Fire death and hypoxic death.

Fire death and hypoxic death. Participation of hypoxic hypoxia in low COHb (Carboxyhemoglobin) concentrations frequently observed in fire victims was examined using rats and rabbits exposed to low-O2 and CO gas mixtures. Rats exposed to the most hypoxic gas mixture (O2 3%-CO 0.3%) died with COHb value below 40%. Rabbits also died with a low COHb concentration under this condition, but the COHb concentration was not below 50%. From the literature as well as the findings obtained in the present experiment, hypoxic hypoxia did not appear to be a main factor causing death at low COHb concentrations.


Re-evaluation of death by asphyxia based on cerebral blood flow (VII)--on the information on electric potentials obtained from deep electroencephalographic electrodes. The author presents electroencephalographic patterns (a physiological parameter of the brain function observed at rapid and fatal drowning of rabbits), cerebral blood flow (CBF) which support the physiological activities of the brain, and the relationship between systemic respiration and circulation with special reference to changes in the electrical potentials detected by deep electroencephalographic electrodes. The possibility of diagnosis of fatal drowning is examined, based on the results.


Studies on asphyxia: morphological research for the aid of diagnosis of asphyxia using light and electron microscopy and immunohistochemical methods. The lattice-form structure and/or tubular myelin can be found in the debris-like structure which is the pinkish substance in the alveolar space in the Hematoxylin & Eosin stained sections. These findings were obtained by using rats in the air containing oxygen of 5% or mixing and/or contaminating each of methane, carbon dioxide, carbon monoxide and freon gases. The immunohistochemical detection using the monoclonal mouse antibody against human pulmonary surfactant (PS) apoprotein is of highly useful. The positive reaction products observed in the alveolar space indicate the localization of the tubular myelin. The data suggest that the PS appears when the inhaled air contains oxygen in low concentration. The immunohistochemical method using the antibody against human PS apoprotein is worth applying for the diagnosis of oxygen deficiency including the respiratory distress syndrome (RDS) of the new born. We conclude that the appearance of the positive reaction products suggests that, at least, the air did not come in contact with the surface of alveoli, which leads us to the diagnosis of death was from oxygen deficiency, even if we are at the stage when the mode of death is undetermined.


Pathological approaches to SIDS. I. Special emphasis on the histopathological differences between SIDS and asphyxia. Histopathological observation was performed to clarify pathological differences of the lung between SIDS and asphyxia. In regard to pulmonary edema, there was no significant difference between SIDS and asphyxia. Occurrences of microemboli in the pulmonary vessels in cases of SIDS showing aspiration of gastric content into the lung, asphyxia and drowning were significantly high, compared with that of SIDS cases without aspiration.


Diagnosis of asphyxia on the sudden infant death--prone sleeping position and vomit aspiration. An inevitable conclusion of studies in the Netherlands, Great Britain, the United States and Japan is that sudden infant death syndrome (SIDS) is intimately linked to the prone sleeping position of infants. But this cause of death cannot be explained by the conventional view of SIDS. Although asphyxia would be the most plausible explanation, the cause of death in the majority of SIDS-related deaths in Japan are ruled as SIDS, primarily because administrative autopsies in this country are delayed and the diagnosis is most often made from an external examination only. This lack of autopsy reports also hampers research in this area. Moreover, even where autopsies have been conducted, because of the lack of clear criteria for diagnosis, inconsistent rulings are rendered depending on the judgment of the presiding pathologist. Given these considerations, we undertook to examine the diagnostic criteria for death by asphyxiation among infants sleeping in the prone position, and the problems associated with such a diagnosis.


An evaluation of analyzed data of hemoglobin derivatives by CO-Oximeter in medico-legal autopsy. We examined blood samples of autopsy cases by a CO-Oximeter and evaluated the data for investigation of death including asphyxia. When sampling methods were examined, oxyhemoglobin (O2-Hb) concentrations increased, and reduced hemoglobin (R-Hb) concentrations decreased, by the contact of the blood with the air, while carboxyhemoglobin (CO-Hb) and methemoglobin (Met-Hb) concentrations appeared to be unchanged. The CO-Hb concentrations in the left heart blood were higher than those of the right. In the cases of death due to cold exposure, O2-Hb concentrations of the left heart blood were prominently higher than those of the right. In the cases of death in house fires and the asphyxiated, O2-Hb concentrations were extremely low (below 10%) in both of the left and right heart blood.


Efficient methods for production of monoclonal antibodies for forensic applications. To simplify the labor-intensive process of making hybridomas, we fused popliteal lymph node cells, used an autoclavable serum-free culture medium throughout, and cloned hybridomas with human blood cell feeders. To make the best possible use of the serum-free medium, we adapted mouse myeloma cells to it. Using as little as 0.2 ml of human blood per culture plate, we successfully cloned hybridomas and established a hybrid cell line producing anti-peroxidase antibody. Our protocol affords a considerable saving on time, labor, and cost, and hopefully will encourage the forensic scientist to undertake the production of monoclonal antibodies.


Application of commercially available monoclonal blood grouping reagents to detection of antigens in forensic materials. Commercial monoclonal reagents for ABO blood grouping were examined for their characteristics in forensic application. In the absorption-elution tests, the monoclonal reagents showed various reactivities, which were generally weaker than polyclonal ones. False negative reactions were observed in the tests for A antigens in some cases of aged or thin bloodstains and hair samples. Each monoclonal reagent showed a limited reactivity to the stains of animal blood. The monoclonal reagents were comparable to polyclonal ones in the absorption characteristics with bloodstains. They showed various reactivities with salivas. In the immunostaining, each of anti-A and anti-B reagent showed a similar staining property against the group antigens of the red cells, vascular endothelia, and various epithelia including the mucous cells of salivary glands.


Blood grouping of minute samples using monoclonal anti-A,B antibody. The availability of a monoclonal anti-A,B antibody (AB-E6E2) for blood grouping of blood and saliva stains was investigated. The antibody, which was reacted with A, B and AB antigens but not with O antigen, was produced from BALB/c mouse-mouse hybridoma raised to group AB red blood cells. AB-E6E2 had heat-elutability enough to detect ABO antigens in blood and saliva stains by absorption-elution test, whereas it had extremely weak double combining potency in mixed agglutination test. Application of elution-ELISA method will enable the detection of smaller amount of ABH antigens. The antibody, therefore, would be useful to segregate group O minute samples from the other blood group ones.


A novel method for blood group typing with the aid of monoclonal antibody immobilized dyed microspheres. A novel and simple method for blood group typing has been developed. The procedure involves the use of type-specific monoclonal antibodies covalently linked to dyed microspheres of polyglycidyl methacrylate. The presence of ABH and Lewis blood group antigens in saliva and plasma could be determined easily and specifically with respective monoclonal antibodies bound to dyed microspheres. The present method could also be applicable for the determination of the presence of invisible antigens for the forensic and diagnostic purpose with visible agglutination reaction.


Monoclonal antibodies against haptens.

Monoclonal antibodies against haptens. Four kinds of monoclonal antibodies (moAbs) specific to paraquat, diquat, methamphetamine (MA) and melatonin (MT) were produced. 1-Methyl,1'-hexanoic acid-4,4'-bi-pyridinium, 4-amino-D,L-phenylalanine-diazo-coupled diquat, p-amino-methamphetamine as haptens were synthesized and coupled to bovine serum albumin (BSA) directly or to BSA via glutaraldehyde, and an antigen of MT was prepared by binding MT to BSA with the Mannich reaction. These immunogens of BSA conjugates were immunized i.p. to BALB/C mice. Usable moAbs were established 4 to 6 months after the first immunization. Amounts of paraquat, diquat, MA and MT causing a 50% of inhibition by enzyme-linked immunosorbent assay or radioimmunoassay with one of the most specific moAbs from each hapten were 1.1 ng, 0.67 nmol, 10.0 ng and 1.4 ng, respectively.


Genetic polymorphism of complement component C6, C7 and C8(1) in Chinese Han population in northeast China. Distributions of complement phenotypes, C6, C7, and C8(1) were studied using thin agarose gel isoelectric focusing (AGIEF) or ultra-thin polyacrylamide gel isoelectric focusing (PAGIEF) and subsequent immunoblotting techniques in 203 Chinese Han population in Liaoning Province of northeast China. The gene frequencies were as follows: C6*A 0.4704, C6*B 0.5049, C6*B2 0.0148, C6*B3 0.0049, and C6*M 0.0049; C7*1 0.8251, C7*2 0.1108, C7*3 0.0320, and C7*4 0.0320; C8(1)*A 0.5567 and C8(1)B 0.4433, respectively. All the observed numbers of the phenotypes were in agreement with the expected numbers under the Hardy-Weinberg equilibrium. The gene frequencies among Chinese subpopulations and other various populations were compared.


[DNA typing and analysis of the D1S8 (MS 32) allele in the Japanese population by the minisatellite variant repeat (MVR) mapping by polymerase chain reaction (PCR) assay]. Minisatellite variant repeat (MVR) mapping using the polymerase chain reaction (PCR) of the D1S8 (MS32) locus from total genomic DNA and size separated alleles in the Japanese population was performed. DNA was extracted from blood in healthy non-related Japanese individuals. The digital data obtained were computer analysed, and from this single assay all unrelated individuals tested could be unambiguously distinguished. The average difference in diploid codes between unrelated individuals was 36 exclusions over the first 60 repeat unit positions. The mean proportions of a-, t-, and 0-type repeat units were 73.5%, 24.5% and 2.1%, respectively. MVR-PCR gives digital profiles which show extreme levels of individual variation and should prove very useful for personal identification. The advantages and further applications of MVR-PCR are also discussed.


[Sensitive identification of human blood and simultaneous determination of ABO blood group from a minute bloodstain by an ELISA-ABC method]. Sensitive identification of human blood and the determination of ABO blood group from a minute bloodstain were simultaneously carried out by a direct ELISA-ABC method. A cotton thread (1 cm in length) stained with 1 microliter of human or animal blood was stored for 2-4 weeks at room temperature. Hemoglobin (Hb) of the bloodstained thread was gently extracted with 100 microliters of PBS at room temperature, and the thread was washed with PBS to dehemoglobinize. And ABH blood group antigens were extracted from the same dehemoglobinized thread with 100 microliters of 5% ammonia solution at 56 degrees C. The extracts of PBS and ammonia were two-fold serially diluted with 0.1 M sodium carbonate buffer, coated to the wells of a flat bottomed microplate. The PBS extract was tested with a biotinylated antibody against human HbA0 for identification of human blood. Human blood was clearly distinguishable from bloods of other species including Japanese monkey. The minimum detection limit of human blood of the PBS extract of the bloodstained thread was 1:40,960 (3.4 ng Hb), and the limit was found to be approximately 200 times higher than that obtained by a leucomalachite green test or by a precipitation ring test using anti-human HbA serum. The ammonia extract was tested with biotinylated anti-A, anti-B and anti-H antibodies for ABO blood grouping. ABH antigens of the ammonia extract of the bloodstained thread were clearly detected. The minimum determination limits of blood group A, B, AB and O of the ammonia extracts were 1:160, 1:160, 1:80 and 1:160, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)


[Analysis of pedestrian injuries in traffic accidents: impact point, injury portion, and injury severity]. We conducted in-depth case studies of traffic accidents involving 118 pedestrians, who were struck by the fronts of bonnet-type cars. The data were reviewed in order to correlate injury severity with pedestrian age, and area of body contact, contact surface of vehicle or the local environment, and impact speed. It was found that head injuries caused by impacts against the top surface of car bonnets and leg injuries caused by front bumpers both showed high incidence rates. Both head and leg injuries caused by striking the vehicle were more severe than those caused by striking the road surface. In cases of impact between the head and the solid portion of the vehicle, such as the A-pillar, or in cases of secondary impact between the head and underhood solid structures such as shock tower, injuries tended to be more severe. The location of head impact varied according to the stature of the pedestrians.


Otoacoustic emissions (OAE) in paediatric hearing screening--the Singapore experience. Early identification and rehabilitation of hearing impairment is important for development of language in affected children. Behavioural audiological tests in children are unreliable. Brainstem auditory evoked response (BAER) although a reliable objective test, is difficult to perform. Otoacoustic emissions (OAE) is now thought to be a more practicable screening modality. A study to compare the use of OAE and BAER in the paediatric population was thus undertaken. 100 children underwent OAE and BAER screening in SGH from August 1991 to February 1992. OAE was equally effective when compared with the BAER in testing for passed or failed subjects (p < 0.05, X2 = 4.9). The sensitivity and specificity of OAE with respect to BAER was 95% and 93% respectively. Mean test time was 3.1 minutes for OAE and 28.6 minutes for BAER. Success rate for OAE was 100%. We therefore conclude that OAE is a feasible alternative to the BAER as a hearing screening modality.


Peripheral artery cannulation in newborns. This report outlines our experience (retrospectively over a 3-year period) with peripheral artery cannulation for blood gas monitoring in 170 newborn infants. The technique for radial artery cannulation is described in detail. Recorded sites of cannulation were radial (138), posterior tibial (34), dorsalis pedis (2) and temporal (1). Only minor complications occurred which were transient ischaemia (19 cases), accidental blood loss (4 cases) and superficial abscesses (2 cases). Three other cases were suspected to have systemic infection but these were not proven. Cannulae had to be removed in 52% of cases because no blood could be withdrawn for sampling. It is concluded that peripheral artery cannulation in the newborn is a safer and more convenient procedure than umbilical artery catheterisation.


PaO2, SaO2 and what constitutes adequate oxygenation in the premature newborn. 3 neonates admitted into our intensive care unit had their arterial blood gases analyzed. A total of 64, 67 and 73 arterial blood samples were analyzed for the 3 neonates respectively. The relationship between PaO2 and the corresponding SaO2 were plotted in an oxygen hemoglobin dissociation curve. PaO2 of 50mmHg corresponded to SaO2 of 80%, 84% and 92% for the 3 babies respectively, reflecting the fact that SaO2 can differ considerably. PaO2 of 50mmHg or SaO2 of 87% by themselves are inadequate as indicators of lower limit of arterial oxygenation. Indeed a consideration of other factors such as oxygen consumption, cardiac output, hemoglobin concentration are integral to this issue. PaO2 of 70mmHg corresponded to SaO2 of 92%, 93% and 97% respectively. However, at the upper limit of arterial oxygenation, the oxygen hemoglobin dissociation curve flattens out and PaO2 is a more sensitive indicator of the upper limit of arterial oxygenation as compared to SaO2.


Mycoplasma infection in children.

Mycoplasma infection in children. One hundred and eleven children with Mycoplasma pneumonia infection were studied. Their mean age was 6.2 +/- 3.1 years. The two commonest symptoms were cough (98%) and fever (95%). Only 23% of children had cough of greater than one week's duration. Ninety one per cent had positive chest signs. Radiological abnormalities were seen in 95% of chest x-ray. Complications included dermatological (10%), pleural effusion (5%), neurological disorder (3%), septicaemia (1%), bronchiectasis (1%). Two children with Down's Syndrome died. A rare case of Mycoplasma bronchitis with Reye's Syndrome was observed.


Complications of severe lower respiratory tract infections in Singapore children. Over one year period, 240 children with severe lower respiratory infection was admitted to a general paediatric department. The mortality was 1.6%. Apart from pleural effusions and skin exanthems, several major complications were noted. These were septicaemia (1), apnoea (2), encephalopathy (3), meningitis (1), Stevens Johnson Syndrome (1), bronchiectasis (1) and lung abscess (1).


Use of intravenous midazolam for sedation in children undergoing ward procedures. Midazolam is a water-soluble benzodiazepine with low toxicity. It has anxiolytic and sedative effects. This study assessed the efficacy and tolerance of this drug for sedation in various ward procedures. Pethidine was added to bone marrow aspirations for analgesia. 57 children with the mean age of 48 months and mean weight of 15.7 kilograms were studied. The dose of midazolam used to sedate adequately 86% of the children was 0.73mg/kg, the average onset of sedation was 4.3 minutes and mean duration was about 88 minutes. 47.5% were completely sedated, whereas 38.5% were only partially sedated. In 14%, sedation was not achieved at all. There was a statistically significant drop in blood pressure after sedation but this was not associated with any clinical effects. Hypoventilation was not detected in this study.


Discharges of children from hospital against medical advice. A retrospective study on discharges of children from hospital against medical advice or at own risk (AOR) discharges was conducted at our department from March 1981 to February 1990. There were altogether 890 patients giving an average incidence of 2%/year. The racial composition comprised 62.5% Chinese, 28.5% Malay, 7.3% Indian and 1.7% others. The common reasons for AOR discharge includes: (a) Inconvenience of having the child hospitalised (18.4%). (b) Preference of being treated by the general practitioner (15%). (c) Parents think child is well (14%). (d) Preference of being treated by private specialist or other hospital (11.9%) etc. Neonate comprised 16.9%, infants (except neonates) 44%, children > 1-5 yrs 28.6%, > 5-10 yrs 7.7% and > 10 yr 1.9%. The common diagnoses of these children include gastroenteritis (13.9%), febrile fit (13%), upper respiratory tract infection (11.7%), neonatal jaundice (5.7%). In conclusion AOR discharges of children from hospital is not uncommon and more could be done to reduce the incidence.


Cutaneous neonatal lupus erythematosus in Chinese neonates. Neonatal lupus erythematosus (NLE) is a well established subset of Lupus erythematous (LE). Three chinese female neonates presented to our Skin Centre, from May 1990 to May 1991 with NLE. All had skin lesions without congenital heart block and systemic problems. Two had photosensitive annular erythematous lesions on scalp, urticarial lesions on body, and one with facial atrophy, with aplasia cutis congenita. The biopsies were non specific while one had C3 in vessel walls. The major serogical marker was anti La antibody/SSB in two babies and anti Ro antibody/SSA in one. Two mothers were known cases of LE and one, was undiagnosed. Two infants were treated with short term low dose prednisolone. The infants will require long term follow up with paediatricians, in view of the fact that they can develop SLE later. The diagnosis of NLE is emphasised in infants with facial lesions to avoid delay in diagnosis, and full work up in both infants and mother is necessary.


Obesity-cerebral-ocular syndrome--a case report. The obesity-Cerebral-Ocular Syndrome is an uncommon disorder which closely resembles the Laurence-Moon-Biedl-Syndrome. It is also one of several disorders in which obesity, mental retardation and ocular abnormalities are associated. The article presents a case study followed up over 18 years and emphasises the importance of ophthalmic review in preserving visual function.


Growth and pubertal assessment after treatment in acute leukemia. To evaluate the effect of leukaemia and its treatment on growth and puberty, we studied retrospectively the serial heights and pubertal development of 37 children with acute leukaemia. The age of diagnosis ranged from 10 months to 13 years, with a duration of follow-up varying from 2 years to 14 years. The SDS (Z score) which reflects the deviation of height measurements from the population mean was used to assess height change at yearly intervals. Pubertal assessment was also made using the Tanner standards. 25 (69%) children showed a falling trend in mean Z scores over a 5 year follow-up period. The difference between the mean Z scores at 0 and 5 years was statistically significant (p < 0.035). However, there was no significant correlation between age of onset of disease and duration of survival with the deviation in the Z score. 11 children did not demonstrate a fall in the Z scores. There were, however, no defined factors such as age of onset, duration of follow-up, and sex distribution which could predict growth failure. Pubertal assessment showed normal development in all children with the pubertal age group (n = 11), except for 3 boys, two of whom had received testicular irradiation.


Detection and molecular analysis of alpha and beta thalassaemia genes--recent developments in screening protocols. Molecular and non-molecular techniques have been utilized for the detection and characterisation of alpha- and beta-thalassaemia genes. Non-molecular techniques example, haematological indices and haemoglobin electrophoresis allow samples to be screened rapidly without the use of radionuclides but these techniques are unable to detect mutations at the gene level. Molecular analysis of alpha- and beta-globin genes either by Southern Blotting and radionuclides or DNA amplification using the polymerase chain reaction (PCR) allows detection of specific mutations and have enabled prenatal diagnosis of the thalassaemias.


Routine immunisation against chickenpox. Is it time? Natural varicella in healthy children is normally not a severe illness. Nevertheless, the need to be away from school such as during an important examination, or from work, may be inopportune. It is therefore attractive to be able to prevent chickenpox. Such a proposition became a reality in 1974 with the development of a live attenuated varicella vaccine (the Oka strain). This has since been used in leukaemic children and children with other malignancies, and found to be safe and effective. Some of these children were immunised without complete suspension of anticancer therapy. The vaccine has also been used on healthy children and adults, mainly in Japan and North America. The results too indicated the vaccine to be safe and immunogenic, with minimal side effects. It has been shown to confer protection even if given within 3 days of exposure. The occurrence of zoster appears to be no higher than in natural infection. The vaccine has so far been shown to be protective up to 10 years post-immunisation. It appears safe enough to offer the vaccine routinely to those who are at risk of infection. One dose of vaccine given subcutaneously is usually sufficient for healthy children, but two doses are needed for immunocompromised children and adults.


Ingested foreign body in young children. Locally, ingested foreign body is a problem commonly seen in the adult patients. Paediatric patients constituted about 6.5% of all cases of ingested foreign body. In adults and older children who are able to communicate, the management is usually straight forward. However, the diagnosis of ingested foreign body in a prelingual child may pose a problem as the child is unable to talk. A high index of suspicion is needed in the diagnosis of ingested foreign body. This article presents a case of undiagnosed ingested foreign body causing pharyngeal perforation with retropharyngeal abscess in a two year-old boy. The management of ingested foreign body in young children is discussed.


Epidemiology of dengue and dengue haemorrhagic fever in Malaysia. III. A comparative study of clinical features seen in virologically confirmed cases for periods between 1963-1987--a review. Dengue fever, Dengue hemorrhagic fever and Dengue shock syndrome within the dengue complex is a sinister disease of great public health importance and continues to ravage children, young adults and the aged in Malaysia. The history of the disease is traced for over the years and the changing pattern of clinical presentation are noted. Various hospital based studies have been compared and the pathognomonic features of the disease in Malaysia are highlighted.


A supersensitive in-house enzyme-linked immunosorbent assay (ELISA) for measurement of thyroid-stimulating hormone (TSH) and its clinical applications. A supersensitive ELISA was developed for measurement of thyroid-stimulating hormone (TSH) concentrations in serum using in-house rabbit polyclonal antisera and a commercial monoclonal antibody. The assay was optimised and validated by recovery, linearity and cross-reactivity experiments and further compared to other available assays and EQAS samples. Good precision was obtained with a working assay range of 0.2 to 100 mIU/L with < 10% coefficient of variation (CV) for both intra and interassay. The assay is highly sensitive and specific with a minimum detectable limit of 0.07 mIU/L and negligible cross-reactivities against LH, FSH, HCG and other pituitary peptides. Good correlations were obtained when compared to Abbott hTSH EIA (r = 0.993; p < 0.001; n = 85) and NETRIA IRMA (r + 0.995; p < 0.001; n = 76). The normal reference range established was 0.4 to 4.0 mIU/L (n = 76). TSH levels in serum of thyrotoxic patients (n = 83) were significantly lower (0.07 to 0.20 mIU/L, p < 0.0001) and completely distinct from normal values thereby obviating the requirement of a TRH-stimulation test. Stability studies showed that coated wells can be stored at 4 degrees C for at least 2 months. This highly sensitive in-house hTSH ELISA which is cheap, stable and readily available is useful for diagnosis and management of patients with various thyroid disorders.


Spirometry and flow-volume in Malay adults. Respiratory function testing was done using a portable electronic spirometer in 223 normal Malay subjects between the ages of 15 to 75 years. Tests of FEV1, FVC, PEFR, and MMF were recorded using standard forced expiratory maneuvers. Malay adults have lower respiratory function values compared to Caucasians and other Asians.


Treatment of bleeding gastroesophageal varices: a report of forty-four cases. Bleeding gastroesophageal varices is associated with a high morbidity and mortality. Forty-four cases of bleeding gastroesophageal varices were treated at the Department of Surgery, Universiti Kebangsaan Malaysia, General Hospital, Kuala Lumpur over four and a half years. Thirty-two of them had liver cirrhosis. Hepatitis B infection was noted in 13 and alcoholic abuse was present in 14 patients. Five patients had associated hepatoma. Thirty-four percent had gastric fundal varices and a third of these bled from them. A total of 179 endoscopic injection sclerotherapy sessions were performed averaging 4 per person. Rebleeding rate was 4% and mortality was high (50%) in these cases. It was concluded that injection sclerotherapy is a safe and effective means of controlling bleeding oesophageal varices. Operative surgery was employed in those who rebled after injection and would be considered in those in Child's A.


The role of prophylactic antibiotics in caesarean section--a randomised trial. A prospective randomised controlled study was conducted over a 6 month period on the value of administering prophylactic antibiotics in patients undergoing emergency caesarean section at the Ipoh General Hospital. A total of 222 patients were randomised to receive 24 hours of ampicillin (500 mg per dose), cefoperazone (1 gm per dose) or no antibiotics. In all parameters of patient morbidity, the group receiving cefoperazone showed significantly better results as compared to the group not receiving antibiotics. The ampicillin group also had favourable results but generally not achieving statistical significance. Prophylactic antibiotics appear to be beneficial and consideration should be given to make it a routine in all emergency caesarean sections.


Propofol and methohexitone for elective caesarean--a comparative study. Two identical groups of females underwent caesarean operations. One group was induced with propofol 2.04 (SD 0.023) mg per kilogram and the other group induced with methohexitone 1.05 (SD 0.15) mg per kilogram body weight. Maintenance of anaesthesia was identical in both groups. Post-intubation blood pressure in the methohexitone group was significantly raised whereas with propofol the changes were not significant. There were no significant differences in the Apgar scores, uterine contractility and umbilical venous or arterial blood gases. There was a significant difference in the analgesic requirement in the first hour of the post-operative period; in the propofol group, patients needed less analgesia compared to the methohexitone group. There was no maternal awareness in both groups.


Routine coagulation tests in cases of missed abortion--is it really necessary? Many gynaecological units have a policy of performing routine coagulation tests in cases of missed abortion. For many years now, it has been accepted practice in our unit to perform routinely a platelet count, bleeding time (BT), clotting time (CT) and plasma fibrinogen (P. fib) level prior to evacuation in cases of missed abortion. We are not sure how or why these 4 tests came to be chosen as a coagulation 'screen'. As they are not totally adequate in detecting disseminated intravascular coagulation (DIC), we wondered if these tests added to the management in any way.


Once daily felodipine monotherapy in mild to moderate hypertension. In a single-blind study conducted at our centres, 78 hypertensive patients were enrolled with 58 completing the study according to the protocol. Mean supine and standing blood pressures were significantly reduced after treatment with felodipine, reductions being 27/21 mmHg (p < 0.0001) and 25/19 mmHg (p < 0.0001) respectively. Of 46 patients given felodipine 5 mg, 44 (95.7%) achieved target blood pressure defined as a diastolic blood pressure of < 90 mmHg, while all 12 patients on felodipine 10 mg did so. The 2 patients who did not achieve target pressure at the final visit did so on previous visits. There were no differences in pre and post-treatment laboratory variables. Treatment was discontinued in 6 patients because of headaches. No adverse events of clinical significance were reported in the 58 patients who completed the study. In conclusion, we found felodipine given once daily to be effective in the treatment of mild to moderate hypertension.


Carcinoma of the larynx in Malaysia.

Carcinoma of the larynx in Malaysia. A retrospective study of cases with carcinoma of the larynx seen in the Universiti Kebangsaan Malaysia (UKM) and General Hospital Kuala Lumpur (GHKL) between 1981 to 1988 was performed. The aim was to document the distribution and the pattern of behaviour of this tumour amongst our patients. There were 137 cases, the majority of whom were Chinese (54%). The peak incidence was in the seventh decade and the male to female ratio was 7.6:1. The most common symptom at presentation was hoarseness (90%). The most common histological type was squamous cell carcinoma (87%) whilst by site, transglottic involvement was commonest (55%). The overall 3 year survival rate was 68%. Supraglottic carcinoma behaved differently in that a significantly large number presented with dysphagia (33.3%) and neck nodes (42%). Compared to tumours of other sites of the larynx, they had the poorest 3 year survival rate of 50%. Amongst the T2 and T3 tumours, the results of surgery appeared better than primary radiotherapy. Considering that 26% of patients presented with stridor, 20% with neck nodes and 55% with multiple site involvement, it can be concluded that our patients present themselves late.


A one year community-based study on the incidence of diarrhoea and rotavirus infection in urban and suburban Malaysian children. A 1 year longitudinal study of 156 Malaysian children from urban and suburban areas in the Klang Valley revealed that the incidence rate of diarrhoea was 23.6 per 100 person-year with abnormal faeces reported on 0.26% of the total days of observation. Diarrhoea cases were detected in children from all socioeconomic classes. Rotavirus was isolated from 12% of the diarrheic children and asymptomatic rotavirus infection occurred in 3.2% of the children. All rotaviruses isolated were group A rotaviruses with long electrophoretypic pattern.


Chlamydia pneumoniae respiratory infection in a child--a case report. A case of respiratory infection in a child due to Chlamydia pneumoniae is reported. The diagnosis was made by the detection of chlamydial antigen in the tracheal secretion and a significant increase in C. pneumoniae antibody titre. The infection responded well to erythromycin therapy.


A case of empyema thoracis caused by actinomycosis. A female patient who presented with left empyema thoracis caused by Actinomyces odontolyticus is reported. She responded to treatment with penicillin and metronidazole but after 3 weeks developed leucopenia complicated by gram-negative septicaemia. Leucopenia improved rapidly on withdrawal of metronidazole. Treatment was continued with a prolonged course of penicillin and she made an uneventful recovery.


The use of interventional radiology in ruptured solitary kidneys. This case report illustrates how a life-threatening renal bleeding which has failed to be controlled by open surgery can be elegantly managed by a minimally invasive technique of interventional radiology. It also allows maximal conservation of renal tissue so that the patient can avoid chronic dialysis or renal transplantation.


The surgical treatment of multiple small bowel strictures in Crohn's disease by combined resection and stricturoplasty. Crohn's disease is extremely rare among Asians. Resection of strictures causing obstruction has traditionally been the accepted choice in surgical therapy. This may lead to problems such as iatrogenic short bowel syndrome and its sequelae. Stricturoplasty is an acceptable and safe alternative. We report a case where combined stricturoplasty and resection was performed safely and advocate its use.


Schistosoma haematobium infection in Malaysia--a case report. An imported case of Schistosoma haematobium infection presenting with haematuria and proteinuria is described. This would constitute a first case of urinary schistosomiasis in Malaysia. The patient failed to respond to multiple antibiotic treatment and was successfully treated with praziquantel.


[Genetics and cancers].

[Genetics and cancers]. Multiple genome alterations can be seen within a tumor and continue to accumulate throughout development of the growth. Chromosome deletions occurring in tumors are generating much interest. To date, the best known model is retinoblastoma whose study gave rise to the concepts of anti-oncogene or tumor suppressor gene. Studies of genetic anomalies in colorectal tumors have led to an elegant model of colonic carcinogenesis in which multiple steps, each with its corresponding genetic anomaly, successively accumulate, with deletion of the p53 gene occurring as a late event. Successive anomalies of the p53 gene (mutations, deletions) occur during passage from a low-grade astrocytoma to a higher-grade astrocytoma. Studies of familial forms of breast cancer and of breast and ovarian cancer have also provided insight into the biology of these tumors, with the identification of a predisposing chromosomal area whose location is 17 q-12-21. These approaches open up possibilities for screening techniques and use of preventive treatments in highly selected patients. However they raise many ethical problems. There is a need for developing a charter for these family studies in the near future.


[Epidemiology and treatment of stomach cancer: news in 1992]. Four studies presented at the 1992 ASCO and AACR meetings are analysed. Wanebo compared treatment of gastric cancer in the USA and in Japan. Retrospective analysis of 18,365 patients showed an important delay in diagnosis and surgical treatment without radical lymph node dissection (less than 10%) in the North-American patients. In 1982, the overall 5-year survival in the USA was 17.5%, not different from that of thirty years ago. MacDonald undertook a prospective randomised study of adjuvant FAM chemotherapy in 221 patients operated on for gastric cancer. With a median follow-up of 7 years, the median overall and disease free survival were respectively 36 and 29 months in the FAM group and 28 and 22 months in the control group. These differences were not significant and the authors concluded that FAM is not an effective adjuvant chemotherapy in resected gastric cancer. Ajani studied the efficacy of pre and post-operative EAP (etoposide, adriamycin, platine) chemotherapy in fourty-eight patients with potentially resectable gastric carcinoma. The overall clinical response rate was 31%, fourty-one patients were operated on and thirty-seven had a curative resection (70%). There was one chemotherapy related death. These data indicate that pre and post-operative EAP chemotherapy is feasible and effective in patients with potentially resectable gastric carcinoma. Correa made a lecture on human gastric carcinogenesis. The "intestinal" type of gastric cancer appears to be the end result of a long series of cellular changes called "multifocal chronic atrophic gastritis". Alterations in the function of the gland neck cells appear to be responsible for the preneoplasic changes.(ABSTRACT TRUNCATED AT 250 WORDS)


[Treatment of disseminated malignant melanoma. Results are promising, but toxicity is high]. After the promising results achieved with immunotherapy in disseminated malignant melanoma, a disease reported to show little response to chemotherapy, use of combination chemotherapy regimens with interferon or interleukin and interferon has been shown to provide higher response rates and responses of longer duration. A few phase I-II trials on monoclonal antibodies have also been reported. However, toxicity is substantial with these complex combination regimens.


[Pathophysiologic mechanisms of psychopathologic phenomena and psychopharmacotherapy]. The paper is concerned with the questions of genesis of psychopathological symptomatics in terms of the theory of Academician G. N. Kryzhanovsky of determinant structures and generator activity. The complexity of experimental modelling of severe psychopathological disorders is indicated since not all psychopathological phenomena possess objective characteristics. It should be keep in mind that the psychopathological method itself is a subjective one. The stability of clinical manifestations of psychoses, e.g. schizophrenia, and reactions to the psychopharmacotherapy in an individual over a long period of time suggests the involvement in pathological process of determinant structures. Variety of clinical manifestations of schizophrenia is predetermined by unequal involvement of the brain hemispheres. In connection with this one may think about the determinant structures and generator mechanisms predominating in either hemisphere. Quantitative EEG investigation in schizophrenia patients with hallucinatory-paranoid and schizoaffective symptomatics showed that in the former group after a week long therapy using stelazine the activation of the left hemisphere prevailed, and in the latter group--of the right one. Stelazine predominantly blocks the hemisphere in which generator processes are weaker (the right one in the case of hallucinatory-paranoid syndrome, and the left hemisphere with the schizoaffective one). This accounts for a great probability of development of postpsychotic depression in the patients with the schizoaffective syndrome after administration of neuroleptic therapy. Phenomenologically similar psychopathological symptomatics, in particular a depressive one, can occur as a result of the activities of various determinant structures. Anxiety, unlike other psychopathological phenomena, is responsive to practically all types of psychotropic compounds with different mechanisms of action.(ABSTRACT TRUNCATED AT 250 WORDS)


[Systemic mechanisms of nervous disorders]. Apart from the lesion and destruction of nervous structures and nervous links there is a different, so far little known, aspect of pathogenesis of nervous disorders, i.e. appearance of new pathological integrations in the nervous system. Formation and activity of these integrations is realized by endogenous, intrinsic to the damaged nervous system itself mechanisms. Pathologic integration occurring at the level of systemic relations is a pathologic system. The main biological sign of a pathologic system, due to which it differs from a physiologic system, is a dysadaptive or directly pathogenic significance of its activity for the organism. The pathologic system may be originate as a result of hyperactivation and loss of control over the physiologic system or due to the formation of a new, pathodynamic organization in the central nervous system. The neuropathological syndrome is clinical expression of the corresponding pathologic system activity. Every syndrome has its pathologic system and the specificity of the syndrome depends on what structures of the central nervous system are part of the pathologic system. Simple, linear pathologic systems underlie the monomorphic syndromes and symptoms, and complex ones underlie the polymorphic syndromes. Due to plasticity the positive connections between the parts of the pathologic system are consolidated therefore with course of time the resistance of the pathologic system to the endogenous sanogenetic mechanisms and to therapy increases. Stabilization of pathologic system underlies the chronization of nervous disorders. The concept of the pathologic system as a basic pathophysiological mechanism of nervous disorders is a new approach to understanding pathogenesis, elaboration of models and development of new principles and method of treatment of nervous disorders.


Second messengers derived from excitable membranes are involved in ischemic and seizure-related brain damage. The intracellular accumulation of PAF following cell stimulation suggests an intracellular signal transduction pathway. High affinity binding sites for PAF in microsomal membranes and displacement of PAF from these sites by structurally distinct PAF antagonists suggests the existence of an intracellular receptor. Suppression of primary genomic responses by a PAF antagonist selective for the intracellular Ca2+ and arachidonic acid metabolites, is linking the intracellular generation of PAF to immediate-early transcription. Several of the metabolites that transiently accumulate after injury may elicit beneficial effects on regenerative processes. The membrane metabolite PAF, which accumulates after seizure and ischemia, may initiate reparative processes by promoting transcriptional activation of immediate-early transcription factors. The long-term effects of these immediate-early gene transcription factors may provide a synthetic mechanism to replenish and rebuild cells following traumatic events.


Sequelae of biochemical events following photochemical injury of rat sensory-motor cortex: mechanism of ganglioside protection. In culture the protracted and abusive stimulation of glutamate (GLU) receptors results in neuronal death through a mechanism involving the persistent translocation of PKC and the destabilization of (Ca2+)i homeostasis [(Ca2+)i HD]. In contrast, intermittent GLU receptor use elicits a coordinated expression of immediate early genes (IEG) acting as nuclear third messenger. Brain ischemia also is known to result in the paroxysmal abusive stimulation of glutamate receptors. The glutamate receptive elements in turn degenerate largely as a function of their inability to control homeostatic Ca2+ due to the irreversible translocation of PKC. In the present study we employed an in vivo model of focal brain ischemia using the photosensitive dye, Rose bengal. With this model we sought to determine the neuroprotective actions of MK-801, a noncompetitive blocker of GLU at the NMDA-sensitive receptor and of the semisynthetic gangliosides LIGA 4 and LIGA 20 which in vitro have been demonstrated to block PKC translocation. Moreover, we sought to establish whether the persistent stimulation of ionotropic glutamate receptors would led to a change in ionotropic glutamate expression in the focal and perifocal area. Importantly, the perifocal area (i. e., the region surrounding the area of primary insult) is a region in which profound cellular reorganization occurs including neuronal death and glial proliferation and is a key region to target various neuroprotective drugs aimed at ameliorating the neurodegeneration following stroke. Receptor abuse dependent antagonists (RADA) drugs such as gangliosides selectively curtail the amplification steps that specifically differentiate signal transduction following physiological receptor use from that following pathological receptor abuse.(ABSTRACT TRUNCATED AT 250 WORDS)


Potential physiological and pathophysiological roles of nitric oxide in the brain. Nitric oxide (NO) is a free radical molecule which has been described to play a role as a messenger molecule in at least three systems: white blood cells, blood vessels and most recently in the nervous system. In the brain, NO is produced enzymatically in postsynaptic structures in response to activation of excitatory amino acid receptors. A major action of NO is to activate soluble guanylate cyclase and to raise cGMP level in target cells. The role of NO as a messenger in long-term potentiation and in long-term depression has been established and recent studies have directly implicated NO in neuronal damage associated with vascular strokes. Concerning the role of NO in the excitatory amino acid neurotoxicity, more studies will be necessary to elucidate the implication of NO mediating neuronal damage. Whatever the exact function of NO, it is sure that this substance play an important role in the brain and that pharmacological manipulations of NO pathway will constitute a novel approach for therapeutical applications in the future.


Immediate-early genes in the nervous system-are they involved in mechanisms of chronic pain? Evidence suggests that long-term changes in the nervous system may represent a cause of chronic pain. Recent processes became accessible at the cellular level of the nervous system by analyzing immediate-early genes (IEG). The nuclear proteins encoded by these genes function as transcription factors, i.e. they control the expression of other genes. Many conditions of physiological and pathological stimulation can activate IEGs in the nervous system, and these findings have led to the concept of "stimulation-transcription-coupling". Noxious stimuli such as electrical C-fibre stimulation, noxious skin heating or subcutaneous formalin injection result in the transsynaptic induction of the IEG encoded proteins c-Fos, C-Jun and Krox-24, in the dorsal horn of the spinal cord. Non-noxious stimuli usually fail to induce the expression of IEGs. Nerve lesions result in a selective expression of C-Jun protein in the axotomized nerve cells, both in the peripheral and central nervous systems. Expression of IEGs after noxious stimuli and nerve lesions last for days or weeks, indicating profound alterations in the biochemistry and function of nerve cells. These changes could be involved in central nervous mechanisms of chronic pain.


[Possible molecular mechanisms of brain dysfunction in phenylketonuria]. Recent experimental data are summarized about changes in the functioning of calcium ion channels in clonal cellular lines (pheochromocytoma PC12) and hippocampal neurons of newborn rats on the background of altered intracellular level of aromatic amino acid L-tyrosine or its precursors L-phenylalanine. Elevation of the level of L-phenylalanine persistently down-regulated the high-threshold voltage-operated calcium channels in both types of cells without affecting the low-threshold ones in hippocampal neurons. This depression could be to some extent reversed by elevation of the level of L-tyrosine. Thus both amino acids seem to exert a long-lasting antagonistic modulatory effect on the corresponding channels, mediated probably through changes in tyrosylation of some cytoskeletal proteins. The participation of these molecular mechanisms in brain dysfunction during congenital disease phenylketonuria is suggested.


Phantom limb pain.

Phantom limb pain. A phantom limb is universally experienced after a limb has been amputated or its sensory roots have been destroyed. A complete break of the spinal cord also often leads to a phantom body below the level of the break. Furthermore, phantom breasts, genitals and other body areas occur in a substantial number of people after surgical removal or denervation of the body part. The most astonishing feature of a phantom limb (or other body area) is its incredible "reality" to the person. An examination of phantom limb phenomena has led to a new theory. It is proposed that we are born with a widespread neural network--the "neuromatrix"--for the body-self, which is subsequently modified by experience. The neuromatrix imparts a pattern--the "neurosignature"--on all inputs from the body, so that experiences of one's own body have a quality of self and are imbued with affective tone and cognitive meaning. The theory is presented with supporting evidence as well as implications for research.


[Dynamics of the functional state of the brain in acute focal ischemia]. Complex clinical-neurophysiological investigation of 200 patients with cerebral acute focal ischemia was carried out. It included polymodal monitoring of brain functional activity: monitoring of electroencephalography (EEG), compressed spectral array and toposelective mapping of somatosensory evoked potentials, acoustic short-latency evoked potentials, transcranial cortical electric stimulation, electromyo- and electroneuromyography. The development of acute focal cerebral ischemia was shown to be independent of its location, kind and prognosis, accompanied by functional reorganization of whole brain: its supersegmented specialized motor and sensory functional systems, nonspecific formations of segmental peripheral system. These changes in cerebral functional activity can be found already during first hours of ischemia and they remain generalized during 3-5 days.


Diffuse noxious inhibitory controls (DNIC) in animals and in man. Some neurones in the dorsal horn of the spinal cord are strongly inhibited when a nociceptive stimulus is applied to any part of the body, distinct from their excitatory receptive fields. This phenomenon was termed "Diffuse Noxious Inhibitory Controls" (DNIC). DNIC influence only convergent neurones: the other cell types which are found in the dorsal horn, including specific nociceptive neurones, are not affected by this type of control. In normal conditions, these inhibitions can be triggered only by conditioning stimuli which are nociceptive. The inhibitions are then extremely potent, affect all the activities of the convergent neurones and persist, sometimes for several minutes, after the removal of the conditioning stimulus. In fact, only activity of A delta- or A delta- and C-peripheral fibres can trigger DNIC. DNIC are sustained by a complex loop which involves supraspinal structures since, unlike segmental inhibitions, they can not be observed in animals in which the cord has previously been transsected at the cervical level. The ascending and descending limbs of this loop travel respectively through the ventro-lateral and dorso-lateral funiculi respectively. We proposed that DNIC result from the physiological activation of some brain structures putatively involved in descending inhibition. However, lesions of the following structures did not modify DNIC: Periaqueductal grey (PAG), Cuneiform nucleus, Parabrachial area, locus coeruleus/subcoeruleus, rostral ventromedial medulla (RVM) including Raphe Magnus, Gigantocellularis and Paragigantocellularis nuclei. By contrast, lesions of Subnucleus Reticularis Dorsalis (SPD) in the caudal medulla strongly reduced DNIC. Both electrophysiological and anatomical data support the involvement of SRD neurones in spin-bulbo-spinal loop(s). Indeed, they are unresponsive to visual, auditory or proprioceptive stimulation but are preferentially or exclusively activated by nociceptive stimuli with a "whole-body receptive field"; they encode precisely the intensity of cutaneous and visceral stimulation within the noxious range and are exclusively activated by cutaneous A delta- or A delta- and C-fibre peripheral volleys; they send descending projections through the dorsolateral funiculus that terminate in the dorsal horn at all levels of the spinal cord. In man, exactly analogous results have been obtained by means of combined psychophysical measurements and recordings of nociceptive reflexes. Electrical stimulation of the sural nerve at the ankle simultaneously induces a nociceptive reflex in a flexor muscle of the knee (the RIII reflex) and a painful sensation from the territory of the nerve. Painful heterotopic conditioning stimuli, no matter whether thermal, mechanical or chemical in nature, depress both the reflex and the associated painful sensation, with stronger effects being observed with more intense conditioning stimuli.(ABSTRACT TRUNCATED AT 400 WORDS)


[Opioids and the heart].

[Opioids and the heart]. The possible role of the opioid system in the cardiovascular function is an area that attracted significant attention in recent years. In order to clarify the possible role of opioids in cardiac regulation we have studied the myocardial effects of some opioids and their antagonists. Our results show that in vitro some opioids (dermorphin, alpha- and gamma-endorphins, dalargin and other) may exert inotropic, but not chronotropic, action and may act as modulatory agents on the cholinergic myocardial effects. Some of the opioidergic effects were blocked by naloxone and some were not. The results of pharmacological and physiological analysis show that opioidergic-cholinergic interaction may occur at the postsynaptic myocardial level via different mechanisms. It is well known that in vivo opioids play a significant role in shock and stress; sometimes they act as positive and sometimes--as a negative factor; the mechanisms of these effects are still not clear. We have shown that the endogenous opioid antagonist tetrapeptide FMRFa (Phe-Met-Arg-Phe-NH2) acted as a preservative agent to the acute hypobaric hypoxia and hemorrhagic shock, blood pressure and respiration and also the time of life. The efficacy of FMRFa was higher than that of naloxone. It was suggested that one of the possible mechanism of FMRFa preservative action was the increasing of sympathetic nervous system activity mediated by the endogenous opioid system inhibition.


[Stress as an indicator of individual-typologic differences]. Typological peculiarities of the behaviour of adult white male rats were determined using the "emotional resonance" test, i. e. reaction of avoidance of the signals of the defensive state of the other animal of the same species (vocalization, release of pheromones, motor excitation). The rats developed a conditional motor food reflex, and then they were subject to a stress of inescapable pain reaction. Judging by the preserved conditional food reflexes, the rats which avoided the partner's pain screams proved to be the most stable. The rats unable to determine the dominating motivation and incessantly running from one section of the chamber to the other are the least stable. The highest level of catecholamines was found in the blood of the latter group. The sensitivity to the partner's signals of defensive excitation correlates with the degree of such shifts, occurring under the stress influence as the content of noradrenaline, dopamine and 5-oxyndolacetic acid in the tissues of the brain, the state of the lipid component of the cerebral membranes. According to the obtained results the stress reveals the individual peculiarities of the physiological functions which are not obvious without the stress influences. The animals, highly sensitive to the signals of the partner's emotional state, possess high resistance to the action of the most various stresses. It can be assumed that thanks to such stability natural selection preserved the capacity for zoosocial "empathy"--phylogenetic predecessor of human altruism.


[Stress: postulates, analysis in terms of the general theory of functional systems]. Further developing of the general theory of stress, put forward by Selye, the theory of functional systems treats stress, of any origin, as a systemic response of the organism to a conflict situation. The theory of functional systems regards, along with the action of stressors, the conflict behavioral situation in which the subjects are deprived of a possibility to satisfy their main requirements, i. e. attainment of useful adaptation results, as the leading cause of stress. It is the conflict behavioral situation that gives rise to the primary reaction of the organism, viz. psychoemotional stress. Cerebral mechanisms of emotional stress in terms of the theory of functional systems are primary in the pathogenesis of psychomotor disorders in stress. The specific neurochemical changes in the limbico-reticular structures of the brain, certain neurochemical disintegration of the neuronal elements, constituting the limbico-reticular structures of the brain, underlie emotional stress. Our experiments showed that predisposition to emotional stress is accounted for by the decreased level of catecholamines and certain oligopeptides such as substance PI (?), beta-endorphins, peptide, causing delta-sleep in the limbico-reticular structures of the brain.(ABSTRACT TRUNCATED AT 250 WORDS)


[Etiopathogenesis of information disease]. On the basis of the results of animal experiments and observations of people the concept of the information disease was formulated. It is understood as a form of psychoneural pathology characterized by special causes bringing it about, as well as by a number of peculiarities of its manifestation and pathogenesis. Besides, the information diseases, as any nosological form, is characterized by distinct protection mechanisms. The methods of prophylaxis and treatment, based on the specifics of its pathogenesis, were developed in animal experiments and effectively tested on humans. The information disease (ID) is understood as various disturbances of the higher functions of the nervous system, as well as resulting from it, disturbances of the functioning of the other systems of the organisms, occurring because of the brain being for a long time in the conditions of unfavorable combinations of the three following factors, i. e. certain volume of information to be processed for an important decision to be made, the factor of time assigned for the brain work and the level of motivation determining the importance of information and necessity of its being processed. The combination of these three factors can be unfavourable if: 1) it is necessary to process a large volume of information, including the function of decision making, in the conditions of prolonged deficit of time assigned for such work of the brain with the high level of behavioral motivation, or 2) there is information deficit during a long period of time, and the behavioral motivation is also high.(ABSTRACT TRUNCATED AT 250 WORDS)


[Role of the GABA system in adaptation to long-term pain stimulation]. Pain syndrome induced by daily peritoneal electrostimulation in rats within two weeks caused decrease in body weight and in motor behavior in open-field test. Moreover, there were a decrease in thymus weight, an increase in adrenal weight and an appearance in most of animals of gastric mucosal erosions. The disturbances of the behavior and somatic state of animals are accompanied by changes of GABA and energy metabolism in the neurons of the frontal cortex. These changes manifested themselves in activation of GABA degradation with simultaneous rise of the succinate--but not isocitrate dehydrogenase activity, inhibition of glutamate dehydrogenase activity and worsening of blood supply to neurons. Chronic (14 days) administration of GABA positive drugs (baclofen--7.5-12.5 mg/kg; depakin--200-400 mg/kg) increases resistance of animals to long-term exposure to pain, which correlates with the normalization of GABA and energy metabolism. Moreover, depakin but not baclofen prevents the development of the microcirculatory disturbances, which is indicated by the normalization of either the activity of sodium phosphatase or the quantity of active capillaries. It is suggested that activation of the inhibitory GABA-ergic mechanisms is a factor of both neuromediatory and metabolic adaptation to the pain.


[Brain structure as a basis for its reliability]. The construction and activity of the brain are characterized by high degree of the reliability. Some structural-functional premises of the reliability have been described: 1) the superfluity of the nervous elements of many brain structures, which guarantees the brain reserve properties in norm and in different forms of pathology: 2) growth in the mammals row the factors of the superfluity and plasticity of the macro- and microlevels of new evolutionally cerebral systems organization; 3) the multifunctionality peculiar to diverse brain systems different degree. The study of neurochemical bases of reliability in norm and pathological conditions has now a special meaning (by stimulation of corresponding natural transmitter brain systems). The measure of reliability, its "reverse side", is the idea of the brain vulnerability. Some indices of the vulnerability increase in comparative animal row to the man, especially in the sensory and vegetative spheres.


Comparison of marginal adaptation between direct and indirect composites. The evaluation of composite resin as a posterior restorative material has been slow and attended by several problems. Gap formation has been considered a serious problem by many researchers. The purpose of this in vitro study is to compare the marginal adaptation of posterior composite resins placed by a direct method with those placed by an indirect method utilizing flexible dyes. Conclusions drawn from the results of this study are that both techniques produced marginal gaps. Also there were no differences in the width of marginal gaps in the composite resin restorations placed by our direct or indirect methods, and no marginal gap differences were observed as a result of anatomical location.


Occlusal margin defects around different types of composite resin restorations in posterior teeth. Using stone replicas of individual restorations from a clinical study investigating three types of posterior composite resins, four types of defects were identified on the occlusal margins. It was observed that particular types of defects were commonly associated with each type of composite resin. The microfilled composite usually exhibited crevice formation (marginal fracture), the small-particle hybrid showed evidence of both wear and crevice formation, and a coarse composite resin most noticeably exhibited wear. Fracture of excess composite was associated with the fine-textured composites.


Interfacial morphology of an adhesive composite resin and etched caries-affected dentin. The interfacial structure between an adhesive composite resin and dentin after caries removal and acid conditioning was investigated. The hybrid layer between the adhesive resin and surface-demineralized dentin was found to be wider in the area of empty tubules compared with that of the occluded tubules, and was found to be the thinnest at the lateral walls of the cavity where the dentinal tubules run parallel to the cavity surface. Thus, the extent of demineralization by acid conditioning as well as impregnation of resin into the intertubular dentin forming the hybrid layer is probably related to the degree of closure and direction of the dentinal tubules.


The effects of acid etching on the pulpodentin complex. Acid etching of dentin is used by many bonding systems to remove the smear layer and permit bonding directly to the dentin matrix. Although early animal studies indicated that acid etching caused moderate to severe pulpal reactions, there is a high probability that the pulpal irritation may have been due to microleakage of bacteria and their products. As these reactions are not seen following acid etching of dentin using newer dentin bonding systems, it is clear that one can acid etch dentin if, and only if, one can seal the dentin with subsequently placed bonding systems. Because acid etching increases dentin permeability and dentin wetness, successful bonding of adhesive resins to acid-etched dentin requires the use of hydrophilic resins that bond equally well to both peritubular and intratubular dentin. Future trends seem to be toward lowering both the concentration of acids and the time of etching of dentin. While all bonding systems should be carefully scrutinized prior to marketing, the future looks very promising for the use of adhesive resins on acid-etched dentin.


Dental amalgam: success or failure?

Dental amalgam: success or failure? A review of recent literature suggests that reasons for amalgam failure can generally be identified and avoided. These include: retentive failure, marginal breakdown, fracture of the tooth or restoration, reasons for sensitivity, poor surface characteristics, and contributions to periodontal disease. Materials themselves are least often the source of problems; rather, most of the failures can be attributed to lack of attention to detail in cavity preparation and handling of the materials.


Oral health of children with congenital cardiac diseases: a controlled study. Congenital cardiac disease (CCD) is one of the most common developmental anomalies in children. Affected children require special care in dentistry because of their susceptibility to infective endocarditis from oral infections, yet little information is available on the oral health of children with CCD. The present study, which investigated 39 children with CCD and 33 healthy control siblings, showed that CCD children generally suffered poorer oral health. In patients with primary dentitions, 52% of CCD children had enamel hypoplasia, compared with only 23% in the control group. In addition, CCD children had significantly more teeth with untreated dental decay (mean dmft 4.2 vs. 2.3), and more endodontically treated teeth. Children with CCD also had less than optimal professional and home dental care. Only 31% had professional advice regarding increased preventive dental health behavior, and only 15% used fluoride supplements, although the children resided in a nonfluoridated area. Furthermore, significantly fewer CCD children had parental help with tooth brushing compared to control children. This study shows that children with CCD should be targeted for vigorous preventive dental care.


Antibiotic prophylaxis for patients with hydrocephalus shunts: a survey of pediatric dentistry and neurosurgery program directors. A survey of antibiotic prophylaxis recommendations for patients with hydrocephalus shunts was sent to directors of advanced programs in pediatric dentistry and neurosurgery. Recommendations were sought for patients with ventriculoperitoneal (VP) or ventriculoatrial (VA) shunts who were to receive dental care. Most respondents believed that shunt infection (SI) was related infrequently to dental procedures. Pediatric dentists believed that 5.2% of infected VA shunts were related to dental procedures, while neurosurgeons believed the rate to be 3.0% (P < 0.05). There was no difference in perceived risk for VP shunts. Except for the equal risk associated with extractions, pediatric dentists were significantly more likely than neurosurgeons to recommend chemoprophylaxis for patients with VA shunts undergoing invasive dental procedures (P < 0.05). They were more likely to agree with neurosurgeons when VP shunts were involved. Except for the equal risk associated with dental prophylaxis, pediatric dentists and neurosurgeons believed VA shunt patients were at greater risk for SI than VP shunt patients (P < 0.05). Pediatric dentists were significantly more likely to ascribe SI to streptococcal organisms, and recommended penicillin for prophylaxis for both VA and VP shunts (P < 0.01 and 0.025, respectively). Although neurosurgeons believed that staphylococcal organisms were most likely to be responsible for SI (P < 0.001), 60% still recommended using penicillin for shunt prophylaxis following dental procedures.


Parent child separation during dental care: a survey of parent's preference. Seventy-nine parents were surveyed to determine if they preferred to be present when their children underwent dental care. The participants were asked to complete a closed-ended questionnaire before the visit. Sixty-six per cent of the parents wanted to be present with their child for care. Of the parents wishing to accompany their children, 85% responded that they would feel better, and 92% believed the child would feel better. Of the 34% of parents who did not wish to be present, most felt that their children were old enough to receive treatment by themselves (82%), or their presence might cause the child to misbehave (63%). There was no significant difference (P < .01) between the two groups concerning military status, education level, parent's age, parent's previous dental experience, or having other children in the family. Sixty-seven per cent of the parents previously had accompanied their children into the dental operatory. Generally, parents who wanted to be present had younger children, or children making an initial dental visit.


The influence of practice type, region, and age on treatment recommendations for primary teeth. The purpose of this study was to investigate dentists' treatment recommendations for interproximal surfaces of primary molars based on the type of practitioner (general dentist or pediatric dentist), geographic location, and age of practitioner. Simulated cases, which included histories and pictures of bite-wing radiographs, were mailed to a random sample of 2000 general dentists and 1000 pediatric dentists. Dentists were asked to select their treatment recommendations for eight cases involving the interproximal surface of a specified primary molar. The return rate was 42% (1245) overall, with 36% (723) from general dentists and 52% (522) from pediatric dentists. An amalgam restoration was recommended most often for these eight cases. Dentists in the age 60+ category and pediatric dentists were more likely to recommend treatment for smaller interproximal lesions. Composite resins were recommended infrequently; however, dentists in the 60+ age category and dentists in the Northeast and Southwest were somewhat more likely to recommend composite resin than younger dentists, or dentists in other geographic locations. Dentists in the 40-49 age range, pediatric dentists, and dentists in the Southwest were the most likely to recommend stainless steel crowns. These simulated cases demonstrate differences and similarities in the treatment recommendations for interproximal lesions on primary molars based on age, practice type, and region.


The detection of oral Candida in pediatric leukemia patients. Among leukemia patients, a significant number of deaths are due to Candida septicemia, many of which are associated with previous oral infections. Oral candidiasis detection methods vary, and the relationship between oral candidiasis and Candida colonization (CC) is not well defined. The main objectives of this study were to compare the incidence of CC in a healthy and leukemic population, and also to evaluate the efficacy of three simple and inexpensive methods of detecting oral CC in predicting the occurrence of oral candidiasis. A secondary objective was to portray speciation in the examined populations. Forty-two pediatric leukemia patients and 42 healthy, age-, race-, and gender-matched control patients participated in this study. The three methods of detection were cytological examination of the oral mucosa, and direct culture methods from mucosal smears using Sabouraud's dextrose agar (Becton Dickinson Microbiology Systems, Cockeysville, MD) and Oricult-N (Orion Diagnostica, Espoo, Finland). This study demonstrated an increased prevalence of CC in pediatric leukemia patients with the direct culture method detecting CC in a significantly greater proportion of the population (Oricult-N,P = 0.034; Sabouraud's dextrose agar, P = 0.0036). Candida albicans was the predominant species. Further study is needed to determine the clinical significance of oral CC and its relationship to oral candidiasis and systemic infection in pediatric leukemia patients.


Primary hyperoxaluria in a pediatric dental patient: case report. A case is presented in which primary hyperoxaluria and oxalosis in a 14-year-old Caucasian female were diagnosed. Generalized root resorption resulted in a remarkable mobility of her maxillary central and lateral incisors, although no bone loss was noted. The management of the patient's dental concerns in this rare heritable metabolic disorder consisted of removing the maxillary incisor teeth and placing two sequential prostheses, which the patient tolerated well. A history of trauma to the maxillary incisors was ruled out, so this case adds previously unreported information to our knowledge about the effect of oxaluria on teeth and oral tissues.


IV sedation in pediatric dentistry: an alternative to general anesthesia. This prospective study was conducted to determine the sedative effects of IV ketamine and fentanyl on vital signs and behavior. Twenty-seven children, classified as ASA I, with a mean age of 34 months, were studied. The dosages of IV ketamine and fentanyl given were 0.5 mg/kg and 0.5 mcg/kg, respectively, approximately every 15-20 min. The pulse rate averaged 125 throughout the case. Blood pressure averaged 112/64. The respiration rate averaged 22 breaths per min. Mean behavior composite scores were 1.9 at the initial examination and 3.3 during treatment. One child vomited during treatment. Post-treatment complications were discomfort in 19% (5), nausea in 22% (6), and vomiting in 15% (4) of the patients. We concluded that IV sedation of precooperative healthy pediatric patients with ketamine, fentanyl, and nitrous oxide/oxygen appears to be a safe and effective sedation modality with minimal side effects when administered and monitored by a qualified anesthetist, offering the practitioner an alternative to general anesthesia.


Effect of nursing caries on body weight in a pediatric population. A review of anesthesia and sedation records of children with nursing caries was undertaken. The weights of these 115 children with otherwise noncontributory medical histories were compared to subjects matched for age, gender, race, and socioeconomic status. Nursing caries children were treated using either sedation or general anesthesia and received treatment for at least one pulpally involved tooth. Comparison subjects had no gross carious lesions. The average age for both the comparison and test groups was 3.2 years (SD = 1.01 and 0.98, respectively). While comparison patients weighed 16.2 +/- 3.08 kg, patients with nursing caries weighed only 15.2 +/- 2.66 kg. This difference was statistically significant (P < 0.005). Of the nursing caries patients, 8.7% weighed less than 80% of their ideal weight, compared with only 1.7% of the comparison patients (P < 0.02). Of nursing caries children, 19.1% were in the 10th percentile or less for weight, compared with only 7.0% of comparison subjects (P < 0.01). The mean age of "low weight" patients with nursing caries was significantly greater than for patients at or above their ideal weights, indicating that progression of nursing caries may affect growth adversely.


Nutrient intake and dental caries in the primary dentition. An extensive literature has assessed the influence of diet on dental caries, but to date dietary influences on caries of the primary dentition have not been studied widely. This study examined the role of specific nutrients in the caries experience of preschool children. A total of 628 children ages 2 to 6 years received a dental examination, parent interview, and a seven-day diet diary. The diary was completed adequately for 269 children (43%). The average daily intakes of 15 nutrients were computed and compared with recommended dietary allowances (RDA); total sugar consumption and Ca/P ratio were calculated. Each child's gender, age, fluoride history, previous dental experience, and nutrient intakes were examined as independent variables. Stepwise logistic regression showed the combination of categories most predictive of caries was older age, suboptimal fluoride consumption, and recall dental visit. No association was apparent between dental caries and the intake of specific nutrients, total sugar consumption, or Ca/P ratio.


Effects of phenytoin on dental caries and plaque in Streptococcus sobrinus-infected rats. Effects of phenytoin (PHT) administration on dental caries in rats infected with Streptococcus sobrinus 6715 were investigated. Twenty-day-old specific pathogen-free Fischer male rats were infected with S. sobrinus 6715 and fed diet 2000 containing 56% sucrose with or without PHT for 52 days. Antibody responses against anti-S. sobrinus in serum and saliva failed to show a statistical difference between PHT-treated and nontreated rats. These results indicate that PHT treatment increased plaque deposition and dental caries in the rats infected with S. sobrinus 6715 and fed diet 2000 containing PHT (1-2 mg/g), as compared with those similarly infected and fed diet without PHT (P < 0.001).


Evaluation of morphine as compared to meperidine when administered to the moderately anxious pediatric dental patient. This investigation evaluated two narcotic regimens used to sedate pediatric dental patients who previously demonstrated uncooperative behavior. One consisted of submucosal morphine (0.15 mg/kg), and the other, oral meperidine (2.2 mg/kg); both were administered in combination with oral promethazine (1.1 mg/kg). Patients 2-7 years old were sedated with one of the two regimens and videotaped during dental treatment. If sedation was successful, the child received the other regimen at the next appointment, resulting in a total of 42 sedations in 29 children. Later, patient behavior was rated blindly by two independent observers viewing tapes of specific events during dental treatment. Fourteen of 23 (61%) patients receiving morphine and 11 of 19 (58%) patients receiving meperidine were sedated successfully. Vital signs, including pulse, respirations, blood pressure, and oxygen saturation were monitored and remained stable for both groups. ANOVA for repeated measures showed no significant differences for any vital sign in either group across time. Wilcoxon's signed rank test revealed significant improvement for the patients successfully treated in both groups when presedation behavior was compared with behavior during the events of rubber dam application, operative, restorative treatment, and exit (meperidine, P < 0.005 and morphine, P < 0.001). Improvement also was seen in the meperidine group for the event of local anesthesia (P < 0.01). Chi-square analysis showed no statistically significant differences in effectiveness or safety between the two sedative regimens.


Method of payment for children's dental services by practice type and geographic location. The purpose of this project was to evaluate practice type and geographical differences in methods of payment accepted for children's dental services. A survey was mailed to 2000 general dentists and 1000 pediatric dentists randomly selected to provide representation from the 50 United States. Dentists were asked to specify the type of practice and the state in which they primarily practice. The survey included Medicaid, dental insurance, preferred provider organizations (PPO), and self-payment as payment options. Dentists were asked to indicate whether they never, occasionally, or frequently accepted each option of payment for children's dental services. Responses were received from 1245 (42%) dentists, including 723 general dentists and 522 pediatric dentists. Chi-square statistical analysis revealed significant practice type and regional differences in the acceptance of Medicaid for payment. Pediatric dentists accept Medicaid more frequently than general dentists (P < 0.001). Most dentists accept dental insurance and self-payment, while few indicate involvement with a PPO. The study revealed significant practice type differences only in the acceptance of Medicaid as payment for children's dental services. On a geographic basis, there were significant differences in the acceptance of Medicaid and dental insurance.


Enamel protein in smooth hypoplastic amelogenesis imperfecta. Amelogenesis imperfecta (AI) remains a poorly understood group of hereditary enamel defects characterized by a wide array of clinical presentations. Although numerous reports have described the histological features of AI, knowledge concerning the biochemical composition of the affected enamel remains minimal. The purpose of this investigation was to examine the protein of smooth hypoplastic AI enamel. Exfoliated primary teeth were obtained from an individual with smooth hypoplastic AI together with exfoliated teeth from normal healthy individuals for controls. Enamel was dissected from the AI and control teeth to determine protein content and amino acid profile. The analyses showed that the hypoplastic AI teeth contained 2% protein, compared with 0.3% in normal primary enamel. The protein content of the hypoplastic AI enamel was similar to that reported for the late maturation stage of normal primary enamel. The amino acid profiles of both normal and AI enamel were similar although there appeared to be increased amounts of glycine in the AI enamel. Hypoplastic AI enamel showed an amino acid profile similar to normal mature primary enamel in contrast to hypomaturation AI that exhibits an amelogenin-like character. The amount of retained protein also was different from that reported for hypomaturation AI enamel which contains approximately 5% protein compared with the 2% seen in hypoplastic AI enamel. This study emphasizes the potential usefulness of protein characterization in delineating different AI types and illustrates how this information may lead to an understanding of the developmental defects responsible for producing abnormal enamel.


The influence of social status and prior explanation on parental attitudes toward behavior management techniques. The purpose of this study was to determine whether parental social status influences preference toward behavior management techniques used during dental treatment of children. One hundred and twenty-two parents from two private practices and one institutional site completed a questionnaire and rated eight commonly used behavior management techniques. These techniques were tell-show-do, nitrous oxide/oxygen, Papoose Board (Olympic Medical Group, Seattle, WA), voice control, hand-over-mouth (HOM), oral premedication, active restraint, and general anesthesia (GA). Half the parents viewed these eight techniques on a videotape which contained prior explanation for each technique (experimental group). The other half (control group) viewed the same techniques on videotape, but without prior explanations. Parents indicated their degree of acceptability by marking a line on a visual analogue scale (VAS, scored from 1 to 99). A score below 50 was considered acceptable. The parents were divided into "high" and "low" social status groups. Significant differences for HOM and GA were noted between mean scores of the experimental and control groups for both "high" and "low" social status groups; the control groups were less accepting except for GA in the "low" group where the reverse was true (P < 0.05). Techniques judged least acceptable were HOM, GA, Papoose Board and oral premedication. Parental acceptance of individual techniques varied greatly, suggesting the importance of informed consent irrespective of social status.


A pilot study of preschoolers' use of regular-flavored dentifrices and those flavored for children. Ingestion of fluoride dentifrice by preschool children recently has been implicated as a risk factor for dental fluorosis. The availability of dentifrices flavored for children could increase fluoride ingestion by young children at risk for dental fluorosis. This article reports results of a pilot study of use of regular-flavored dentifrice and those flavored for children among 29 preschool children. Using a crossover design, larger quantities of fluoride dentifrice specially flavored for children were used compared with the quantities of regular-flavored dentifrice. Pediatric dentists and other health care providers should advise parents to supervise preschoolers' toothbrushing. Preschoolers should use only small, pea-sized quantities of dentifrice to avoid increased risks of dental fluorosis.


Histopathology of the pulp in primary incisors with deep dentinal caries. The purpose of this study was to assess the histological appearance of the pulp of human primary incisors extracted because of deep, unrestorable caries, and to determine how clinical pulp exposures affected the histological status of the pulp compared to nonexposures. Caries was removed carefully from all teeth after fixation; 24 incisors had pulp exposures, and 29 teeth had no pulp exposures. Histological examination showed normal pulps in 69% of the teeth without pulp exposures, compared to 33% of teeth with exposed pulps (P < 0.05). Microabscesses were observed in 33% of cases with pulp exposures, compared to 10% of cases without pulp exposures. In this study, 46 of 53 pulps remained vital in spite of the multiple and deep carious lesions. Teeth without pulp exposures were diagnosed in the treatable category in 20 of 26 cases.


[Antiphospholipid antibodies and the central nervous system]. Among anti-phospholipid antibodies (APA), anti-cardiolipin antibodies and lupus anticoagulants are associated with arterial and venous thrombo-embolic manifestations. Antiphospholipid antibodies can be secondary to numerous diseases, especially systemic diseases, but they are usually encountered in the primary antiphospholipid syndrome. Neurological manifestations associated with APA are most often, if not always, ischemic in nature: large or small subcortical, often multiple, infarcts and transient ischemic attacks are the usual clinical presentations. Several mechanisms can lead to cerebral ischemia in the primary antiphospholipid syndrome, and their diagnosis is probably important for therapeutic choices. A prospective controlled study has started, which should provide data on the prognosis and management of this syndrome.


Symptomatic benign migratory glossitis: report of two cases and literature review. Benign migratory glossitis (geographic tongue) is a common clinical finding in routine pediatric dentistry. The condition usually discovered on routine clinical examination, appearing as an asymptomatic, ulcer-like region on the dorsum of the tongue. The lesion may recur at different sites on the tongue, creating a migratory appearance, and in many cases, will resolve completely. The presentation of symptomatic geographic tongue in children is rare. This article presents two cases of symptomatic geographic tongue. Both children presented with a chief complaint of significant oral pain which was affecting daily activity, eating, and sleeping. Both patients presented with a classical clinical presentation of ulcer-like regions on the dorsum of the tongue in which the filiform papillae were denuded. Successful management was achieved with topical and systemic antihistamine. The clinician should be aware that this condition may be symptomatic in children.


[Cerebrovascular complications of cancers]. About 15% of patients with cancer have cerebrovascular lesions, resulting from 4 kinds of disorders sometimes intermingled in advanced disseminated cancer: coagulation disorders, direct effects of the tumor, infections and therapeutic measures. Infarction, hardly less frequent than hemorrhage, mostly complicates lymphoma and carcinoma. Hypercoagulation states, such as chronic disseminated intravascular coagulation, nonbacterial thrombotic endocarditis, and nonmetastatic cerebral venous thrombosis account for about 50% of cases. Tumor emboli, as seen in intravascular malignant lymphomatosis, arteritis related to aspergillus, granulomatous angiitis with or without herpes zoster and radiation-induced atherosclerosis are rarer. Cerebral hemorrhages, excluding bleeding from the metastases of choriocarcinoma and melanoma are mainly associated with leukemia by acute disseminated intravascular coagulation as in promyelocytic leukemia, by leukostasis or by pancytopenia. Both infarction and hemorrhage rarely reveal the neoplasia. Lesions are often small and disseminated, and therefore produce a picture of diffuse acute or subacute encephalopathy rather than acute focal deficits. Finally, there may be no relationship between the cerebrovascular event and the neoplasia, and atherosclerosis or traumatic subdural hematoma may well be the causal factor.


[Interhemispheric transfer in multiple sclerosis. Morphofunctional correlations]. Signs of cerebral disconnection, especially left ear suppression to dichotically presented verbal stimuli, have been reported in multiple sclerosis patients and found to be correlated to morphological atrophy of the corpus callosum on magnetic resonance imaging. To reinvestigate this issue, 26 patients satisfying criteria for definite multiple sclerosis were proposed 3 tasks aimed at evaluating interhemispheric function: a dichotic listening task, a motor finger-tapping task and a sensory transfer task. Performance at these tasks suggested impaired callosal function in MS patients, compared to normal controls. Callosal morphology was assessed on midsagittal MRI sections using a digitalised method of partition of the callosal area into 6 subregions and automatized surface measurements. Results of correlations between task performance and callosal areas showed a significant correlation between total callosal atrophy and severity of interhemispheric impairment on each functional task. Moreover, impaired motor transfer was specifically related to atrophy of the anterior callosal regions. These results suggest that MS patients may constitute a suitable population to studying interhemispheric transfer of information through the callosal commissure and that this approach may be useful in the clinical management of MS patients.


Ewing's sarcoma of the mandible in a young patient: case report. Ewing's sarcoma, a malignant tumor, rarely occurs in children younger than 5 years of age. Although it may appear in any bone, it is more common in the axial skeleton, rarely involving the jaws (1 to 2% incidence, mostly in the mandible). The most common symptoms are pain and swelling in the affected area. History of trauma often is reported. The case of a 4-year, 10-month-old Caucasian male with a rapidly expanding mass on the right side of his face following an injury to his mandible is reported.


[Dopa-sensitive dystonia].

[Dopa-sensitive dystonia]. Dopa-sensitive dystonia has been recognised for twenty years. It may occur in the first years of life. It first affects the lower limbs, then generalized becomes, as in torsion dystonia. Eight clinical cases are presented in five boys and three girls. The absence of the disorder in the parents, but its presence in siblings in three cases suggests that it might be recessively inherited. The symptoms are severe enough to cause major functional disability. In some cases, the intensity of the motor disorder varies during the days being, less pronounced in the morning or after a nap and more marked in the evening. Nonetheless, this feature is not constant and thus cannot be considered as an essential diagnostic criterion. Treatment with levodopa gives remarkable and durable results, but it must be continued indefinitely. Abnormal movements accompany an overdose but regress when the dosage is decreased. Unlike Parkinson's disease, it is not necessary to increase or fragment doses to avoid fluctuations in the efficacy of treatment during the day. On the contrary, after several years of the illness a decrease in daily dosage sometimes to a single dose is possible. Discontinuing treatment leads to reappearance of dystonia after two or three days. There are no established biological criteria to aid diagnosis. However, a decrease in urine levels of homovanillic acid was observed in two cases. Dopa-sensitive dystonia should be regarded as distinct from juvenile Parkinson's disease, firstly because of its symptomatology and secondly, and more importantly, because of its particular course, since fluctuations in therapeutic efficacy are never observed. It is the only known example of dopaminergic insufficiency that is chronically almost completely controlled by a modest exogenous supply of levodopa.


[Central pontine myelinolysis after hepatic transplantation]. We report two cases of central pontine myelinolysis (CPM) following liver transplantation. The incidence may well be underestimated as in the past the diagnosis of CPM was based on postmortem findings. Malnutrition, poor clinical condition, encephalopathy are common features of transplanted patients developing CPM. The clinical course is characterized by a biphasic pattern; after normal recovery from anesthesia, there is a subsequent and gradual deterioration in the neurological state. The complex syndrome associates loss of consciousness, flaccid quadriplegia and pseudobulbar palsy. Among the many factors suspected of inducing CPM, a rapid correction of natremia (> 12 mmole/l/day) seems most probable. With regards to liver transplantation, CPM presents rather specific problems. Delaying transplantation to correct hyponatremia carries a risk of severe hepatic encephalopathy. On the other hand, the intraoperative compensation of blood losses with high sodium content blood products tends to induce an abrupt rise in sodium serum concentration. Moreover, renal capacity to excrete sodium is often impaired, due to hepatic insufficiency and surgical procedure. Transplantation should not be delayed, but as infusion of large amounts of sodium cannot be avoided (fresh frozen plasma, human albumin, red blood cells), natremia may be controlled by continuous veno-venous hemofiltration with low sodium content substitution fluids.


[Pseudoradicular syndrome in multiple sclerosis. 4 cases diagnosed by magnetic resonance imaging]. Four patients with multiple sclerosis presented with pseudoradicular limb pain. There was a limb weakness with sensory loss and areflexia. Magnetic resonance imaging showed a demyelinating plaque in the cervical cord with a characteristic T2 relaxation time. A direct relationship between the plaque and the clinical troubles was established in all cases. Treatment with corticosteroids was helpful, and other treatments (carbamazepine) were not necessary. The mechanisms of such pain are unknown but some of the symptoms may be the result of lesions in the endogenous pain control system.


[Polysaccharide amylopectin-type storage myopathy]. We report a late onset form of polysaccharide myopathy with progressive limb girdle muscles weakness, without cardiomyopathy. Muscle biopsy showed a vacuolar myopathy in type 1 fibres. The PAS positive diastase resistant deposits were made of filamentous material at electron microscopy similar to long chain glycogen. Muscle glycogen levels and glycogen metabolism enzymes were normal. Numerous abnormal mitochondrial with paracrystalline inclusions were observed around the storage material. Twelve patients with polysaccharide amylopectin-like storage myopathy have previously been reported. This disease must be distinguished from other diseases with polysaccharide accumulation such as branching enzyme deficiency and some cases of phosphofructokinase deficiency. In other disorders, no deficient enzymes in the glycogen pathway was found. Some of them show systemic storage (Lafora disease, adult polyglucosan body disease). Corpora amylacea, Bielchowsky bodies and basophilic degeneration of the myocardium represent localised depositions. A few inclusions can also be observed in hypothyroid myopathy. In polysaccharide myopathy allosteric inactivation of phosphofructokinase by a mitochondrial dysfunction is considered by analogy with cases of polysaccharide storage related to phosphofructokinase deficiency.