair of coarctation. Each dog was studied in the conscious state before the definitive procedure and again 24 hr later. Plasma renin activity increased significantly after operation in the sham and in the transection groups. Renin activity and proximal blood pressure were significantly elevated and distal pulse pressure was diminished preoperatively in both the repair and the occluder groups. After their respective definitive procedures, the elevation in renin activity and in proximal pressure persisted in the repair group but decreased in the occluder group.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 2666752 TI - Insulin response to glucose challenge after transient hepatic dearterialization for rat liver malignancy. AB - In the palliative treatment of liver malignancy, hepatic dearterialization is being increasingly used. To study the metabolic consequences of this treatment, the present investigation was conducted to elucidate the insulin, glucose, and lactate responses to an intravenous glucose challenge after transient hepatic dearterialization in a liver tumor model in inbred Wistar-Furth rats. We found that nonfasted rats bearing dearterialized liver tumors showed slightly higher basal plasma glucose levels and an exaggerated elevation of plasma glucose during the glucose infusion compared to the controls. Further, they had a depressed insulin response to the glucose challenge. Their glycogen stores were at the same time depleted, in both the liver and the tumor tissues, and the plasma lactate production during the glucose infusion was elevated after dearterialization. We conclude that immediately after hepatic dearterialization in rats with liver malignancies, glucose intolerance and impaired glucose-induced insulin secretion exist. PMID- 2666754 TI - Studies of alcohol: past, present and future. PMID- 2666755 TI - The Center of Alcohol Studies and the Journal of Studies on Alcohol: celebrating 50 years. PMID- 2666756 TI - Alcoholism and Alcoholics Anonymous in U.S. films, 1945-1962: the party ends for the "wet generations". AB - At least 34 Hollywood films were made between The Lost Weekend (1945) and Days of Wine and Roses (1962) with an alcoholic as a major character; six depicted an Alcoholics Anonymous-like self-help organization. Presentations of alcoholism's origin as mysterious competed with psychodynamic interpretations and situational explanations, often in the same film and sometimes concerning the same character. Will-power and mutual help were each frequently shown as paths to recovery, whereas neither professional treatment nor AA's spiritual side were often shown. For the women alcoholics (17 of 39 depicted), drinking went with sexuality, but for men it replaced it. "Creative" occupations were hugely overrepresented among screen alcoholics, in part reflecting the personal struggles with drinking of the movies' creators. These writers, actors and directors were drawn from the "wet generations" of middle-class youth, who had adopted heavy drinking in their college years as a generational revolt against "Victorian morality." Alcoholics Anonymous was founded and peopled by members of these same cohorts as a generational solution to their eventual life-problems. The flurry of alcoholism films represented a parallel and overlapping generational response. PMID- 2666757 TI - Spontaneous gastroduodenal perforation in cancer patients receiving cytotoxic therapy. AB - Spontaneous gastroduodenal perforation (SGDP) occurs in cancer patients receiving cytotoxic drugs, corticosteroids, or radiation therapy as primary or adjuvant treatment for their tumors. A retrospective review identified 12 patients from 1974 to 1987 at the Memorial Sloan-Kettering Cancer Center who underwent surgery for SGDP while receiving anticancer therapy. There were five gastric and seven duodenal perforations. Vague abdominal pain was the most common symptom. Exploration was delayed in six patients because of an absence of physical findings. All patients received a Graham omental patch. The in-hospital operative mortality was 33%, with all major complications occurring in those that died. There were no prognostic indicators identified that would preoperatively predict outcome. Aggressive surgical intervention is advised in all patients who have a reasonable chance of worthwhile palliation if not cure. PMID- 2666758 TI - Use of transrectal ultrasound in detection of prostatic carcinoma: a preliminary report. AB - Three hundred twenty patients who were asymptomatic males aged 55-70 years, were evaluated with transrectal ultrasound in both the axial and sagittal projections to evaluate the efficacy of transrectal ultrasound in detecting early prostatic carcinoma. Thirteen patients had palpable nodules that were positive for prostatic carcinoma, and ten patients had normal rectal examinations but ultrasound abnormalities, which were confirmed with prostate biopsy positive for prostatic carcinoma. This preliminary report points to certain advantages of this screening procedure, but conclusions as to its efficacy must await the results of more extensive trials. PMID- 2666759 TI - The effect of desmopressin acetate (DDAVP) on postoperative blood loss after cardiac operations in children. AB - We investigated the effect of an intraoperative desmopressin acetate infusion on blood loss after cardiac operation in 60 children, by using a prospective, randomized, double-blind trial. Thirty patients received a desmopressin dose of 0.3 microgram/kg intravenously over 15 minutes at the conclusion of cardiac bypass, and 30 received a saline placebo. The two groups were comparable with respect to age, sex, cardiac lesion, presence of cyanosis, and prevalence of Down's syndrome. Results showed no significant difference in postoperative blood loss between the two groups (30.5 +/- 37.9 ml/kg in the placebo group versus 40.0 +/- 33.1 ml/kg in the desmopressin group). Postoperative bleeding time, total urine output, postinfusion hemodynamics, and postoperative coagulation studies did not differ significantly between the two groups. We conclude that postbypass desmopressin infusion does not reduce blood loss in children undergoing cardiac operations. PMID- 2666760 TI - Technique of bronchial closure after pneumonectomy. AB - Three hundred thirty-two patients had a pneumonectomy at Wythenshawe Hospital, Manchester. England, between 1974 and 1984. In all patients, the bronchus was closed with a posterior flap from the pliable membranous bronchus, leaving no stump, and with the suture line proximal to the carina. In a mean follow-up of 54 months, none of the patients had bronchopleural fistual, and 10 patients had empyema in the pneumonectomy space (3%). A fistula could not be found in any of these patients. The suture material used in closing the bronchus in all these cases was 2-0 chromic catgut, which underlines the fact that bronchial healing is not affected by the type of suture material as long as no tension exists at the suture line. PMID- 2666761 TI - Mitral valve surgery: the Leeds legacy. PMID- 2666762 TI - Myocardial aneurysm of the ascending thoracic aorta: management with pericardial patch and bilateral pectoralis muscle flaps. PMID- 2666763 TI - A lightweight hybrid microdrive for use with awake unrestrained animals. AB - A hybrid microdrive is described, comprising remote stepper motors connected by a hydraulic link to a slave electrode positioner which is light enough for use with freely walking cats. The system provides 18 mm of electrode movement in 2 or 10 microns steps. PMID- 2666764 TI - [Evaluation of the format in clinical training in psychiatry--educational significance of planning recreation for patients]. PMID- 2666765 TI - [Primary myelofibrosis: description of a series of 53 patients]. AB - The clinical and hematological profile of 53 patients in whom primary myelofibrosis (PMF) had been diagnosed during the last 15 years was evaluated. Median age was 64 years (range 17-86). Thirty-five patients were males and 18 females. The most frequent symptoms were associated with the hypermetabolic state, anemia and splenomegaly. The latter was found in 96% of patients, while 83% had hepatomegaly and 9% had lymphadenopathy. Thirty-three patients had anemia at the time of diagnosis. The leukocyte and platelet counts were normal or moderately high in most cases. Myelemia was found in 83% of patients, with circulating erythroblasts in 72%. The most common biochemical abnormalities were the increased serum LDH (84%) and hypocholesterolemia (62%). Bone marrow aspirate was not analyzable in most cases. Bone marrow biopsy showed myelofibrosis in hypercellular phase in 22 patients, myelofibrosis without osteosclerosis in 17, and myelofibrosis with osteosclerosis in 14. The median survival of the series was 3.8 years; 34 patients had died at the time of the analysis. The major causes of death were infection, cardiovascular complications and hemorrhage. In 4 patients the evolution from PMF to acute leukemia was observed. PMID- 2666766 TI - [Adverse reactions to drugs and drug surveillance]. PMID- 2666767 TI - [Human immunodeficiency virus infection and primary health care]. PMID- 2666768 TI - [Diabetic morbidity in Spain]. PMID- 2666770 TI - [Thalidomide 1989]. PMID- 2666769 TI - [Programs of diabetological education: a basic tool in the treatment of diabetes mellitus]. AB - To assess whether the programs of diabetologic education (PDE) are effective to improve metabolic control in diabetes mellitus, depending on their inclusion in an overall therapeutic program and on the setting where they are imparted (hospital versus primary care center, PCC), we evaluated the changes in the HbA1 values in 230 insulin-treated diabetic patients, after receiving a PDE in a PCC (group A; n = 88) or as hospital inpatients (group B; n = 72) or outpatients (group C; n = 50). The remaining 20 patients (group D) received the same PDE, but their treatment did not depend on our Unit. The initial mean HbA1 levels were significantly reduced 3, 6 and 9 months after the PDE in group A patients (10.6% vs 9.6%, p less than 0.05; vs 9.4%, p less than 0.02; vs 9.1%, p less than 0.01), in group B patients (10.0% vs 9.5%, p less than 0.05; vs 9.1%, p less than 0.05; vs 9.0%, p less than 0.05) and group C patients (10.1% vs 9.5%, p less than 0.05; vs 9.1%, p less than 0.02; vs 8.9, p less than 0.01); however, they did not significantly change in group D patients (10.3% vs 10.7%, vs 10.3%, and vs 10.0%). Mean HbA1 in months 3, 6 and 9 were not different between groups A, B and C, but they were lower (p less than 0.05) than in group D. Our results confirm that PDE and treatment are effective to improve metabolic control in diabetic patients, whereas diabetological education alone is not useful. The place where PDE is given is not determinant for its effectiveness. PMID- 2666771 TI - [Systemic lupus erythematosus and end-stage chronic renal insufficiency. Therapeutic perspectives]. PMID- 2666772 TI - [Infectious endocarditis: elaboration of a prophylactic schedule]. PMID- 2666773 TI - [Mechanisms of functional change of von Willebrand factor]. PMID- 2666774 TI - [Inaccuracy of bibliographic references: a cause of fraudulent publications?]. PMID- 2666775 TI - [Primary cutaneous nocardiosis and human immunodeficiency virus infection]. PMID- 2666776 TI - [Continuous positive airway pressure by the nasal route in sleep apnea syndrome with central predominance]. PMID- 2666777 TI - [Osteoporotic fracture of the femur in Spain]. PMID- 2666778 TI - [Course of the incidence of membranoproliferative glomerulonephritis in the population of children in Spain]. PMID- 2666779 TI - [Influence of informatics on clinical and epidemiologic investigation]. PMID- 2666780 TI - [Multiple hepatic nodules in a 51-year-old male]. PMID- 2666781 TI - [Treatment of vomiting induced by cytostatic agents]. PMID- 2666782 TI - [Paraquat poisoning]. PMID- 2666783 TI - [Failure of a cyclophosphamide-dexamethasone combination in paraquat poisoning]. AB - A 37-year-old female deliberately ingested a 20% solution of paraquat in water. One hour later gastric lavage was carried out and bentonite was administered. Five hours later cyclophosphamide (5 mg/kg/day) and dexamethasone (24 mg/day) were started and a continuous intestinal lavage was carried out; four hours later, hemodialysis was begun. After 36 hours, features of renal and respiratory failure developed, with a rapid progress to respiratory distress. The patient died 94 hours after the ingestion of the poison. Despite early therapy with dexamethasone and cyclophosphamide, this patient's evolution does not support the presumed effectiveness of this drug association for paraquat poisoning. PMID- 2666784 TI - [Wilson Jones angiosarcoma of the face and scalp]. AB - Because of its rarity and its fast development, we report a case of a 84-year-old woman, who developed all the clinical and histopathological characteristics of the angiosarcoma of face and scalp, with a fatal evolution within four months and metastases to liver, lungs and bone marrow. PMID- 2666785 TI - [Lichen striatus. Epidemiologic study]. AB - The authors are showing a retrospective study of 53 cases of lichen striatus concerning sex, colour, age, place of lesions, associated diseases and period of the year of occurrence of the dermatosis. There was a larger number of cases in females of white race and age-between 2 and 5 years old. A greater occurrence was observed in the months of September and March which correspond to spring and summer. Adding the fact that there have been more cases in children, at times in brothers and the trend to spontaneous involution, the authors suggest the possibility of a virus as etiology to this entity. PMID- 2666786 TI - [A new classification of photodermatoses]. AB - The authors present a new classification for photodermatosis in five groups: 1. Primary toxic photodermatosis that means lesions produced in all human beings by non-ionized radiation. 2. Photodermatosis induced by drugs, with two subgroups- phototoxic and photoalergic--according to the mechanism of action of the drug. 3. Idiopathic photodermatosis in which the photonic effects are known but the chromophores are unknown; four conditions are included here polymorphous actinic eruption, solar urticaria, actinic reticuloid and hidroa vacciniforme. 4. Miscelanea group which includes several conditions of unknown mechanism which are not included in the other groups, such as: actinic cheilitis, actinic poikiloderma, actinic ceratoses, epitheliomas, melanomas and others. 5. Conditions precipitated or aggravated by solar radiation with two sub-groups: hereditary (xeroderma pigmentosum, Hartnup's syndrome and other) and acquired (lupus erythematosus, pellagra and other). In group 1, the authors propose the designation of actinic elastotic dermatosis to unify different conditions described by several authors such as: diffuse elastosis, citrein skin, cutis rhomboidalis, and others. PMID- 2666787 TI - [Bjornstad syndrome]. AB - We present a four year old boy with Bjornstad syndrome. The hair showed typical features of pili torti which were confirmed by optical and scanning electron microscopic evaluation. On computerized X-ray diffraction the hairs showed no abnormal constituents. There was a serious bilateral sensorineural deafness. PMID- 2666788 TI - [Experience in the treatment of skin mycoses with ciclopirox olamine]. AB - Ciclopirox olamine cream 1%, a new antifungal agent has been studied in 30 patients with dermatophytosis and pityriasis versicolor. Diagnosis of dermatophytosis was confirmed by microscopic examination of KOH preparations and culture in Sabouraud medium. Pityriasis versicolor was diagnosed by direct exam preparation. Cultures and direct exam preparations were performed before starting treatment and weekly thereafter. Cultures and KOH preparations were positive in all patients. Treatment with ciclopirox olamine cream 1% was applied topically twice daily. Direct examination and cultures were negative in 26 cases (86.6%) after one week treatment and in 4 cases (13.4%) after two weeks. A parallel improvement in clinical signs and symptoms was evident with disappearance of erythema, pruritus and scaling. Clinical cure was achieved in most all cases (96.7%), between the third and fourth week of treatment. PMID- 2666789 TI - [The Winer dilated pore]. AB - Dilated pore (Winer) is a not uncommon adnexal benign tumor with follicular differentiation. Clinically the lesion looks like a giant comedo, usually located on the facial area of the elderly. Due to annular elevation of the borders, differential diagnosis needs to be made with basal cell epithelioma and senile sebaceous adenoma. The histology shows a typical infundibular dilatation with subinfundibular atrophy of hair structures. The authors report two typical cases of this badly known but not infrequent lesions. PMID- 2666790 TI - [Antiphospholipid syndrome in a patient with T-cell skin lymphoma]. AB - This case report describes the simultaneous occurrence of antiphospholipid antibody syndrome in a patient with cutaneous T-cell lymphoma. An abnormal T cell B cell cooperation is postulated to explain this unusual association. To the best of our knowledge, no similar cases have been reported previously. PMID- 2666791 TI - [Incidence of malignant, primary and metastatic solid skin tumors at a pediatric dermatology service]. AB - The incidence of primary and metastatic cutaneous malignant solid tumors was investigated in a pediatric dermatology department. Among 25,000 first time patients seen between 1971 and 1985, 19 had cutaneous malignant solid tumors with an annual incidence of 0.7 for every 1,000 pediatric dermatology patients. Nine cases had primary cutaneous tumors and 10 cases metastatic tumors. The majority of patients were infants (zero to two years). The tumors found were rhabdomyosarcoma, six cases; basal-cell carcinoma, four cases; neuroblastoma, three cases; malignant melanoma, two cases, squamous-cell carcinoma, dermatofibrosarcoma, atypical fibroxanthoma and myxopapillary ependymoma, one case of each. Predisposing factors for the developing of malignancy were present in 42% of patients. PMID- 2666792 TI - [Congenital solitary fibromatosis]. AB - Infantile myofibromatosis is included in fibrous proliferations of infancy, processes with specific clinic, histology, and evolution, that are characterized by nodules in the skin, bones, and viscera. It's prognosis is varied, depending on whether it is manifested in the solitary or multicentric form. We describe a patient with congenital solitary myofibromatosis. PMID- 2666793 TI - [Surgical treatment of mycetoma located in the face]. AB - The first case described in Mexico, was studied by Cicero in 1900 and 1911 Ocaranza, in Sonora, reports some cases, pointing out that the first known case dates back to 1874. In USA Gonzalez Ochoa identifies the causative agent of the cases he studied, as the same identified in USA, but he calls attention to the fact that it has already been described under the name of Actinomyces brasiliensis, finally, taxonomically it is included among the nocardias. In Mexico the micetoma is caused in 90% of the cases by Nocardia brasiliensis, and 8% by Streptomysis and other actinomycetos and only in 1.5% it is determined by true fungi. Until the observation of the present case, mycetomas had been reported located or scattered in different places of the human body, except the face. This case is observed in a 24 years old woman patient, of peasant extraction, who presents tumoration of the left hemiface, irregularly oval, 18 x 25 cm. of anfractous surface, with nodes and fistulas that secrete suppuration. The evolution is of seven years duration, and begins after a trauma. The mycologic and histopathologic study, confirms N. brasiliensis as the causative agent. X rays prove that the skull bones are not affected, but the mycosis cause anemia. Specific treatment for anemia is installed with trimetropryn and sulphametoxazol plus sulphone, for a period of six months. A change is made to streptomycin to a total of 40 g. and then this is replaced by isonizasyn, adding to both these drugs alphamatoxipyridazine, for a period of six months and in last months, riprampycin plus sulphone are given; always with bad results.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 2666794 TI - [Secondary sulfone resistance--presentation of a case of leprosy-Oswaldo Cruz Foundation, Rio de Janeiro-Brazil]. AB - Report on a case of dapsone resistance in a BL patient with clinical diagnosis and laboratory confirmation. The resistance appeared after 17 years of dapsone treatment, and the laboratory tests revealed total resistance to all the tested dapsone concentrations. The case reported occurred in the city of Rio de Janeiro (Brazil) which presents a leprosy prevalence of 1.79/1,000. PMID- 2666795 TI - [Gangrenous pyoderma associated with subcorneal pustular dermatosis (Sneddon Wilkinson disease)]. AB - This case report describes the simultaneous occurrence of pyoderma gangrenosum and subcorneal pustular dermatosis. They are both neutrophilic dermatoses that have been described associated in several instances. The association of pyoderma gangrenosum and other cutaneous diseases is also reviewed. PMID- 2666796 TI - [Reiter's syndrome exacerbated by indomethacin]. AB - A 26-year-old man, with a personal history of drug abuse and positive serology for HIV, had Reiter's syndrome for six years. He experienced progressive worsening of his cutaneous lesions after initiation of indomethacin therapy. The skin lesions were almost completely resolved after the discontinuance of the drug and its reintroduction resulted in a similar deterioration. To our knowledge, indomethacin has not been reported to aggravate Reiter's syndrome. This case study documents anti-inflammatory drugs as possible causal factors for triggering Reiter's syndrome. Possible implicated mechanisms are also discussed. PMID- 2666797 TI - [Lever's facial granuloma. Study using direct immunofluorescence in 2 cases]. AB - Cases of two 48 and 55 year-old males affected of facial granuloma with eosinophilia are presented. In both cases direct immunofluorescence studies revealed the presence of IgG, IgA and C3 along the basement membrane. A brief comments on clinical and histological appearance, previous immunofluorescence studies, pathogenesis and treatment are made. PMID- 2666798 TI - [Immunohistochemical study of the distribution of carcinoembryonic antigen and keratin in tumors of epidermal origin. II: Keratoacanthoma and premalignant lesions]. AB - Carcinoembryonic antigen (CEA) has been studied extensively, in association with visceral tumors and normal tissues. Although CEA has been demonstrated in sweat gland cutaneous tumors, little is known about its presence in skin and epithelial related tumors. We studied the presence of CEA and keratin in keratoacanthomas and precancerous skin lesions using immunohistochemical techniques. Its distribution related with differentiation, proliferation and malignant potential is observed. The expression of both antigens is correlated. PMID- 2666799 TI - [Lichen amyloidosis with extensive skin lesions]. AB - Lichen amyloidosus is a chronic pruritic skin disorder, unusual among Europeans, and classically seen over the shins. The exact nature of the amyloid fibril protein, in lichen amyloidosus, is a matter of controversy and no specific treatment is available. Diffuse cutaneous involvement in a 60-year-old portuguese man is described. New pathogenic aspects and recent therapeutic approaches are discussed. PMID- 2666800 TI - [Inflammation mediators and the skin]. AB - Inflammation is a complex process that results from injured tissues. Several chemical mediators armoniously participate in this process to accomplish its goal: the repair of damaged tissue. The skin is the organ that is most accessible to investigators to study how mediators work. Arachidonic acid metabolites, the eicosanoids, are some of these mediators, that have particular interest in several inflammatory diseases of the skin. In this article, the metabolism of arachidonic acid and its effects on the skin are discussed, as well as some therapeutic applications that result from the understanding of them. PMID- 2666801 TI - [Papillary eccrine adenoma]. AB - Papillary eccrine adenoma is a rare benign eccrine tumor of the skin occasionally difficult to differentiate from tubular apocrine adenoma. A new case of this eccrine lesion with immunohistochemical characterization is reported and a review of the literature emphasizing the differential features between these two entities is made. PMID- 2666802 TI - Cholecystokinin and gastrin antagonists. PMID- 2666803 TI - 1,4-Dihydropyridines--a basis for developing new drugs. PMID- 2666804 TI - Irritable bowel syndrome: present and prospective pharmacological intervention. PMID- 2666805 TI - Biosynthesis of platelet-activating factor: the role of the remodeling pathway. PMID- 2666807 TI - Directory of otolaryngologic societies. PMID- 2666806 TI - Reconstructive rhinoplasty. PMID- 2666808 TI - Laser safety in otolaryngology--head and neck surgery: anesthetic and educational considerations for laryngeal surgery. AB - Two investigations concerning anesthetic and educational considerations for laser safety in microlaryngeal carbon dioxide laser surgery have been performed. The first study demonstrated that attendance at a "hands-on" laser surgery course that stressed safety precautions was associated with a reduced rate of laser related complications in the selected group of otolaryngologists who participated in the course, when compared to another selected group of otolaryngologists who were members of a senior otolaryngology society, and surveyed solely on the basis of their society membership. The second series of studies compared the incendiary characteristics of three endotracheal tubes in various mixtures of oxygen, diluted with either helium or nitrogen. It was determined that the polyvinyl chloride tube should not be used for laser surgery, even when wrapped with reflective, metallic tape. The safest anesthetic gas mixture was found to be 30% oxygen in helium; the addition of 2% halothane did not have an adverse effect, as had been previously reported. Both the Xomed Laser-Shield and Rusch red rubber endotracheal tubes were found to be safe, when used with the laser in the pulsed mode in an atmosphere of 100% oxygen. When the laser was used in the continuous mode, both tubes ignited in an atmosphere of 30% oxygen in helium. These findings challenged the previously reported levels of safety associated with the use of an unwrapped Xomed tube. Based on the results of this investigation, it has been concluded that both the Rusch red rubber tube and the Xomed Laser-Shield tube should be wrapped with reflective, metallic tape, when used for cases of microlaryngeal surgery with the carbon dioxide laser. PMID- 2666810 TI - Modeling the diagnosis of stroke at two hospitals. AB - A comparison of five major categories of stroke in 651 patients revealed significant differences in the frequencies of diagnoses at the Beth Israel and Massachusetts General hospitals in Boston, Mass. (P less than 0.001 by chi-square test). To analyze these differences, we modeled the diagnostic process at each hospital with a Bayesian procedure and performed a crossover study in which each patient was rediagnosed by the model from the opposite hospital. The results indicate that the differences in the frequency of lacune and subarachnoid hemorrhage were associated with the patient population, whereas the differences in the frequency of embolism and atherothrombosis were associated with the diagnostic process. There was a marked difference in the use of arteriograms on the two stroke services, but no difference in morbidity or mortality. The modeling procedure described can be used to compare clinical processes when the allocation of patients is thought to be biased. PMID- 2666809 TI - Very low density lipoprotein secretion by cultured hepatocytes of rabbits fed purified or autoxidized cholesterol. AB - The main objectives of this study were to compare the effects of dietary commercial cholesterol (containing 5% of oxidized cholesterol derivatives) and purified cholesterol on the secretion rate of very low density lipoprotein apolipoproteins and lipids by cultured rabbit hepatocytes and to verify the hypothesis that products of cholesterol autoxidation stimulate the rapid development of hypercholesterolemia. Rabbits fed dietary (old) commercial cholesterol for six weeks showed a fivefold increase in the serum concentration of cholesterol compared with that in purified cholesterol-fed rabbits. The secretion rates of very low density lipoprotein total protein and very low density lipoprotein [3H]apolipoproteins were similar for the hepatocytes of these two cholesterol-fed groups of animals and were two- and threefold greater, respectively, than for cells from control rabbits. Cholesteryl ester content of the hepatocytes from dietary (old) commercial cholesterol-fed rabbits was dramatically increased in comparison with hepatocytes from control and purified cholesterol-fed rabbits. The elevated intracellular cholesteryl ester content is assumed to account for such an increase of very low density lipoprotein cholesteryl ester secretion by cells prepared from dietary (old) commercial cholesterol-fed rabbits. These effects appear to be caused by activation of cholesterol esterification by oxidized cholesterol derivatives. The rapid development of hypercholesterolemia induced by dietary (old) commercial cholesterol is associated, at least in part, with the stimulated production of hepatic very low density lipoprotein apolipoproteins and cholesteryl esters. PMID- 2666811 TI - Improvements in MR angiography using phase-corrected data sets. AB - The objective of this work is refinement of an MR angiography technique via postprocessing removal of phase errors which inhibit static signal subtraction. Projective views of the object are obtained using interleaved flow-compensated and noncompensated gradient waveforms. Complex subtraction of data sets is required since a projection dephase pulse is used for static signal suppression. This renders the difference image susceptible to systematic phase errors which are modeled as a smoothly varying multiplicative phase function. The error function is estimated by comparison of heavily spatial filtered renditions of the object acquired without projection dephasing in order to minimize influence of flow. The phase correction is then applied to high-resolution data sets collected with projection dephasing to enhance flow sensitivity. The technique is demonstrated by improvement of MR angiograms of rats acquired on a 2-T, 31-cm bore system. PMID- 2666812 TI - Reduced proliferative response of mouse spleen cells to mitogens during infection with Salmonella typhimurium or Listeria monocytogenes. AB - A significant reduction in the mitogenic responsiveness (uptake of 3H-thymidine) of murine spleen cells to concanavalin A, phytohemagglutinin or lipopolysaccharide was observed during infection with virulent Salmonella typhimurium. The decreased response to mitogens could be observed independent of the immunity to typhimurium (Ity) genotype, i.e. in CBA/J mice and C3H/HeJ mice (Ityr) as well as in C57BL/6 mice (Itys). Because reduced responsiveness was demonstrated in C3H/HeJ mice, which are susceptible to S. typhimurium infection but are unresponsive to lipopolysaccharide, it is concluded that the two phenomena are not correlated with one another. A similar decrease in response to mitogens was shown in mice infected with Listeria monocytogenes. Reduction in mitogenic responsiveness was directly correlated with the number of viable bacteria detected in the spleen cell suspension. Decreased lymphoproliferation could be observed as early as 2 days after infection and lasted 3 weeks in sublethally infected mice. The question remains whether or not the reduced responsiveness indicates an enhanced susceptibility to infection or merely represents a high degree of activation of defense mechanisms. PMID- 2666813 TI - Synthetic oligonucleotide probes complementary to the HLA-B variable region hybridize with Klebsiella pneumoniae. AB - Three oligonucleotide probes complementary to base sequences of the HLA-B variable region were used to probe clinical and foodborne isolates of Klebsiella spp. by DNA colony hybridization. One oligonucleotide (RR-3) corresponding to amino acid residues 66-74 of the HLA-B27.1 sequence and one corresponding to residues 66-74 of the HLA-B7 sequence (RR-5) hybridized with K. pneumoniae under conditions of high stringency. A genomic library was constructed using K. pneumoniae K43 chromosomal DNA, and a 1 kb PstI restriction fragment was found to contain the sequence associated with specific binding of the oligonucleotide probes. After purification and radiolabeling, the cloned fragment hybridized with 96.2% of the K. pneumoniae isolates by DNA colony hybridization. These results confirm the presence of sequence similarities between bacterial DNA and the MHC Class I variable region. PMID- 2666814 TI - [Methods used in evaluating mutagenic and genotoxic properties of chemical compounds. II. The Ames test (an abridged version)]. AB - The paper presents in vitro the technique developed by Ames et al (1.5), applied in screening tests for evaluations of mutagenic effects of chemical substances. As the experimental model in the test use histidine-dependent bacterial cells of Salmonella typhimurium series TA strains. Chemical substances biotransformation is carried out in the presence of microsomal activating system (fraction S9), mostly obtained from rat's liver. Mutagenic activity of chemical substances is measured by an induction of his- mutation reversion in S. typhimurium strains, expressed as number His+ of revertant colonies, as compared to number His+ of spontaneous revertant colonies of a given strain on Petri dishes containing minimal glucose agar after 48-72 hr incubation at 37 degrees C. PMID- 2666815 TI - Inherited collagen disorders. AB - The investigation of the inherited matrix disorders has been an example of progress on two parallel fronts. Two decades of protein chemistry have provided detailed background information on the structure, if not the function, of collagen. This has been used to identify the likely candidate genes for analysis using DNA markers. Segregation analysis has in turn sorted out which diseases are caused by collagen gene mutations and which are not. This information is now concentrating effort on defining the mutations in the linked diseases and establishing linkages to other genes in the rest. Using the background structural information, efficient and specific strategies for rapidly identifying individual mutants are being designed. Best of all, prenatal diagnosis is now a reality for many parents faced with the prospect of having a severely crippled child. PMID- 2666816 TI - Cloned autoantigens in the study and diagnosis of autoimmune diseases. PMID- 2666817 TI - The molecular pathology of the serpins. PMID- 2666818 TI - HLA class II sequences infer mechanisms for major histocompatibility complex associated disease susceptibility. PMID- 2666819 TI - Prenatal diagnosis of the major haemoglobin disorders. PMID- 2666820 TI - The molecular and cell biology of apolipoprotein-B. PMID- 2666821 TI - Duchenne muscular dystrophy: the gene and the protein. PMID- 2666822 TI - Recent advances in the genetics of renal cystic disease. PMID- 2666823 TI - Propeptide cleavage: evidence from human proalbumins. PMID- 2666825 TI - Task Force on access to health care. Concludes first phase of work. PMID- 2666824 TI - Health care for the uninsured. The statistics are staggering. PMID- 2666826 TI - Health care to the uninsured a national embarrassment. PMID- 2666827 TI - The membrane potential theory of carcinogenesis. AB - Inoculation of target cells with oncogenic viruses can cause production of tumors after an extremely short latent period, whereas other carcinogenic stimuli have a much longer latency. These differences are consistent with a new and novel theory of carcinogenesis. PMID- 2666828 TI - Sudden infant death syndrome and lipoproteins. AB - Lipoprotein secretion and vitamin E transport depend on an adequate supply of inositol which functions synergistically with choline. Feeding rats a choline deficient diet was associated with decreased linoleic and arachidonic acids and increased docosapentenoic and docosahexenoic acids in liver phosphatidylethanolamine. Lipoprotein secretion by the liver is impaired by long chain omega 3 fatty acids and by the high carbohydrate diet of Kwashiorkor. Pulmonary surfactant is a lipoprotein which functions in preventing alveolar collapse in the lung. Inositol supplements to premature infants altered the composition of surfactant phospholipids and reduced the need for oxygen therapy. Oxygen free radicals, generated in oxygen therapy, convert low density lipoproteins (LDL) into potent toxins, without adequate antioxidants and free radical scavengers to block free radical generation. Vitamin E deficiency predisposes humans to increased susceptability to oxygen toxicity leading to Bronchopulmonary dysplasia (BPD), a form of chronic pulmonary insufficiency. PMID- 2666829 TI - Prolactin, human nutrition and evolution, and the relation to cystic fibrosis. AB - Cystic fibrosis (CF) is a lethal, genetically transmitted disease of Caucasian populations. Its prevalence is highest (ca 1:2000 live births) among Western and Central Europeans and their descendants. Major clinical symptoms are chronic, obstructive, pulmonary disease, impaired intestinal digestion and absorption and elevated concentration of salt in sweat. The last is important, not only for diagnosis, but because it is an example of an electrolyte transport defect present in other epithelial tissues. Numerous other clinical manifestations are generally present. The history of prolactin (PRL), especially its role in osmoregulation, is outlined and related to the symptomatology and electrolyte defect of CF. Data are presented showing the relation of PRL to regulation of sweat electrolytes and its presence and probable synthesis in the coil of the human sweat gland. The basic biochemical defect of CF has not yet been elucidated, but recent research has shown that it is probably an abnormality of a regulatory factor. We propose that PRL is a likely candidate. The large variety of functions of PRL, in particular the regulation of the transport of sodium and chloride across epithelial membranes, and the regulation of mucus production, can be matched to the major disease symptomatology. Additionally, every other one of the multiple abnormalities of CF can be associated with described activities of PRL. In lower vertebrates epithelial tissues regulated by PRL are phylogenetic progenitors of affected tissues in CF. In the human, these tissues contain cells of the Diffuse Neuroendocrine System, or APUD cells, that show PRL-like immunoreactivity, or overt synthesis of the hormone. Thus, the regulatory activity of these tissues could be paracrine. The geographic distribution and the dietary habits of early Caucasians are examined. It appears that the Neolithic revolution, with the necessity of adapting to agriculturally produced foods, i.e. milk and wheat, could have brought about the genetic selection of post translational variants of PRL. It is suggested that the combination of two or more of these mutations in the same individual may be responsible for CF. This is illustrated with proposed models of CF inheritance. We conclude by postulating that PRL acts at the level of the target cell by triggering (in conjunction with a steroid) the gene expression of unique proteins; these act as intermediaries of PRL activity; two or more abnormalities of these proteins when present in an individual produce CF; the protein abnormalities are the consequence of nutritional and ecological pressure. PMID- 2666830 TI - [Symposium on the development of occupational hygiene approaches in honor of Nicola Zurlo. Milan, 3 June 1988]. PMID- 2666831 TI - [Sampling and analysis of organic pollutants in indoor environments]. AB - The paper describes the particular conditions pertaining to sampling of airborne organic pollutants in indoor environments, with a summary of the principles applied to this type of sampling and a discussion of the main methods that have thus been developed. Particular attention is given to the advantages and the difficulties of "passive" sampling methods, based on the diffusion of vapours in the air. To conclude, a summary is given of the most widely used methods of analysis for identification of organic compounds in indoor environments. PMID- 2666832 TI - [The work of Nicola Zurlo]. PMID- 2666833 TI - [Corpuscular pollutants: the problem of particles and fibers (optic microscopy)]. AB - The "Clinica del Lavoro" had already begun work on dust pollution in the working environment in the mid-1930's but was only able to study the problem more in depth at the beginning of the 1950's when the Industrial Hygiene Laboratory was established under the fortunate direction of Professor Nicola Zurlo. The first research studies in that period were aimed at the correct choice of the most suitable sampling equipment and analytical methods for assessment of the extent of such types of pollution. The results achieved in these initial studies, the experience acquired in the field and further, more detailed research enabled Professor Zurlo to develop and perfect new types of sampling instruments that were more appropriate to the goals it was desired to achieve and these instruments are still widely used to-day. The paper also considers the evolution of analytical methods using the optical microscope for determination of the concentration of particles and fibres, most of which were developed and perfected in our Laboratory, up to the present time. It is stressed that phase contrast microscopy is still indispensable for dust analysis and still offers ample scope for research in the field of artificial fibres that have recently been put on the market, even though the electron microscope is now the only acceptable solution for research in living environments. PMID- 2666834 TI - [From industrial health to occupational and environmental health]. PMID- 2666835 TI - [The respirable fraction: measurement and characterization]. AB - A definition is first of all made of the fractions of airborne dust that can deposit in the various regions of the respiratory apparatus, according to the aerodynamic size of the particles. Since the "respirable" fraction is the most important fraction from a medical point of view, instruments have always been developed that were designed to sample this portion of dust. The author describes the evolution of the criteria for sampling the "respirable" dust fraction and the contribution to research in this field made by the group of industrial hygienists of Milan, under the leadership of Prof. Zurlo, in particular with the development of the aeolian classifier. The results are reported of a comparison made between the four respirable dust selectors most widely used in European Community countries, that was carried out in a pyrite mine in Tuscany. The mean values obtained were practically identical, thus demonstrating that sampling techniques have now achieved proven homogeneity. PMID- 2666836 TI - [Sampling strategy and analytical problems in work environments]. AB - The paper reviews the problems involved in sampling and analysis of pollutants in working environments. Special attention is given to the practical consequences of the particular working conditions of to-day, which are characterized by low levels of environmental pollution but are at the same time subject to the presence of mixtures of chemical substances. There is no doubt that the time has come to attempt to reach the greatest possible consensus on these problems (e.g., analytical procedures for complex mixtures). Guidelines and procedures are indicated for the control of indoor pollution and indoor air quality limits are proposed both for long-term (ALTER) and short-term (ASTER) exposures. PMID- 2666837 TI - [Sampling of gaseous pollutants: evolution of passive samplers]. AB - A synthetic historical review is made of the evolution of passive samplers and of their corroborating tests. The main factors which can influence their efficiency are discussed and also how far the passive system can be considered innovative and advantageous compared to the traditional sampling methods for gaseous pollutants. PMID- 2666838 TI - Cefixime--a new oral cephalospalosin. PMID- 2666839 TI - [Seroepidemiologic studies in helminthiasis]. AB - Epidemiological parameters subjected to variations corresponding to immunological structure of population are outlined on the basis of brief characteristics of immunity specificity in helminthiasis patients. Main trends in seroepidemiological studies are established. Authors analyzed the feasibility of assessment of some constituents of epidemic processes of various nosoforms by means of serological screening at the population level. PMID- 2666840 TI - [Prevention of pneumonia in artificial respiration therapy]. PMID- 2666841 TI - [Parkinson syndrome. II: New aspects of therapy]. PMID- 2666842 TI - Dimorphism in Histoplasma capsulatum: a model for the study of cell differentiation in pathogenic fungi. AB - Several fungi can assume either a filamentous or a unicellular morphology in response to changes in environmental conditions. This process, known as dimorphism, is a characteristic of several pathogenic fungi, e.g., Histoplasma capsulatum, Blastomyces dermatitidis, and Paracoccidioides brasiliensis, and appears to be directly related to adaptation from a saprobic to a parasitic existence. H. capsulatum is the most extensively studied of the dimorphic fungi, with a parasitic phase consisting of yeast cells and a saprobic mycelial phase. In culture, the transition of H. capsulatum from one phase to the other can be triggered reversibly by shifting the temperature of incubation between 25 degrees C (mycelia) and 37 degrees C (yeast phase). Mycelia are found in soil and never in infected tissue, in contrast to the yeast phase, which is the only form present in patients. The temperature-induced phase transition and the events in establishment of the disease state are very likely to be intimately related. Furthermore, the temperature-induced phase transition implies that each growth phase is an adaptation to two critically different environments. A fundamental question concerning dimorphism is the nature of the signal(s) that responds to temperature shifts. So far, both the responding cell component(s) and the mechanism(s) remain unclear. This review describes the work done in the last several years at the biochemical and molecular levels on the mechanisms involved in the mycelium to yeast phase transition and speculates on possible models of regulation of morphogenesis in dimorphic pathogenic fungi. PMID- 2666843 TI - The family of highly interrelated single-stranded deoxyribonucleic acid plasmids. AB - Many plasmids from gram-positive bacteria replicate via a single-stranded deoxyribonucleic acid (ssDNA) intermediate, most probably by a rolling-circle mechanism (these plasmids are referred to in this paper as ssDNA plasmids). Their plus and minus origins are physically separated, and replicative initiations are not simultaneous; it is this feature that allows visualization of ssDNA replication intermediates. The insertion of foreign DNA into an ssDNA plasmid may provoke a high frequency of deletions, changes of replicative products to high molecular-weight forms, segregational loss, and decreased plasmid copy numbers. When an ssDNA plasmid is inserted into the chromosome, both deletions and amplifications may be induced. Both the mode of replication and the copy control mechanism affect the fate of inserted foreign material, usually selecting for its loss. Thus, after having tasted various morsels of DNA, the resulting plasmid stays trim. The features of the ssDNA plasmids seem to be beneficial for their viability and propagation, but not for their use as cloning vectors. However, plasmids replicating via ssDNA intermediates are being exploited to yield insights into the mechanisms of recombination and amplification. PMID- 2666844 TI - Insecticidal crystal proteins of Bacillus thuringiensis. AB - A classification for crystal protein genes of Bacillus thuringiensis is presented. Criteria used are the insecticidal spectra and the amino acid sequences of the encoded proteins. Fourteen genes are distinguished, encoding proteins active against either Lepidoptera (cryI), Lepidoptera and Diptera (cryII), Coleoptera (cryIII), or Diptera (cryIV). One gene, cytA, encodes a general cytolytic protein and shows no structural similarities with the other genes. Toxicity studies with single purified proteins demonstrated that every described crystal protein is characterized by a highly specific, and sometimes very restricted, insect host spectrum. Comparison of the deduced amino acid sequences reveals sequence elements which are conserved for Cry proteins. The expression of crystal protein genes is affected by a number of factors. Recently, two distinct sigma subunits regulating transcription during different stages of sporulation have been identified, as well as a protein regulating the expression of a crystal protein at a posttranslational level. Studies on the biochemical mechanisms of toxicity suggest that B. thuringiensis crystal proteins induce the formation of pores in membranes of susceptible cells. In vitro binding studies with radiolabeled toxins demonstrated a strong correlation between the specificity of B. thuringiensis toxins and the interaction with specific binding sites on the insect midgut epithelium. The expression of B. thuringiensis crystal proteins in plant-associated microorganisms and in transgenic plants has been reported. These approaches are potentially powerful strategies for the protection of agriculturally important crops against insect damage. PMID- 2666846 TI - Side effects of therapeutic drugs against organophosphate poisoning. AB - The possible side effects of therapeutic drugs against organophosphate poisoning were investigated. First, dose-effect curves were obtained with atropine sulphate (AS), P2S, obidoxime, aprophen, N-methylatropine nitrate and HI-6. The first three drugs are currently used in the therapy of organophosphate poisoning, the others are potentially useful candidates. Automated tests measuring open field behavior, motor coordination and shuttlebox performance, as well as neurophysiological techniques such as the quantified EEG (qEEG) and visual evoked responses were used. The sign-free doses of these compounds were determined; it appeared that open field behavior and the qEEG were the most sensitive methods for these drugs. Subsequently, these two methods were used to investigate the effects of the combinations of AS and P2S, AS and obidoxime or AS and HI-6, each compound given in a sign-free dose. Synergistic or additive effects were found with the combination of AS and P2S, which were smaller with the combination of AS and obidoxime and absent with the combination of AS and HI-6. These results indicate that the untimely use (false alarm, panic) of the current drug combinations may cause undesirable side effects. PMID- 2666847 TI - Medical expansionism: some implications for psychiatric nursing practice. AB - The paper discusses how health care models in general have been influenced by the authors' concept of 'medical expansionism'. Emphasis is given to addressing the impact of medical theory and practice on models of psychiatric nursing. The initial section discusses the concepts of medicalisation and medical imperialism, offering general health definitions and examination of mental health problems in more detail. From this analysis a definition is presented of a medical model in psychiatry. The effects of this model of health care on the future development of nursing models in psychiatry is discussed. PMID- 2666845 TI - Synthesis of ribosomes in Saccharomyces cerevisiae. AB - The assembly of a eucaryotic ribosome requires the synthesis of four ribosomal ribonucleic acid (RNA) molecules and more than 75 ribosomal proteins. It utilizes all three RNA polymerases; it requires the cooperation of the nucleus and the cytoplasm, the processing of RNA, and the specific interaction of RNA and protein molecules. It is carried out efficiently and is exquisitely sensitive to the needs of the cell. Our current understanding of this process in the genetically tractable yeast Saccharomyces cerevisiae is reviewed. The ribosomal RNA genes are arranged in a tandem array of 100 to 200 copies. This tandem array has led to unique ways of carrying out a number of functions. Replication is asymmetric and does not initiate from every autonomously replicating sequence. Recombination is suppressed. Transcription of the major ribosomal RNA appears to involve coupling between adjacent transcription units, which are separated by the 5S RNA transcription unit. Genes for many ribosomal proteins have been cloned and sequenced. Few are linked; most are duplicated; most have an intron. There is extensive homology between yeast ribosomal proteins and those of other species. Most, but not all, of the ribosomal protein genes have one or two sites that are essential for their transcription and that bind a common transcription factor. This factor binds also to many other places in the genome, including the telomeres. There is coordinated transcription of the ribosomal protein genes under a variety of conditions. However, the cell seems to possess no mechanism for regulating the transcription of individual ribosomal protein genes in response either to a deficiency or an excess of a particular ribosomal protein. A deficiency causes slow growth. Any excess ribosomal protein is degraded very rapidly, with a half-life of 1 to 5 min. Unlike most types of cells, yeast cells appear not to regulate the translation of ribosomal proteins. However, in the case of ribosomal protein L32, the protein itself causes a feedback inhibition of the splicing of the transcript of its own gene. The synthesis of ribosomes involves a massive transfer of material across the nuclear envelope in both directions. Nuclear localization signals have been identified for at least three ribosomal proteins; they are similar but not identical to those identified for the simian virus 40 T antigen. There is no information about how ribosomal subunits are transported from the nucleus to the cytoplasm.(ABSTRACT TRUNCATED AT 400 WORDS) PMID- 2666850 TI - Bioactive recombinant methionyl bovine prolactin: structure-function studies using site-specific mutagenesis. AB - A method has been developed for the extraction from transformed Escherichia coli cells of methionyl bovine PRL (met-bPRL) in a relatively pure form. While the extracted met-bPRL was as reactive as the native hormone with respect to polyclonal anti-bPRL antibodies, its bioactivity, as measured by the Nb2 lactogen in vitro bioassay, was relatively low. The bioactivity of the met-bPRL could be increased to the same order as that of the native hormone by treatment with a mixture of oxidized and reduced thioredoxin. A number of variant met-bPRLs containing specific amino acid changes have been generated by site-specific mutagenesis. The changes involved the substitution (or deletion) of some of the conserved amino acids in bPRL by the different amino acids present at the corresponding positions in the related, but nonlactogenic bovine GH. Nine mutants containing single amino acid changes had bio- and immunoactivities of the same order as those of met-bPRL. One mutant, which incorporated two of the single amino acid changes (serine 62 to threonine and threonine 65 to alanine), had immunoactivity approximating that of met-bPRL but much lower bioactivity (45%). A further mutant, generated by the deletion of tyrosine 28, had essentially no bioactivity although it could not be distinguished immunologically from met-bPRL or bPRL. The findings are discussed in the light of the putative three dimensional PRL structure and current hypotheses which seek to relate specific regions of PRL to lactogenic activity. It appears that the first putative alpha helix of bPRL is important for the binding and mitogenic activity of the hormone. PMID- 2666849 TI - Disassembly and reconstitution of yeast 60S ribosomal subunits. AB - Yeast 60S ribosomal subunits have been dissociated by reversible modification with dimethylmaleic anhydride. Treatment with 40 mumol reagent/ml releases 35% of the protein, producing core particles inactive in polyphenylalanine synthesis, which are totally or highly deficient in 17 different proteins. This preparation of residual particles recovers 45% of the original activity upon incubation with the released proteins. The reconstituted particles can be isolated by centrifugation without loss of activity, having the protein composition of the original subunits. PMID- 2666848 TI - Molecular mechanisms of collagen gene expression. AB - Collagens are a structurally and functionally heterogenous group of proteins encoded by a family of genes that share evolutionary history. Collagen gene expression is regulated both in developmental, tissue-specific manners as well as in response to a variety of biologic and pharmacologic inducers. In the present review we have attempted to synthesize a conceptual overview of the available information from studies aimed at deciphering the molecular mechanisms of collagen gene expression. We have chosen to focus our discussion mainly, although not exclusively, to observations relating to type I collagen gene for a number of practical reasons. The underlying theme that emerges from this survey of the literature is that the regulation of collagen gene expression is complex, utilizing transcriptional, posttranscriptional and translational mechanisms. Although the transcriptional control mechanisms that involve activation and modulation of collagen gene transcription by RNA polymerase II appear to predominate, preferential stabilization of collagen mRNAs and modulation of translational discrimination appear to play significant roles in the regulation of collagen biosynthesis under some physiological situations. Molecular organization of the regulatory regions of collagen genes reveal a mosaic of subdomains with overlapping sequence motifs, involved in positive and negative transcriptional regulation. The precise identity of the cis-acting subdomains of the promoter/enhancer-proximal DNA of collagen gene and how they interact with the trans-acting nuclear protein(s) have yet to be elucidated and will remain the focus of future studies. PMID- 2666851 TI - Release of an endothelial cell growth factor from cultured porcine thyroid follicles. AB - It has been proposed from in vivo studies that thyroid angiogenesis during thyroid enlargement may be due to paracrine mitogenic factors released by epithelial thyroid cells. To study this paracrine growth regulating communication between thyroid cells and endothelial cells in vitro, culture medium from isolated porcine thyroid follicles was investigated for a growth promoting effect on porcine aortal endothelial cells. Serum-free conditioned medium (CM) from thyroid follicles in suspension culture contains a dose-related mitogenic activity which stimulates endothelial cell growth up to 197%. Stimulation of the thyroid follicles with TSH (1 mU/ml) significantly reduced the mitogenic activity for endothelial cells in CM to 131%. Thyroid hormones had no influence on mitogenic activity in CM. When follicles were treated with iodide (20 microM) during CM production, no proliferation of endothelial cells was observed by this CM. In contrast, CM from epidermal growth factor-treated thyroid follicles significantly enhanced the mitogenic activity for endothelial cells up to 235%. The mitogenic activity was precipitable by saturated ammonium sulfate, showed high affinity to heparin by chromatography on heparin-sepharose, and was abolished after treatment of CM with trypsin. On gel electrophoresis the heparin binding fraction showed a double band with a mol wt of 15 and 15.5 k. These data show a paracrine mitogenic activity on endothelial cells released by thyroid follicles which is regulated by TSH, epidermal growth factor, and iodide in parallel with the direct effect of these substances on thyroid cell growth. The data suggest that the mitogenic factor is a polypeptide, which belongs to the heparin-binding growth factors. PMID- 2666852 TI - Cryptococcus neoformans in the seminal fluid of an AIDS patient. A contribution to the clinical course of cryptococcosis. AB - In a 33-year-old HIV-positive homosexual male suffering from unexplained headache, cryptococcosis was diagnosed in a progressive secondary stage. After treatment with the standard combination therapy of amphotericin B + flucytosine for 34 d, the patient was clinically symptom-free and discharged, upon his own request, from the hospital. He remained under ambulatory mycological control. After an interval of 65 d during which the urine had been free from Cryptococcus neoformans (Cr.n.), the fungus could not be isolated from urine but 3 X 10(5) CFUs/ml were found in the seminal fluid. Andrologically, teratospermia and hyposemia were present. There were no clinical signs in the genitourinary tract including the prostate. The significance of ecological niches for Cr.n. colonization of the genitourinary tract after antimycotic therapy is discussed. In such cases, in addition to cultural examination of urine for Cr.n. by the membrane filtration technique (MFT) and Staib agar, an additional cultural examination of seminal fluid is recommended. It is also proposed to pay more attention to Cr.n. in andrological examinations. Special regard should be given to a possible occurrence of Cr.n. in the seminal fluid of AIDS patients. In cytology of the seminal fluid, use of the Giemsa stain is unsuitable for the purpose of Cr.n. detection. For this reason, it should be supplemented by PAS staining. PMID- 2666853 TI - [15N tracer kinetics of the utilization of yeast nitrogen]. AB - The utilization of nitrogen from 15N-labeled Saccharomyces cerevisiae cells was studied in 6 infants by means of oral pulse labeling, comparing native and heat treated yeast cells. The 15N dose used was 3 mg/kg. The body weight of the subjects varied between 5500 and 9400 g. The yeast cells were harvested from a culture medium which contained 15N ammonium chloride as the only source of nitrogen. The 15N-enrichment of the cells amounted to 95 atom-%. In the course of 48 h following the administration of the native yeast cells, 11% of the tracer dose were renally excreted. The corresponding value after labeling with heat treated yeast cells was 17.9%. The cumulative renal excretion of the tracer tended to be faster as compared with pulse labeling of the native yeast cells. A paired comparison with labeled native and heated yeast cells in 3 subjects did not reveal any differences in the retention rate of 15N. When untreated 15N yeast cells were administered, 13.2% of the tracer dose were excreted in the urine and 10% respectively in the faeces. The retention was 76.8%. After single pulse labeling with 3 mg 15N/kg from heat-treated yeast cells the corresponding values were 19.4%, 4.4% and 76.2%, respectively. The kinetic of the renal 15N excretion points at the partial absorption of the yeast nitrogen from the colon. PMID- 2666854 TI - Benveniste controversy. INSERM closes the file. PMID- 2666855 TI - Bacteria-yeast conjugation. Generic trans-kingdom sex? PMID- 2666856 TI - Bacterial conjugative plasmids mobilize DNA transfer between bacteria and yeast. AB - Conjugative plasmids of Escherichia coli can mobilize DNA transmission from this bacterium to the yeast Saccharomyces cerevisiae. The process shares some of the features of conjugation between bacteria and could be evolutionarily significant in promoting trans-kingdom genetic exchange. PMID- 2666857 TI - Drugs testing. Parallel trial controversy. PMID- 2666858 TI - More grist for Dingell's mill. PMID- 2666859 TI - Isomerase modification. PMID- 2666860 TI - Erythrocyte knobs and malaria. PMID- 2666861 TI - Complete mutagenesis of the HIV-1 protease. AB - Retroviruses encode a protease which needs to be active for the production of infectious virions. A disabling mutation in the protease results in the production of non-infectious virus particles and examination of proteins from these mutant virions reveals unprocessed Gag and Gag-Pol precursor proteins, the substrates of the viral protease. Each amino acid of the HIV-1 protease was individually mutated using a simple mutagenesis procedure which is capable of introducing and identifying missense mutations in each residue of a protein. Phenotypic screening of these mutants in a heterologous assay system reveals three regions within the protease where multiple consecutive amino-acid residues are sensitive to mutation. These results show that random mutagenesis can be used to identify functionally important regions within a protein. Mutants with conditional phenotypes have also been identified within this collection. PMID- 2666862 TI - Leprosy vaccine: India finally agrees to trials. PMID- 2666863 TI - Association of class I major histocompatibility heavy and light chains induced by viral peptides. AB - We describe a cell in which association of a major histocompatibility complex class I heavy chain with beta 2-microglobulin is induced by a peptide derived from influenza nucleoprotein. Association of antigenic peptides with the binding site of class I molecules may be required for correct folding of the heavy chain, association with beta 2-microglobulin and transport of the antigen-MHC complex to the cell surface. PMID- 2666864 TI - [Which kidneys can be used for transplantation?]. PMID- 2666865 TI - [Alopecia areata; pathogenesis and topical immunotherapy]. PMID- 2666866 TI - The state of Nebraska, Medicaid, the Sunderbruch Corporation & you. PMID- 2666867 TI - [Surgical lesions of the brain stem]. PMID- 2666868 TI - Inheritance of Alzheimer's disease: epidemiologic evidence. AB - The available evidence suggests that there may be two subtypes of AD-- inherited and noninherited. Inherited AD may have certain characteristics, e.g. younger age at onset and some clinical signs or symptoms, which distinguish them from noninherited cases. It is possible that the noninherited type of AD may also have a similar genetic defect as the inherited kind, the only difference being that in one case the defect is inherited from the parents and in the other the defect arises de novo during embryogenesis. An environmental factor operating during embryogenesis may be responsible for causing a genetic defect which later manifests as noninherited AD. Currently, however, there is no precise way to separate these two subtypes. The exact proportion of all cases of AD which are inherited on a genetic basis is not known, but it must be small. The mode of inheritance of genetic AD is not known. It must be emphasized that the subtypes of inherited and noninherited AD are not synonymous with the older categorization of AD into presenile and senile AD. PMID- 2666869 TI - Production and characterization of biologically active recombinant human nerve growth factor. AB - Nerve growth factor (NGF) is required for the differentiation and maintenance of sympathetic and sensory neurons. In animal models, NGF prevents the death of septal and basal forebrain cholinergic neurons deprived of endogenous NGF, suggesting that NGF may be of benefit in neurodegenerative diseases of humans. However, little is known about NGF in human brain, partly because a sensitive assay for hNGF has been lacking. As a first step toward developing the tools for the study of NGF in humans, recombinant human NGF (rhNGF) was produced by expressing exon 4 of the human NGF gene in COS cells. The expression vector is driven by the adenovirus major late promoter and contains an SV40 origin of replication. NGF was secreted by transiently transfected cells. Conditioned medium was assayed with an enzyme immunoassay (EIA) that utilizes a monoclonal antibody (clone 27/21) against mouse beta-NGF, and contained 15 ng/ml of rhNGF. The rhNGF migrated as a dimer of 26-29 Kd on a gel permeation chromatography column, and stimulated neurite outgrowth and neuropeptide Y mRNA levels in PC12 cells. With optimization, the described expression system is capable of providing sufficient hNGF for research and therapeutic purposes. PMID- 2666870 TI - Examination of a possible mechanism by which anisomycin suppresses pulsatile luteinizing hormone release in ovariectomized rats. AB - An initial study was performed to ascertain the effects of anisomycin, a reversible inhibitor of protein synthesis, on pulsatile luteinizing hormone (LH) release in adult, ovarietomized (OVX) rats. For this experiment, rats OVX 3-4 weeks earlier were fitted with indwelling atrial cannulae. On the next day (approximately 13.00 h), the rats received a subcutaneous injection of either 100 mg/kg body weight (BW) anisomycin or its saline vehicle. Administration of anisomycin significantly suppressed mean plasma LH levels, mean trough values, and both LH pulse frequency (saline: 6.3 pulses/3 h vs. anisomycin: 2.7 pulses/3 h) and amplitude. To determine whether anisomycin affected anterior pituitary LH responses to LH-releasing hormone (LHRH), a second experiment was performed in which saline- and anisomycin-treated OVX rats were given an intravenous injection of 10 ng/100 g BW LHRH 1.5 h later (14.30 h). Rats then were sacrificed and the anterior pituitary and brain removed. Whereas preinjection plasma LH levels were significantly lower in anisomycin-treated rats, they were significantly higher in anisomycin-treated rats 20 min after LHRH. Consequently, mean maximal increments and percent increments were significantly higher in anisomycin-treated rats. AP LH content and content of LHRH in the medial preoptic and suprachiasmatic nuclei were not influenced by anisomycin treatment. However, median eminence (ME) LHRH concentrations in anisomycin-treated rats were almost double the LHRH levels measured in control rats. A third study was conducted to assess the effects of anisomycin on basal and potassium (K+)-stimulated LHRH release from superfused ME explants.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 2666871 TI - Spontaneous changes in LHRH release during the rat estrous cycle, as measured with repetitive push-pull perfusions of the pituitary gland in the same female rats. AB - In the present study, we examined the in vivo release profiles of luteinizing hormone-releasing hormone (LHRH) during the rat estrous cycle by utilizing repetitive push-pull perfusions of the anterior pituitary in the same freely behaving animal. Throughout the estrous cycle, LHRH levels were higher than those reported from previous work using a push-pull cannula placed in the mediobasal hypothalamus. A significant increase in LHRH input to the anterior pituitary was obtained in proestrus (Pro), though the magnitude of increment was different among animals. This LHRH increment in Pro was attributable to a significant increase in the amplitude of LHRH pulses. Interestingly, no changes were observed in the frequency of LHRH pulses (about 1 pulse/50 min) throughout the estrous cycle. The data demonstrate that the anterior pituitary of female rats receives an increased amount of LHRH during Pro due to changes in the amplitude of the LHRH signal without changes in the frequency. PMID- 2666872 TI - Neuronal cell bodies in the hypothalamic paraventricular nucleus mediate stress induced renin and corticosterone secretion. AB - The present studies were undertaken to determine the involvement of neurons in the hypothalamic paraventricular nucleus (PVN) in stress-induced renin secretion. The stressor was a 10-min conditioned emotional response (CER) paradigm. Bilateral electrolytic lesions in the PVN prevented the stress-induced increase in plasma renin activity (PRA), and plasma renin concentration (PRC). Stress induced corticosterone secretion was also blocked, supporting the histological verification and suggesting that the lesion included corticosterone-releasing factor neurons in the PVN. Stress-induced renin secretion appears to be restricted to the PVN, as electrolytic lesions in the nucleus reuniens, dorsal and caudal to the PVN, did not prevent the stress-induced increase in either PRA or PRC. The next step was to determine whether cell bodies in the PVN or fibers of passage through the PVN mediate the stress-induced increase of these hormones. For this purpose, bilateral stereotaxic injections of the cell-selective neurotoxin ibotenic acid (10 micrograms/microliter; 0.3 microliters per side) were performed 14 days prior to the stress procedure. Histological evaluation of the tissue revealed cell death and lysis in the PVN. Ibotenic acid injection into the PVN prevented the effect of stress on PRA, PRC and corticosterone levels. None of the lesions prevented the stress-induced rise in plasma prolactin concentration. These results suggest that neurons in the PVN play an important role in mediating stress-induced increases in renin and corticosterone but not prolactin secretion. PMID- 2666873 TI - Inhibition of proestrous LH surge and ovulation in rats evoked by stimulation of the medial raphe nucleus involves a GABA-mediated mechanism. AB - The neurotransmitters involved in the inhibition of luteinizing hormone (LH) release induced by electrochemical stimulation (anodic d.c., 100 microA/30 s) of the medial raphe nucleus (MRn) were studied. Stimulation applied at noon on the day of proestrus blocked the preovulatory surge of LH and ovulation. This effect was prevented by pretreating the animals (15 min before stimulation) with the 5 HT antagonist, methysergide (3.5 mg/kg, i.p.). The inhibition of LH release induced by stimulation of the MRn was also suppressed by the injection of the gamma-aminobutyric acid (GABA) antagonists, picrotoxin (0.8 mg/kg, i.p.) and bicuculline (6 mg/kg, i.p.). Injection of 5-HT (15 micrograms) into the third ventricle on the day of proestrus mimicked the effect of MRn stimulation, a response which was prevented by methysergide, picrotoxin or bicuculline. An intraventricular injection of GABA (10 micrograms) also inhibited the preovulatory surge of LH and ovulation, but whereas the administration of bicuculline prevented the effect of GABA, that of methysergide failed to produce any change. It is concluded that stimulation of the MRn inhibits the proestrous surge of LH by activating a serotonergic pathway and that the effect is mediated by GABAergic neurons. PMID- 2666874 TI - Depression of decerebrate rigidity in the rat by antagonists of excitatory amino acids. AB - Effects of intravenous antagonists of excitatory amino acids on decerebrate rigidity in the rat were examined. Kynurenate, ketamine, (4S, 5R)-4-(2 methylpropyl)-3-[3-(perhydroazepin-1-yl)propyl]-5-phenyl- 1,3- oxazolidin-2-one hydrochloride (MLV-6976), (+)-5-methyl-10,11-dihydro-5H-dibenzo[a,d] cyclo-hepten 5,10-imine maleate (MK-801), 3-((/-)-2-carboxypiperazin-4-yl)-propyl-1-phosphonic acid (CPP) and DL-2-amino-7-phosphonoheptanoic acid (APH) reduced the severity of decerebrate rigidity in a dose-dependent manner, although there was a large variability in the effective doses. The blood pressure, which was determined simultaneously, did not show a uniform change in the presence of these antagonists. The time course of the change of the blood pressure did not coincide with that of decerebrate rigidity. These results suggest a possibility that the glutamatergic system may function, at least in part, in the onset of the decerebrate rigidity. PMID- 2666875 TI - Solubilization of stereospecific and quisqualate-sensitive activity of [3H]glutamate binding in the pituitary of the rat. AB - Binding activity of a putative central excitatory neurotransmitter, L-glutamic acid, was solubilized from the pituitary glands of the rat by treatment of the membranous homogenates with a nonionic detergent, Nonidet P-40. The binding activity of [3H]glutamic acid increased linearly with increasing concentrations of the solubilized proteins, up to 15 micrograms. The binding activity reached an equilibrium within 10 min at 2 degrees C, while the time required to attain equilibrium at 30 degrees C was 60 min. Addition of an excess of nonradioactive glutamic acid rapidly decreased the activity detected at 30 degrees C, to the nonspecific binding level. Scatchard analysis of these data revealed that the solubilized binding activity consisted of a single component with a Kd of 0.34 microM and a Bmax of 53.6 pmol/mg protein. L-Glutamic but not D-glutamic acid inhibited the binding activity in a concentration-dependent manner, at the concentration range greater than 10(-8) M. An agonist for a certain subclass of the central glutamate receptors, quisqualic acid, significantly inhibited the solubilized activity, whereas the other two agonists, such as N-methyl-D-aspartic acid and kainic acid, had no significant effect. Reduction of the incubation temperature from 30 degrees C to 2 degrees C resulted in a drastic attenuation of the binding activity due to a decrement in the number of apparent binding sites. These results suggest that the binding activity of [3H]glutamic acid in the pituitary may be derived from a quisqualate-sensitive membranous constituent with a stereospecific high affinity for the central neurotransmitter. PMID- 2666876 TI - Leadership in neurosurgery. AB - These are challenging times for neurosurgery. Although no one can predict our future, great changes are in the wind--many of which we are powerless to prevent. We must all take on added social responsibility, above and beyond that of patient care. The leadership of your organization can only act with the support of active and concerned neurosurgeons who are willing to participate in many programs available to our profession. The individual must personally embrace the leadership standards of Sir William Osler and Harvey Cushing. One of the privileges of giving a presidential address is to pay public homage to those who have been supportive and instrumental in my long professional journey. During my residency, Dr. Dwight Parkinson was my mentor and teacher and set a wonderful standard for the ideal practice of neurosurgery. Decisions were black or white, never gray, with Dr. Parkinson, who left little doubt as to the correct way to handle clinical problems. He was, and continues to be, one of the most incisive, imaginative, innovative scientific minds in neurosurgery, and I owe him a great debt of gratitude. Two other men influenced my neurosurgical development. They are Dr. William Horsey, formerly neurosurgeon at the St. Michael's Hospital in Toronto, and Dr. Peardon Donaghy, with whom I spent a most enjoyable and productive year in Burlington at his microvascular neurosurgical laboratory. These two men demonstrated the humility, warmth, and kindness to patients that cannot be learned by formal study, but comes from observing the example of people who manifest those qualities in their own personality.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 2666877 TI - Intracranial and spinal meningiomas in patients with breast carcinoma: case reports. AB - Breast carcinoma has a high predisposition to metastasize to the brain parenchyma or spinal epidural space with development of progressive neurological symptoms and signs and frequently death of the patient. We report 8 patients with known breast cancer who developed neurological symptoms attributable to an intracranial meningioma and 1 patient who developed spinal cord dysfunction resulting from a thoracic meningioma. The removal of the meningiomas resulted in return of normal neurological function in all patients. At follow-up, all our patients are alive without evidence of meningioma or breast carcinoma recurrence, except 1 patient who died of a metastatic malignant melanoma. This clinical association requires repeated emphasis because of the potential benefit in management of patients with suspected metastatic disease. We have reviewed and summarized the reported literature and added our 8 cases. The mean age of presentation before the second tumor was 6 years. Breast carcinoma was diagnosed first in 85% of cases. The clinical symptoms of the meningiomas were focal neurological signs in 50% of the patients, raised intracranial pressure in 40%, and a seizure in 10%. PMID- 2666878 TI - Lipomeningioma: report of three cases and review of the literature. AB - Lipomeningioma is a benign tumor of the meninges that contains mature adipose tissue. It demonstrates fat density on computed tomographic scan and mixed signal intensities on magnetic resonance imaging scan. Although the pluripotential nature of the mesenchymal cell has long been recognized, only a single case with this diagnosis has been documented in the literature to date. Three patients with this diagnosis seen at the Johns Hopkins Hospital during the last two years are presented, and the literature is reviewed. PMID- 2666879 TI - Aspergillus disc space infection: case report and review of the literature. AB - Aspergillus disc space infection is an unusual complication of the immunocompromised state. Magnetic resonance imaging may aid the clinician in arriving at a prompt diagnosis of discitis in affected patients. We report a case of systemically acquired Aspergillus discitis at multiple levels diagnosed by plain x-ray films, bone scan, magnetic resonance imaging, and biopsy. We review the literature on this subject and suggest that aggressive diagnosis with early biopsy, treatment with systemic antifungal agents, and surgical debridement of the infected disc space yield the best outcome for these patients. PMID- 2666880 TI - Propionibacterium acnes causes postoperative brain abscesses unassociated with foreign bodies: case reports. AB - Propionibacterium acnes was isolated in pure culture from brain abscesses that occurred in two patients after intracranial surgery. Although such infections are usually associated with cerebrospinal fluid shunts and other foreign bodies, these cases clearly demonstrate the pathogenicity of this anaerobic diphtheroid in the absence of such. Progression of P. acnes infection in the central nervous system can be insidious. To treat such infections adequately, therapy cannot rely upon some standard antimicrobial agents. Metronidazole, which is useful against most anaerobic organisms, is not effective against P. acnes. PMID- 2666881 TI - Radiosurgery with the linear accelerator. PMID- 2666882 TI - Intramedullary cavernous angioma with trigeminal neuralgia: a case report and review of the literature. AB - A case of intramedullary cavernous angioma of the upper cervical spinal cord, initially associated with trigeminal neuralgia, is reported. Magnetic resonance imaging precisely depicted the entire extent of the lesion. The angioma was totally removed and the operation was successful in relieving the patient of neuralgia. The previously reported 23 cases of intramedullary cavernous angiomas are reviewed, and the clinical symptoms, diagnosis, and treatment of this rare condition are discussed. PMID- 2666883 TI - [Hyperandrogenism originating from the adrenal gland. Current observations on a clinical case]. AB - Recent reported data on hyperandrogenisms of suprarenal origin are presented and the case of a 26-year-old woman suffering from hirsutism and secondary amenorrhoea reported. Preoperative hormonal measurement showed very high Dehydroepiandrosterone (DHEA) levels (8,000 ng/ml) and a less dramatic increase in Androstenedione (A) and Testosterone (T), of 3.5 and 1.17 ng/ml respectively. Androgens were uniformly increased following administration of ACTH (250 micrograms for 3h for 2 days) and inhibited by intake of Desamethazone (8 mg/die for 3 days per os). ACTH values were low and failed to increase after insulin induced hypoglycaemic stimulus. Pelvic echography and laparoscopy showed normal ovaries. A suprarenal scan revealed slight bilateral hyperplasia with irregular trace distribution on the left. CT showed a slight anomaly of the left gland which appeared spherical with convex margins. Unilateral suprarenectomy was carried out and the controlateral gland explored. The removed gland presented a histological picture of "micronodular focal hyperplasia". Treatment was begun with Prednisone and temporary remission of the clinical and biochemical pictures was achieved but one year after the operation androgen concentration was found again to be abnormally increased. The final diagnosis was "Bilateral suprarenal hyperplasia" with initial unilateral involvement. To conclude, this particular hyperandrogenism with ACTH levels at the lower limits of normal and with underlying primary suprarenal hyperplasia may be included among the better known suprarenal hyperplasia syndromes responsible for the Cushing and Conn syndromes. PMID- 2666884 TI - [Comparative study of short-term antimicrobial chemoprophylaxis in gynecologic surgery: cefotetan versus cefazolin]. AB - The results obtained in 80 patients hospitalized at the University of Obstetrics and Gynecology Clinic in Perugia for abdominal and vaginal hysterectomy are reported and evaluated in a prospective and randomized study of perioperative antibacterial prophylaxis. In the 75 patients available to study a single intravenous dose of 2 g cefotetan was compared with a triple dose of 1 g intravenous cephazolin. A reduction in the incidence of post-operative infections both in abdominal hysterectomy from 24% (cephazolin group) to 11.53% (cefotetan group) and in vaginal hysterectomy from 40% (cephazolin group) to 71.4% (cefotetan group) was noted. These results show that a single intravenous dose of 2 g cefotetan can be considered a valid therapeutic support for antibacterial prophylaxis. In addition the absence of alterations in the parameters considered (haematological, biochemical and urinary) points to the safety, effectiveness and non-toxicity of the drug. PMID- 2666885 TI - [Effects of therapy and pregnancy on hyperprolactemia caused by a pituitary adenoma. A clinical case]. AB - A woman who presented with amenorrhea and galactorrhea with a large prolactinoma (8.5 mm) which regressed on bromocriptine therapy is described. When treatment with bromocriptine was instituted (10 mg/daily) mean serum prolactin concentration fell from 490 ng/ml to 108 ng/ml. Despite a progressive reduction in size up to disappearance of the adenoma after the first 5 years of therapy, prolactin levels remained high. Bromocriptine treatment was stopped after 6 years, when pregnancy was diagnosed. Pregnancy proceeded without complications and lactation was initiated and maintained. After 8 months of breast-feeding, menstrual function resumed spontaneously and bromocriptine therapy was no longer required. Bromocriptine can cause not only a decrease in serum prolactin levels but also a regression in the size of prolactinomas in hyperprolactinemic women. No problems associated with pregnancy and/or breast-feeding were noted in these patients. PMID- 2666886 TI - Idiopathic unilateral hyperlucent lung. AB - The entity of unilateral hyperlucent lung in the adult is presented as a disease which has its origins in childhood and carries the potential for cardiopulmonary morbidity. PMID- 2666887 TI - Pyrrolizidine alkaloids. PMID- 2666888 TI - Fatty acids and glycerides. PMID- 2666889 TI - The biosynthesis of shikimate metabolites. PMID- 2666891 TI - Software guide. Addendum. Software products for nursing applications. PMID- 2666890 TI - A race nearly lost. PMID- 2666892 TI - [Comparative evaluation of morphometric and intravital measurements of the intraorbital portion of the optic nerve and of the distance from the posterior pole of the eyeball to the common tendinous ring]. AB - The paper describes results of comparative assessment of morphometric and in vivo measurements of the intraorbital part of the optic nerve and the distance from the posterior pole of the eye ball to the muscular tendon ring. It is shown that the method of ultrasound scanning is accurate enough and may be used for measuring the length of the intraorbital part of the optic nerve and the distance from the posterior pole of the eye ball to the muscular tendon ring in each concrete case. PMID- 2666893 TI - [Ways of resolving the problem of secondary cataract]. PMID- 2666894 TI - [Various approaches to the diagnosis of initial open-angle glaucoma]. AB - Glaucoma is characterized by a triad of symptoms: increased intraocular pressure, widening of disc cupping and scotomata in the paracentral part of the visual field. Attempts to discern it by one of the symptoms only or, on the contrary, essentially to increase the number of the analysed signs prevent to improve early diagnosis of the disease. In the recent years, a particularly serious progress could be achieved thanks to perimetric studies, such as multiple statistical perimetry. The author and his associates have approved, on many thousands of patients, original methods for diagnosis of glaucoma with the help of a disc test and a glaucoma tester. Together with assessment of the eye fundus and intraocular pressure these perimetric data allowed to conduct a clear differential diagnosis of glaucoma, preglaucoma and increased intraocular pressure. The computerization of individual methods and creation of summary data in the computer bank memory open good perspectives for improvement of glaucoma diagnosis. PMID- 2666895 TI - Tumoral calcinosis with unusual dental radiographic findings. AB - Tumor calcinosis is a rare disease of unknown cause, manifesting itself as abnormal calcifications of cystic masses in the fibrous tissues adjacent to, but not involving, the joint spaces. A family with multiple siblings affected by tumoral calcinosis and found to have unusual dental radiographic findings consistent with varying degrees of expression of dentinal dysplasia is described. PMID- 2666896 TI - A rapidly fatal palatal ulcer: rhinocerebral mucormycosis. AB - A case of a patient with a palatal ulcer who was in a diabetic ketoacidotic coma is described. This ulcer proved to be the presenting sign of rhinocerebral mucormycosis. The patient had hemifacial swelling, ocular signs, and gross tissue destruction and died less than 4 weeks after she was first seen. PMID- 2666897 TI - Management of oral squamous cell carcinoma in situ with topical 5-fluorouracil and laser surgery. AB - Oral squamous cell carcinoma in situ has been described as a relatively rare lesion. However, difficult decisions with respect to clinical management of the lesion in this location parallel those reported for other mucosal sites, such as the cervix or the larynx. The lesion, though superficial, may extend over a large area of tissue, and attempts at irradication with surgery or radiation therapy may be associated with a great deal of morbidity. However, the risks in deferral of treatment while "watchfully waiting" may also be unacceptable. A method and rationale for management of oral squamous cell carcinoma in situ with the use of topical 5-fluorouracil and carbon dioxide laser are described in this article. A technique for using an intraoral prosthesis to potentiate drug delivery is also described. Though morbidity can be very significantly reduced, patient compliance is an important consideration for success with this protocol. PMID- 2666899 TI - [Fractures of the spine]. AB - The standard treatment for stable fractures of the spine is functional. Owing to the improvement of surgical methods and special implants, the percentage of operatively treated spine fractures has increased from 10% to 20%. In contrast to the necessity for multisegmental fixation with the rod instruments used formerly, the recently developed implants (plates, fixators) allow stable, brief, and therefore functionally more favourable immobilization. PMID- 2666898 TI - Primary osteosarcoma of the parotid gland. AB - Four cases of primary osteosarcoma of the parotid gland, where these tumors rarely occur, are presented. This neoplasm may arise after radiation therapy, but the majority arise de novo. As a group, extraosseous osteogenic sarcomas are aggressive and lethal. Patients with these tumors have an average 5-year survival rate of 15.6%. Of the four patients reported on two died within 6 months to 3 years, one has lung metastases, and one has been lost to follow-up. PMID- 2666900 TI - [Changes and progress in fracture treatment of the proximal and distal lower leg]. AB - In the treatment of proximal and distal tibial fractures, special attention has to be focused on the severity of tissue damage. Guidelines are given in the paper. (1) For tibial head fractures, stable internal fixation is usually necessary but should be delayed for 1 week. The best approach is lateral or ventral. The use of implants for buttressing has to be kept to a minimum. Concomitant ligamentous injuries are reconstructed, and damaged menisci should be preserved. (2) In the case of distal tibial fractures, those not involving the joint can be treated non-operatively. The internal fixation method by Ruedi is rarely indicated. When joint fractures involve tissue damage reconstruction is necessary. It is essential to achieve normal length of fibula. The joint is reconstructed with minimal use of implants. In addition, external fixation is usually necessary. PMID- 2666901 TI - [Fractures of the proximal humerus]. AB - The Neer four-part classification for displaced proximal humeral fractures is the most useful classification so far devised for consistent diagnosis and treatment. Nevertheless, there are several points in the Neer classification that need changing. Group II fractures, i.e., displaced fractures of the anatomical neck have a severe prognosis, excluding a mild graduation as in group II. Displaced four-segment fractures can be classified in group IV as well as in group V, which means the classification less than sharp. Without disregarding Neer's criteria, we use our own simplified classification: group A: extra-articular non-displaced two- to four-segment fractures; group B: extra-articular displaced two- to four segment fractures; group C: intra-articular impacted or dislocated two- to four segment fractures. The prognosis following fracture treatment is heavily influenced by the outcome of avascular necrosis of the head. Additionally, surgical treatment offers the change of further devascularization. Rigid plate fixation leads to a high incidence of avascular necrosis. In the case of displaced fractures, we prefer open reduction and internal fixation by means of tension-band wiring. Screws have a limited use in the presence of decreased pullout strength in osteoporotic bone. A Neer II prosthesis is indicated as a primary procedure for impacted fractures of the humeral head, displaced or dislocated four-part fractures and dislocated three-part fractures in elderly patients. In other patients primary open reduction with internal fixation is preferred. Relief of impaction of the humeral head should be avoided. In case of a late osteonecrosis in younger patients hemiarthroplasty is indicated as a secondary procedure. PMID- 2666902 TI - [Fractures of the distal end of the radius]. AB - Attitudes to the treatment of distal radial fracture are now more critical than previously, especially where intraarticular fracture is concerned. Inadequate primary reduction and such complications as redislocation or dystrophic problems lead to poor results. Quantification of fracture instability is becoming increasingly important in fracture classification, determination of the indications for the different treatment modalities and management. Accurate anatomical reduction also improves later function. The quality of alignment attained during the treatment depends on the quality of reduction. Closed reduction by means of traction should be achieved by pulling on fingers I, II and IV. The radial dislocation should be corrected first and then the dorsal dislocation; a cast applied to the lower arm is sufficient for immobilization. Primary surgery is indicated more urgently and the type of surgery in more detail, for example, when there are steps in the articular surface or when there is more than one factor in instability. Pin fixation should be applied sooner and more frequently with either primary or early secondary indications. Plate fixation is mostly achieved from the volar surface; it is indicated in flexion fractures and sometimes in extension fractures, but only in combination with rigid screw fixation with or without bone grafting. We are finding increasingly more indications for external fixation, not only in the case of open fractures with soft tissue damage but also with multiple fragments or comminuted fractures, sometimes in combination with bone grafting. PMID- 2666903 TI - [Changes and progress in fracture treatment in polytrauma]. AB - The last 20 years have seen a great deal of controversy about the indications for and the timing of operative fracture treatment in multiply injured patients. In central Europe a standardized concept of treatment has been widely adopted since the late 1970s. In this concept a few types of fractures are given a high priority and are operated on early. Most fracture types, however, are not stabilized by internal fixation until several days after the injury. The treatment of closed femoral shaft fractures is still hotly debated. So far, not a single prospective study proving the advantages or disadvantages of early fixation has been published. PMID- 2666904 TI - The human dbl-proto-oncogene product is a cytoplasmic phosphoprotein which is associated with the cytoskeletal matrix. AB - The translational product of the dbl oncogene is a 66 kDa (p66) protein with no apparent sequence similarity to any of the known oncogene products, whereas the human dbl proto-oncogene encodes a translational product of 115 kDa (p115). We compared proto-dbl p115 and dbl p66 with respect to their subcellular localization, biogenesis and post-translational modifications. Like p66, p115 was found to be a cytoplasmic phosphoprotein present in both cytosol and crude membrane preparations. Membrane fractionation studies revealed that p115 as well as p66 were primarily associated with fractions enriched in plasma membranes, suggesting that this subcellular compartment is a likely site of action of dbl proteins. The membrane-associated forms of p115 and p66 were fairly resistant to solubilization by nonionic detergents, suggesting that dbl proteins associate with the cytoskeletal matrix. p115 was also found to be phosphorylated primarily on serine residues. However, p115 was phosphorylated to a lesser extent as compared to the phosphorylated form of p66. The half-life of proto-dbl p115 was significantly shorter (1 hour) than that of dbl p66 (5-6 h). The higher stability of p66 is likely due to the acquisition of unrelated human sequences and/or to the deletion of the N-terminal region of proto-dbl. PMID- 2666905 TI - Expression of the c-rel and c-myc proto-oncogenes in avian tissues. AB - Reticuloendotheliosis virus (REV-T) transforms very immature avian lymphoid cells and induces a rapidly fatal lymphoma. The viral oncogene, v-rel, encodes a 59 kDa phosphoprotein which is complexed with cellular proteins in the cytosol of REV-T transformed lymphoid cell lines. The proto-oncogene, c-rel, has been highly conserved among both vertebrate and invertebrate species. The expression of both the c-rel and c-myc protoncogenes was characterized during avian development. Two distinct rel-related transcripts were detected. A 4.0kb mRNA was the principal transcript expressed in cells of hematopoietic origin with highest levels detected in bursa, thymus, and spleen tissue obtained from hatched birds. Relatively low levels of this 4.0 kb transcript were detected in nonhematopoietic tissues. Thus, the distribution of this mRNA correlated with the presence of target cells for transformation by v-rel. The 4.0 kb c-rel transcript had a half life of nearly 2 h in an avian lymphoid cell line. A second rel-related transcript was identified in the ovary of young hens and appeared to be expressed either in primary oocytes or in the developing follicle. This 2.6 kb c-rel mRNA was detected at substantially lower levels in cells of hematopoietic origin. Using radiolabeled RNA probes, the 2.6 kb c-rel transcript was not detected in liver, brain, testes, or muscle. The c-myc proto-oncogene was also expressed in cells of hematopoietic tissue and ova obtained from hatched birds. While intermediate RNA levels were observed in muscle and liver cells, the c-myc gene was not expressed in avian testes. PMID- 2666906 TI - Oncogenes conferring metastatic potential induce increased branching of Asn linked oligosaccharides in rat2 fibroblasts. AB - Increased -GlcNA beta-6 Man alpha 1-6 Man beta 1- branching of Asn-linked oligosaccharides has been observed in a number of rodent and human tumor cell lines and the structures have been correlated with enhanced metastatic potential of murine tumor cells. Here we have compared the malignant potential and levels of beta 1-6-branched oligosaccharides in rat 2 fibroblast transfected with the cytoplasmic tyrosine kinase v-fps/fes, the activated GTPase T24 H-ras, and the nuclear oncogene c-myc. Rat2 cells transfected with activated c-myc were non tumorigenic in nude mice and did not show elevated levels of beta 1-6 branched oligosaccarides, whereas transfectants carrying H-ras or v-fps were tumorigenic and generally exhibited metastatic potential which was associated with increased beta 1-6 branching. Enhanced expression of beta 1-6 branched oligosaccharides did not correlate with increased ratios of UDP-HexNAc to UDP-Hex, but was accompanied by elevated GlcNAc-transferase V activity, increased sensitivity of the cells to the toxic effects of leukoagglutinin, and an altered intracellular distribution of beta 1-6-branched oligosaccharides as visualized by fluorescent lectin staining. These results provide information on the quantitative and qualitative relationships between oncogene expression and cellular glycosylation and suggest that the ability of an oncogene to confer metastatic potential may be related to its ability to induce increased branching of Asn-linked oligosaccharides. PMID- 2666907 TI - Point mutations in both transforming and non-transforming codons of the N-ras proto-oncogene of Ph+ leukemias. AB - The distribution and frequency of point mutations in the first and second coding exons of the N-ras proto-oncogene was examined in 6 cases of Philadelphia positive (Ph+) hemopoietic malignancies. To increase the detection sensitivity of the mutations and to estimate more accurately the frequency of abnormal alleles in the hemopoietic cell population, a polymerase chain reaction (PCR)/shotgun cloning/double stranded DNA sequencing method was used. Mutations activating the ras oncogenes involving codon 61 were observed in 5 out of 6 cases; in one of these cases (CML3), mutation at codon 61 involved a two base transition. Mutations involving codon 59 were also observed in one case (CML1). In longitudinal studies of 3 cases of chronic myelogenous leukemia samples obtained at the time of initial diagnosis and 5 to 7 years later, a multiplicity of mutations were detected at the time of initial diagnosis prior to any therapy. In one case (CML3), a mutation in codon 61 detected at diagnosis was still present 5 years later, in a second case (CML1) a mutation in codon 61 appeared during the course of the disease and persisted for at least one year, and in the third case (CML2) a mutation in codon 61 was present at diagnosis but absent 5 years later. In one instance (CML1) a mutation in codon 59 was present at the time of initial diagnosis but was not detectable in later samples. Several other point mutations leading to aminoacid changes were scattered predominately through the second exon but were not consistently detected in longitudinal studies on cells from the same patient. The data suggest that there is considerable genetic instability in the 2nd exon of N-ras in the myeloid leukemias but in every case a small subset of cells contains the mutations and these cells do not have a proliferative advantage. PMID- 2666908 TI - N-ras dependent revertant phenotype in human HT1080 fibrosarcoma cells is associated with loss of proliferation within normal tissues and expression of an adult membrane antigenic phenotype. AB - To investigate how the activated N-ras oncogene contributes to the tumorigenic potential of malignant human fibrosarcoma HT1080 cells we analysed the behavior of the parental cell line and of two flat revertants (1c and 10a) in an organ culture assay for invasion. In this assay the two revertants retain the ability of HT1080 cells to migrate within the chick cardiac muscle but lose the capacity to proliferate and to replace the normal tissue. Moreover the reversion of tumorigenic potential is associated with an evolution from an oncofoetal membrane antigenic pattern towards expression of a normal adult phenotype. Both the 4F2 antigen, which is implicated in the control of HT1080 cell proliferation, and heterodimers of the two chains (alpha and beta) of the IL2 receptor (IL2-R) are expressed in embryonic and HT1080 cells, but not in normal adult fibroblasts or in the revertant cell lines. For the first time in a non-lymphoid environment, we have detected a complex between the two IL2-R chains, together with a new species of mRNA (2.8 kB) from the IL2-R alpha gene. The behavior of these membrane markers strengthens the hypothesis that HT1080 cells may represent a block in the differentiation pathway of fibroblastic cells. PMID- 2666909 TI - Expression of the dbl proto-oncogene in Ewing's sarcomas. AB - We have investigated the expression of the dbl proto-oncogene in childhood tumors of known or suspected neuroectodermal origin. We found that while the dbl gene is consistently found expressed in Ewing's sarcoma as a single mRNA species, of approximately 5.0 kb, it is generally absent in two seemingly related categories of tumors, neuroblastoma and neuroepithelioma. The specificity of expression of the dbl proto-oncogene in Ewing's sarcoma supports the concept that Ewing's sarcoma may be differentiated from two closely related tumors, neuroblastoma and neuroepithelioma, on the basis of the presence of specific molecular markers. PMID- 2666910 TI - Developmental regulation of intermediate filament and actin mRNAs during myogenesis is disrupted by oncogenic ras genes. AB - Terminal differentiation of skeletal myoblasts is accompanied by down-regulation of vimentin and beta-, gamma-actins and up-regulation of desmin and sarcomeric alpha-actin(s). To investigate whether the normal decline in expression of vimentin and beta-, gamma-actins was coupled to withdrawal of proliferating myoblasts from the cell cycle or was a direct consequence of terminal differentiation, expression of the mRNAs encoding the actin microfilaments and intermediate filaments was examined in differentiation-defective C2 myoblasts bearing oncogenic ras genes. When transferred to mitogen-deficient medium, myoblasts transfected with the valine-12 allele of the human Harvey (H)-ras gene ceased dividing but failed to appropriately down-regulate vimentin and beta-, gamma-actin mRNAs. On the contrary, the level of vimentin mRNA expression was increased about 2.5-fold. Conversely, alpha-sarcomeric actin and desmin mRNAs continued to be expressed at basal levels in ras-transfected myoblasts that had withdrawn from the cell cycle. The ability of the ras oncogene to interfere with developmental regulation of actin and intermediate filament mRNAs was dependent upon mutational activation and was not observed in myoblasts transfected with proto-oncogenic ras alleles. These results demonstrate that, in addition to preventing up-regulation of muscle-specific gene products during myogenesis, the oncogenic forms of ras interfere with the mechanism(s) responsible for down regulation of genes whose expression declines during myoblast fusion. PMID- 2666911 TI - Rapid detection of ras oncogenes in human tumors: applications to colon, esophageal, and gastric cancer. AB - We have developed a rapid, nonradioactive large scale method for the detection of ras oncogenes in human tumors. DNA is amplified by the polymerase chain reaction (PCR), and then digested with specific restriction enzymes to detect either endogenous or primer-mediated Restriction Fragment Length Polymorphisms (RFLPs). We report here that three of 15 colon tumors tested contain K-ras codon 12 aspartic acid mutations and one, along with the HCT 116 colon carcinoma cell line, contains a K-ras codon 13 aspartic acid mutation. On the other hand, we did not detect H- or K-ras codon 12 mutations or the K-ras codon 13 aspartic acid mutation in 25 esophageal and 27 gastric cardia tumors isolated from patients in Lin-xing County, China. By incorporating nucleotide substitutions in PCR primers, this method can be applied towards the rapid, non-radioactive screening of virtually any genetic disease caused by known point mutations. PMID- 2666912 TI - A human rel proto-oncogene cDNA containing an Alu fragment as a potential coding exon. AB - Two rel-containing cDNA clones were isolated from a library derived from the Daudi human cell line, which is known to express c-rel mRNA. Clone #1 appeared to contain the entire c-rel coding sequence, which differs from v-rel in having three additional N-terminal residues and 111 additional C-terminal residues. In addition, Clone #1 had an internal 32 amino acid exon not found in v-rel or in turkey c-rel. Clone #2 was truncated at its 5' end and did not contain this new exon. Analysis of a genomic clone of human c-rel revealed that the new exon was a portion of an inverted Alu repeat. The occurrence of potential splice sites and of open reading frames in the inverted consensus Alu sequence suggests that the incorporation of Alu fragments as potential coding exons could be a relatively common event in human mRNAs. Whether such messages can be translated is unknown: antiserum raised against a peptide at the predicted C-terminus of the c-rel protein precipitated p82hc-rel, but antiserum raised against a peptide located in the Alu exon did not. PMID- 2666913 TI - Defense for physicians under attack. PMID- 2666914 TI - A plea for the little guy in medicine. PMID- 2666915 TI - [Current concepts of the mechanisms of atherosclerosis development]. PMID- 2666916 TI - [Arachidonates--regulators of bronchial tone]. PMID- 2666917 TI - [Acute inflammation: key events and new problems]. PMID- 2666918 TI - Adopted adolescents and the birth parent quest. PMID- 2666919 TI - Organ transplantation in adolescence: moral issues. PMID- 2666920 TI - Treatment refusal, noncompliance, and the pediatrician's responsibilities. PMID- 2666921 TI - Differential diagnosis of diseases producing hypotonia. PMID- 2666922 TI - Central nervous system disorders producing hypotonia. PMID- 2666923 TI - Spinal muscular atrophy. PMID- 2666924 TI - Hereditary motor and sensory neuropathies. PMID- 2666925 TI - Myasthenia gravis. PMID- 2666926 TI - Myopathies of infancy and childhood. PMID- 2666927 TI - Pain associated with juvenile rheumatoid arthritis. AB - Despite a comprehensive approach to the treatment of JRA patients, pain remains a largely underdeveloped area of research and an undertreated clinical problem. Pain is a highly prevalent condition in JRA patients, one that in adults has been shown to be highly predictive of current medication usage and future disability. This recurrent or chronic pain syndrome is currently treated primarily with nonsteroidal anti-inflammatory drugs, but inclusion of pain management specialists on the interdisciplinary team will allow for greater use of nonpharmacologic means of pain management. PMID- 2666928 TI - The management of pain in sickle cell disease. AB - For people with sickle cell disease, vaso-occlusive crisis pain is a frequently encountered problem that poses unique and often perplexing challenges in management. This article reviews the natural history of vaso-occlusive crisis and discusses intervention appropriate for the care of patients with pain due to this chronic illness. PMID- 2666929 TI - The undertreatment of pain in children: an overview. AB - At the present time, the management of pain in children is not addressed with the same vigor and enthusiasm as is the management of pain in adults. Limited accessible information and limited research have allowed inaccurate and inadequate information to persist, which serves to justify the status quo. The personal nature of pain and the complexity of assessing it have offered further obstacles. Changes are occurring, however, which will dramatically alter present practice. It will soon be unacceptable socially and medically to ignore the suffering of children. PMID- 2666930 TI - Developmental and psychological factors in children's pain. AB - It is clear that previously we were ill-informed and misinformed about children's pain. Recent investigations have led not only to a burgeoning of understanding of pediatric pain, but also an increase in our ability to appropriately measure and treat children's pain. Both pharmaceutical and nonpharmaceutical treatments have made major strides in the past few years. Even more crucial is the change that has happened in the willingness of health professionals to recognize that children do suffer pain and that aggressive treatment is often indicated. However, careful consideration must be given to physiologic, cognitive, affective, and psychosocial development, both in order to maximize the effectiveness of interventions and to recognize the limits that development may place on any specific approach. PMID- 2666931 TI - The assessment of pain in children. AB - This article focuses on the methods of pain measurement and assessment in children. The concepts of reliability and validity and the available types of physiologic, self-report, and behavioral measures are addressed. Methods of pain assessment in infants and toddlers, preschoolers, school-aged children, and adolescents are detailed. Finally, some practical suggestions for pediatric pain assessment are provided. PMID- 2666932 TI - Neonatal pain associated with caregiving procedures. AB - This article presents evidence that newborns react to aversive caregiving procedures--heelsticks, circumcision, and surgery--with distinct physiological, behavioral, and metabolic responses. These responses are similar to those associated with pain in adults. Suggestions are made on methods of ameliorating the infant's responses to aversive caregiving procedures. PMID- 2666933 TI - Colic--a pain syndrome of infancy? AB - A review of colic research supports the theory that colic may be caused by pain, particularly pain generated by gastrointestinal causes. At the same time, it also supports the view that disturbing crying in the first 3 months of life may be secondary to behavioral-interactive problems or simple parental misinterpretation of cry. In fact, a closer look at the methodology of colic studies along with our preliminary results suggest there may be at least two different patterns of disturbing infant crying. It is possible that one is associated with true pain and the other not. Dependence on retrospective parental reports alone to substantiate the presence of pain is only as reliable as parent interpretation of crying. Although specific cry patterns may represent specific infant conditions, parents may not be accurate interpreters of those patterns. In trying to determine the presence of gastrointestinal pain in colicky crying, close attention therefore should be given to the nature of the cry. Specific attention to qualitative and quantitative aspects of crying in colicky infants is identified as important by our pilot work. In the future this may help to explain the apparent discrepancies in the colic literature and to determine to what extent infant colic is a true pain syndrome. PMID- 2666934 TI - Sonographic pattern of gallbladder disease in children with sickle cell anaemia. AB - A prospective analysis of ultrasound examinations of the gallbladder in 161 children with sickle cell anaemia revealed cholelithiasis in 7 cases (4.2%). Biliary sludge was present in 12 cases (7.5%). The commonest abnormality noted was gallbladder wall thickening seen in 13 patients (8.1%). The age range of patients studied was 2 1/2 months to 16 years with a mean of 7.96 years. The youngest age for development of cholelithiasis was 10 years while biliary sludge was noted earliest at 5 years. Gallbladder wall thickening appeared as early as 4 years. Dietary and environmental factors are probably responsible for the low incidence of cholelithiasis in Africans with sickle cell anaemia. The low incidence of cholelithiasis in the African child with this disease does not justify routine and follow-up ultrasound scans in all cases with sickle cell anaemia. PMID- 2666935 TI - Renal ultrasound and excretory urography in infants and young children with urinary tract infection. AB - The main purpose of the study was to see whether excretory urography (EU) can be safely replaced by ultrasound (US) in children with urinary tract infection (UTI) younger than 6 years. 101 hospitalised children were admitted to the prospective study. They were all diagnosed as having UTI and were treated accordingly. All children had voiding cystography (VCU), EU and US done. US and EU correlated well in 94% of the cases. In all 6 cases with discrepancy between EU and US, the VCU was abnormal. Our results confirm the data from other authors, that VCU and US should be sufficient as an initial work-up on children with UTI, while EU should be done only in the cases with abnormal findings on either one or both of the former investigations. However, it should be kept in mind that some cases of parenchymal involvement or mild subpelvic stenosis can be missed using this protocol. If EU is obtained only in the cases with abnormal US and/or VCU, only 55 children (54%) in our group would have had an EU done. PMID- 2666936 TI - Pyonephrosis in childhood--is ultrasound sufficient for diagnosis? AB - The validity of ultrasound in the diagnosis of pyonephrosis in infants and children was retrospectively investigated in 14 patients. The disease was unilateral in 13 patients and bilateral in one. The diagnosis was proven by percutaneous nephrostomy in 7 and by operation in 7 patients. Ultrasound was true positive in 9 patients (10 kidneys) and false negative in 5. Large staghorn calculi were present in 2 of the 5 false negative cases. A group of 20 patients with simple hydronephrosis, investigated by percutaneous punctures, served as a control group. There were two false positive cases in this group. The sensitivity of sonography for the diagnosis of pyonephrosis was only 66.7%, which is considerably lower than in previous reports. We therefore recommend early sonographically guided percutaneous puncture of the renal pelvis whenever pyonephrosis is suspected. PMID- 2666937 TI - Ileocolic intussusception with enterogenous cyst: ultrasonic diagnosis. PMID- 2666938 TI - Perinatal unilateral hydrocephalus. Atresia of the foramen of Monro. AB - Unilateral hydrocephalus is rare, and is usually associated with a neoplasm or inflammatory response at the foramen of Monro. It is even more uncommon with congenital atresia of one foramen of Monro. We report the fifth such case documented in the perinatal period, and the second case of unilateral hydrocephalus diagnosed by prenatal ultrasound. PMID- 2666939 TI - Primary mediastinal tuberculous abscess: demonstration with MR. AB - An unusual case of primary mediastinal tuberculous abscess is presented in whom the diagnosis was obtained on magnetic resonance (MR) and ultrasound (US) guided aspiration cytology. Mycobacterium tuberculosis was isolated from direct smear as well as from culture of the "pus". Normal spine signal with MR and normal bone scintigraphy excluded any vertebral focus of infection. MR was helpful in, defining the extent and characterising the abscess, besides excluding a vertebral focus of infection. PMID- 2666940 TI - Unusual sonographic appearance of a perforated appendiceal abscess. AB - In this report, the clinical and unusual sonographic manifestations of a perforated appendiceal abscess is described. PMID- 2666941 TI - International travel and the child younger than two years: I. Recommendations for immunization. PMID- 2666942 TI - Timentin therapy for Staphylococcus aureus infections in children: results of a multicenter trial. AB - Multicenter trials of ticarcillin/potassium clavulanate (Timentin) for bone, joint, skin and soft tissue infections in children were performed from 1983 to 1986. Fifty children with culture-confirmed Staphylococcus aureus infections were identified. Sixteen children (ages 6.2 +/- 3.9 years) with bone and joint infections received Timentin for 8.7 +/- 2.4 days with 11 of 16 cures, 5 of 16 improved, 11 of 11 bacteriologic cures and 3.9 +/- 3.5 days of fever. Thirty-two children (ages 5.7 +/- 3.5 years) with skin and soft tissue infections received Timentin for 5.3 +/- 1.6 days with 22 of 32 cures, 10 of 32 improved, 32 of 32 bacteriologic cures and 1.4 +/- 1.3 days of fever. Three patients had S. aureus bacteremia; all were clinical and bacteriologic cures. All S. aureus isolates were susceptible to Timentin, 18 of 23 isolates tested produced beta-lactamase and 21 of 44 isolates tested were resistant to ticarcillin. The purpose of this report is to describe the clinical efficacy of Timentin in treating these types of S. aureus infections in children. PMID- 2666943 TI - Brain abscess in infants and children. PMID- 2666944 TI - Intussusception associated with Escherichia coli O157:H7. PMID- 2666945 TI - Osteomyelitis associated with varicella infection. PMID- 2666946 TI - [Ultrasonographic diagnosis of mild fatty infiltration of the liver with the difference between liver and kidney echolevels]. AB - At the same dynamic range (DR) a constant difference of echolevels was found between two materials with different acoustic impedance in any gain-setting by the phantom study. Our retrospective study in which we compared the difference between liver-kidney echolevels with the US-findings of fatty liver indicated that the difference over 10 in echoleveled by our equipment with 3.5 MHz phased array sector scan and 42 dB DR had a possibility of the fatty infiltration of the live. In our prospective study of 1452 abdominal US-studies we found 93 cases (6.5%) with the difference over 10 in echolevel. In all these patients the difference of liver-spleen CT-numbers and liver-kidney echolevels was compared. Although the liver CT-number is normally higher than the spleen, 75 of 93 patients showed the lower liver CT-number than that of the spleen, indicating fatty infiltration of the liver. The abnormal difference of echolevels were independent from the severity of fatty infiltration. Concerning the US-findings, "bright liver" (77.4%) and "masking sign" (66.7%) were more sensitive than "vascular blurring" (44.1%) and "deep attenuation" (44.1%). But for the severe fatty infiltration with the difference over -20 H.U. between liver-spleen CT numbers, the last two findings seemed very credible. The abnormal difference between liver-kidney echolevels was most sensitive (80.7%), especially in mild cases with 0 to -19 H.U. (53 in 75 cases), and very objective than the other US findings. PMID- 2666947 TI - [High-resolution ultrasound of the thyroid in patients with Graves' disease]. AB - The thyroid glands in 53 patients with Graves' disease were scanned with 10-MHz high-resolution ultrasound. Homogeneous echo pattern was noted in 21 patients (39.6%), and heterogeneous echo pattern was noted in 31 patients (60.4%). Each mean value of the serum triiodothyronine (T3), thyroxine (T4), and free thyroxine (Free T4) in patients with heterogeneous-echo thyroid was noted higher than that of the group with homogeneous-echo thyroid. (p less than 0.05) However, between the two groups, there is no significant difference in mean age and mean duration of treatment with antithyroid drugs. The heterogeneous echo pattern is strongly suggested to be correlated with the severity of hyperthyroidism. PMID- 2666948 TI - [Development and clinical application of double catheter system for angiography]. AB - Simultaneous double angiography of the two main branches of the aorta usually requires bilateral puncture of the femoral arteries. A double catheter system was devised to avoid this inconvenience. This system is composed of a 7F sheath with a valve of two small holes and two 3.5F catheters. Using this system and DSA, simultaneous double angiography of the two main branches of the aorta was performed with only one puncture site of a femoral artery in five cases. In four cases the splenic vein, superior mesenteric vein and portal vein were all opacified simultaneously. This system promises to be useful for visualization of the portal venous system and can be used for other simultaneous double angiography. PMID- 2666950 TI - Research in nursing practice. PMID- 2666949 TI - Baccalaureate education in nursing: key to a professional career in nursing 1989 90. PMID- 2666951 TI - Nursing care of adults. PMID- 2666952 TI - Teaching research in undergraduate nursing education. AB - This textbook provides alternative ways of thinking about research and the use of research in nursing practice. New textbooks on nursing research may be written, curricula reorganized to provide a different emphasis on research, new teaching strategies applied, and new learning experiences offered; but, in the final analysis, the key to inculcating in students an excitement about inquiry in nursing rests with the faculty. Faculty clearly convey their own beliefs about research and its relevance for practice; they can encourage or dampen a student's interest and inquisitiveness about nursing phenomena, in part, by their own beliefs about inquiry and, in part, by their approach to students. PMID- 2666953 TI - No more watching the clock. PMID- 2666954 TI - Nurse/patient dependency in community nursing. AB - Patient/nurse dependency measures developed in the setting of acute hospital care were shown to be not wholly appropriate to community nursing. In a literature search undertaken to locate a tool suitable for measuring nurse/patient dependency in the community, a number of studies were found with material relevant to the subject. It appeared that age and mobility were determining factors in the allocation of district nursing time, but the complexity of other variables, including home conditions and the presence or absence of other carers, defied precise measurement. A functional assessment scale was found which had been developed for assessing and monitoring patients in the community and this might be utilised as a dependency measure if timings could be attached. A small pilot study undertaken in 1984/5 to investigate this possibility was followed by a larger study completed in 1987. PMID- 2666955 TI - Understanding our past to build our future. PMID- 2666956 TI - Nurses and PDQ: what's in it for you? AB - In March 1989, the National Cancer Institute's Physician Data Query (PDQ) celebrated its fifth year. PDQ, a computerized cancer information database, was created to enhance the communication and application of cancer research data to the oncology community. Because of the variety and currency of the information contained within the system, it can be an extremely valuable resource for cancer nurses and patients. Future enhancements of the system will provide nurses with even more material for patient teaching and self-learning. This article discusses the development of PDQ, reviews its content and objectives, and identifies its possible uses for oncology nurses practicing in a variety of patient care settings. PMID- 2666957 TI - Managing chemotherapy-related nausea and vomiting: the state of the art. AB - The consequences of inadequately controlled chemotherapy-related nausea and vomiting range from minor discomfort to dose-limiting toxicity. Physical complications may occur secondary to protracted nausea and emesis. Furthermore, patient discomfort may be reflected in altered quality of life or noncompliance with therapy. As a primary caregiver, the nurse takes an active role in collaborating with the physician to prevent and/or minimize these side effects and their sequelae. An understanding of the patterns, mechanisms, and risk of chemotherapy-related nausea and vomiting is crucial to providing optimal patient care. Concepts of drug therapy are emphasized as the cornerstone of antiemetic management. PMID- 2666958 TI - The treatment of alcohol withdrawal. AB - Abrupt cessation of regular use of alcohol in a dependent person causes a withdrawal syndrome that may range from mild to extremely severe. Most patients require pharmacologic intervention, especially those with severe symptoms. Historically, the pharmacotherapy of alcohol withdrawal has involved a wide variety of agents. Benzodiazepines are currently preferred due to their consistently high degree of efficacy and laudable record of safety. In addition, beta blockers and clonidine are useful, as both effectively combat the hypertension and tachycardia commonly associated with withdrawal. They are ineffective as anticonvulsants; however. Opinions differ concerning the best treatment for withdrawal seizures. Prophylaxis with benzodiazepines may be all that is required, although some authors advocate the use of phenytoin for 5 days, especially in persons with a history of prior seizures during alcohol withdrawal. Once established, delirium tremens are difficult to treat. Benzodiazepines are most commonly used to provide sedation, and extremely large doses may be required. Careful clinical assessment is essential to the proper treatment of patients undergoing alcohol withdrawal since the coexistence of medical problems may complicate the condition. PMID- 2666959 TI - Proarrhythmia: a paradoxic response to antiarrhythmic agents. AB - Antiarrhythmic drugs may effectively terminate and prevent symptomatic tachycardias, but they may also provoke life-threatening rhythm disturbances. The electrophysiologic mechanisms responsible for proarrhythmia can be extrapolated from the existing models of reentry and abnormal automaticity. Although all antiarrhythmic drugs may cause proarrhythmia with seemingly similar frequency, the profile of the disturbance with each class of agents appears somewhat distinct. All agents may cause an increased frequency of premature beats or new or worsened ventricular tachycardia, but the classic form of proarrhythmia due to type la agents is torsades de pointes. Recent information has provided clues to the underlying mechanism of drug-induced torsades de pointes and has provided a clinical picture of patients with this adverse effect. Types lb and lc agents only rarely precipitate torsades de pointes. The latter, however, may cause a rapid, sustained, monomorphic ventricular tachycardia in certain high-risk patients that can be resistant to resuscitation efforts. Amiodarone may cause a broad variety of arrhythmias that are complicated by their extended duration and difficulty in distinguishing proarrhythmia from simple inefficacy. Proarrhythmia is a relatively common, paradoxic side effect that necessitates the clinician to make careful risk-benefit decisions in choosing antiarrhythmic drug therapy. PMID- 2666960 TI - Prolonged paralysis associated with long-term pancuronium use. AB - We cared for a 4-year-old patient who had undergone orthotopic liver transplantation and was placed on a ventilator for respiratory distress associated with Pneumocystis carinii pneumonia. The neuromuscular blocking agent pancuronium bromide 1.0-1.2 mg every hour as needed was used to facilitate artificial ventilation for 40 days. On discontinuation of pancuronium, the patient experienced severe, generalized neuromuscular dysfunction. Because no improvement was seen for 2 weeks, the acetylcholinesterase inhibitors edrophonium and pyridostigmine were instituted. Shortly thereafter the patient's condition began to improve. Gradual improvement occurred over 3-4 months and the patient has since returned to baseline neurologic function. We suggest that long-term pancuronium use was the cause of the patient's prolonged paralysis. The improvement experienced after the initiation of antidotal therapy strongly supports our proposal. PMID- 2666961 TI - Synthesis of alpha- and beta-calcitonin gene-related peptide by a human pheochromocytoma. AB - One histologically verified human pheochromocytoma, out of a total of nine such tumors examined, contained calcitonin gene-related peptide (CGRP)-like immunoreactivity (151 pmol/g wet weight) that was localized to a scattered population of tumor cells. The immunoreactivity was resolved by high performance ion-exchange chromatography into two components with the retention times of human alpha-CGRP and beta-CGRP in the approximate ratio 1:2. No pheochromocytoma in this series contained calcitonin-like immunoreactivity. In contrast, two neuroendocrine tumors of the pancreas contained calcitonin-like immunoreactivity (190 pmol/g and 125 pmol/g) but no CGRP-like immunoreactivity was detected. These results indicate a degree of tissue selectivity in the processing of the primary transcripts of the calcitonin/CGRP genes in human tumors. PMID- 2666963 TI - Reversed-phase liquid chromatography of radiolabeled peptides using a C18 guard PAK precolumn system. AB - In order to avoid radioactive contamination of high-performance liquid chromatography columns and injectors, we have investigated the use of a Guard-PAK precolumn system for the chromatography of [125I] labeled peptides. Two gonadotropin-releasing hormone analogs: 1) [D-Ala6-des-Gly10]-GnRH (GnRH-[Ala6]) and 2) [D-Ser(TBu)6-des-Gly10]-GnRH (GnRH-[Ser6]) and rat prolactin (r-PRL) were radiolabeled with 125I and subjected to reversed-phase liquid chromatography using a C18 Guard-PAK precolumn system. Major peak fractions of purified [125I]GnRH-[Ala6], [125I]GnRH-[Ser6], and [125I]r-PRL eluted at 24%, 28%, and 55% acetonitrile, respectively. Purified [125I]GnRH analogs showed specific high affinity binding to rat anterior pituitary gland membranes (specific activity: 1500-1700 Ci/mmol). Purified [125I]r-PRL showed high affinity binding to r-PRL antibody by RIA (specific activity: 70-75 microCi/micrograms). This rapid and efficient chromatographic method should be useful in the separation of a wide range of radiolabeled protein and peptide molecules. PMID- 2666962 TI - Influence of vasoactive intestinal polypeptide (VIP) on splanchnic and central hemodynamics in healthy subjects. AB - The influence of VIP, a potent vasodilator, on central hemodynamics, splanchnic blood flow and glucose metabolism was studied in six healthy subjects. Teflon catheters were inserted into an artery, a femoral vein and a right-sided hepatic vein. A Swan-Ganz catheter was introduced percutaneously and its tip placed in the pulmonary artery. Determinations of cardiac output, systemic, pulmonary arterial and hepatic venous pressures as well as splanchnic blood flow were made in the basal state and at the end of two consecutive 45 min periods of VIP infusion at 5 and 10 ng/kg/min, respectively. Arterial blood samples for analysis of glucose, FFA, insulin and glucagon were drawn at timed intervals. VIP infusion at 5 ng/kg/min resulted in an increase in cardiac output (55%) and heart rate (25%) as well as a reduction in mean systemic arterial pressure (15%) and vascular resistance (45%). With the higher rate of VIP infusion heart rate tended to rise further while cardiac output and arterial pressure remained unchanged. At 15 min after the end of VIP infusion the above variables had returned to basal levels. Splanchnic blood flow and free hepatic venous pressure did not change significantly. Arterial concentrations of glucose, FFA, insulin and glucagon increased during VIP infusion. At 15 min after the end of infusion the glucose levels were still significantly higher than basal (20%). Net splanchnic glucose output did not change in response to VIP infusion. It is concluded that VIP exerts a potent vasodilatory effect resulting in augmented cardiac output and lowered systemic blood pressure and vascular resistance.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 2666964 TI - Drug-resistant tuberculosis. New threats from an old disease. PMID- 2666965 TI - Sudden hearing loss. Determining the specific cause and the most appropriate treatment. PMID- 2666966 TI - Osteoporosis. Overcoming a costly and debilitating disease. AB - As the aging population continues to increase, so too will the problem of osteoporosis. Because the first manifestation of the disease may appear at a stage when prevention is no longer possible, early education of both men and women regarding causes and treatment is desirable. Estrogen replacement is the most valuable tool in treating women and should be started within the first 3 years of menopause. Calcium alone or in combination with vitamin D is a safe preventive measure for women over age 40 and men over age 50. PMID- 2666967 TI - Pancreatic function testing. Methods to identify exocrine insufficiency. AB - The diagnosis of chronic pancreatitis is ideally established by an appropriate clinical history and confirmatory radiologic imaging. However, in cases where imaging results are normal or equivocal, pancreatic function testing is necessary. Direct (intubation) tests are generally accepted as the best methods for study of pancreatic exocrine capacity, but indirect tests, which are well tolerated and generally simple to perform, are gaining interest. Their shortcoming is that they are too insensitive to reliably differentiate patients with early exocrine dysfunction (ie, before malabsorption has occurred) from controls. Sensitivity is not improved by combining two or more studies. However, several modified tests (eg, two-stage paraaminobenzoic acid test, pancreolauryl test) have improved specificity and are able to distinguish pancreatic from other causes of steatorrhea. Their reproducibility in individual cases is of value in sequential studies and in patients with established pancreatic exocrine deficiency to seek evidence of improvement or deterioration in function and to determine patient compliance with replacement therapy. PMID- 2666968 TI - Cancer of unknown primary site. Deciding how far to carry evaluation. AB - Management of most patients who present with metastatic cancer from an unknown primary site is challenging. These patients often are debilitated from the onset of their disease, have symptoms that are hard to control, and respond poorly to systemic therapy. The decision regarding the extent of a frequently unrewarding diagnostic evaluation, especially in these days of cost containment, is difficult. Knowing that few will benefit from aggressive therapy, the treating physician should make quality of life the most important goal in caring for these patients. PMID- 2666969 TI - Cancer screening in the office. Can it be a cost-effective lifesaver? PMID- 2666970 TI - Drug-induced illness in the elderly. AB - The elderly are predisposed to adverse drug reactions because of age-related physiologic changes, interaction of one drug with another, and interaction between a drug and a coexisting medical condition. Recognition of such adverse reactions is essential, because many are reversible and many are even preventable. Assessment of clinical disorders in the elderly should include evaluation of drugs as a causal or aggravating factor. Careful choice and dosage of drugs in the elderly will minimize the likelihood of drug-induced illness. PMID- 2666971 TI - Anaphylaxis from insect stings. Myths, controversy, and reality. AB - Some myths and controversies regarding allergy to insect stings have been resolved through research, and venom immunotherapy now has an important place in the prevention of life-threatening reactions to stings. Both children and adults who had cardiovascular and/or respiratory reactions to their most recent sting are candidates for this treatment, which should be discontinued at the end of 5 years (or sooner, if venom skin tests or radioallergosorbent tests are negative). PMID- 2666972 TI - Aerosolized pentamidine in HIV. Promising new treatment for Pneumocystis carinii pneumonia. AB - Pneumocystis carinii pneumonia is the most common life-threatening disease diagnosed in patients infected with the human immunodeficiency virus (HIV). Patients treated for their initial episode are at risk for recurrence of the disease. HIV-positive patients with low T4 lymphocyte counts are also at risk. Conventional treatment regimens with parenteral pentamidine isethionate (Pentam 300) or trimethoprim-sulfamethoxazole have a 50% to 60% incidence of serious adverse effects and a 20% to 40% rate of failure. Aerosolized pentamidine represents a promising new therapy for HIV-infected patients. Major adverse reactions have not been reported with its use. The Food and Drug Administration's (FDA's) recent approval of aerosolized pentamidine may also have a positive effect on healthcare costs by preventing episodes of P carinii pneumonia. In addition, FDA approval may result in reimbursement of patients for this new therapy by more insurance companies. PMID- 2666973 TI - Presyncope and syncope. How to find the cause and avoid staggering costs. AB - Presyncope and syncope are relatively common in the primary care population, but episodes may signal serious metabolic, neurologic, or cardiovascular disease. Accurate diagnosis is important, because treatment must be directed to the underlying cause. The cost of a full evaluation can be staggering; therefore, a goal-oriented approach to diagnosis is most productive and cost-effective. PMID- 2666974 TI - Tuberculosis makes a comeback. Giving and interpreting the Mantoux test. AB - Tuberculosis is on the increase in the United States, so physicians would be prudent to renew familiarity with the disease. Physicians should be prepared to administer the Mantoux test correctly and interpret the results according to the specific condition of each patient. Patients with certain diseases (eg, chronic renal failure, lymphoid disorders) are likely to be anergic but are also more likely than other persons to have tuberculosis. In these patients, the goal is to administer the test before they become anergic, so infection can be identified if it occurs. Preventive therapy is useful in some situations (eg, when public health is a factor) and should also be chosen on the basis of the individual patient, weighing the risk of disease against the risk of drug toxicity. PMID- 2666975 TI - Characterization of complement activity in turkeys: evidence for classical and alternative complement pathways. AB - Complement activity in turkey serum was examined by using inhibitors or activators of mammalian complement. Hemolytic test systems using sheep red blood cells sensitized with specific antibody (SSRBC) and horse red blood cells (HRBC) were developed to measure residual complement activity of turkey sera treated with the various inhibitors or activators. Lysis of SSRBC was blocked by treatment with 6-mM EDTA, 10-mM ethylene glycol-bis-beta aminoethylether N,N,N',N' tetraacetic acid (EGTA), and carrageenan. In contrast, lysis of HRBC was blocked by 6-mM EDTA, but not by 10-mM EGTA or carrageenan. Addition of magnesium to EGTA-chelated serum facilitated the lysis of HRBC but not the lysis of SSRBC. Treatment of serum with zymosan at 1 mg/mL and inulin at 5 mg/mL depleted hemolytic activity against both SSRBC and HRBC, suggesting depletion of components common to both pathways. Differences in the hemolytic activities of sera against SSRBC and HRBC after treatment with the various complement inhibitors and activators demonstrate the presence of two complement pathways in turkeys. PMID- 2666976 TI - Neurosurgical treatment of persistent pain. Physiological and pathological mechanisms of human pain. PMID- 2666977 TI - Effects of a competitive inhibitor (mevinolin) of 3-hydroxy-3-methylglutaryl coenzyme A reductase on human and bovine endothelial cells, fibroblasts and smooth muscle cells in vitro. AB - Mevinolin, a competitive inhibitor of 3-hydroxy-3-methylglutaryl-coenzyme A reductase activity, is a potent inhibitor of cholesterol synthesis. We have tested the effects of mevinolin on cell replication (3H-thymidine incorporation), prostacyclin production (6-keto-PGF1 alpha) and cell death (51Cr release) in cell cultures (human umbilical vein endothelial cells, bovine endothelial cells, human fibroblasts and bovine smooth muscle cells). Mevinolin concentrations ranging from 0.05 mumol/l (reported therapeutic concentration) to 20 mumol/l were used. In human endothelial cells the replication was reduced by 11% at a concentration of 2.0 mumol/l (P less than 0.01). In fibroblasts and smooth muscle cells the reduction was significant already at 0.1 mumol/l (10%, P less than 0.01). The prostacyclin production was reduced in endothelial cells at 1.0 mumol/l (19%, P less than 0.01) and in smooth muscle cells at 2.0 mumol/l (15%, P less than 0.05). At 20 mumol/l both cell replication and prostacyclin production was markedly reduced by about 40% in all cell types. No effects on 51Cr release or trypan blue staining was seen at any concentration. It is concluded that mevinolin has an effect on DNA synthesis and prostacyclin production on the tested cell types in vitro. These effects were, however, observed only at concentrations higher than those recommended for therapeutical use. PMID- 2666978 TI - [The Clara cell]. PMID- 2666980 TI - Purification and identification of a neutral endopeptidase in Plasmodium falciparum schizonts and merozoites. AB - An endopeptidase specific to the Plasmodium falciparum erythrocytic schizont stage and to free merozoites was detected using the fluorogenic GlcA-Val-Leu-Gly Lys(or Arg)-AEC substrate. The enzyme was purified by high performance liquid chromatography (HPLC); its optimal activity was around pH 7.5 and its isoelectric point was 4.4. The molecular weight of the enzyme was about 68,000, as demonstrated by sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS PAGE) under reducing conditions. The endopeptidase was strongly inhibited by thiol proteinase inhibitors, leupeptin, and antipain. The possible involvement of this neutral endopeptidase in the reinvasion process is discussed. PMID- 2666981 TI - Scanning electron microscopic study of adults and microfilariae of Dunnifilaria meningica (Filarioidea: Onchocercidae). AB - Dunnifilaria meningica from naturally infected Neotoma micropus in Mexico were studied by scanning electron microscopy (SEM). The anterior end of adults is surrounded by two pairs of buccal and two pairs of cervical papillae. Two amphidial openings lie near the central mouth opening, surrounded by a thick cuticular ring. The cuticular surface of males and females shows fine transversal striations. At the posterior end of the male is a semicircular cloaca, a large preanal central papilla, two pairs of perianal and two pairs of postanal papillae. The short, strong, and almost equal spicules are rolled plates that end in a knob-shaped apex, showing a central groove. In the female, the vulva is located 550 microns from the anterior end. The inconspicuous anus is subterminally situated in the right ventrolateral portion of the posterior end. The anterior tip of the sheathed microfilariae is formed by a cap-like disk. Cuticular annulations were clearly demonstrated across the body. PMID- 2666982 TI - Lobe-specific responses of cultured islet cells of canine pancreas to carbamylcholine, glucose, and pancreatic polypeptide. AB - Using cultured islet cells from both splenic lobe (SL) and uncinate process (UP) of the dog pancreas, we have measured responses of insulin, glucagon, and pancreatic polypeptide (PP) to glucose, carbamylcholine (carbachol), and exogenous PP. The results show that both insulin and PP cells of the two developmentally distinct lobes of the pancreas respond differentially to secretagogues. The results suggest that PP may play a role in regulation of islet cell secretion. Secretion of insulin by SL and UP cultures in response to 28 mM glucose in a 2h incubation was significantly greater, 2.9- (p less than 0.01) and 1.5-fold (p less than 0.01), respectively, than secretion by respective control cultures at 2.8 mM glucose. The difference in degree of stimulation between SL and UP was also significant (p less than 0.02). At 2.8 mM glucose, SL and UP cultures secreted 10% and 8.8%, respectively, of immunoreactive insulin (IRI) contents of the cultured cells (NS). Dose-response curves showed that for up to 8.5 mM glucose the degree of stimulation of SL was no greater than UP, but the UP response had nearly plateaued; whereas, the SL response continued to increase, such that SL was greater than UP at 16.7 mM glucose (p less than 0.01). Secretion of PP by SL and UP cultures in response to 5 microM carbachol and 2.8 mM glucose in a 2-h incubation was significantly greater, 2.2- (p less than 0.002) and 3.9 fold (p less than 0.002), respectively, than secretion by respective control cultures without carbachol. The difference in degree of stimulation between SL and UP was also significant (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 2666983 TI - Proliferation of immunocytochemically identified islet beta cells in culture: effect of growth factors, hormones, and nutrients. AB - Immunocytochemically identified, differentiated, single beta-cells proliferate to form colonies, which then grow into hillocks and islets. Beta-Cell proliferation is most easily quantified during the first week, when colonies are forming. The experimental objective was stimulation of beta-cell proliferation by culture medium supplementation with growth factors, hormones, or nutrients. We found that beta-cell proliferation is stimulated by iron-saturated transferrin, interleukin 1-alpha, fetal calf serum, and glucose. In response to transferrin, proliferation of beta-cells is progressively stimulated, reaching a maximum at 30 micrograms/ml. At greater concentrations the stimulatory effect is progressively lost. Interleukin-1-alpha maximally stimulates beta-cell proliferation at 10 pg/ml, regresses to control levels at 10(3) pg/ml, and inhibits proliferation progressively at greater concentrations. Fetal calf serum maximally stimulates beta-cell proliferation at concentrations of 10%, and glucose stimulates maximally at 15 mM concentrations. The proliferative response to transferrin, interleukin-1-alpha or glucose is serum dependent. Serum and transferrin synergistically stimulate glucose-induced beta-cell proliferation. Interleukin-1 beta, interleukin-2, rat growth hormone, and rat prolactin fail to stimulate beta cell proliferation. PMID- 2666979 TI - The role of free oxygen radicals in the expulsion of primary infections of Nippostrongylus brasiliensis. AB - The many and varied pathological, immunological and physiological manifestations of infection with Nippostrongylus brasiliensis may be unified by considering the role of leukocyte-generated free oxygen radicals in worm expulsion. Aside from directly damaging the adult stage of N.brasiliensis and possibly leading to its elimination from the small intestine, free radicals may also damage intestinal cells, thereby contributing to the gut pathology characteristic of infection. gamma-Interferon (and possibly tumour necrosis factor) may be involved in the initiation of free radical generation in response to N. brasiliensis and may also contribute to various side effects of infection such as hypertriglyceridaemia and cachexia. gamma-Interferon may initiate free radical generation via the agency of protein kinase C, an enzyme that can induce various additional responses including lysosomal enzyme and amine secretion and arachidonic acid metabolism. The possible interactions between these mediators and free radicals are subtle and diverse and may profoundly affect the course of infection. PMID- 2666984 TI - Enzyme regions in structural and viral proteins. AB - Enzyme sequences similar to structural and viral sequences are presented. Evolutionary and functional relationships are implicated from these findings. PMID- 2666985 TI - Value of testicular and sperm profiles in optimizing reproductive success: lessons learned from selective breeding programs of domestic and laboratory animals. AB - The economic potential of the biotechnology of artificial insemination for genetic improvement and disease control was recognized in the United States 50 years ago. To fully exploit this technology in dairy cattle, researchers worked closely with industry to study testicular function, best methods for harvesting and evaluating semen, techniques for preserving and inseminating sperm and finally, methods for mass recording of fertility information. Methods of testicular and semen evaluation have been developed which are highly correlated with other reproductive characteristics, including fertility. This has resulted in an unprecedented opportunity to study experimentally imposed conditions and naturally occurring environmental conditions upon reproductive efficiency in the male. The selection and testing of sires has resulted practically in the elimination of genes which produce lethal or severely depressed performance. The use of one male for the controlled insemination of many females also has facilitated studies on reproductive problems in the female. While less selective breeding programs have been conducted with the rabbit relative to reproductive function, the rabbit has been used extensively as a model for large domestic animals and humans. The rabbit is the smallest laboratory animal which can be trained easily to ejaculate into an artificial vagina and use the semen for insemination. This permits longitudinal and correlative studies to be performed relating testis function and epididymal transport to sperm output, semen quality and fertility. Spermatogenesis of both bulls and rabbits is sensitive to toxicants. The effects can be monitored by testicular biopsy and cytological evaluation of the testis, by semen collection and semen evaluation, and by in vitro and in vivo fertility testing. Gross effects on the testis are detectable in the live animal by measuring testis size and by ultrasound profiles. PMID- 2666986 TI - Nonhormonal mediation of male reproductive tract damage: data from contraceptive drug research. AB - Chemicals can interfere with hormonal control of the male reproductive tract and/or directly alter male reproductive tract function. A review is presented of those chemicals developed and tested as male contraceptive agents which have a direct effect on the male reproductive tract with minimal disturbance of the hormonal milieu. Such chemicals can have one or more sites of action: 1) the testis, disturbing spermatogenesis; 2) the epididymis, altering sperm maturation; 3) the vas deferens, affecting sperm transport; and 4) the accessory sex glands, entering the ejaculate and changing the functional activity of the spermatozoa. Examples of each mode of action are presented. PMID- 2666987 TI - Effects of radiation therapy and chemotherapy on testicular function. AB - Chemotherapy and radiation therapy are commonly used alone or in combination in the curative management of many malignancies in adolescent and adult males. Over the last 15-20 years, the striking success in the treatment of some common cancers in reproductive males has led to increasing concern for damage to normal tissues, such as the testes, resulting from curative cancer treatment. Indeed, a major future goal for cancer treatment will be to improve on the complication free cure rate. Inherent in achieving this goal is to understand the pathophysiology and clinical expression of testicular injury. Both chemotherapy and radiation therapy result in germ cell depletion with the development of oligo to azoospermia and testicular atrophy. The type of drug (particularly the alkylating agents), duration of treatment, intensity of treatment, and drug combination are major variables in determining the extent and duration of testicular injury. Testicular injury with chemotherapy also appears to vary with the age of the patient at the time of treatment. Newer drug combinations are now being used which appear to have curative potential in tumors such as Hodgkin's disease and germ cell testicular cancer with less potential for testicular injury. The most accurate and complete information on radiation injury to the testes is derived from two studies of normal volunteers who received graded single doses directly to the testes. A clear dose-response relationship of clinical and histological testicular damage was found with gradual recovery occurring following doses of up to 600 cGy. While these two studies provide an important clinical data base, radiation therapy used in treating cancers involves multiple daily treatments, usually 25-35 delivered over several weeks. Additionally, direct testicular irradiation is seldom used clinically. Based on several recent studies of testicular injury following conventional radiation therapy, it appears that fractionated scatter irradiation may have a more profound effect than single dose irradiation and that recovery of normal testicular function may be delayed. Testicular injury from doses as low as 20 cGy is reflected principally in transient elevations in serum FSH levels. With higher radiation doses (greater than 200 cGy), Leydig cell dysfunction is also seen as evidenced by elevations in LH. Recently, testicular shields have been constructed which can reduce scatter dose to the testes by up to a factor of 10. Today, the routine use of a testicular shield and other technical innovations in the clinical use of radiation therapy should minimize the risk of significant testicular injury. PMID- 2666988 TI - The value of multiple endpoint data in male reproductive toxicology: revelations in the rat. AB - To explore the relationship between sperm measures and reproductive success in the laboratory rat, a review has been conducted of results of several male reproductive toxicology studies containing both fertility and multiple endpoint data. Comparisons are made between subchronic and acute exposure studies, emphasizing for each approach the value of multiple endpoint data. Further, the choice of endpoints in male reproductive toxicology is discussed with select examples of endpoints for which an understanding is evolving. We conclude that sperm measures are far more sensitive indicators of reproductive organ impairment than is the measurement of fertility, and that evaluation of multiple endpoints in acute studies is a key step in determining mechanisms of toxicant action that are critical for accurate interspecies risk extrapolation. PMID- 2666989 TI - Correlation of sperm and endocrine measures with reproductive success in rodents. AB - This paper compares the statistical precision and biological sensitivity of multiple indices of reproductive function to infertility in the male rodent. The studies discussed include those that examined reproductive function in the male following perinatal exposure to reproductive toxicants and others in which the compounds were administered to young-adult males, often with very diverse results. For example, some chemicals that alter sex differentiation reduce fertility by affecting breeding performance alone (polychlorinated biphenyls (PCBs), fenarimol, or losulazine), without altering sperm and testicular measures. Others also markedly alter sex differentiation of the genitalia, the accessory glands and the testis in addition to their effects on central nervous system (CNS) sex differentiation and mating behavior (testosterone, flutamide, cyproterone acetate, tamoxifen, estradiol and diethylstilbestrol (DES)). In contrast, prenatal exposure to compounds that alter primary germ cell survival (busulphan, congo red) induce partial gonadal/germ cell agenesis without altering sex differentiation. These chemicals dramatically reduce testicular sperm production in the male offspring, and the most severely affected males are infertile. In a series of studies conducted in our laboratory, young male rats were exposed to known reproductive toxicants in a dose related manner from puberty, through young adulthood and breeding. We have found that the profile of effects varies considerably depending upon the chemical's mechanism of toxicity. When a compound produced infertility through direct effects of testicular function (Carbendazim (MBC) and dibutyl phthalate (DBP)), then testis weight, testicular histology, and testicular sperm head counts provided sensitive indicators of toxicity. In general, dramatic reductions in sperm production are required to induce infertility and these changes were accompanied by elevated serum luteinizing hormone (LH) and follicle-stimulating hormone (FSH) and changes in human chorionic gonadotropin (hCG)-stimulated testosterone synthesis. Chemicals that have hormonal activity, alter the internal endocrine environment, or directly effect CNS function induce a completely different profile of effects. For example, estrogen administration alters the function of the seminal vesicle and the endocrine system, and reduces epididymal sperm reserves; while testicular measures are relatively unaffected. Since very different spectrums of effects are produced by different compounds, no single endpoint will consistently be the most sensitive indicator of reproductive toxicity.(ABSTRACT TRUNCATED AT 400 WORDS) PMID- 2666990 TI - The use of multiple endpoints to define the mechanism of action of reproductive toxicants and germ cell mutagens. AB - Although a variety of endpoints are routinely assessed in reproductive toxicity studies, the inclusion of additional (and potentially more sensitive) endpoints may increase our ability to detect adverse effects on male or female reproduction and also provide information pertaining to the mechanism of action of the reproductive toxicant. Methyl chloride (MeCl) is a well characterized reproductive toxicant in the male rat, and can serve as a model to illustrate the importance of using multiple endpoints to determine the biological basis of chemically induced toxicity in the reproductive system. Exposure of male rats to MeCl results in bilateral testicular degeneration and epididymal inflammation and sperm granuloma formation. Females bred to these males in a dominant lethal assay exhibit elevated rates of postimplantation embryonic death during the first 2 weeks after treatment and increased preimplantation embryonic loss during weeks 2 to 8 post-exposure. Since the chemical is known to be a direct-acting mutagen in vitro and a kidney carcinogen in vivo, the increased embryo death rate observed might reasonably be considered good evidence that MeCl is a direct-acting germ cell mutagen. However, subsequent investigations revealed that MeCl-induced preimplantation loss was a result of cytotoxic rather than genotoxic effects on sperm, with a significant decrease in the count of motile sperm of normal morphology in exposed males during weeks 2 to 8 after treatment. In fact, examination of the fertilization rate during these weeks using a system of embryo recovery and culture revealed that the entire elevated rate of preimplantation loss detected in the dominant lethal assay was the result of failure of fertilization; it had no genetic component at all. Postimplantation death is considered a more reliable indicator of dominant lethality than is preimplantation loss. In the MeCl dominant lethal assay, such increased postimplantation loss was detected only when the fertilizing sperm had been present at the site of MeCl-induced acute inflammation in the cauda epididymis. Inflammatory cells, such as those in the MeCl-exposed epididymis, are known to produce a variety of genetic lesions in the DNA of neighboring cells. Therefore, male rats were concurrently exposed to MeCl and treated with an anti-inflammatory agent (BW755C) to inhibit the epididymal inflammation.(ABSTRACT TRUNCATED AT 400 WORDS) PMID- 2666991 TI - Evaluation of the human testis and its age-related dysfunction. AB - The human testis has been evaluated by its endocrine function, daily sperm output in ejaculates, general appearance of seminiferous tubules, differential cell counts in the testis, and daily sperm production. Within-subject variation for total sperm count in ejaculates is extremely high at 42% to 75% coefficient variation. This variation can be reduced to 12% by averaging the counts obtained for the last three of five daily ejaculates. Plasma FSH concentrations are particularly useful in assessing the status of seminiferous epithelium and/or its Sertoli cell function in infertile men. In aged men, plasma LH, FSH, and estradiol concentrations are higher while plasma testosterone, free testosterone, and the ability of the testis to secrete testosterone following stimulation are reduced. Other age-related changes in human testes include a high incidence of azoospermia, reduced sexual activity, reduced testicular size, impaired spermatogenesis, reduced tubular length, increased thickness of tubular boundary tissue, sclerosis, focal mononuclear orchitis, and dilation of the rete testis. Due to the long duration of the spermatogenic cycle and low numbers of germ cells in human testis, daily sperm production per g parenchyma (efficiency of spermatogenesis) is much lower in humans than in other species. Testicular parenchymal weight, proportion of testis occupied by seminiferous epithelium, volume of seminiferous epithelium, and daily sperm production are significantly reduced in aged men. In various species, including man, germ cell degeneration occurs during spermatocytogenesis, meiosis, and/or spermiogenesis. Germ cell degeneration plays a pivotal role in spermatogenesis, but the mechanisms of degeneration, its etiology, and approaches for its prevention remain unclear. PMID- 2666992 TI - Examination of data from programs of in vitro fertilization in relation to sperm integrity and reproductive success. AB - This paper reviews the work of 11 different in vitro fertilization (IVF) groups from around the world in an effort to determine the effectiveness of IVF as a therapy for male factor infertility as well as threshold values for semen parameters that are synonymous with success. Two key questions that are asked are: 1) What fertilization rate is expected for male factor patients and 2) Can we predict which patients will fertilize. The immediate problem which arises in attempting to compare results from various groups is that there is no standardization in male factor criteria. This lack of agreement in what constitutes an abnormal semen sample is also reflected in the fertilization rates and threshold values. The first group reviewed (Mahadevan, 1983) suggest greater than 20% motile in the initial semen sample as a threshold value required for success while the second group (Cohen, 1985) presents 6 couples with less than 20% motility achieving pregnancy. Such inconsistencies in results are typical of this confusing and controversial area. Fertilization in IVF has been achieved with as few as 2 x 10(6) sperm/ml or as low as only 2% motility in the initial semen sample. It appears that most workers would agree that the lower limits of traditional semen parameters that are compatible with success are not well defined. Consensus might also be reached on the fact that fertilization rates are usually significantly lower in male factor cases than in normal semen parameters coupled with tubal infertility. Beyond those two factors, little agreement is found in the literature. The spectrum of methodology for semen processing is very broad and often not clearly detailed. In addition to the additional semen parameters of count, motility, and morphology, attempts have been made to establish other prognostic tests such as the sperm penetration assay (SPA), acrosome reaction determinations, and motility parameters such as velocity, linearity and lateral head displacement. Controversy abounds concerning the value of these newer tests. Threshold values for acrosome reaction and motility parameters have not been established. The SPA is believed to be highly predictive by some and unreliable by others. The one redeeming feature of this IVF male factor area is that it seems to be one of the most effect treatments for male factor infertility. PMID- 2666993 TI - Biological basis of in vitro tests of sperm function. PMID- 2666994 TI - Eicosanoids and rheumatology: inflammatory and vascular aspects. AB - Eicosanoids are not only involved in inflammation but also are important in the maintenance of blood vessel tone and blood flow. This may be relevant in the rheumatological disorders of vasculitis and RS. Although little work has been carried out in vasculitis, the beneficial effects of the natural and synthetic antiplatelet vasodilator PGs in RS are well documented. Less well tested has been the effects of manipulation of AA metabolism. It should be remembered however that many patients with Raynaud's Phenomenon do not have an associated rheumatological disorder. Conservative management with vasodilators such as the calcium channel blockers may be very successful (119). At the present time PG treatment should be reserved for patients with severe RS, particularly those whose Raynaud's is complicated by digital ulceration. PMID- 2666995 TI - Eicosanoids and the hypothalamo-pituitary axis. PMID- 2666997 TI - Methods of bone mineral measurement. PMID- 2666996 TI - Arachidonic metabolism and radiation toxicity in cultures of vascular endothelial cells. PMID- 2666998 TI - [Autotransfusion]. AB - The risk of contracting certain disorders following a blood transfusion is currently becoming worrisome not only for physicians who are aware of this problem, but also for patients who, with increased media attention on AIDS, are more afraid of this potential risk than of the surgical or anesthetic risks. In fact, hepatitis constitute the major risk involved in homologous transfusion since some 60,000 cases are reported each year in France. Prevention of transmission of disease by blood transfusion is based on decreasing homologous transfusions and especially by saving blood. Indeed, when surgery is planned, units of the patient's blood can be obtained in the weeks prior to it to be used during the operation or the immediate follow-up period. In case of emergency surgery, blood is collected preoperatively making it possible to obtain hemodilution during surgery and an autotransfusion if necessary at the conclusion of the procedure. Finally, there are methods to recover blood at the actual site of the surgical procedure. PMID- 2667000 TI - [The risk of general anesthesia in surgery of the veins of the lower limbs]. AB - Venous surgery on the lower limbs does not involve specific problems for the anaesthetist. General anaesthetic is still indicated in particular cases, even though techniques of locoregional anaesthetic are being more and more widely used in venous surgery of the lower limbs. Certain authors have found that the indications for general anaesthetic are limited to the counterindications or failures of local anaesthetic; others give general anaesthetic a wider application when surgery is to be carried out on a patient in the ventral decubitus position. The aim of general anaesthetic for venous surgery of the lower limbs is simply to facilitate a purely functional surgery. In this context, injury or fatality directly connected with the anaesthetic seems unacceptable. However, the accident rate is far from being low, as various inquiries have revealed. In France, the inquiry set up by INSERM found that serious accident related wholly or partially to the anaesthetic occurs once in every 3,000 operations. Of course, the accident rate increases with age and depends on the previous pathological condition. But, quite apart from cardio-vascular accidents, which have multiple causes and usually involve high-risk patients, these studies show that respiratory accidents involve every type of patient, whatever their medical history. Moreover, the majority of such accidents could have been avoided had there been adequate monitoring to detect any anomaly before the occurrence of the accident. It is thus appropriate to recall the recommendations of the American Society of Anesthiologists for standard pre-operative monitoring: monitoring of ventilation (spirometry, capnometry, debrancher alarm), monitoring of oxygenation, circulation (continuous ECG and pulse assessment) and monitoring of temperature.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 2666999 TI - [Technics of locoregional anesthesia of the lower limb]. AB - Regional anesthesia represents a selective method for surgery of the lower limbs because of its simplicity and its handiness. The various techniques of regional anesthesia are analysed with their risks and benefits. Epidural and spinal anesthesia represent safe and simple methods. Moreover, epidural anesthesia enables postoperative analgesia by means of a continuous infusion of local anesthetics or the injection of narcotics. Nervous blocks of the lower limbs represents also safe techniques especially for elderly patients and for day-case surgery. Intravenous regional anesthesia does not represent an usefull technique because of the possible toxicity due to a great volume of local anesthetic drugs. PMID- 2667001 TI - [Postoperative pulmonary embolism]. AB - Post-operative thrombo-embolic disease remains a frequent occurrence in spite of advances in their prophylaxis. Evaluation of 60 case-reports of this disease which often includes peripheral manifestations and always pulmonary manifestations, enables to specify the role of the procedure itself (mostly orthopaedic surgery 60%), pelvic surgery 20%, the chronology of events (possibility of early embolism between D1 and D3 and usual occurrence of manifestations between D8 and D18, and the importance of the background, whether investigated or not: deficiencies in anti-thrombin III, protein C and S: 4 cases. The diagnosis is based on clinical signs (non-specific) and the laboratory tests, especially scintigraphy (screening) and angiography, absolutely necessary for the diagnosis and evaluation of the amputation coefficient (Miller index). With a diagnosis of pulmonary embolism, it is always necessary to look for a proximal venous thrombosis. The treatment, calls for heparin (quite seldom), thrombolytics (Urokinase, Plasminogen in our experience), the indication of which must take into consideration the delays and the nature of the previous procedure, and finally surgery (massive forms where thrombolytics are contraindicated). The thrombo-embolic manifestations with thrombogenic thrombopenia secondary to heparin are quite frequent, in a surgical environment (10 cases) and difficult to treat. PMID- 2667002 TI - Exposure of mice to UV-B radiation suppresses delayed hypersensitivity to Candida albicans. AB - Groups of mice were exposed to a single dose of UV radiation before or after immunization with Candida albicans. The delayed type hypersensitivity (DTH) response was markedly depressed in all UV-irradiated groups. Exposure of mice to UV radiation before sensitization induced splenic suppressor cells that, upon transfer to normal recipients, impaired the induction of DTH to Candida. In contrast, exposure of mice to UV radiation after sensitization interfered with elicitation of the DTH response, but this suppression was not transferable. These studies demonstrate that immunity to Candida albicans in mice is impaired by exposure to UV radiation and that two separate mechanisms may be involved. PMID- 2667003 TI - Reversibility of metabolic changes induced by feeding schedule in rats. AB - This study aimed to investigate the effect of free-feeding on rats kept on meal feeding schedule for a prolonged period. Thus, rats meal-fed for 4 and 20 weeks were given free access to food for subsequent 5 weeks. The metabolic adaptation of higher hepatic glycogen content, low plasma FFA values and sustained glycemia during 22-hr fast, reported for rats subjected to meal-feeding, completely disappeared after free-eating period. The rate of body weight gain increased as a consequence of the free access to food in both groups but the control values (group with food ad lib all the time) were attained only in rats previously submitted to meal-feeding for the shorter period of time (4 weeks). The findings of this study suggest that the recovery of body weight by meal-fed rats, for the control values, seems to depend on the duration of the meal-feeding schedule and the age when it is imposed. PMID- 2667004 TI - The effect of controlled feeding conditions on the metabolic characteristics of rats. AB - To evaluate the effect of feeding conditions on blood glucose, insulin and free fatty acid concentrations, rats were maintained on a 2-hr feeding/22-hr fasting (regular-fasted) schedule for 4 weeks. The animals were then subjected to glucose or insulin loads immediately prior to the usual meal time. Animals fasted for only 22 hr (single-fasted) just before the experiments, and rats having access to food ad lib were similarly loaded and tested. The results demonstrate that the regular fasting regime induces certain metabolic alterations well described in the literature for the single-fasted-period to become more pronounced, specifically, a reduction in insulin secretion and a probably increase in peripheral responsiveness to this hormone. In addition, glucose loading was more effective in lowering plasma free fatty acid concentration in rats restricted to a regular fasting scheme. PMID- 2667005 TI - Brain 3-hydroxybutyrate, glutamate, and GABA in a rat model of dietary obesity. AB - Whole brain concentrations of 3-hydroxybutyrate, glutamate and gamma-aminobutyric acid (GABA) have been measured in two strains of rats with differing susceptibility to obesity. S 5B/Pl rats are resistant to developing obesity when eating a high-fat diet, whereas Osborne-Mendel rats readily develop obesity when eating the same diet. We tested the hypotheses that brain 3-hydroxybutyrate, glutamate and GABA differ between S 5B/Pl rats and Osborne-Mendel rats, and that these substrates/neuroregulators are altered when eating a high-fat diet primarily in S 5B/Pl (resistant) rats. Blood and brain 3-hydroxybutyrate concentrations were higher in S 5B/Pl rats than in Osborne-Mendel rats (p less than 0.05) but diet effects were not significant. Brain glutamate concentration, like 3-hydroxybutyrate, was higher in S 5B/Pl rats than in Osborne-Mendel rats (p less than 0.01) and was not affected by adding fat to the diet. Brain GABA differed only slightly between strains but increased after adding fat to the diet (p less than 0.05) in both strains with a greater increase occurring in S 5B/Pl rats. The brains of S 5B/Pl rats are chronically exposed to higher levels of 3 hydroxybutyrate and glutamate than are those of Osborne-Mendel rats. Thus, 3 hydroxybutyrate is a potential signal in the regulation of body weight. Brain GABA increases with fat feeding, especially in S 5B/Pl rats, suggesting that the ability to adjust to an energy dense diet may be through suppression of food intake by elevated brain GABA. PMID- 2667006 TI - The two-process distinction in apparent motion. PMID- 2667007 TI - Alcoholism, aging, and functional cerebral asymmetries. AB - Reviews research concerning the possible relationship between cognitive decline and abnormal hemispheric asymmetries in alcoholic and aging individuals. Because the deteriorative effects of alcoholism on the central nervous system have suggested greater visuospatial than language-related functional impairments, numerous investigators had hypothesized that right-hemisphere integrity may be selectively disrupted (rather than the left hemisphere). Furthermore, performance on diverse perceptual and cognitive tests used to measure right-hemisphere functions in alcoholics had been observed to decline with normal chronological aging as well, thereby raising the possibility that certain neuropsychological deficits associated with alcoholism (presumably related to right-hemispheric decline) are identical to those associated with aging. However, an extensive review of empirical research findings on cerebral asymmetries both in alcoholics and in aging individuals suggested that their patterns of functional laterality are similar to those of normal controls. PMID- 2667008 TI - Does violence beget violence? A critical examination of the literature. AB - Critically examines the "violence breeds violence" hypothesis broadly defined. Organized into seven sections, the literature review includes (a) the abuse breeds abuse hypothesis; (b) reports of small numbers of violent/homicidal offenders; (c) studies examining the relationship of abuse and neglect to delinquency, (d) to violent behavior, and (e) to aggressive behavior in infants and young children; (f) abuse, withdrawal, and self-destructive behavior; and (g) studies of the impact of witnessing or observing violent behavior. A detailed discussion of methodological considerations and shortcomings precedes the review. The author concludes that existing knowledge of the long-term consequences of abusive home environments is limited and suggests that conclusions about the strength of the cycle of violence be tempered by the dearth of convincing empirical evidence. Recommendations are made for further research. PMID- 2667009 TI - Frustration-aggression hypothesis: examination and reformulation. AB - Examines the Dollard et al. (1939) frustration-aggression hypothesis. The original formulation's main proposition is limited to interference with an expected attainment of a desired goal on hostile (emotional) aggression. Although some studies have yielded negative results, others support the core proposition. Frustrations can create aggressive inclinations even when they are not arbitrary or aimed at the subject personally. Interpretations and attributions can be understood partly in terms of the original analysis but they can also influence the unpleasantness of the thwarting. A proposed revision of the 1939 model holds that frustrations generate aggressive inclinations to the degree that they arouse negative affect. Evidence regarding the aggressive consequences of aversive events is reviewed, and Berkowitz's cognitive-neoassociationistic model is summarized. PMID- 2667010 TI - Temperature and aggression: ubiquitous effects of heat on occurrence of human violence. AB - Outlines 5 models of the temperature-aggression hypothesis: negative affect escape, simple negative affect, excitation transfer/misattribution, cognitive neoassociation, and physiological-thermoregulatory. Reviews relevant studies. Aggression measures include violent crime, spouse abuse, horn-honking, and delivery of electric shock. Analysis levels include geographic regional, seasonal, monthly, and daily variations in aggression, and concomitant temperature-aggression effects in field and laboratory settings. Field studies clearly show that heat increases aggression. Laboratory studies show inconsistencies, possibly because of several artifacts. Specific models have not been adequately tested, but the excitation transfer/misattribution and cognitive neoassociation approaches appear most promising, whereas the negative affect escape appears the least viable. Suggestions for future work are made. PMID- 2667011 TI - Self-statement modification in the treatment of child behavior disorders: a meta analysis. AB - Reviews 48 outcome studies that applied self-statement modification (SSM) to childhood behavior disorders. Selection criteria restricted the review to controlled experimental studies and to children with disorders of clinically relevant severity. Meta-analysis was used to provide summary information about the observed effects of SSM. Collectively, SSM outcomes surpassed no treatment and placebo treatment by roughly a half of a standard deviation, on the average. Efficacy varied considerably with length of follow-up, experience level of therapists, age of children, outcome content area, and a number of other clinical and methodological differences among the studies. These qualifiers of observed efficacy are summarized and discussed in terms of implications for further research and application of SSM in child psychotherapy. PMID- 2667012 TI - Cognitive change processes in psychotherapy. AB - Several types of cognitive-behavioral therapy are now practiced that use different sets of theoretical concepts and propose different kinds of change mechanisms. None, however, is directly grounded in experimental research in cognitive and social psychology, and few address basic issues such as the relevance of conscious versus nonconscious cognitive processes and the validity of the self-report data on which therapy depends. Put forward in this article is a model that describes the conscious and nonconscious processing of emotional stimuli and distinguishes between knowledge that is verbally accessible and knowledge that can only be recovered by exposure to situational cues. Also proposed are three mechanisms of cognitive change that involve altering verbally accessible knowledge, the accessibility of nonconscious situational memories, and self-regulatory strategies. These mechanisms are related to the current practices of behavioral and cognitive-behavioral therapists. PMID- 2667013 TI - Context effects in letter perception: comparison of two theories. PMID- 2667014 TI - Laterality and human evolution. AB - The question of whether there is a fundamental discontinuity between humans and other primates is discussed in relation to the predominantly human pattern of right-handedness and the left-cerebral representation of language. Both phenomena may go back at least to Homo habilis, 2-3 million years ago. However, a distinctively human mode of cognitive representation may not have emerged until later, beginning with H. erectus and the Acheulean tool culture about 1.5 million years ago and culminating with H. sapiens sapiens and rapid, flexible speech in the last 200,000 years. It is suggested that this mode is characterized by generativity, with multipart representations formed from elementary canonical parts (e.g., phonemes in speech, geons in visual perception). Generativity may be uniquely human and associated with the left-cerebral hemisphere. An alternative, analogue mode of representation, shared with other species, is associated with the right hemisphere in humans. PMID- 2667015 TI - Desipramine increases circulating growth hormone in elderly depressed patients: a pilot study. AB - Serial blood samples were collected from 15 elderly depressed inpatients, ages 62 to 95 years, following random assignment to a 50 mg oral test dose of desmethylimipramine (DMI) or amitriptyline (AMI). Nine female and six male subjects began the 210-min study at 0800h. Serum growth hormone (hGH), cortisol, and prolactin (hPRL) were determined by radioimmunoassay. Baseline hormone concentrations were related to self and observer ratings of anxiety and depression. There was a trend for the hGH, cortisol, and hPRL concentrations to decline during the period of study. This trend for all three hormones reversed in those subjects receiving DMI, beginning approximately 90 min after drug ingestion. The DMI-induced increase of hGH reached statistical significance at the very end of the sampling period. There was an apparent latency in the DMI induced effect for all three hormones. There was no stimulatory effect of AMI on hGH, cortisol, or hPRL. The female subjects had higher baseline hGH levels than the men. In addition, a significant negative correlation was found between baseline hPRL levels and self ratings of anxiety. PMID- 2667016 TI - Dopaminergic, but not cholinergic, involvement in regulation of hypoglycemia induced oxytocin release in man. AB - The plasma oxytocin response to insulin-induced hypoglycemia was evaluated in 20 normal male subjects in the basal state (insulin tolerance test (ITT) alone) and after pretreatment with the muscarinic antagonist pirenzepine (40 mg IV 10 min before the ITT in six subjects), the nicotinic antagonist trimethaphan (0.3 mg/min IV for 30 min before the ITT in six subjects), and the dopaminergic receptor agonist bromocriptine (2.5 mg PO 1 hr before the ITT in eight subjects). The drugs did not modify arterial blood pressure nor produce side effects capable of altering oxytocin secretion. Neither pirenzepine nor trimethaphan administration changed the oxytocin response to hypoglycemia, whereas bromocriptine significantly reduced the oxytocin increase during the ITT. These data suggest the involvement of dopaminergic, but not of cholinergic, muscarinic or nicotinic, receptors in the oxytocin response to hypoglycemia. PMID- 2667017 TI - Insulin response to a short stress period. AB - In 24 healthy volunteers (seven women, 17 men; mean age 23 +/- 5 years), we studied the insulin response to a short stress period of 30 min, induced by cognitive conflict under social pressure. Insulin, growth hormone (GH), blood glucose and blood pressure (BP) determinations were performed before and after the stress period. There was a significant increase in insulin levels following the stress period (p = 0.02, paired t-test). A multiple stepwise regression analysis, with insulin difference as the dependent variable and initial GH and blood sugar levels, their increments and body mass index as predictors, showed that insulin variation was independent of any of the predictors. We discuss the influence of autonomic innervation on insulin secretion and the possible change in insulin sensitivity during stress. PMID- 2667018 TI - Modern mind-brain reading: psychophysiology, physiology, and cognition. AB - This paper reviews the actual and potential benefits of a marriage between cognitive psychology and psychophysiology. Psychophysiological measures, particularly those of the event-related brain potential, can be used as markers for psychological events and physiological events. Thus, they can serve as "windows" on the mind and as "windows" on the brain. These ideas are illustrated in the context of a series of studies utilizing the lateralized readiness potential, a measure of electrical brain activity that is related to preparation for movement. This measure has been used to illuminate presetting processes that prepare the motor system for action, to demonstrate the presence of the transmission of partial information in the cognitive system, and to identify processes responsible for the inhibition of responses. The lateralized readiness potential appears to reflect activity in motor areas of cortex. Thus, this measure, along with other psychophysiological measures, can be used to understand how the functions of the mind are implemented in the brain. PMID- 2667019 TI - Chemical agents for removing intrinsic stains from vital teeth. I. Technique development. PMID- 2667020 TI - Retention of amalgam restorations: undercuts versus bonding. PMID- 2667021 TI - The effect on microleakage of four dentin-enamel bonding systems. PMID- 2667022 TI - Modification of a disposable syringe for injecting irreversible hydrocolloid. PMID- 2667023 TI - Comparison of the bond strength of resin-bonded retainers using two metal etching techniques. PMID- 2667024 TI - In vitro marginal quality of dentin-bonded composite resins in Class V cavities. PMID- 2667025 TI - Plunging ranula: a report of two cases and review of the literature. PMID- 2667026 TI - Survival after total-body irradiation. I. Effects of partial small bowel shielding. AB - The small intestine of the rat was shielded during total-body irradiation (TBI) to evaluate the effects of radiation dose and length of intestine shielded on survival. Sprague-Dawley rats were anesthetized in groups of 10. Using aseptic surgical procedures 80, 40, 20, or 10 cm, or none of the proximal or distal small intestine were temporarily exteriorized and shielded during irradiation with photons from an 18 MeV linear accelerator. Less than 17% of the dose was delivered to the shielded intestines. In unshielded animals deaths occurred from Days 4 to 6 with 13, 15, or 17 Gy and from Days 8 to 30 with 9, 11, and 12 Gy. However, in all animals exposed to 15 Gy with all or part of the small intestine shielded, survival was increased to between 5 and 9 days. Shielding of the distal small intestine was more effective in prolonging survival than shielding of the proximal small intestine. The previously identified target of radiation damage in the small intestine is the crypt stem cell. In this study, the analysis of histological specimens of shielded and irradiated small intestine suggested that humoral factors also influence intestinal histology and survival after irradiation. These humoral factors are thought to originate from the irradiated body tissues, the shielded proximal intestine, and the shielded distal intestine. Further studies are required to identify these factors and to determine their mode of action and their therapeutic potential after radiation damage to the small intestine. PMID- 2667027 TI - Organ-specific metallothionein induction in mice by X irradiation. AB - Metallothioneins (MTs) are induced in cultured cells and experimental animal tissues by a variety of chemical agents. We report that whole-body X irradiation (1 to 80 Gy) induces MT-1 mRNA transcription and protein expression and accumulation in liver but not in kidney or spleen. The degree of induction was comparable to maximum levels achieved after treatment with metal salts, but the peak of MT-1 mRNA and protein accumulation was approximately 10 h later than with treatment with metal salts and remained high for an extended period. Because of the lack of induction of MT-1 by X rays in cultured cells, and the similarity of the tissue pattern of MT induction between X rays and other agents that also do not induce MT expression in cultured cells, it appears that these agents may act through the mediation of tissue-specific factors. The implications of radiation induced metallothionein synthesis and organ-specific resistance to cellular damage are discussed. PMID- 2667028 TI - The effect of perinatal 60Co gamma radiation on brain weight in beagles. AB - Beagle dogs were given single, whole-body 60Co gamma-radiation exposures at one of three prenatal (8, 28, or 55 days postcoitus) or three postnatal (2, 70, or 365 days postpartum) ages to evaluate the relative radiosensitivity of various stages of brain development. A total of 387 dogs received mean doses ranging from 0.16 to 3.83 Gy, and 120 dogs were sham-irradiated. Groups of dogs were sacrificed at preselected times from 70 days to 11 years of age. Brain weight decreased significantly with increasing dose in dogs irradiated at 28 or 55 days postcoitus or at 2 days postpartum. Irradiations at 28 days postcoitus were dramatically more effective in causing a reduction in brain weight than those at 55 days postcoitus or 2 days postpartum. Among dogs given 1.0 Gy or more and followed for up to 4 years, there was a radiation effect evident at all three sensitive exposure ages. Among dogs given lower doses and followed for up to 11 years, there was a significant decrease in brain weight in dogs given 0.80-0.88 Gy at 28 days postcoitus. All decreases in brain weight were present after normalization for radiation-induced reductions in skeletal (body) size. No specific morphologic changes were noted in the brains which showed the radiation related reductions in size. PMID- 2667029 TI - [Fundamentals of positron emission tomography]. AB - Positron emission tomography is a modern radionuclide method of measuring physiological quantities or metabolic parameters in vivo. The method is based on: (1) radioactive labelling with positron emitters; (2) the coincidence technique for the measurement of the annihilation radiation following positron decay; (3) analysis of the data measured using biological models. The basic aspects and problems of the method are discussed. The main fields of future research are the synthesis of new labelled compounds and the development of mathematical models of the biological processes to be investigated. PMID- 2667030 TI - [Positron emitters for the study of tumor metabolism]. AB - Positron emission tomography with metabolically active substances is a noninvasive imaging modality to determine tumor metabolism. Quantification of tumor metabolism provides valuable information, e.g., for the differential diagnosis of malignancies. Radiolabeled therapeutic substances can be traced with PET. Measurement of fluorouracil metabolite concentrations provides data about the accumulation pattern of the cytostatic agent and allows assessment of the therapeutic outcome. PMID- 2667031 TI - [Fundamentals and technical aspects of magnetic resonance spectroscopy in relation to patients]. AB - This paper presents a short introduction to the basic principles of MR spectroscopy and its applications in vivo. The potential value of this method is outlined with respect to clinical problems. Emphasis is placed on the practical problems of clinical examinations, and the localization methods currently used are also taken into consideration. PMID- 2667032 TI - [Application of multinuclear in vivo magnetic resonance spectroscopy in oncology]. AB - Cell metabolism and the metabolism of drugs can be monitored noninvasively and in vivo by magnetic resonance spectroscopy (MRS). At present, tumors cannot be differentiated by means of 31P MRS. This method can be used in tumor therapy follow-up for early detection of metabolic tumor response. 31P MRS is not helpful in determining whether patients respond to therapy or not. The first clinical results have been obtained using 1H MRS; however, no clinically relevant results have been obtained as yet. Preliminary experiments demonstrate that 19F MRS can be used to observe the metabolism of drugs. PMID- 2667033 TI - [DSA and duplex sonography of aortic prostheses]. AB - In 95 patients with aortal grafts, DSA was compared with duplex ultrasonography. In 4 patients the graft was better visualized by means of angiography. Kinking, coiling, dilatations, pseudoaneurysms, stenoses, and occlusions could be sufficiently diagnosed with both methods. Marginal thrombosis and periprosthetic pathologies could only be found with ultrasonography. The ultrasonographic and angiographic examination techniques are described and the limitations of both methods discussed. PMID- 2667034 TI - Absence of effect in stochastic processes: its influence on test validation and test use. AB - Negativity in stochastic processes presents problems in interpretation because it is never possible to attain an absolutely adequate assurance of safety with such processes. Thus, it is extremely difficult to have complete confidence in the utility of validation studies of new methods in comparison to those that are accepted to be well established, especially when these processes are stochastic in the statistical sense of this term. The regulatory scientist who must make decisions on the basis of available evidence, therefore, has to make a number of assumptions in dealing with negativity. It is important to review the validity and usefulness of these assumptions from time to time to ensure that they cannot be replaced by improved methodology in the light of new scientific knowledge. PMID- 2667035 TI - The evaluation of negative epidemiologic studies: the importance of all available evidence in risk characterization. AB - The importance of publishing and utilizing all available epidemiologic evidence in risk assessment is recognized. This recognition includes the findings from negative epidemiologic studies, described as well designed and executed studies where the hypothesized association with an adverse health effect was not found or found to be very weak. In assessing negative evidence, the random (chance) and nonrandom (bias, confounding) sources of variation need to be considered as well as dilution effects, dose-response patterns, biologic plausibility, and methods for data pooling (meta-analysis). Meta-analysis may be a useful statistical approach for a systematic review of results from multiple studies, but cannot overcome the bias of missing evidence. PMID- 2667036 TI - The role of "negative" epidemiology data in the evaluation of risk. AB - The identification and quantification of risk is a complex process that depends upon a variety of different disciplines. All contribute, but none provides a complete and comprehensive perspective. In the past, emphasis has been placed upon the limitations of each individually. Toxicology, for example, is plagued by low predictive value positive; epidemiology, by qualitative measures of exposure. Focusing instead upon the contributions of each to the whole, and the contributions of all of the data--both "positive" and "nonpositive"--a better understanding of potential hazards can be achieved. Examples are provided for styrene and phenoxy herbicides. PMID- 2667037 TI - Statistical considerations in the interpretation of negative carcinogenicity data. AB - The regulation of toxic substances present in the environment requires that carcinogens be distinguished from noncarcinogens on the strength of the available toxicological and epidemiological evidence for carcinogenicity. In this article, we consider the difficulties associated with establishing strong evidence against carcinogenicity. In particular, the ability of both animal and human studies to detect small increases in tumor occurrence rates is evaluated in statistical terms. Consideration is also given to resolving apparent conflicts between the toxicological and the epidemiological sources of data. PMID- 2667038 TI - Immunological aspects of toxicology: premises not promises. AB - The immune system is gaining increasing attention as a target of toxicant action. Many compounds, including metals, drugs, and pesticides, are able to alter immune functions. Additionally, the ability of toxicants to experimentally alter resistance to a variety of bacterial, viral, and tumor challenges is suggestive for the possible involvement of toxicants in morbidity and mortality. However, the implications of immunotoxicology as a subject of study may not be fully realized in some laboratories due to unfamiliarities into the workings of immunity by toxicologists. In an attempt to bridge this toxicology-immunology gap, this paper presents the major concepts of the immune system by reviewing specific examples of immune responses and their environmental interactions. Data from selected toxins are then used to illustrate how these responses may be altered. PMID- 2667039 TI - Our sacred food--a perspective. PMID- 2667040 TI - Nongenotoxic carcinogens in the regulatory environment. AB - The biological activity of many carcinogens is to directly induce mutational events, thereby altering the information encoded in the DNA. Short-term tests for potential carcinogens and risk assessment models generally rely on the assumption that the agent in question will operate through a genotoxic mechanism. However, carcinogenesis is a multistep process, and it is increasingly clear that the primary biological effect for many carcinogenic chemicals involves events other than direct DNA reactivity. For many experimental rodent models as well as human cancers, nongenotoxic mechanisms appear to be the driving force in the formation of tumors. Many of these nongenotoxic mechanisms are highly species-specific. Thus, it is increasingly important to ask if the rodent model applies to the human situation at all, in addition to the examination of appropriate, hypothetical, mathematical risk assessment models. More research is now being focused to better define the mechanisms by which the many distinctly different classes of nongenotoxic carcinogens are acting. This understanding will become the basis for new predictive assays and more realistic risk assessment models. If specific conditions are met, then a no observed effect level with a safety factor may be the most appropriate risk model for some carcinogens. PMID- 2667041 TI - Ecosystem health. II. Quantifying and predicting ecosystem effects of toxic chemicals: can mammalian testing be used for lab-to-field and field-to-lab extrapolations? AB - An understanding of the "health" of an ecosystem after exposure to toxic chemicals can be achieved through studies which concentrate on the description of effects on ecosystem homeostasis, identification of disruption, and determination of pathways between these. Studies using native mammals to determine effects of toxicants on terrestrial ecosystems must be designed so that they identify the populations at risk, select appropriate biological effect endpoints, and obtain appropriate numbers and types of samples and contextual ecological data. Accompanying laboratory studies are often needed to complement or confirm observations from the field. Although aquatic biologists routinely use about 10 selected native species for toxicological work, terrestrial biologists seem to prefer using laboratory mammals in "ecotoxicological" studies. Some have advocated using only laboratory rodents in a field setting, while others have suggested using both laboratory mammals and native species. We take the position that there are considerable limitations in the use of laboratory rodents in toxicological studies which purport to be meaningful with regard to prediction of toxicant-induced effects on ecological systems. Nevertheless, we are able to suggest an integrated plan that includes the systematic monitoring of native species in conjunction with laboratory animals exposed in the laboratory and in the field. PMID- 2667042 TI - [The heart and the blood vessels]. PMID- 2667043 TI - [Echography compared with conventional radiology in Osgood-Schlatter disease]. AB - This paper was aimed at estimating sonographic (US) accuracy in patients with clinical suspicion of Osgood-Schlatter's disease. This disease affects the patellar tendon in its attachment to the tibial tuberosity; boys are affected more frequently than girls, and during adolescence. Its pathognomic signs are: focal soft-tissue swelling anterior to the tibial tuberosity, edema of the inferior infrapatellar fat pad, and swelling of the ligamentum patellae with loss of the interface between the latter and posterior soft tissue. A comparative study was carried out of the X-rays and US examinations of the knee in 21 patients with Osgood-Schlatter's disease; X-rays exams employed the double-shield and double-film box methods, to allow the contemporaneous evaluation of both skeletal and soft-tissue features. The results prove that the soft-tissue changes observed with X-rays can be correctly depicted also by US. Thus, in our opinion, US has proved to have the same diagnostic accuracy as X-rays, and could therefore become the first-choice examination in both the diagnosis and the follow-up of Osgood-Schlatter's disease. PMID- 2667044 TI - [ERCP in the diagnosis of bilio-pancreatic pathology. Comparison with echography and CT]. AB - The authors have evaluated both sensitivity and specificity of ERCP in comparison with other imaging methods, such as US and CT, on the basis of a study of 63 patients with suspected pancreatobiliary pathologies. Our results show ERCP of chronic pancreatitis to have 83% sensitivity and 66% specificity. As for biliary pathologies, sensitivity was 94% and specificity 88%. In pancreatic pathologies, CT sensitivity was 99% and its specificity was 70%. The combined use of ERCP and CT determines a considerable rise in the percentages, and allows the evaluation of both the excretory tree and the parenchyma. As for biliary pathologies, the role of ERCP is fundamental, since its combination with the other methods (CT: sensitivity 72%, specificity 3.5%; US: sensitivity 70%, specificity 3.5%) has not determined but a slight increase in sensitivity, and no significant increase in specificity. PMID- 2667045 TI - [Course of acquired renal cystic disease. An ultrasonic follow-up study]. AB - The authors evaluated the evolution of acquired renal cystic disease with a 40 month US follow-up. Eighty-one patients were examined by US: 66 of them were hemodialysis patients, and 15 transplant recipients. Cystic kidney disease had progressed in 52/66 hemodialysis patients, whereas the picture was unmodified in 14/15 transplant recipients. As an explanation to the different evolution possibilities, the authors hypothesize that disease etiopathogenesis is to be sought in uremic toxic elements together with constitutional factors. Hemodialysis, prolonging the life of these patients, appears to facilitate the onset and/or evolution of the disease. On the contrary, kidney transplantation stops disease evolution, because it removes biologically active substances associated to uremia. In no cases new kidney tumors were found. PMID- 2667046 TI - [Transvaginal echography: initial experiences in oncologic gynecology]. AB - The authors report their initial experience in a selected group of 30 patients with suspected gynecological neoplasms (10 ovarian tumors, 8 recurrences of ovarian tumors, 6 cervical carcinomas, 3 ovarian cysts, 3 fibromyomas) who underwent both transabdominal (US) and transvaginal (TV) sonography. All the scans were retrospectively reviewed. In 18 cases US and TV provided equivalent information as to the organ of origin of the mass, while TV was more useful in 9 cases, and US in 3 cases. The anatomical relationship of the mass to the adjacent organs was better demonstrated by TV in 15 cases, while in 15 cases the information provided by US and TV was equivalent. The two techniques yielded the same results as to the internal architectural details of the mass in 9 cases, while TV was superior in 18 cases and US in 3 cases. TV allowed the early identification of: small amounts of free fluid in the cul-de-sac in 3 cases, compression of the ureter in 1 case, and compression of the uterine vessels in 1 case. These findings had not been demonstrated by US. Our preliminary results indicate that adjuvant TV sonography provides important diagnostic information in gynecological neoplasms in about 39% of patients. PMID- 2667048 TI - [Role of CT and US in the diagnosis of myelolipoma of the adrenal glands]. AB - The Computed Tomographic (CT) and Sonographic (US) features are reported of 3 adrenal myelolipomas, occasionally found in 3 patients. Even though US and CT are capable of detecting the majority of adrenal tumors, they are often limited in their ability to suggest specific histologic diagnosis. Adrenal myelolipoma represents an apparent exception to this limitation, since the myelolipomas large enough to be detected by CT or US often contain macroscopic fat. In some cases a myelolipoma containing macroscopic quantities of nonfatty material (blood, calcium, myeloid tissue) may have a non-specific CT/US appearance, due to the fat inside the lesion being shaded. In equivocal cases, needle biopsy may be needed to reach the correct diagnosis. PMID- 2667047 TI - [Tumors of the testis. Correlations between echographic, macroscopic and histological features in 48 cases]. AB - The authors retrospectively reviewed the ultrasonographic findings of 48 histologically confirmed testicular neoplasms in order to analyse the echomorphologic findings and identify any typical patterns. A wide spectrum of US features was observed for testicular tumors, corresponding to the different macromorphologic parenchymal textures of the various neoplasms. US was extremely useful for differentiating testicular tumors from non-neoplastic scrotal pathologies. US could neither distinguish the only benign lesion nor classify histologically malignant neoplasms. US was 100% accurate in the evaluation of testicular tumors, and allowed the identification of frequent typical patterns in some types of neoplasms. PMID- 2667049 TI - [Hydropneumothorax caused by rupture of pulmonary hydatid cysts. Description of a case]. PMID- 2667050 TI - Current applications of color Doppler imaging in the abdomen and extremities. AB - Recent advances in ultrasound technology have resulted in the development of diagnostic instruments that combine cross sectional imaging with spectral and color flow Doppler analysis. These instruments have expanded the role of diagnostic ultrasonography in the assessment of disease states involving the extracranial carotid artery, the peripheral vascular system, and the major abdominal vessels. The current applications of color Doppler imaging (CDI) combined with conventional spectral Doppler are demonstrated. PMID- 2667051 TI - Seminal vesicle imaging. AB - The purpose of this paper is to enhance the understanding of CT, MRI and US images of the seminal vesicles. Accurate interpretation of images requires knowledge of normal anatomy, embryology and pathology. Anatomy and a spectrum of abnormalities are reviewed and discussed. Cases are from an analysis of clinical and surgical files to show the diagnostic features of various cystic diseases of the seminal vesicles. Tissue characteristics of the seminal vesicles on CT, MRI and US images are emphasized. PMID- 2667052 TI - Mammography as a radiographic examination: an overview. AB - The mammographic examination can be considered from many different perspectives, not the least of which include the complex diagnostic or public health issues that determine the place of this study in modern medical practice. There is, however, no finer example than mammography of the role of radiological science in radiography. It is important that radiologists remain ever cognizant of this role in order to maximize the benefit of the examination to their patients. PMID- 2667053 TI - Ultrasound case of the day. Pedunculated retroperitoneal liver hemangioma. PMID- 2667054 TI - A two-part resin-bonded partial overdenture. PMID- 2667055 TI - A survey of casting and melting techniques used in the lost wax casting of yellow gold and metal/ceramic alloys in British dental schools. PMID- 2667056 TI - [Immediate effect of nasal continuous positive pressure in the treatment of obstructive sleep apnea]. AB - In 8 patients with severe sleep apnea syndrome we have studied the immediate effect of nasal continuous positive airway pressure. A good adaptation to the machine during their stay at the laboratory and the beneficial immediate effect on somnolence was observed. There was found a better efficiency of sleep, shortening of latency, decrease of stage 1, increase of REM and shortening of the latency of REM (rebound of REM sleep). Significant correlations were found between the needed pressure to eliminate apneas and the proportion of stage 1 (r = 0.83), of REM stage (r = 0.72) and stage 2 (r = -0.84) of basal night sleep. PMID- 2667057 TI - [Hemostasis and cancer]. AB - It is well known that patients with neoplasms have a greater incidence of thrombosis and bleeding episodes. Many are the analytic alterations observed and there are many works on the possible pathophysiologic mechanisms which support them as well as their importance in the process of metastasis: fibrinolytic activation, tumor coagulability and aggregability; inflammatory-immune system; tumoral neovascularization and the liberation of specific tumor substances. This paper is a bibliographic review of the role of these mechanisms giving the best possible unified outlook. PMID- 2667059 TI - [Biliary lithiasis: a present-day perspective]. PMID- 2667058 TI - [Raynaud's phenomenon]. AB - Raynaud's phenomenon (RP) is characterized by paroxysmal ischemic crisis of the hands and feet provoked by physical or emotional stimuli. The RP's prevalence is estimated between 4 and 5% of the general population, accompanying or not other conditions, or preceding in years the appearance of various connective tissue diseases. We have to consider, in its pathogenesis, alterations in the vascular tone or intraluminal thromboembolic phenomena. The diagnosis is based on the clinical picture since there are no specific tests to detect primary RP. Therapeutic measures include: change in lifestyle, vasodilator drugs and anti platelet aggregation drugs, plasmapheresis and surgery. Treatment should be individualized. PMID- 2667060 TI - [Acute lobar nephritis: usefulness of ultrasonics for diagnosis]. PMID- 2667061 TI - New aspects in the molecular growth regulation of mammary tumors. PMID- 2667062 TI - Estrogen-induced mitogens in breast cancer and their prognostic value. PMID- 2667063 TI - Physiological significance of thymic B lymphocytes: an appraisal. PMID- 2667064 TI - Diagnosis of a human case of Rift Valley fever by immunoperoxidase demonstration of antigen in fixed liver tissue. PMID- 2667065 TI - Filter paper confetti in a serological Rift Valley fever survey. AB - In order to collect epidemiological data about the Rift Valley fever epidemic in Mauritania, we decided to use the filter paper method. The mean recovery level of specific antibodies from filter paper, tested using an immunoenzymatic method, is around one fourth. Taking the mean haematocrit into account, we estimated the extract square with a 1/300 dilution. This method was very useful for epidemiological studies, we observed few patient refusals, but it is necessary to know the exact specificity of the antibodies. PMID- 2667066 TI - [Significance of IgM titration by an immunoenzyme technic for the serodiagnosis and epidemiological surveillance of dengue in French Polynesia]. AB - The usefulness of IgM antibody capture enzyme-linked immunosorbent assay (ELISA IgM) for the diagnosis of dengue was studied using several groups of sera. An attempt was made to detect IgM against each dengue serotype. Of 76 paired sera from patients with dengue type 4 infection, the diagnosis was confirmed by ELISA IgM in 74: in 47 out of 49 primary dengue infections and in all 27 secondary dengue infections. It was possible to detect IgM in 15 of the acute sera of primary infections and in 16 of the acute sera of secondary infections. In 20 patients from whom only single serum with high haemagglutination-inhibition titre (greater than or equal to 640) was available, 18 were found positive for dengue IgM. Dengue infection was also confirmed in 10 patients with dengue type 1 and in 10 patients with dengue type 2. IgM was detected in 1 of the acute sera of patients with either dengue type 1 or dengue type 2 infection. In all cases in which IgM was detected, a positive response was obtained for the homologous antigen. ELISA-IgM on sequential serum samples from 7 proven cases of dengue type 4 revealed that antibody titres greater than or equal to 400 are reached early in the second week of the illness and persist for 60 days or more at a low level (titre less than 400). An attempt was made to obtain a type-specific presumptive diagnosis by analysing the relative titre against each of the 4 antigens. It was possible to make a diagnosis of dengue type 4 in 85% and 52% of IgM-positive responses in primary and secondary infections (p less than 0.01), respectively, using paired sera from patients with known dengue type 4 infection. ELISA-IgM was shown to be of interest in the diagnosis and surveillance of dengue in French Polynesia where dengue viruses are, presently, the only known flavivirus. PMID- 2667067 TI - Isolation of Rift Valley fever virus from human peripheral blood mononuclear cells: Mauritanian epidemic. AB - During the Mauritanian Rift Valley fever (RVF) epidemic of 1987, peripheral blood mononuclear cells (PBMC) were studied from 78 sick patients. RVF virus (RVFV) was isolated in 5 cases, on Aedes pseudoscutellaris AP61, from both PBMC and serum. Among the 78 cases studied, RVF was proven in 19 cases (24.3%) by specific IgM detection, and in 12 cases (15.3%) by virus isolation from serum, of which 3 also exhibited anti-RVF IgM. Among the 5 PBMC-positive RVFV cases, 2 strains were isolated in the presence of specific IgM from patients presenting with neurologic signs. These observations raised the question as to the role of specific IgM in cellular infection, and suggest that, in certain cases, mononuclear cells may promote RVFV dissemination into brain cells. Further investigations need to be undertaken to determine the RVFV receptor expressed on PBMC membranes. PMID- 2667068 TI - Like a cheap toy. PMID- 2667069 TI - [Medical evaluation of travelers returning from the tropics: which diagnostic studies and for whom?]. AB - Annually ten percent of Swiss people expose themselves to the risk of acquiring a tropical or cosmopolitic disease during travel to exotic countries. A systematic check-up of returning travellers is however indicated only for those with acute or recurrent symptoms or after a prolonged residence in a critical region. Febrile states should be considered medical emergencies. Investigations comprise routine laboratory tests (examination of blood film and feces for presence of parasites) complemented by special tests based on anamnestic and clinical criteria. Special attention is given to fecal analysis which has to be adapted to the search for specific pathogens (Bacteria, Protozoa, Helminths). Serologic tests are of increasing importance for the detection of parasitic infestation allowing for specific therapy in certain cases. PMID- 2667070 TI - [Non-ulcer dyspepsia and Campylobacter pylori]. AB - Dyspepsia, defined as chronic vague upper abdominal symptoms, is a common condition. The pathogenesis of this syndrome remains poorly understood. The etiologic role of Campylobacter pylori and associated gastritis remain controversial though this organism colonizes the gastric antrum in one third to one half of patients with non-ulcer dyspepsia. Recent studies raise the prospect that treatment with bismuth improves gastritis and is successful in treating symptoms in the Campylobacter pylori positive and negative patients. To determine if Campylobacter pylori causes dyspepsia requires proof that long term eradication of the organism heals gastritis and abolishes symptoms. PMID- 2667071 TI - [A case from practice (142). Patient: Mr. R. W., born 1960, cook]. PMID- 2667072 TI - [Epidermal cell cultures: does it have clinical applications?]. PMID- 2667073 TI - [The diagnosis of dermatomycoses by a non-specialist]. PMID- 2667074 TI - [Classical sexually transmissible diseases and AIDS]. PMID- 2667075 TI - [When and how should varices be treated?]. PMID- 2667076 TI - [Treatment of duodenal ulcer with famotidine. (Multicenter study)]. AB - A multicenter open study aimed at evaluating the effect of famotidine in the treatment of duodenal ulcer was performed in several institutions located in 15 different cities of Mexico. One-hundred-and-fourteen patients with duodenal ulcer demonstrated by endoscopy were given 40 mg. of famotidine daily, administered as a single dose at night. After 4 and 6 weeks of treatment, healing of the ulcer was observed in 81.6% and 95.6% of patients, respectively. Side-effects were very unusual. In only one patient, who experienced vertigo during the treatment, administration of the drug had to be stopped. PMID- 2667077 TI - [Hepatic encephalopathy. Part II. Treatment]. PMID- 2667078 TI - [Nutrition and cancer of the digestive tract]. PMID- 2667079 TI - [Treatment of gastric ulcer with famotidine. (Multicenter study)]. AB - A multicentric open study designed to evaluate the effect of famotidine in the treatment of gastric ulcer was performed in several institutions located in 15 different cities of Mexico. 54 patients with gastric ulcer demonstrated by endoscopy were given 40 mg of famotidine daily, administered as a single dose at night. After 6 and 8 weeks of treatment, healing of the ulcer was observed in 63% and 88.9%, respectively. Side-effects were very unusual. PMID- 2667080 TI - Symptom management in the home-based terminal cancer patient. AB - Comprehensive symptom management is the hallmark of good medical care of the terminally ill cancer patient. Careful attention to patient comfort and early assessment and intervention to alleviate distressing symptoms enable the patient to remain at home, and maximize the quality time which the patient and family can share. PMID- 2667081 TI - The Rhode Island Medical Journal heritage. PMID- 2667082 TI - [Palpation and sonography of lymph node metastasis of the neck]. AB - In a retrospective study, the diagnostic value and ranking of preoperative palpation and sonography for the identification of cervical lymph nodes was assessed in 130 patients with tumours of the head and neck. The diagnostic accuracy (85%) of palpation is below that of sonography (90%). The importance of sonography lies in reducing false negative findings. The increase in sensitivity (palpation 74%, sonography 90%) is, however, offset by an increase in false positive findings, i.e. by a reduction in specificity (palpation 94%, sonography 90%). PMID- 2667083 TI - [Thoracic diagnostic requirements of an intensive care unit from the anesthesiology viewpoint]. AB - Diagnostic procedures of the thorax in intensive-care units are conventional x ray chest images, chest images by digital luminescence radiography, sonography and transoesophageal Doppler echocardiography. In addition to these bedside methods the stationary usable techniques, such as computed tomography, digital subtraction angiography and the seldom in intensive care patients used computed nuclear spin resonance tomography (NMR) are applicable. The selection of the above mentioned techniques depends on the availability and the quality of the methods as well as the qualifications of the involved staff. The diagnostic procedures of the chest must be arranged depending on the decision if patients have to be transported or not. In conclusion it can be stated that in spite of growing technical preconditions the availability of the methods in immobile patients and the diagnostic potency of the techniques have to be examined. PMID- 2667084 TI - [CT studies of the lung in opportunistic infections]. AB - Immunosuppressive patients are at high risk of opportunistic infections whose main site of manifestation is the lung. The prognosis depends largely on starting therapy in time. Thorax CT supplies an important contribution especially in diagnosis and monitoring of pneumomycoses, which are particularly relevant among the problem infections on account of their frequently lethal course: compared with conventional thorax imaging, CT detects infiltrates much earlier; in addition, it presents a characteristic course of pulmonary changes enabling at least in part some conclusions regarding the pathoanatomical substrate. The article reports on the prerequisites for an infection justified indication for thoracic CT, on its execution and on the findings as for example in pneumomycoses. PMID- 2667085 TI - [Radiologic diagnosis of thoracic injuries]. AB - A radiological check list in trauma of the thorax is presented that is oriented by means of topographic locations (thoracic wall, pleura, lung, mediastinal organs). Focus is on the specific features of lung contusion and lesions of the mediastinal organs with special reference to modern examination methods. PMID- 2667086 TI - [Angiography in intensive care medicine]. AB - Angiography is rarely performed in the intensive-care ward. Indications are: pulmonary embolism, unstable angina pectoris or myocardial infarction, gastrointestinal haemorrhage, acute arterial occlusion, traumatic vascular lesions, aneurysms and if a foreign body has to be extracted. It will always be necessary to weigh the pros and cons, that is to say the risks and danger involved in transporting the patient and in performing an invasive diagnostic procedure on the one hand, and the possible therapeutic gain on the other. PMID- 2667087 TI - [Pelvi-rachidian involvement in sarcoidosis. Apropos of a case. Review of the literature]. PMID- 2667089 TI - [The polyarticular and destructive form of amyloid arthropathy in dialysis patients. Apropos of a case]. PMID- 2667088 TI - [Osteomalacia revealing Gougerot-Sjogren syndrome]. PMID- 2667090 TI - [A syndrome associating severe fever bouts, hepatic disorder, pancytopenia and disseminated intravascular coagulation in the course of Still's disease in adults]. PMID- 2667091 TI - Growth deficiency with high circulating growth hormone levels: the insulin stimulation test in 39 children. AB - Thirty nine patients with abnormal high basal hGH levels were selected and analysed as a part of a retrospective study of the results of 1,500 insulin stimulation tests (IST), applied in children and adolescents with growth deficiency. Their height, weight, and bone age were lower than their corresponding chronological age. Both in girls and in boys groups, responders and nonresponders subgroups were detected as judging by the results of the secretagogue action of insulin on hGH. The hGH basal levels were 43.88 +/- 18.27 microU/ml (X +/- SD) in boys (no = 22) and 56.61 +/- 35.21 microU/ml in girls (no = 17). It is to be noted that the hGH nonresponder group had deeper hypoglycemia at 30 minutes post-insulin injection than the responder group: 53.6 +/- 13.0 mg/100 ml (X +/- SD) vs 66.0 +/- 11.5 mg/100 ml respectively (p less than 0.01). Two siblings, a girl and a boy, had the highest basal and stimulated hGH, either during the IST or starvation. One of them, the boy, during the starvation test, had a paradoxical fall of about two orders of magnitude of the serum hGH 4 hr after basal sample collection. These two siblings are similar to the familial Laron type dwarfism. The possible mechanisms of growth deficiency in children with constant high but variable hGH values are discussed, as well as the aspects concerning the therapeutic ways to improve their linear growth. PMID- 2667092 TI - Thyro-gonadic failure, a risk factor in cardiovascular pathology. PMID- 2667093 TI - The Nobel Prize for Medicine or Physiology, 1901, awarded to Emil Adolf von Behring. PMID- 2667095 TI - Salmonella bacteremia in renal transplant recipients. AB - Three cases of salmonella bacteremia in renal transplant recipients are reported. Two patients had prolonged salmonella infections with recurring bacteremia. The longest interval between bacteremic relapses was 15 years. 27 cases from the literature of salmonella bacteremia in renal transplant recipients are reviewed. The courses of salmonellosis in renal transplant recipients are more serious than in other non-compromised patients, being complicated by bacteremia in 70% of the cases. Renal transplant recipients have prolonged carrier states and frequent relapses or recurrences of salmonellosis. 45% of the salmonella bacteremias in renal transplant recipients are seen after a high dose methylprednisolone treatment for graft rejection episodes. PMID- 2667094 TI - Deficiency of the eighth component of complement. Evidence for linkage of C8 alpha-gamma pattern with C8 beta deficiency in sera of twelve patients. AB - The C8 alpha-gamma subunit of the eighth component of complement was analysed by sodium dodecyl sulphate-polyacrylamide gel electrophoresis and immunoblotting in sera from 68 normal individuals, 12 C8 beta-deficient patients (from seven unrelated families), and 10 of the parents of the latter. Three different forms of the C8 alpha-gamma subunit were observed: 34/68 normal individuals were found to have a C8 alpha-gamma triple band (termed C8 alpha-gamma 1, C8 alpha-gamma 2, C8 alpha-gamma 3 variants), 23/68 the C8 alpha-gamma 2 and C8 alpha-gamma 3 variants, and 11/68 the C8 alpha-gamma 1 and C8 alpha-gamma 3 variants. In contrast, all C8 beta-deficient patients had detectable C8 alpha-gamma 2 and C8 alpha-gamma 3 variants but lacked the C8 alpha-gamma 1 variant in addition to the C8 beta subunit. Three out of ten parents of the C8 beta-deficient patients were found to have the C8 alpha-gamma triple band, whereas 7/10, like their children, had the C8 alpha-gamma 2 and C8 alpha-gamma 3 variants only. We conclude that there is a linkage between the C8 alpha-gamma pattern and C8 beta deficiency. These data may support earlier findings that in humans the genes encoding for C8 alpha-gamma and C8 beta are closely linked on chromosome 1. PMID- 2667096 TI - Central nervous system complications in patients with bacteremia. AB - The occurrence of central nervous system (CNS) complications was studied retrospectively in 150 patients with bacteremia caused by Staphylococcus aureus, Streptococcus pneumoniae, beta-hemolytic streptococci or Escherichia coli. The incidence and clinical manifestations of different CNS complications were noted during 1 month after the bacteremia. Special attention was paid to vascular complications (infarction or hemorrhage), infections (meningitis or brain abscess) and mental changes when they were the only signs of CNS origin (lowered level of consciousness, confusion or delirium). The risk of cerebral infarction was elevated in the patients with bacteremia during the first month after the positive blood culture as compared with the overall risk of stroke in the general population. 10/150 patients (7%) developed cerebral infarction during that month. Two of these cases were associated with bacterial meningitis and 1 with endocarditis. Mental changes as a main symptom of CNS origin occurred in 27% of patients with bacteremia. Increasing patient age predisposed to this complication. Mental changes were not associated with any bacterial species studied. Altogether 40% of the patients developed CNS complications, which were a significant risk factor for death during the first month after the bacteremia. PMID- 2667097 TI - Plasmid-mediated beta-lactamases among aminoglycoside resistant gram-negative bacilli. AB - Plasmid-mediated beta-lactamases were characterized by DNA hybridization in 371 aminoglycoside resistant gram-negative bacilli with known aminoglycoside resistance mechanism. Positive hybridization was detected in 50% to a TEM-1 probe, in 2% to a SHV-1 probe, and in 3% to both probes simultaneously. No hybridization was obtained to OXA-1, OXA-2, PSE-1/PSE-4/CARB-3 or PSE-2 beta lactamase probes. TEM-1 beta-lactamase occurred simultaneously in 82% of strains showing the AAC(3)-V type of aminoglycoside resistance mechanism. Using isoelectric focusing as a control method, we found potentially plasmid-encoded beta-lactamases, other than TEM-1 and SHV-1, at various pIs in 13% of 288 randomly selected strains. The pIs of these strains or strains showing positive hybridizations did not fit to pIs of recently characterized plasmid-mediated enzymes against third-generation cephalosporins (e.g. CTX-1). In addition, the strains did not show resistance to cefotaxime or ceftazidime. According to the in vitro susceptibility data ceftazidime and cefotaxime were active against most of the aminoglycoside resistant strains studied. In contrast, the activity of piperacillin was much lower than that of the cephalosporins tested. PMID- 2667098 TI - Poor response to long-term albendazole therapy of hydatid liver cysts. AB - Seven patients with uncomplicated hepatic hydatid cysts (Echinococcus granulosus) were treated with albendazole 10 mg/kg/day for 2-6 months (mean 4 months). Serial sonographic evaluation showed reduction in cyst size in only 1 patient (the anteroposterior diameter decreased from 16.5 cm to 4.9 cm). Therapy in this patient was discontinued after 4 months due to development of jaundice. Albendazole appears to have a limited role in the treatment of hydatid disease of the liver. PMID- 2667099 TI - Advancing age and acute infection influence the kinetics of ceftazidime. AB - The pharmacokinetics of ceftazidime were studied after single intravenous injections of 2 g in 10 healthy, elderly male volunteers (63-76 years old). None of the subjects were on concurrent drug treatment and all had normal age correlated glomerular filtration rate. Mean values for major pharmacokinetic variables were: terminal half-life 2.63 h, area under the serum concentration curve 417.6 h mg/l, total clearance 74.6 ml/(min 1.73 m2), renal clearance 53.6 ml/(min 1.73 m2), urinary recovery/12 h 71.7% of dose and apparent volume of distribution (Vss) 15.0 l/1.73 m2. Data were compared with our earlier findings in studies of young male volunteers and elderly, acutely ill male patients. Advanced age was accompanied by a reduction in clearance of ceftazidime, while no significant age-related changes in distribution were noted. Acute infection was associated with increased Vss and enhanced renal clearance; alterations possibly caused by fever-induced changes in vascular permeability and renal blood-flow. PMID- 2667100 TI - Diagnosis of pyogenic liver abscess via liver scanning with indium-111 labelled granulocytes. AB - An 82-year-old man presented with a history indicating cancer or a developing pyogenic abscess in the liver. The latter diagnosis was established by a liver scan with indium-111 labelled granulocytes, whereas ultrasonography, computed tomography and percutaneous liver puncture were inconclusive. PMID- 2667101 TI - Influenza B in transplant patients. AB - Six cases of influenza B occurred in transplanted patients in a period of 3 weeks. Three renal allograft recipients recovered within 5 days without antiviral therapy. Two allogeneic bone marrow recipients were treated with ribavirin inhalations during the leukopenic phase. Treatment was given until influenza B was no longer detected and fever disappeared after 5 and 6 days, respectively. Engraftment was not delayed and no side-effects were noted. One recipient of autologous marrow was treated for 2 days, but ribavirin was discontinued due to pleuritic pain. We conclude that influenza B can be spread by asymptomatic carriers in the nursing staff and in spite of reversed isolation with the use of gown, hand wash and gloves. PMID- 2667103 TI - Ciprofloxacin in the elimination of enteric Salmonella carriage stage. AB - According to the present experience, ciprofloxacin seems to be a new promising drug for the treatment of enteric salmonella carriage stage. This paper reviews results with ciprofloxacin and older drugs. While the cure rates in previous studies were about 70%, it was at least 90% with ciprofloxacin although the treatment time was shorter and the rate of side effects was lower. However the final place of ciprofloxacin on this indication needs to be investigated further. PMID- 2667102 TI - Ciprofloxacin in meningococcal carriers. AB - Chemoprophylaxis of meningococcal disease is still necessary in spite of the availability of an effective vaccine against group A, C, Y and W135 strain meningococci. After emergence of sulphonamide resistant meningococcal strains, rifampin has been the drug used for chemoprophylaxis. Development of rifampin resistance in meningococci during short term prophylactic treatments makes this treatment less suitable. At present, there are several studies where ciprofloxacin has shown good effect in eradication of meningococci from nasopharyngeal carriers. It also seems obvious that one single dose of ciprofloxacin is enough for the purpose. Ciprofloxacin can be recommended for chemoprophylaxis of meningococcal disease in adults. PMID- 2667104 TI - Tolerance of intravenous ciprofloxacin. AB - Available information about the safety of intravenous (i.v.) administration of ciprofloxacin is reviewed. No increased incidence of systemic toxicity is apparent over the oral route. CNS side effects occur, but at a low rate and they are mild. Caution is indicated in patients with tendency for seizures. Laboratory changes are minimal, mainly mild elevations of liver enzymes. No increased risk of crystalluria has been seen. Local side effects in the form of erythema and burning are relatively common in some volunteer studies and are also seen in clinical studies, infusion phlebitis also occurs. It is recommended that i.v. ciprofloxacin is administered in slow infusion through a large or preferably central vein. PMID- 2667105 TI - Safety of ciprofloxacin. A review. AB - In clinical trials phase II and III world wide 8,861 courses of ciprofloxacin were entered into the data base for safety evaluation. The following adverse reactions were observed-gastrointestinal 5%, metabolic and nutritional 4.6%, central nervous system 1.6%, skin 1.4%, hemic and lymphatic 1%, cardiovascular 0.4%, body as a whole 0.4%, urogenital 0.3%, special senses 0.3%, musculo skeletal 0.1%, respiratory 0.08%. Total incidence of adverse reactions was 10.2%. Ciprofloxacin interacts with theophylline and certain antacids. Caution should be exercised in treating patients with known history of convulsions. Crystalluria does not appear to be a problem. Ciprofloxacin is well tolerated and side effects are usually mild or moderate in intensity. However, unusual and unexpected reactions have to be watched for. PMID- 2667106 TI - Overview of Scandinavian in vitro studies with ciprofloxacin. AB - Scandinavian studies have confirmed that ciprofloxacin is highly active against most Gram-negative bacterial species with extremely low minimal inhibitory concentrations (MIC-values) except for Pseudomonas aeruginosa. The antibacterial activity is approximately four times higher than that of norfloxacin. Gram positive cocci are less sensitive with MIC-values of 0.5 to 1 mg/l. For pneumococci the ciprofloxacin concentration inhibiting 90% of clinical isolates (MIC90) is approximately 2 mg/l. The antibacterial activity of ciprofloxacin is influenced very little by an increased inoculum and culture conditions. However, urine reduces the antibacterial activity. Resistance to ciprofloxacin occurs extremely rarely among E. coli, but development of resistance among species like P. aeruginosa and Staphylococcus aureus may be more frequent. Ciprofloxacin is a bacterial antibiotic but killing of staphylococci was poor when studied kinetically. Ciprofloxacin plus piperacillin act synergistically against strains of P. aeruginosa. Ciprofloxacin has a post-antibiotic effect (PAE) of approximately 2h against both Gram-negative rods and Gram-positive cocci. PMID- 2667108 TI - Ciprofloxacin in urinary tract infections. AB - The high in vitro activity of ciprofloxacin against most urinary tract pathogens and its favourable pharmacokinetics suggests considerable potential for use in therapy. The published controlled clinical trials show that ciprofloxacin has few adverse reactions and is at least as effective as the drugs with which it was compared. PMID- 2667107 TI - Effect of ciprofloxacin on human lymphocytes--laboratory studies. AB - 4-Quinolones affect mammalian cellular functions in vitro in several ways. Inhibition of cell proliferation differ widely among 4-quinolones. Ciprofloxacin is one of the most antiproliferative inhibiting cell growth with about 30% at 20 mg/l. Genotoxicity tests with 4-quinolones are probably "false" positive due to an increased [3H]-thymidine uptake not related to DNA damage. Ciprofloxacin at 10 mg/l and up causes significant DNA strand breaks which seemingly are quickly repaired and not causing mutations or cancerogenesis. Ciprofloxacin at 5 mg/l inhibits immunoglobulin production but the growth factor interleukin 2 (IL-2) is increased by 4-quinolones at the same concentration and hyperinduced at higher concentrations. Thus the effects are very contradictory. Increased IL-2 may contribute to CNS side effects. PMID- 2667110 TI - Ciprofloxacin in the treatment of acute and chronic osteomyelitis: a review. AB - The clinical and bacteriological efficacy and safety of ciprofloxacin given as oral doses of 500 to 1,500 mg (normally 750 mg) twice daily for treatment of Gram negative bacillary osteomyelitis are reviewed. In 182 patients of whom a majority had Pseudomonas aeruginosa or mixtures of Ps. aeruginosa and other bacteria as the causative agents, clinical cure or improvement was achieved in 75%. Data from 85 patients with Ps. aeruginosa as the infecting pathogen could be analysed and showed that 20 strains persisted and that nine of them became resistant to ciprofloxacin during treatment. In patients with Staphylococcus aureus as a copathogen, that organism was eradicated during ciprofloxacin treatment in more than 90% of the cases. Despite very long treatment times (up to 476 days), the safety of ciprofloxacin seemed comparable to that reported with shorter treatment times and lower doses. However, it was noted that three patients developed photosensitization during treatment and that reversible renal failure related to ciprofloxacin occurred in one patient. In conclusion, ciprofloxacin offers a well tolerated and efficacious alternative to injectable antibiotics for the treatment of Gram-negative osteomyelitis. PMID- 2667109 TI - Ciprofloxacin versus doxycycline in the treatment of uncomplicated urogenital Chlamydia trachomatis infections. A double-blind comparative study. AB - Two-hundred patients with confirmed Chlamydia trachomatis infection of the urogenital region were treated with either ciprofloxacin 1.5 g/day or doxycycline 100 mg/day for seven days. One-hundred and fifty-seven patients were males and 43 females. C. trachomatis was isolated prior to treatment from urethra alone in 155 patients, from cervix alone in 27 and from both urethra and cervix in 15. The first re-examination was carried out at the end of treatment and the second one week later. Six patients in the ciprofloxacin group and three in the doxycycline group never returned for the first re-examination. At the second re-examination there were seven defaulters in the ciprofloxacin group and 11 in the doxycycline group. Altogether there were 12 bacteriological failures in both groups. Clinical failure despite bacteriological cure occurred in 20 patients in the ciprofloxacin group and eight in the doxycycline group. The total number of treatment failures was 32 in the ciprofloxacin group and 20 in the doxycycline group. The results suggested that neither treatment was efficient enough in the treatment of uncomplicated urogenital infections caused by C. trachomatis. PMID- 2667111 TI - Clinical efficacy of ciprofloxacin in lower respiratory tract infections. AB - The sputum pharmacokinetics and clinical efficacy of ciprofloxacin in lower respiratory tract infections is reviewed. Following intravenous administration, ciprofloxacin penetrates rapidly into bronchial tissue; the elimination half life is between 3 and 4 h and a dose dependency is seen. Following oral intake, the time to reach maximal concentrations is approximately two hours and after a dose of 750 mg the concentration may reach 1.7 mg/l in patients without cystic fibrosis and range from 0.5 to 3.4 mg/l in cystic fibrosis patients. Coadministration of ciprofloxacin increases serum levels and decreases total body clearance of theophylline. In controlled comparative clinical trials, ciprofloxacin has been found to have similar clinical efficacy as amoxycillin, ampicillin, cefalexin, doxycycline, co-trimoxazole, imipenem-cilastatin and ceftazidime for the treatment of a range of lower respiratory tract infections. Ciprofloxacin has been found to be superior in clinical efficacy to cefaclor. Experimental animal models suggest a role for ciprofloxacin in infections caused by Legionella pneumophila and Mycoplasma pneumoniae. The clinical and bacteriological efficacy of ciprofloxacin is less pronounced in lung infections caused by Pseudomonas aeruginosa, but is comparable to the combination of beta lactams and aminoglycosides. Development of resistance is frequently observed during ciprofloxacin treatment of Ps. aeruginosa. Because of the availability of other oral and effective agents, ciprofloxacin is not recommended for empirical treatment of community acquired lower respiratory infections, but should be reserved for infections caused by multiply resistant organisms. PMID- 2667112 TI - Suppression of the oropharyngeal and gastrointestinal microflora by ciprofloxacin: microbiological and clinical consequences. AB - The impact of ciprofloxacin on the human oropharyngeal and gastrointestinal microflora has been studied by several authors during the last years. The use of ciprofloxacin for selective decontamination in immunocompromised patients has also been investigated. This review article summarizes the published data concerning these studies. The results show that the impact on the oropharyngeal microflora is minor. Administration of ciprofloxacin leads to a rapid elimination of the major components of the aerobic Gram-negative intestinal microflora. The aerobic Gram-positive flora is partly affected, while the impact on the anaerobic microorganism is minor. Oral ciprofloxacin given prophylactically to immunocompromised patients during severe granulocytopenia prevented colonization with potentially pathogenic aerobic Gram-negative rods, and reduced the incidence of infections caused by these microorganisms. There was no effect on the incidence of aerobic Gram-positive or fungal infections. Administration of ciprofloxacin seems not to predispose to the development of resistant microorganisms. PMID- 2667113 TI - The relation between urinary tract infections and stone composition in renal stone formers. AB - During a seven-year period (1975-1981) a total of 1325 patients hospitalized for stone disease were studied as to the occurrence of positive urine cultures. Urinary stones from 535 surgically treated patients were analyzed with infrared spectrophotometry and the relationships between stone composition, level of surgery and bacteriological strains were studied. Positive urinary cultures were found in 34% of the surgically treated patients and in 21% of those not operated upon. Among the surgically treated patients with urinary tract infection (UTI) E. coli was the most frequent microorganism (35%), followed by Proteus (28%). Patients with Proteus infection had the highest frequency of UTI episodes, most of which occurred before hospitalization. There was a higher frequency of magnesium ammonium phosphate (MAP) calculi among patients with Proteus infection than among those with non-Proteus infection, in whom no difference in stone composition was found. Patients infected with E. coli had more phosphate containing stones (CaP+MAP) than non-infected patients. The highest frequency of oxalate calculi (CaOx+CaOx/CaP) was found among patients without infection. No E. coli infections were seen in male patients with CaP and MAP calculi. MAP stones were most often found in the kidney and oxalate stones in the ureter. PMID- 2667114 TI - Factors influencing physical working capacity in renal transplant patients. AB - Clyne N, Jogestrand T, Lins L-E & Pehrsson SK. Division of Nephrology and Cardiology, Department of Medicine and Department of Clinical Physiology, Karolinska Hospital, Stockholm, Sweden. We have examined uraemic patients' exercise capacity, and the factors influencing this capacity, before and after successful renal transplantation. Eleven uraemic patients (mean age 41 +/- 10 years) with an average glomerular filtration rate (GFR) of 5 +/- 4 ml/min x 1.73 before and 45 +/- 19 ml/min x 1.73 after transplantation participated in the study. The maximal exercise capacity, measured by standardized exercise test on a bicycle ergometer, averaged 106 +/- 25 W before and 126 +/- 35 W (p less than 0.05) after transplantation. The patients interrupted the tests prior to and after transplantation because of general fatigue, leg tiredness or both. No patient experienced angina pectoris. All, but one, had a normal ECG reaction during exercise. Total haemoglobin (THb) was 55 +/- 8% of the expected normal before and 84 +/- 19% after transplantation (p less than 0.01). The increase in working capacity was linearly correlated to the increase in THb (r = 0.84, p less than 0.01), but not to the improvement in GFR nor to the decrease in parathyroid hormone. In conclusion, successful renal transplantation improves working capacity. The results indicate that an increased THb is a major determinant for this increase in working capacity. PMID- 2667115 TI - Lack of antibodies to Legionella pneumophila and Legionella micdadei in hemodialysis patients. AB - In 231 adult hemodialysis patients and 134 healthy adults, we measured antibodies to Legionella pneumophila (serogroups 1-6) and Legionella micdadei by indirect immunofluorescent antibody tests to assess the risk of Legionnaires' disease. One of the patients had a titer of 1:512 to Legionella pneumophila but he had no history of Legionnaires' disease. Two had a titer of 1:64 to Legionella pneumophila, and none had a titer of greater than or equal to 1:64 to Legionella micdadei. By contrast, none of the control group had a titer greater than or equal to 1:64 to Legionella pneumophila and two had a titer of 1:64 to Legionella micdadei. Thus, our population of maintenance hemodialysis patients did not display increased prevalence of antibodies of Legionella pneumophila and Legionella micdadei, but prospective studies of pneumonia in hemodialysis patients might further evaluate possible risk of Legionnaires' disease. PMID- 2667116 TI - [Plant protection and groundwater]. PMID- 2667117 TI - [Good expert practice of agriculture in the water protection area]. PMID- 2667118 TI - [Toxicologic aspects of the estimation of pesticide residues in drinking water]. PMID- 2667119 TI - [Pesticide use and groundwater protection--an introduction to the current questions]. PMID- 2667120 TI - [Diagnosis and therapy of stomach ulcer]. AB - The patient suffering from gastric ulcer disease needs more attention than one suffering from duodenal ulcer disease, especially regarding the necessity of endoscopic bioptic control of healing, which is vital to ensure that malignancy is not missed. Greater patience is also necessary during therapy, since a gastric ulcer is generally larger than a duodenal ulcer and more time is thus necessary for complete healing. Otherwise the natural course of the disease and the therapeutic requirements for acute and maintenance treatment are similar. This also relates to the indication for surgery. PMID- 2667121 TI - [Surgical therapy of stomach ulcer]. AB - Gastric ulcer is situated at a locus minoris resistentiae of the gastric body, an area of which operative removal is technically simple and without major risks. A gastric ulcer which has not completely healed after 3 months of medical therapy is potentially malignant and requires surgical therapy. For type I gastric ulcer we perform partial gastrectomy with Billroth I reconstruction. Type II gastric ulcers call for partial gastrectomy with Billroth I reconstruction and vagotomy of the gastric stump. For type III gastric ulcers, 2 equivalent surgical procedures - proximal gastric vagotomy and partial gastrectomy with Billroth I reconstruction - are available. PMID- 2667122 TI - [Clinical aspects, spontaneous course and therapy of chronic pancreatitis. With special reference to the problem of nomenclature]. AB - This clinical review is based on prospective long-term observation of 205 cases of alcoholic and 82 cases of non-alcoholic pancreatitis (CP). The long-term course of pancreatitis is the key to clinical classification, which thus far has been erroneously based one-sidely on morphologic criteria. CP exhibits a typical continuous alteration of the main variables (clinical picture, function, morphology) dependent on duration of the disease and etiology. Progress of the disease is determined, first, by progressive destruction of glandular tissue and, second, by possible occurrence of local complications in the pancreas. Basically there are three typical models of disease course from the clinico-biologic and morphologic viewpoint: in uncomplicated CP, (1) the early stage and (2) the late stage; in complicated CP, (3) CP with local complications (chiefly pseudocysts and duct obstruction). - In uncomplicated CP with durable pain syndrome there is a close relationship between pain attacks and pancreatic function, i.e. persistent freedom from pain occurs parallel with severe pancreas dysfunction in the late stage. Complicated CP with lasting pain syndrome, usually due to local complications, is reconverted by surgical eradication of the latter into uncomplicated CP with foreseeable course as regards postoperative pain recurrence, depending on the early or late stage of the disease. In clinical picture and long-term course, non-alcoholic CP differs in certain essential respects from alcoholic CP. The two forms do not differ essentially as regards mortality and survival. PMID- 2667123 TI - [Imaging in chronic pancreatitis]. AB - The author presents the different imaging modalities that are now available for the diagnosis and treatment of chronic pancreatitis. These methods are indispensable although they do not preclude clinical examination and laboratory studies. The classical examinations such as plain abdominal film, upper GI studies and barium enema, cholangiography and arteriography are still of interest, especially in the diagnosis of complications and preoperative cartography. ERCP is still the only means of visualizing the many ducts, and often serves to differentiate pancreatitis from certain neoplastic lesions. CT is now the most effective method, even though a negative scan does not exclude the diagnosis of pancreatitis. Sonography maintains its usefulness in initial screening as well as in follow-up evaluation. Magnetic resonance imaging does not offer an advantage over CT, but future prospects are encouraging. Percutaneous diagnostic or therapeutic procedures under radiological guidance now belong to the current medical arsenal. Under fluoroscopic, sonographic or CT control, percutaneous drainage is often offered as an alternative or a complement to surgery. PMID- 2667124 TI - [Surgical therapy of chronic pancreatitis]. AB - From a series of 411 surgical operations in chronic pancreatitis patients, 142 were analyzed with respect to indication, early and late mortality, and results. Average follow-up time was 10 years. Resective procedures were used in 51 patients and drainage in 24. Late mortality was twice as high for drainage (19%) as for resection (7.5%). The subjective late results were best for resection, since in these cases relapse occurred only in 16% and improvement of symptoms in 79%; for drainage the improvement rate was only 65% and the recurrence rate 39%. Drainage was followed by latent or manifest diabetes in 21% of cases, and resection in 63%. Deterioration of exocrine pancreas function was observed in 29% of resections but in only 14% of drainages. These data indicate that prognosis of the disease depends on the surgical procedure as well a withdrawal of alcohol. PMID- 2667125 TI - [Pain-free piezoelectric extracorporeal shock wave lithotripsy in gallbladder stones. Initial experiences]. AB - Efficacy and side effects of lithotripsy of gallbladder stones with a piezoelectric lithotriptor are assessed. 16 treatments were performed in 8 patients (1-3 per patient). Patients required no premedication, analgesia, infusion or monitoring. Gallstone fragmentation was achieved with all treatments. Laboratory findings remained unchanged after treatment, with the exception of one patient with mild pancreatitis. With adjuvant oral bile acid treatment, 6 of the 8 patients were stone-free within 3 days to 3 months. Extracorporeal shockwave lithotripsy with piezoelectric shock waves provides painless and efficient gallstone fragmentation. Repeated treatments may speed complete fragment dissolution. PMID- 2667126 TI - [Hepatic veno-occlusive disease: indication for liver transplantation?]. AB - Since 1976 liver replacement has become a widespread and successful procedure in the management of acute or chronic Budd-Chiari syndrome. Since transcaval resection of the liver with direct hepato-atrial anastomosis provides a less formidable method of treating Budd-Chiari syndrome, we consider liver transplantation only in cases with thrombosis of central liver veins (veno occlusive disease). Even in such a desperate situation liver transplantation can be very helpful, as documented in this report. PMID- 2667127 TI - [Segmental hemorrhagic colitis following amoxicillin therapy]. AB - We report on three young females complaining of bloody diarrhea of acute onset due to hemorrhagic colitis associated with oral amoxicillin therapy. The bloody diarrhea with abdominal cramps began 4 to 6 days after starting the treatment. Right colon was involved in two patients, and the descending and sigmoid colon in the other. Stool cultures and search for Cl. difficile toxins were repeatedly negative. Biopsy revealed marked mucosal hemorrhage (2/3), erosions (2/3) and thrombosed vessels (2/6). Symptoms rapidly resolved after 2 to 6 days. Extensive allergic evaluation in one patient did not reveal a hypersensitivity reaction. A literature review reveals another 31 patients with this characteristic form of colitis associated with ampicillin or amoxicillin therapy. PMID- 2667128 TI - [Suicide and cancer]. AB - Epidemiological studies demonstrate that cancer patients are at increased risk of suicide. While affective illness and alcoholism are the most important determinants of suicide in the physically healthy population, vulnerability to suicide in cancer patients is influenced by a number of other factors including psychosocial and psychosomatic effects of advanced illness, pain, organic mental syndromes and preexisting psychopathology. Ways of influencing these risk factors are discussed, together with their use in preventive care and management of suicidal cancer patients. PMID- 2667129 TI - [The diagnosis of cardiomyopathies using magnetic resonance]. AB - Magnetic resonance imaging (MRI), a relatively new, noninvasive technique, provides comprehensive information on the myocardial anatomy through its excellent contrast resolution, high spatial resolution and intrinsic high contrast between the blood pool and the surrounding soft tissues. Cine MRI possesses an adequately high time resolution for the analysis of the global and regional function of the left ventricle. 31phosphorus magnetic resonance spectroscopy (MRS) is a unique tool for the assessment of alterations of the myocardial high energy phosphate metabolism in the intact, working heart. On the basis of personal data and an overview of the literature, the current relevance and future perspectives of MRI and MRS in the diagnosis of cardiomyopathies are presented. PMID- 2667130 TI - [Autologous bone marrow transfusion in the treatment of adults with hematologic neoplasms. Experiences from Bern]. AB - 21 patients with hematological neoplasias (8 ALL, 4 AML, 4 NHL, 5 HD) were treated with high dose therapy and autologous bone marrow rescue (ABMT). At the time of ABMT 12 patients were in CR, 6 in PR and 3 in relapse. 66% of the patients were at high risk at the time of diagnosis. Before ABMT patients received an ablative regimen such as cyclophosphamide or ARA-C, VP-16, DNR and 12 Gy TBI in 6 fractions. In 9 patients the bone marrow was treated in vitro with monoclonal antibodies and complement. The hospital stay was a median 33 (24-57) days and isolation 19 (9-49) days. Complications were septicemia (7), herpes stomatitis (7), infections (6), fungal sepsis (1) and hemorrhagic cystitis (2). Late complications (up to 6 months after ABMT) were pneumococcal sepsis (1), cerebral toxoplasmosis (1) and herpes zoster (3). 10 of 19 evaluable patients are alive and relapse-free 1-33 months (median 10) after ABTM, and 3 of 10 more than 2 years later: 4 of 5 were transplanted in 1. CR, 4 of 6 in greater than or equal to 2. CR and 2 of 8 in PR. 4 patients are living in therapy sensitive relapse 2, 11, 11 and 39 months after ABMT in 2. CR or PR. 5 patients died 1-13 (median 3.5) months on relapse, 2 of 21 from septicemia. The morbidity of ABMT is comparable with conventional high dose chemotherapy. Relapse-free survival was significantly influenced by the remission status at ABMT. Long-term survivors can be expected even in patients with high risk hematological malignancies. However, only wider trials will serve to establish the efficacy of ABMT. PMID- 2667131 TI - [High-dosage chemo-radiotherapy with autologous bone marrow transfusion in malignant lymphoma: indications and personal experience]. AB - We report the results of a pilot study of dose intensification with autologous bone marrow support in patients with malignant lymphoma. Since January 1988 11 patients with malignant lymphoma have been treated by intensive chemoradiotherapy or combination chemotherapy followed by autologous bone marrow support. 6 of the patients had non-Hodgkin's lymphoma in first remission with unfavorable histology and/or unfavorable clinical prognostic factors, and 5 patients were in second or subsequent remission (2 non-Hodgkin's lymphoma, 3 Hodgkin's disease). Bone marrow harvest and cryopreservation of marrow cells were uneventful. 10 patients showed full hematologic recovery, while one patient with Hodgkin's disease died early of pneumocystis pneumonia. With the exception of one interstitial pneumonitis of unknown etiology, the clinical course during hospitalization was otherwise uncomplicated. The mean duration of hospital stay was 33 days. 2 patients relapsed after dose intensification, while the others are in continued remission (median 7 months, range 2-14 months). PMID- 2667132 TI - Alternatives to animals in toxicity testing. PMID- 2667133 TI - The middle-ear muscles. PMID- 2667134 TI - The electrodiagnosis of the carpal tunnel syndrome. AB - The carpal tunnel syndrome is one of the most commonly discussed subjects among the public, as well as the medical community, these days. Even though this is a rather simple nerve compression, which can be easily corrected, the carpal tunnel syndrome can induce further complications, sometimes leading to total disability of the patient. Early, proper diagnosis and treatment is very vital. Unfortunately, the exact pathomechanism and proper diagnosis is yet to be seen. As electromyographers, the authors would like to re-visit this debatable carpal tunnel syndrome emphasizing the electrodiagnosis. Among the electrodiagnostic tests, comparison of distal motor or sensory latency of the median nerve to the ulnar nerve along with amplitude of the response, was found to be the most sensitive test. Also, the C6 cervical radiculopathy and the pronator syndrome can present similar clinical pictures and require a differentiation. After successful surgery many patients still complain of subjective residual symptoms. The electrophysiologic findings do not correspond to the clinical progress in many cases. The authors also experienced that most of the victims, following successful surgery, still would benefit from a proper exercise program including instruction for proper body mechanics before they return to their previous activities, to lessen the undesirable complications including the reflex sympathetic dystrophy. PMID- 2667135 TI - The bitter pill. AB - Fundamentally new approaches to birth control--for example, a male pill, a once-a month menses inducer, and an antifertility vaccine--cannot be realized before the next century, and then only if the virtual withdrawal of the pharmaceutical industry from this field can be reversed. Major changes in product liability would be the most significant incentive. PMID- 2667136 TI - Transcriptional regulation in mammalian cells by sequence-specific DNA binding proteins. AB - The cloning of genes encoding mammalian DNA binding transcription factors for RNA polymerase II has provided the opportunity to analyze the structure and function of these proteins. This review summarizes recent studies that define structural domains for DNA binding and transcriptional activation functions in sequence specific transcription factors. The mechanisms by which these factors may activate transcriptional initiation and by which they may be regulated to achieve differential gene expression are also discussed. PMID- 2667137 TI - The location of DNA in RecA-DNA helical filaments. AB - The helical filament that the RecA protein of Escherichia coli forms around DNA is the active apparatus in protein-catalyzed homologous genetic recombination. The actual position of DNA within this complex has been unknown. Image analysis has been performed on electron micrographs of filaments of RecA on double stranded DNA and on single-stranded DNA to visualize a difference that is consistent with one strand of the double-stranded DNA. This localization of the DNA gives additional information about the unusual structure of DNA in the complex with RecA protein. PMID- 2667138 TI - Hydrophobic organization of membrane proteins. AB - Membrane-exposed residues are more hydrophobic than buried interior residues in the transmembrane regions of the photosynthetic reaction center from Rhodobacter sphaeroides. This hydrophobic organization is opposite to that of water-soluble proteins. The relative polarities of interior and surface residues of membrane and water soluble proteins are not simply reversed, however. The hydrophobicities of interior residues of both membrane and water-soluble proteins are comparable, whereas the bilayer-exposed residues of membrane proteins are more hydrophobic than the interior residues, and the aqueous-exposed residues of water-soluble proteins are more hydrophilic than the interior residues. A method of sequence analysis is described, based on the periodicity of residue replacement in homologous sequences, that extends conclusions derived from the known atomic structure of the reaction center to the more extensive database of putative transmembrane helical sequences. PMID- 2667139 TI - Triggering of allostery in an enzyme by a point mutation: ornithine transcarbamoylase. AB - The origin of allostery is an unanswered question in the evolution of complex regulatory proteins. Anabolic ornithine transcarbamoylase, a trimer of identical subunits, is not an allosteric enzyme per se. However, when the active-site residue arginine-106 of the Escherichia coli enzyme is replaced with a glycine through site-directed mutagenesis, the resultant mutant enzyme manifests substrate cooperativity that is absent in the wild-type enzyme. Both homotropic and heterotropic interactions occur in the mutant enzyme. The initial velocity saturation curves of the substrates, carbamoyl phosphate and L-ornithine, conform to the Hill equation. The observed cooperativity depends on substrate but not enzyme concentration. The finding underscores the possibility that a single mutation of the enzyme in the cell could turn transcarbamoylation into a regulatory junction in the biosynthesis of L-arginine and urea. PMID- 2667140 TI - Epidemiology of bone and soft tissue sarcomas. AB - Although bone and soft tissue sarcomas are not common, a significant number of patients who develop these tumors will die with metastatic disease. Part of the reason is that many of the patients have advanced disease at diagnosis. Identification of an etiologic agent should allow for diagnosis at an earlier stage. This is particularly true of radiation-induced sarcomas because patients who develop this malignancy seem to have a poor prognosis. As more patients survive their malignancies, we may see an increase in the incidence of postradiation sarcomas. Therefore, patients who receive radiation should be monitored closely, and a high index of suspicion should be maintained for complaints referable to the irradiated site. The role of various chemical agents in the development of sarcomas needs further definition, as the literature is replete with conflicting reports. Problems exist in that we are dealing with a variety of agents with different levels of exposure, possibly resulting in different types of neoplasms. Additionally, many of the agents in question are not pure substances, but frequently are contaminated with other potentially carcinogenic agents. Finally, the majority of studies reported are from different countries. Thus, there may be unidentified operative genetic and environmental factors. The recent advances in cytogenetics and molecular biology have already resulted in a significant increase in information related to bone and soft tissue sarcomas. Many chromosomal abnormalities identified will have diagnostic, prognostic, and therapeutic implications. Even more exciting is the fact that the identification of chromosomal abnormalities directs us to investigate abnormal areas of the genome that may identify the changes responsible for malignant degeneration on a molecular basis. PMID- 2667141 TI - Issues in the pathology of sarcomas of the soft tissue and bone. PMID- 2667142 TI - Role of radiation therapy in the management of patients with bone and soft tissue sarcomas. PMID- 2667143 TI - Surgery for adult patients with soft tissue sarcomas. PMID- 2667144 TI - Chemotherapy of advanced soft tissue and osteosarcomas. PMID- 2667145 TI - Adjuvant chemotherapy for soft tissue sarcoma: an approach in search of an effective regimen. PMID- 2667146 TI - Adjuvant chemotherapy for osteosarcoma. AB - From this review of chemotherapy trials, several observations can be made. Osteosarcoma is a complex disease involving multiple histologies, each with a different prognosis. Prognostic factors that have been shown to be important include anatomic location of the primary tumor, stage at presentation (patients with metastatic or local recurrent disease fair far worse than those with primary disease), age at onset (children fair worse than the teenager with osteosarcoma), and location within the extremity (patients with more distal tumors fairing better than patients with more proximal tumors). There is convincing evidence for the efficacy of chemotherapeutic agents such as methotrexate in high doses (at least 8 g/m2 for adults, 12 g/m2 for children), Adriamycin, and cisplatin. The combination of Adriamycin and cisplatin appears to be more beneficial relative to either one of these agents alone. The efficacy of the combination of BCD as a triple-drug regimen, although useful in several different trials, has not been convincingly shown. Finally, from several of the recent randomized trials, it appears, that chemotherapeutic regimens containing an Adriamycin and cisplatin combination appear to be superior to those that do not include this combination. However, these observations are made from a historical perspective and have not been conclusively proven by randomized prospective investigations. The observations concerning the natural history of the disease and the activity of various chemotherapeutic agents suggest certain clinical practice algorithms. Essential staging procedures would include a bone scan looking for multifocal or metastatic disease, and CT scans of the chest looking for metastases to the lung. From all studies, it is apparent that surgery is mandatory for the primary tumor and should be an integral portion of all treatment methods. Chemotherapy should be considered for all patients with osteosarcoma, and the essential drugs in the regimen appear at present to minimally include high-dose methotrexate, Adriamycin, and cisplatin. It would also appear from several of these reports that not only is the adjuvant use of these chemotherapeutic agents indicated, but that the preoperative use of these agents has had significant advantages. The neoadjuvant chemotherapy begins the essential systemic chemotherapy at a very early stage, allows histologic assessment of treatment effect, permits altering drug regimens postoperative, and in many reported trials has allowed less than amputative surgery (limb salvage) to be performed. Finally, close follow-up of patients with osteosarcoma has therapeutic value.(ABSTRACT TRUNCATED AT 400 WORDS) PMID- 2667147 TI - Regional chemotherapy for osteosarcoma. PMID- 2667148 TI - Making health policy management intersectoral: issues of information analysis and use in less developed countries. AB - There is a growing awareness of the need to approach health problems intersectorally. This has important implications for health policy management, centrally so for the informations systems which should enable 'managers' to monitor performance and also provide feedback to those with broader policy responsibilities. Yet relatively little is being done to adjust the information systems to this new intersectoral awareness: the focus of health information systems remains the collection of health service data. Much of the information collected is not used to provide adequate feedback to planners and managers, and to influence programme implementation. The paper--which focuses on the problems in less developed countries--argues that more attention needs to be paid to analysing the expected links between interventions and outcomes, as well as to cost considerations. Flexible procedures are required to address locally or regionally relevant problems. Thought must be given to making information of interest to health workers by linking it to the outcomes of activities, and by enabling them to discuss the implications of findings. Community members may also be thus involved. Often such processes are wholly neglected. The paper examines institutional and political arrangements that influence the capacity to use information for management and policy making, and which need to be understood if information systems are to be broadened beyond the health sector. The paper ends by discussing the main indicators which have been proposed, and occasionally used, to broaden health monitoring in an intersectoral direction. It argues that much relevant information is being routinely produced by the various departments and discusses briefly how such information can be used to build up gradually an intersectoral information system for health. PMID- 2667149 TI - Family response in head injury: denial ... or hope for the future? AB - Denial is often seen as a major obstacle to successful adaptation in the family of the head-injured. In fact, it is typically inadequately understood in the rehabilitation setting. The term is frequently used in a simplistic way, with the social and cultural factors behind the denial, particularly the stigma of head injury, not examined or confronted. There is very little hard data on what constitutes successful family adaptation over the long term. Professionals have a tendency to focus exclusively on the patient's deficits and the family's difficulties, ignoring the positive ways in which people cope. This article suggests that there is a need for a paradigm shift, based on the transactional theory of stress and coping, in which denial is seen as a positive response in some situations. Instead of becoming locked into trying to dispel what is usually called denial and adopting an adversary stance to the family, it may be more beneficial for rehabilitation staff to work together with family members to understand why head injury is so difficult to deal with, develop positive models for living with the sequelae, and encourage hope for the future. PMID- 2667150 TI - Role of the Papanicolaou smear in diagnosis of chlamydial infections. AB - The accuracy of the routine Papanicolaou (Pap) smear in diagnosis of Chlamydia trachomatis infection of the cervix has stimulated controversial reports over the years. In the present study Pap smears from 100 women, evenly divided between culture-positive and culture-negative for C. trachomatis, who had been seen in a single university clinic and cultured in the same laboratory were reviewed by two cytologists. With use of typical inclusions as evidence of chlamydial infection, the sensitivity of the Pap smear was 8.3%. Review of another series of 40 Pap smears that had been reported previously as positive for C. trachomatis showed only 25 with inclusions, an observation suggesting that routine Pap smears are being overread for chlamydial infection. Attempts to improve the sensitivity by immunoperoxidase staining were unsuccessful. Therefore, if strict cytologic criteria are used, C. trachomatis infections may be diagnosed on Pap smears, but the sensitivity will be low. PMID- 2667151 TI - Sexually transmitted disease in young people: the importance of health education. AB - In most cultures sexually transmitted diseases (STD) and unwanted pregnancy are major health problems for sexually active youths aged 15-24. Since the early 1970s contraceptive use has increased in developed countries, but as few as 4-6% of young people in developing countries have access to reliable, modern contraceptives. In most countries the age-specific rates for STD are highest in the younger age groups. One of the few methods available to limit the extent of these problems, and particularly the problem of infection with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS), is health education directed toward behavioral change. The content, timing, and characteristics of the source presenting the information are all important. This article reviews international data on the problems of STD and AIDS in young people and the experience of various countries in preventive efforts through health education. PMID- 2667152 TI - Early detection of genital chlamydial infection in women: an economic evaluation. AB - A decision analysis model was constructed for comparison of early detection of asymptomatic genital chlamydial infection in women by the direct immunofluorescence antibody (DFA) test and the enzyme-linked immunosorbent assay (ELISA) with no intervention. Early-detection programs using the DFA test and ELISA were shown to be cost-effective in female populations where the prevalences of chlamydial infection exceeded 6% and 7%, respectively. Sensitivity analysis showed that the two most important factors were the probability of developing pelvic inflammatory disease and the cost of the test. The DFA method was more appropriate for an early-detection program because of its higher sensitivity. PMID- 2667153 TI - Treatment of nongonococcal urethritis: comparison of ofloxacin and erythromycin. AB - Ofloxacin, a new quinolone carboxylic acid derivative, has been reported to be effective and safe in the treatment of nongonococcal urethritis (NGU). In the present investigation 188 male outpatients with NGU were randomized to double blind treatment with either erythromycin (500 mg twice a day) or ofloxacin (200 mg twice a day) for seven days. Before therapy Chlamydia trachomatis was isolated from 43.6% of the patients. One relapse and one reinfection occurred in the erythromycin-treated group, whereas all patients in the group given ofloxacin were culture-negative at follow-up. Among the C. trachomatis-positive group of patients, the clinical efficacy of ofloxacin was 83.7%, and that of erythromycin, 77.4% at the final follow-up. In the C. trachomatis-negative group, the efficacy of ofloxacin was 93%, and that of erythromycin, 84.3%. The differences are not significant. No serious adverse effects were demonstrated. The results indicate that ofloxacin might be a valuable alternative for the treatment of NGU in men. PMID- 2667154 TI - Proportional payment for pelvic inflammatory disease: who should pay for chlamydial screening? AB - The occurrence of acute pelvic inflammatory disease (PID) caused by Chlamydia trachomatis could be reduced if chlamydial screening were more widely instituted, but financial support for such programs remains limited. Logically, the agencies that could most cost-effectively fund screening programs are those that benefit most from reduction in costs incurred by PID. Therefore, the authors retrospectively analyzed charges for 630 women with acute PID presenting to a county hospital over a 2-year period. Sixteen per cent of patients required hospitalization. Of the total charges, 54% were not paid by any agency, 18% were paid by the county, and 22% by the state. A computer model was developed for analysis of screening programs in high-risk women (prevalence, 17%). The savings in charges for acute cases of PID alone did not make it cost-effective for any single agency to fund chlamydial screening. However, the model showed that it would be cost-effective for the county and the state jointly to fund a screening program using a direct antigen test costing under $7 per test. PMID- 2667155 TI - Did Benvenuto Cellini (1500-1571) have Reiter's disease? AB - The Renaissance artist Benvenuto Cellini admitted in his autobiography to the contraction of a sexually transmitted disease. Passages of Cellini's autobiography discussing symptoms are reviewed, and his own statements form the basis for concluding that he suffered from Reiter's disease. PMID- 2667156 TI - Clinical efficacy of new quinolones for therapy of nongonococcal urethritis. AB - Ninety-five patients with nongonococcal urethritis were enrolled in a double blind study and were randomly assigned to a one-week treatment with ciprofloxacin (500 mg twice daily) or ofloxacin (200 mg twice daily). Two weeks after treatment the results obtained for the 79 evaluated patients were as follows: 59 patients (75%) were clinically cured, and of the 54 patients with initial positive cultures, 39 (72%) remained culture-negative. We did not find any statistically significant differences between the results obtained with the two treatments. These results did not vary with the cause. Patient compliance with the regimens of two doses per day was excellent, and no serious adverse effects occurred with either drug. PMID- 2667157 TI - Neurological evaluation of occupational hand pain. AB - The evaluation of the patient with pain, weakness, or numbness of the hand or upper extremity begins with knowledge of neuroanatomy and of the proper examination techniques. Neurological diseases of the peripheral nerves or central nervous system often present with vague complaints or minimal findings on clinical examination that may be diagnosed only with a combination of radiologic and neurodiagnostic studies. However, tests alone cannot determine the best treatment as each case must be individualized. An understanding of the utility and limitations of the electromyogram and nerve conduction studies is important when treating these patients. PMID- 2667158 TI - The role of psychological evaluations in occupational hand injuries. AB - The benefit of including a psychological evaluation of a worker with a hand injury is that additional diagnostic and prognostic information regarding the patient is obtained. Psychological evaluations examine the emotional and social factors that can either complicate recovery from injury or aid in rehabilitation. PMID- 2667159 TI - Tendonitis of the wrist and elbow. AB - Although common and frequently transitory, tendonitis in the upper extremity may be quite disabling and resistant to treatment. The physician's best hope for a swift and successful resolution lies in a careful history of all possible precipitating causes and a precise localization of symptoms to obtain an exact diagnosis. PMID- 2667160 TI - Chronic pain: a difficult problem. AB - The author discusses the general problem of the small but significant population of people in whom pain persists for months or years after a precipitating event, such as a hand injury. The nature of pain, the perception of pain, and characteristics of chronic pain patients are discussed, as well as evaluation and treatment of chronic pain. PMID- 2667161 TI - Finger tip and nail bed injuries. AB - Damage to any of the anatomic structures of the finger tip can result in a change in use of the hand, even making some tasks impossible. Prevention is naturally most important; however, when an injury occurs, anatomic restoration should be the goal. Treatment should be the most direct and simple to reach the optimal structural and functional result. Caveats of treatment are: (1) save nails; (2) reapproximate nail matrix lacerations; (3) use wound contraction and epithelialization to advantage; (4) restore pulp when necessary with volar innervated flaps from the same finger; (5) reduce fracture angulation and displacement; (6) use skin grafts when subcutaneous tissue is sufficient; and (7) replace small noncrushed skin-pulp amputations and traumatic flaps. PMID- 2667162 TI - Hand infections seen in the industrial clinic. AB - Following a few basic principles will help the industrial physician in managing hand infections. They are: (1) recognizing the infection early; (2) drainage and/or debridement; (3) identifying the organism; and (4) antibiotics. Following the course of a wound is extremely important. The infected wound that does not respond to surgery and antibiotics may need to be re-explored and cultured again. The wound that heals well without antibiotics or on the wrong antibiotic may be left alone. That is, antibiotics can be withheld or stopped. PMID- 2667163 TI - Contact injuries to the hand. AB - This article stresses that all contact injuries to the hand require careful documentation and close follow-up. The late manifestations of such an injury can be very significant if it leads to impairment of the power of the worker's grasp. PMID- 2667164 TI - Indications for surgery in work-related compression neuropathies of the upper extremity. AB - Symptoms caused by compression neuropathies are subjective and often difficult to quantify. The author describes sites of compression involving the median, ulnar, and radial nerves and their branches, and emphasizes that surgical procedures should be performed only when objective evidence of an abnormality is present and the chance for surgical correction is high. PMID- 2667165 TI - Hand and wrist fractures in occupational medicine. AB - Hand fractures are so common in the workplace that a wide variety of physicians see and treat these injuries on a daily basis. This article is designed to assist in their primary diagnosis and care, as well as to recommend when it is best to arrange treatment by a hand specialist. PMID- 2667166 TI - Indications for replantation in the adult upper extremity. AB - Physicians involved in the evaluation and initial treatment of patients with severe hand injuries should be familiar with the indicators for, the contraindications to, and expectations following replantation, including preoperative preservation of the amputated part. This article covers these topics and discusses experiences with various types of replantations. PMID- 2667167 TI - Return-to-work programs following occupational hand injuries. AB - Return-to-work programs are no longer luxuries that only the major industries can afford to provide. Direct cost savings can be documented with the use of such programs, but just as important is the message that the company cares and looks out for the employee's best interest. The occupational medicine team's responsibility to the patient and the employer no longer ends with the provision of quality medical treatment. The ultimate goal is to return the patient to his or her job. Return-to-work programs successfully facilitate that process. PMID- 2667168 TI - Ergonomic considerations and job design in upper extremity disorders. AB - This chapter has outlined some of the outcomes of poor job design, identified and defined risk factors associated with poor job design, and presented a brief overview of a layman's approach to job analysis. With this information, persons interested in fixing jobs that have ergonomically poor designs can begin to develop a working understanding of the problem, what caused it, and considerations regarding its solution. PMID- 2667169 TI - [The value of the initial bone biopsy in chronic myeloproliferative syndromes. Review of 80 cases]. AB - In order to review the histological characteristics and to evaluate the presence of valuable findings for diagnostic or prognostic purposes, 80 patients diagnosed of chronic myeloproliferative syndromes (CMPS) who had undergone initial bone marrow biopsy were studied in retrospect. The patients were distributed into 26 cases of chronic myeloid leukaemia (CML), 22 of myelofibrosis (MF), 16 of polycythaemia vera (PV) and 16 of essential thrombocythaemia (ET). The histological findings in the 26 cases of CML consisted of hypercellular bone marrow with fat depletion in all cases; marked thickening of trabeculae was seen in 4 cases and neoformation-like osseous tissue in 7 others. Erythroblastic nests were found in 11 patients, eosinophilia in 23 instances, and abnormal location of immature precursor cells (ALIP) was present in 16 cases. Reticulinic fibrosis was found in 22 patients, collagen fibrosis in 6 and sinusoidal dilatation in 5 cases. Of the 22 MF patients, 8 had normal bone trabeculae, while 14 had trabecular thickening, of moderate degree in 6 cases and marked in 8. Osteoid tissue formation was observed in 21 instances; diminished or absent fat was appreciated in 19 cases. Erythroblastic nests were present in 12 instances, ALIP in 5 and eosinophilia in 14. Reticulin fibres were increased in 22 instances, collagen fibrosis was present in 18 cases, sinusoid dilatation in 12, and lymphoid follicles were seen in 4 patients. Trabecular thickening was found in 15 cases of the PV group (16 patients) and osteoid tissue formation in 2. Fatty tissue was decreased or absent in 11 instances Erythroblastic nests plus eosinophilia were seen in 15 cases, and ALIP in 2.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 2667170 TI - [Physiopathology of thrombotic microangiopathy]. PMID- 2667171 TI - [Progress in the treatment of acute lymphoid leukemia in children. Experience of the GATLA/GLATHEM, 1967-1987]. PMID- 2667173 TI - Vascular complications associated with orthopedic procedures. AB - Damage to vascular structures during orthopedic procedures occurs relatively infrequently; when it does occur, however, recognition and prompt intervention are essential. We report herein 11 vascular injuries secondary to orthopedic procedures encountered between 1978 and 1988. Two injuries occurred as a consequence of lumbar laminectomy, three as a result of total hip replacement, three secondary to open reduction and internal fixation of a fracture of a lower extremity, two secondary to attempted closed reduction of humeral fractures and one injury as a result of hip flexion contracture release. Injury occurred to three iliac arteries, three popliteal arteries, two brachial arteries, one femoral artery, one graft to femoral anastomosis and two iliac veins. Five arterial injuries were repaired primarily, one with a vein patch, while five required bypass grafts. One venous injury was repaired primarily and the other required placement of a Greenfield filter for thrombosis. Major complications were a result of diagnostic delay and subsequent ischemia in most patients. There were no deaths. We conclude that vascular injuries can occur as a result of laceration, compression or traction during orthopedic procedures as a result of the proximity of vascular structures to the spine, joints and long bones. Also, we conclude that injuries manifest themselves primarily as hemorrhage or ischemia; that excellent results can be obtained with prompt recognition and treatment; that angiography is useful in those with mild ischemia in whom diagnosis is delayed, and that preoperative documentation of the vascular status of patients is critical prior to orthopedic procedures. PMID- 2667172 TI - Peroperative diagnosis and treatment of metastases to the regional lymph nodes in papillary carcinoma of the thyroid gland. AB - The management of two groups of patients with papillary carcinoma of the thyroid gland (n = 165) was evaluated retrospectively. Total thyroidectomy was the standard procedure in both groups, but the peroperative diagnosis and treatment of metastases to the regional lymph nodes differed. In group 1 (n = 84), only clinically positive lymph nodes were resected, and if residual postoperative 131I uptake was found, an ablation dose of 131I was given. In group 2 (n = 81), all of the tissue in the tracheoesophageal groove was removed routinely at total thyroidectomy and frozen section was done of the lymph nodes lying along the internal jugular vein. If metastases were found, a modified radical dissection of the neck was performed on the affected side. The two patient groups were comparable with regard to risk factors--local tumor stage, age and sex. Almost twice as many patients were found to have metastases to the lymph nodes in group 2. There was no significant difference in the ten year over-all or recurrence free survival time between the two groups. In group 1, there were more recurrences on the explored side of the neck but fewer distant metastases; however, both findings were not significant. In group 2, significantly more instances of hypoparathyroidism and palsy of the accessory nerve were found (p less than 0.05). Thus, when a more extensive search was carried out, more metastases to the lymph node were discovered and treated, but this did not prevent recurrences in the neck nor did it improve survival time. This approach resulted in more postoperative morbidity. There seems to be no justification for prophylactic removal of regional lymph nodes in instances of papillary carcinoma of the thyroid gland, but modified radical neck dissection may be beneficial if clinically suspect regional lymph nodes are present in the lateral part of the neck. PMID- 2667174 TI - Transrectal ultrasonography in the evaluation of rectal and extrarectal disease. AB - Transrectal ultrasonography is a technique that is gaining popularity in the assessment of rectal and extrarectal disease. From April 1987 to May 1989, 53 transrectal sonograms were done to evaluate rectal disease. Twenty-seven of 30 adenocarcinomas have been correctly staged. The operative procedure and the decision to use preoperative radiotherapy have been influenced by the results of these studies. Recurrent tumors and less common anorectal disease have also been evaluated with this technique. When feasible to perform, ultrasonographically guided biopsies yield specimens that can provide added information on which to base a therapeutic approach. PMID- 2667175 TI - A new technique for stabilization of the sump drain. PMID- 2667176 TI - A technique for fixation of retention sutures using two bolsters. AB - Retention sutures using two bolsters provide inherent mechanical advantages in approximating wound edges. As demonstrated in geometric terms, distribution of tension along a bolster maximizes closing force while at the same time reducing stress at the individual suture site. This technique also eliminates circumferential compression of the interceding tissues as well as providing easy access to the wound for daily care. These features make this technique ideal for patients at high risk of wound disruption. PMID- 2667177 TI - Use of the circular stapler in construction of the duodenoneocystostomy for drainage into the bladder in transplants involving the whole pancreas. AB - The use of a circular stapler to construct a duodenoneocystostomy for exocrine drainage of transplants of whole pancreas is described herein. All but one of 15 grafts were technically successful, and the one failure was not related to the anastomosis. This method is easier than the handsewn technique we had been using, and the complication rate may be lower. PMID- 2667178 TI - Guy de Chauliac and the Grand Surgery. PMID- 2667179 TI - The status of transplantation of the human lung. AB - Transplantation for end-stage pulmonary disease is now established as an effective therapy for selected patients. Initially, combined heart and lung transplantation was the only therapeutic option for these patients. Recent developments that include improved immunosuppression, preservation of grafts and technical advances and markedly decreasing bronchial anastomotic complications have made unilateral pulmonary transplantation a clinical reality. PMID- 2667180 TI - Presumptive antibiotics for penetrating abdominal wounds. AB - The optimal antimicrobial agent or agents for penetrating abdominal injuries remains undetermined. During the three year period ending August 1987, 317 consecutive patients undergoing celiotomy for penetrating abdominal trauma were prospectively randomized to receive either mezlocillin, 4 grams every six hours, or clindamycin, 600 milligrams every six hours, and gentamicin, loading dose of 2.0 milligrams per kilogram, then 1.5 kilograms every eight hours. Antibiotics were begun in the emergency department with duration of coverage based on the pattern of injury: the colon, five days; other hollow visceral injury, two days, and all others, one day. Twenty-three patients were excluded because of breach of protocol and 16 others died within 72 hours of presentation. The two study groups, 136 patients receiving mezlocillin and 142 patients receiving gentamicin and clindamycin, were comparable with respect to age, sex, mechanism of injury, shock, intraoperative replacement of blood, abdominal trauma index and distribution of hollow visceral injuries. The over-all incidence of septic morbidity was similar: infections developed in 21 (15 per cent) of the patients receiving mezlocillin compared with 19 (13 per cent) of patients receiving gentamicin and clindamycin. There was no significant difference in major infections (lobar pneumonia and intra-abdominal abscess), with 13 per cent in each group. The offending pathogens were similar. The most common isolates in intra-abdominal abscess were Escherichia coli, Klebsiella and Enterococcus species and anaerobic Bacteroides species. Mezlocillin, an extended spectrum penicillin, achieved similar results, compared with the expensive and potentially toxic combination regimen in patients with penetrating abdominal injuries. PMID- 2667181 TI - Clinical psychiatric assessment of patients with burning mouth syndrome resisting oral treatment. AB - Of 100 consecutive patients referred for investigation of symptoms related to oral galvanism, 18 with persisting symptoms of burning mouth syndrome (BMS) remained after investigation and treatment (Hugoson 1986). In addition to the oral and medical treatment, 16 (14 women, 2 men) of these patients underwent psychiatric investigation. The results of this investigation are presented in this report. The psychiatric investigation was performed as a semistructured interview, elucidating current symptoms, the patient's opinion as to the onset and causes, previous illnesses and psycho-social conditions. Two hours were reserved for each patient interviewed with the aim of obtaining a holistic picture of each individual. The patients with refractory burning mouth syndrome did not differ from the others with respect to oral status, salivary secretion or calculated galvanic currents. No patient had burning mouth as the only symptom, all reporting many symptoms from different organs. Three patients had had symptoms for at least 20 years, 9 for 5-10 years and 4 patients for less than 4 years. Seven patients related the onset of symptoms to oral treatment. Thirteen of the patients reported one or more medical diagnoses and 10 patients were taking 1-3 medicines. Ten patients reported significant negative experiences in connection with previous contacts with the health services and several considered themselves wrongly diagnosed and treated. Most of the patients had experienced catastrophes in their lives in the form of stillborn children or children born with various handicaps, children injured in accidents or prolonged social problems. One patient was judged to have somatic causes of the symptoms, 8 patients somatic and psychological causes, 6 patients psychological causes and in 1 patient the cause was unknown. Three cases are presented in more detail. PMID- 2667183 TI - [Senile dementia. Difficult behavior in elderly with dementia. A literature review (II)]. PMID- 2667182 TI - Opinions and wearing habits among patients new to removable partial dentures. An interview study. AB - Thirty-five patients treated at the Department of Prosthetic Dentistry, University of Umea, who had received removable partial dentures (RPD) during the period July 1st 1981 to December 31st 1982, were interviewed regarding the use and experiences of their dentures. None of the patients had previously used an RPD. The treatment had been carried out by dentists and dental students. At the time of the interview, 1-2 1/2 years after receiving the prosthesis, 34 subjects (97%) declared that they used their RPDs during various parts of the day. PMID- 2667184 TI - [Senile dementia. Difficult behavior in elderly with dementia. A literature review (I)]. PMID- 2667186 TI - Medicare answers your most common questions. PMID- 2667185 TI - Designer drugs. AB - Designer drugs are synthetic analogs of substances with known psychoactive properties. These analogs are dangerous due to their direct pharmacological effects and the presence of toxic by-products that occur during synthesis. Three groups of designer drugs are reviewed (fentanyl, meperidine, and methamphetamine analogs), and their psychoactive effects and clinical presentations are described. PMID- 2667187 TI - Symptoms and selection bias: the influence of selection towards specialist care on the relationship between symptoms and diagnoses. AB - Observations with respect to the relationship between symptoms and diseases can seriously be biased by selection phenomena. This selection may occur from the general population, via consultation behavior, diagnostic and therapeutic activities of the general practitioner, and by referral. Relationships may be suggested and reproduced even if they do not exist in unselected populations, as a product of diagnostic routines. Correction for selection bias can only be achieved by choosing proper comparison groups. While this can be done in a general practice setting, this is almost impossible after referral, as is demonstrated in this paper. Surprisingly, the most unbiased estimation of the relationship between symptoms and diseases after referral can be made from patient groups that are referred for reason unrelated to the disease under study. Definitive answers for the general practitioner can only be provided by prospective studies from a primary care setting. In the meantime, however, biased relationships can be maintained by teaching knowledge derived from a specialist experience. PMID- 2667188 TI - [Check-ups in pneumonology]. AB - Check-up examinations in chest medicine are useful tests for early detection of numerous diseases of the respiratory system. They should focus in particular on the most frequent and chronically progressive airway-diseases (asthma, chronic bronchitis) in order to avoid severe illness and early disability including bronchial carcinoma and tuberculosis to offer a more favourable outcome to the patient. By the correct planning of an individual check-up the patient's conditions have to be carefully considered by estimating epidemiological facts, personal risk factors, the presence of prodromal symptoms and the availability of cost-effective diagnostic procedures as well. The efficacy of the individual screening in respiratory diseases implies systematic and periodical check-up examinations which unfortunately are not everywhere established. PMID- 2667189 TI - [Is the measurement of carcinoembryonic antigen still indicated in digestive cancers?]. AB - Carcinoembryonic antigen (CEA) is not useful for detecting asymptomatic cancer. Its sensitivity and specificity are not high. For some cancers, antigen levels at the time of diagnosis provide more precise prognosis than staging alone. Regular determination of CEA is useful as a method of surveillance after surgery for cancer in the colon and in the rectum. Unfortunately the clinical gain of detecting postoperative relapses is low since curative surgical treatment is usually impossible. PMID- 2667190 TI - [Screening for colorectal tumors using fecal occult blood studies]. AB - Guaiac tests such as Hemoccult are widely used but are affected by several factors. Occult blood testing does uncover subclinical colorectal cancer often at early stage, but a favorable effect on survival remains to be proven. The sensitivity for the detection of malignancies is from moderate to good, but it is poor for benign polyps. Predictive value of a positive test for cancer ist about 8-12%. Thus, most of the individuals with a positive test would not need colonic investigations. Recommendations relating to the testing for of occult blood could change rapidly with the new immunologic techniques or with new data on mortality coming from controlled clinical trial now being conducted. PMID- 2667191 TI - Our knowledge of drug interactions with oral contraceptives. AB - In the introduction the author points out the importance, mechanism and consequence of interactions between oral contraceptives and other drugs. The interactions between certain drugs with different pharmacological action and the contraceptive tablets which decrease or increase the contraceptive effect as well as the drugs whose effect may be influenced by the contraceptive tablets have been discussed. Cases in which only a few data refer to, or no clinical proof supports interaction, are also mentioned. According to interactions observed until present in women taking Anteovin, the recommended measures to be taken in these cases have been described. Finally it has been emphasized that the knowledge of interactions between drugs is just as important in family planning counselling as is when prescribing other drug treatments. PMID- 2667192 TI - Intestinal infections: current aspects and new possibilities of prophylaxis and treatment. AB - Intestinal infections of still high importance from the hygienic-epidemiological aspects and the recent results obtained in this field have been surveyed. Recently recognized enteric pathogens (campylobacter, Yersinia, rotavirus, Clostridium difficile, etc.) as well as the newest data on the pathomechanism of intestinal infections have been discussed. These data not only have increased our knowledge of the pathology but also resulted in basic, favourable changes in therapy. Detailed information is given on specific preventive measures, currently used vaccines and the research activities in this field. Detailed description of the therapeutic methods, salt and fluid substitution and up-to-date aspects of antibiotic treatment have been given as guidelines for the everyday medical practice. PMID- 2667193 TI - Lidocaine ointment and spray. AB - The 10% Lidocaine spray produced and marketed by EGIS has the following routine fields of indications: in ENT surgery and dentistry, superficial minor surgical interventions, and the introduction of anaesthesia by injection. The 5% Lidocaine ointment has been routinely used in the treatment of chronic locomotor diseases, traumatological and surgical conditions, and in painful skin and mucous membrane ulcers and erosions accompanied by epithelial deficiency. PMID- 2667194 TI - Fifteen years of experience on the use of Libexin tablets. AB - The antitussive Libexin was synthesized in the Research Laboratory of CHINOIN Pharmaceutical and Chemical Works Ltd., Budapest. Observations of the drug in different disease groups have been surveyed on the basis of data published over more than twenty years. According to the unanimous opinion of the authors the drug does not depress respiration, it rather improves the values of the respiratory function. The majority of the examining physicians are on the opinion that it does not hinder expectoration. The drug proved to be of high value in alleviating nocturnal coughing controlling spastic bronchitis in children, as a pretreatment before bronchological examinations and their anaesthesia. It may successfully be used in both acute and chronic bronchitises in preoperative and postoperative cases, in cardiology, otorhinolaryngology and paediatrics. PMID- 2667195 TI - In memoriam Mihaly Lenhossek. PMID- 2667196 TI - A review of the toxicity and carcinogenicity of anthraquinone derivatives. AB - Anthraquinones (AQs) are a group of functionally diverse chemicals structurally related to anthracene. Both natural and synthetic AQs have widespread applications throughout industry and medicine, thereby indirectly and directly exposing the human population. Because of the close similarity in structure between AQs and the toxic analogue, anthracene, there is concern over the potential damage which these compounds may produce. This review summarizes the toxicity and carcinogenicity of synthetically-derived AQs in experimental animals, classified into 3 categories based upon phenolic, amino, or nitro substitution to the AQ ring structure. The effect of chemical substitution in relation to toxicity and carcinogenicity is discussed. PMID- 2667197 TI - A transcranial Doppler study of blood flow velocity in the middle cerebral arteries performed at rest and during mental activities. AB - While changes in blood velocity in the middle cerebral artery relative to rest were assessed by transcranial Doppler sonography, 70 volunteers with no sign of cerebrovascular disease performed two (left and right middle cerebral artery) series of six cognitive tasks. The tasks are assumed to be processed predominantly by either the left (verbal and mathematical tests performed aloud) or the right hemisphere (dot/distance estimation, spatial perception, and face recognition performed silently). All tasks were shown to increase middle cerebral artery blood flow velocity on both sides, by 1.6-10.6%. After an initial maximum at approximately 8 seconds, velocity decreased then increased again. A steady state was reached after approximately 24-42 seconds. The initial minimum during the following rest phase was reached some seconds later, followed by a slow increase to the reference rest steady state. A difference according to side could be determined only during the three right-hemispheric tasks (right greater than left, 2.5-2.9%). Left-handedness/ambidexterity, familial sinistrality, and profession seemed to have no influence on the results. The middle cerebral artery blood flow velocity increase on both sides was higher in women than in men during the dot/distance estimation and was also higher bilaterally in older than in younger subjects during the dot/distance and the spatial perception tasks. Habituation in performing the tasks was an important factor associated with a decrease of blood flow velocity, especially in the right middle cerebral artery. The habituation more pronounced on the right side possibly reflects the role of the right hemisphere in attention and arousal. The absolute blood velocities at rest decreased bilaterally with age. PMID- 2667198 TI - Doppler ophthalmic blood pressure measurement in the hemodynamic evaluation of occlusive carotid artery disease. AB - In 102 patients with angiographically proven occlusive carotid artery disease of 60-100% diameter reduction, Doppler ophthalmic artery pressure and blood flow direction were recorded by the recently developed ophthalmomanometry-Doppler technique. Among these 102 patients, 50 presented with complete carotid artery occlusions and 52 with carotid artery diameter stenoses of greater than or equal to 60%. Mean +/- SD Doppler ophthalmic artery pressure was 69 +/- 15 mm Hg ipsilateral to the occlusion and 86 +/- 18 mm Hg ipsilateral to a stenosis of the carotid artery (p less than 0.001). The mean +/- SD Doppler ophthalmic pressure index (ratio of the ophthalmic artery to systemic blood pressure) was lower ipsilateral to the occlusion (0.46 +/- 0.08) than ipsilateral to a carotid artery stenosis (0.54 +/- 0.08; p less than 0.001); in both, the index was clearly diminished compared with normal values (0.68 +/- 0.04; p less than 0.001). It is concluded that the intracranial hemodynamic consequences in the patients with occlusion are on average more profound than in the patients with stenosis. In carotid artery occlusions, the mean +/- SD ipsilateral ophthalmic pressure index was 0.46 +/- 0.06 for antegrade and 0.46 +/- 0.09 for retrograde ophthalmic artery blood flow. In carotid artery stenoses, the mean +/- SD ipsilateral ophthalmic pressure index was 0.55 +/- 0.07 for antegrade and 0.48 +/- 0.06 for retrograde ophthalmic artery blood flow (p less than 0.01). These results indicate that in carotid stenoses the collateral capacity of the ophthalmic artery is insufficient compared with intracranial collaterals, while in carotid occlusions the blood flow direction in the ophthalmic artery does not predict intracranial hemodynamic compensation. PMID- 2667199 TI - Brain perfusion in acute and chronic hyperglycemia in rats. AB - Recent studies show that acute and chronic hyperglycemia cause a diffuse decrease in regional cerebral blood flow and that chronic hyperglycemia decreases the brain L-glucose space. Since these changes can be caused by a decreased density of perfused brain capillaries, we used 30 adult male Wistar rats to study the effect of acute and chronic hyperglycemia on 1) the brain intravascular space using radioiodinated albumin, 2) the anatomic density of brain capillaries using alkaline phosphatase histochemistry, and 3) the fraction of brain capillaries that are perfused using the fluorescein isothiocyanate-dextran method. Our results indicate that acute and chronic hyperglycemia do not affect the brain intravascular space nor the anatomic density of brain capillaries. Also, there were no differences in capillary recruitment among normoglycemic, acutely hyperglycemic, and chronically hyperglycemic rats. These results suggest that the shrinkage of the brain L-glucose space in chronic hyperglycemia is more likely due to changes in the blood-brain barrier permeability to L-glucose. PMID- 2667200 TI - Middle cerebral artery occlusion in rats studied by magnetic resonance imaging. AB - Ischemia due to middle cerebral artery occlusion was studied in 29 rats from 1 to 24 hours after occlusion using magnetic resonance imaging. Images were made before and after the injection of a superparamagnetic iron oxide compound, AMI 25. Subtraction images demonstrated the region of perfusion deficit as early as 1 hour after occlusion, earlier than conventional T2-weighted images. The area of altered perfusion detected by this technique (subtraction imaging after AMI-25 administration) correlated with that demonstrated by iodoantipyrine autoradiography. Since this magnetic resonance technique can be used to serially estimate the location and size of the ischemic area, the technique can be an important adjunct to metabolic studies of focal ischemia using magnetic resonance spectroscopy. The technique may have clinical applications as well. PMID- 2667201 TI - Ethics of life support in patients with severe stroke. PMID- 2667202 TI - Pulsed Doppler assessment of arterial obstructive disease. PMID- 2667203 TI - Evidence that cold preservation-induced microcirculatory injury in liver allografts is not mediated by oxygen-free radicals or cell swelling in the rat. AB - The critical injury of cold preservation is to the hepatic microcirculation. Oxygen free radical injury and cell swelling have been proposed to be causes of allograft failure, and new solutions such as Marshall's isotonic citrate and University of Wisconsin (UW) solutions were designed to prevent cell swelling and free radical injury. Experiments were done to determine whether Marshall's solution and UW solution protect the microcirculation, and whether they do so by preventing cell swelling or free radical-induced injury. To determine if the new solutions reduce sinusoidal lining cell injury, rat livers were examined after preservation at 4 degrees C in NaCl 0.9% and CaCl2 2 mM for 4 hr and 8 hr, in Collins' solution for 8 hr, and in both UW and isotonic citrate solutions for 8 hr and 16 hr. Next, the role of cell swelling in preservation injury was studied by storing livers in hypotonic solutions that accelerate liver weight gain, and in a choline chloride-based preservation solution. Finally, to evaluate the role of active oxygen species, SOD, catalase, and allopurinol were added to preservation solutions. The effect of allopurinol alone was also studied. In a related study, sucrose was substituted for the free radical scavenger, mannitol, in isotonic citrate solution. All livers were studied by light microscopy after perfusion-fixation. Storage in UW and isotonic citrate solutions resulted in clear improvement in the morphology of the sinusoidal lining. Increasing the rate of liver weight gain by the use of hypotonic solutions did not accelerate the endothelial injury. Choline chloride-based solution prevented weight gain during preservation, but unlike UW or isocitrate solutions it did not retard the microcirculatory injury. After preservation in the presence of SOD and catalase, or allopurinol, no improvement in the defined morphological features of the endothelial injury was noted when compared with respective controls; nor was the benefit of isotonic citrate solution lessened by the removal of the free radical scavenger mannitol. We conclude that microvascular injury produced by cold injury is due neither to free radical-mediated injury nor to cell swelling. As both UW and isotonic citrate solutions provide significant protection to the microcirculation, they must do so by a yet-undetermined mechanism. PMID- 2667204 TI - Difference in effect of cultured fetal pancreas transplants on retinal and renal capillary basement membrane thickness in diabetic mice. AB - The goal of endocrine pancreas transplants should be the prevention of diabetic complications. The differential effect of grafts of organ-cultured fetal mouse pancreas on diabetic complications in the retina and kidney was tested by comparing capillary basement membrane thickness (BMT) in mice made diabetic with streptozotocin and transplanted either early or late, or treated with insulin. BALB/c female mice were grafted with a single organ-cultured syngeneic fetal pancreas at either 3 weeks or 7 months after induction of diabetes. Controls were sex- and age-matched nondiabetic; diabetic untreated; and diabetic insulin treated mice. All mice were killed at 20 months of age and their eyes and kidneys fixed for electron microscopy. BMT was measured on coded micrographs. In all mice glomerular capillary BM were thicker than retinal capillary BM. Mice grafted early after the induction of diabetes had normal BMT in both sites, while those transplanted after 6 months of disease had normal retinal, but thickened glomerular, capillary BM. In each case the late-transplanted animals had BM thickness significantly less than the insulin-treated or untreated diabetics. PMID- 2667205 TI - Tubular expression of intercellular adhesion molecule-1 during renal allograft rejection. AB - Molecules responsible for adhesion between cells are known to play an important role in the immune response. The expression of one of these molecules, intercellular adhesion molecule-1 (ICAM-1), was examined on normal and allografted kidneys using a specific monoclonal antibody and an indirect immunoperoxidase technique. The expression of this molecule was compared to that of HLA class II antigens. On normal kidneys and most allograft biopsies taken immediately before implantation, ICAM-1 was expressed only on vascular endothelial cells (VEC) and parietal epithelium of Bowman's capsule. In the 11 kidneys where biopsies were available before and after transplantation, the appearance of rejection was associated with de novo expression of ICAM-1 on renal tubular epithelial cells that closely paralleled that of HLA class II antigens. In addition, an increase in endothelial cell expression of these molecules was also seen in rejection. In 23 random allograft biopsies, most of those with rejection showed tubular expression of both HLA class II antigens and ICAM-1. However, the presence of these molecules on tubules in several biopsies that did not show rejection limits the clinical usefulness of monitoring these antigens in posttransplant biopsies. The upregulation of these molecules is presumed to be secondary to the release of cytokines by cells infiltrating the allograft, although other mechanisms may be operating that explain the expression of these molecules in nonrejecting grafts. PMID- 2667206 TI - The impact of center variation on the HLA-DR matching effect in kidney graft survival. AB - Data from 7436 cases of first-cadaver transplants between 1981 and 1986 from 50 transplant follow-up centers within Eurotransplant, were analyzed with respect to the effect of HLA-DR matching on graft prognosis within the first year posttransplant. The use of cyclosporine was allowed for as well as the variation in graft survival rate between transplant follow-up centers. After adjustment for these variables, HLA-DR matching was still very significant. The effect of CsA on graft survival varied between centers--i.e., interaction was observed--but the effect of HLA-DR mismatching did not vary significantly between centers. Over all the centers there was a 1.4-fold increase in relative risk for each increase in HLA-DR mismatch, corresponding to predicted one-year graft survivals of 86.5%, 81.9%, and 75.4% for 0, 1, and 2 HLA-DR mismatches respectively, in patients receiving CsA, and 72.5%, 64.2%, and 53.6% in patients not receiving CsA. PMID- 2667207 TI - The relevance of induced class II HLA antigens and macrophage infiltration in early renal allograft biopsies. AB - Using a panel of monoclonal antibodies, immunohistological analysis was performed on frozen sections taken from 14 peritransplant renal biopsies and 42 biopsies taken 6 +/- 2 days posttransplantation. The following parameters were examined: tubular expression of HLA-DR, DP, and DQ and infiltration with T lymphocytes and macrophages. Of the 42 posttransplant biopsies, 26 were diagnosed as rejecting and 16 as nonrejecting according to clinical and histopathological criteria. HLA DR antigens were strongly expressed on 8 of 14 peritransplant biopsies, 23 of 26 rejecting biopsies and 13 of 16 nonrejecting biopsies. Tubular expression of HLA DP and DQ was weak or absent. In the rejecting biopsies there was a significantly increased infiltrate of T lymphocytes of all phenotypes and of macrophages when compared with the nonrejecting biopsies. Graft outcome was invariably favorable in the nonrejecting group, with no graft losses in the first posttransplant year. There were 4 graft losses in the rejecting group, all due to rejection, and further analysis revealed that all 4 had macrophage-dominated infiltrates in their early allograft biopsies. We conclude that immunohistological analysis of early allograft biopsies provides an accurate prognosis of subsequent graft acceptance or rejection and that early macrophage infiltration is a poor prognostic sign. PMID- 2667208 TI - Unconventional living kidney donors--attitudes and use among transplant centers. AB - The organ shortage remains a major barrier to renal transplantation in the United States today. The use of unconventional living donors, including genetically unrelated adults and related minors, could help increase the number of kidneys available for transplantation. Although these donor sources had generally been discarded, recent developments (including improved success and the demonstration of minimal risk) have caused some to reconsider this policy. Therefore, we surveyed all U.S. transplant centers regarding their attitudes toward unconventional living kidney donors. Of the nearly 60% responding: 76% would consider using spouses and 48% would even consider adult friends; 64% would consider using monozygotic twin minors and 43% would consider closely related non twin minors; the mean minimum donor age accepted was 16 +/- 3 years, and the range was wide. On the other hand, many centers expressed reservations about these donor sources and indicated that such donors are seldom used. We conclude that under certain circumstances many U.S. transplant centers would consider accepting unconventional living kidney donors. Yet, at the same time, the centers appear uneasy about actually using these donors and no clear consensus exists. Our data indicate a need to openly readdress these issues. PMID- 2667209 TI - Campath-1M--prophylactic use after kidney transplantation. A randomized controlled clinical trial. AB - Campath-1M is a rat monoclonal IgM antibody that binds human complement and recognizes virtually all peripheral human mononuclear cells. It is known to be effective in T cell depletion of bone marrow grafts, and encouraging results were obtained in a pilot study in which the antibody was used in prevention and treatment of rejection of kidney, pancreas, and liver allografts. In this randomized controlled clinical trial, Campath-1M has been evaluated as a prophylactic agent following renal allografting. It is shown that patients who received a 10-day course of the antibody immediately postoperatively, in addition to standard therapy with high-dose cyclosporine (17 mg/kg), experienced a significantly lower incidence of early acute cellular rejection than control patients who received cyclosporine alone. There was no evidence of "rebound" rejection following the end of antibody treatment to suggest that rejection had merely been delayed. However, patients who received this additional immunosuppression experienced a significantly higher incidence of serious infections than controls, this negating any benefit from the treatment in terms of graft survival. Thus, a monoclonal antibody of broad specificity directed against lymphocytes may be effective as a prophylactic agent after organ transplantation but its use should be accompanied by a reduction in other immunosuppressive drugs. PMID- 2667210 TI - Biopsy diagnosis and clinical outcome of persistent focal pulmonary lesions after marrow transplantation. AB - We reviewed the results of all percutaneous fine needle aspirations (FNA) and open lung biopsies (OLB) after bone marrow transplantation at our center (1984 1987) for the evaluation of focal lung lesions that developed or persisted despite antibiotic administration. We sought to determine the prevalence and types of infections, the yield of diagnostic procedures, and the clinical outcome of these focal lesions. Infection was documented in 78% (18/23) of all lesions and was fungal in each case. FNA detected fungal lung infection with a sensitivity of 67% (10/15) but had a negative predictive value of only 50% (5/10). Complications occurred in 15% of FNA. OLB without prior FNA was performed in 6 cases and demonstrated fungal infections in 5. Overall, seven of the 18 patients with localized invasive fungal lung disease recovered after antifungal therapy. This study demonstrates that focal lung lesions that develop or persist despite antibiotics after BMT are most often fungal. FNA may safely identify these localized infections in selected patients and with appropriate treatment recovery may be achieved. PMID- 2667211 TI - Different patterns of donor MHC antigen induction in rat kidney allografts following active and passive enhancement. AB - We compare the expression of donor class I and class II major histocompatibility complex antigens in DA kidney grafts transplanted to PVG recipients treated by different protocols of donor-specific immunosuppression. MHC expression was evaluated using donor-specific antibodies and assays by immunohistology and quantitative absorption analysis. PVG recipients were either untreated or treated by (A) twice-weekly intravenous injections of 0.5 ml DA blood for 12 weeks; (B) 0.5 ml DA blood intravenously at 7 days pregraft; (C) as for (B), but with the addition or oral cyclosporine at 10 mg/kg/day from the day of grafting; and (D) passive enhancement with DA anti-PVG serum. Grafts were assessed at 3, 5, and 7 days after transplantation. In untreated controls at day 3, there is a periarteriolar leukocyte infiltrate, weak or absent class II induction, but strong class I induction. Class II induction in untreated controls is maximal at day 5. We confirm that active enhancement by blood transfusion, even using the intensive protocol of twice-weekly transfusions for 3 months, results in accelerated leukocyte infiltration and accelerated donor class I and class II MHC induction. At day 3, there is an intense, diffuse leukocyte infiltration and maximal class II induction. Cyclosporine treatment of blood-transfused recipients reduced the leukocyte infiltration and MHC induction to levels seen in untreated controls--i.e., the accelerated MHC induction caused by the transfusion was partially reversible by cyclosporine. In passively enhanced recipients, leukocyte infiltration and class I MHC induction were similar to untreated controls. However, class II induction was much delayed, not being evident until day 7. PMID- 2667212 TI - A pilot clinical study of retrograde oxygen persufflation in renal preservation. PMID- 2667213 TI - Nephrotic-range proteinuria after donor nephrectomy and transplantation in a monozygous twin recipient. PMID- 2667214 TI - The effect of preservation fluid on the blood flow of pediatric liver allografts. PMID- 2667215 TI - Ranitidine and the cyclosporine-treated recipient. PMID- 2667216 TI - Eukaryotic chromosome replication requires both alpha and delta DNA polymerases. PMID- 2667217 TI - The great GATC: DNA methylation in E. coli. AB - In Escherichia coli the methylation of the adenine in the sequence 5'-GATC-3' is catalysed by the dam gene product, a DNA adenine methylase. We review the proposed roles for this methylation, and the sequence it modifies, in mismatch repair, DNA-protein interaction, gene expression, the initiation of chromosome replication, chromosome segregation, chromosome structure and the occurrence of mutational hotspots. PMID- 2667218 TI - Mammalian chromosome banding--an expression of genome organization. AB - Banding of metaphase chromosomes is an invaluable aid to analysing the complex genomes of vertebrates, but the biochemical basis for this phenomenon is poorly understood. Advances in molecular biology are beginning to point to features of genome organization that may play roles in chromosome banding. PMID- 2667219 TI - Mitochondrial RNA polymerase: dual role in transcription and replication. AB - Mitochondrial RNA polymerases from humans, Xenopus laevis and Saccharomyces cerevisiae are very similar in protein composition and function. They consist of a nonspecific core RNA polymerase and a protein factor that confers promoter selectivity on the core component, and they participate in transcription as well as in DNA replication. Amino acid sequence comparisons indicate that the yeast mitochondrial core component is related to bacteriophage T3 and T7 RNA polymerases; mitochondrial and phage polymerases may therefore belong to a family of related polymerases. PMID- 2667220 TI - Unwarranted pessimism in cancer chemotherapy. PMID- 2667221 TI - State- and use-independent Ca2+ antagonists offer hope in control of GI disorders. PMID- 2667222 TI - Electrophysiology of 5-HT3 receptors in neuronal cell lines. PMID- 2667223 TI - Mechanism of action of scopolamine as an amnestic. PMID- 2667224 TI - Analysis of mercapturic acids as a tool in biotransformation, biomonitoring and toxicological studies. PMID- 2667225 TI - Iterative least squares fitting of pH-partition data. PMID- 2667226 TI - Can equal pA2 values be compatible with receptor differences? AB - Situations exist in which pA2 analysis leads to conclusions about receptor differentiation that conflict with those drawn from other convincing lines of evidence. Robert Raffa and colleagues address this issue in its broadest context, particularly in relationship to the concept of accessory binding sites, using the controversy of delta-opioid receptor-mediated antinociception as an example. When the possibility of accessory binding sites is considered, it becomes clear that the finding of equal pA2 values does not necessarily mean action at the same receptor, and that the finding of unequal pA2 values does not necessarily confirm action at different receptors. PMID- 2667227 TI - Adenosine release may mediate spinal analgesia by morphine. AB - Spinal analgesia produced by morphine is blocked by methylxanthine adenosine receptor antagonists. In biochemical studies, morphine releases adenosine from spinal cord synaptosomes prepared from the dorsal spinal cord, as well as from the intact spinal cord in vivo. Adenosine release is reduced by intrathecal and neonatal pretreatment with capsaicin but not by intrathecal pretreatment with 6 hydroxydopamine or 5,7-dihydroxytryptamine, indicating that adenosine originates from small-diameter primary afferent neurons but not descending monoaminergic pathways. In this Viewpoint Jana Sawynok and colleagues review the evidence supporting the hypothesis that the spinal analgesic action of morphine is due to the release of adenosine from primary afferent nerve terminals and subsequent activation of A1 and A2 adenosine receptors. PMID- 2667228 TI - Corticotropin-releasing factor: endocrine and autonomic integration of responses to stress. AB - Corticotropin-releasing factor, a 41-residue peptide, is established as the principal physiological regulator of the pituitary-adrenal axis. The neuroanatomic distribution of corticotropin-releasing factor and its receptors suggests that this peptide may be a neurotransmitter in pathways outside the hypophysiotropic zone. Indeed, corticotropin-releasing factor demonstrates potent neuropharmacological actions that are independent of its pituitary effects. Laurel Fisher reviews the combined anatomical, pharmacological and physiological evidence that supports a role for corticotropin-releasing factor in mediating the integrated endocrine, autonomic and cardiovascular responses to stress. PMID- 2667229 TI - Pharmacology in space. Part 1. Influence of adaptive changes on pharmacokinetics. AB - The topic of pharmacology in space, i.e. the administration of drugs during space flight and the subsequent pharmacokinetic handling of the pharmaceuticals, is a new field about which little is known. In a two-part series, Claire Lathers and colleagues highlight some of the current questions in this field. In this first article the physiological and biochemical changes associated with weightlessness in space are discussed. These changes induce adaptive alterations which may influence the pharmacokinetic properties of drugs. The cardiovascular system is of particular relevance here. Also discussed are the classes of pharmacological agent that are most likely to be used during space flight for medical problems and thus, by necessity, will become drugs to be examined in space to determine whether their pharmacokinetic and pharmacodynamic properties are altered. Therapy of the most common spaceflight ailment-motion sickness-will be considered next month in Part 2. PMID- 2667230 TI - [Possibilities of cytogenetic studies of meiosis in male sterility]. AB - A survey of the literature is devoted to the discussion of positive aspects, informativeness and negative moments of the methods for cytogenetic analysis of male germ cells at different stages of their development in man in norm and with male sterility. PMID- 2667231 TI - [Contribution of whole body plethysmography to respiratory functional exploration]. PMID- 2667232 TI - [The synoviorthesis]. PMID- 2667233 TI - [Liposarcoma: epidemiologic and etiopathogenic study]. PMID- 2667234 TI - [Role of imaging in the diagnosis of acute kidney insufficiency]. PMID- 2667235 TI - [2 cases of leiomyoma (gastric and intestinal)]. PMID- 2667236 TI - [Our experience in dacryocystorhinostomy using bicannular intubation]. PMID- 2667237 TI - [Acute pancreatitis and hydatid cysts of the liver opening into the bile ducts. Apropos of a new case]. PMID- 2667238 TI - [Thyroglobulin]. PMID- 2667239 TI - [Liposarcoma: clinical study and therapeutic results (46 cases)]. PMID- 2667240 TI - [Cancer of the pancreas. Current results and future perspectives (apropos of 31 cases)]. PMID- 2667241 TI - [131 cases of hemorrhagic ulcer]. PMID- 2667242 TI - [Visceral larva migrans syndrome: apropos of 2 cases]. PMID- 2667243 TI - [Diagnosis in neonatal hydronephrosis]. AB - Maternal ultrasonography makes it possible to detect hydronephrosis in the fetus. After birth, hydronephrosis should be confirmed by repeating the ultrasonic examination. Reflux may coexist with all causes of hydronephrosis, for which reason it is necessary to do a voiding cystourethrogram. It is also necessary to do a renography, partly to estimate the relative renal function of each kidney, and partly to estimate the drainage function. In most cases ultrasound, voiding cystourethrography and renography are able to reveal the cause of hydronephrosis. Only in case of doubt it is necessary to do an excretory urography, which is rendered difficult by excessive bowel gas and poor renal function in neonates. PMID- 2667244 TI - [Fresh rupture of the Achilles tendon]. AB - In the Unfallkrankenhaus Salzburg (Salzburg Trauma Hospital) 586 inpatients with a recent Achilles-tendon rupture (ATR) underwent treatment within the years 1967 to 1984. Sporting activities were the dominant cause of the lesion (75% of total cases). Due to the location of our hospital skiing injuries dominated within this group. Pathogenesis of the lesion is discussed according to type and mechanism of the injury. Surgical approach has clearly been the standard therapeutic procedure (475 patients), whereas conservative treatment (twelve patients) resulted in a distinctly higher rate of reruptures. Thus the latter approach should be chosen in patients only when local factors or general disease rule out surgery. Rerupture is the most serious long-term complication. Therefore those cases have been critically analyzed with special attention to the type of surgical approach. In two thirds of our patients we conducted a follow-up with a questionnaire. The average time post trauma in this group was 8.9 years. Results are presented considering comments of the patients as well as occurrence of complications in the various surgical procedures. PMID- 2667245 TI - [An evaluation of breast stereotaxis]. PMID- 2667246 TI - [Suicide: an update]. AB - The authors relate etiological and epidemiological data on suicide. They also discuss cognitive and psychodynamic as well as biological factors involved. In the second part, they described different ways of predicting and dealing with suicide. They propose the use of a scale as a useful way for the assessment of suicide risk. PMID- 2667247 TI - Migrating suture masquerading as a renal pelvic carcinoma: an unusual complication of the Kock pouch. AB - Following a radical cystectomy and the creation of a Kock pouch, a filling defect developed in the renal pelvis that appeared to be a transitional cell carcinoma. This appearance was produced by the retrograde migration and implantation of a fragment of suture material used in the creation of the pouch. It represents a previously undescribed complication of this procedure. PMID- 2667248 TI - Segmental infarction of the renal allograft: ultrasound/MRI observations. AB - Ultrasound and magnetic resonance imaging allow noninvasive identification of focal vascular obstruction of the renal allograft. Definitive delineation of a potentially salvageable kidney is afforded by angiography. PMID- 2667249 TI - Percutaneous nephrostomy in pyonephrosis. AB - A series of 76 pyonephrotic kidneys in 73 patients were drained by percutaneous nephrostomy (PN) tube and examined to evaluate the contribution of this technique to the treatment of pyonephrosis. In 71 patients, clinical symptoms disappeared 24-48 h after the procedure. Two patients died from sepsis subsequent to anuria and underlying malignancy. Once the acute phase had remitted, interventional procedures were carried out in 39 cases, and constituted the definitive therapy in 36. In 32 cases, elective surgery was the definitive therapy, including the 3 cases not resolved after interventional procedures. Three patients in whom the obstruction cleared spontaneously following PN needed no additional treatment. Major complications included 6 cases of sepsis, all of which resolved satisfactorily with proper medical therapy. PMID- 2667250 TI - Transverse fusion of the renal pelvis and single ureter. AB - We present a case of a rare renal anomaly in which the 2 kidneys (separate or fused across the midline) are drained by a common renal pelvis and ureter. Previously reported cases have been reviewed and are classified in 3 groups according to their anatomical features. The lesion is associated with some frequency with imperforate anus, sacral and other vertebral defects, neurogenic bladder, vesicoureteral reflux, upper tract dilatation, and urinary tract infections. PMID- 2667251 TI - Circumferential perirenal urinoma mimicking nephromegaly on urography. AB - Four cases of circumferential perirenal urinoma in patients with cancer are described. Intravenous urography showed evidence of apparent renal enlargement. In 1 case, opacification of extravasated urine was dense enough to be seen on the urogram, and the diagnosis was confirmed by computed tomography (CT). In the other cases, sonography followed by CT diagnosed urinoma, after tumor invasion had been suggested because of the pseudonephromegaly. Ureteral obstruction was demonstrated in all cases, due to retroperitoneal adenopathy in 1 case and to pelvic tumor in the other 3. Sonography or CT is required for the diagnosis of circumferential perirenal urinoma mimicking nephromegaly urographically. PMID- 2667252 TI - [The hormonal response in bulls to the administration of zeranol and rumensin]. AB - The objective of the study was to investigate the influence of the growth stimulators Ralgro zeranol and Rumensin on changes in concentrations of certain hormones in the blood of beef bulls. In the first experiment 21 bulls were investigated which were divided into three groups. The first group was control, the second was administered the Ralgro stimulator (3X) and the third the Ralgro and Rumensin stimulators. In the second experiment there were 12 bulls. The animals in the test group were implanted Ralgro five times during the fattening period. Alternate changes, mostly insignificant, were recorded between the groups in the concentration of triiodothyronine and cyclic adenosine phosphate. Thyroxine concentrations were reduced during all investigations of the first and second experiments in the animals stimulated by the Ralgro preparation. A significant increase was recorded in the bulls at the age of 14.3 months in the second experiment (62.8 nmol.l-1, in comparison with 56.9 nmol.l-1). In both experiments an identical trend of insulin content was observed--in seven out of the total number of eight observations the animals treated with the Ralgro preparation had statistically insignificantly higher values. The largest differences were recorded at the age of 11.1 and 14.3 months in the second experiment (3.9 microIU.ml-1 and 3.6 microIU.ml-1). Significant differences were observed in testosterone concentrations in the second bulls of the test group were lower by 1.9+ nmol.l-1 and 3.4++ nmol.l-1, respectively. PMID- 2667253 TI - Multiple drug-resistant S typhimurium. PMID- 2667254 TI - [Clinico-morphologic validation of the therapeutico-prophylactic use of decimeter waves following obstetric surgery]. PMID- 2667255 TI - [Bile protein fractions in patients with viral hepatitis]. AB - A study of bile protein fractions by means of polyacrylamide gel electrophoresis in patients with viral hepatitis revealed changes in the protein fraction range in those with a prolonged course of nonicteric convalescence manifested in an increase of the amylolytic and reduction of proteolytic fractions. It is suggested that enzymatic disorders of the pancreatic function may lead to development "enzymatic" cholecystitis and protracted convalescence of patients with viral hepatitis. PMID- 2667256 TI - [Immunoenzyme analysis in the diagnosis of chronic nonspecific lung diseases in children]. AB - Immunoenzyme assay (non-direct ELISA) was used for analysis of sera from children (age: 4-14 years) with chronic bronchopulmonary diseases. Antibodies to adenoviruses were revealed in 46% of sera as well as a 3-5 time increase of specific antibodies in 50% of cases. Peroxidase-labelled protein A staphylococcus aureus was effective for detection of immune complexes. PMID- 2667257 TI - [The regulatory mechanisms of gastric secretory function in peptic ulcer (a review of the literature)]. PMID- 2667258 TI - [The role of the complement system in physiologic and pathologic body reactions (a review of the literature)]. PMID- 2667259 TI - Clinical experience with ciprofloxacin. AB - In a multicenter study of 32 patients treated with ciprofloxacin (mean daily dosage, 1,000 mg per day; mean duration of treatment, 9.5 days) for a variety of infections, eight were microbiologically proved. Of these, bacteriologic cure and/or improvement resulted in all cases. For all 32 infections, clinical cure and/or improvement resulted. Four infections were classified as chronic. There were 3/32 (9.4 per cent) adverse reactions (ADRs), and one case each of nausea, dizziness and increased menstrual flow. Only the dizziness and nausea were considered related definitely to ciprofloxacin therapy. Therapy with ciprofloxacin was discontinued in all three patients because of adverse effects. PMID- 2667260 TI - Host-mediated bacterial mutagenesis and enterohepatic circulation of benzidine derived mutagenic metabolites in rodents. AB - 1. Administration of benzidine (100 mg/kg, i.p.) to bile duct-cannulated rats led to a sustained excretion of metabolites in bile which, following glucuronide hydrolysis, were mutagenic to Salmonella typhimurium strain TA98. 2. When the biliary metabolites were re-infused into the duodena of a further group of rats, enterohepatic circulation of mutagens was indicated by extensive re-excretion of biliary mutagens in the recipients. 3. Furthermore, in mouse host-mediated mutagenicity assays, both i.p. injection of benzidine (100 mg/kg) and intracaecal administration of rat biliary metabolites of benzidine produced a mutagenic response in Salmonella typhimurium strain TA98 cells isolated from the liver. 4. The results indicate that enterohepatic circulation adds to the biological persistence of reactive metabolites of benzidine and may contribute to the carcinogenicity of this aromatic amine. PMID- 2667261 TI - [Does the stomach balloon modify the function of the esophagus and lower esophageal sphincter, stomach emptying and release of gastrointestinal peptides?]. AB - The Willmen gastric bubble has been used as an adjunct to weight loss in morbidly obese patients. 35 patients with morbid obesity were studied with routine manometry, esophageal 24-h-pH-measurement, and gastric emptying studies before and 4 weeks after bubble placement. During emptying studies blood samples were taken to measure gastrin, PP, CCK, VIP, neurotensin and insulin. No patient developed heartburn or regurgitation after bubble placement. Esophageal motility and LES function remained unchanged. There was no important pathological gastroesophageal reflux before and after gastric bubble. The gastric emptying time of solid food was unchanged by gastric bubble placement and the emptying time of liquids was accelerated up to normal. In patients with fasting gastrin levels less than 20 pg/ml at the beginning of the first test we found no differences in gastrin release before and after bubble insertion. In patients with primary high fasting values gastrin release was significantly increased. CCK, VIP, neurotensin and insulin levels were unchanged. With PP we measured significantly raised fasting levels after gastric bubble. We conclude that esophageal and LES functions are not altered by Willmen gastric bubble placement and that primary retardation of fluids is changed to normal. Bubble induced gastric tension increases fasting PP. In case of high fasting gastrin the bubble leads to an extremely high food response without any clinical signs. PMID- 2667262 TI - [Extracorporeal lithotripsy of gallbladder calculi with piezoelectrically generated shock waves: initial experiences]. AB - A piezoelectric lithotripter ("Piezolith 2300") was used in 24 patients for extracorporeal fragmentation of radiolucent gallbladder stones. In 19 patients with one stone and 4 patients with two stones (diameter: 0.8-3.1 cm) fragmentation to a maximal fragment size of 7 mm was achieved. One to three treatment sessions were necessary (mean 1.5). During adjuvant oral litholytic therapy with chenodeoxycholic acid and ursodeoxycholic acid (500 mg each daily up to 80 kg bodyweight and 750 mg in patients with more than 80 kg bodyweight) 4 patients came to be completely free of stones within a mean follow-up time of 15 weeks. Treatment was well tolerated by all patients, no analgesia or sedation was needed. Side effects were cutaneous petechiae in two patients, microscopic haematuria in two others and leucocyturia in another. We conclude that lithotripsy of gallbladder stones can be performed safely and effectively not only by the established underwater spark discharge type of lithotripter but also by the piezoelectric system. PMID- 2667263 TI - [Causes and clinical diagnosis of chologenic diarrhea]. AB - Among the numerous differential diagnoses of chronic diarrhea, chologenic diarrhea is rarely taken into account. However, diseases or postoperative syndromes leading to bile acid malabsorption and thus resulting in chologenic diarrhea such as Crohn's disease or ileal resections have increased considerably. Further, malabsorption of bile acids might be incriminated in the pathogenesis or sequels of other digestive diseases (e.g. irritable bowel syndrome or chronic pancreatitis) and also can be the only characteristic in the rare "idiopathic" bile acid malabsorption. Etiologies, pathophysiology and the clinical sequels of impaired bile acid absorption have been elucidated in recent years, but in clinical medicine several questions remained unresolved since valid and generally acceptable analytical methods for the detection of bile acid malabsorption have not been developed until recently. In this field, radioisotope methods have considerably expanded our diagnostic facilities. PMID- 2667264 TI - [Immunosuppressive therapy in myocarditis and dilated cardiomyopathy--a critical analysis]. AB - Clinical and experimental examinations suggest that autoimmunological mechanisms may play an important role in the pathogenesis of postmyocarditic cardiomyopathy. These may be due to the viral infection itself or may be induced by the viral persistence. Following these ideas an immunosuppressive therapy to prevent the progression of myocarditis to dilative cardiomyopathy is discussed. Since the introduction of endomyocardial biopsies in the diagnosis of myocarditis several papers reported trials of an immunosuppressive therapy in histologically proven myocarditis. But all of these studies were not randomized and only a limited number of patients were treated. Both the primary diagnosis, "myocarditis", as well as the histological findings to evaluate the course of the disease are not well defined and therefore were used differently in the studies published so far. Moreover, the regimens used for immunosuppressive therapy until now were not standardized, thus making it impossible to compare the various studies. Another important problem is the often observed spontaneous remission of histologically proven myocarditis. It may be that it is due to these factors that the results published so far report quite different success rates for the immunosuppressive therapy in myocarditis. Recent scientific findings indicate that the combination of virological, histological, immunohistological and immunological examinations will allow a marked improvement in the finding of the diagnosis and the further control of the course of myocarditis in the near future. But as long as no significant results about the clinical advantage of immunosuppressive therapy in myocarditis exist a general use of immunosuppressive therapy should be avoided. It is to be hoped that the doubleblind-randomized multicenter studies now in progress will provide definite results about the use of immunosuppressive therapy in myocarditis. PMID- 2667265 TI - [Lack of effectiveness of coenzyme Q10 (ubiquinone) in long-term treatment of dilated cardiomyopathy]. AB - In a chronic, placebo-controlled, double-blind cross-over study a potential therapeutic effect of coenzyme Q10 (ubiquinone) was investigated in 25 patients suffering from dilative cardiomyopathy (NYHA functional class I, II, III). During a period of four months patients were treated with 3x 33.3 mg of coenzyme Q10 per day, given orally, 15 patients received verum during the first four months and placebo during the following four months (V/P). In the second group of patients (n = 10) the sequence of treatment was reversed (P/V). Therapeutic effect was assessed by means of echocardiogram, chest x-ray, radionuclide ventriculography combined with exercise test and impedance cardiography. Control values for left ventricular function parameters were similar in both groups (left ventricular ejection fraction: 39.5 +/- 11.5% (P/V), 37.6 +/- 17.0% (V/P); left ventricular enddiastolic diameter: 65 +/- 9 mm (P/V), 67 +/- 8 mm (V/P); Cl: 5.1 +/- 1.4 l/min (P/V), 5.1 +/- 1.1 l/min (V/P]. Chronic treatment by coenzyme Q10 did not exhibit any influence on hemodynamic parameters, on the electrocardiogram, on incidence of ventricular arrhythmias, or on exercise tolerance. It was not possible to demonstrate any therapeutic effect of coenzyme Q10 in patients with dilative cardiomyopathy. PMID- 2667266 TI - [Volumetric and golgi studies of the corpus geniculatum laterale pars dorsalis of Alticola stoliczkanus barakshin and Alticola argentatus semicanus]. AB - The dorsal lateral geniculate bodies (dLGB) in Alticola stoliczkanus barakshin, the Gobi-Altai-Mountain vole, and in Alticola argentatus semicanus, the silver grey mountain vole, and investigated using the nissl- and the golgi method. The geniculo-cortico-relay neurons (GCR neurons) of both species have 5 primary dendrites (D1), a dendritic field of about 100 micron, about 17 free dendritic distal parts (FDE), 10 branching points (VZP) and a average of the perikaryon of 10 micron. All tufted neurons are small and topographically distinctly localised. The dLGB's volume of Alticola stoczkanus, barakshin is 0.16 mm3, the dLGB's volume of Alticola argentatus semicanus is 0.23 mm3. PMID- 2667267 TI - [Study years 28 and 43--they have seen some changes. Interview by Britta Nilsson]. PMID- 2667268 TI - [Genetics of diabetes mellitus]. PMID- 2667269 TI - [Molecular biological aspects of the pathogenesis of diabetes mellitus]. AB - The discovery of the key role played by the immune system in the pathogenesis of insulin-dependent diabetes mellitus (IDDM) opens up new possibilities for its early diagnosis, at the stages preceding its clinical manifestation. Analysed are the markers of genetic susceptibility to IDDM associated with some major histocompatibility complex antigens (specifically with HLA-DR 3, HLA-DR4, and HLA DQ), of the cellular and humoral anti-islet autoimmunity, as well as the origin of the islet-cell autoantigens. The markers' significance for the diagnosis and prognosis is discussed. PMID- 2667270 TI - [Clinico-therapeutic aspects of diabetes mellitus]. AB - The mechanisms of diabetes mellitus development are outlined and the share of immunological disorders in the pathogenesis of insulin-dependent diabetes (IDDM) and in progress of diabetic angiopathy is substantiated. Affection of peripheral tissues in noninsulin-dependent diabetes (NIDDM) is explained, specifically the deranged plasma cell membrane function and insulin-receptor relationships. The actions of insulin on the metabolic status of the target cells are demonstrated using the fibroblast culture. The role of hyperinsulinaemia and activation of sorbitol glucose metabolism pathway in the pathogenesis of diabetic angiopathies is elucidated. New diagnostic and therapeutic devices are described. PMID- 2667271 TI - [Psychopathology of fragile X syndrome]. PMID- 2667272 TI - Prolonged rat heart allograft survival and reduced graft immunogenicity after photochemical donor and transplant pretreatment. AB - The purpose of these experiments was to evaluate the influence of pretreatment of the heart donor with the photosensitizer 8-methoxypsoralen plus ex vivo longwave ultraviolet irradiation of the graft (PUVA) on survival time and immunogenicity of rat heart allografts in a donor-recipient combination that was different at the major histocompatibility complex (MHC). PUVA treatment of the donor hearts significantly prolonged their survival in allogeneic recipients. The efficacy of this therapy was dependent on the time of ultraviolet irradiation. Immunohistological studies using monoclonal antibodies to rat MHC class I and II antigens showed a significant reduction of class II antigen expression in heart cryostat sections after PUVA treatment. No differences were seen in the tissue distribution of class I antigen. This reduction of donor MHC class II antigens may influence the antigen presentation as well as the activation of T helper cells. In conclusion, PUVA treatment is effective to reduce the immunogenicity and to improve the graft survival time of rat heart allografts. These experimental findings are new and suggest a possible clinical application of photochemical pretreatment. PMID- 2667273 TI - [What is the contribution of echography in Crohn disease?]. AB - The alimentary tract often contains some gas which may obstruct the passage of the ultrasonic beam. However, when a pathological process involves the intestinal wall, a "target" pattern or a "pseudo-kidney" pattern may be visualized by ultrasound. It is also possible to visualize by US examination some complications of Crohn's disease: intestinal obstructive lesion with distended loops, fistula, abscesses and renal or biliary lithiasis. Because sonography is non-invasive and simple to perform without radiation exposure, it should often be used in Crohn's disease as the initial diagnosis and as the following-up test. PMID- 2667274 TI - Perioperative myocardial ischaemia and infarction in connection with cardiac and non-cardiac surgery. AB - Although perioperative myocardial infarction has a relative low incidence, its occurrence is associated with a high morbidity and mortality. Although many single risk factors for developing a perioperative myocardial infarction have been described, it soon became apparent that surgical risk could hardly be determined by one single factor. A multifactorial approach for the preoperative assessment of patients at risk for developing cardiac complications in association with surgery and anesthesia was introduced. Further investigation, however, indicated that the risk of developing a perioperative myocardial infarction was not only determined by preoperative risk factors and a number of peroperative risk factors were also identified. Since identification of those patients, particularly at risk for developing a perioperative myocardial infarction, is a matter of prime importance in the choice of the treatment and the monitoring, a thorough understanding and knowledge of the different pre- and peroperative risk factors is a must for every surgeon and anesthetist. PMID- 2667275 TI - [Heparin-associated thrombocytopenia]. AB - Thrombocytopenia and heparin. Heparin associated thrombocytopenia (HAT), more specially type 2, is an important complication of anticoagulant treatment in clinical practice. Diagnosis may be difficult and requires special laboratory techniques. Platelet count should be performed every two days. Severe complications may occur in 23% of type 2 HAT patients and is associated with a high mortality. Until now there are no prophylactic measurements for high risk patients. PMID- 2667276 TI - [Immunology of inflammatory diseases of the digestive tract]. AB - The etiology of inflammatory bowel diseases is unknown: infectious factors have been suspected but couldn't be confirmed. The multifactorial origin remains the most credible. The development of immunologic knowledge and in particular of the digestive immune system, has allowed to evoke the responsibility of immunologic abnormalities in the genesis, the chronicity or the recidive of inflammatory bowel disease, the more that the histologic lesions evoke an immune mediated pathology. An increased production of mucosal immunoglobulins exist in the inflammatory bowel diseases; some have a specificity for bacterial antigens; the activation of the complement is observed during acute access of the disease. Mucosal or circulating lymphocytes are cytotoxic in vitro for colonic epithelial cells, this reaction being modulated by seric factors and bacterial antigens. The T lymphocytes are increased in the mucosa without the ratio T helper/T suppressor being significantly modified. The immunoregulation is also perturbed, the modulation of the local immune reaction being altered essentially during the active phases of the disease. It is not clear yet whether this perturbation is primitive or secondary to inflammation. It seems reasonable to believe that the humoral and cellular responses to digestive antigens are the corollary of an enhanced antigenic absorption, of a more adequate antigenic presentation to the immune system, consequence of the expression of class II antigens by an inflamed mucosa and of an alteration of immune control. PMID- 2667277 TI - [Evaluation of the immunologic response in various types of bone grafts using lymphocytic nucleoli activity]. AB - Assessment of the activity of nucleoli in lymphocytes is considered an important sign for assessment of the degree of activation of the immune system after transplantation. The authors evaluated the activity of nucleoli in lymphocytes of patients with transplantations of different types of bony tissues (autografts, frozen alloimplants, autolyzed antigen-free allogenic bone, control group) before operation, two weeks, 70 days and longer after operation. Differences were revealed during the period between two weeks and 70 days after operation. While in autografts and autolyzed antigen-free allogenic bone at that time a slight decline of inactivated forms of lymphocytes occurred, in frozen alloimplants a rise was recorded. The number of active forms of lymphocytes increased in autolyzed antigen-free allogenic bone and declined in frozen alloimplants. In autografts a mild decline was recorded in active as well as inactive forms of lymphocytes at the expense of an increased number of annular nucleoli. In the conclusion the authors present different interpretations. PMID- 2667278 TI - Bonding and gap formation of glass-ionomer cement used in conjunction with composite resin. AB - Glass-ionomer cement has been suggested as liner in cavities restored with composite resin. The purpose of the present investigation was to measure 1) tensile bond strength between etched glass-ionomer cement and composite resin, and 2) gap formation as assessed by wall-to-wall polymerization contraction and by microleakage with a silver nitrate technique. The influence of the following variables was examined: type of glass-ionomer cement and composite resin, duration of acid etching, irradiation time of unfilled and composite resin, preparation of bevel, conditioning with polyacrylic acid, and storing time in water before gap measurement. Bond strengths varied from 0 MPa when etching was omitted to 3.9 MPa after etching. Glass-ionomer cement lining reduced wall-to wall contraction and penetration of silver nitrate. A positive correlation was found between wall-to-wall contraction and silver nitrate penetration. PMID- 2667279 TI - Some salivary factors in insulin-dependent diabetics. AB - The aim of the study was to compare salivary flow rate, salivary pH, buffer capacity of the saliva, salivary glucose content, and number of Candida albicans, lactobacilli, and Streptococcus mutans in the saliva in age- and sex-matched adult long- and short-duration insulin-dependent diabetics and non-diabetics. Ninety-four long-duration and 86 short-duration diabetics and 86 non-diabetics, aged 20-70 years, participated in the study. Paraffin-stimulated whole saliva was collected. Both long- and short-duration diabetics had a decreased salivary flow rate and an increased salivary glucose content compared with non-diabetics. However, the differences were small. There were no significant differences between the groups in salivary pH, buffer capacity, or bacterial counts. PMID- 2667280 TI - Evaluation of new treatment methods for head and neck cancer: a challenge. AB - Surgery and radiotherapy are still the best local and regional treatments for the majority of head and neck cancer patients, each alone having an impressive cure rate. However, it appears that surgery and radiotherapy have reached their upper limits. To improve the results obtained by surgery and radiotherapy, combined approaches with chemotherapy or immunotherapy must be further explored. Prospective randomized trials are essential for the evaluation of the efficacy of such multimodality treatments. Although there is an increasing commitment to this type of clinical research amongst otolaryngologists/head and neck surgeons, we still lag considerably behind other surgical and medical disciplines. Broad peer support is the conditio sine qua non that prospective randomized studies will be successfully conducted in head and neck oncology. Such studies, irrespective of their outcome in terms of which treatment is best, will provide data on important issues like that of failure sites. Accurate evaluation of the magnitude of the failure problem at respectively the local, the regional and the distant level are essential for estimating the potential for gains and establishing priorities for clinical research. PMID- 2667281 TI - Norepinephrine content in guinea-pig nasal mucosa response to histamine and methacholine provocation. AB - The effects of histamine and methacholine (cholinergic substance) on norepinephrine (NE) content in nasal mucosa of the guinea-pig has been investigated. Histamine application for seven consecutive days was found to reduce NE content on both sides of nasal mucosa with bilateral provocation and on the affected side with unilateral stimulation, whereas NE content increased on the unaffected side with unilateral application. Methacholine provocation enhanced NE content on both sides after the bilateral application to nasal mucosa and the affected side after the unilateral application, whereas there was no effect on the other side. Time course evaluation of NE content after unilateral histamine application demonstrated that NE content on the affected side was decreased 30 min after application, but was restored to a normal level by 120 min after application; there was no change on the other side. These results suggest that histamine promotes NE release in nasal mucosa although it possesses the inhibitory effect mediated by the parasympathetic nerve, suggesting that repeated histamine stimulation may deplete NE content and cause a functional disturbance of the sympathetic nerve predisposing patients to the non-specific nasal hypersensitivity observed in nasal allergy. PMID- 2667282 TI - Treatment of craniopharyngiomas--the stereotactic approach in a ten to twenty three years' perspective. I. Surgical, radiological and ophthalmological aspects. AB - A multi-modality treatment programme, where stereotactic methods were used preferentially, gave results in a consecutive series of craniopharyngiomas, not inferior to those reported after microsurgical removal. Fourty-two patients with a follow-up range of 10-23 years are reported. PMID- 2667283 TI - Stereotactic mesencephalic tractotomy in the treatment of chronic cancer pain. AB - A report is given on indications and results of treatment of chronic cancer pain using stereotactic mesencephalic tractotomy (SMT), based on own experiences in 202 patients. Percutaneous cervical cordotomy for upper body pain syndromes has been abandoned and replaced by SMT. Operative mortality of SMT was less than 0.5%, and also its morbidity was low and usually transitory. Bilateral procedures may be performed with an interval of at least seven days. Early recurrences within one month (15%) are due to insufficient coagulation. Late pain recurrence occurred in 4% and may be due to either nervous system regeneration (sprouting) or transmission of pain by alternate secondary pathways. PMID- 2667285 TI - Stereotactically guided convergent beam irradiation with a linear accelerator: localization-technique. AB - A stereotactic convergent beam irradiation technique using a linear accelerator has been developed in order to precisely apply single high doses of up to 50 gray and more to brain lesions (radiosurgery). Accurate positioning of the patient and the target point of irradiation is an absolute requirement for this method. The stereotactic localization system developed for this purpose is described. PMID- 2667286 TI - Capillary electrophoresis. AB - The combined techniques that comprise capillary electrophoresis are under rapid development for a wide range of molecules and sample types. The capillary format provides fast, highly efficient separations and makes automation possible. At present, systematic approaches to separation methodology are still in the development stages and better detection schemes need to be developed. There is no doubt that electrophoresis in a capillary tube will take its place as a substitute for HPLC in specific applications. This is especially apparent when analysis time, efficiency, or simplicity is of greatest concern. Capillary electrophoresis will prove extremely useful for separations of nucleotides and proteins for analytical purposes in biotechnology. Finally, the ability to use ultrasmall-volume samples makes capillary electrophoresis ideal for the development of separations-based sensors for the analysis of microenvironments. PMID- 2667284 TI - Complications of anterior cervical discectomy without fusion in 450 consecutive patients. AB - The complications of anterior discectomy without fusion were analyzed on the basis of 450 consecutive cases treated surgically for degenerative disc disease. There was no death related to the procedure. The most common complication was a worsening of the pre-existing myelopathy. This occurred in 3.3%, including one case with severe medullary contusion. Wound infection developed in 1.6%. Additional radicular symptoms and wound haematoma, respectively, occurred in 1.3%; recurrent nerve palsy, Horner's syndrome, and respiratory insufficiency, respectively, in 1.1% of the cases. Epidural haematoma and instability of the cervical spine, respectively, occurred in 0.9%, nerve root lesion and aseptic spondylodiscitis, respectively, in 0.4%. There was one case each (0.2%) with a pharyngeal lesion, meningitis due to dural perforation, transient additional myelopathy, and epidural abscess. The results and the management of complications are discussed in relation to numerous previously published reports, including posterior procedures and anterior fusion techniques. Precise knowledge of all potential accidents and pitfalls related to the surgical procedure and of their aetiology may contribute to preventing failures. The rate of complications in this series has been reduced in the past years by better patient selection, by paying more attention to correct positioning of the patient during the operation, and by meticulous removal of all offending structures. Discectomy without interbody fusion is now considered to be a reasonably safe procedure with an acceptable operative morbidity and lack of mortality. PMID- 2667287 TI - High-performance immunoaffinity chromatography. PMID- 2667288 TI - Protein purification by multidimensional liquid chromatography. AB - Recently Giddings discussed the prospect of combining two separation mechanisms in such a way that when "a sample is subjected to two displacement processes oriented at right angles to one another" a two-dimensional separation is carried out. In this review I have focused attention on the various ramifications of this concept in terms of combining two or more chromatographic techniques on-line to conduct MDLC for the purpose of purifying proteins. In general, the MDLC approaches discussed here were classified into two major categories. The first category involves the placement of several separation mechanisms in the same chromatographic work space (the chromatographic column). In this case the displacement processes are collinear. It is hoped that these new chromatographic packings and columns will display surface characteristics capable of a wide range of highly discriminating selectivities that can be modulated by mobile-phase changes to a greater extent than the nonspecific chromatographic techniques such as IEC and HIC. The ability to modulate the mobile phase to generate new selectivities is important in expanding the usefulness of these packings in comparison to the very high selectivity of affinity chromatography, which usually has little use outside its initial intended purpose to purify a particular protein. The second category involves the on-line physical coupling of two or more chromatography columns, each packed with a different chromatography material. Again the idea is to create or design a simple self-contained system that is capable of generating a wide range of high selectivities. Indeed, the on line coupling of two different chromatographic packings for the purification of a single protein represents a line trace through "a discrete independent 2 dimensional system". These systems are highly attractive in large-scale purification, especially when using "on-off" chromatography, which eliminates the need for sophisticated gradient elution hardware. The purification of a single protein from its biological matrix is usually a multidimensional process utilizing several different separation technologies. By nature this leads to lengthy purifications that are frequently labor-intensive and expensive to scale up. It is my belief that future developments in the concept of on-line MDLC techniques involving complex chromatographic materials and column coupling will merge to create significant improvements in the protein purification process. PMID- 2667289 TI - Fluorescence derivatization in high-performance liquid chromatography. PMID- 2667290 TI - Multidimensional chromatography in biotechnology. PMID- 2667291 TI - Reference values. PMID- 2667292 TI - Biochemical detection of hepatitis B virus constituents. PMID- 2667293 TI - Monitoring acid-base and electrolyte disturbances in intensive care. PMID- 2667294 TI - Monoclonal antibodies: production, purification, and technology. PMID- 2667295 TI - Monoclonal antibodies: clinical applications. PMID- 2667296 TI - Neopterin as marker for activation of cellular immunity: immunologic basis and clinical application. PMID- 2667297 TI - Aspirin prophylaxis for cardiovascular disease. U.S. Preventive Services Task Force. AB - Low-dose aspirin therapy should be considered for men over age 40 who are at significantly increased risk for myocardial infarction and who lack contraindications to the drug. Patients should understand the potential benefits and risks of aspirin therapy before beginning treatment. PMID- 2667298 TI - Diarrhea in critically ill patients. AB - The onset of diarrhea complicates the care of critically ill patients, who often have complex cardiopulmonary, renal or metabolic problems. Diarrhea further upsets fluid and electrolyte balance and creates difficulties in nutritional support. Common causes of acute diarrhea in critically ill patients include medications, enteral feedings, ischemic bowel disease, pseudomembranous colitis, short bowel syndrome, intestinal fistulas, pancreatic insufficiency and opportunistic infections in patients with AIDS. PMID- 2667299 TI - Evaluating hematuria in adults. AB - Although most causes of hematuria are benign, urinary tract bleeding may signal the existence of a life-threatening disease. Gross and microscopic hematuria share a common differential diagnosis, including urinary tract infection, urolithiasis and bladder cancer. Clinical evaluation may be guided by the patient's age, sex, medical history and physical examination. Intravenous pyelography or sonography is usually the first procedure performed, although cystoscopy is indicated in the face of active bleeding. Those patients who remain undiagnosed after a complete evaluation should be followed with routine urinalysis and cytology to allow early detection of malignancy. PMID- 2667300 TI - HTLV-I: newest addition to blood donor screening. AB - The Food and Drug Administration has recommended that blood donated for transfusion in the United States be screened for antibodies to human T lymphotropic virus type I. Since seropositive donors will be referred to health care providers for advice, physicians should become familiar with HTLV-I, its modes of transmission and its disease associations. According to current knowledge, seropositive persons should neither donate blood for transfusion nor share needles. Women should be advised against breast feeding. Advice about sexual activity is more difficult to formulate and must be individualized. PMID- 2667301 TI - Sonography in newborns with cutaneous manifestations of spinal abnormalities. AB - High-resolution ultrasound is the screening method of choice for neonates with cutaneous signs of underlying spinal pathology. This examination does not require sedation, does not use radiation and is less expensive than computed tomography or magnetic resonance imaging. Ideally, sonograms should be obtained as soon as the cutaneous marker (sacral dimple, hairy patch, skin-covered mass) is found at the newborn examination. PMID- 2667302 TI - Somatization disorder in family practice. AB - Although often difficult to recognize, somatization disorder--the presence of multiple physical symptoms but no apparent physical or psychiatric disease--is a common problem in primary care practices. Onset is usually before age 30. The disorder manifests as a myriad of symptoms, including gastrointestinal complaints, various types of pain, cardiopulmonary symptoms, pseudoneurologic complaints, sexual problems and complaints related to the female reproductive system. Vigilance is necessary, because somatization disorder may mimic numerous physical and psychiatric ailments. PMID- 2667303 TI - Conference covers endoscopy and bleeding ulcers. PMID- 2667304 TI - Effectiveness of intravenous propafenone for conversion of atrial fibrillation and flutter of recent onset. AB - The efficacy of intravenous propafenone (2 mg/kg) was assessed in 83 consecutive patients: 68 with atrial fibrillation (AF) and 15 with atrial flutter lasting less than 15 days. Conversion to sinus rhythm occurred in 47 patients (57%), including 42 (62%) of those with AF and 5 (33%) of those with atrial flutter (p less than 0.05). The mean time to conversion was 29 +/- 24 minutes. The success rate was strongly affected by arrhythmia duration. Thus, conversion occurred in 40 patients (71%) among the 56 with arrhythmia lasting less than 48 hours but in 7 patients (26%) among the 27 with a longer lasting arrhythmia (p less than 0.0005). Left atrial size (determined echocardiographically in 56 patients) was significantly larger in nonconverters (49 +/- 12 vs 39 +/- 7 mm, p less than 0.0005). In nonconverters the mean ventricular rate decreased from 141 +/- 26 to 104 +/- 22 beats/min (p less than 0.0005). Except for reversible low output state in 3 patients already hemodynamically compromised, no significant side effects were observed. In conclusion, (1) intravenous propafenone allows a quick restoration of sinus rhythm in the majority of patients with AF of recent onset, whereas it seems less effective in atrial flutter; (2) its efficacy is influenced by the duration of the arrhythmia and by left atrial dimensions; (3) the drug allows control of ventricular rate; and (4) its use seems to be safe except in patients with severe cardiac failure. PMID- 2667305 TI - Response to dynamic exercise of the orthotopically transplanted human heart in men immunosuppressed with cyclosporine. PMID- 2667306 TI - Nephrotoxicity of a nonionic (iopamidol) versus an ionic (diatrizoate) contrast agent in the patient after cardiac transplant with moderate cyclosporine-induced renal insufficiency. PMID- 2667307 TI - George Burch and the scientist's passion. PMID- 2667308 TI - A symposium: The George E. Burch Festschrift. PMID- 2667309 TI - Urapidil-induced hemodynamic changes in humans. AB - In hypertensive patients as well as in normal subjects urapidil has a hypotensive action. This is mainly mediated by a peripheral alpha 1-adrenoceptor blockade with a decrease in systemic vascular resistance; in addition, during acute animal experiments a centrally mediated hypotensive action was demonstrated, possibly by 5-hydroxytryptamine1A (5-HT1A)-receptor stimulation. Studies in humans showed an increase in cardiac output, which was not always significant; it did result either from an increased heart rate or an increased stroke volume. Acute changes in pulmonary hemodynamics after administration of urapidil were most pronounced in patients with pulmonary hypertension: pulmonary artery pressure and pulmonary vascular resistance decreased significantly and pulmonary capillary wedge pressure decreased nonsignificantly. A small reduction in pulmonary artery pressure and capillary wedge pressure were seen in patients with congestive heart failure and in patients in whom acute blood pressure elevation developed after coronary bypass surgery. In patients with essential hypertension forearm, renal and splanchnic flow were shown to increase and vascular resistance to decrease significantly after acute intravenous doses of urapidil. The hemodynamic changes during chronic therapy are largely unknown, except for systemic vascular resistance which remains decreased. PMID- 2667310 TI - Acute responses to urapidil in hypertensive persons. AB - Urapidil is a new antihypertensive agent involving both a peripheral and a central mode of action. To evaluate the acute effects of this drug on renal vascular tone and on pressor systems a randomized placebo-controlled crossover study was conducted in 10 patients with uncomplicated essential hypertension. Each subject received, on 2 separate days 1 week apart, an intravenous injection of either placebo or urapidil (25 or, if necessary, 50 mg). Before and after this injection blood pressure and heart rate (Dinamap), renal plasma flow (125I hippuran), active plasma renin concentration, angiotensin II, aldosterone and catecholamines in plasma were measured. The results show that urapidil, when compared with placebo, greatly reduced blood pressure, while increasing heart rate, renal blood flow, and noradrenaline and adrenaline levels. However, dopamine levels were suppressed. Whereas renin and angiotensin II were only mildly stimulated, aldosterone levels increased significantly. It is concluded that urapidil, given intravenously, has an immediate blood pressure-lowering effect associated with a decrease in renal vascular tone and an increase in renal perfusion. Consequently, both the sympathetic and renin-angiotensin systems are stimulated, although the latter only to a mild degree. The increase in aldosterone may be partially related to the decrease in dopamine levels. PMID- 2667311 TI - Therapeutic assessment of urapidil or angiotensin-converting enzyme inhibition in systemic hypertension. AB - The antihypertensive efficacy of urapidil, a postsynaptic alpha blocker with an additional central action, was compared with that of the angiotensin I converting enzyme inhibitor captopril under conditions of general practice (multicenter study). The study was performed in a double-blind, randomized, parallel-group fashion. After a 2-week washout and placebo phase, 295 essential hypertensive patients (World Health Organization grades I and II) were treated for 12 weeks with either urapidil or captopril, initially with urapidil, 60 mg twice daily or captopril, 25 mg twice daily, with the possibility of adjusting the dose according to blood pressure response after 2 weeks of treatment. Blood pressure values at the end of the 12-week treatment decreased significantly in the group receiving urapidil (n = 142, all dosages), from 175/103 to 154/89 mm Hg (p less than 0.001), and in the group receiving captopril (n = 153, all dosages) from 175/103 to 154/90 mm Hg (p less than 0.001); these values corresponded to 62% urapidil and 58% captopril responder rates (diastolic blood pressure less than or equal to 90 mm Hg), respectively. The computer-assisted frequency distribution of the patients with controlled diastolic blood pressure (less than or equal to 90 mm Hg) over the duration of the study demonstrated comparable efficacy for both drugs. Adverse effects were observed in 45 patients in the urapidil group and in 18 patients in the captopril group (vertigo, nausea, headache). The results revealed that the 2 antihypertensive agents with different modes of action controlled blood pressure with equal efficacy.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 2667312 TI - Overview of clinical trials with urapidil. AB - Urapidil has been approved as sustained-release capsules containing 30, 60 and 90 mg, respectively, and as ampules containing 25 and 50 mg for treatment of all grades of hypertension, in several countries in Europe, South America, as well as in Japan and other Asian regions. In general, the treatment should start with 60 mg twice daily, 1 capsule in the morning and 1 in the evening. This schedule may be adapted according to the therapeutic needs. During the last few years, urapidil has been investigated extensively in comparison with several types of established antihypertensive drugs. Urapidil given orally has been tested in comparative trials against placebo, acebutolol, metoprolol, captopril, nifedipine and nitrendipine with responder rates of 40 to 70%. These responder rates are to be expected for a variety of antihypertensive drugs in monotherapy. Further studies with clonidine, prazosin and alpha-methyldopa showed similar responder rates as established for the other antihypertensive drugs studied. Adverse reactions include dizziness, headache and nausea and occasionally tiredness, orthostatic dysregulation and gastric disorders. These symptoms were transient, mostly occurring during the early phases of therapy and disappearing as treatment continued. Adverse effects are considered to be mainly due to blood pressure reduction. Intravenous comparative trials have been performed with urapidil against placebo, diazoxide and sodium nitroprusside. Adverse effects of parenterally applied urapidil are similar to those observed during oral treatment. Specific contraindications for urapidil are unknown. However, as for other vasodilating drugs, intravenous urapidil should not be administered to patients with stenosis of the aortic isthmus or with aortic valve insufficiency. PMID- 2667313 TI - Evaluation of an alternating-calorie diet with and without exercise in the treatment of obesity. AB - This study examined the effects of calorie alternation and exercise on weight loss. Moderately obese women (130-160% of ideal body weight) were randomly assigned to an alternating- or constant-calorie diet with or without aerobic exercise. Both diets provided an average of 1200 kcal/d over a 12-wk period; daily intake of subjects in the alternating-diet condition varied in a prescribed pattern from 600 to 1800 kcal/d. Exercising subjects walked 5 d/wk. All subjects participated in an intensive outpatient behavior-modification program. At the end of the study, exercised subjects had greater reductions in body weight and body fat percentage than did nonexercised subjects. The type of caloric restriction did not affect weight or fat loss. Changes in resting metabolic rate did not differ among groups. Alternating calories was neither beneficial nor detrimental as a weight-loss strategy whereas exercise was clearly beneficial in weight-loss therapy. PMID- 2667314 TI - Fat distribution, androgens, and metabolism in nonobese women. AB - Eighty-five randomly selected women, all born in 1948, were studied. All were nonobese (body mass index [BMI], 23.3 +/- 0.3 (means +/- SD]). The relationships between three indicators of fat distribution (waist-hip, waist-thigh, and subscapular-triceps ratios) and hormonal and metabolic variables were studied. Increased androgenic activity (ratio of free testosterone [T] to total testosterone [free-total T ratio]) and degree of obesity (BMI) were independently related to increased waist-hip ratio. Waist-hip and waist-thigh ratios showed higher correlations with all metabolic variables than did the triceps-subscapular skinfold thickness ratio except for diastolic blood pressure. After adjustment for BMI and free-total T ratio, the waist-hip ratio was still significantly positively related to total cholesterol and C peptide and negatively to the HDL total cholesterol ratio. In such multiple regression, BMI was independently related to insulin, C peptide, and diastolic blood pressure. The free-total T ratio was independently related to triglycerides. BMI and waist-hip ratio gave important complementary information about risk factors for diseases such as cardiovascular disease and diabetes mellitus. PMID- 2667315 TI - Insulin and glycemic responses in healthy humans to native starches processed in different ways: correlation with in vitro alpha-amylase hydrolysis. AB - The aim of the study was to elucidate how extracted starches submitted to food processing (or not) can influence plasma insulin and glucose responses in healthy subjects. Native starches from wheat, manihot, smooth peas, or mung beans were tested either raw, as starch gels (boiled and cooled), or cooked and cooled after a preliminary industrial processing: extrusion cooking for wheat, tapioca for manihot, and noodles for mung beans. Eighteen healthy subjects randomly assigned received three different starches under one form of conditioning. All products were submitted to in vitro alpha-amylolysis. Raw manihot starch produced the lowest (p less than 0.05) metabolic responses. Cooking significantly (p less than 0.01) increased plasma responses. However, cooked mung bean noodles gave metabolic responses similar to those of raw products. Close correlations were found between percentages of in vitro starch hydrolysis at 30 min and mean areas under the glycemic curves and the insulinemic curves (r = 0.95, p less than 0.001). PMID- 2667316 TI - Folic acid safety and toxicity: a brief review. AB - Oral folic acid (pteroylglutamic acid) is generally regarded as not toxic for normal humans but it may cause neurological injury when given to patients with undiagnosed pernicious anemia. The vitamin should be given with caution to drug treated epileptic patients because seizure control may be affected. Some studies suggest that folic acid supplements interfere with intestinal zinc absorption in humans and animals but others do not confirm such an effect. The weight of current evidence favors the view that daily supplements of 5-15 mg folic acid do not have significant adverse effects on Zn nutriture in healthy nonpregnant subjects. Because antifolate medications are now being used to treat a wide range of malignant and nonmalignant disorders, further investigation is needed concerning folate metabolism and the safety of supplements in patients with these disorders. PMID- 2667317 TI - Fast neutron therapy clinical trials in the United States. AB - The National Cancer Institute (NCI) began supporting clinical fast neutron clinical studies in the United States beginning in the early 1970s using physics based cyclotrons and linear accelerators at a number of locations and facilities. The early work pointed out the handicaps imposed by the limitations of horizontal beams and low energy neutrons. This, combined with some encouraging, clinical results using neutrons and photons in a mixed mode of therapy, prompted the NCI in 1979 to initiate a 10-year contract program to design, develop, and build hospital-based neutron therapy machines and to conduct phase III clinical trials. As we approach the end of the 10-year effort, three hospital-based neutron facilities are currently operational-at the University of Washington, Seattle; University of California at Los Angeles: and M. D. Anderson Hospital at University of Texas System Cancer Center, Houston. Phase III trials are in progress in four sites: head and neck, prostate, and lung tumors, and cancers of radioresistant histologies, such as melanoma, renal cell carcinoma, and sarcomas of the soft tissue and bone. The contractors will continue to receive limited NCI support to complete the clinical studies. PMID- 2667318 TI - Evaluation of neutron irradiation of pancreatic cancer. Results of a randomized Radiation Therapy Oncology Group clinical trial. AB - Between 1980-84, the Radiation Therapy Oncology Group conducted a trial in patients with untreated, unresectable localized carcinomas of the pancreas. Patients were randomly chosen to receive either 6,400 cGy with photons, the equivalent dose with a combination of photons and neutrons (mixed-beam irradiation), or neutrons alone. A total of 49 cases were evaluable, of which 23 were treated with photons, 11 with mixed-beam therapy, and 15 with neutrons alone. The median survival time was 5.6 months with neutrons, 7.8 months with mixed-beam radiation, and 8.3 months with photons. The median local control time was 6.7 months with neutrons, 6.5 months with mixed-beam radiation, and 2.6 months with photons. These differences are not statistically significant. Evidence of moderate-to-life-threatening gastrointestinal or hepatic injury was present in three patients treated with neutrons and one patient treated with photons. The causes of this apparent difference are discussed. This study demonstrates there is no evidence to suggest that neutron irradiation, either alone or in combination with photon irradiation, produces better local control or survival rates than photon irradiation. PMID- 2667319 TI - Fast neutron teletherapy in advanced epidermoid head and neck cancer. A review. AB - An extensive review of clinical studies employing fast neutron teletherapy for advanced epidermoid carcinomas of the head and neck is presented. Head and neck tumors have represented an excellent study site because of their accessibility to physical examination for measurement of tumor response, and because early neutron beams have had poor depth dose characteristics, making the treatment of more deeply seated tumors technically difficult. A summary of the major trials comparing neutron and mixed-beam (combination neutron and photon) therapy with conventional therapy indicates no conclusive evidence of improvement in local control or survival rates for the experimental arms. Exceptions to this are the Hammersmith experience and the slightly higher lymph node control rates seen in two studies. An evaluation of toxicity indicates that with the new generation of cyclotrons, complication rates may approach parity with those of photon linear accelerators. PMID- 2667320 TI - Fast neutron radiotherapy for the treatment of carcinoma of the urinary bladder. A review of clinical trials. AB - The major clinical investigation employing fast neutrons in the treatment of invasive bladder cancer are reviewed. Although data suggest that preoperative radiation schedules employing neutrons may result in a greater degree of pathologic downstaging than conventional precystectomy photon regimens, this has not led to an improved survival rate for neutron-treated patients over photon treated patients. Randomized clinical trials comparing primary neutron irradiation and primary photon irradiation do not disclose an advantage for neutrons over photons as measured by survival rate or freedom from local tumor recurrence. The late complications in normal pelvic tissues following neutron irradiation with low-energy beams exceed those experienced after photon irradiation and have led to an unexpectedly high rate of treatment-related morbidity and mortality. A partial explanation for the toxicity may be attributed to the use of neutron beams with poor depth dose characteristics for the treatment of what is a deep-seated malignancy. An additional explanation is the documented lack of a differential in radioresponsiveness to neutrons between the bladder primary tumor and adjacent normal pelvic tissues. PMID- 2667321 TI - Fast neutron radiation for inoperable and recurrent salivary gland cancers. AB - The current standard treatment of salivary gland cancers consists of surgical resection, with or without postoperative low linear energy transfer (LET) radiation, resulting in high locoregional control rates. However, tumor control prognosis is poor when conventional radiation is used alone for advanced, inoperable cases. An extensive review of the world's literature on fast neutron irradiation for inoperable, unresectable, or recurrent malignant salivary gland neoplasms is presented and compared with the experience using conventional low LET radiotherapy. The pooled data indicate a locoregional control rate of 67% for fast neutrons versus 25% for photons and/or electrons in the treatment of such advanced disease. The radiobiological rationale supporting this observed increase in tumor control is discussed. The overall significant late complication rate is 19%, but several suboptimal treatment factors were present that contributed substantially to the reported toxicity. With the modern machines and treatment techniques now available, the evidence overwhelmingly supports the role of fast neutron radiation as the treatment of choice for inoperable and recurrent salivary gland cancers. PMID- 2667322 TI - Fast neutron radiotherapy for sarcomas of soft tissue, bone, and cartilage. AB - The basic radiobiological rationale for the use of fast neutron radiotherapy in the treatment of classically radioresistant tumors such as soft tissue sarcomas, osteogenic sarcomas, and chondrosarcomas is reviewed. There are no definitive randomized studies comparing high and low linear energy transfer radiotherapy for these tumor systems, but a review of published series is highly suggestive of a therapeutic advantage for fast neutrons. For soft tissue sarcomas, the local control rate is 53% (158 of 297) with fast neutrons, compared with 38% (49 of 128) with photons/electrons; for osteogenic sarcomas, the local control rate is 55% (40 of 73) with fast neutrons, compared with 21% (15 of 73) with photons/electrons; and for chondrosarcomas, the local control rate is 49% (25 of 51) with fast neutrons, compared with 33% (10 of 30) with photons/electrons. An ongoing clinical trial for these tumors is also described. PMID- 2667323 TI - Mitoxantrone, vincristine, and dexamethasone in patients with refractory lymphoma. AB - Twenty-seven patients with failed malignant lymphomas (19 with intermediate grade, 4 with low-grade, 3 with high-grade lymphomas, and 1 with Hodgkin's disease) who had failed a median of 3 prior multidrug regimens, all previously exposed to anthracyclines (median prior doxorubicin 360 mg/m2), were treated with a combination of mitoxantrone (M), vincristine (V), and dexamethasone (D) every 4 weeks. Mitoxantrone was given in a 3 times daily schedule (days 1-3), at doses between 5 and 10 mg/m2/day; vincristine, 2-mg total dose, was given on day 1 and day 8; dexamethasone, 20 mg/m2, was given on days 1-5. A total of 71 courses was administered; there were 4 complete responses (CR) and 14 partial responses (PR) (response rate 66%). At the highest doses, hematological toxicity was severe (5 patients died while pancytopenic); the nadir for WBC and platelets was on day 13, with a median hematological recovery on day 23. There were transient hepatic, renal, and oral toxicities; vincristine-related neuropathy was seen in 8 patients. All patients had normal prestudy cardiac function, as assessed by gated pool scans; follow-up scans showed a greater than 15% decrease of the left ventricular ejection fraction (LVEF) in 2 patients, without evidence of cardiac dysfunction. Although responses lasted a median of 10 weeks (range 4-37), our data indicate that mitoxantrone, at the doses and schedules used, is an effective drug in malignant, doxorubicin-resistant lymphomas. This observation warrants the use of mitoxantrone in the upfront treatment of malignant lymphoma. PMID- 2667324 TI - A phase III randomized trial of epirubicin versus 5-fluorouracil in metastatic rectal/sigmoid adenocarcinoma. AB - Seventy-seven patients with previously untreated, measurable, histologically confirmed, metastatic adenocarcinoma of the rectum or sigmoid were randomized to receive either epirubicin 90 mg/m2 (75 mg/m2 if prior radiotherapy) i.v. once every 3 weeks or 5-fluorouracil 500 mg/m2 (450 mg/m2 if prior radiotherapy) i.v. once daily for 5 consecutive days every 4 weeks. None of 38 (0%) evaluable patients who received epirubicin demonstrated a response, whereas seven of 39 (18%) patients who received 5-fluorouracil had an objective response. Epirubicin is ineffective against metastatic rectal cancer at the dose and schedule used. PMID- 2667325 TI - High-dose methotrexate and 5-fluorouracil in patients with advanced colorectal carcinoma. A randomized study of two pretreatment intervals. AB - Thirty-two patients with untreated advanced colorectal carcinoma received high dose methotrexate pretreatment followed sequentially by 5-fluorouracil (5-FU). Patients were randomized to receive high-dose methotrexate pretreatment at one of two intervals (0 h or 3 h before 5-FU). There were 16 patients in each study arm. The median methotrexate dose was 1,000 mg/m2 (range, 600-1,200 mg/m2) and that of 5-FU was 1,000 mg/m2 (range, 800-1,200 mg/m2). Treatments were repeated every 21 days. Three patients achieved partial remission (1 in the 3-h interval arm and 2 in the 0-h interval arm). As the response rate using this regimen was noted to be 9% with a less than 5% chance of achieving a response rate higher than 20%, we terminated this study although the therapy resulted in mild-to-moderate but infrequent toxicity. We thus conclude that pretreatment with high-dose methotrexate given at short intervals followed by 5-FU has no significant activity against colorectal carcinoma. PMID- 2667326 TI - Interferon alternating with chemotherapy for patients with metastatic renal cell carcinoma. AB - A prospective randomized trial tested the hypothesis that interferon and cytotoxic chemotherapy delivered sequentially would be synergistic and would increase the response rate in metastatic renal cell carcinoma. Thirty-six patients were entered and randomized to chemotherapy only (5-fluorouracil, doxorubicin, mitomycin, and cis-platin) vs. interferon alternating with the same chemotherapy. Only 4 of 32 evaluable patients (13%), 2 in each arm, had a major response. Three patients in the alternating arm had minor responses. Complete, partial, and minor responses totaled 7 (22%). All four patients whose only disease was lung metastasis had some evidence of response (p = 0.001). Interferon alternating with chemotherapy did not appear to improve the major response rate over chemotherapy alone. Responses in metastatic renal cell carcinoma appear confined to a favorable subset of patients. PMID- 2667327 TI - Trial of fractionated total-body irradiation in the treatment of patients with acquired immunodeficiency syndrome: a preliminary report. PMID- 2667328 TI - Increased levels of soluble interleukin-2 receptor in non-Hodgkin's lymphomas. Relationship with clinical, histologic, and phenotypic features. AB - In this study the authors investigated the serum levels of the released soluble form of interleukin-2 receptor (sIL-2R) in patients with non-Hodgkin's lymphomas (NHLs). Data were evaluated in relationship to the morphologic and immunophenotypic heterogeneity of NHL at diagnosis and in progressive advanced diseases. Increased sIL-2R levels were found in most cases, when compared with levels observed in healthy controls. No obvious statistical correlation has been observed between sIL-2R values in different NHL subtypes as defined by current classifications. On the other hand, major significance was related to the extent of the disease. Very high values, comparable to those observed in hairy cell leukemia, were observed in a number of large cell NHLs complicating low-grade B cell lymphoproliferations and in a single case of T-cell Kil+ NHL. The authors' findings suggest that the detection of sIL-2R in NHL may represent a good marker in improving risk assignment of single cases and/or for monitoring remissions and exacerbations during the treatment of cases with very high levels at diagnosis. Nevertheless, the observed overlap between groups on an individual case basis can render the clinical application of this marker problematic. PMID- 2667329 TI - The complexity of endothelial cells. A review. AB - This review of the biology peculiar to endothelial cells (ECs) is based mainly on data available within the last decade. The functions described refer to angiogenesis, coagulation, and EC-platelet interaction, inflammation and immune response, synthesis of stromal components, vascular tone regulation, and miscellaneous metabolic activities. Emphasis is placed on the marked variability of ECs from tissue to tissue and from one species to another. This heterogeneity is evident morphologically, functionally, and in the response of ECs to injury. PMID- 2667330 TI - Mechanical properties and clinical applications of orthodontic wires. AB - This review article describes the mechanical properties and clinical applications of stainless steel, cobalt-chromium, nickel-titanium, beta-titanium, and multistranded wires. The consolidation of this literature will provide the clinician with the basic working knowledge on orthodontic wire characteristics and usage. Mechanical properties of these wires are generally assessed by tensile, bending, and torsional tests. Although wire characteristics determined by these tests do not necessarily reflect the behavior of the wires under clinical conditions, they provide a basis for comparison of these wires. The characteristics desirable in an orthodontic wire are a large springback, low stiffness, good formability, high stored energy, biocompatibility and environmental stability, low surface friction, and the capability to be welded or soldered to auxiliaries. Stainless steel wires have remained popular since their introduction to orthodontics because of their formability, biocompatibility and environmental stability, stiffness, resilience, and low cost. Cobalt-chromium (Co Cr) wires can be manipulated in a softened state and then subjected to heat treatment. Heat treatment of Co-Cr wires results in a wire with properties similar to those of stainless steel. Nitinol wires have a good springback and low stiffness. This alloy, however, has poor formability and joinability. Beta titanium wires provide a combination of adequate springback, average stiffness, good formability, and can be welded to auxiliaries. Multistranded wires have a high springback and low stiffness when compared with solid stainless steel wires. Optimal use of these orthodontic wires can be made by carefully selecting the appropriate wire type and size to meet the demands of a particular clinical situation. PMID- 2667331 TI - Chronic sinusitis. The disease of all ages. PMID- 2667332 TI - Informed consent for lumbar puncture. AB - Informed consent procedures are commonly employed prior to lumbar puncture. An understanding of the legal and ethical basis of informed consent is important in developing an acceptable approach to consent and in dealing with problems confronted when consent cannot be obtained. I review the current legal concepts in informed consent and their ethical foundation, and make recommendations to clinicians for obtaining consent for this common procedure in the ambulatory pediatric population. PMID- 2667333 TI - Comparison of amoxicillin and clavulanic acid (augmentin) for the treatment of nonbullous impetigo. AB - We undertook a prospective double-blind controlled study to compare the efficacy of a drug that usually has no antistaphylococcal activity (amoxicillin trihydrate) with the efficacy of the same drug with an addition of a beta lactamase inhibitor (amoxicillin plus clavulanic acid [Augmentin]) in the treatment of nonbullous impetigo. Fifty-one culture-positive patients, aged 6 months to 9 years, were included, 26 in the amoxicillin group and 25 in the Augmentin group. The study groups were clinically and bacteriologically comparable at the start of the study. Staphylococcus aureus was isolated from all patients and beta-hemolytic streptococcus from 14 (29%). All staphylococci were sensitive to Augmentin but resistant to amoxicillin. Forty-nine patients completed the study. The clinical response was significantly better among the Augmentin recipients (marked improvement in 71% and 95% of patients after 2 and 5 days, respectively; no new lesions during the treatment course) than among the amoxicillin recipients (marked improvement in 44% and 68% of patients after 2 and 5 days, respectively; new lesions appeared in 20% of patients). Recurrence within 3 weeks occurred in 12 (26%) of 49 patients, and no difference was observed between the two groups. We conclude that S aureus is common in nonbullous impetigo, and that at least in some cases it plays an important role in the course of the disease that can be altered by specific therapy. PMID- 2667334 TI - Hereditary hemochromatosis: pathogenesis and clinical features of a common disease. AB - Hereditary hemochromatosis (HHC) is a common inherited disorder of iron metabolism characterized by excessive iron absorption and the toxic accumulation of iron in parenchymal cells. Homozygous inheritance of an abnormality on chromosome 6 causes this disorder by increasing the intestinal absorption of iron, which is slowly deposited in parenchymal cells of the liver, heart, pancreas, and other endocrine organs. Symptoms develop only after the marked accumulation of iron stores develop, which causes functional insufficiency of these organs. The symptoms are often variable, nonspecific, and attributed to other diseases. Early diagnosis requires a high index of suspicion and an awareness of the clinical features of HHC. Serum iron, total iron-binding capacity (TIBC), and ferritin levels are useful screening studies, but liver biopsy with quantitative chemical determination of iron concentration is essential to evaluate histopathological changes and to help distinguish hereditary hemochromatosis from secondary iron overload. Treatment with weekly phlebotomy frequently results in some clinical improvement in patients with established disease, and if initiated early, organ damage can be prevented and a normal life-span can be expected. The hereditary nature of the disease mandates familial screening of index cases. PMID- 2667335 TI - The diagnostic yield of superior mesenteric angiography: correlation with the pattern of gastrointestinal bleeding. AB - In an attempt to evaluate the usefulness of mesenteric angiography in relation to the nature and rate of gastrointestinal bleeding, we reviewed the records of all patients hospitalized at Montefiore Medical Center between 1983 and 1986 who had mesenteric angiography as part of their diagnostic evaluation for gastrointestinal bleeding. Fifty-eight patients were classified according to the pattern of blood loss: 14 patients with chronic occult, 28 patients with recurrent acute, and 16 patients with acute bleeding. The sensitivity and specificity of mesenteric angiography for each group was: chronic occult, 40% sensitivity and 100% specificity; recurrent acute, 30% sensitivity and 100% specificity; acute, 47% sensitivity and 100% specificity. Vascular lesions accounted for most of the diagnosed abnormalities, including four of five lesions in patients with chronic blood loss and four of six lesions in each of the groups with recurrent acute and acute bleeding. A positive angiogram was correlated with a high likelihood of surgery in patients with recurrent acute as well as acute hemorrhage. Five of six in the former group and six of seven in the latter group required an operative procedure. Mesenteric angiography is an integral part of the diagnostic evaluation of patients with gastrointestinal bleeding, although the frequency of positivity varies with the pattern of bleeding. PMID- 2667337 TI - Intraoperative ultrasonography and ultrasonic dissection in liver surgery. AB - The results of 79 liver resections performed in the period January 1972 to May 1987 are described with emphasis on the role of intraoperative ultrasonography and ultrasonic liver parenchyma dissection. The aim of this study is to see whether these adjunctive techniques are able to lower mortality and morbidity. Resections were done for benign disease (44 patients) or malignancy (35 patients). In these patients, 24 major and 55 minor liver resections were performed. Six of these patients (7.6%) died within 30 days after the operation. In one-third of the patients, complications occurred. In 25 of the 79 resections, intraoperative ultrasonography and ultrasonic liver dissection were used. Intraoperative ultrasonography changed the planned resection in eight patients. No statistically significant difference in morbidity and mortality could be found in patients operated with ultrasonic dissection, compared to patients with conventional dissection techniques. From this study, we conclude that intraoperative ultrasonography is a useful adjunct in liver surgery. PMID- 2667336 TI - Cisapride accelerates colonic transit in constipated patients with colonic inertia. AB - A double-blind cross-over trial of oral cisapride 10 mg before meals and placebo was performed to determine its effects on colonic transit in patients with severe idiopathic constipation. Nine patients with less than 3 spontaneous bowel movements/wk were studied. After passing a tube to the cecum, 50 muCi of 111In DTPA were instilled into the cecum and followed for 48 h using colonic transit scintigraphy. In the group as a whole, cisapride had little effect on transit. The patients were then divided into two groups based on transit: functional rectosigmoid obstruction (FRSO) and colonic inertia (CI). In the CI group, cisapride accelerated the half emptying time of the cecum and ascending colon from 2.50 to 1.21 h (p less than 0.05). The progression of the geometric center was also faster after cisapride in CI. In FRSO, the geometric center was unchanged by cisapride except at 48 h. Cisapride thus has a prokinetic effect on colonic transit in patients with severe idiopathic constipation, colonic inertia subtype. It may be a useful agent in the treatment of this group of patients. PMID- 2667338 TI - Analysis of hepatofugal flow in portal venous system using ultrasonic Doppler duplex system. AB - Blood flow directions of the portal trunk, splenic vein, and superior mesenteric vein were studied using an ultrasonic Doppler duplex system in 146 healthy adults, 132 patients with liver cirrhosis, 76 with hepatocellular carcinoma, 32 with idiopathic portal hypertension, 134 with chronic hepatitis, 18 with acute hepatitis, and 142 with other diseases. Spontaneous hepatofugal flow in one or more of the three vessels examined was detected in 14 patients. Spontaneous hepatofugal flow in the portal trunk was detected in three patients with liver cirrhosis. In two of these three patients, the hepatofugal flow in the portal trunk disappeared after medication. This is interesting, since hepatofugal flow may, in fact, be more common than we suspected in patients who, because of the severity of their disease, are not able to undergo invasive examination. Postoperative hepatofugal flow in the portal system was detected in 20 of 71 cases: 15/17 patients after interposition mesocaval shunting, 2/17 after distal splenorenal shunting, 2/31 after splenectomy, and 1/6 after splenic artery occlusion with steel coils. In more than half the cases of interposition mesocaval shunting (9/17 patients), blood flow in the portal trunk was hepatofugal. However, hepatopetal blood flow in the portal trunk was maintained in most cases of distal splenorenal shunting (13/17), showing the merits of this technique as a selective portosystemic shunt operation. PMID- 2667339 TI - The Kasabach-Merritt syndrome: severe bleeding disorder caused by celiac arteriography--reversal by heparin treatment. AB - Studies are presented on a 62-yr-old woman with extreme hepatomegaly due to a giant hemangioma with alterations in the clotting system indicating a consumption coagulopathy. There was a fall of hemoglobin, fibrinogen, antithrombin III, and platelet number after arteriography of the truncus celiacus. Furthermore, there was sustained bleeding in the patient's right thigh caused by puncture of the arteria femoralis. Continuous administration of iv heparin corrected the clotting disorder including a rise in platelets from 95,000/microliters to 148,000/microliters, permitting surgical removement of the hematoma. Celiacography is a useful tool for the diagnosis of hepatic hemangiomata, as well as ultrasound, computed tomography, and magnetic resonance imaging. Being an invasive technique, it requires testing for possible consumption coagulopathy if used in patients with hemangiomatosis. Its application should be restricted to cases in which exact diagnosis cannot be established by other means. PMID- 2667340 TI - Tubercular abscess of the pancreas. PMID- 2667341 TI - Severe hemolysis and red cell fragmentation caused by the combination of a spectrin mutation with a thrombotic microangiopathy. AB - Two patients are described who presented with severe hemolysis and erythrocyte fragmentation. One patient had renal allograft rejection and disseminated intravascular coagulation, and the other had thrombotic thrombocytopenia purpura. The severity of hemolysis and the red cell abnormalities were considerably more profound than usually seen in patients with thrombotic microangiopathies. After evaluation of blood smears prepared before the onset of the disease and biochemical characterization of proteins of the red blood cell skeleton, a mutation of the skeletal protein spectrin, designated Sp alpha l/65, was identified. In the heterozygous form, this mutation manifests as mild, often asymptomatic, hereditary elliptocytosis. We conclude that in these two patients with thrombotic microangiopathy, the intrinsic red cell membrane instability resulting from the underlying skeletal defect aggravated the mechanical red cell fragmentation, producing morphological features similar to the severe hemolytic form of hereditary elliptocytosis or hereditary pyropoikilocytosis. PMID- 2667342 TI - Splenic cyst carcinoma presenting in pregnancy. AB - A case report of squamous cell carcinoma in an epidermoid cyst of the spleen is diagnosed in a pregnant female. Elaboration on the clinical, radiological, and pathological findings is presented to emphasize the distinguishing features of benign and malignant cysts. PMID- 2667343 TI - Current approaches to the chemotherapy of B-cell chronic lymphocytic leukemia: a review. AB - Standard therapy has not substantially improved the outcome of patients with chronic lymphocytic leukemia (CLL). However, an increased understanding of the biology and immunology of CLL, and the availability of several new and active chemotherapy agents (eg, fludarabine, 2'-deoxycoformycin [DCF], 2 chlorodeoxyadenosine [CDA]) has stimulated enthusiasm for clinical trials. DCF induces CRs or PRs in 25% of heavily treated patients. Fludarabine has been associated with a response rate of greater than 50% in previously treated patients, and greater than 70% in untreated patients, with almost a third of these achieving a CR. Currently, phase I and II clinical trials are evaluating combinations of these drugs with each other or with conventional agents (eg, fludarabine/chlorambucil [CLB]/prednisone [P]; DCF/CLB/P; fludarabine/DCF; fludarabine/P) in previously treated patients. To facilitate comparison of these regimens, each study is adhering to the NCl-Working Group guidelines for eligibility and response criteria, and toxicity assessment. A collaborative phase III trial will then compare the most promising of these regimens with "standard" chemotherapy in previously untreated patients. The widespread availability of these clinical trials will allow clinicians ready access to the new treatments. PMID- 2667344 TI - Chronic myelogenous leukemia and Sweet syndrome. AB - We report a 64-year-old woman with chronic myelogenous leukemia of 3 years duration who developed Sweet syndrome. Improvement in her blood counts after hydroxyurea was not associated with a decrease in size of the skin lesions. However, the cutaneous lesions of Sweet syndrome quickly resolved with systemic prednisone. Sweet syndrome has only been documented in the literature for five other chronic myelogenous leukemia patients. The characteristics, treatment, and differential diagnosis of this disorder in chronic myelogenous leukemia patients are reviewed. PMID- 2667345 TI - Use of digital subtraction fluorography in screening for coronary artery disease in patients with chronic renal failure. AB - The diagnosis of coronary artery disease remains a major problem in patients with end-stage renal disease. Screening with conventional noninvasive techniques is limited by the poor exercise capacity of these patients. This study evaluated the accuracy of digital subtraction fluorography in detecting coronary calcification as a noninvasive, nonexercise screening test for coronary artery disease. Eighty six patients under evaluation for renal transplantation and considered at increased risk of coronary artery disease were studied by coronary arteriography and digital subtraction fluorography for coronary calcification. Significant coronary disease (greater than or equal to 50% obstruction in at least one vessel) was present in 36 (42%) patients. The detection of coronary calcification by digital subtraction fluorography had a sensitivity of 78% and a specificity of 66%. The probability of disease being present in the absence of coronary calcification in this group was 18%. The detection of coronary calcification by digital subtraction fluorography appears to be a satisfactory and inexpensive screening test in this setting. PMID- 2667346 TI - De novo membranous glomerulonephropathy in renal allografts: a report of ten cases and review of the literature. AB - De novo posttransplantation membranous glomerulonephropathy (MGN) is the most common form of de novo glomerulopathy in renal allografts. The clinical and pathological features of ten patients with de novo MGN were studied and the related literature was reviewed to assess the clinical features, morphologic characteristics, and natural course of this disease. De novo MGN may occur in both living related and cadaveric allografts at any time after transplantation. It presents clinically either as asymptomatic proteinuria or the nephrotic syndrome, a feature of poor prognostic implication. Morphologically, de novo MGN in most instances has distinct differences from idiopathic MGN in native kidneys and is accompanied by varying features of rejection. About 50% of grafts which develop de novo MGN eventually fail. This rather poor outcome may not represent the natural history of de novo MGN per se but rather the consequences of associated chronic rejection. Evidence is presented that many of the cases of so called de novo MGN may be a complication of transplant glomerulopathy rather than being caused by mechanisms totally independent from rejection. PMID- 2667347 TI - Reprocessing of hemodialyzers: a critical appraisal. AB - The reprocessing of hemodialysis equipment was originally developed to conserve scarce resources and to reduce the time necessary to construct early dialyzers. Although most dialyzers in current use are marketed as disposable items, the majority of dialysis facilities in the United States reprocess these devices and use them multiple times on the same patient. Recent studies have shown that certain reprocessing techniques confer improved biological properties on dialyzers compared with new membranes as prepared by manufacturers. Several studies have suggested that these biological properties may lead to improved clinical outcomes. However, critics of dialyzer reprocessing argue that it may expose patients to risks that produce increased morbidity and mortality. This article critically reviews the available scientific information regarding reprocessing hemodialyzers. PMID- 2667348 TI - Practical considerations of recombinant human erythropoietin therapy. AB - The effect of long-term hemodialysis in 58 nonanemic end-stage renal disease patients treated with recombinant human erythropoietin (r-HuEPO; EPOGEN [epoetin alfa], AMGEN Inc, Thousand Oaks, CA) has been examined in detail. Increased dialyzer prescription (Kt/V) was correlated with the need for a lower maintenance dose of r-HuEPO. After 1 year of therapy, stable increases in hemoglobin, hematocrit, and reticulocyte levels were obtained without other clinically significant hematologic changes. In a randomly selected subgroup of 14 patients, 5 developed predialysis increased diastolic pressures. In this group, an early increase in cardiac output and ejection fraction was accompanied by a decrease in total peripheral resistance index (TPRI). Later changes showed a steady increase in TPRI with an associated mild increase in mean arterial pressure. A slight increase in cardiac responsiveness to fistula occlusive maneuvers was also found. Hospital admissions and mortality rates were not significantly different from those of a cohort control population. At a fixed Kt/V there were slight decreases in solute clearances with correction of anemia, with phosphate, urate, and creatinine changing significantly. Corrective measures required simple compensatory adjustments in dialysis blood-flow rates. Intradialytic complications were noticeably improved. Patients receiving long-term r-HuEPO replacement therapy do remarkably well without major complications. PMID- 2667349 TI - Guidelines for recombinant human erythropoietin therapy. AB - Extensive testing has proven that recombinant human erythropoietin (r-HuEPO; EPOGEN [epoetin alfa], AMGEN Inc, Thousand Oaks, CA) corrects the anemia of end stage renal disease and eliminates the need for transfusions in virtually all patients. Patients whose hematocrit levels are less than 0.30 or who are transfusion dependent are candidates for therapy. A dosage of 50 to 150 U/kg body weight intravenously three times a week produces an increase in hematocrit by approximately 0.01 to 0.02 per week. Once the hematocrit reaches 0.30 the dose is adjusted so that a target hematocrit of 0.32 to 0.38 is maintained. Eighty percent of patients need maintenance doses of r-HuEPO of less than or equal to 150 U/kg; the other 20% of patients require larger doses. Reasons for poor responses include iron deficiency, inflammation due to surgery or infection, and osteitis fibrosa. Most patients require iron supplementation to prevent functional iron deficiency. BP increased in one third of patients, and in 3% seizures occurred during the initial phase of therapy, often associated with a sudden increase in BP. This hypertension can be controlled with medication. Increased dialyzer clotting may occur, which is prevented when heparin doses are adjusted, and dialyzer solute clearances may decrease slightly. Treatment with r HuEPO does not elicit an antibody response. The mechanism of action of r-HuEPO is identical to that of natural erythropoietin, and therefore is an appropriate therapy for the long-term management of anemia in chronic renal failure. PMID- 2667350 TI - Association of pigmentary anomalies with chromosomal and genetic mosaicism and chimerism. AB - We have evaluated eight patients with pigmentary anomalies reminiscent of incontinentia pigmenti or hypomelanosis of Ito. All demonstrated abnormal lymphocyte karyotypes with chromosomal mosaicism in lymphocytes and/or skin fibroblasts. In seven the skin was darkly pigmented, and in all of these seven cases the abnormal pigmentation followed Blaschko lines. The literature contains at least 36 similar examples of an association between pigmentary anomalies and chromosomal mosaicism, as well as five examples of an association with chimerism. The pigmentary anomalies are pleomorphic, and the chromosomal anomalies involve autosomes and sex chromosomes. The pigmentation patterns are reminiscent of the archetypal paradigm seen in allophenic mice and demonstrate the clonal origin of melanoblasts from neural crest precursors. Patients with anomalous skin pigmentation, particularly when it follows a pattern of Blaschko lines, should be appropriately evaluated for a possible association with chromosomal or genetic mosaicism or chimerism. PMID- 2667352 TI - Online searching by trained health-care professionals versus searching by librarians. PMID- 2667353 TI - Use of the strategic-planning process by hospital pharmacy directors. AB - The extent to which hospital pharmacy directors use strategic planning was assessed. The strategic-planning process was divided into six steps: (1) specification of goals and objectives, (2) identification of threats and opportunities and strengths and weaknesses, (3) generation of alternatives, (4) evaluation of alternatives, (5) alternative selection and implementation, and (6) monitoring and obtaining feedback. Eight questions about these steps made up one part of a questionnaire mailed to the pharmacy directors of 1100 hospitals. In another part of the questionnaire, each director was asked to rate on a scale of 0 (low) to 100 (high) the level of the pharmacy department's performance in the areas of patient, employee, physician, and hospital administrator satisfaction; financial management; professional image; employee turnover and productivity; and clinical programs. The questionnaire was mailed on July 1, 1987, with a second mailing on August 1, 1987. A total of 343 questionnaires were returned with usable responses, for a response rate of 31.2%. Based on responses to the eight strategic-planning questions, hospital pharmacy directors were classified into seven levels of planning sophistication. Results indicated that the number of directors classified in each level increased significantly as the level of planning sophistication increased. The majority of respondents considered the scope and quality of services and the department character, quality, and reputation during the strategic-planning process, whereas less than 50% considered profitability and future needs. Pharmacy directors with a high level of planning sophistication rated their departments significantly higher in terms of hospital administrators' satisfaction, professional image among hospital administrators, number of clinical programs, and quality of clinical programs.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 2667351 TI - Prenatal diagnosis and carrier detection of a cryptic translocation by using DNA markers from the short arm of chromosome 5. AB - DNA markers from the short arm of chromosome 5 were used to examine a large family in which a microscopically undetectable translocation was segregating. In addition to confirming that three retarded children were hemizygous for loci distal to 5p14, these analyses identified five individuals as being carriers of the balanced translocation. The use of molecular probes provided informed genetic counseling to the family for the first time. With the DNA markers from 5p, prenatal diagnosis was performed on two fetal chorionic villus samples, both of which were found to have unbalanced karyotypes. The identification of translocation carriers was complicated by recombination between the small translocated segment of 5p and the corresponding region on the normal homologue, which changed the haplotype of the translocated 5p segment. PMID- 2667354 TI - Stability of cefazolin sodium, cefoxitin sodium, ceftazidime, and penicillin G sodium in portable pump reservoirs. AB - The stability of cefazolin sodium, cefoxitin sodium, ceftazidime, and penicillin G sodium in prefilled drug reservoirs that were stored at -20 degrees C for 30 days, thawed at 5 degrees C for four days, and pumped at 37 degrees C for one day was studied. Each antimicrobial agent was diluted with sterile water for injection to a concentration representative of the most common dosage when administered via a portable infusion pump. Ten milliliters of each drug solution was placed in individual glass vials to serve as controls, and volumes appropriate to deliver the designated dosages were loaded into the drug reservoirs. Triplicate reservoirs were prepared for each drug. One-milliliter samples from all containers were taken on days 0, 30, 31, 32, 33, 34, 34.5, and 35. All solutions were observed for color change and precipitation. Drug concentrations were determined using high-performance liquid chromatography. Leaching of the plasticizer diethylhexyl phthalate (DEHP) was analyzed by packed column gas chromatography on days 0 and 35. No color change or precipitation was observed. No DEHP concentrations above 1 ppm were detected. More than 90% of the initial concentrations of each drug remained, except penicillin G sodium, which had a mean concentration of 83.9 +/- 0.5% at the end of the study. Cefazolin sodium, cefoxitin sodium, and ceftazidime in admixtures with sterile water for injection are stable under the conditions of this study. Penicillin G sodium should not be administered for more than 12 hours after such a cycle of freezing and thawing. PMID- 2667355 TI - Impact of pharmacists in two ambulatory-care clinics in a Veterans Administration medical center. PMID- 2667356 TI - Elevated tumor necrosis factor alpha and interleukin-6 serum levels as markers for complicated Plasmodium falciparum malaria. AB - PURPOSE: Tumor necrosis factor alpha (TNF-alpha) has been implicated in the pathology of experimental malaria. To establish its relevance to human malaria, we studied serum levels of two monocyte-derived cytokines, TNF-alpha and interleukin-6 (IL-6), as well as of the lymphocyte-derived mediator interferon gamma (IFN-gamma) in patients with malaria before and during antiparasitic treatment. PATIENTS AND METHODS: One hundred twenty serum samples of 40 patients with malaria (Plasmodium falciparum [n = 32], Plasmodium vivax [n = 8]) were analyzed. IL-6 was measured by a highly sensitive and specific bioassay, TNF alpha by immunoradiometric assay, and IFN-gamma by radioimmunoassay. RESULTS: Elevated cytokine levels could be detected in the majority of patients with P. falciparum malaria before treatment (31 of 32, 21 of 32, and 21 of 32 for TNF alpha, IL-6, and IFN-gamma, respectively), but only in some patients with P. vivax malaria (four of eight, one of eight, and zero of eight for TNF-alpha, IL 6, and IFN-gamma, respectively). Serum concentrations of the monokines TNF-alpha and IL-6 correlated significantly with parasitic density (p less than 0.001). No such correlation was obtained with the circulating IFN-gamma concentration. The levels of monokines TNF-alpha and IL-6 were markedly elevated in 18 P. falciparum infected patients with complicated clinical courses (median values for TNF-alpha 172 pg/mL, for IL-6 16 U/mL, peak values: 896 pg/mL and 1,000 U/mL, respectively). The correlation between TNF-alpha and IL-6 concentrations in serum (n = 40, r = 0.56, p = 0.0002) suggests co-ordinate production of those mediators. CONCLUSION: Organ impairment in human malaria was found to be correlated with the amount of circulating cytokine levels of TNF-alpha and IL-6. Thus, imbalances of the cytokine network in untreated P. falciparum infection serve as markers of severity of disease. Modulation of cytokine response could represent a novel approach to the treatment of severe organ dysfunctions in human malaria. PMID- 2667357 TI - Observations on spiraling empiricism: its causes, allure, and perils, with particular reference to antibiotic therapy. PMID- 2667358 TI - Primary Hodgkin's lymphoma: an unusual cause of graft dysfunction after kidney transplantation. PMID- 2667359 TI - Treatment of loin pain hematuria syndrome by renal autotransplantation. PMID- 2667360 TI - Beta-2-microglobulin amyloidosis in long-term dialysis patients. PMID- 2667361 TI - Peritoneal morphology on maintenance dialysis. AB - Thirty-eight peritoneal biopsies from 37 patients with normal renal function or with end-stage renal failure without replacement therapy or utilizing continuous ambulatory peritoneal dialysis (CAPD), haemodialysis (HD) or a functioning transplant were examined histologically. No abnormality in peritoneal membrane morphology was observed in uraemia in the absence of dialysis. Significant abnormalities of peritoneal membrane morphology were observed in association with CAPD, the predominant finding being the development of peritoneal fibrosis which had a deleterious effect on membrane function. Abnormal peritoneal morphology was less commonly observed in patients on maintenance HD and with functioning transplants but may have implications regarding the future use of CAPD in these patients. PMID- 2667362 TI - Anuria in a patient with pulmonary edema. PMID- 2667363 TI - Acute interstitial nephritis associated with Yersinia pseudotuberculosis infection. AB - We report two cases of acute interstitial nephritis associated with Yersinia pseudotuberculosis infection. The patients had fever, abdominal pain, vomiting and acute renal failure coinciding with elevated agglutination antibody titer for Y. pseudotuberculosis. Renal biopsy revealed interstitial nephritis in both patients. Although it is well known that yersiniosis sometimes affects glomeruli, this is the first report to demonstrate acute interstitial nephritis in patients with Y. pseudotuberculosis infection. PMID- 2667364 TI - Pyelonephritis complicating relapsing acute pancreatitis. AB - A case of right pyelonephritis with hydronephrosis complicating relapsing acute pancreatitis and right pararenal phlegmon formation is presented. Hydronephrosis is a reportedly rare complication of extrapancreatic inflammation; the only 6 previous cases involving the right side are reviewed. The present case report, to our knowledge, is the first to describe clinical and laboratory evidence of pyelonephritis secondary to partial obstruction of the right upper renal tract by an extrapancreatic phlegmon. The clinician caring for patients with acute pancreatitis should be aware of this important complication, since the presentation of pyelonephritis-flank pain and fever--could erroneously be attributable solely to the pancreatitis. PMID- 2667365 TI - Dialysis patients' attitudes about cardiopulmonary resuscitation and stopping dialysis. AB - Dialysis patients are a unique population because of their chronic dependence on complex medical technology. Furthermore, their illness forces them to make critical decisions about medical care (mode of dialysis, renal transplantation, withdrawal from dialysis). The reasons dialysis patients discontinue therapy are not well understood, nor is it known whether they view dialysis therapy differently from other life-support interventions. We asked four groups of patients - in-center hemodialysis (HD), peritoneal dialysis (PD), renal transplant, and ambulatory elderly - questions about their wishes for (1) medical information, (2) participation in medical decision-making, (3) life-supporting therapy including cardiopulmonary resuscitation (CPR) and ventilatory support, and (4) stopping dialysis at the time of the study and in certain hypothetical situations. All groups wanted information and involvement in making medical decisions. Most patients desired CPR (96% of renal transplant, 76% of HD, 63% of PD, 82% of elderly), but PD patients chose CPR less often in all circumstances (at study, p = 0.004; in coma, p = 0.004; in permanent coma, p = 0.04), and they were less willing to undergo chronic ventilation (p = 0.001). PD patients were more likely to stop dialysis (p = 0.02) in coma than were HD patients. PD patients attended religious services more frequently and were less comfortable with machines, but these differences did not correlate with their decisions about life-support therapy. Dialysis patients have rarely considered stopping dialysis; they are similar to ambulatory elderly patients with regard to decisions about CPR and desire for involvement in medical decision-making. PD patients are a distinct subgroup worthy of further study. PMID- 2667366 TI - Nephrology in the natural history of Pliny the Elder (23-79 A.D.). PMID- 2667367 TI - Transplanted to Saudi Arabia. PMID- 2667368 TI - Using biofeedback to ease the pain of childbirth. PMID- 2667369 TI - Clinical indications for and procedures associated with penetrating keratoplasty, 1983-1988. AB - We reviewed the preoperative clinical indications and associated surgical procedures for 2,299 penetrating keratoplasties performed at our institution from 1983 through 1988. Pseudophakic bullous keratopathy was the most common indication overall, accounting for 526 cases (23%). A marked increase was noted in the incidence of pseudophakic bullous keratopathy as an indication for penetrating keratoplasty beginning in 1985. The association of anterior chamber intraocular lenses in eyes with pseudophakic bullous keratopathy undergoing penetrating keratoplasty increased from 19 of 43 cases (44%) in 1983 to 79 of 108 cases (73%) in 1988. The incidence of intraocular lens exchange at the time of penetrating keratoplasty in cases of pseudophakic bullous keratopathy increased from six of 43 (14%) in 1983 to 63 of 108 (58%) in 1988. Other major indications for penetrating keratoplasty included Fuchs' dystrophy (375 cases, 16%), keratoconus (348 cases, 15%), aphakic bullous keratopathy (331 cases, 14%), and regraft (233 cases, 10%). Cataract extraction, with or without intraocular lens implantation, was combined with penetrating keratoplasty in 397 of 1,532 phakic eyes (26%). The incidence of triple procedure (penetrating keratoplasty, cataract extraction, and intraocular lens implantation) increased from 27 of 248 phakic eyes (11%) in 1983 to 68 of 258 phakic eyes (26%) in 1988. PMID- 2667370 TI - Complications after surgery for congenital and infantile cataracts. AB - We reviewed the records of 78 patients who underwent 128 surgical procedures for congenital or infantile cataracts before age 30 months for the type and frequency of postoperative complications. The surgeries included 92 limbal lensectomies and anterior vitrectomies, 13 pars plicata lensectomies, 20 aspirations, and three additional procedures. Complications developed after 21 of the 105 lensectomy and anterior vitrectomy procedures. Ten eyes (10%) required additional surgery for a secondary membrane, 12 eyes (11%) developed glaucoma, and one (1%) developed a retinal detachment. Patients who underwent surgery by 8 weeks of age had a significantly greater number of complications (P less than .025). Patients undergoing cataract surgery early in life should be routinely examined for possible postoperative glaucoma. The best method for reducing secondary membrane formation and some types of glaucoma appears to be an extensive removal of the lens cortex, posterior capsule, and anterior vitreous. PMID- 2667371 TI - Custom orbital implant in the repair of late posttraumatic enophthalmos. AB - We repaired late, posttraumatic enophthalmos in 21 patients by inserting a large, soft, Silastic block through a lower eyelid flap and transconjunctival approach to the orbit. These blocks were hand carved at the time of surgery to match bony defects as characterized by hypocycloidal tomographic biometry. Enophthalmos and hypo-ophthalmos were ameliorated with acceptable appearance in all cases. No implant rejections, migrations, or infections were found. Complications included upper eyelid blepharoptosis, lower eyelid retraction, and conjunctival prolapse. The improvements were stable over a median follow-up of 13 months. PMID- 2667372 TI - Hypotony following instillation of apraclonidine for increased intraocular pressure after trabeculoplasty. PMID- 2667373 TI - Granuloma formation by artificial microparticles in vitro. Macrophages and monokines play a critical role in granuloma formation. AB - To investigate the basic mechanisms of granuloma formation, in vitro granulomas were induced by culturing murine spleen cells in the presence of artificial microparticles. Large granulomas developed around dextran beads. The lesions were inducible by spleen cells from either normal mice or athymic nude mice. Minimal inflammation was produced around latex beads. The histologic features and time kinetics of granulomas in vitro. Culture supernatants of dextran induced granulomas contained high levels of interleukin-1 (IL-1) activity but not interleukin-2 (IL-2) or interleukin-4 (IL-4) activity. IL-1 activity was correlated with granuloma size. Additionally, granulomas were produced by culturing spleen cells in the presence of agarose beads coupled to recombinant IL 1 or recombinant tumor necrosis factor-alpha (TNF-alpha). Granulomatous lesions also were induced by macrophage-enriched populations in the presence of monokine coupled beads. Adherent macrophages, but not nonadherent cells, were required for induction of granulomas in vitro. In contrast, very small lesions were seen when spleen cells or adherent cells were cultured in the presence of beads coupled to recombinant IL-2 or recombinant interferon-gamma (IFN-gamma). These results suggest that macrophages and monokines such as IL-1 and TNF-alpha play an essential role in granuloma formation in vitro. PMID- 2667374 TI - Analysis of rehabilitation techniques after anterior cruciate reconstruction. AB - Numerous postoperative therapies have been advocated for the rehabilitation of patients who have undergone ACL reconstruction. The effectiveness of these various methods, many of which are based on sound scientific principles, has yet to be documented. The purpose of this study was to determine the efficacy of five commonly used rehabilitation programs. Five groups of 20 patients, all of whom underwent the same method of ACL reconstruction, were compared in order to determine the effects of the following treatments (some in combination): transcutaneous electrical nerve stimulation (TENS), immobilization in flexion, immobilization in extension, electrical muscle stimulation (EMS), and continuous passive motion (CPM). Clinical evaluation, volumetric thigh measurements, instrumented varus-valgus stress testing, KT-1000 arthometer (Medmetric, San Diego, CA) measurements, and Cybex II (Cybex, Division of Lumex, Ronkonkoma, NY) muscle evaluation were used to examine the patients. TENS did not reduce the amount of pain medication required, nor was there improvement in any other clinically measurable parameter of performance. There was no clear difference in stability between those treated in extension and those treated in flexion; however, since three patients who were treated in extension required manipulation, there may be some advantage to treating patients with early limited range of motion in flexion. EMS did not reduce atrophy but it did minimize strength decrease during immobilization. EMS also resulted in significantly greater range of motion than those treated with extension or flexion with early limited motion. Compared to all groups, EMS patients had a significant reduction in the incidence of patellofemoral crepitation.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 2667375 TI - Mechanics of the healed meniscus in a canine model. AB - The mechanical behavior of the intact canine stifle joint was studied, using a surgical model of meniscal injury and repair. Thirty-eight animals were divided into five study groups: Group S received only a sham arthrotomy (without a meniscal incision), Groups P13 and P26 received peripheral medial meniscal incisions, and Groups R13 and R26 received radial medial meniscus incisions. All meniscal incisions were repaired anatomically with absorbable suture. Groups P13 and R13 were sacrificed at 13 weeks following surgery and Groups P26 and R26 at 26 weeks. Following sacrifice, the joints were subjected to gross and histologic examination, and structural and material properties testing. All meniscal repairs healed, and the peripheral repairs were virtually invisible, with no articular damage. The radial repairs healed with 3 to 5 mm wide fibrovascular scars, and several joints demonstrated articular erosions. The radial repair tissue contained unorganized collagen bundles and ground substance deficient in mucopolysaccharides. Groups S, P13 and P26 demonstrated no statistically significant differences between test and control limbs in compressive force displacement behavior, input energy (EI), and ratio of dissipated to input energy (ED/EI). There were significant test-control differences in the load-displacement characteristics of Groups R13 (P less than 0.05) and R26 (P less than 0.05), with the repaired joint stiffer than the control. EI decreased 26% in Group R13 (not significant) and 34% in Group R26 (P less than 0.05), while the ratio ED/EI increased from 27% to 44% in Group R13 (not significant) and from 31% to 38% in Group R26 (P less than 0.05). Medial compartment contact area did not change significantly in either peripheral repair group, but decreased by 25% in Group R13 (P less than 0.05) and by 13% in Group R26 (P less than 0.05). Yield stress, maximum stress, and Young's modulus decreased significantly (P less than 0.05) relative to the controls in tensile tests of the radial repair tissue. There were no significant changes in these properties from 13 to 26 weeks. We concluded that in this animal model, the mechanical function of the meniscus is restored following repair of peripheral longitudinal lesions; however, it appears that in the radial repairs, progressive spreading at the repair site (filled by a fibrovascular scar) altered normal meniscal geometry and structure, adversely influencing mechanical function. Future studies may document whether protective measures (immobilization, limited weightbearing, etc.) can preserve normal mechanical function following repair of radial lesions. PMID- 2667376 TI - The aging athlete. AB - In summary, the purpose of this material is to demonstrate that the aging athlete does differ from the younger competitor in many facets. There are physiological, structural, and psychosocial differences which distinguish them as a unique entity in the athletic world. Despite the unavoidable alterations that the passage of time imposes on our bodies, these competitors are still capable of incredible performances of strength, skill, and endurance. In reference to injury, these athletes are at risk from both their current program and their past indiscretions. The literature strongly suggests that the greatest threat to the health of the aging athlete is not the aging process itself but rather inactivity. Astrand concurs with this and states that "there is less risk in activity than in continuous inactivity--it is more advisable to pass a careful physical examination if one intends to be sedentary in order to establish whether one's state of health is good enough to stand the inactivity." It appears that the body systems were designed to reinforce activity and when there is disuse, a large number of atrophic changes take place. It has been estimated that regular exercise may be able to retard the physiologic decline associated with old age as much as 50%. Taken in this light, exercise is truly a fountain of youth from which we can all rejuvenate ourselves. Science has proven that life does not begin at 40, but it has also demonstrated that it does not have to end there. As one author so aptly states, "Not too many years ago the words grandma and grandpa conjured images of rocking chairs and inactivity."(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 2667377 TI - Factors affecting the region of most isometric femoral attachments. Part I: The posterior cruciate ligament. AB - We measured how the distance between selected tibial and femoral attachments of the PCL changes with knee flexion in six intact cadaver knee. The femoral location was the primary determinant of whether the distance increased, decreased, or remained nearly constant. The proximal-distal location of a fiber's femoral attachment had a stronger effect than had the anterior-posterior location. The tibial location had only a small statistically significant effect. These results suggest that the function of fibers within the PCL is determined primarily by their femoral attachment location. We determined all femoral attachments whose tibio-femoral distance changed 0, 2, 4, 6, 8, and 10 mm during flexion from 0 degrees to 90 degrees. No absolutely isometric point existed. Attachments whose separation distance changed less than 2 mm formed a bullet shaped region whose base was against the roof of the intercondylar notch and whose nose pointed posteriorly and slightly distally. The axis of the "bullet" was near the proximal edge of the femoral insertion of the PCL. Along the axis, anterior attachments, located near the roof of the intercondylar notch, were more isometric than were posterior attachments, located near the cartilage. Attachments located distal to the axis moved away from the tibial insertion of the PCL when the knee was flexed. The more distal the femoral attachment, the larger the increase in tibiofemoral distance that occurred with flexion. The opposite was true of attachments proximal to the 2 mm region. PMID- 2667379 TI - Management of orbital blow-out fractures. Case reports and discussion. AB - Blow-out fractures are fractures of the orbital floor or medial wall that occur as a consequence of blunt trauma. Impact increases the intraorbital pressure, forcing the nondistensible orbital contents through the orbital floor. The fracture is commonly caused by impact from a baseball or tennis ball. However, any blunt trauma to the orbit, as from a knee or elbow, can result in a blow-out fracture. The characteristic clinical findings include double vision, a sunken globe, and numbness in the distribution of the infraorbital nerve. Sometimes, the only sign of a blow-out fracture is the abrupt inflation of periorbital tissue with air when the patient blows his nose. Standard evaluation of these fractures includes history, physical examination, and radiographs. Some patients benefit from computed tomography (CT), which can be both diagnostic and prognostic. Blow out fractures do not often produce serious sequelae, and the current trend is toward no treatment. However, it is imperative to rule out any serious injury to the eye itself that would require emergency treatment. PMID- 2667378 TI - Factors affecting the region of most isometric femoral attachments. Part II: The anterior cruciate ligament. AB - During flexion of the intact knee, we measured the changes in distance between possible tibial and femoral attachments of an intraarticular ACL substitute. The change in distance during motion was described by the difference between the longest and shortest distances measured. Using knees from eight cadaver donors, we studied the effects of varying tibial and femoral attachment locations, applying anterior and posterior forces, and altering the range of flexion. We found that altering the femoral attachment had a much larger effect than had altering the tibial attachment. No femoral attachments were completely isometric. Femoral attachments that produced the smallest change in tibiofemoral distance, 2 mm and less, formed a band whose greatest width ranged from 3 to 5 mm. The axis of the 2 mm region was nearly proximal-distal in orientation and located near the center of the ACL's femoral insertion. Attachments located anterior to the axis moved away from the tibial attachment with flexion, whereas attachments located posterior to the axis moved toward the tibia. The AP position of the tibial attachment affected the orientation of the 2 mm region. Moving the tibial attachment posteriorly caused the proximal part of the region to move anterior, with little change in the location of the distal part of the region. Changing the applied joint force from anterior to posterior was similar to moving the tibial attachment posteriorly, but the effect was less pronounced. Increasing the range of flexion from 90 degrees to 120 degrees caused the 2 mm region to become narrower and changed its orientation. PMID- 2667380 TI - The natural history of conservatively treated partial anterior cruciate ligament tears. AB - Twenty-five patients with arthroscopically proven partial ACL tears were reviewed. All patients underwent examination under anesthesia and arthroscopy following an acute injury to a previously normal knee. The percentage of tear was estimated during arthroscopy. Postoperatively, patients were treated with early motion and hamstring strengthening. Weightbearing and quadriceps rehabilitation were delayed. A detailed rating of symptoms and function was performed at a minimum of 18 months after injury, using a modification of the AOSSM ACL follow up form. Neither the estimated percentage of ligament tear, length of followup, nor age at time of injury significantly correlated with clinical score at followup. Thirteen patients underwent partial meniscectomy at the time of original arthroscopy. Their clinical outcome was not different from those without meniscectomy. Two patients (8%) underwent ACL reconstruction 8 and 64 months after injury, respectively. Overall results were judged as excellent (28%), good (32%), fair (24%), and poor (16%). Only 44% were able to resume sports at their preinjury level, and 72% had activity-related symptoms. PMID- 2667381 TI - Binding function in relation to injury risk in downhill skiing. AB - Time-trend studies suggest that in the recent past, the use of modern equipment and adequately functioning ski bindings have had a preventive effect on injuries. The question of whether a further decrease of injury figures can still be expected from better binding adjustment is investigated in a case-control study (N = 1,148) conducted among Dutch skiers. Nonrelease of both bindings directly before injury was associated with a higher risk (odds ratio = 3.3) for lower extremity (LE) injury. Binding release before LE injury was highest (31%) among those for whom adjustment was performed and then confirmed with a test device. The proportion of nonrelease is highest for knee injuries. No effect on injury risk could be found for the time of adjustment, the method of adjustment, or the person performing the adjustment. Direct measurement of binding function seems indispensable. The use of rented or borrowed skis was associated with a higher risk (odds ratio = 1.9) for LE injury. The same holds for ignorance concerning the type of ski and the age of the skis and bindings. We concluded that binding adjustment still seems to be a risk factor open to manipulation. The efficacy of intervention aimed at better adjustment should be studied experimentally. PMID- 2667382 TI - Sports injuries in school-aged children. An epidemiologic study. AB - In November 1982, epidemiologic data were collected in a unique, large scale, population-based survey on sports injuries in school-aged children living in Holland. A total of 7,468 pupils, aged 8 to 17, completed questionnaires covering a retrospective period of 6 weeks. Seven hundred ninety-one sports injuries were registered, amounting to an incidence of 10.6 sports injuries per 100 participants. In 31% of the cases, medical consultation was needed. Injuries incurred during the study period caused 36% of the children to miss one or more physical education classes and caused 6% to miss school for at least 1 day. Contusions and sprains were the most common lesions (77%). Three of four injuries involved the lower extremity, in particular the ankle. Sixty-two percent of all the injuries occurred in organized sports, 21% in physical education classes, and 17% in unsupervised sports activities. The highest injury rates were found in basketball and field hockey. In this study population, 15 and 16-year-old boys who had a high sports activity index and played team sports, particularly contact team sports, formed a high risk group. PMID- 2667383 TI - Surgical treatment of chronic lateral instability of the ankle joint. A new procedure. AB - Sixty patients with chronic lateral functional and mechanical instability of the ankle joint were treated with shortening and reinsertion of the lateral ankle ligaments. All patients were followed prospectively for 2 to 5 years (mean, 3 years 6 months). We found the functional results to be excellent or good in 53 patients (88%). Patients with unsatisfactory results had either generalized joint hypermobility or long-standing ligament insufficiency. Anterior talar translation (ATT) and talar tilt (TT) were measured radiologically on standardized radiographs. Patients with excellent and good functional results had better mechanical stability, both ATT and TT, than those with fair and poor functional results. A good correlation was found between clinical, functional, and radiological results. In conclusion we found that reconstruction of the ankle stability by shortening and reinsertion of the lateral ankle ligaments is a safe and simple method and is a good alternative to other more complex methods of ligament reconstruction. The method should, however, be used with great care in patients with generalized joint hypermobility or in patients with long-standing ligament insufficiency. PMID- 2667384 TI - Color flow duplex screening of infrainguinal grafts combining low- and high velocity criteria. AB - The aim of this prospective study was to evaluate the ability of duplex ultrasonography to identify infrainguinal grafts at high risk for failure. The criteria used identified low flow by low peak systolic velocity (less than 45 cm/s) and stenosis by high velocity (greater than 300 cm/s) or by velocity at the stenosis three times the velocity in the adjacent normal graft. A total of 114 patent grafts were scanned and compared with concurrent angiograms. Duplex scanning correctly identified 18 high-risk grafts by low-flow criteria and an additional 21 by stenosis criteria. There was one false-negative finding (sensitivity 98 percent). The velocity ratio of the stenosis to the adjacent graft was useful in estimating the degree of stenosis. Color flow duplex imaging reduced examination time through visual feedback by highlighting the graft and areas of high velocity. These results indicate that color flow duplex scanning, combining low- and high-peak systolic criteria, is a very sensitive screening test in the early detection of failing grafts. PMID- 2667385 TI - Clinical trials of a new polytetrafluoroethylene-silicone graft. AB - A self-sealing polytetrafluoroethelene (PTFE)-silicone graft designed to be used early after implantation was placed in 30 end-stage renal disease patients. Thirty-five conventional PTFE grafts were used in the control group. All patients were followed for 1 year. In the PTFE-silicone graft group, median time for first use was 1 day after implantation. Conventional PTFE grafts were first used 2 to 4 weeks after implantation. Early punctures of the PTFE-silicone grafts (first 10 sessions), although more difficult to perform than late punctures, were not more difficult than punctures of conventional PTFE grafts. Late punctures in PTFE silicone grafts were easier than conventional PTFE graft punctures. Bleeding after needle removal was significantly decreased after early and late punctures of PTFE-silicone grafts compared with conventional PTFE grafts (p less than 0.001). The PTFE-silicone graft can be used immediately after implantation, sparing patients additional access procedures for short-term dialysis. This results in less morbidity, decreased bleeding complications, shorter hospital stay, and a significant reduction in expenses. PMID- 2667386 TI - An in vivo feasibility study of intravascular ultrasound imaging. AB - Increasingly complex vascular reconstructions and emerging endovascular therapeutic modalities have stimulated the need for improved vascular imaging. To determine the feasibility of in vivo intravascular ultrasound, a miniature probe 1 mm in diameter with a 25 MHz center frequency was used to obtain two dimensional, 360-degree cross-sectional images. In sheep, 14 superficial femoral arteries were imaged at different sites, and a portion of each vessel was resected for immediate in vitro imaging and histologic examination. In vivo images clearly showed the intima, media, and adventitia of the vessel wall as well as the lumen-intima and media-adventitia interfaces. There was a significant correlation in measured lumen area between resected artery ultrasound images and histologic sections. We conclude that intravascular ultrasound can produce high resolution dynamic images that demonstrate vessel wall architecture and allow precise calculation of lumen area. PMID- 2667387 TI - Sir Geoffrey Stephen William Organe, 25 December 1908-7 January 1989. PMID- 2667388 TI - Comparison of hyperbaric and plain bupivacaine with hyperbaric cinchocaine as spinal anaesthetic agents. AB - In a double-blind study, 90 patients (ASA 1 or 2) received spinal anaesthesia with 2 ml hyperbaric cinchocaine 0.5%, 4 ml hyperbaric bupivacaine 0.5% or 4 ml plain bupivacaine 0.5%. All injections were made in the left lateral position, and the patients turned supine immediately. Hyperbaric bupivacaine produced a significantly faster and a higher dermatomal level of bilateral complete sensory blockade than the other solutions (p less than 0.005 for each). The duration of sensory blockade was significantly longer with plain bupivacaine than with either hyperbaric solution (p less than 0.0005). The intensity of sensory blockade was significantly greater with both bupivacaine solutions than with hyperbaric cinchocaine (p less than 0.05). Onset and intensity of motor blockade were similar with all agents, but motor blockade was of significantly shorter duration with hyperbaric bupivacaine than the other agents (p less than 0.0005). Hyperbaric bupivacaine appears to be the best agent for rapid and intense sensory blockade of intermediate duration. Plain bupivacaine is more appropriate if a longer duration of action but a lower height of blockade are required, and has the advantage of less cardiovascular disturbance. PMID- 2667389 TI - The management of caesarean section in a patient with an intracranial arteriovenous malformation. AB - The anaesthetic management of elective Caesarean section in a 25-year-old woman with an inoperable intracranial arteriovenous malformation is described. The literature is reviewed. PMID- 2667390 TI - Viability measurements in mammalian cell systems. PMID- 2667391 TI - Assay for aliphatic amino acid decarboxylases by high-performance liquid chromatography. AB - A sensitive and rapid assay for aliphatic amino acid decarboxylases based on separation of the product from the substrate by ion-pairing reversed-phase high performance liquid chromatography and subsequent fluorometric detection has been developed. The resolution of substrates and products of seven amino acid decarboxylases, namely, arginine, aspartate, 2,6-diaminopimelate, histidine, glutamate, lysine, and ornithine decarboxylase, is complete within 15 to 35 min of isocratic elution. The limit of detection for the product is 40 pmol. The applicability of the procedure was assessed with glutamate decarboxylase. The formation of the product 4-aminobutyrate proved to be linear with time and protein concentration. The method allows the time course of the reaction to be followed in a single assay and works well with crude extracts of bacteria or tissues. PMID- 2667392 TI - A radioactive method for the measurement of trypsin and trypsin-like activities. AB - A simple and highly sensitive method for the assay of trypsin has been developed by making use of the phosphorylated synthetic peptide Leu-Arg-Arg-Ala-Ser-(32P) Leu-Gly as substrate. The technique has been adapted from the phosphocellulose method of R. Roskoski, Jr. (in Methods in Enzymology (Corbin, J., and Hardman, J., Eds.), Vol. 99, pp. 3-6, Academic Press, New York) used for measuring of protein kinases. In addition to measuring the activity of trypsin at the microgram level, the 32P-labeled peptide method can be used for measuring other trypsin-like enzymes. It has been successfully utilized for the identification of a new peptidase from the fungus Saccobolus platensis. PMID- 2667393 TI - Synthesis of N7-ethyldeoxyguanosine 5'-triphosphate and placement of N7 ethylguanine in a specific site in a synthetic oligodeoxyribonucleotide. AB - N7-Ethyldeoxyguanosine 5'-triphosphate (N7-Etd-GTP) was synthesized by direct ethylation of dGTP with diethyl sulfate and purified by TLC on cellulose plates at approximately 5% yield. N7-EtdGTP was identified by its uv spectra at pH 1, 7.4, and 13, by its absorbance maxima and minima, and by the lability of the glycosidic bond to acid- and heat-induced cleavage. At pH 7.4, spontaneous cleavage of the glycosidic bond proceeded with a half-life of greater than 48 h. An enzymatic method for placing an N7-ethylguanine in a specific site in DNA was developed using terminal deoxynucleotidyltransferase and the 3' to 5' exonuclease and 5' to 3' polymerase of the Klenow fragment of Escherichia coli DNA polymerase I. The method should be readily adaptable to other modified bases as long as the modification does not occur at a base-pairing site (e.g., 5-methylcytosine, N6 methyladenine, and others). PMID- 2667394 TI - Pesticides. PMID- 2667395 TI - Pharmaceuticals and related drugs. PMID- 2667396 TI - Food. PMID- 2667397 TI - Terbium chelate labels for fluorescence immunoassays. AB - Bovine serum albumin was labelled with a terbium complex by means of a reagent prepared from diethylenetriaminepentaacetic acid or diethylenetriaminepentaphosphonic acid and p-aminosalicylic acid. The ternary mixed ligand complexes showed strong fluorescence and were stable in very dilute solution (10(-10)M). The fluorescence of the conjugated products was compared with regard to their application in the fluoroimmunoassay of bovine serum albumin. PMID- 2667398 TI - Histological studies on the endocrine pancreas in the dog. AB - Based on histological structure and cellular formation, the endocrine pancreas (pars endocrina pancreatis) (PEP) or pancreatic islet (insulae pancreaticae), was divided into two types in the dog. One type of PEP was the islet of Langerhans. In the glandular lobule, the islet was surrounded by exocrine acini. The other type of PEP, in general, exhibited a feature of a neuro-insular complex. It was found within the interlobular connective tissue of the pancreas. This type of PEP was attached to a nerve bundle or ganglion. In the pancreas of the immature dog, a large population of endocrine cells was recognized to form a blood islet within the neuro-insular complex. PMID- 2667399 TI - Low-dose intrathecal morphine for postoperative pain control in patients undergoing transurethral resection of the prostate. AB - Thirty patients undergoing lidocaine spinal anesthesia for transurethral resection of the prostate (TURP) were studied to evaluate the effectiveness of low-dose intrathecal morphine (ITM) for postoperative analgesia. In a double blinded fashion, groups of ten patients received either 0.1 mg morphine, 0.2 mg morphine, or placebo (control group) intrathecally with lidocaine 75 mg. Standard postoperative analgesics were available to all patients. Patients receiving 0.1 mg or 0.2 mg morphine reported significantly less postoperative pain as assessed by an inverse numerical visual pain scale and required significantly fewer postoperative analgesic interventions than the control group. There was no difference between the 0.1 mg ITM and 0.2 mg ITM groups with regard to severity of postoperative pain or analgesic requirements. The incidence of nausea and vomiting was significantly higher in the group receiving 0.2 mg ITM than in the control group. Six patients (60%) in the 0.2 mg ITM group, two patients (20%) in the 0.1 mg ITM group, and one patient (10%) in the control group experienced nausea and vomiting. No clinically evident respiratory depression occurred in any of the subjects. The authors conclude that administration of 0.1 mg or 0.2 mg of morphine intrathecally is effective in reducing postoperative pain following TURP and that 0.1 mg ITM is not associated with nausea and vomiting. PMID- 2667400 TI - Effectiveness of triazolam, diazepam, and placebo as preanesthetic medications. AB - Eighty-three ASA Physical Status 1-2 patients were orally premedicated with triazolam (0.125, 0.25, or 0.5 mg), diazepam (5, 10, or 15 mg), or placebo to evaluate the effectiveness of these drugs and doses in reducing preoperative anxiety, providing sedation, and producing amnesia. The drug treatments were administered in a randomized, double-blind manner. The results obtained with each drug (dose) group were compared against those of the placebo group as a control. Changes in anxiety at 60 min after drug administration were evaluated: 1) by a trained anesthesia nurse clinician using an analog scale, 2) by the patient using the same analog scale, and 3) by the patient with the Multiple Affect Adjective Check List (MAACL). Changes in sedation at 60 min were also evaluated by the patient and nurse clinician using an analog scale. Amnesia was assessed by postoperative recall of picture cards shown to the patient 1 h after receiving preanesthetic medication. There were no significant differences between any drug (dose) and placebo for changes in patient-evaluated anxiety or sedation on the analog scale. With the other measures of anxiety, only triazolam (0.5 mg) reduced anxiety more than did placebo on both the patient (MAACL) and the nurse (analog) scales. With the nurse (analog) measure of sedation, only the highest doses of triazolam and diazepam were more sedating than placebo. Triazolam (0.5 mg) was the only drug dose that produced significant amnesia. The authors conclude that drug effects on anxiety, sedation, or amnesia that are statistically significant versus placebo effect are seen at only the highest doses of triazolam (0.5 mg) and diazepam (15 mg). PMID- 2667401 TI - Propofol: a new intravenous anesthetic. PMID- 2667402 TI - New ultrasonic femoropopliteal and tibiofemoral tests in the study of patency of the deep venous system. AB - In phlebology, every new noninvasive examining method is of great importance. Now there are new femoropopliteal and tibiofemoral tests, described originally by Odisio in Argentina and, in a modified form applying ultrasound, introduced in Europe by Krcilek and Bartak. An experiment with 25 patients was performed to verify the conclusive evidence of the tests. The diagnosis of deep venous thrombosis was examined here by clinical and femoropopliteal and tibiofemoral tests according to Odisio. Finally the diagnosis was verified by the Doppler ultrasonic method. The principle of the femoropopliteal test is the palpative perception, when the fingertips of the left hand applied to the inguen somewhat medially from the femoral artery detect the deep venous wave caused by a repeated percussion of the right hand in the fossa poplitea. Getting some experience enables one to practice simple examinations leading to verification of a suspected diagnosis of femoral thrombosis. Replacing the palpating hand by a sonde of an ultrasonic detector gave substantial precision to examinations in the test modification. Similarly the diagnosis of deep venous thrombosis of the calf was verified by the percussional tibiofemoral test, when the right hand repeatedly percussed on the calf in the course of crural veins, while the left hand palpated the transmission of the wave to the inguen. Both modifications of the femoropopliteal and tibiofemoral tests were verified by the classical ultrasonic examination method. The results were compared with those from a control group of 25 patients without clinical and phlebogic symptoms of disease of the lower limbs. PMID- 2667403 TI - Noninvasive surveillance of allografted kidneys by ultrasonic duplex scanning. AB - Over a one-year period 1,000 duplex Doppler evaluations were performed in 70 patients submitted to kidney transplantation for end-stage renal failure. Duplex monitoring was performed to evaluate transplant status from hemodynamic patterns of the graft arteries. A duplex scanner with a 3.75 MHz sector transducer was used; pulsed Doppler was utilized to detect blood flow velocities in the main renal, segmental, interlobar and arcuate arteries. Arterial signals were quantified through a pulsatility index (PI). Three cases of acute rejection (AR), 9 cases of chronic rejection (CR), 2 cases of cyclosporine nephrotoxicity (Csa Tox), and 4 cases of acute tubular necrosis (ATN) were recognized and biopsy proved. At each arterial site PI values of normally functioning allografts were lower than 1.5; AR patients showed PI values ranging from 1.7 to 3.1, promptly lowered by immunosuppressive treatment. CR patients had a spectrum of PI from 0.5 to 3.1. Patients with Csa Tox and ATN showed in all the explored sites normal arterial signals and thus normal PI values. PI variations reflect even slight blood flow reductions due to immunologically mediated increases in intrarenal arterial resistances. Duplex sonography of allografted kidneys shows great diagnostic attitudes in the noninvasive characterization of transplant malfunction. PMID- 2667404 TI - Sonography of vertebral arteries in De Kleyn's position in subjects and in patients with vertebrobasilar transient ischemic attacks. AB - Two groups of subjects, matched for age, were studied. The first group consisted of 190 healthy subjects, the second, of 60 patients with vertebrobasilar transient ischemic attacks (TIAs), 22 of whom underwent angiography. After it was ascertained that the findings from continuous-wave (cw) Doppler of carotid and vertebral arteries, performed in the standard position, were normal, the examination was then done in De Kleyn's position, the velocity signal being detected at the mastoidal slopes. The abnormal findings were classified into two groups: "loss of diastolic velocity signal" and "absence of velocity signal." In the control group, changes of flow were detected in 6.31%, whereas in the group of patients abnormal Doppler parameters were detected in 33.33%. None of the patients who were submitted to angiography showed abnormal hemodynamic findings. The authors suggest that the detection of the velocity signal of the vertebral arteries in De Kleyn's position could be of help in revealing conditions that could cause, in time, signs and/or symptoms of vertebrobasilar insufficiency in subjects with possible asymptomatic anomalies of the circle of Willis. PMID- 2667405 TI - Neurologic aspects of mitral valve prolapse. AB - Mitral valve prolapse (MVP), the most frequently encountered valvular condition in the population, has been reported in an increasing variety of neurologic, muscular, and psychiatric disorders during the last twelve years. Extensive review of reports indicates this has resulted from observations of either (1) inordinate incidence of MVP in well-defined neurologic entities or (2) development of neurologic or ophthalmologic complications attributed to MVP. In the review presented, basis is found for categorizing MVP by its association with (1) well-defined, genetically determined neurologic disorders; (2) disorders characterized by structural abnormalities, many genetically determined, or inflammatory processes of connective tissues; (3) "mechanical" prolapse resulting from disproportion of mitral valve annulus and left ventricular size, which is, at times, reversible; and (4) a generally asymptomatic state that, at times, is associated with ischemic, thrombotic, embolic, and infectious disorders of the brain and eye. The paradox between the large number of persons with MVP in the general population who remain healthy and a subpopulation of patients with complications of MVP (eg, stroke) or other entities has been identified. A second paradox is found between the well-known increased incidence of MVP, especially in young patients with stroke, and the apparent rarity of stroke among patients with both common (eg, migraine) and unusual (eg, myotonic dystrophy) neurologic entities in which an extraordinary high prevalence of MVP is known to exist. PMID- 2667406 TI - EMT-defibrillation: the Wisconsin experience. AB - The survival rate for patients with prehospital cardiac arrest has improved in some communities with early defibrillation by emergency medical technician defibrillators (EMT-Ds). In rural areas, previous studies on survival with defibrillation by EMT-Ds have been variable. We conducted an EMT-D study to determine effectiveness in various prehospital settings. Sixty-four ambulance services from communities ranging in size from rural areas to city suburbs participated in our prospective study. EMTs were trained in rhythm recognition and the use of a manual defibrillator during a standardized 20-hour course. Over 18 months, data were collected locally for central analysis. Five hundred sixty six patients with primary cardiac arrest were included in our study: 36 (6.4%) survived. Retrospective review revealed survival before EMT-D implementation to be 3.6% (P less than .02). Three hundred four patients (54%) had an initial rhythm of ventricular fibrillation, with 33 (11%) surviving. The survival rate for EMT-D-witnessed arrest with an initial rhythm of ventricular fibrillation was 42%. Patients with asystole were countershocked in our study; however, there were no survivors from this group. The neurologic status of survivors at time of hospital discharge was normal in 72%. The average response time, defined as time of emergency medical services activation to the time of EMT-D arrival, was 7.3 +/ 5.8 and 3.7 +/- 2.0 minutes for nonsurvivors and survivors, respectively (P less than .002). There were no survivors when the response time was more than eight minutes.(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 2667407 TI - Computed tomography in the initial evaluation of the cervical spine. AB - Unstable injury of the cervical spine must be considered in all victims of blunt trauma. To evaluate the role of limited, directed computed tomography (CT) in the initial evaluation of the cervical spine, a one-year study involving 104 high risk patients was undertaken. Sensitivity was 0.78 overall, but in the group of patients scanned after inadequate plain radiographs, CT had a sensitivity of 1.0 for unstable cervical injury. All false-negative studies involved atlantoaxial rotary subluxation. We conclude that limited, directed CT of the cervical spine is appropriate in the initial evaluation of patients at risk, particularly if plain radiographs are inadequate, but is of limited value in the evaluation of ligamentous injury of the upper cervical spine. PMID- 2667408 TI - Accuracy of interpretations of emergency department radiographs: effect of confidence levels. AB - We conducted a prospective study to assess the relationship between the interpretive agreement rate for emergency department radiographs and the degree of interpretive confidence. We hoped to identify a subset of ED radiographs that did not require mandatory review by a radiologist. For each of the 1,872 plain radiographs studied, emergency physicians assigned a confidence level to the interpretation before comparing it with the radiologist's dictated report. A second radiologist was consulted to resolve disagreements. The overall rate of interpretive agreement was 94.6%. Agreement varied significantly (P less than .001) as a function of confidence level and by type of radiograph, but not by training level. Agreement varied significantly (P less than .001) as a function of confidence level for some types of radiographs (eg, chest, extremities) and for some types of radiographic findings (acute positive). No subset of radiographs had 100% agreement. Treatment was potentially altered in 38 patients as a result of the interpretive disagreement that occurred in 2% of studied radiographs. We conclude that the interpretive agreement rate increases in relation to interpretive confidence but that confidence levels cannot safely exclude certain radiographs from mandatory review by a radiologist. PMID- 2667409 TI - [Guillain-Barre syndrome in children. Analysis of 23 cases]. AB - A group of 23 children aged 5 months to 6 years a diagnosis of Guillain Barre syndrome has been analysed. In 2/3 of our patients the illness appeared in autumn winter period. We considered muscle weaknesses, pain and impairments of cranial nerves to be the main characteristics of the disease. The presence of denervation activity was an indication of worse evolutive prognosis. Hormone treatment was started in 21 cases and plasma exchange in one more, with rapid reduction of the vegetative and the motor symptoms. The progress was considered to be highly favourable in all of them. One child had a recidivant form of this disease. PMID- 2667410 TI - [Pediatric pharmacology: is treatment of children preceded by an adequate investigation?]. AB - The articles published in 1985 in 9 journals (3 of Internal Medicine, 3 of Pediatrics and 3 of Clinical Pharmacology) are revised with the purpose of studying: a) Number of clinical trials published. b) Number of clinical trials published accomplished in children. Among the 533 trials published, 102 were done in children. The type of trial done is studied based on the methodology used, if healthy volunteers are included, if pharmacokinetics studies were done, the ages of the subjects, the number of subjects included, the sex and the way of obtaining the informed consent. PMID- 2667411 TI - [Cutis laxa syndrome associated with articular calcification punctata]. AB - One case of congenital cutis laxa with delayed development, ligamentous and articular laxity, multiple diverticulum and articular punctuated calcifications, with ultrastructural study, is presented. Literature is reviewed, reporting the known data about pathogenesis and inheritance. PMID- 2667412 TI - [Acute lobar nephronia (focal bacterial pyelonephritis). Apropos of 3 cases in children]. AB - We present three cases of acute lobar nephronia or acute focal bacterial nephritis on paediatric patients. Both radiological and echographic pictures are described, emphasizing those aspects which, together with a clinical symptomatology, allow a differential diagnose with abscess and neoplasias renally settled. We think that, among those patients suffering from pyelonephritis, an early practice of renal echography followed by further controls, allow an early detection of lobar nephronia cases and assessing a response to the treatment. PMID- 2667413 TI - [Health recommendations for nursery schools (day care centers)]. AB - A review is made of the health and sanitary conditions, preventive pediatrics, infraestructure, staff and material support as well as safety measures that should be available in day nurseries (creche). This review is made bearing in mind the absence of legislation on a national level to regulate this matters. PMID- 2667414 TI - [Partial trisomy 3q. Contribution of a new case to the literature]. PMID- 2667415 TI - [Subcapsular hepatic hematoma in the neonatal period: echographic diagnosis]. AB - We report a case of Subcapsular Hematoma in a preterm neonate. The etiology, clinical findings and therapeutic features of this entity are reviewed and emphasis is made on the importance of radiographic and sonographic images in early diagnosis. We also discuss the absence of intestinal air in the premature, as well as possible etiologies and differential diagnosis. PMID- 2667416 TI - [Intracerebellar hemorrhage in full-term newborns. Importance of transfontanellar echography. Apropos of a case]. PMID- 2667417 TI - [Rhinoliquorrhea in a case of dysosteosclerosis with sclerosis of the aqueduct of Sylvius]. PMID- 2667418 TI - Diagnosis of deep-vein thrombosis using duplex ultrasound. AB - PURPOSE: To critically evaluate the accuracy, advantages, and drawbacks of duplex ultrasound as a diagnostic test for proximal deep-vein thrombosis. DATA IDENTIFICATION: An English-language search using MEDLINE (1980 to 1988) and bibliographies from articles, and a hand search of pertinent radiology and ultrasound journals from 1988. STUDY SELECTION: All series comparing duplex ultrasound to the reference standard, contrast venography, were reviewed and classified into levels based on the quality of study design. DATA EXTRACTION: Results of duplex ultrasound compared with venography in the proximal deep venous system, technical problems encountered, frequency of diagnosis of other causes of leg swelling, and frequency of unsuccessful or inconclusive studies were collated. RESULTS OF DATA SYNTHESIS: Four well-designed studies reported similar results. The sensitivity of duplex ultrasound in detecting proximal thrombi ranged from 92% to 95% with a combined sensitivity of 93% (CI, 88% to 98%), and the specificity ranged from 97% to 100% with a combined sensitivity of 98% (CI, 96% to 100%). Similar findings were noted in nine other studies that had minor methodologic flaws. Four studies reported that ultrasound was able to identify a nonthrombotic cause of leg swelling in 5% to 15% of cases. Four studies found that duplex ultrasound was inconclusive in 1% to 6% of cases, with a combined frequency of 2%. CONCLUSIONS: Duplex ultrasound appears to be very accurate in the detection of acute proximal deep-vein thrombosis. This test has major advantages as well as certain limitations compared with other diagnostic methods. PMID- 2667419 TI - Mitral valve prolapse: causes, clinical manifestations, and management. AB - PURPOSE: To assess the causes, methods of diagnosis, clinical spectrum, and management of mitral valve prolapse. DATA IDENTIFICATION: Results of prospective study of over 800 subjects at Cornell Medical Center from 1979 to the present were used along with studies published from 1963 to 1989 identified by computerized literature searches of Index Medicus and MEDLINE, and by hand searches. STUDY SELECTION: Studies involving controlled design, longitudinal follow-up, or critical assessment of diagnostic methodology, and clinical studies or previous reviews that have contributed most to the understanding of mitral valve prolapse were selected. DATA EXTRACTION: Data concerning the causes, clinical manifestations and complications, and prevalence of mitral valve prolapse, as well as the strength of association between mitral valve prolapse and diagnostic signs, were evaluated and used to develop a practical approach to evaluating and managing patients. RESULTS OF DATA SYNTHESIS: Most instances of mitral valve prolapse are primary and inherited, with possible genetic heterogeneity. Mitral prolapse may be diagnosed by auscultation of midsystolic clicks and late-systolic murmurs that respond typically to maneuvers, or by billowing of mitral leaflets across the mitral anular plane in long-axis, two dimensional echocardiographic views or by a late-systolic, posterior leaflet displacement of at least 2 mm in meticulously targeted M-mode recordings. Mitral valve prolapse is associated with thoracic bony abnormalities, low body weight, low blood pressure, and a modest excess of orthostatic hypotension, syncope, palpitations, and atrial arrhythmias, but not with nonspecific symptoms (atypical chest pain, dyspnea, anxiety or panic attacks). Complications of mitral valve prolapse, including about 4000 mitral valve operations, 1100 cases of endocarditis, and possibly 4000 sudden deaths per year in the United States, are concentrated disproportionately in older men, with about 5% of affected men and 1.5% of affected women ultimately requiring valve surgery. CONCLUSIONS: Prophylaxis for endocarditis and closeness of follow-up should be related to the occurrence of the independent risk factors for complications of mitral prolapse (presence of mitral regurgitation, male gender, and age over 45 years), whereas active management and close observation are needed for severe mitral regurgitation and advanced ventricular arrhythmias. PMID- 2667420 TI - Norfloxacin: a new drug in the treatment of falciparum malaria. PMID- 2667421 TI - A pragmatic approach to standard setting--the example of coal tar products and asphalt. AB - This article will outline a pragmatic approach directed to incorporating key elements of a scientific review of the literature and derive a proposal for an occupational exposure standard for coal tar, coal tar pitch, creosote, petroleum pitch, bitumen and asphalt, six substances which contain polynuclear aromatic hydrocarbons. Five approaches to the standard setting process are reviewed and their strengths and weaknesses discussed. Unfortunately there does not exist an acceptable epidemiological data set, other than the coke oven emission studies, on which to base a valid and reliable risk assessment model. Based on comparative potency experiments of complex mixtures, consideration of the state-of-the-art sampling and analytical methods, prevention of acute human health effects, and current existing standards for these substances throughout the world, a set of recommended exposure standards are derived for health policy makers. PMID- 2667422 TI - [Labor in patients previously subjected to cesarean section: maternal and fetal aspects. Review of the literature]. AB - In the present study the authors, on the basis of the existing literature, analyse the delivery problem in previous cesarean section patient, especially about maternal mortality and morbidity. After cesarean section vaginal delivery may occur only in selected patients, with precautionary measures and continuous monitoring in labor. The maternal mortality is lower in vaginal delivery patients after cesarean section than in iterative cesarean section patients; also the post operating complications are more frequent after iterative cesarean section. Perinatal mortality is in relation to uterine rupture, perinatal morbidity to iatrogenic prematurity and neonatal respiratory adaptation. PMID- 2667423 TI - [Large colpohematometra with bilateral hematosalpinx resulting from progressive obstruction caused by incomplete vaginal septum]. AB - Complete or incomplete transverse vaginal septum is a rare malformation of the female genital tract. Usually the complete congenital type occurs at puberty because of the collection of menstrual blood above the septum with amenorrhea and cyclic lower abdominal pain as presenting symptoms. On the contrary, in the case shown by the authors, the subacute epilogue occurred in the perimenopausal phase: a very large colpohematometra is reported in a 49 years old woman, with an incomplete vaginal septum resulting in progressive obstruction. The association between this malformation and the presence of endometriotic localizations in the genital tract, as reported by other authors, is interesting. In this case, endometriosis can be secondary to the presence of the septum or could have determined the impairment of the obstruction in consequence of the associated status of chronic flogosis. PMID- 2667424 TI - [Primary carcinoma of the fallopian tube: cases from 1971 to 1985 (27 patients). Current therapeutic approaches]. AB - Twenty-seven patients with carcinoma of the fallopian tube were treated at the First Obstet. Gynecol. Clinic, University of Milan. Nineteen of them had the primary surgical procedure in our center and accounted for 2% of tubal and ovarian carcinomas. The others had been operated elsewhere. Another primary genital cancer occurred in 7 of these women and a breast carcinoma was recorded in the history of other 2. At laparotomy, 11 tumors were Stage I, 9 Stage II, and 7 Stage III. Postoperative adjuvant therapy was not homogenous, however chemotherapy was given to about 59% of patients. Five years survival rate was 65% for Stage I, 34% for Stage II and 17% for Stage III. The discussion deals with early diagnosis, prognostic and/or therapeutic role of pelvic and/or aortic lymphadenectomy and effectiveness of adjuvant therapy. PMID- 2667425 TI - [Deficiencies in humoral immunity]. AB - B cell immune deficiencies are characterized by inadequate production of antibodies and/or low levels of one or more classes of immune globulins (IgG, IgA, IgM) or IgG sub-classes. They include: 1) severe deficiencies involving all the immune globulins (Bruton agammaglobulinemia, variable hypogammaglobulinemia); 2) selective deficiencies in immune globulins (IgA deficiency, IgM deficiency, deficiencies in IgG sub-classes, dysgammaglobulinemias); 3) transient infantile hypogammaglobulinemia; 4) B cell immune deficiencies with normal gammaglobulin levels. Symptoms of B cell immune deficiencies are variable but respiratory manifestations are usually more prominent than the other features that include digestive disorders, fungal infections, autoimmune conditions, joint manifestations, and severe bacterial or viral infections (pneumococcus, meningococcus, enterovirus). Management of IgM and IgA deficiencies rests on antimicrobial agents and non-specific measures. The prognosis of the other B cell immune deficiencies has improved dramatically since effective replacement immune globulin therapy has become available; this treatment combined with antimicrobial therapy and chest physiotherapy can usually prevent development of bronchiectases. The main risk is chronic enteroviral neuromeningeal infection. PMID- 2667426 TI - [Neutropenias in children]. AB - Whereas the clinical expression of childhood neutropenias is fairly uniform, consisting mainly in infections, a wide variety of etiologies may be involved. Pathophysiologic mechanisms have not all been completely elucidated. We review the different etiologies of neutropenia in children using the classification that we believe is the most helpful to clinicians. The clinical features and management of primary chronic neutropenias are described in detail. On the basis of our experience we suggest a practical diagnostic strategy for investigating children with neutropenia. PMID- 2667427 TI - [Chronic septic granulomatosis. Clinical and therapeutic aspects]. AB - Chronic granulomatous disease of childhood is characterized clinically by the occurrence of severe and recurrent bacterial and fungal infections. The underlying biologic anomaly is defective microbicidal capacity of phagocytic cells with an abnormal oxidative response during phagocytosis. In most instances, inheritance is recessive and X-linked. Purulent adenitis and skin infections are the most common manifestations, but the overwhelming majority of deaths are caused by pulmonary aspergillosis, abscesses of the liver, and Salmonella infections. The most frequently recovered microorganisms include staphylococci, Aspergillus, Salmonellae, and Gram-negative rods. Bacterial infections seem to be considerably less frequent in patients under long-term prophylactic treatment with the trimethoprim-sulfamethoxazole combination. However, no oral antifungal agent is as yet available for the prevention of pulmonary aspergillosis, as ketoconazole has proved ineffective. PMID- 2667428 TI - [Chediak-Higashi disease: a new case treated by bone marrow allograft]. AB - We report a new case of Chediak-Higashi disease successfully treated by the transplantation of allogeneic bone marrow. Recurrent infections led to the diagnosis of the disease at the age of 15 months. At two and a half years of age, during a phase of accelerated disease activity, the patient received a bone marrow transplant donated by an HLA-identical brother. The patient was conditioned by chemotherapy alone; T-cells were removed from the graft and cyclosporin A was given to prevent graft-versus-host disease. Evidence of acceptance of the transplant was apparent 14 days after the procedure. Two months after the transplant, the blood count was normal, NK activity was satisfactory and no evidence of GVH disease was present. Incomplete hematopoietic chimerism was found (with two erythrocyte and lymphocyte populations). After four years follow-up, the patient is doing well and has no infections or evidence of active disease. PMID- 2667429 TI - [Prenatal diagnosis of severe and hereditary immune deficiencies]. AB - Antenatal diagnosis is now available for most severe inherited immune deficiencies. Several techniques are used: the development of methods for sampling fetal tissue as soon as the tenth week of gestation has made possible the antenatal diagnosis of immune deficiencies associated with detectable enzyme defects, and, in combination with recent molecular biology techniques, can be expected to allow early identification of severe combined immune deficiencies due to the absence of T lymphocyte precursors, agammaglobulinemia, and some instances of X-linked chronic granulomatous disease. A great number of immune deficiencies can be identified by direct studies of fetal lymphocytes or polymorphonuclear leukocytes in fetal blood sampled by fetoscopy at the twentieth week of gestation. Fetal blood studies combined with skin biopsy examination allows the diagnosis of immune defects associated with partial albinism such as Chediak Higashi disease. No reliable antenatal diagnostic method is as yet available for two severe diseases: Wiskott-Aldrich syndrome, that can be expected to become detectable in utero using molecular biology techniques, and ataxia telangiectasia. Antenatal diagnosis of a severe immune deficiency does not necessarily indicate termination of the pregnancy as in some cases, such as severe combined immune deficiencies, HLA-identical bone marrow transplantation at birth or in utero is permanently successful in over 90% of cases. PMID- 2667430 TI - [Echographic study of gallbladder contraction: normal and pathologic aspects. Apropos of 115 patients]. AB - The gallbladder volume was measured on abdominal ultrasonography in 115 patients consisting of three population groups, before and after ingestion of a fatty meal and/or intravenous administration of cholecystokinin. The variation in volume, estimated as a percentage, was used to assess gallbladder contraction. The first group, consisting of 40 normal individuals without gallstones or impaired gallbladder or hepatic function, can be considered to constitute a control group. In this population, gallbladder contraction exceeded 50% in every case. The second group consisted of 40 cases of acute cholecystitis, including 30 cases with acute gallstones and 10 cases of stone-free acute cholecystitis proven surgically (7 cases) or by guided aspiration (3 cases). Gallbladder contraction was less than 15% in every case. Lastly, a third group of 35 patients with uncomplicated gallstones discovered on routine ultrasonography, demonstrated gallbladder contraction of between 10 and 85%. In this last group, 12 patients with vague gastrointestinal symptoms and gallbladder contraction less than 15% were operated: the histological results demonstrated severe lesions of chronic gallstone cholecystitis. The authors believe that absent or weak gallbladder contraction after endogenous stimulation is a supplementary sign to be taken into consideration in a context suggestive of the diagnosis of acute stone-free cholecystitis and to suggest, in the presence of gastrointestinal symptoms not directly related to the gallbladder, the hypothesis of chronic gallstone cholecystitis. PMID- 2667431 TI - [Therapeutic indications in the treatment of cancer of the ovary]. AB - Cytoreductive surgery is undoubtedly the optimal treatment for ovarian carcinomas. However adjuvant therapies are yet necessary to optimize therapeutic results. An analysis of the literature concerning radiotherapy and chemotherapy allows us to discuss their indications in the post-operative phase of ovarian carcinomas. In advanced stages and for cases where surgical excision was incomplete, chemotherapy clearly appears to be main adjuvant treatment. Radiation treatment is used in order to reduce residual tumor masses or initially grossly invaded areas. In early staged cases and in cases for those in which surgical excision was complete, we discuss the timing between radiotherapy and chemotherapy, and concept of the microscopic residual disease. PMID- 2667432 TI - [Radiotherapy after chemotherapy and second-look laparotomy in the treatment of advanced ovarian cancers]. AB - In order to better assess the place of abdominopelvic irradiation after chemotherapy in the treatment of advanced ovarian carcinoma, the survival times in 25 patients treated from 1976 to 1986 were examined. 2 stage IIc, 18 stage III and 4 stage IV were treated. Treatment included chemotherapy (with cisplatin in 16/25 cases) and a second-look laparotomy. 12 patients had only microscopic residual tumor, 5 had macroscopic tumor less than 2 cm, and 8 patients had no detectable residual tumor. A whole abdomen irradiation of 22.50 Gy with a pelvic boost to 45 Gy was also performed. Actuarial 3-year survival was 58% for the entire population. 10 loco-regional relapses were observed. The 3-year-actuarial survival was 71% for stage III patients. Haematologic tolerance of irradiation was poor with only 17 patients (68%) receiving the complete dose of irradiation. One late grade 3 intestinal complication was observed. These results and others previously published, suggest that abdominal irradiation is valuable in the treatment of advanced ovarian carcinoma for stage IIc or III patients without macroscopic residual disease after chemotherapy and second-look laparotomy. PMID- 2667433 TI - [Imaging of malignant tumors of the uterus and ovary]. AB - Authors discuss the role of new imaging methods in the management of malignant tumors of the ovaries and uterus. After briefly reviewing the imaging methods and particularly lymphangiograms, they discuss the value of these techniques for each tumor. The indications of these techniques detailed in the last chapter. PMID- 2667434 TI - [Macroangiopathy of a kidney graft caused by cyclosporin A]. AB - We report a case of renal macroangiopathy occurring after transplantation in a 50 year-old woman who received a cadaveric kidney and who was immunosuppressed with cyclosporin A. Accelerated hypertension at 3 months led to renal angiography which revealed diffuse narrowing of the two main renal arteries and their intrarenal branches. The patient returned to regular haemodialysis four months post-transplantation. These angiographic cyclosporin A-ascribed findings are similar to those recently reported by Sawaya. PMID- 2667435 TI - [Scrotal echography in the diagnosis of cancer of the testis: misleading images and echographic patterns]. AB - Ultrasound seems to be the investigation of choice when a testicular tumor is suspected, especially when physical examination appears to be normal. 37 testicular tumors have been diagnosed out of a series of more than one thousand case of scrotal ultrasonography. The most important sonographic patterns are presented and their etiologies are discussed. PMID- 2667436 TI - [Volvulus of the sigmoid colon]. AB - The authors report of 34 cases of sigmoid colon volvulus occurring in young subjects (15%) and in elderly subjects (60% over the age of 75 years). The diagnosis is frequently suggested by the clinical features and the history (30% of patients have a history of a previous identical episode) and is confirmed by a plain abdominal x-ray and/or an opaque enema. Endoscopy is performed in every case, except in the presence of peritoneal signs, in an attempt to perform detorsion and colonic intubation under direct vision in order to avoid emergency surgery; this procedure is effective in 87% of cases. Emergency surgery has a high mortality rate (43.5%). Elective or deferred emergency surgery after preparation is much safer (6.6% mortality). In patients with multiple diseases, non-surgical conservative management after detorsion too frequently results in repeated complications, leading to decompensation of the concurrent illnesses and a mortality rate of 34%. Endoscopic detorsion followed by surgical resection after a short 3 to 4 day preparation seems to be the best guarantee of therapeutic success. PMID- 2667437 TI - [Total gastrectomy versus partial gastrectomy of adenocarcinoma of the antrum. A French prospective controlled study]. AB - In a prospective multicentric trial we compared the post-operative mortality and the 5-year survival of elective total gastrectomy (TG) versus subtotal gastrectomy (SG) for adenocarcinoma of the antrum operated on with intent of cure. Two hundred and one patients were included in the study: thirty two were excluded after pathological examination (linitis plastica, superficial cancer, lymphoma). One hundred and sixty nine patients remained for analysis with 93 TG and 76 SG. Elective TG did not increase post-operative mortality (1.3%) in comparison with SG (3.2%). There was no difference in the 5-year survival rate (48%). Analysis of survival showed no difference in the two techniques when related to nodal involvement and serosal extension. It is concluded that both operations TG and SG can be performed safely in patients with adenocarcinoma of the antrum; however TG did not increase the survival rate. PMID- 2667438 TI - [Microvascular sutures using a CO2 laser. Initial clinical applications. Apropos of 6 cases]. AB - Six microvascular anastomoses were performed using a CO2 low output laser. Time of execution was shorter than with the conventional technique. CO2 laser seems to be promising technique and should allow a better patency rate in microvascular surgery. PMID- 2667439 TI - [2 cases of villous tumor of the appendix]. AB - Villous tumors of the vermiform appendix are uncommon with two cases and a review of the literature, the authors indicate the lack in specific clinical sign, and lay stress on the importance of the pathologic study on the therapeutic management. PMID- 2667440 TI - [A case of parathyroid adenoma localized in the middle mediastinum]. AB - The discovery of a parathyroid adenoma in the middle mediastinum is exceptional and fewer than 10 cases have been reported. On the basis of a new case, the authors propose several pathogenic hypotheses: this adenoma develops and/or migrates from the fourth branchial pouch. Preoperative imaging is very useful for guiding the operation via sternotomy. The absence of any CT signs in the present case caused us to explore the retro-aortico-caval region. Sternotomies performed for the treatment of primary hyperparathyroidism are unsuccessful in one third of patients. In more than 30% of cases, the cause for this failure is related to the persistence of a cervical adenoma: when the pathological gland is actually located in the mediastinum, the possibility of middle mediastinal ectopia should be considered when investigation of the classical sites in the neck and mediastinum remains negative. PMID- 2667441 TI - [Value of digital subtraction of left ventriculographies by the venous route. Comparison with balanced scintigraphy of the heart cavities]. AB - The development of numerisation material in radiology currently permits to perform usual cardiovascular tests. The authors report a series of 48 patients who benefited from the determination by numerised left ventriculography, of their stroke volume (SV). In 37 cases, the peripheral venous route is used while in 11 cases the central venous route is used, in the pulmonary artery trunk. The SV values obtained with both methods (one advocated by the manufacture and another one developed by the authors), are correlated with the SV values obtained with the isotopic method, used as reference. The correlations are satisfactory, approximately 0.79 for all patients of the study, and markedly improve when the injection of the contrast material is performed in the pulmonary artery (approximately 0.95). The authors conclude that determination of the left ventricle SV by numerisation is an interesting technique in centers where there is no department of nuclear medicine, and is absolutely necessary to complement right catheterisation. PMID- 2667442 TI - [Arterial and venous thromboembolic complications in patients with renal transplants. Apropos of 2 cases]. AB - The study of two cases of young patients with renal transplants who, successively and a few months after the procedure, presented a thrombophlebitis of the lower extremities (with or without pulmonary embolism), then an acute coronary insufficiency, without any encouraging or triggering factor, raises the hypothesis that this is not a mere coincidence. In fact, in the literature, numerous cardiovascular risk factors) inherent in complicated chronic renal failure, dialysis, steroid therapy and immuno-suppressive treatment (Azathioprime, under these circumstances) were demonstrated. In addition, abnormalities of the platelets aggregation, hemostasis and fibrinolysis, were at the origin of thrombo-embolic accidents. Besides any specific cardiovascular risk factor or any obvious biological anomaly, there is still a predisposition of patients with renal transplants, to arterial as well as venous thrombo-embolic accidents. PMID- 2667443 TI - [Comparison of the left ventricular stroke volume and fraction measured with MRI and contrast ventriculography]. AB - 27 patients who underwent a contrast ventriculography in right anterior oblique at 30 degrees (for various cardiopathies) were studied by MRI with a mean delay of 5.7 +/- 6.2 days. After location of the medio-ventricular area, a diastolic horizontal section (apex of the R wave) and a systolic section (descending portion of the T wave) are carried out using the spin ultrasound technique. The same calculations are used for MRI au X-Ray contours (modified area-length method) by two strictly independent operators. With MRI, the LVSF is under estimated (40.4 +/- 19%) as compared angiography (46.1 +/- 18%). The linear correlation is 0.79 and in half of the patients (13 in 27) the deviation of the LVSF exceeds 10 p. cent. The volumes also tend to be underestimated with MRI (97 +/- 50 and 64 +/- 51 ml for the diastole and systole respectively) compared with angiography (123 +/- 66 and 73 +/- 62 ml), but the difference is only significant for the diastole and the linear correlation coefficients are improved at 0.82 and 0.90. Underestimation of the parameters measured with MRI is the consequence of multiple factors including the imprecise determination of the true telesystole, the marked effect of the partial volume related to the thickness of the section, and especially the obliquity of the plane studied on MRI, compared with the long axis of the heart. The error made by using a calculation algorithm, conceived for projective methods showing the long axis of the modeled ellipsoid, also explains the underestimation of volumes obtained with MRI, tomographic method. The simple technique used here seems especially interesting in the analysis of segmental contraction. Finally, the development of cine-MRI will undoubtedly be extremely beneficial in the study of ventricular contraction and relaxation. PMID- 2667444 TI - [Ifenprodil tartrate in the treatment of occlusive arteriopathies of the lower limbs. Results of a prospective double-blind controlled multicenter trial]. PMID- 2667445 TI - New immunologic markers for monitoring of cancer. PMID- 2667446 TI - CEA directed second-look surgery for colon and rectal cancer. PMID- 2667447 TI - Tumour markers in gastric cancer. AB - We still lack clinically useful tumour markers in gastric cancer. To be of clinical value markers should be elevated in the early stages of the disease, when surgery for cure is possible. However, tumour markers available today, like CEA, CA 19-9 and CA 50, mainly detect advanced gastric cancer, for which only palliative treatment is available. The use of tumour markers in the follow-up of radically operated patients seems to be of only academic interest, mainly because a recurrence of gastric cancer is incurable. The preoperative tumour marker level may have a prognostic value and may be clinically useful in selecting patients for adjuvant treatment. To elucidate this, prospective controlled trials are needed. A short review of tumour markers in gastric cancer will be presented. PMID- 2667448 TI - Tumour markers in pancreatic cancer. AB - Patients with pancreatic cancer usually lack signs and symptoms in the early course of the disease. Even when malignancy is suspected, differential diagnosis between benign and malignant pancreatic disorders may be difficult with current methods. An increasing interest has been focused on the utility of immunological tumour markers. CEA has been widely used since the early seventies, but the results in diagnosis of pancreatic cancer have been disappointing. Tumour marker tests for CA 19-9 and CA 50 are based on monoclonal antibodies to colonic carcinoma cell lines. CA 19-9 and CA 50 are strongly expressed in most tissue specimens from pancreatic carcinomas, but are also found in normal pancreas and benign pancreatic diseases. The CA 19-9 and CA 50 antigens are shed or released into the circulation, and are found in increased concentrations in 70-80% of patients with pancreatic cancer. Also 50-65% of patients with small resectable carcinomas have elevated CA 19-9 and CA 50 levels, although very high serum concentrations usually indicate advanced disease. Slightly elevated serum CA 19-9 and CA 50 levels are seen in some patients with benign pancreatic diseases, more often in acute than in chronic pancreatitis. Elevated values are often observed in patients with benign obstruction of the common bile duct, particularly in patients with cholangitis. In patients with jaundice of hepatocellular origin, the CA 19-9 and CA 50 levels are lower than in extrahepatic cholestasis. CA 19-9 and CA 50 have better diagnostic accuracy for pancreatic cancer than CEA, CA 125, DU-PAN-2, TPA and PSTI/TATI. However, the sensitivities and specificities of CA 19-9 and CA 50 are too low for screening of an asymptomatic population. Nevertheless, CA 19-9 and CA 50 have in our experience shown to be useful complements to other diagnostic methods in symptomatic patients with suspicion of pancreatic cancer. Combinations of different markers improve the sensitivity only slightly compared to the use of CA 19-9 or CA 50 alone. Follow-up using CA 19-9 and CA 50 is a simple and sensitive way of monitoring the postoperative course of patients with pancreatic cancer, and may give a lead time of several months for a recurrence compared to conventional methods. PMID- 2667449 TI - Tumour markers in breast cancer. PMID- 2667450 TI - The clinical use of human tumour markers. PMID- 2667451 TI - Tumour markers in testicular and prostatic cancer. PMID- 2667452 TI - Tumour-associated trypsin inhibitor, TATI. Clinical use and biological function. PMID- 2667453 TI - The role of cholesterol oxidation products in the pathogenesis of atherosclerosis. AB - Cholesterol undergoes spontaneous autoxidation, leading to the production of potentially atherogenic oxidation derivatives. When 25-hydroxycholesterol (25-OH) or cholestane-3 beta, 5 alpha, 6 beta-triol (triol) was injected intravenously into rabbits, the aortic surfaces showed numerous balloon-like protrusions and crater-like defects indicative of endothelial damage. Alterations in membrane function caused by these cholesterol oxides could be the mechanism for their cytotoxic effect. Carrier-mediated hexose transport by cultured rabbit aortic smooth muscle cells, measured using 2-deoxyglucose, was reversibly inhibited by triol within one hour. A membrane-bound enzyme, 5'-nucleotidase, was inhibited after 24 to 48 hrs incubation with either 25-OH or triol. Endocytosis was also significantly inhibited by both 25-OH and triol. Depletion of membrane cholesterol content by the cholesterol oxides could account for the membrane functional alterations. Cholesterol biosynthesis is markedly inhibited by 25-OH. Triol has a lesser effect on cholesterol biosynthesis, but it is more potent in blocking uptake of cholesterol by arterial cells in culture. Cholesterol oxides may also influence cholesteryl ester accumulation by arterial smooth muscle cells. Incubation of cells with 25-OH resulted in a four-fold increase in cholesterol esterifying activity but no effect on cholesteryl ester hydrolytic activity. The cholesterol oxides appear to be transported in the blood primarily by very low density lipoproteins (VLDL) and low density lipoproteins (LDL). Oxidized LDL has cytotoxic effects and enhances macrophage lipid accumulation. These be effects may be directly related to the cholesterol oxide content of these lipoproteins. PMID- 2667454 TI - Increased urinary lipoperoxide levels in renal transplant patients. AB - Using high performance liquid chromatographic methods, both plasma and urine lipoperoxide concentrations were measured, as malondialdehyde (MDA), in 30 stable renal transplant patients receiving daily cyclosporine and/or azathioprine therapy. Their MDA concentrations were compared with previously reported reliable reference values using the same liquid chromatographic methods. Although their plasma concentrations were within the reference range, their mean urine MDA values averaged 3.7 to 5.0 times the normal reference values (p less than 0.001). The primary cause of the increased urine MDA concentrations following renal transplantation in these patients is unknown; it could be due to (a) renal lipid peroxidation directly related to the cyclosporine/azathioprine therapy, (b) drug induced or other nephrotoxicity by an alternative mechanism with secondary lipid peroxidation, (c) increased lipid peroxidation owing to an immunologic response to the kidney graft, or (d) a combination of these possibilities. PMID- 2667455 TI - Goodpasture's syndrome mimicking idiopathic pulmonary hemosiderosis. AB - A patient initially diagnosed by clinical findings and pulmonary biopsy as suffering from idiopathic hemosiderosis was subsequently proven by renal biopsy and serologic assay to have Goodpasture's syndrome with minimal renal alterations. The authors speculate on the relationship of these two complex disorders. PMID- 2667456 TI - Townes-Brocks syndrome. Report of a case and review of the literature. AB - The authors report a new case of Townes-Brocks syndrome with cardiac defect, ossicular anomalies and dominant transmission. The intrafamilial variability of the phenotype and the difficulty of diagnosis in isolated cases are underlined. PMID- 2667457 TI - The 8p-syndrome. AB - A partial de novo deletion of 8p in a 10 1/2 month-old boy is described, the karyotype being 46,XY,del(8) (p21.3-qter:). Reduced birth weight, growth and psychomotor retardation, craniofacial dysmorphism with microcephaly and low set, deformed ears, stubby nose, wide set nipples, congenital heart defect and undescended testes were the main clinical findings. Death occurred at 2 1/2 years of age due to fulminant tracheo-bronchitis. Red cell glutathion reductase activity was normal. A review of previous cases with similar deletions outlines a definite clinical entity. PMID- 2667458 TI - Digeorge anomaly associated with partial deletion of chromosome 22. Report of a case with X/22 translocation and review of the literature. AB - Partial monosomy of 22q, resulting from a de novo unbalanced translocation t(X;22)(q28;q11) was detected in a newborn female with manifestations of the DiGeorge anomaly including multiple anomalies, type I truncus arteriosus, T-cell abnormalities, thymic aplasia and parathyroid hypoplasia noted on postmortem examination. Although DiGeorge anomaly is causally heterogeneous, our patient, together with 18 previously known cases, confirm that partial monosomy of the proximal long arm of chromosome 22 is the single most common cause of this polytopic developmental field defect. PMID- 2667459 TI - De novo dir dup (1)(q3200----4200) in an adult. Further delineation of the pure 1q trisomy syndrome. AB - An adult male patient with a "de novo" pure trisomy 1q32---q42 was studied. Literature review of 33 cases with 1q trisomy allowed singling out a distinctive phenotype by eliminating clinical features of concomitant aneusomies. It is concluded, however, that the clinical pictures of the "pure" and "impure" 1q trisomies are similar and that the critical segment includes bands q32 and q41. PMID- 2667460 TI - Characterization of the microbial community colonizing the anal and vulvar pores of helminths from the hindgut of zebras. AB - Scanning and transmission electron microscopy were used to examine the adherence and in situ morphology of the microbial community colonizing the anal and vulvar pores of the subfamily Cyathostominae (Nematoda: Strongylidae) from the colon of Burchell's zebra (Equus burchelli antiquorum). Two different morphological types of asporogenous rod were prominent in the microbial community. One was a thin, septate, filamentous organism (0.4 to 0.5 micron by 2 to 3 microns) with blunt ends, which was more prominent at the site of attachment. The other was a larger (1.8 to 2.4 microns by 5 to 10 microns) multicellular rod with round ends in the form of a trichome. Spiral- and vibrio-shaped bacteria were also present in the thin sections. The septate filaments were shown to contain a cell spacer similar to those described in Methanospirillum hungatei. Attachment to the cuticle was by means of an amorphous electron-dense material with fibrillar appearance and not by specialized holdfast segments. Ten isolates were obtained from a habitat simulating medium on which a homogenate from the posterior region was plated. Antibodies were raised to whole cells of five rod-shaped isolates in rabbits and fluorescein isothiocyanate labeled. Positive bright-yellow fluorescence was obtained with one of the clostridial isolates. The results are discussed with reference to other bacteria with similar morphology, the nature of this unique interrelationship between the microbial community and its parasitic host inside the equine hindgut, and the possibility of biological control of parasitic helminths. PMID- 2667461 TI - Hyperexpression of a Bacillus circulans xylanase gene in Escherichia coli and characterization of the gene product. AB - A 4.0-kilobase (kb) fragment of Bacillus circulans genomic DNA inserted into pUC19 and encoding endoxylanase activity was subjected to a series of subclonings. A 1.0-kb HindIII-HincII subfragment was found to code for xylanase activity. Maximum expression levels were observed with a subclone that contained an additional 0.3-kb sequence upstream from the coding region. Enhancer sequences in the upstream region are thought to be responsible for these high expression levels. Southern hybridization analyses revealed that the cloned gene hybridized with genomic DNA from Bacillus subtilis and Bacillus polymyxa. Xylanase activity expressed by Escherichia coli harboring the cloned gene was located primarily in the intracellular fraction. Levels of up to 7 U/ml or 35 mg/liter were obtained. The protein product was purified by ion exchange and gel permeation chromatography. The xylanase had a molecular weight of 20,500 and an isoelectric point of 9.0. PMID- 2667462 TI - Survival of chlorine-injured enterotoxigenic Escherichia coli in an in vitro water system. AB - Survival of chlorine-injured and noninjured subpopulations of enterotoxigenic Escherichia coli was compared in KH2PO4-buffered water and chlorine-neutralized tap water. Injured cells were no less persistent than noninjured cells and did not exhibit limited survival as a consequence of chlorine injury. At high inoculum densities, some injured cells were able to repair, apparently owing to the accumulation of materials arising from the chlorination procedure. PMID- 2667463 TI - Novel method for monitoring genetically engineered microorganisms in the environment. AB - A method has been devised for directly detecting and monitoring genetically engineered microorganisms (GEMs) by using in vitro amplification of the target DNAs by a polymerase chain reaction and then hybridizing the DNAs with a specific oligonucleotide or DNA probe. A cloned 0.3-kilobase napier grass (Pennisetum purpureum) genomic DNA that did not hybridize to DNAs isolated from various microorganisms, soil sediments, and aquatic environments was inserted into a derivative of a 2,4-dichlorophenoxyacetic acid-degradative plasmid, pRC10, and transferred into Escherichia coli. This genetically altered microorganism, seeded into filter-sterilized lake and sewage water samples (10(4)/ml), was detected by a plate count method in decreasing numbers for 6 and 10 days of sample incubation, respectively. The new method detected the amplified unique marker (0.3-kilobase DNA) of the GEM even after 10 to 14 days of incubation. This method is highly sensitive (it requires only picogram amounts of DNA) and has an advantage over the plate count technique, which can detect only culturable microorganisms. The method may be useful for monitoring GEMs in complex environments, where discrimination between GEMs and indigenous microorganisms is either difficult or requires time-consuming tests. PMID- 2667464 TI - Use of a novel air separation system in a fed-batch fermentative culture of Escherichia coli. AB - A novel air separation system based on permeable membrane gas separation technology was used to cultivate Escherichia coli. The system fulfilled the dissolved oxygen requirements of a culture of E. coli grown on a glucose synthetic medium at a high and constant growth rate of 0.55 h-1. A biomass yield of 45 g (dry weight) per liter was achieved, and no by-product inhibition by acetate or CO2 was observed. PMID- 2667465 TI - Growth rate control of adherent bacterial populations. AB - We report a novel in vitro method which, through application of appropriate nutrient limitations, enables growth rate control of adherent bacterial populations. Exponentially growing cells are collected by pressure filtration onto cellulose acetate membranes. Following inversion into the bases of modified fermentors, membranes and bacteria are perfused with fresh medium. Newly formed and loosely attached cells are eluted with spent medium. Steady-state conditions (dependent upon the medium flow rate) at which the adherent bacterial biomass is constant and proportional to the limiting nutrient concentrations are rapidly achieved, and within limits, the growth rate is proportional to the medium flow rate. Scanning electron microscopic studies showed that such populations consist of individual cells embedded within an extracellular polymer matrix. PMID- 2667466 TI - Inositol polyphosphates and intracellular calcium release. AB - The hydrolysis of inositol lipids triggered by the occupation of cell surface receptors generates several intracellular messengers. Many different inositol phosphate isomers accumulate in stimulated cells. Of these D-myo-inositol 1,4,5 trisphosphate (Ins 1,4,5-P3) is responsible for discharging Ca2+ from intracellular stores. Specific membrane binding sites for Ins 1,4,5-P3 have been detected. The properties of these sites and their possible relationship to the calcium release process is reviewed. Ins 1,4,5-P3 binding sites may be present in discrete subcellular structures ("calciosomes"). Kinetic and some electrophysiological evidence indicates that Ins 1,4,5-P3 acts to open a Ca2+ channel. Recent progress on the purification of the receptor from neuronal tissues is summarized. Phosphorylation of Ins 1,4,5-P3 by a specific kinase results in the production of D-myo-inositol 1,3,4,5-tetraphosphate (Ins 1,3,4,5 P4). This inositol phosphate has been reported to increase the entry of Ca2+ across the plasma membrane, activate nonspecific ion channels in the plasma membrane, alter the Ca2+ content of the Ins 1,4,5-P3-releasable store, and bind to and alter the activity of certain enzymes. These data and the possible biological significance of Ins 1,3,4,5-P4 are discussed. PMID- 2667467 TI - Influence of glycosylation on the oligomeric structure of yeast acid phosphatase. AB - Secreted yeast acid phosphatase is found to be an octamer under physiological conditions rather than a dimer, as previously believed. The octameric form of the enzyme dissociates rapidly into dimers at pH below 3 and above 5, or by treatment with guanidine hydrochloride or urea, without further dissociation of dimers. Crosslinking experiments revealed that the dissociation of the octamer occurs through very unstable hexamers and tetramers, showing that the octamer is built of dimeric units. Dissociation to dimer was in all cases accompanied with a loss of most of the enzyme activity. The underglycosylated acid phosphatase, with less than eight carbohydrate chains per subunit, secreted from cells treated with moderate tunicamycin concentrations, contained besides octamers a high proportion of the dimers. With decreasing levels of enzyme glycosylation, the proportion of dimers increases and the amount of octamers correspondingly decreases. Furthermore, underglycosylated octamers were found to be significantly less stable than the fully glycosylated ones. This showed that carbohydrate chains play a significant role in the octamer formation in vivo, and in stabilization of the enzyme octameric form. PMID- 2667468 TI - Identification of type III protein kinase C in bovine aortic tissue. AB - We identified a subtype of protein kinase C in bovine aortic tissue. In Western blots, both the soluble and the particulate fractions from the aorta reacted only with MC-3a. In the case of hydroxylapatite column chromatography, a single activity peak of protein kinase C from the soluble and the particulate fractions was obtained with about 140 mM of potassium phosphate, a finding similar to that with the Type III protein kinase C from rabbit brain. The sandwich-type enzyme immunoassay for protein kinase C, with which the contents of each protein kinase C isozyme can be determined in the crude extracts, revealed that the Type III bovine aortic protein kinase C included 25.9 ng/mg protein. These results strongly suggest that it is the Type III protein kinase C which is mainly expressed in aortic tissue. Kinetic parameters of the Type III protein kinase C of the soluble and the particulate fractions, with respect to the Km for ATP, were 33 and 15 microM and the Km values for myosin light chain from chicken gizzard were 6.3 and 4.6 microM, respectively. PMID- 2667469 TI - Evidence for eosinophil degranulation in the pathogenesis of herpes gestationis. AB - Herpes gestationis is a pregnancy-related bullous dermatosis of unknown origin with associated tissue and peripheral blood eosinophilia. In this report, eosinophil degranulation in herpes gestationis was studied, and the role that the eosinophil may have as an effector cell that induces tissue damage through deposition of toxic cationic proteins is discussed. Using indirect immunofluorescence with antibody to human eosinophil granule major basic protein, major basic protein was observed both within tissue eosinophils and deposited extracellularly outside eosinophils in the dermis of eight patients with herpes gestationis. Possible mechanisms whereby eosinophils might be activated to degranulate in herpes gestationis are reviewed. PMID- 2667470 TI - Proteus syndrome. AB - The term Proteus syndrome was coined in 1983 to describe a disorder of skeletal, hamartomatous, and other mesodermal malformations. The syndrome was named after the Greek god Proteus, whose name means "the Polymorphous." Clinical features of this new syndrome are currently being defined. Including the case reported herein, we have found 34 patients with Proteus syndrome described in the English literature. Major clinical findings, defined as those findings seen in more than half of the cases, include hemihypertrophy, macrodactyly, exostoses, epidermal nevi, characteristic cerebriform masses involving the plantar or palmar surfaces, a variety of subcutaneous masses, and scoliosis. Histologic examination of subcutaneous masses has identified a variety of lipomatous, hamartomatous, and angiomatous tumors. PMID- 2667471 TI - Resection of hepatic metastases from colorectal cancer. Biologic perspective. AB - During the past decade the results of slightly fewer than 1000 resections of liver metastases from colorectal carcinoma have been analyzed, retrospectively reanalyzed, and reviewed. The following are confirmed conclusions: major liver resection can be performed safely (less than a 5% operative mortality rate); 20% to 25% of these patients are cured; no other regional therapy options have any curative potential. The following caveats are also obvious: most patients who are operated on are not cured; although predictors have been proposed to select patients most likely to benefit from surgery, none is discriminating in and of itself; most therapy questions in this group of patients have not been addressed in any formal way; surgery for isolated regionally recurrent colon and rectum carcinoma remains an important stopgap only until effective systemic therapy is discovered. This review of our own and other single and multi-institutional prospective and retrospective data will be framed by the following questions. (1) Does resection of liver metastases cure patients or simply select those who would have survived in the long-term without any therapy? (2) In the absence of any formalized, properly designed trial, how can one judge the benefit of resection? (3) Why do metastases recur only in the liver? (4) What new therapies should focus on the predominant secondary failure sites in the majority of patients who do not benefit from hepatic metastasis resection? PMID- 2667472 TI - Emptying of the gastric substitute after total gastrectomy. Jejunal interposition versus Roux-y esophagojejunostomy. AB - Emptying of the gastric substitute and small bowel transit time of a 99mTc labeled solid test meal were measured in 20 tumor-free patients 13 to 63 (median, 35) months after total gastrectomy with Roux-y (n = 11) and jejunal interposition (n = 9) reconstruction. The emptying half-times ranged from 2 minutes to greater than 20 minutes. Rapid emptying was associated with dumping symptoms (p less than 0.03) and shorter orocoecal transit-time (p less than 0.05). Serum glucose concentrations rose more quickly in jejunal interposition, but the areas under the curve were identical in both groups. The median insulin-to-glucose ratio (areas under the curve) during the 20 minutes after the meal was 11.4 in jejunal interposition and 7.1 in Roux-y esophagojejunostomy (NS). Interposition cases had regained a significantly higher percentage (89%) of their premorbid weight than patients with Roux-y (78%; p less than 0.05). The weight/height2 ratio was above the 50th centile in 45% of interpositions, but below the 50th centile in all patients after the Roux-y mode of reconstruction (p less than 0.05). It is concluded that the emptying velocity of the gastric substitute has no impact on postoperative weight gain. The authors contend that the concept of a gastric substitute pouch is not supported by the findings of this study. PMID- 2667473 TI - Reversal of hypersplenism following orthotopic liver transplantation. AB - The purpose of this study was to clarify the effect of orthotopic liver transplantation on hypersplenism. In a 1-year period from July 1, 1986 to June 30, 1987, 196 adult patients underwent 233 orthotopic liver transplantations. Of the 58 patients with hypersplenism who were analyzed in this study, hypersplenism was more commonly associated with postnecrotic cirrhosis than other kinds of liver disease (55.3% (47/85) vs. 14.5% (11/76); p less than 0.001). Postoperative platelet counts were statistically higher than preoperative values (p less than 0.05). The latest platelet counts were more than 100,000/mm3 in 53 patients (91.4%). Of the eight patients whose preoperative and postoperative spleen volumes could be compared, all showed the reduction in the spleen size (p less than 0.02). We conclude that orthotopic liver transplantation, which is a radical surgical procedure for portal hypertension, reverses hypersplenism. PMID- 2667474 TI - Congenital absence of the portal vein. AB - A 14-year-old girl presented at the hospital after discovering an abdominal tumor. CT scan and ultrasonography indicated a hepatic tumor and also revealed the absence of the portal vein. The patient was admitted to excise the hepatic tumor. It was found that the venous blood from the small intestines flowed into the left renal vein and then emptied directly into the inferior vena cava. A tumor extending from the right lobe through the middle portion of the liver was excised. The postoperative course was satisfactory and marked regeneration of the residual hepatic tissue was observed. Also the blood level of ammonia in the superior mesenteric vein was low, approximately 120 micrograms/dl, compared to the normal value of 350 micrograms/dl in the portal vein. This low blood level may indicate the presence of some homeostatic control mechanism. PMID- 2667475 TI - Percutaneous aspiration and alcohol sclerotherapy for symptomatic hepatic cysts. An alternative to surgical intervention. AB - Eight patients with 15 symptomatic nonneoplastic congenital hepatic cysts underwent ultrasound-guided percutaneous aspiration and temporary injection of 99% ethanol into the cyst. All cysts were treated at least twice at the same sitting. The volume of alcohol injected varied from 20 to 100 ml, depending on the size of the cyst. A cure was usually achieved with one alcohol sclerotherapy treatment. Only minor side effects such as transient pain and temperature elevation occurred. No recurrences were found during a follow-up period of 12 to 32 months. The results indicate that aspiration and alcohol sclerotherapy is a feasible alternative to surgical intervention in patients with symptomatic nonneoplastic congenital hepatic cysts. We recommend it as the treatment of choice in cases with high surgical risk or polycystic liver disease. PMID- 2667476 TI - Peripheral blood leukocyte kinetics following in vivo lipopolysaccharide (LPS) administration to normal human subjects. Influence of elicited hormones and cytokines. AB - Lipopolysaccharide (LPS, endotoxin) administration to human subjects elicits significant elevations in plasma cachectin/TNF, epinephrine, and cortisol. This study examined the temporal relationship between changes in blood leukocyte subsets and plasma mediators following endotoxin administration to normal human subjects. A five-minute intravenous infusion of purified LPS (20 units/kg Escherichia coli) was administered to 12 healthy volunteers. Blood samples were obtained at varying intervals after infusion and analyzed for differential cell counts and lymphocyte subsets (CD2, CD3, CD4, CD8, CD20, and HLA-DR) by flow microfluorimetry, and also assayed for plasma cachectin/TNF, epinephrine, and cortisol. Plasma cachectin/TNF was significantly elevated at 75 and 90 minutes after infusion with a peak concentration of 261 +/- 115 pg/ml noted 75 minutes after infusion. A significant plasma epinephrine elevation of 181 +/- 75 pg/ml was demonstrated one hour after infusion, while significant elevations in plasma cortisol were noted from one to five hours after infusion with a peak level of 34 +/- 3 micrograms/dl three hours after infusion. A profound monocytopenia (p less than 0.01) was noted one hour after infusion. Temporally associated with the rise in plasma cortisol was a reversal of the early granulocytopenia to a significant granulocytosis (p less than 0.01 versus preinfusion mean), whereas a marked lymphocytopenia (p less than 0.01) was observed from one to six hours after infusion. During the period of hypercortisolemia, CD2, CD3, and CD4 lymphocyte percentages were decreased (p less than 0.01) while CD20 and HLA-DR lymphocyte percentages were increased (p less than 0.01). There was a small percentage decrease in CD8 lymphocytes from one to 24 hours after infusion (p less than 0.01), although relative to the one-hour nadir, there was a significant rise in the percentage during the time of elevated plasma cortisol concentrations. A six hour infusion of epinephrine (30 ng/kg/min) administered to six healthy volunteers resulted in a monocytosis (p less than 0.05) and granulocytosis (p less than 0.01) without a change in lymphocyte number or lymphocyte subset percentage. Previous reports have shown that in vivo corticosteroid infusion causes a prominent granulocytosis, monocytopenia, and lymphocytopenia with a decrease in the percentages of CD3 and CD4 lymphocytes. The peripheral blood leukocyte dynamics documented in the current study are similar to patterns observed following in vivo corticosteroid administration. This study suggests that the acute adrenocortical response to endotoxemia primarily mediates the subsequent changes in leukocyte subsets. PMID- 2667477 TI - Successful repair of left ventricular rupture after redo mitral valve replacement. AB - A patient with an extensive type I left ventricular rupture after a redo mitral valve replacement was successfully treated using a patch of glutaraldehyde preserved pericardium sutured to the endocardium around the tear. PMID- 2667478 TI - Traumatic laceration of a saphenous vein graft: successful surgical repair. AB - Traumatic laceration of a saphenous vein grafted for coronary artery bypass is extremely rare. Successful surgical repair of a laceration was performed in a 64 year-old man who developed retrosternal hematoma from a saphenous vein graft after blunt injury to the chest. PMID- 2667479 TI - Interlocking figure-of-8 closure of the sternum. AB - Sternal dehiscence and mediastinitis are two of the most severe complications of a median sternotomy. A technique of closure is described that appears to provide a more stable sternal approximation without any increase in overall complication rate. Using this technique in 978 consecutive patients, no cases of sternal dehiscence or mediastinitis have been seen. PMID- 2667480 TI - Allograft aortic valve replacement for bicuspid aortic valves with 180-degree coronary ostia. AB - Congenital bicuspid aortic stenosis is often an indication for aortic valve replacement in young adults and children. However, when the coronary ostia are exactly 180 degrees opposite each other, placing a trileaflet human allograft with freehand technique can be difficult. The described technique enlarges the left ventricular outflow tract beginning at the annulus level, using only allograft tissue. In addition to allowing placement of a larger allograft, this method rotates the coronary ostia toward each other, converting the aortic root to three-sinus anatomy. PMID- 2667481 TI - Unterdruck and Uberdruck, 1904. PMID- 2667482 TI - Free radicals and myocardial protection: a surgical viewpoint. AB - Oxygen-derived free radicals are now considered important contributors to tissue injury associated with ischemia and reperfusion. Transition metals, primarily iron, greatly enhance the generation of these active species, which can destroy a large variety of biomolecules, in particular the lipid components of cell membranes. This review tries to demonstrate why cardiopulmonary bypass and aortic cross-clamping are situations that predispose to oxygen free radical production, and how "anti-free radical" agents such as enzymatic scavengers, antioxidants, and iron chelators may prove to be useful therapeutic adjuncts in the clinical setting of open heart surgery. PMID- 2667483 TI - Proliferative activity of human spermatogonia from fetal period to senility measured by cytophotometric DNA quantification. AB - The proliferative activity of human spermatogonia from the fetal period to senility was studied by means of cytophotometric quantification of the nuclear DNA content in histological sections. Proliferating spermatogonia that were replicating or had replicated their DNA (DNA content between 2.5c and 4.5c) were observed in all ages. The percentages of these spermatogonia were high (18.2%) in the second trimester of gestation, decreased in the third trimester (8.2%), maintained similar values in newborns (7.1%) and infants (9.5%), and increased markedly in 4- to 9-year-old children (22.5%). The latter percentage was maintained during puberty (20.1%), decreased significantly in adulthood (17.8%), and was higher in aging testes (25.2%). About 2% of spermatogonia with a DNA content higher than 4.5 c were observed from 4-15 years of age as well as in the testes of elderly men. Sertoli cells replicating their DNA were observed only in fetuses. PMID- 2667484 TI - Age-related changes in human prostatic inhibin peptide: an immunocytochemical study. AB - Age-related changes in human prostatic inhibin peptide (PIP) were carried out immunocytochemically in the prostate of various age ranges from newborn to 60 years. PIP was localized in the cytoplasm of the epithelial cells of the prostate at age 14 years and it persisted thereafter. PMID- 2667485 TI - Oligo/azoospermia in Nigeria. AB - Oligo/azoospermia contributes significantly to infertility in male Nigerians, being responsible for most of the problem. By definition, it would appear that the criteria for the diagnosis of this problem in Nigerians should be sperm density below 10 million/ml, total sperm ejaculate below 25 million, motility below 40%, and normal forms below 40% in agreement with more recent findings in other parts of the world. This reinforces the already generally accepted that the WHO may need to review its criteria for diagnosing oligo/azoospermia. Preventable causes of oligo/azoospermia in Nigeria include poorly treated infections such as venereal diseases, delayed treatment of torsion of the testis and of undescended testis, and repair of inguinal hernia by inexperienced native doctor [3, 4]. In addition, better approaches to the diagnosis of causes of infertility, such as a careful search for and rational treatment of varicocele, may improve the chances of infertile couples. Hormonal disorders are important factors to consider in oligo/azoospermic Nigerians, as with their counterparts elsewhere. Wide-spread availability of hormonal assays will therefore be a great help in separating the untreatable (primary testicular disease) from the treatable (hypothalamic/pituitary) diseases and planning rational treatment. With improvement of clinical care, many more patients with sickle-cell disease are reaching reproductive age. Oligo/azoospermia is quite common in patients with sickle-cell disease, and sickle-cell disease will eventually contribute more proportionately to the etiology of oligo/azoospermia in Nigerians. Extensive investigations have been conducted on the nature, etiology, and diagnosis of oligo/azoospermia [2-11, 25, 30-56].(ABSTRACT TRUNCATED AT 250 WORDS) PMID- 2667486 TI - Reproductive effects of the anticancer drug cyclophosphamide in male rats at different ages. AB - This study was undertaken to determine the effects of the anticancer and immunosuppressant drug cyclophosphamide (CP) on several endpoints of the male rat reproductive system at different ages; 10-day-old (experiment A), 45-day-old (experiment B), and adult (experiment C) Sprague-Dawley rats were injected intraperitoneally with CP at doses of 20 mg/kg/day or/week and 100 mg/kg/week for 2 weeks (experiment A), doses of 20 mg/kg/day for 5 weeks and 100 mg/kg/day for 10 days (experiment B), and doses of 20 mg/kg/day for 5 weeks (experiment C). In all groups CP induced a significant rate of mortality. Body weight gain was moderately to severely reduced in two groups of experiment A (20 mg/kg/day and 100 mg/kg/week) and of experiment B (20 mg and 100 mg/kg/day) but normal in the others. Absolute as well as relative reproductive organ weights decreased following some of the treatments in experiments A and B. At the light microscope level, effects of CP ranged from nonapparent in immature rats (experiment A, 100 mg/kg/week for 2 weeks) and young adult animals (experiment B, 100 mg/kg/day for 10 days) to moderate in the other groups treated for 5 weeks (experiments B and C). Affected tubules exhibited atrophy, exfoliation, and a decrease in the number of spermatogonia, primary spermatocytes, and round and elongated spermatids. Sertoli cell function appeared preserved, whereas Leydig cells, present in the intratubular tissue of the rats in all the experiments, were occasionally and moderately altered in animals of experiment B, as shown by significant decreases of serum testosterone and LH levels. Leydig cell dysfunction in these rats was associated with normal in vitro basal and hCG-stimulated testosterone production. A significant decrease in epididymal sperm reserves was observed only in one group of animals (experiment B, 100 mg/kg/day for 10 days). Since in these animals the number of spermatids in the seminiferous tubules was normal, it is possible that CP at a high dose alters the epididymal function. Furthermore, fertility trials demonstrated that despite no change in the number of implantation sites, there was a dramatic fall in the number of fetuses per female in all the experimental groups. In conclusion, this study shows that in pre- and postpubertal rats treated chronically or subacutely, CP primarily and essentially induces alterations of germ cells, whereas this compound has little or no direct effect upon Leydig cell and Sertoli cell functions, respectively. PMID- 2667487 TI - Pharmacological studies on the hypoglycemic effect of 7,8-dihydro-2-(4 methylpiperazinyl)-4-(1-pyrrolidinyl)-6H-thi opyrano [3,2-d] pyrimidine dimaleate (MTP-1307), a novel hypoglycemic agent. AB - MTP-1307, 7,8-dihydro-2-(4-methylpiperazinyl)-4-(1-pyrrolidinyl)-6H- thiopyrano[3,2-d]pyrimidine dimaleate, is a novel oral hypoglycemic agent, structurally different from any existing hypoglycemic drugs. In fasted rats, the hypoglycemic effect of MTP-1307 was accompanied by elevation of the plasma insulin. In glucose tolerance tests, MTP-1307 suppressed the hyperglycemia after glucose loading and significantly enhanced the glucose-induced insulin secretion. In isolated hepatocytes from fasted rats, MTP-1307 inhibited gluconeogenesis from lactate and alanine. Furthermore, MTP-1307 increased the lactate/pyruvate ratio but did not increase the lactate level. MTP-1307 did not influence glycogenolysis in isolated hepatocytes from fed rats. In genetically diabetic ob/ob mice, MTP 1307 decreased the blood glucose level and improved glucose tolerance, but did not affect the level of plasma insulin. MTP-1307 increased 14CO2 production from glucose in isolated epididymal fat pads of ob/ob mice. Thus, these findings suggest that MTP-1307 produces hypoglycemic activities not only in normal animals but also in genetically diabetic animals, and that the hypoglycemic mechanism of MTP-1307 involves the promotion of glucose utilization in adipose tissue and, partially, the inhibition of gluconeogenesis in the liver and the stimulation of insulin release from the pancreas. PMID- 2667488 TI - [Meningioma of the third ventricle. Presentation of a case]. AB - Meningiomas of the third ventricle are extremely rare; the authors report a case of meningothelial meningioma located in the anterior part of the third ventricle. The tumor was successfully removed through a trans-ventricular approach. The clinical presentation, radiological findings and surgical management of these tumors are reviewed. PMID- 2667489 TI - [Triggering factors in attempted suicide]. AB - A sample of hundred and thirty-six cases of attempted suicide is studied from the standpoint of principal trigger factor. Absolute and percentual frequencies are exposed and analysed the associations between principal trigger and other variables: sex, age, marital status, retirement, previous suicidal attempts, severity of the act, suicidal intention, psychiatric diagnosis and opinion about recidive. PMID- 2667490 TI - [Meningeal melanocytoma. Presentation of a case and review of the literature]. AB - We would present a fifteen years old girl's case, which after two years from the beginning of his symptoms; a pigmented meningioma was removed at the cervical level of the spinal cord. It showed morphologically and clinically like the named by Limas "meningeal melanocytoma". Four years after the operation, the girl developed a malignant melanoma with invasion of the posterior mediastinum. We conclude that we ought to consider the meningeal melanocytoma as a borderline tumour, similar in the other way to the cellular blue naevus and the spindle A melanoma of the uveal tract. PMID- 2667491 TI - Splenopentin--influence on antibody formation in immunosuppressed animals and on phagocytic capability of human granulocytes. AB - Sublethally x-ray irradiated C57 Bl/6 Bln. mice (whole body irradiation with 600 cGy) were treated with or without a splenopentin derivative (DA SP-5: N alpha acetyl-L-arginyl)-(N alpha-acetyl-L-lysyl)-L-glutamyl-L-valyl-L-tyrosine and compared for their capacity to produce antibodies against target sheep red blood cells. As demonstrated DA SP-5 treated mice produced antibodies earlier and in a higher level than animals untreated. Furthermore, DA SP-5 influences the phagocytic capability of human granulocytes in a dose dependent matter. PMID- 2667492 TI - [The genotoxic effect of epichlorohydrin and epoxy resins]. AB - The aim of this study is the interpretation of the available bibliography concerning the present information about the mutagenic and carcinogenic effects of epichlorohydrin and epoxy resins. An intervention study on 141 exposed workers shows the necessity of an investigation about the well-timed perception of the carcinogenic risk. The development of an electrophoretic method is recommended to detect the alkylated hemoglobin by way of the biological monitoring. PMID- 2667493 TI - Dependence of susceptibility to carcinogenesis on species life span. AB - The data presented show no direct correlation between spontaneous tumor incidence and (a) the life span of species, (b) the life span of different strains or stocks of the same species, and (c) the life span of certain populations of the same strain or stock. This conclusion is in conflict with the concept suggesting a summation effect of the events that cause malignant growth irrespective of aging per se, in the age-related increase in cancer incidence, and indicates an important role of age-related changes occurring in the organism in the realization of carcinogenic effect of endogenous and/or exogenous factors. PMID- 2667494 TI - Evaluation of two types of 'medically significant error limits' and two quality control procedures on a multichannel analyzer. AB - Analytical error limits based on two different concepts of "medical significance" are derived. The ability of the system to detect medically significant errors using standard (1(3s] and enhanced (mean and range) quality control procedures is investigated. Error detection is found to be adequate for most analytes when error limits are based on physicians' opinions and a mean and range quality control system is used. Error detection is unsatisfactory when error limits based on intraindividual biological variation are used and this cannot be improved by using better quality control systems. The limiting factor is analytical precision. The use of error limits based on biological variation as proposed by major clinical chemistry professional bodies cannot be achieved using most current types of analytical technology. PMID- 2667495 TI - Proliferative activity and steroid receptors determined by immunohistochemistry in adjacent frozen sections of 102 breast carcinomas. AB - Adjacent frozen sections of 102 consecutive female breast carcinomas were examined for the expression of the Ki-67 antibody-reactive proliferation associated nuclear antigen and of estrogen and progesterone receptors with the use of monoclonal antibodies and peroxidase histochemistry. The results of steroid receptor stainings were semiquantitatively assessed (histoscore) on the basis of nuclear staining intensity and the percentage of positively stained carcinoma cell nuclei. Carcinomas negative for either receptor had significantly higher percentages of Ki-67-positive cells. The highest percentages of Ki-67 positive cells were observed in carcinomas negative for both estrogen and progesterone receptors. There was a highly significant decrease in receptor histoscores with increasing proliferative cell fractions as determined by Ki-67 positivity. No significant (progesterone receptor) or poor negative correlation (estrogen receptor) was observed when proliferative cell fractions were related to receptor concentrations from conventional steroid-binding assays. Immunoperoxidase staining for the Ki-67 antibody-defined proliferation antigen and steroid receptors in tissue sections provides a simple means to gain information of therapeutic and prognostic importance. PMID- 2667496 TI - Amniotic band syndrome. Report of two cases and review of the literature. AB - The amniotic band syndrome, a complex collection of asymmetric congenital anomalies, is almost certainly an underdiagnosed entity. No two cases are exactly alike. Two cases are reported, each of which exhibits craniofacial, visceral, body wall, and limb anomalies, the common types of defects seen in this syndrome. The literature is reviewed, and the most commonly accepted theory of pathogenesis is discussed in juxtaposition to another major theory. The importance of recognizing this syndrome is stressed, since it very rarely recurs in families. PMID- 2667497 TI - Cysts of the testicular parenchyma and tunica albuginea. AB - Five cases of cysts of the tunica albuginea and two cases of cysts of the testicular parenchyma are described. The cysts of the albuginea were located in the anterior, lateral, and inferior faces of the testis (distant from the epididymis) and covered by a thin albuginea. They extended toward the testicular parenchyma or toward the tunica vaginalis. Their epithelial lining varied from low cuboidal to columnar and consisted of ciliated or nonciliated cells. These cysts were probably of mesothelial origin. The cysts of the testicular parenchyma were also located distant from the mediastinum testis and were not in contact with the albuginea. Their epithelial lining consisted of flattened, cuboidal, nonciliated cells. The origin of the cysts of the testicular parenchyma is not clear. In one case the occurrence of spermatozoa in the cyst lumen and connections with seminiferous tubules suggests an origin in the rete testis. PMID- 2667498 TI - Hyperreactio luteinalis. Benign disorder masquerading as an ovarian neoplasm. AB - Hyperreactio luteinalis (HL) refers to moderate to marked cystic enlargement of the ovaries due to multiple benign theca lutein cysts and is most often associated with hydatidiform mole or choriocarcinoma. The cause of this condition is unknown, but is believed to be related to elevated levels of, or abnormal ovarian response to, human chorionic and pituitary gonadotropins. Only 47 cases of HL unassociated with trophoblastic disease have been previously reported in the English-language literature, mostly before 1974, and almost exclusively in the gynecologic literature. We present two additional cases of HL unassociated with trophoblastic disease and review the literature. One of our case reports documents the unusual occurrence of unilateral HL. Of the 49 cases described, 11 occurred with fetal hydrops (8 immunologic; 3 non-immunologic), 8 with multiple pregnancies, and 30 in otherwise normal single pregnancies. Hyperreaction luteinalis is most often bilateral and found incidentally at the time of cesarean section. However, HL may present during any trimester as an abdominal mass or acute abdomen. The natural course is postpartum regression. Recognition of HL is important, since misinterpretation at laparotomy or erroneous histologic diagnoses have resulted in unnecessary surgery, often with sterilization in 16 of the cases. A conservative approach is indicated with wedge biopsy and frozen section diagnosis. Oophorectomy is necessary only to remove infarcted tissue or to control hemorrhage. PMID- 2667499 TI - Sarcoidosis of the uterus. AB - The present case of sarcoidosis of the uterus and the previously reported cases are reviewed. Uterine sarcoidosis is usually detected during the investigation of abnormal uterine bleeding in patients with prior evidence of sarcoidosis in another site. However, in several of the reviewed cases, either the uterus was the site of the initial diagnosis of sarcoidosis or its involvement was detected soon afterward. When hysterectomies were performed on patients with endometrial involvement, the myometrium was usually found to contain nonnecrotizing epithelioid granulomas. By contrast, uterine tuberculosis usually spares the myometrium. The differential diagnosis between uterine sarcoidosis and uterine tuberculosis is discussed. PMID- 2667500 TI - Ectopic or heterotopic liver (choristoma) associated with the gallbladder. AB - A 43-year-old man with a history and symptomatology of hereditary spherocytosis underwent splenectomy and cholecystectomy for treatment of his underlying disease and of cholelithiasis. The removed gallbladder showed a serosal encapsulated nodule, supported by a short mesentery, measuring 11 x 6 x 4 mm, that histologically was an ectopic or heterotopic functioning liver. This nodule did not have any connection with the main liver. It is because of the comparative rarity of this anatomic anomaly that we are presenting a new case; a simple classification of these aberrant liver tissues, which are found in the wall of the gallbladder; the embryological development; and a complete review of the literature. We also stress the need to restore the term choristoma, now in disuse. PMID- 2667501 TI - Major abdominal complications following cardiac transplantation. Utah Transplantation Affiliated Hospitals Cardiac Transplant Program. AB - Serious complications involving the alimentary tract are commonly reported following cardiac transplantation, and may be associated with significant morbidity and mortality. The aim of this report was to review the incidence, severity, and outcome of abdominal complications in our heart transplant population in whom we used corticosteroid-sparing protocols for immunosuppression. From March 1985 through September 1988, 178 patients underwent 185 cardiac transplants. Twenty-six cardiac transplant recipients (15%) sustained 33 major abdominal complications, including gastrointestinal bleeding (n = 8), pancreatitis (n = 8), bowel perforation (n = 6), cholecystitis (n = 4), and miscellaneous other problems (n = 7). Operative therapy was required in 61% of cases. No deaths were caused by the gastrointestinal complications of their operative management. Corticosteroid-sparing immunosuppression may be responsible for the low incidence of abdominal morbidity, and early, aggressive surgical intervention may reduce subsequent mortality. PMID- 2667502 TI - Stratifying the causes of death in liver transplant recipients. An approach to improving survival. AB - The causes of death in 21 adults and 23 children in a consecutive series of 180 liver transplantations were reviewed and classified into four categories. A previously described preoperative risk score was applied prospectively to estimate the relative risk of mortality following liver transplantation in adults. Categorization of the causes of death allowed for a systematic search for errors in management and technique. Comparison of the preoperative risk score with the cause of death category revealed that higher-risk adults were most likely to die of causes related to preoperative morbidity. They also accrued higher hospital costs, regardless of outcome. The data are useful for designing strategies to reduce mortality. However, the inexorable role that preoperative morbidity has on outcome was also emphasized. This has important implications in developing strategies to reduce the costs of liver transplantation and to provide optimal distribution of scarce donor organs. PMID- 2667503 TI - Duplex venous scanning for the prospective surveillance of perioperative venous thrombosis. AB - A total of 361 patients undergoing a variety of major neurosurgical procedures were entered into a prospective surveillance program using duplex ultrasound scanning for detection of perioperative deep venous thrombosis (DVT). All patients had duplex scans of the major veins of both legs preoperatively, on the third and seventh postoperative days, and at weekly intervals thereafter if hospitalized. All patients received elastic stocking and intermittent mechanical calf compression. Perioperative DVT was diagnosed by duplex scan in 17 cases (4.7%); 2 cases were present preoperatively and the remaining 15 cases developed after surgery. Venography detected only one false-positive scan in this series. One patient with DVT died, but the postmortem examination revealed no pulmonary embolism. The results of serial venous scans were normal in 344 cases. There were no in-hospital pulmonary embolisms in any patient with normal venous scan results. Two patients (0.6%) with normal serial scan results had fatal pulmonary embolism 1 and 3 weeks after discharge. Duplex venous scanning was useful for prospective DVT surveillance of a high-risk group. The overall incidence of DVT (4.7%) is below that expected in such patients, suggesting the effectiveness of the program of prophylaxis. Scan results were reliable for therapeutic decisions and did not jeopardize patient safety. PMID- 2667504 TI - A pilot study of haloperidol treatment of psychosis and behavioral disturbance in Alzheimer's disease. AB - Nine outpatients meeting research criteria for probable Alzheimer's disease who had psychosis or behavioral disturbance participated in a single-blind, placebo controlled pilot study. Oral haloperidol in doses of 1 to 5 mg daily improved target symptoms, confirmed by double-blind ratings of videotaped interviews. Patients could not be maintained on more than 4 mg of haloperidol daily due to the severity of extrapyramidal side effects. Modified Mini-Mental State scores worsened while taking haloperidol, with only partial recovery in the final 4-week placebo phase. Severe extrapyramidal side effects and decline in cognitive function may compromise the efficacy of commonly used doses of neuroleptic drugs in patients with Alzheimer's disease. PMID- 2667505 TI - The neurology in Shakespeare. AB - William Shakespeare's 37 plays and poetry contain many references of interest for almost all of the medical specialties. To support that the Bard could be considered a Renaissance neurologist, the following important neurological phenomena have been selected from his repertoire for discussion: tremors, paralysis and stroke, sleep disturbances, epilepsy, dementia, encephalopathies, and the neurology of syphilis. PMID- 2667506 TI - Cicatricial pemphigoid associated with D-penicillamine treatment. PMID- 2667507 TI - Analysis of ophthalmic surgical charges for services to Medicare recipients: 1980 and 1985. PMID- 2667508 TI - The Glaucoma Laser Trial. I. Acute effects of argon laser trabeculoplasty on intraocular pressure. Glaucoma Laser Trial Research Group. AB - The Glaucoma Laser Trial Research Group has examined the acute effects of argon laser trabeculoplasty on immediate change in intraocular pressure and the formation of peripheral anterior synechiae among the 271 eyes assigned to argon laser trabeculoplasty as initial treatment for primary open angle glaucoma. Argon laser trabeculoplasty was administered in two sessions. Intraocular pressure rises of greater than 5 mm Hg occurred in 34% of eyes after one or both of the treatment sessions; intraocular pressure rises of greater than 10 mm Hg occurred in 12%. Eyes that had an intraocular pressure rise after the first session were more likely to have a rise after the second session than eyes with no rise after the first session. Among the many patient, eye, and treatment characteristics examined, only pigmentation of the trabecular meshwork was strongly associated with intraocular pressure rises. Forty-six percent of eyes developed greater than or equal to 1 degree of peripheral anterior synechiae. Brown iris color and posterior placement of laser burns were associated with higher rates of peripheral anterior synechiae formation. PMID- 2667509 TI - MK-927: a topically effective carbonic anhydrase inhibitor in patients. AB - The effects on intraocular pressure of the novel topical carbonic anhydrase inhibitor MK-927 were investigated for the first time in patients. Three drops of 2% MK-927 was administered in a two-center, double-masked, randomized, placebo controlled, two-period crossover study in 25 patients with bilateral primary open angle glaucoma or ocular hypertension. At 4.5 hours after the dose, MK-927 treated eyes demonstrated a peak mean change of -7.7 mm Hg from a mean intraocular pressure of 27.8 mm Hg immediately before the dose; this compares with a change of -3.9 mm Hg from a mean intraocular pressure of 28.2 mm Hg when the same eyes were treated with placebo. The peak mean percent change in intraocular pressure in eyes treated with MK-927 was -26.7% at 6 hours after the dose compared with a change of -13.7% after treatment with placebo. No contralateral effect on intraocular pressure due to MK-927 was observed. PMID- 2667510 TI - Aland Island eye disease (Forsius-Eriksson syndrome) associated with contiguous deletion syndrome at Xp21. Similarity to incomplete congenital stationary night blindness. AB - We report the ophthalmological findings of a 6-year-old boy who has features of both Aland Island eye disease (also called Forsius-Eriksson ocular albinism) and incomplete congenital stationary night blindness, as defined by Miyake, leading us to suspect that they are the same entity. This child has a deletion of part of band 21 of the short arm of the X chromosome (Xp21) and three other X-linked disorders: congenital adrenal hypoplasia, glycerol kinase deficiency, and Duchenne type muscular dystrophy. The electroretinogram showed negative scotopic and abnormal photopic waveforms that were similar, if not identical, to the electroretinographic findings in both Aland Island eye disease and X-linked incomplete congenital stationary night blindness. Because of this similarity and the defective dark adaptometry that has been reported in patients with this disorder, we believe that Aland Island eye disease is more appropriately classified as a form of congenital night blindness than as a form of ocular albinism. From our case and review of the literature, Aland Island eye disease and incomplete congenital stationary night blindness appear indistinguishable. If further studies confirm that the disorders are the same, we recommend use of the term Aland Island eye disease or Forsius-Eriksson-Miyake syndrome. We also recommend that the gene symbols CSNB1 and CSNB2 be used for complete congenital stationary night blindness and Aland disease, respectively. PMID- 2667511 TI - Meconium peritonitis due to meconium ileus presenting as fetal ascites: a case report. AB - A case of meconium peritonitis due to meconium ileus is described. The condition was detected antenatally as fetal ascites on ultrasonography. Plain X-ray of abdomen post-natally showed specks of calcification mainly at the flanks, while on ultrasonography specks of high echogenic areas were seen throughout the abdomen which has been described as "snow-storm sign". The aetiology of meconium ileus is briefly discussed. PMID- 2667512 TI - Leukoencephalopathy following treatment with carmofur: a case report and review of the Japanese literature. AB - A 53-year-old woman was treated with 5 courses of CAP treatment following operation for FIGO Stage Ia cancer of the ovary in September 1986. And in April 1987, she started an oral adjuvant chemotherapy with 400 mg/day of carmofur. In early June, she developed vertigo and dysarthia and was hospitalized. A CT scan showed low-density areas adjacent to both lateral ventricles, and an EEG revealed abnormally slow waves. She improved gradually after carmofur was discontinued and left the hospital in October 1987. There have been 24 reported cases of leukoencephalopathy because of carmofur in Japan, but the pathophysiological mechanism involved is not known. Since it is more common in women than in men, its incidence will probably increase in gynecological patients. Therefore, we must be on the lookout for central nervous system signs and symptoms in patients receiving adjuvant chemotherapy with carmofur. PMID- 2667513 TI - Effect of amniotic fluid volume on umbilical cord length. AB - To study effect of amniotic fluid volume on umbilical cord length, 939 pregnant women at 24-41 weeks of gestation, including 10 twin cases, 51 preterm premature rupture of the membranes (PROM) and 70 premature delivery cases, were examined for their amniotic fluid volume within a week of delivery by the ultrasound procedure and these 949 newborns were also examined for umbilical cord length and incidence of fetal distress. In the polyhydramnios group (pocket size of more than 8 cm), 8 of 20 infants (40%) had longer cords and 6 infants (30%) had shorter cords, while only one of 49 infants (2%) with oligohydramnios (pocket size of less than 2 cm) had a longer cord and 36 infants (73.5%) had shorter cords than the mean cord length (+/- SD) of the normal group. The 20 twins had significantly shorter cords than those of the normal group (P less than 0.05) and the polyhydramnios group (P less than 0.01). The PROM group showed significantly higher incidence of oligohydramnios (P less than 0.05) and fetal distress (P less than 0.01), which suggests that intrauterine space availability is important for assuring fetal well-being. PMID- 2667514 TI - Direct and indirect IQ heritability estimates: a puzzle. AB - Direct estimates of IQ heritability based on a single family relationship such as adopted-apart relatives are often 50% greater than indirect estimates that rely on differences in correlations such as the classical twin method or nonadoptive adoptive comparisons. Factors such as nonadditive genetic variance, assortative mating, selective placement, measurement error, age differences, and genotype environment correlation and interaction do not obviously explain the difference between direct and indirect IQ heritability estimates. Because direct estimates are derived from separated individuals and indirect estimates are derived from individuals reared together in families, some aspect of the within-family environment seems a likely candidate but its exact nature remains to be understood. PMID- 2667515 TI - The discrepancy between ryanodine binding and its effects on the calcium releasing system of the sarcoplasmic reticulum. AB - Heavy sarcoplasmic reticulum vesicles isolated from rabbit skeletal muscle were reacted in high ionic strength solutions with ryanodine. The effect of this reaction on ATP - and dinitrophenyl phosphate supported calcium uptake and caffeine induced calcium release were studied. At pH 7.0 calcium uptake and caffeine induced calcium release are simultaneous affected by the occupation of 0.5 pmol ryanodine binding sites/mg protein, having an affinity of 0.33 nM-1. PMID- 2667516 TI - Activations of the Ca dependent K channel by Ca released from the sarcoplasmic reticulum of mammalian smooth muscles. AB - In mammalian smooth muscles, the outward K current recorded using the whole cell voltage clamp or patch clamp methods can be classified into the Ca-dependent and independent K currents. The former is sub-classified into the extra- and intra cellular Ca dependent K current. The intra-cellular Ca dependent K current has a close relation to Ca released from the sarcoplasmic reticulum, i.e. Ca released by inositol 1,4,5-trisphosphate (InsP3), ryanodine or Ca ionophores (A23187 or ionomycin) modify the appearance of the K current. The transient (Ca dependent) outward current evoked by depolarization pulses, as measured using the whole cell voltage clamp method, is closely related with after-hyperpolarization of the action potential as recorded using the microelectrode method and is postulated to be due to activations of the Ca-induced Ca release mechanism in the sarcoplasmic reticulum. The oscillatory (Ca dependent) outward K current is closely related with the amount of Ca released from the sarcoplasmic reticulum during the long depolarization induced by electrical stimulation (command pulse) or applications of Ca releasers such as InsP3 or ryanodine. In this review, the Ca dependent K current recorded from smooth muscle cells is compared with the influx and release of Ca. PMID- 2667518 TI - Long-term effects of altered activity on skeletal muscle. AB - This paper is a brief summary of some results obtained by stimulating denervated rat soleus (SOL) and extensor digitorum longus (EDL) muscles in vivo with different patterns of stimuli. It is concluded (1) that appropriate stimulation can maintain and restore normal properties in extrajunctional regions of denervated muscle; (2) that SOL and EDL respond differently to identical stimulation, indicating that the two muscles are intrinsically different; (3) that both frequency and amount of stimulation influence contractile properties but to varying degrees depending on the property and on the type of muscle under study; and (4) that the effects of stimulation on isometric and isotonic speed of shortening can be partly accounted for by its effect on excitation-contraction coupling processes and myosin heavy chain (MHC) expression. PMID- 2667517 TI - Proteolytic enzyme activities in skeletal muscle of high jumping rats. AB - Physical activity can be studied by various kind of exercises. Many works have been published in field of proteolytic enzyme activities in skeletal muscle during endurance training. In this work we used high jumping as a dynamic force velocity training to study the changes in proteolytic enzyme activities during this type of exercise. The activity of cathepsin D, cathepsin L and ATN-ase (Acetyl-Tyrosine-paranitroanilide-splitting enzyme) in vastus lateralis muscle was measured after one, 3, 7 or 11 weeks of high jumping exercise. The results demonstrated that proteinase activity began to increase when the load, i.e. number of jumping and the weight put on the rat's back was too much for their muscles. They could carry out the task consuming the energy originating from muscle tissue in the first period of the experiment, but in the second period (after 7 weeks) the type of training with this load became equal with an endurance training. PMID- 2667519 TI - Stereoselective, strong inhibition of ribonucleotide reductase from E. coli by cisplatin. AB - Using ribonucleotide reductase (EC 1.17.4.1) purified from E. coli clones with overproducing plasmids for the B1 and B2 subunits, respectively, studies have been carried out of the inhibition of this enzyme by cisplatin. Under anaerobic conditions, using the dithiol, reduced form of the enzyme, it was found that ribonucleotide reductase is extremely sensitive to cisplatin: greater than 90% inhibition was achieved with 2-fold molar excess of platinum reagent even at 10( 8)M enzyme. Inhibition was essentially instantaneous and irreversible to G-25 gel filtration. The site of inhibition was found to be the B1 subunit. Transplatin was much less effective. Inhibition of the enzyme by cisplatin (molar ratio cisplatin:B1 = 4.3) led to a decrease in thiol titre corresponding to approximately 1 thiol group per dimer of B1 subunits under conditions leading to 94% inactivation of the ribonucleotide reductase activity. PMID- 2667520 TI - Nicking of single chain Clostridium botulinum type A neurotoxin by an endogenous protease. AB - Botulinum neurotoxin (NT) serotype A isolated from cells from young cultures (approximately 8 h) of Clostridium botulinum type A is a approximately 150 kDa single chain protein. Supernatant from older cultures (96 h) yields approximately 150 kDa dichain NT composed approximately 50 and approximately 100 kDa subunits, that remain associated by disulfide and noncovalent bonds. This had led to the assumption that an endogenous protease cleaves a peptide bond at 1/3rd the distance from the N- or C-terminals of the single chain protein. An endogenous protease that causes such a cleavage (nicking) has now been purified greater than 1,000-fold from C. botulinum type A (Hall strain) culture; this culture also produces the single chain NT and eventually yields the dichain NT. The purified protease nicked the pure preparation of single chain type A NT, in vitro at pH 5.6, into a dichain form that was indistinguishable from the dichain NT normally isolated from 96 h cultures. The protease appears specific for nicking serotype A NT because it did not nick single chain serotype B and E NT nor did it enhance toxicity of serotype A, B and E NT. PMID- 2667522 TI - Radioligands of the vesicular monoamine transporter and their use as markers of monoamine storage vesicles. PMID- 2667521 TI - 3H-azidopine photoaffinity labeling of high molecular weight proteins in chloroquine resistant falciparum malaria. AB - Using 3H-azidopine, we have succeeded in labeling proteins from chloroquine resistant (CR) human falciparum malaria parasites in the molecular weight range of 155-170 kd. Vinblastine does not compete, but azidopine blocks the labeling using 3H-azidopine. Relatively little or no labeling of the 155-170 kd protein is seen in the chloroquine sensitive strain using 3H-azidopine. Further competition can be seen with nicardipine and reserpine (71%) respectively and verapamil (61%), chloroquine (48%), quinacrine (56%), trifluoperazine (32%) and chlorpromazine (33%). We speculate that this may be the glycoprotein responsible for the resistance to chloroquine in falciparum malaria. PMID- 2667523 TI - Comparison of nisoldipine and atenolol in the treatment of essential hypertension. AB - The antihypertensive effects of nisoldipine, a calcium channel blocker, and atenolol, a beta-adrenergic blocker, were compared in patients with mild or moderate essential hypertension. Both drugs produced significant reductions in blood pressure from the 8th week through the end of the 12-week treatment period. The hear rate decreased significantly in the atenolol group but not in the nisoldipine group. Following oral administration of 50 mg of captopril, the rise in plasma renin activity was significantly smaller in both treatment groups than in normotensive controls. The magnitude of the pressor response during a hand grip test tended to be smaller in both groups of patients than in the controls, with no significant difference between the treated groups. Although the plasma catecholamine concentration rose significantly in the control and nisoldipine groups, there were no significant intergroup differences in these parameters. The hemoglobin, GOT, creatinine, total cholesterol and serum sodium and potassium concentrations all decreased significantly in the nisoldipine group, although the values remained within normal limits. These results indicate that both nisoldipine and atenolol significantly suppress both plasma renin activity and the pressor response to stress leading to reduction of blood pressure. PMID- 2667524 TI - Synthesis and oral hypoglycemic properties of two 4-oxo-4,5,6,7-tetrahydroindole 3-acetic acids. AB - Condensation of beta-acetyl-2-hydroxy-4,4-dimethyl-6-oxo-1-cyclohexene-1 propionic acid (3) with n-butyl and isobutylamines affords the title acids 4 and 5, respectively, which show good oral hypoglycemic activity in normal rats. Acids 4 and 5, are also active in streptozocin-induced diabetic rats. Results of extensive pharmacological and acute toxicity tests are reported. PMID- 2667525 TI - [Glucose tolerance and electrolyte metabolism in nifedipine and nifedipine dihydroergotoxin treated healthy subjects]. AB - The effects of three oral doses of nifedipine 20 mg or nifedipine 20 mg/dihydroergotoxin 2 mg (Pontuc, HN 85) during three subsequent days on an oral glucose load (100 g) were compared to placebo. Neither drug altered the glucose load or inhibited the secretion of insulin or C-peptide. The fall of serum potassium was also identical to controls. Basal plasma norepinephrine concentrations were lower following nifedipine/dihydroergotoxine than after nifedipine alone (2 p less than 0.05). A decrease of the serum sodium concentration by 2 mmol/l was observed with nifedipine but not with the combined drugs. PMID- 2667526 TI - [Efficiency of homeopathic preparation combinations in sinusitis. Results of a randomized double blind study with general practitioners]. AB - In a controlled randomized double-blind trial carried out by 47 physicians in private practice with totally 152 patients with sinusitis the therapeutic success of the following homeopathic drug preparations was investigated: Group A: combination of luffa operculata D4, kalium bicromicum D4 and cinnabaris D3. Group B: combination of kalium bicromicum D4 and cinnabaris D3. Group C: luffa operculata D4. Group D: placebo. Criteria for the therapeutic result were headache, blocked nasal breathing, trigeminal tenderness, reddening and swelling of nasal mucosa and postnasal secretion. There was no remarkable difference in the therapeutic success among the investigated homeopathic drug combinations nor between the active drugs and placebo. Averaged over all four groups 81% of the patients with acute sinusitis and 67% of the patients with chronic sinusitis recovered. In the literature comparable therapeutic results are reported for antibiotic therapy, decongestant nose drops and for the drainage of nasal cavities. PMID- 2667527 TI - beta-VLDL and acetylated-LDL binding to pigeon monocyte macrophages. AB - Blood-derived monocytes are an important source of foam cells in atherosclerotic lesions of White Carneau pigeons. Based upon studies with cultured blood monocytes (monocyte macrophages) and peritoneal macrophages from a variety of mammalian species, it has been proposed that these cells become loaded with cholesteryl esters through the uptake of lipoproteins including beta-migrating very low density lipoproteins (beta-VLDL) and low density lipoproteins that have been chemically modified in a manner analogous to experimental acetylation (Ac LDL). The purpose of this study was to determine whether similar mechanisms functioned in pigeon monocyte macrophages. Radioiodinated pigeon beta-VLDL and Ac LDL were incubated with White Carneau pigeon monocyte macrophages that had been maintained in culture for 7 days. Scatchard analysis of the specific binding data revealed the presence of specific and saturable receptors for both beta-VLDL and Ac-LDL. beta-VLDL receptors had both low and high affinity binding components, whereas Ac-LDL receptors displayed a single class of high affinity binding sites. beta-VLDL binding remained relatively constant from 3 to 10 days in culture while Ac-LDL binding increased with time in culture. Competition studies demonstrated a high degree of binding specificity for 125I-Ac-LDL, but less for 125I-beta-VLDL. Binding of 125I-beta-VLDL was not competed for by Ac-LDL, but was by beta-VLDL and by low density lipoproteins from both normal and hypercholesterolemic pigeons. Following binding of beta-VLDL and Ac-LDL, the lipoproteins were rapidly internalized and degraded. Although the majority of degradation was secondary to internalization by the monocyte macrophages, approx. 5% of the degradation resulted from enzymatic activity in the culture medium, presumably due to secretion of proteolytic enzymes by the cells. As measured by esterification of [14C]oleate to cholesterol, it was shown that the cholesterol liberated from the degradation of both beta-VLDL and Ac-LDL stimulated cholesteryl ester synthesis in pigeon monocyte macrophages. These studies confirm the existence of specific beta-VLDL and Ac-LDL receptors on the surface of pigeon monocyte macrophages which facilitate both internalization of the lipoproteins and subsequent stimulation of cholesteryl ester synthesis. This is the first demonstration of beta-VLDL and Ac-LDL receptors on monocyte macrophages from an avian species, and the findings support the potential role for the receptor-mediated uptake of a variety of abnormal lipoproteins in the formation of monocyte-derived foam cells in the arterial wall of White Carneau pigeons during the development of atherosclerosis. PMID- 2667528 TI - Liquid diet technique of ethanol administration: 1989 update. AB - A technique of feeding alcohol as part of a liquid diet is reviewed that achieves an alcohol consumption of clinical relevance, while maintaining dietary control and providing adequate nutrition. With this procedure, blood alcohol levels are obtained which mimic clinical conditions and allow experimental duplications of many pathological complications caused by alcohol. In the rat, the liquid diet technique provides a model for the alcoholic fatty liver, various alcohol-induced metabolic, endocrine and central nervous system abnormalities (including tolerance and dependence) and the interaction of ethanol with industrial solvents, many commonly used drugs, analgesics, carcinogens and nutrients. This technique also resulted in the discovery of a new pathway of ethanol metabolism in the microsomes involving an ethanol-specific cytochrome P-450 (P450IIE1), which has now been confirmed in man. P450IIE1 contributes not only to the metabolic tolerance to ethanol, but also explains the enhanced susceptibility of the alcoholic to many ubiquitous xenobiotic agents. The liquid diet technique provides the flexibility to adjust to special experimental or physiological needs by allowing for various substitutions including changes in lipids, proteins or other dietary constituents. This procedure is thereby ideally suited for the study of the interactions of alcohol with deficiency or excess of various nutrients. The technique also facilitates the comparison with controls by simplifying pair feeding procedures. Although the flexibility of the liquid diet technique is one of its key advantages, a standard 'all purpose' liquid diet is described which is appropriate for most experimental applications. In addition, two other general formulae are given, namely a low fat diet (that allows the study of the effects of ethanol in the presence of minimal hepatic lipid accumulation) and a high protein diet (to meet increased needs, e.g. during pregnancy and lactation). The optimal amount of ethanol for the rat liquid diet was found to be 5 g/dl or 36% of total energy. With lesser amounts of alcohol, intake falls below a critical threshold; blood levels of alcohol then become negligible and the model becomes irrelevant to clinical conditions. In the rat, amounts of ethanol above 5 g/dl were not found to be associated with any further gain in alcohol ingestion. By contrast, in the baboon, the ethanol content could be raised profitably to 7 g/dl or 50% of total energy and resulted in the development of cirrhosis. This higher alcohol intake, together with species difference, may explain the greater severity of liver lesions produced by alcohol in the baboon.(ABSTRACT TRUNCATED AT 400 WORDS) PMID- 2667529 TI - Alcohol and the young. PMID- 2667530 TI - Disulfiram hepatotoxicity: a consideration of its mechanism and clinical spectrum. AB - Disulfiram-induced hepatotoxicity is a recognised entity despite the difficulty in determining its contribution to the damage when alcoholism itself is a frequent cause of liver disease. Less well characterised is the mechanism of disulfiram-induced hepatotoxicity and the high fatality rate associated with this entity. The clinical spectrum of the disease is reviewed and experimental data suggesting the mechanism of toxicity are presented. Failure to recognise this problem and to terminate therapy as soon as possible may result in death due to massive hepatic necrosis. PMID- 2667531 TI - [Immunohistochemical analysis of hormonal receptors in cancer of the breast. Current evaluation]. PMID- 2667532 TI - [Alloimmunity and autoimmunity. I. Skin aspects]. AB - Graft versus host reaction and autoimmunity. Acute cutaneous lesions and lupus erythematous. Clinical features Histological and ultrastructural features Immunopathological features Immunoglobulin deposits and circulating immune complexes Class II antigens Lymphocyte phenotypes Mechanisms leading to chronic lesions. Cutaneous aspects of chronic graft versus host-disease Early lichenoid eruption and idiopathic lichen planus. Clinical features Histological and ultrastructural features Lymphocyte phenotypes Late sclerotic phase and scleroderma Clinical features Histological and ultrastructural features Collagen immunotyping Pathological mechanisms. PMID- 2667533 TI - [Mucines: glycoproteins in search of recognition]. PMID- 2667534 TI - [The maxillo-mandibular desmoid fibroma. Synthesis of knowledge about a rare entity. Apropos of 3 cases]. AB - Three cases of maxillo-mandibular desmoplastic fibroma are added to the 41 cases already described in the literature. A synthesis of the actual knowledge concerning the tumor is presented. The tumor is mainly composed of fibrous tissue with bundles of mature collagen, and can be easily confused with a low grade fibrosarcoma. Most of the patients are caucasian males. It is a young people tumor (0 to 30 years) with a peak between 6 to 15 years. The mandible was involved in 36 cases and the maxilla in 8 cases. The left side was involved in a ratio of 2 to 1 compared to the right side. In the mandible, the tumor was observed most frequently in the body and at the angle of the jaw. Pain or tumefaction were the most prevalent clinical features. The etiology of the tumor is unclear but trauma is often implicated. When the treatment is conservative, recurrences are frequent. The maxillo-mandibular desmoplastic fibroma should be recognized early to avoid local tissue destruction. PMID- 2667535 TI - [Cerebral gliomatosis. An anatomoclinical case]. AB - Gliomatosis cerebri is a glial neoplastic process. It is diffusely distributed through brain structures whose anatomical configuration remains intact. Clinical diagnosis of this rare disease is difficult. The symptoms are varied and biological and radiological data are not specific. The case reported shows the characteristic features of the disease. Diagnosis was possible only on autopsy, in spite of several previous clinical and biological investigations and nuclear magnetic resonance study. PMID- 2667536 TI - The effect of progressive muscle relaxation on stress among clerical workers. AB - Stressors such as the lack of challenge and opportunities for advancement, and the inability to influence the organization help explain why clerical work is considered a demanding and stressful occupation. One stress management technique which may be effectively implemented on the job for clerical workers is progressive muscle relaxation. In primary prevention, nursing intervention strives to reduce the effects of harmful stress by identifying and assessing stressors and then implementing measures to strengthen lines of defense. PMID- 2667537 TI - Perimortem cesarean section. AB - Perimortem cesarean section probably represents an underemphasized procedure on the skills list of the emergency physician. Although fraught with emotional and medicolegal overtones, the procedure can yield viable infants in at least 15% of cases and occasionally alters maternal hemodynamics so as to restore the pulse in a clinically dead woman. This article reviews the physiology and hemodynamics of the maternal-fetal unit and discusses prognostic factors for the survival of healthy mother and infant, leading to recommendations for when to perform a perimortem cesarean section. The article then describes the technical aspects of the procedure. PMID- 2667538 TI - Positioning for breastfeeding. AB - Difficulties in breastfeeding frequently arise from the failure of mothers and caregivers alike to understand what is happening as babies breastfeed, and what that means about positioning the baby for breastfeeding. This paper summarizes and criticizes some concepts of how babies breastfeed that have been inadequately researched or influenced by literature about how babies bottle feed. Recent ultrasound studies confirm overlooked earlier work and offer the basis for a rational understanding of how to facilitate adequate contact between the baby's mouth and the mother's breast and how to recognize poor positioning. The importance of breast shape, tension, and protractility are discussed, and the role of engorgement in nipple trauma explained; the differences between breastfeeding and feeding from so-called orthodontic teats are outlined. Understanding these matters is important to preventing breast and nipple problems and premature weaning. PMID- 2667539 TI - [Immuno-allergic thrombopenias and leukopenias induced by drugs]. AB - Certain types of cytopenia are due to the destruction of blood cells by an antibody, active only in conjunction with a drug which has previously provoked sensitivity in patients when administered in standard doses. Drug-induced thrombocytopenia and leucopenia of allergic origin are relatively rare. They produce characteristic symptoms, i.e. brutal onset and acute development of the disease; healing takes place when the drug in question is withdrawn. Haematological diseases of drug-related aetiology are being brought to light by serological methods which detect the specific antibody for the drug responsible for the accident. The physiopathological mechanism is still not clearly elucidated. PMID- 2667540 TI - Neuropathology of amnesic syndromes. PMID- 2667541 TI - Evaluating the affective and cognitive effects of a drug: theoretical and methodological considerations. AB - Current research leads to new drugs with new properties which are clinically screened toward a sum of traditional validation methods and clinical expression of biological models. Two complementary but different theoretical procedures underlie clinical studies. Drugs can be evaluated in "categorial" or "dimensional" perspective. In the first case, their effects are studied on a nosographic entity (for example meeting DSM III criteria for dementia or depression) by global scales whatever clinical heterogeneity or biological specific properties of the drug. In the second case, drugs effects are assessed on a single clinical dimension constituting a continuous parameter from normal to pathological state. Result of these different levels of organisation cannot be compared or correlate. Irrespect of this principle led, in the past, to confusion and lack of interpretable results. A coherent approach may clarify all the process of development of new drugs. PMID- 2667542 TI - Drug development in age-related memory disorders. PMID- 2667544 TI - Memory training programs as a reference to the clinical evaluation of drugs in memory disorders. PMID- 2667543 TI - Chronobiological rhythm constraints of memory processes. AB - Memory performances are not constant but undergo fluctuations whose periodicity may be analyzed. Low frequency infradian rhythms (periods longer than 28 hours), circadian rhythms (periods between 20 and 28 hours) and ultradian rhythms (periods less than 20 hours) are involved in memory disorders. Paradoxical sleep represents a preferential period in which certain processes, such as the activation of the central nervous system for example, may facilitate learning process. Relations between sleep and memory lead to the discussion of the incidence of the cyclic nature of sleep (and notably the rhythm of 90 minutes' paradoxical sleep) on the daily course of cerebral activation and its effects on the variable aptitude of our capacity for remembering. The close interrelation between biological rhythms and cognition is demonstrated using two examples of mental disorders in which severe memory deficiencies are observed. PMID- 2667545 TI - Event-related potentials and brain aging. PMID- 2667546 TI - Quantified EEG: a possible tool for classification of sdat and prediction of drug effects on cognition. PMID- 2667547 TI - How to evaluate a drug efficacy at the behavioural level? PMID- 2667548 TI - Models of human memory. AB - The capacity to store and retrieve information is a property common to biological organisms and certain artefacts. Psychological models of human memory fall into two rival classes: a) "bionic" models which draw inspiration from the structural and functional properties of the central nervous system (computo bionic models); b) "symbolic information processing" models in which the inspiration for description and explanation of natural processes is drawn from the structural and functional properties of Von Neumann computers (computo-symbolic models). PMID- 2667549 TI - Experimental dissociation of memory systems in mice: behavioral and neurochemical aspects. AB - Evidence for different types of memory in mice may lead to development of animal models for human memory disorders and provides informations on neurobiological systems underlying these processes. Series of experiments in mice, using a 8-arm radial maze with or without cholinergic drugs or chronic alcohol consumption supply arguments for multiple memory stores and for cholinergic influence greatest for short-term system. Studies of differential cholinergic activation following training militate for dissociation in time of hippocampal and cortical cholinergic pathways. Age-related memory involvement seems to be associated with an attenuation of central cholinergic activation. Several problems inherent to sensitivity and selectivity of the tasks remain in discussion. PMID- 2667550 TI - Comparative study of two types of cholinergic lesion in rats. AB - The cholinergic systems of the forebrain may be divided in two major sub-units: the septohippocampal system and the innominate-cortical system. This analysis is limited to the behavioral effects of lesions of pathway origins i.e. Medial Septal Area (MSA) and Nucleus Basalis of Meynert (NBM). Working memory is regularly involved by MSA lesion; NBM lesions also seem to affect working memory but is more often the cause of altered reference memory. However, multiple techniques of lesions are used, impairing interpretation of all the results by their bias and discrepancies. PMID- 2667551 TI - [Ground water improvement in the Ruhr--then and now]. AB - The waterworks founded during the second half of the last century obtained the raw water exclusively from the Ruhr-valley; they were responsible for the water supply of the industrial area situated on the right of the river Rhine. The rapidly growing water demand, limited possibilities in water catchment, the very bad quality of the Ruhr-water and epidemic typhoid fever required new methods in the water supply. Consequently, the Hygiene-Institute of Gelsenkirchen was founded and a new method of water production developed: the artificial ground water recharge. In 1913 two associations were founded: the Ruhrtalsperrenverein responsible for the provision of water quantity, and the Ruhrverband, responsible for the improvement of water quality. These associations formed the essential base for the rapid development of the so-called "Revier". In spite of the excellent elimination of bacteria by artificial ground water recharge-operating according to the principle of slow sand filtration-a disinfection of drinking water with chlorine became necessary; this disinfection was started in 1910 by the waterworks of the Ruhr. The construction of reservoirs and clarification plants ameliorated temporary the overall situation in water resources management. These improvements were, however, destroyed by consequences arising from the rapid economical growth before the second world war and the following break-down. After this period, great efforts were necessary to enlarge the reservoirs and increase the capacity of sewage plants. The waterworks pre-purified the water from the Ruhr before infiltration into the underground in order to increase the quantity and quality of the recharged water. Downstream, the number of sewage plants increased; a more and more refined method of analysis indicates now the pollution load of the raw ater and signalized trends which lead to further treatment measures or to the change of existing ones like substitution of chlorine by chlorine-dioxide. The artificial ground water recharge-because of its many advantages-should always be the nucleus of water treatment of the river Ruhr. For the sake of the natural character of water catchment and in order not to degrade the waterworks to mere "water-manufacturers", we are all requested to handle thoroughly and cautiously water-endangering substances. PMID- 2667552 TI - Disinfection with gaseous formaldehyde. First Part: Bactericidal and sporicidal effectiveness of formaldehyde with and without formation of a condensing layer. AB - Suspensions of Staphylococcus aureus ATCC 6538, Streptococcus faecium ATCC 6057, and of spores of Bacillus subtilis var. niger DSM 675 dried on polished stainless steel carriers were exposed in a model chamber to 3.2 mg HCHO l-1 air at temperatures of 20, 25, 30, 35 and 40 degrees C and the kinetics of their inactivation were determined by successive colony counting during the exposures. The HCHO treatment was carried out once with the formation of a condensing layer on the carriers and once without recondensation, at a RH of about 90%. In both procedures the cells or spores were suspended and dried in saline peptone water and additionally, in the case of the exposure without condensate layer, suspended in peptone water only. For S. aureus and S. faecium, significant differences between the two processes were only observed at 20 degrees C, whereby S. aureus showed for example a D-value of 14.8 minutes and after an exposure with condensate a D-value of 28.1 min. However at higher temperatures the effectiveness of HCHO in gaseous or condensate form was rather similar. At 35 degrees C the D-values after exposure to HCHO in condensate and gaseous form was for S. aureus 4.1 min and 5.9 min respectively, whereas after treatment at 40 degrees C D-values of 3.2 min and 3.8 min respectively were determined. At 35 and 40 degrees C D-values for S. aureus suspended in peptone water and exposed to gaseous HCHO were 50% lower than when suspended in saline peptone water. At lower exposure temperatures large differences were not registered. For the B. subtilis spores exposure to formaldehyde without condensation showed D-values of 34.8 and 5.6 min at 20 and 40 degrees C respectively. These are 8- and 4-fold lower than those of a corresponding exposure with a condensing layer. No D-value differences were observed for spores suspended and dried in saline peptone water or in peptone water after exposures to gaseous formaldehyde. PMID- 2667553 TI - [A literature review of the concentrations of arsenic, lead, cadmium, and mercury in body fluids and tissues to establish normal levels and to detect exposure. 3. Mercury]. AB - The 3rd of 4 communications on metal concentrations in human body media deals with mercury. Publications obtained from a comprehensive data bank search from January 1980 to April 1984 are listed in tables; study groups have been assigned to the following categories: normal, exposed; and exposed, exhibiting adverse health effects. Quality and strength of evidence of analytical procedures and reported data are discussed, particularly in light of adverse health effects. General methods and individual analytical procedures were presented in the 1st communication, a summary of mean exposure levels, critically elevated levels, and references will be published in the 4th communication. PMID- 2667554 TI - [A literature review of concentrations of arsenic, lead, cadmium and mercury in body fluids and tissues for establishing normal values and detection of body burden. 4. Lead, summary of average values for As, Cd, Hg and literature references]. AB - The last of 4 communications on metal concentrations in human body media deals with lead. It includes also a summary of mean exposure levels, critically elevated levels, and references. Publications obtained from a comprehensive data bank search from January 1980 to April 1984 are listed in tables; study groups have been assigned to the following categories: normal; exposed; and exposed, exhibiting adverse health effects. Quality and strength of evidence of analytical procedures and reported data are discussed, particularly in light of adverse health effects. General methods and individual analytical procedures were presented in the 1st communication. PMID- 2667555 TI - [Effect of high frequency treatment on several microorganisms important to food health]. AB - There is an increasing consumer interest in the microwave oven as a more convenient and quicker means of meal preparation. This study investigated whether growth or inactivation of microorganisms in the microwave field follows the same dynamics as conventional heat processing. Product safety during microwave treatment of food products is of special interest. As parameters D-values of Escherichia coli, Salmonella typhimurium and Staphylococcus aureus were calculated after microwave exposure and conventional heat treatment at +55 degrees C and +60 degrees C respectively. The irradiation frequency was 2450 MHz; the microwave power ranged from 0 to 1037 W. Furthermore an assessment was made on the growth rates of E. coli at +37 degrees C and on the influence of microwaves on lyophilized E. coli-cells. With a special temperature measurement system (Luxtron 1000 A) which used nonmetallic and microwave transparent fiber optic probes, the temperature was recorded during each experiment. At certain temperatures some of the strains showed slight although significant differences depending on which of the abovementioned techniques had been applied. However there was no particular trend evident from the results. D-values of E. coli at +55 degrees C and S. typhimurium at +55 degrees C and +60 degrees C obtained from both heat sources were coincided. Microwave reduction of S. aureus at +55 degrees C was more rapid than conventional heat inactivation; on the other hand a slower inactivation rate of S. aureus and E. coli at +60 degrees C was observed. Growth of E. coli was slightly delayed during microwave incubation. There are no effects concerning microwave-treated E. coli-cells. The hypothesis positing the existence of so called "athermal effects" was neither proved nor rejected on the basis of the experiments. In terms of product safety, it must be taken into account that microwave heat processing in general use may result in a markedly uneven distribution of temperature within the product. Adequate means should be provided for heat conduction so as to allow temperatures of "hot" and "cold" spots to be sufficiently equilibrated. PMID- 2667556 TI - [Glucuronidase detection and indol capillary test as reliable rapid identification procedures for the detection of E. coli in foods--toxinogenic strains included]. AB - The fluorogenic beta-D-Glucuronidase test, together with an Indol-capillary test for rapid identification of E. coli, were proved with 60 toxinogenic, 335 nontoxinogenic wild-type strains, and 87 other gram-negative isolates from food. With a sensitivity of 96.5% and a specificity of 95.6%, the fluorogenic assay can be recommended as a reliable method for presumptive determination of E. coli. For confirmation, a time-, material- and labour-saving Indol-capillary test with simultaneous demarcation of fluorescence-positive Salmonella spp. should be carried out. This includes enterotoxigenic E. coli as well, with the exception of some fluorescence-negative Verotoxin-producing strains. As the primary cultivation medium the Plate-count-Monensin-KCl-Agar supplemented with 50 micrograms/ml 4-methyl-umbelliferyl-beta-D-glucuronide (PMK-MUG) can be recommended. Not suitable appear such media containing lactose due to acidification, while metabolizing the carbohydrate. This may significantly reduce or extinguish the fluorescence. The procedure recommended here permits also a reliable determination of lactose-negative E. coli-biotypes. PMID- 2667557 TI - UV disinfecting experiments with E.coli and actinometric determination of the irradiation intensity. AB - The UV disinfection of E. coli was carried out and additionally an actinometric determination of the irradiation intensity was made. This kind of proceeding renders it possible--in regard to the time of exposure--to set up a dose-effect relation for the UV disinfection of water. PMID- 2667558 TI - Mycobacteria in biofilms. AB - The objective of this study was to elucidate the role of biofilms as the habitat of aquatic mycobacteria. Investigations were carried out on a biofilm which grew on the inner surface of a silicone tube constantly perfused by water of a distribution system known to be contaminated with Mycobacterium kansasii and M. flavescens. The biofilm yielded 2 x 10(5) cfu/cm2 of M. kansasii and 7 x 10(4) cfu/cm2 of M. flavescens after 10 months of perfusion. Microscopic examination revealed that approximately 1/4 to 1/3 of the biofilm organisms visualized by the Ziehl-Neelsen procedure were acid-fast bacteria, most of which occurred in densely packed microcolonies. These findings indicate that biofilms are an important habitat and site for proliferation of aquatic mycobacteria. Biofilms may be an explanation for the problems of controlling mycobacterial contamination of water distribution systems by means of chemical disinfection. PMID- 2667559 TI - Hyperglycaemia after burn injury. AB - The effect of burn injury on blood sugar levels, serum insulin levels and glucose tolerance was studied in male rats. In the burned group (following 50 per cent surface burn injury), the blood sugar level was significantly increased after burn injury in comparison with control uninjured rats. Hyperglycaemia was blocked by injection of phentolamine (10 mg/kg) for 24 h or propranolol (50 micrograms/kg) 30 min before burn or if the animals were adrenalectomized 4 days before injury. Serum insulin levels were significantly decreased in the scalded rats and their glucose tolerance was impaired. Early hyperglycaemia probably arises as a result of adrenal medullary hyperactivity. The initial rise in blood glucose probably arises from glycogen breakdown, followed later by increased hepatic production of glucose. The 50 per cent body surface scald injury is followed, acutely, by a period of glucose intolerance. In part, this intolerance may be due to decreased serum levels of insulin. The inadequate response of insulin secretion in response to glucose loading may be due to inhibition of insulin secretion by pancreatic beta cells caused by elevated catecholamine levels, possibly in combination with the action of antagonists such as glucagon, which may be secreted in excess as a result of stimulation by catecholamines. PMID- 2667560 TI - Thymic response to thermal injury in mice: I. Alterations of thymocyte subsets studied by flow cytometry and immunohistochemistry. AB - The dynamics of thymocyte subset changes in mice subjected to sublethal thermal injury were studied in cell suspensions by flow cytometry and in situ by immunohistochemistry. Thermal injury caused acute thymic involution in the first 2 days which was the consequence of a considerable decrease in numbers of Thyl.2high+ CD4+ CD8+, cortical thymocytes. Medullary, Thyl.2low+ thymocytes were more resistant and their relative values increased. In the regenerative phase (2 14 days) the recovery of large CD4- CD8-, early thymocytes, mainly localized in the subcapsular area of the thymus, preceded the regeneration thymocytes of the cortical phenotype. Judged by the absolute numbers of medullary thymocytes it can be seen that CD4+ CD8- (T-helper/inducer cells) were more sensitive to the effect of thermal injury than CD4- CD8+ (T-suppressor/cytotoxic cells). While values of CD4+ CD8- cells were constantly and progressively lower during 2 weeks after thermal injury, absolute numbers of CD4- CD8+ cells showed cyclic changes with lower and higher values compared to controls. An increase in the numbers of CD4- CD8+ cells was found at day 6 after thermal injury. PMID- 2667561 TI - Survival of an infant with massive thermal injury: a case report. AB - Survival of infants with greater than 80 per cent body surface area burns has not been well documented. Survival of a 4-month-old infant with 80 per cent full skin thickness flame injury is reported. Data from the National Burn Information Exchange showed that there were 2266 infants under 8 months of age treated for burns in reporting hospitals. Only four children of the 2266 were treated for full skin thickness thermal injury covering more than 80 per cent TBSA and none survived except for the child reported here. It was felt that early aggressive excision of the burn eschar was an important factor leading to the survival of this infant. Complex rehabilitation issues related to developmental issues as well as physical and psychosocial needs were identified and addressed throughout her time in hospital by a multidisciplinary team to ensure the best possible quality of life. PMID- 2667562 TI - Burn care facilities in the UK. PMID- 2667564 TI - Osteoarthropathy of patients undergoing long-term hemodialysis. AB - Maintenance hemodialysis, while capable of prolonging life, is an incomplete substitute for the patient's native functioning kidneys. Recently, it has become clear with time that long-term survivors of hemodialysis develop an osteoarthropathy differing from classic secondary hyperparathyroidism. The radiographic appearance includes erosive or destructive changes of articular surfaces, bone cysts, osteopenia, and periarticular calcific deposits. The most important clinical factor related to the development of the disease is increasing duration of hemodialysis. Although amyloid appears to be a causative factor, the exact etiology and treatment remain uncertain. It is important that the radiologist be aware of this entity and not mistake it for secondary hyperparathroidism, a variant of rheumatoid arthritis or infection. PMID- 2667563 TI - Clinical comparison of commercially available Biobrane preparations. AB - This prospective clinical comparison of the three commercially available Biobrane preparations indicated that: (1) All three products of Biobrane are excellent skin substitutes. (2) Regular Biobrane has satisfactory wound adherence, however, its non-porous structure allows limited wound drainage. Because of this, it has the highest incidence of haematoma and fluid accumulation (13.3 per cent) and delayed epithelialization (18.8 per cent) of the three products. (3) Thin Porous Biobrane has poor adherence which limits patient activity and provides poor pain relief. The infection rate of 10 per cent was the highest of the three products. (4) Regular Porous Biobrane demonstrated superiority to the other two Biobrane products in this study. It provided good wound adherence while maintaining wound drainage because of its porous structure. The incidence of blood or fluid accumulation (7.1 per cent) was the lowest in the three products. (5) Most of the complications such as infection, delayed epithelialization, pain and activity impairment were related to fluid or blood accumulation. Adherence was found to be more important and reliable than pore structure. Operative haemostasis thus should be emphasized when using porous Biobrane, as with all skin substitutes. PMID- 2667565 TI - CT of pulmonary edema. AB - We describe our experience with CT of the chest in the diagnosis of pulmonary edema due to congestive heart failure, overhydration, renal failure, or increased capillary permeability. CT is able to detect acinar shadows and air-bronchograms more clearly than conventional radiography. Specific pattern of distribution of edema can be imaged in cross-section due to the elimination of superimposition of structures. In patients with adult respiratory distress syndrome, CT can detect microcystic transformation of the lung, which indicates a worse prognosis. Complications of ARDS, not always clearly visible on bedside chest radiographs, can be identified with CT. PMID- 2667567 TI - Receiver operating characteristic (ROC) methodology: the state of the art. AB - Receiver operating characteristic (ROC) methodology has been increasingly used in medical applications in the last 10 years. The text by Swets and Pickett has popularized the technique and the journal Medical Decision Making (1981--) provides a forum for further methodologic issues. In this article, I will (1) describe the nature of the data generated by ROC studies; (2) evaluate the choices of summary indices of performance (accuracy); (3) outline the data analytic techniques used, and how to incorporate data from multiple observers and multiple "readings"; (4) review proposed alternatives to the commonly used binormal ROC model; and (5) discuss issues, such as verification bias, and challenges, such as multicenter comparative imaging studies and the difficulty of obtaining "truth data", which need to be addressed when adapting ROC methods to medical contexts. PMID- 2667566 TI - Radionuclide imaging in the evaluation of osteomyelitis and septic arthritis. AB - Despite controversy over its exact role, radionuclide imaging plays an important role in the evaluation of patients suspected of having osteomyelitis. The differentiation between osteomyelitis and cellulitis is best accomplished by using a three-phase technique using Tc-99m methylene diphosphonate (MDP). Frequently, it is necessary to obtain multiple projections and magnification views to adequately assess suspected areas. It is recommended that a Ga-67 or In 111 leukocyte scan be performed in those cases where osteomyelitis is strongly suspected clinically and the routine bone scan is equivocal or normal. Repeated bone scan after 48 to 72 h may demonstrate increased radioactivity in the case of early osteomyelitis with the initial photon-deficient lesion. In-111 leukocyte imaging is useful for the evaluation of suspected osteomyelitis complicating recent fracture or operation, but must be used in conjunction with clinical and radiographic correlation. The recognition of certain imaging patterns appears helpful to separate osteomyelitis from septic arthritis or cellulitis. PMID- 2667568 TI - [Measurement of intraesophageal pH in the diagnosis of gastroesophageal reflux disease]. PMID- 2667569 TI - Production of recombinant human serum albumin from Saccharomyces cerevisiae. AB - Human serum albumin has been constitutively expressed in a Saccharomyces cerevisiae brewing yeast. After cell growth and disruption the product was associated with the insoluble fraction and represented approximately 1% of total cell protein. After the cell debris was extensively washed, the albumin was solubilized with 8 M urea and 28 mM 2-mercaptoethanol in 50 mM sodium carbonate buffer, pH 10. The denatured albumin was refolded by dialysis and further purified by anion exchange and gel filtration chromatography. Losses of renatured material could be reduced, or higher protein concentrations used during refolding, if the denatured product was purified by cation-exchange chromatography in urea prior to refolding. Apart from an additional N-terminal N acetyl methionine, the refolded product proved identical to human serum albumin derived from plasma when compared by a variety of physical, chemical, and biological analytical methods. PMID- 2667570 TI - Insulin resistance, glucose intolerance and hyperinsulinemia in patients with hypertension. AB - Plasma glucose and insulin responses to an oral glucose challenge and insulin stimulated glucose uptake were measured in 47 age-, weight-, and sex-matched lean white men (16 with normal blood pressure, 14 with untreated hypertension, nine treated with a thiazide diuretic only, and eight treated with combined diuretic and beta-adrenergic antagonist drugs). Following a 75-g glucose dose, plasma glucose and insulin were measured for a three-hour period. In separate studies, insulin-stimulated glucose uptake was estimated by measuring the steady-state plasma glucose (SSPG) and insulin (SSPI) concentrations achieved during the last 30 minutes of a 180-minute continuous infusion of somatostatin, insulin, and glucose (insulin suppression test). Under these conditions endogenous insulin secretion was suppressed, and differences in SSPG concentration allowed comparisons of the ability of exogenous insulin to stimulate disposal of an identical glucose load in different individuals. The results indicated that men with untreated hypertension had significantly elevated plasma glucose (P less than .001) and insulin concentrations (P less than .001) after an oral challenge compared to normal volunteers. Mean SSPG concentrations were also higher (P less than .05) than normal in patients with untreated hypertension.2+ Furthermore, plasma glucose and insulin concentrations after the oral glucose challenge and SSPG concentration during the insulin suppression test were higher in treated than in treated patients than in untreated patients with hypertension. These results confirm earlier observations that untreated patients with hypertension are insulin resistant, hyperglycemic, and hyperinsulinemic compared to a well matched normotensive control group, and suggest that conventional treatment programs for lowering blood pressure many exaggerated these metabolic defects. PMID- 2667571 TI - Effects of calcitonin, calcitonin analogues, and calcitonin gene-related peptide on basal in vitro renin secretion. AB - We investigated the relation of calcitonin as a calcium-active hormone to its more recently described effects on peripheral vascular tone. Basal renal renin secretion in vitro in rat kidney slices was studied in the presence of salmon calcitonin (SCT, 4400 U/mg), amino acid substituted analogues of SCT, 16-alanine SCT (6200 U/mg) and 12,16,19 tri-alanine SCT (350 U/mg), and of rat calcitonin gene-related peptide (rCGRP). All calcitonin species at the same hypocalcemic activity (1 U/mL) modestly but significantly suppressed renin secretion from control levels (9.79 +/- 0.44 to 7.51 +/- 0.53, 7.70 +/- 0.72, and 7.78 +/- 0.90 Goldblatt units/g/h for SCT, 16-ala SCT, and tri-ala SCT, P less than .05 for all calcitonins v control), whereas rCGRP had no effect. Thus, on a molar basis, the renin suppressing effects of the various calcitonin species paralleled their bioassay-defined calcium sequestering activity, 16-ala SCT greater than SCT much greater than tri-ala SCT. Lower concentrations of SCT (10(-2) U/mL and 10(-4) U/mL, approximately 6 X 10(-10) and 6 X 10(-12) mol/L, respectively) had virtually identical effects. Moreover, verapamil (5 X 10(-6) mol/L) blocked the SCT-induced suppression of renin secretion (9.79 +/- 0.44 v 9.36 +/- 1.05 GU/g/h, P = NS). We conclude that the juxtaglomerular apparatus is a calcitonin responsive system, in which calcitonin and its analogues act to suppress basal renin secretion in vitro. This effect seems to depend on and may be mediated by modulating cellular calcium uptake, and suggests a wider, calcium-related role for calcitonin than had previously been suspected. PMID- 2667572 TI - Pathogenesis, diagnosis, and treatment of hypertension-associated stroke. AB - Chronically elevated blood pressure predisposes to stroke through effects on the extracranial and intracranial cerebral vessels. Hypertension-associated disease of small-diameter penetrating cerebral arteries may produce either lacunar infarction or intracerebral hemorrhage. The role of hypertension in the pathogenesis of atherothromboembolic cerebral infarction must be questioned in view of the evidence that antihypertensive therapy does not prevent myocardial infarction. Hypertension, in the absence of rheumatic heart disease, is frequently associated with atrial fibrillation. The incidence of stroke due to embolization of thrombus from the fibrillating left atrium of the nonrheumatic heart may have been overestimated in the past. Ideally, investigation of the patient who has had a stroke should include a brain-imaging study and a cerebral arteriogram. In practice, however, arteriography cannot always be justified. Treatment of the completed stroke is unsatisfactory but tissue plaminogen activator and calcium-channel blockers hold promise for cerebral infarction. Surgical decompression of the posterior fossa can be life-saving in cases of cerebellar infarction or hemorrhage. In patients with cerebral infarction, aspirin has been shown to reduce the incidence of stroke recurrence. PMID- 2667573 TI - Humoral Na+-K+ pump inhibitory activity in essential hypertension and in normotensive subjects after acute volume expansion. AB - Plasma from black male patients with essential hypertension was bioassayed for vascular Na+-K+ pump inhibitory activity. Halves of the same rat tail artery were incubated for two hours in boiled plasma supernates from a hypertensive patient and a paired age-, sex-, and race-matched normotensive subject and then ouabain sensitive 86Rb uptake was measured. Ouabain-sensitive 86Rb uptake by their leukocytes was also measured. Eighteen pairs of subjects were studied. The uptakes were not significantly different in the hypertensive patients and control subjects. However, when we selected from the eighteen hypertensive patients, nine with low plasma renin activity on the day of the study, uptakes were reduced in the hypertensive patients relative to the paired control subjects. We also assayed plasma supernates from normotensive black and white male subjects before and after acute volume expansion (2.5 L saline IV + 1.5 L distilled water orally over a three-hour period) and from paired normotensive subjects before and after sham volume expansion and obtained a positive bioassay in the expanded subjects both on intraindividual and interindividual comparisons. These studies demonstrate increased vascular Na+-K+ pump inhibitory activity in the plasma of black male patients with low renin essential hypertension and in the plasma of normotensive subjects after acute volume expansion. The findings suggest that the inhibitory activity in the hypertensive subjects' plasma is related to volume expansion, relative or absolute. PMID- 2667574 TI - Presentation of the Harvey Award to Arthur C. Guyton. PMID- 2667575 TI - Dominant role of the kidneys and accessory role of whole-body autoregulation in the pathogenesis of hypertension. AB - In this paper I have presented two closely related themes both of which seem to be fundamental in understanding the pathophysiology of hypertension. The first theme is the dominant role of the volume-excretion function of the kidneys in setting the long-term arterial pressure level. That is, each person in general has a rather steady intake of salt, water, and those other constituents that make up extracellular fluid. When the arterial pressure is normal, the kidney excretion of these constituents is exactly the correct amount to balance the intake of each of them. When the pressure is too great, there is more loss than gain, and the body fluid volume decreases; therefore, the pressure falls until the exact balance point is reached again; it is only at this balance point that the loss and gain are equal. At any pressure below the balance point, volume gain is greater than loss, and the pressure will continue to rise until the exact balance level is again reached. This capability of the kidney mechanism to return the pressure all-the-way back to the level of balance between input and output- not merely part-way back--is called the "infinite gain" characteristic of this pressure control system, and the level to which the pressure is controlled is called the "set-point" of the system. In pathophysiological states, the set-point for pressure control can be increased to hypertensive levels as a result of (1) a pathophysiological change in renal function or (2) increased salt and volume intake; then hypertension will ensue. Other abnormalities of circulatory function that do not affect one of these two factors cannot cause chronic hypertension because of the infinite gain feature of the renal-volume mechanism for pressure control. One such condition that does not cause hypertension without some concurrent abnormality that affects renal function is a primary increase in total peripheral resistance. The second theme is that whole-body autoregulation causes the blood flow in all parts of the body to return or remain near to normal when high arterial pressure tries to increase the flow. It does this by increasing the resistance in all parts of the peripheral arterial tree. Therefore, in effect, autoregulation converts any tendency to high cardiac output hypertension into high resistance hypertension. Yet, in so far as is now known, the pressure level will be the same with or without autoregulation.(ABSTRACT TRUNCATED AT 400 WORDS) PMID- 2667576 TI - Goals of antihypertensive therapy. Is there a point beyond which pressure reduction is dangerous? AB - It has been widely assumed that the preventive effect of antihypertensive treatment on cardiovascular events is increased as lower blood pressure (BP) is achieved. This assumption seemed logical in light of the well-known relationship between BP level and future cardiovascular events. Hypertension, however, develops over many years and is associated with both hypertrophic and atherosclerotic changes within the coronary and peripheral vessels. Antihypertensive drugs when instituted will bring down BP and often arterial blood flow within weeks. Coronary blood flow is limited to diastole. Theoretically then, very low diastolic BPs in coronary arteries with hypertrophic and/or atherosclerotic changes might precipitate a chain of events leading to a myocardial infarction and/or a lethal arrhythmia. Recently, results from several trials have been presented indicating a J-shaped relationship between achieved BP level and incidence of coronary heart disease. These trials are reviewed and problems in the interpretation of the findings such as biaz from varying risk at entry, varying follow-up time, and choice of statistical method, are discussed. Although, the burden of evidence strongly supports the hypothesis that low attained BPs are associated with an increased risk of a coronary heart disease event, problems in the interpretation of this evidence call for further analyses of the relationship within the large hypertension trials. Until such results are at hand caution should be to avoid decreasing BP below 85 mm Hg diastolic. PMID- 2667577 TI - Hand preference in gestures and signs in the deaf and hearing: some notes on early evidence and theory. AB - Research has shown that when persons with normal hearing accompany their speech with gestures, right-handers use more right-hand gestures, and left-handers use more left-hand gestures, although to a lesser extent (D. Kimura, 1973a, 1973b, Neuropsychologia, 11, 45-50, 51-55.). Comparable differences have been found in deaf persons when signing, with the direction of hand dominance for signing in both right- and left-handers corresponding to that for nonlinguistic actions (J. Vaid, D. Schemenauer, U. Bellugi, & H. Poizner, 1984, Hand dominance in a visual gesture language. Paper presented at BABBLE, March, Niagara Falls, Ontario, Canada). In this paper, I recount early theories and observational data about hand dominance for gesture and signing, both in the hearing and the deaf. Several of these early theories and observations anticipate current work and also suggest new avenues for investigation. PMID- 2667578 TI - Sjogren's syndrome beyond the eye. AB - Sjogren's syndrome is a common systemic disease with major clinical manifestations in the eye, mouth and musculoskeletal system. The major clinical presentations of Sjogren's syndrome are reviewed with emphasis on diagnostic criteria, laboratory features, complications and treatment. PMID- 2667579 TI - Disorders of calcium and bone metabolism. AB - Calcium levels in blood are maintained within narrow limits by parathyroid hormone, acting on kidney, bone and gut. Our understanding of the mechanisms of these actions has increased greatly in recent years, for example by identification of new hormones (eg 1,25 dihydroxy vitamin D) and by the study of isolated bone cells. Though most clinical disorders of calcium metabolism are now readily diagnosed and many are effectively treated, some serious problems still remain. Foremost amongst these are the early diagnosis of osteoporosis and the treatment of osteoporosis after fractures have occurred. Most disorders of calcium metabolism have ophthalmologic manifestations, sometimes troublesome to the patient, and sometimes diagnostically helpful. PMID- 2667580 TI - Surgical technique for ptosis repair. AB - There are many choices of operation for ptosis repair, but proper classification, diagnosis and an understanding of eyelid anatomy are essential. The anterior levator resection is recommended for ptosis repair with levator function, and fascia lata suspension is described for ptosis repair when no levator function is present. PMID- 2667582 TI - Transcleral ciliary sulcus fixation of posterior chamber intraocular lens implants. AB - We present our results of transcleral ciliary sulcus fixation of posterior chamber intraocular lens implants (IOL) in IOL exchange cases, secondary implants, and complicated cataract extractions. Follow-up data are presented on a total of 19 patients. The technique is facilitated by using a long needle attaching 10-0 prolene suture to both haptics of an all polymethylmethacrylate (PMMA) posterior chamber intraocular lens implant (PCL). Our early results show that the procedure is safe and predictable. PMID- 2667581 TI - Episcleral plaque radiotherapy for uveal melanoma. AB - The use of radioactive Iodine, Ruthenium, Iridium and Cobalt plaques of varying dimensions to treat choroidal and ciliochoroidal melanomas is discussed and placed in perspective with other treatment modalities. The regression pattern following plaque treatment appears to be more rapid for tumours that are more poorly differentiated. The visual results following plaque brachytherapy compare very favourably with those following local resection and external beam radiation. Ocular complications are significantly greater for tumours whose initial thickness exceeds 8 mm. The survival rater after plaque treatment is compared with that for patients who have had primary enucleation for equivalent-sized tumours. PMID- 2667583 TI - A radio translucent intraorbital foreign body. PMID- 2667584 TI - Pulsed Doppler sonography of the hepatoduodenal ligament: efficacy and ease of performance. AB - A prospective analysis of the hepatoduodenal ligament (HDL) in 205 patients with abdominal pulsed Doppler sonography supports the conclusion that Doppler ultrasound is a useful adjunct to routine scanning in this area. Abdominal pulsed Doppler sonography allows reliable differentiation among the HDL structures by identifying and characterizing flow in the portal vein and hepatic arterial structures, while demonstrating no flow in the bile ducts. Proper hepatic arterial signal was obtained in 190 (92.7%) patients. Portal venous signal was obtained in virtually all (203 of 205-99%) patients. Abdominal Doppler sonography shows promise in its ability to provide definitive diagnostic information in situations where images alone may prove misleading. Doppler sonography can differentiate similarly sized bile ducts and arteries and detect dilated arterial and venous structures simulating dilated bile ducts. PMID- 2667586 TI - Physiological considerations in radionuclide imaging of the penis during impotence therapy. AB - The increased use of intracorporeal drugs in the treatment of impotence has advanced our understanding of erectile physiology. Radionuclide imaging of the penis (nuclear penogram) has provided clinicians with a noninvasive, objective measure of blood flow and blood pool changes during erection and with assistance in the quantitative documentation of therapeutic effect. PMID- 2667585 TI - Physiological considerations in radionuclide urodynamic studies. AB - Radionuclear imaging of micturition (RNIM) (Nuclear Uroflowmetry, Voiding Nuclear Cystogram) measures bladder volumes, bladder emptying times, and urinary flow rates. These data help to differentiate normal subjects from those with obstructive uropathy or neuromuscular failure and to quantify the deficit. We discuss the physiological considerations of importance to physicians ordering and interpreting this convenient and noninvasive diagnostic procedure. PMID- 2667587 TI - [Genetic heterogeneity of familial motor neuron disease]. PMID- 2667588 TI - [Immunohistochemical study on distribution of transthyretin in normal human brain tissue and tumors]. AB - Immunohistochemical examination of transthyretin (TTR), which is known to be synthesized in the epithelial cells of the choroid plexus as well as in the liver cells, was carried out on normal brain tissues and 84 human brain tumors, using a peroxidase-antiperoxidase (PAP) technique. TTR was demonstrated diffusely and strongly in the cytoplasm of normal choroid plexus cells, but not in ependyma and other tissues of normal brain. In all of 10 choroid plexus papillomas, TTR was found within the cytoplasm of tumor cells. In contrast, neither the two papillary ependymomas nor any other brain tumors contained TTR. Among the choroid plexus papillomas, some cases showed clear positive reactions in almost all tumor cells, while others had only a few TTR-positive cells. With these immunohistochemical findings, TTR proved a very useful marker of normal choroid plexus and choroid plexus papilloma. PMID- 2667589 TI - [A case of Raeder's syndrome caused by metastatic malignant lymphoma]. AB - A case of Raeder's syndrome caused by metastatic malignant lymphoma was reported. The patient was 67-year-old male. He had complained of diplopia, ptosis and frontal headache at the left side. Neurological examinations revealed left incomplete Horner's syndrome (miosis and ptosis, but normal facial sweating) and left abducens palsy, which was considered to be Raeder's syndrome Group 1 (Boniuk and Schlazinger's classification). CT scan, MRI and angiography demonstrated a mass lesion in the left cavernous sinus extending to the sphenoparietal sinus, and a mass lesion in the anterior part of the superior sagittal sinus. During his hospitalization, enlargement of the left cervical lymph nodes was noticed. "Malignant lymphoma (non-Hodgkin)" was diagnosed on the basis of biopsy. Group 1 of Raeder's syndrome is rare, but it is important to define the site of lesion, which is located around the paratrigeminal region at the middle cranial fossa. Because these lesions are very small and metastatic in many cases, various neuroradiological investigations, especially MRI, are necessary for early diagnosis and early treatment. PMID- 2667590 TI - Acid-etch rethink. PMID- 2667591 TI - William and John Hunter. AB - This article describes some of the contributions which the brothers William and John Hunter made to medical and dental science. John is revered in London and William in Glasgow. Both had an important influence on dentistry and its development as an academic subject. PMID- 2667592 TI - The use of gloves in cross-infection control. A historical note. AB - Routine glove wearing has been an integral part of surgery for almost a century, but it has only recently been considered appropriate for dentists and their staff while treating patients. This paper traces the history of glove use in surgery and compares this with experience of glove use in dentistry at the present time. PMID- 2667593 TI - Electrocardiographic evidence of myocardial salvage after thrombolysis in acute myocardial infarction. AB - There is a need for a simple clinical measurement that will indicate the extent of myocardial salvage after successful thrombolysis. This study examined whether coronary artery reperfusion reduced the infarct size as assessed electrocardiographically after thrombolytic treatment. The sum of the (sigma) ST segment area in leads showing ST segment elevation in the 12 lead electrocardiogram at presentation was used as an index of potential myocardial injury (initial ischaemic index). The evolved infarct size at 48 h was assessed by a QRS scoring system. Two groups of patients, both admitted with anterior myocardial infarction within 6 h of onset, were studied. Group 1 (n = 35) received analgesia only and group 2 (n = 33) received thrombolytic treatment either by the intracoronary (streptokinase, n = 13) or intravenous route (anistreplase, n = 20). Reperfusion was assessed angiographically. The mean (SD) potential infarct size assessed by the initial ischaemic index was similar in both groups (group 1, sigma ST area = 115 (60) mm2 and group 2 = 126 (77 mm2). The QRS score representing evolved infarct size was significantly lower in the treated group (4.1 (2.5] than in group 1 (7.8 (2.6]. The 95% confidence intervals for QRS scores based on the admission sigma ST area from patients with successful reperfusion were applied to a third set of patients (n = 22) to test the ability of the admission ST area (myocardial injury) to predict the QRS score accurately. While patients with successful reperfusion had significantly lower QRS scores than those who did not (4.5 (3.1) versus 9.3 (3.4)), the wide confidence intervals caused by inter-individual variability precluded an accurate prediction of the QRS score in an individual from the sigma ST area at time of presentation. There was no difference in infarct size in patients treated early (