[Mechanisms of cellular detoxication, nuclear aluminum concentration and hepatocyte protection after experimental overload in rats]. A single injection of a massive dose of Al-gluconate (4 mg.kg-1) into the saphenous vein of the rat did not provoke any ultrastructural damage in the liver cells, from 2 min. to 8 days after the injection. Al hepatocytes overload appeared only in nuclei and not in nuclei and not in lysosomes, contrarily to chronic intoxications. Nuclear Al concentration concerned only a small fraction of the quantity injected; another part was sequestered by the macrophage system after precipitation in the blood as phosphates chemically transformed during their incorporation in lysosomes. This effective detoxication mechanism which functioned probably after a first absorption by the hepatocyte, was likely to depend upon the form of gluconate and would explain the resistance of liver cells.


The natural history of asymptomatic complete heart block. A case series from the Manitoba Follow-up Study. Long-standing asymptomatic complete heart block is unusual in adults. The natural history of this condition with advancing age is unknown. Four cases of complete heart block documented in patients for 23 to 48 years are reported. These men had no evidence of structural heart disease and functioned normally without symptoms for many years. Three of the four subsequently developed symptoms and required permanent pacemaker insertion. These cases illustrate the good prognosis of asymptomatic complete heart block, but raise the concern that with advancing age, intervention with pacing frequently is necessary.


Isolated post exercise delayed ST depression as a sign of severe ischemia: the influence of percutaneous transluminal coronary angioplasty. The clinical implications of isolated late recovery ST depression were tested in patients with scintigraphically defined ischemia (coronary artery disease [CAD], n = 18) compared with patients without ischemia (n = 25). Spontaneous (78.4 versus 12.0%, P < 0.008) and exercise-induced angina (44.4 versus 0%, P < 0.0001) were more frequently seen in patients with CAD. Histories of unstable angina (33.3%), prior myocardial infarction (27.8%), ST elevated angina (22.2%) and significant stenosis in the left anterior descending artery (17 of 18, 94.4%) were almost exclusively seen in the CAD group. There was no significant difference between the two groups in capacity for exercise, maximum deviation of ST level or TV2 amplitude. Balloon angioplasty abolished late recovery ST changes in 63.6% of CAD patients. These results suggest that isolated late recovery ST depression, when accompanied with typical chest pain, may be considered as an indicator of myocardial ischemia, but this phenomenon is difficult to distinguish electrocardiographically.


Pulmonary veno-occlusive disease and the CREST variant of scleroderma. Pulmonary veno-occlusive disease is a rare cause of pulmonary hypertension. The authors describe a 48-year-old female with the Calcinosis-Raynaud's phenomenon-Esophageal dysmotility-Sclerodactyly-Telangiectasia (CREST) variant of scleroderma who developed acute pulmonary hypertension with pulmonary infiltrates and a normal pulmonary capillary wedge pressure. At post mortem examination typical changes of pulmonary veno-occlusive disease were found. Similarities between this and other cases in the literature suggest a possible association between the CREST variant of scleroderma and pulmonary veno-occlusive disease.


Disappearance of Q waves following thrombolysis for acute myocardial infarction. The development of Q waves on the surface electrocardiogram generally is considered indicative of myocardial infarction. Such Q waves are usually permanent, though may regress and disappear over months to years. Transient Q waves have been described during myocardial ischemia without evidence of infarction. More recently, Q waves have been noted to develop transiently during the acute phases of infarction, possibly representing stunned myocardium. In this case report, a patient with an evolving anterior myocardial infarction and new septal Q waves was treated with intravenous thrombolytic therapy. Three hours following treatment the patient was clinically improved, and the septal Q waves had been replaced by small but obvious R waves. Despite a large area of myocardium at risk of infarction on the initial electrocardiogram, the resultant infarction was enzymatically and echocardiographically small. Early Q waves in acutely evolving myocardial infarction may represent severely ischemic, rather than irreversibly damaged, myocardium which may still be salvaged with thrombolytic therapy.


Acute effect of rapid ventricular pacing and volume loading on total vascular capacitance. Rapid right ventricular pacing (RRVP) at 250 beats/min plus a saline volume load produces acute heart failure manifested by a limited increase in cardiac output in response to the volume load and increased right atrial, pulmonary artery and capillary wedge pressures. The effects on vascular capacitance are unknown. Three groups of six anesthetized splenectomized dogs were subjected to RRVP alone at 250 beats/min for 40 mins volume loading alone with intravenous 0.9% sodium chloride 40 mL/kg over 10 mins or volume loading followed by RRVP for 15 mins. Vascular capacitance, unstressed volume and compliance were determined from pressure-volume curves using transient circulatory arrests induced by acetylcholine before and 40 mins after starting the interventions. Neither RRVP nor volume loading alone produced acute heart failure or altered total vascular compliance. Fifteen minutes of RRVP after the volume load induced heart failure, reduced compliance (3.4 +/- 0.5 to 2.5 +/- 0.3 mL/mmHg/kg, P < 0.05), increased central blood volume (7.7 +/- 0.7 to 10.6 +/- 0.5 mL/kg, P < 0.01) and reduced the unstressed vascular volume to 57 +/- 10 mL/kg, compared with 77 +/- 9 mL/kg (P < 0.01) after the volume load alone. Stressed blood volume was increased similarly with either volume loading alone (20.1 +/- 2.0 to 30.0 +/- 1.7 mL/kg, P < 0.01) or volume loading plus RRVP (23.5 +/- 3.8 to 30.2 +/- 4.9 mL/kg, P < 0.01). The reduction in unstressed volume rather than an increase in stressed volume was the major peripheral change associated with acute heart failure induced by volume loading plus RRVP. RRVP reduced vascular capacitance by a reduction in unstressed volume. Acute volume loading of this smaller vascular compartment resulted in redistribution centrally and acute heart failure.


Segregation of altered parental properties in fusions between Saccharomyces cerevisiae and the D-xylose fermenting yeasts Candida shehatae and Pichia stipitis. A prototrophic strain of Saccharomyces cerevisiae CSIR Y190 MATa xyl-, resistant to high levels of ethanol, was hybridized with xylose-fermenting, auxotrophic mutants of Candida shehatae and Pichia stipitis through polyethylene glycol-induced protoplast fusion in an attempt to produce ethanol-tolerant, xylose-fermenting hybrids. Mononucleate fusants were obtained, but these dissociated into a mixture of parental-type segregants. Purified Candida- and Pichia-resembling segregants failed to acquire improved ethanol tolerance but expressed other novel properties of S. cerevisiae, suggesting that karyogamy was impaired after internuclear gene transfer.


Utilization of tartaric acid and related compounds by yeasts: taxonomic implications. A survey of yeasts capable of growing on L(+)-tartaric acid as the sole source of carbon and energy showed that this organic acid is assimilated by a significant number of species of basidiomycetous affinity and is seldom utilized by ascomycetous yeasts. This conclusion was further supported by the fact that among approximately 100 isolates from various natural substrates, using selective media with L(+)-tartaric acid, only one strain of ascomycetous affinity was obtained. In a more comprehensive survey 442 yeast strains belonging to 138 species, mostly of basidiomycetous affinity, were also screened for the assimilation of different aldaric acids: D(-)-tartaric acid, meso-tartaric acid, L(-)-malic acid, D(+)-glucaric acid (saccharic acid), and galactaric acid (mucic acid). L(+)-Tartrate was the most frequently utilized tartaric acid isomer (55% of the total number of strains of basidiomycetous affinity belonging to either the Tremellales/Filobasidiales or the Ustilaginales) when compared with the D(-) and meso forms, which were assimilated by 12 and 18% of the total number of strains, respectively (mainly of tremellaceous species). Saccharic acid was utilized by about 75% of the total number of species of Tremellales affinity and by less than 20% of the ustilaginaceous species. Assimilation of mucic acid occurred in more than 50% of the tremellaceous species and only in 5% of the species related to the Ustilaginales. These tests, not used in standard yeast identification sets, appear to contribute to distinguishing taxa at or above the species level.


Effects of potassium sorbate on growth patterns, morphology, and heat resistance of Zygosaccharomyces rouxii at reduced water activity. A study was made of the effects of potassium sorbate on growth, morphology, and heat sensitivity of an osmotolerant yeast, Zygosaccharomyces rouxii, grown in media (water activity (aw) 0.93) supplemented with glucose and sucrose. Growth patterns of Z. rouxii in YM broth supplemented with glucose (YMBG) and sucrose (YMBS) were similar, although increased potassium sorbate concentration in both media resulted in decreased growth rates. Growth in YMBS containing potassium sorbate was not as prolific as that in YMBG containing potassium sorbate. Inhibition of growth was indicated by decreased absorbance (at 600 nm) of cells grown in YMBS and in YMBG and YMBS supplemented with potassium sorbate at 600 or 1000 micrograms/mL. Slight decreases in cell size and alteration of cellular morphology were associated with increased potassium sorbate concentration. Plasmolysis increased as potassium sorbate concentration was elevated in YMBS but not in YMBG. Tolerance of Z. rouxii to potassium sorbate was enhanced by previous adaptation of cells in media with elevated potassium sorbate concentrations. Heat resistance of cells unadapted to potassium sorbate showed little or no increase regardless of culture age, but increased substantially in cells grown in media containing potassium sorbate, particularly YMBS.


Changes in ribosomal proteins during colony development in Streptomyces. The structure and functionality of the ribosomal subunits of the substrate and the aerial mycelium of Streptomyces antibioticus were compared. Using SDS-PAGE and HPLC, several differences between the ribosomal protein pattern from both stages of development were observed, including a clear decrease in the L7/L12 content of the aerial mycelium. The activity of the aerial mycelia ribosomes was also decreased when compared with that of the substrate mycelium. This effect was more pronounced in the 50S subunit. These results suggest that during cell differentiation in Streptomyces important changes occur at the ribosomal level, particularly in the transition from the substrate to the aerial mycelium.


Promotion of apple tree growth and fruit production by the EBW-4 strain of Bacillus subtilis in apple replant disease soil. A field trial was conducted near Kelowna, British Columbia, to determine the effect of biological treatments alone and in combination with formalin fumigation in apple replant disease soil. The response was measured by the increase in cross-sectional trunk area, total shoot growth, and fruit yield of McIntosh apple trees on M.26 rootstock. The postplanting drench application of strain EBW-4 of Bacillus subtilis alone was consistently effective in increasing cross-sectional trunk area for 5 years, total shoot growth for 4 years, and fruit yield for 3 years. The biological agent EBW-4 of B. subtilis in combination with formalin fumigation was also effective in promoting total shoot growth and cross-sectional trunk area. The application of formalin fumigation alone was effective in increasing shoot growth for 2 years and cross-sectional trunk area for 1 year only. This treatment did not increase fruit yield for 3 years. The consistent performance of strain EBW-4 of B. subtilis during 1986-1991 indicates that this bacterium has the potential for biological control of replant disease under orchard conditions in the Okanagan Valley of British Columbia.


Heat-shock response in Fonsecaea pedrosoi, a pathogenic fungus. Using two-dimensional electrophoresis we have investigated the heat-shock response in a pathogenic fungus, Fonsecaea pedrosoi. Fungal cultures were transferred from 37 to 45 degrees C for either 30 or 90 min and then returned back to the initial temperature. Analysis of the total proteins resolved on two-dimensional gels indicated important changes in the accumulation of several peptides according to the duration of treatment and the temperature. The 30-min incubation at 45 degrees C resulted in the induction of several new proteins, whereas other proteins were either increased or decreased. These inductions and repressions of proteins (called heat-shock and heat-stroke proteins, respectively) were either specific to this time period or still present after a 90-min incubation. In addition, the 90-min incubation period led to the enhancement of several proteins, which were therefore called late heat-shock proteins to distinguish them from the early ones detected after 30 min. Finally, when cultures were shifted back to 37 degrees C most of the heat-shock proteins decreased or disappeared; in parallel, most of the heat-stroke proteins were reinduced at this time. These results are in good agreement with previous studies on the heat-shock response and provide additional evidence that this phenomenon is highly conserved among species.


Flocculation of Saccharomyces cerevisiae: inhibition by sugars. Flocculation is governed by the competition between electrostatic repulsion (nonspecific interactions) and polysaccharide-protein bonds (specific interactions). In our study, the inhibition of flocculation by sugars for 12 strains of Saccharomyces cerevisiae leads us to extend the classification described in the literature and to define three groups of yeasts: flocculation mannose sensitive (MS), flocculation glucose-mannose sensitive (GMS), and flocculation mannose insensitive (MI). Only the first two groups showed specific interactions between proteins and mannans. n the MI group, the sugars tested did not inhibit flocculation. To characterize the particularities of the stereochemistry of the cell-wall proteic receptors of strains belonging to the MS and GMS groups, 31 sugars were used as inhibitor probes on two representative strains. The results show that the lectin specificity of strains belonging to the GMS group is less restricted regarding C-1 and C-2 hydroxyl groups than the lectin from strains belonging to the MS group, which interacts with all of the hydroxyl groups of mannopyranose. The two groups also differ with respect to inhibition by sugars: strains belonging to the MS group are partially inhibited whereas strains of the GMS group are completely inhibited. We observed that the presence of ethanol increases sugar fixation by strains from the MS group, but not from the GMS group. Moreover, both receptors interact with disaccharides, provided the two monomers are linked by an alpha(1-4), alpha(1-3), or alpha(1-2) bond.


Enzyme activities of D-glucose metabolism in the fission yeast Schizosaccharomyces pombe. The activities of key enzymes that are members of D-glucose metabolic pathways in Schizosaccharomyces pombe undergoing respirative, respirofermentative, and fermentative metabolisms are monitored. The steady-state activities of glycolytic enzymes, except phosphofructokinase, decrease with a reduced efficiency in D-glucose utilization by yeast continuous culture. On the other hand, the enzymic activities of pentose monophosphate pathway reach the maximum when the cell mass production of the cultures is optimum. Enzymes of tricarboxylate cycle exhibit the maximum activities at approximately the washout rate. The steady-state activity of pyruvate dehydrogenase complex increases rapidly when D-glucose is efficiently utilized. By comparison, the activity of pyruvate decarboxylase begins to increase only when ethanol production occurs. Depletion of dissolved oxygen suppresses the activity of pyruvate dehydrogenase complex but facilitates that of pyruvate decarboxylase. Acetate greatly enhances the acetyl CoA synthetase activity. Similarly, ethanol stimulates alcohol dehydrogenase and aldehyde dehydrogenase activities. Evidence for the existence of alcohol dehydrogenase isozymes in the fission yeast is presented.


Cyanobiont diversity within and among cycads of one field site. Limited diversity was found among cyanobionts from a cultivated population of cycads at a field site in Florida. All isolates were classified as Nostoc but were different from the one Nostoc species found in the soil. These cyanobacteria were root endophytes of several plants of Zamia integrifolia and one of Dioon. The isolates were similar morphologically and in their reactions to four fluorescein isothiocyanate conjugated lectins. Electrophoretic protein profiles and zymograms distinguished one cyanobiont and the soil Nostoc. A tenacious Anabaena epiphyte was also discovered inhabiting the surfaces of root nodules.


Angiographic findings of ischemic stroke in children. A cooperative study was undertaken in the Tohoku district of Japan to investigate the relatively rare phenomenon of cerebral infarction in children. The purpose of the present paper is to describe the cerebral angiographic findings in 48 children whose ischemic lesions were confirmed by CT scan. The majority of lesions were considered to be idiopathic. The areas of cerebral infarction appearing in the CT scans were located in the territory of the middle cerebral artery including the basal ganglia. Angiographical abnormalities were observed in 40 patients (83%). The majority occurred in the supraclinoid portion of the internal carotid artery and in the cisternal portion of the middle and anterior cerebral arteries. Multiple lesions, such as in the C1, A1, and M1 or the C1, M1, and M2 segments were observed in 22 cases. These lesions generally appeared in continuation; no bilateral intracranial lesions were observed. Repeated angiography was performed in 22 cases, and in 55% of these some recovery of the lesions was seen.


Multiple cerebral arteriovenous shunts in children: report of 13 cases. The authors present a series of 13 multiple arteriovenous malformations (MAVMs) in the pediatric population (16.9% of their overall series of brain AVMs in this group). Two types of MAVMs can be distinguished: congenital and acquired. Congenital MAVMs may be of the nidus or fistula type. They may be uni- or bilateral, placed in one or several cerebral lobes, separated or close one to another, or even systematized (Wiburn-Mason syndrome). The symptoms created by these MAVMs are the same as those encountered in the presence of other AVMs, with hemorrhage as revealing symptom in 31% of patients. The responsibility of one particular nidus in the onset of clinical signs is often difficult to determine. From an angioarchitectural point of view, it seems that venous drainage changes are mainly responsible for the symptomatology. The natural history of these MAVMs is difficult to assess; spontaneous regression has been noted in 15% of cases. Acquired cerebral MAVMs can be due to angiogenesis ("sprouting" or "non-sprouting") around a true AVM because of previous hemorrhage or ischemia, or to pial shunts associated with dural arteriovenous malformations. The treatment of MAVMs is difficult. Embolization seems to the authors the best therapeutic modality available, as surgery or radiosurgery are often unable to treat these multifocal lesions. Anatomical cure is rarely obtained; the therapeutic strategy has to be targeted on the symptomatic lesions.


Late MRI after head injury in children: relationship to clinical features and outcome. To characterize the brain pathology in relation to long-term outcome after pediatric head injury, 55 children were studied by magnetic resonance imaging (MRI) at least 3 months after sustaining moderate to severe closed head injury (CHI). Thirty-nine of the patients had abnormal signal intensity consistent with residual brain lesions, including 28 children with lesions involving the frontal lobes. The clinical features of children with frontal lesions, extrafrontal lesions, and diffuse injury were compared. The analysis disclosed that children with frontal lobe lesions were more frequently disabled than children who sustained diffuse injury. Our MRI findings indicate that residual brain lesions are more common after moderate to severe CHI in children than previously thought and that the frontal lobes are most frequently involved. Further investigation is indicated to elucidate whether distinctive cognitive and behavioral sequelae are associated with frontal lobe lesions in children.


Proliferative assessment of craniopharyngioma and epidermoid by nucleolar organizer region staining. The histologic distinction between craniopharyngioma and epidermoid is equivocal. Eight craniopharyngiomas and ten epidermoids (including three dermoids) as well as nine rat (Wistar) abdominal skins that acted as control were investigated by a silver colloid method for nucleolar organizer regions (Ag-NORs). The mean number of Ag-NORs in at least 200 cells of both basal (columnar) epithelial cells and suprabasal (prickle) cells was evaluated. It was found that the mean number of Ag-NORs in basal cells of epidermoid and rat skin was significantly greater than that in suprabasal cells (P < 0.001 in nine of ten epidermoids and in all rat skins). On the other hand, of eight craniopharyngiomas, the mean Ag-NOR number in basal cells was not significantly different from that in suprabasal cells in five cases, and, further, the former was significantly smaller than the latter in the other three cases (P < 0.01 in two and P < 0.05 in one). These findings suggest that a stepwise maturation of the epithelial cells like that in mammalian skin epidermis exists in epidermoids but not in craniopharyngiomas. In craniopharyngiomas, the maturation of the epithelial cells seems to be considerably limited or lost from the aspect of proliferative potential as assessed by Ag-NOR score, which indicates neoplastic growth of craniopharyngiomas. Ag-NOR staining may thus be a useful method to distinguish craniopharyngioma from epidermoid.


A new method for the creation and measurement of experimental craniosynostosis. Craniosynostosis is described as a condition in which the premature closure of one or more cranial sutures is exposed as a skull deformity alone or accompanied by neurological disturbances. According to previous research it seemed possible to create an experimental model for investigating the disease by simply resecting a suture in a newborn rabbit. We resected 16 coronal sutures in 16 newborn rabbits and had the skulls investigated for shape and histology up to 6 months of age. A clear deformity at the cranial vault could be detected. The fused site of the suturectomy later on presented a suture-like structure which was macroscopically distinct from a normal skull suture. The procedure is thus established, first, for investigating procedures for treating craniosynostosis in the growing skull, and, secondly, for studying the pathophysiology of craniosynostosis.


Chronic subdural hematoma in utero. Report of a case with survival after treatment. A case of chronic subdural hematoma and hydrocephalus diagnosed in utero is presented. No history of trauma could be elicited. Laboratory investigations failed to show a coagulation disorder. Both the hematoma and hydrocephalus were surgically treated 8 days after delivery. At 14 months of age the child is showing moderately delayed development. The literature is reviewed and discussed. The importance of correct antenatal diagnosis is stressed.


Spinal epidural meningioma in a child.

Spinal epidural meningioma in a child. A case of spinal epidural meningioma in a 14-year-old girl is presented. Myelographic and computed tomographic findings led to the preoperative diagnosis of a metastatic lesion. Histological examination revealed the tumor to be a meningioma. Total resection was accomplished and the patient made a very good neurological recovery. A review of the literature reveals that these tumors have rarely been reported, especially in childhood.


Biochemical diagnosis of Canavan disease. Canavan disease (CD) is a rare autosomal recessive disorder characterized by macrocephaly and progressive leukodystrophy. Up to now biopsy or necropsy were required to define the diagnosis. Recently the disease has been related to N-acetylaspartic aciduria and deficiency of aspartoacylase, an enzyme possibly involved in the myelin synthesis. These biochemical findings have provided a diagnostic marker for the disease. We report a new case of infantile CD in which the demonstration of N-acetylaspartic aciduria and a marked deficiency of aspartoacylase activity confirmed the diagnosis.


Recurrent intrinsic brain stem epidermoid cyst. The authors report the case of a 14-month-old baby boy with an epidermoid cyst located entirely within the pons and medulla, without an exophytic component. The lesion was examined by computed tomography and magnetic resonance imaging. The child was operated upon three times after two recurrences of the lesion. A suboccipital, subtonsillar approach was used for the first and second procedures and a transtemporal approach for the last one. Excision was thought to be complete the first time, since a solid tumor was found and removed in a large cyst. The cyst wall was not identified. No tumor was found during the second procedure despite recurrence of the cyst, which was drained without an attempt to remove the cyst wall. Finally the cyst recurred with a large tumor in the cyst wall which was again totally removed. Consistent with the high mortality of brain stem epidermoid cysts in the literature, the child eventually died. The therapeutic problems, surgical options, and consequences are discussed.


Developmental changes in energy substrate use by the heart. Marked changes in intermediary metabolism occur during development of the heart. In the fetus, the heart utilises lactate and glucose as its main energy substrates, while in the adult, fatty acids are the main energy substrate. The transition from carbohydrate to fatty acid metabolism is a complex process which involves maturation of mitochondrial processes and dramatic changes in circulating levels of fatty acids and lactate. In addition, developmental changes in the use of energy substrates also involve changes in the regulation of the enzymes involved in both carbohydrate and fatty acid utilisation. This paper reviews these changes in intermediary metabolism which occur during myocardial development. The metabolic differences that exist between immature and adult hearts may explain the observed differences in the ability of immature hearts to withstand hypoxaemia or ischaemia.


Effects of exogenous oxygen derived free radicals on myocardial capillary permeability, vascular tone, and incidence of ventricular arrhythmias in the canine heart. The aim was to examine the effects of exogenous oxygen derived free radicals on myocardial capillary permeability for a small hydrophilic indicator, postischaemic vascular tone, and the occurrence of arrhythmias in the canine heart in vivo. Free radicals were generated by simultaneous intracoronary infusion of hypoxanthine and xanthine oxidase into normally perfused myocardium, and at reperfusion following five minutes of coronary occlusion, respectively, in 20 anaesthetised open chest dogs. Myocardial capillary extraction for 99mTc-DTPA, plasma flow rate, and the interstitial washout rate constant were measured by the single injection, residue detection method, and the capillary permeability-surface area product (PS) was calculated. The maximum plasma flow during reactive hyperaemia was measured by the local 133Xe washout method. Hypoxanthine and xanthine oxidase infusion into normally perfused myocardium induced a 15% decrease in capillary extraction (p = 0.05), a 24% decrease in PS (p < 0.01), and a 23% decrease in the interstitial washout rate constant (NS) two minutes after the end of the infusion. When hypoxanthine and xanthine oxidase were infused into postischaemic myocardium, 86% of animals developed sustained ventricular arrhythmias, in contrast to none in control experiments (p < 0.05). The maximum plasma flow was 363% of preocclusive values in control experiments v 268% in hypoxanthine + xanthine oxidase experiments (p < 0.05). In normally perfused hearts, intracoronary infusion of hypoxanthine and xanthine oxidase induce a decreased capillary extraction, suggesting a reduced capillary surface area. In postischaemic myocardium these substances cause a decreased vasodilatation in the initial phase of reactive hyperaemia, and induce ventricular arrhythmias.


Intimal proliferation in an organ culture of human internal mammary artery. Intimal smooth muscle cell proliferation is an early feature of atherosclerosis. Its progression is difficult to monitor in humans and previous studies have mostly relied on necropsy material. The aim of this study was therefore to establish whether intimal proliferation occurred in an organ culture of human internal mammary artery. Segments of freshly isolated internal mammary artery were maintained din standard tissue culture medium containing 30% calf serum for 14 d. Tissue viability (measured by ATP concentration) was maintained during processing and throughout the culture period [211(SEM 28) nmol ATP.g-1 wet weight on d 1 v 208(27) on d 14]. Histological transverse sections of cultured internal mammary artery showed the development of a neointima containing smooth muscle cells identified by immunocytochemistry for alpha actin. Pulse labelling of cultures with [3H]-thymidine showed proliferating cells predominantly in a neointimal layer with few dividing cells in the media. Cultured de-endothelialized vessels showed less neointimal thickening than cultured freshly isolated vessels [16(3) v 36(5) microns, p < 0.0025] as well as a reduced number of dividing cells per mm of neointimal length [3.1(0.6) v 5.5(1.1), p < 0.05]. Intimal proliferation occurred in organ culture of internal mammary artery. There is evidence for a factor derived from the endothelium, which may be important in the development of intimal proliferation.


Ischaemic preconditioning is not dependent on neutrophils or glycolytic substrate at reperfusion in rabbit heart. The aim was to determine whether reperfusion with either neutrophil free reperfusate or perfusate containing only pyruvate as the metabolic substrate would alter the protection against infarction afforded by preconditioning. Rabbit hearts (n = 4-14 per group) underwent 30 minutes of regional ischaemia followed by 120 minutes of reperfusion. Blood reperfused groups experienced both ischaemia and reperfusion in situ while Krebs reperfused groups experienced regional ischaemia in situ but were reperfused with Krebs buffer in vitro. In another group, glucose in Krebs buffer was replaced by pyruvate. Preconditioning with 5 minutes regional ischaemia caused smaller infarct size in the blood reperfused hearts: 43.0(SEM 5.4)% v 8.8(4.2)%. In Krebs reperfused hearts, preconditioning caused a similar reduction of infarct size [49.9(2.5)% v 22.9(4.3)%] which was not different from that seen in the blood reperfused hearts. Replacing the glucose in the Krebs buffer by pyruvate also had no effect on infarct size in either the control or the preconditioned hearts [40.9(6.1)% v 11.8(5.2)%]. Histology of the ischaemic zones revealed 59.6(15.0) neutrophils per 10 high power fields in hearts reperfused in situ but only 2.6(0.6) in Krebs reperfused hearts, equal to the numbers in nonischemic blood perfused myocardium [2.8(0.9)]. The mechanism of preconditioning is not due to attenuation of neutrophil function during reperfusion. Furthermore, substituting pyruvate for glucose in the reperfusate did not prevent the protection against infarction afforded by ischaemic preconditioning.


Decreased aortic compliance aggravates subendocardial ischaemia in dogs with stenosed coronary artery. The existence of decreased aortic compliance due to arteriosclerosis has been documented in patients with coronary artery disease. The aim of this study was to investigate the effects of decreased aortic compliance on coronary artery disease. To simulate coronary artery disease, a fixed stenosis was made in the left circumflex coronary artery in dogs. Ten anaesthetised open chest dogs were used. Aortic compliance was decreased by banding the thoracic aorta with adjustable plastic rings. The level of coronary stenosis was adjusted to reduce the baseline flow by no more than 10% but enough to eliminate reactive hyperaemia induced by a 10 s occlusion. Measurements of haemodynamics, regional myocardial segment length, subendocardial ECG, and myocardial tissue PO2 were performed at five stages (initial control stage, rest and pacing stages without aortic banding, and rest and pacing stages with the aortic banding). Haemodynamic variables were not changed at any stage, except for increased pulse pressure secondary to the aortic banding. During pacing with aortic banding, subendocardial PO2 (Endo) levels were decreased, and subepicardial PO2 (Epi) levels were increased, compared to those without the aortic banding [Endo: 43.2(SD 9.8) v 36.8(10.0) mm Hg, p < 0.05; Epi: 34.0(11.5) v 44.4(7.9) mm Hg, p < 0.05]. ST elevation on the subendocardial ECG was greater, and myocardial segment shortening was less with the aortic bandage during pacing. When the work of the heart is increased, a decrease in aortic compliance tends to compromise ischaemic myocardium further in the presence of an induced stenosis of a major coronary artery.


Atrial contractility affects phasic blood flow velocity of atrial small vessels in the dog. The aim was to evaluate the relative contribution of atrial muscle contraction and atrial pressure to the phasic patterns of left atrial arterial and venous flows. Using a laser Doppler velocimeter, blood velocities were measured in the atrial small arteries and veins (outer diameter: 150-500 microns) in anaesthetised open chest dogs (n = 21). The velocity sensor was fixed on the vessel surface with a drop of cyanoacrylate glue when good quality Doppler signals were consistently observed. Left atrial pressure and the contractility of the left atrium were changed by premature ventricular contraction and by intracoronary injection of isoprenaline (0.5 microgram), respectively. Premature ventricular contraction increased left atrial pressure significantly during arterial velocity measurements from 8.1(SD 2.7) to 16.4(1.3) mm Hg and during venous measurements from 8.2(1.2) to 14.3(3.7) mm Hg. However, premature ventricular contraction did not change the blood velocity patterns, the maximum deceleration rate of the systolic velocity wave in arteries, or the maximum acceleration rate of the systolic velocity wave in veins. Although isoprenaline did not change the left atrial pressure, it decreased minimum arterial blood velocity during atrial systole, from 3.3(3.4) to -2.5(3.2) cm.s-1, and increased maximum venous blood velocity from 15.9(5.5) to 19.2(7.4) cm.s-1. Isoprenaline also increased both the maximum arterial systolic velocity deceleration rate, from 90(45) to 234(143) cm.s-2, and the maximum venous systolic velocity acceleration rate from 356(230) to 763(366) cm.s-2. (1) Left atrial pressure is not a major determinant of the blood flow patterns of the atrial arteries and veins, and therefore it may not closely reflect pressure around mural vessels. (2) Atrial contractility affects the blood flow patterns of the atrial arteries and veins.


[Use of cytogenetic and molecular biology in the detection of chronic myeloid leukemia]. The examination of the presence of Ph chromosome and of the fused gene BCR-ABL in patients with chronic myeloid leukemia (CML) is significant for the precise diagnosis and in some cases for the prognosis of the disease. We examined peripheral blood for the presence of BCR-ABL fused gene by polymerase chain reaction (PCR) in eight patients with CML consecutively cytogenetically studied before and after the bone marrow transplantation and in two patients treated with interferon. Southern blot analysis was performed before BMT in two patients and the molecular rearrangement of Ph chromosome was found. In all cases our results have proved that cytogenetic and recombinant DNA evaluations confirm each other. Due to the high sensitivity of PCR technique the minimal residual leukemia can be detected.


[Fibrinogen seen as an independent cardiovascular factor from the molecular aspect]. The blood protein fibrinogen is one of the main independent cardiovascular risk factors and it is very likely that an increased fibrinogen level is not the consequence of cardiovascular disease but its direct cause. Fibrinogen participates actively in many processes in the organism and undergoes various changes of the molecule but it is not known what is the molecular background, why even a slight increase of the fibrinogen level is so dangerous as regards increased risk of cardiovascular attacks. In the present work the authors compared, using monoclonal antibodies, the rate of release of fibrinopeptides A and B (FpA, FpB) by the action of thrombin from fibrinogen in solution and from fibrinogen adsorbed to a solid surface. The authors revealed that the rate of FpB breakdown from sorbed fibrinogen, contrary to fibrinogen in solution is comparable to the release rate of FpA and does not depend on the release of FpA (except for competitive inhibition). The release of FpB from sorbed fibrinogen thus takes place, contrary to fibrinogen in solution, at a significant recordable rate from the very onset of thrombin action. Fibrinogen adsorption to a solid surface is associated with conformation changes which cause this effect and which lead to the formation of a two-dimensional formation formed by fibrinogen after its interaction with the surface of activated platelets.(ABSTRACT TRUNCATED AT 250 WORDS)


[Aberrations of the p53 antioncogene in malignant tumors]. The results of the present study of the p53 antioncogene in a broad panel of human cell lines (n = 32) and biopsy specimens (n = 435) from both normal and tumour tissues can be summarized as follows: 1. Cells in primary cultures from normal tissues express very low levels of the p53 protein while strong nuclear accumulation of p53 can be seen in all SV 40 transformed human cell lines and the vast majority of tumour--derived cell lines studied. 2. Similarly, in human tissues strong nuclear p53 expression is found in high proportion of malignancies of various histogenesis, in contrast to benign lesions, nonmalignant tissues surrounding malignant tumours and normal tissues in which the p53 protein levels remain below the limits detectable by common immunohistochemical methods. 3. Sequence analysis of p53 mRNA amplified by polymerase chain reaction (PCR) revealed point mutations in the central region of the p53 gene in several cancer cell lines. Furthermore, very good correlation was found between the presence of such mutations and accumulation of the mutated p53 protein. This study confirms and extends our current view of p53 as the gene most frequently altered in human cancer and suggests that simple immunohistochemical methods can be used to screen for aberrations of this antioncogene.


[Ferrochelatase gene expression in erythroid cells]. The mRNA level for ferrochelatase was assessed in the total cytoplasmic RNA isolated from mouse erythroleukaemic cells, line 707, in the course of induction of erythroid differentiation with hexamethylenebisacetamide and from spleen cells of mice in different stages of erythroid differentiation after phenylhydrazine administration. The level of this mRNA increased after five days of induction of erythroleukaemic cells about six times. An even more marked increase of the mRNA level for ferrochelatase (13.5X) was found in the total cytoplasmic RNA isolated from erythropoietic spleen cells of mice after induction of haemolytic anaemia by phenylhydrazine. Haem synthesis inhibitors (succinylacetone, isonicotinic acid hydrazide and penicillamine) caused a reduced gene expression for ferrochelatase in erythroleukaemic cells of mice induced with hexamethylenebisacetamide. Conversely addition of precursors of haem synthesis (5-aminolaevulinic acid or protoporphyrin IX) led to an increased mRNA synthesis for ferrochelatase. In addition to protoporphyrin synthesis the supply of another substrate, iron, is decisive for the gene expression ferrochelatase. Iron chelators (desferrioxamine or pyridoxal isonicotinoylhydrazone) reduced and iron donors (iron bound to transferrin or pyridoxal isonicotinoylhydrazone) enhanced mRNA synthesis for ferrochelatase. Added haemin reduces mRNA synthesis for ferrochelatase in fully induced erythroleukaemic cells but increases the gene expression ferrochelatase in the course of induction of erythroid differentiation because it acts as an inducing agent.


[Nucleolar asynchrony in human acute myeloid leukemia blast cells]. Nucleolar asynchrony (the presence of "active" and "sleeping" nucleoli with respect to the RNA synthesis in one and the same nucleus) was noted and studied in blastic cells of the peripheral blood in patients of acute myeloid leukemias (M1 - M4 according to FAB classification) by means of light microscopy of smears after visualization of RNA containing structures. Nucleolar asynchrony seems to be a regular phenomenon in a certain number of blastic cells in the peripheral blood and has been also verified by electron microscopy. No significant difference has been noted in the incidence of blasts with nucleolar asynchrony between the peripheral blood of patients treated and untreated by cytostatic therapy at the time of taking samples for the present study: The presence of the nucleolar asynchrony/might contribute to the resistance of a certain population of leukemic blasts to the cytostatic therapy. This supposition is supported by the present experiments "in vitro" on mouse leukemic myeloblasts sensitive and resistant to Doxorubicin. The Doxorubicin resistant myeloblasts were characterized by a significantly larger incidence of the nucleolar asynchrony as compared with myeloblasts of the Doxorubicin sensitive cell line.


[Antithrombin III. Structure, pathophysiology, determination and therapeutic importance]. The article is devoted to the coagulation proteinases inhibitor antithrombin III which plays an important role in the processes of blood coagulation. The molecular and gene structure, physiology and pathophysiology, assays and therapeutical meanings are dealt with.


[Blood transfusion preparations with a low leukocyte count. I. Preparation of thrombocyte concentrates from buffy coats]. The preparation of platelet concentrates from "buffy coat" makes it possible to obtain a platelet concentrate with a low leucocyte and erythrocyte content. Concurrently prepared resuspended red cell concentrates "buffy coat" removed have moreover a low leucocyte and thrombocyte content. The mean number of thrombocytes in 1 TU of thrombocyte concentrate was 0.45 +/- 0.2 x 10(11), the leucocyte content was 0.03 +/- 0.03 x 10(9) and the red cell content was 0.8 +/- 0.7 x 10(9). The described method makes it possible to process in a rational manner blood samples into resuspended red cell concentrate a thrombocyte concentrate and plasma content. The administration of transfusion preparations with of preparation of platelet concentrates in common practice.


[New methods of isolating recombinant proteins]. Recombinant proteins are isolated from very complex protein mixtures present in the producing cell. The isolation process involves in general four mutually interconnected stages: 1. release of the recombinant protein from the cellular environment, 2. preparation of the specimen for separation, 3. separation, 4. qualitative and quantitative analysis of the preparation. Each of these stages is formed by a complex series of methods which destroy the cellular wall, solubilize the specimen and involve the use of suitable precipitation, chromatographic, electrophoretic, immunochemical and other techniques for separation and analysis. In the submitted paper the authors describe a relatively simple isolation of recombinant peptide used for the preparation of a diagnostic kit for AIDS. From knowledge of the sequence of nucleotides in cDNA antisense peptides can be derived which have a high affinity with the isolated protein and they can be also used for affinity chromatography. An effective isolation technique is the use of mimetic ligands on the basis of textile dyes. By their combination and possible modification it is also possible to achieve separation of the required protein from contaminating substances. The mentioned highly specific methods can be combined with classical chromatographic techniques. During every step individual chromatographic fractions are tested by SDS electrophoresis in polyacrylamide gel incl. possible use of immunoblotting a specific staining.


[A registry of potential bone marrow donors]. Transplantation of bone marrow is relatively successful treatment in some haematological diseases. The most suitable donor of bone marrow is a HLA genotypic identical sibling; however, roughly only 30% of patients have a suitable related donor. In order to find a HLA identical non-related donor for a maximum number of patients it is necessary to create as extensive registers as possible of potential bone marrow donors. The authors mention the possibility to obtain these donors from the ranks of regular blood donors and they mention the advantages of obtaining a register from this group of subjects.


[Detection of carriers of hemophilia B]. Thirty-two families with haemophilia B were divided into sub-groups based on assessment of fIX:Ag, fIX:C and the thromboplastin time with bovine thromboplastin. In confirmed carriers from these families after assessment of fIX:Ag and, fIX:C the normal range of individual sub-groups of confirmed carriers was assessed and compared with values of fiX:Ag and fiX:C of the control group. It will be possible to use these groups after their extension to assess probable carriers in sub-groups CRM+ and CRM-. In the sub-group CRMR the only criterium of transmission is a reduced fIX:C level. A prolonged TP with bovine thromboplastin in families with BM haemophilia cannot be used to assess carriers.


[Results of bone marrow transplantation at the Institute of Hematology and Blood Transfusion in Prague]. The first allogenic bone marrow transplantation (TKD), when for the preparation whole body irradiation was used, was implemented in the Institute of Haematology and Blood Transfusion (UHKT) in Prague in 1986. Before June 1992 36 TKD were performed incl. 28 allogenic, 2 syngenic and 6 autologous. For the first time bone marrow from a non-related donor was transplanted. Of 30 allogenic and syngenic TKD to the present time 17 patients survive, i.e. 56.6% of the whole group. According to individual diagnoses 8 patients with the diagnosis of chronic myeloid leukaemia (CML) survive, 5 of 10 patients with the diagnosis of acute leukaemia (AL) and 3 of 4 patients with the diagnosis of severe aplastic anaemia (SAA) or with Fancon's anaemia (FA) resp. The survival period of the whole group is from 1-62 months since the transplantation. The main cause of death of 8 from 13 patients who died were infections associated with acute or chronic disease of the graft against the host (GVHD). In autologous TKD the bone marrow was treated with etoposide. Of the six transplanted patients with AL five survive 1.5-30 months after transplantation. The authors present some general information of pretransplantation preparation, prevention of GVHD, its incidence and results of TKD.


[Problems associated with the development of vaccines based on recombinant vaccinia virus]. A collection of single and double vaccinia virus recombinants was prepared. The recombinants contained either genes for different forms of surface protein or core protein of HBV or the gene for glycoprotein I of varicella-zoster virus. Cells infected with the recombinants produced the respective foreign antigens. Specific antibodies against the heterologous antigens were induced in mice immunized with the recombinants. The insertion of the second foreign gene into the genome of single recombinants did not influence either the extent of production of the first protein in vitro or its immunogenicity for mice.


[Homozygosity or an undetermined antigen at the HLA locus--a problem for forensic experts]. The author analyzed possibilities as regards the solution of paternity suits where paternity depends whether on the HLA 1 locus he is a homozygote or not. The authors presents a case of solution of a suit where the result depended on whether the man is a HLA-A2 homozygote or whether he has on the locus along with HLA-A2 also HLA-28 antigen.


[Parkinson disease. The newest etiopathogenic concepts]. Three main current hypotheses, concerning etiopathogenetic mechanisms of Parkinson's Disease are presented. Various aspects of MPTP activity, free radical involvement and genetic factors are discussed.


[Beta-carotene and prevention of lung carcinoma]. The recent findings are critically reviewed on metabolism, pharmacokinetics, both nutritional and biochemical epidemiology, and the probable mechanisms of chemopreventive action. Some recommendations of practical value are highlighted.


[Determination of NK cell activity on flow cytometry]. The authors assessed the activity of NK cells on a flow cytometer using 5-carboxyfluorescein diacetate as fluorescent substrate. They examined 25 healthy subjects aged 23-52 years. In NK cellular activity the normal distribution applies and the value of NK cellular activity for the whole group as regards the ratio of effector cells to target cells was 25:1, 23.46 +/- 15.84 percentage. The authors did not detect any significant differences in the activity of NK cells in relation to age and sex. They revealed statistically significant correlations of NK activity and the number of CD16+ and CD57+ cells as well as CD57+ CD3- cells. The optimal ratio of effector and target cells for assessment of NK activity was 25:1. Assessment of NK activity on a flow cytometer can be considered an equivalent substitute of the classical method, using radiochromium.


[Correlation between urinary excretion of neopterin and levels of thyroid gland hormones in patients with goiter]. The authors assessed in 18 patients with goitre the urinary excretion of neopterin and the blood level of thyroid hormones. They revealed a significant correlation between urinary neopterin excretion and the thyroxine (T4) and triiodothyronine (T3) blood level. This correlation did not apply in female patients treated with large doses of Carbimazol: these patients had a high neopterin excretion, while the thyroid hormone levels were only slightly elevated. This suggests again that Carbimazol has in addition to an antithyroid effect also an immunomodulating action.


[Clinical experience with long-term administration of "essential" phospholipids in chronic active hepatitis. Review of 3 double-blind studies]. The results from three double-blind studies, obtained after a 12-month treatment with Essentiale or placebo in patients (n = 85) with HBsAg positive or HBsAg negative chronic active hepatitis provide evidence of the clear improvement of the clinical and histological picture in the majority of the patients treated with Essentiale forte.


Multivesicular bodies in the transitional epithelium of the neonatal mouse urinary border. The origin of late endosomes - multivesicular bodies (MVBs) in the superficial cells of 16 and 17 embryonic old transitional epithelium of mouse urinary bladder was studied by electron microscopy, lectin labelling and HRP tracing. Analysis of hexagonally structured membrane particles, WGA, and RCA I binding sites revealed structural similarity between plasmalemma, fusiform vesicles and multivesicular bodies. Early endosomes are lined by symmetric unit membrane as well as by asymmetric thickened membrane regions. Multivesicular bodies and fusiform vesicles have asymmetric unit membranes. MVBs may be derived from primary endosomes as well as from fusiform vesicles in the cytoplasm.


The influence of maternal nicotine exposure on neonatal lung carbohydrate metabolism. The influence of maternal nicotine exposure (1 mg/kg body mass/day) during pregnancy and lactation on energy metabolism of lung tissue of neonatal rats were investigated. The glucose turnover of the lung tissue of the neonatal rats exposed to nicotine via the placenta and mother's milk was 86.4% higher than that of the controls. Glycolysis was however suppressed by 22.7% (P < 0.01). The adenine nucleotide pool (ATP+ADP+AMP) was 32.8% higher for the lungs of the 3 week old neonates exposed to nicotine than that of the control rat lung. After 4 weeks of nicotine withdrawal glycolysis of those animals exposed to nicotine were still inhibited to the same extent than during exposure. The adenine nucleotide pool was 69.95% higher than that of the controls. It is proposed that the inhibition of glycolysis was due to the high ATP/ADP ratio of the lungs of the nicotine exposed rats.


Lidocaine 0.5% spinal anaesthesia: a hypobaric solution for short-stay perirectal surgery. The efficacy of subarachnoid injection of 8 ml lidocaine 0.5% was assessed in ten outpatients having perirectal surgery in the jackknife position. This solution is hypobaric, with a baricity 0.9985 +/- 0.0003 (mean +/- SD). Injections were made with the patient in the surgical position (with the upper torso at a 15 degrees downward inclination). Sensory level was tested by pinprick. Times to two-segment regression, to complete resolution of sensory analgesia, to urination, and to discharge from the recovery room were recorded. All injections produced effective anaesthesia for surgery. Lidocaine 0.5% behaves clinically as a hypobaric solution. Dermatomal levels remained low (T11 to L5) while the patients were in the surgical position (head down), but rose two to six dermatomes if the patient's head was elevated after surgery. Time to two-segment regression was 97 +/- 36 min, time until regression to S1 was 116 +/- 22 min, time to complete resolution of sensory blockade was 151 +/- 23 min, time to urination was 197 +/- 64 min, and time to discharge from the recovery room was 205 +/- 45 min. Lidocaine 0.5% provides effective spinal anaesthesia of short duration appropriate for outpatient surgical procedures. Dermatomal sensory spread of anaesthesia, and our measurements of specific gravity, indicate that this solution is hypobaric. It appears that changes in position can alter the spread of analgesia for at least one hour after injection and, thus, we caution against elevating the patient's head in the immediate postoperative period.


Haemodynamic responses to tracheal intubation following etomidate and fentanyl for anaesthetic induction. The haemodynamic response to anaesthetic induction and tracheal intubation was studied in 29 patients undergoing elective myocardial revascularization surgery. All patients included in the study were anaesthetized with etomidate, 0.3 mg.kg-1. The patients were randomized to three groups: Group I received fentanyl, 2.5 micrograms.kg-1; Group II received fentanyl, 5 micrograms.kg-1; and Group III received fentanyl, 10 micrograms.kg-1. Haemodynamic variables were measured at baseline (awake), after anaesthetic induction, and at one, three, five, and ten minutes after tracheal intubation. The number of patients with haemodynamic responses to intubation (> 20% increase in heart rate or mean arterial pressure) was greater (P < 0.05) in Group I than in Groups II and III. Statistically significant, but clinically minor, decreases in mean arterial pressure and cardiac output occurred in all groups at the last three study times. The frequency of involuntary muscle movements was 14%, and all of these events occurred in patients in Group I. In conclusion, the authors recommend using fentanyl, 5-10 micrograms.kg-1 to blunt the haemodynamic response to tracheal intubation following anaesthetic induction with etomidate, 0.3 mg.kg-1.


[The measurement of pH and gases in the blood using microanalysis: the effect of storage at 4 degrees C for an hour. A study in the rat]. The effects of one hour storage at 4 degrees C on micro blood gas samples (150 microliters) were studied for a wide range of values (pH: 7.11-7.58; PCO2: 26-97 mmHg; PO2: 31-503 mmHg) in 20 rats with indwelling carotid artery catheters. Blood gas values were modified by varying the composition of inspired gases: normoxia, hypocapnic hypoxia, hyperoxia, hypercapnia (in this case eight animals were anaesthetized with halothane 1.1%). One hundred and eight double micro-samples were taken. For each double sample, one was analysed immediately (H0) and compared with the second sample after one hr storage at 4 degrees C (H1). The Bland and Altman method was used for the statistical analysis of results. After one hr storage at 4 degrees C, the PCO2 was slightly higher than at H0 (mean difference +/- SD: +1.08 +/- 1.7 mmHg) and arterial pH was slightly lower (mean difference +/- SD: -0.016 upH +/- 0.011 upH). These results show that for these two variables, in the range studied, one hour storage at 4 degrees C had little effect. In contrast, for arterial PO2 the mean difference between all measurements between H1 and H0 was -17 +/- 25 mmHg. If results lower than 200 mmHg (56 double samples) are considered separately, the mean difference between values at H1 and H0 was only -0.98 +/- 5.3 mmHg. For PaO2 greater than 200 mmHg (52 double samples), the mean difference was -34 +/- 26.3 mmHg; this may be due to low reproducibility of measurements of elevated PO2 levels and to the effects of cellular metabolism.(ABSTRACT TRUNCATED AT 250 WORDS)


Efficacy, duration, and absorption of a paediatric oral liquid preparation of ranitidine hydrochloride. The objectives of this study were to assess the clinical efficacy of a new oral ranitidine liquid preparation in reducing gastric acidity and volume, to determine the degree of absorption of the drug, and to determine the duration of drug effect. Eighty preoperative children between the ages of one and six years were enrolled in each of three centres. Each subject was allocated to one of the following groups: Group A - apple juice, 5 ml.kg-1 plus placebo liquid; Group B - apple juice, 5 ml.kg-1 plus ranitidine hydrochloride 2 mg.kg-1; Group C - water, 5 ml and placebo liquid; or Group D - water, 5 ml and ranitidine liquid 2 mg.kg-1. All study agents were administered at least two hours before surgery along with a dye marker, sulfobromophthalein 1 ml (50 mg.ml-1). Following induction of anaesthesia, gastric fluid was aspirated, and analyzed for pH, volume, and sulfobromophthalein content (as an index of the ingested fluids). A serum sample was also drawn and analyzed for ranitidine content by high performance liquid chromatography. Groups B and D had fewer subjects with pH below 2.5 and gastric volume > 0.4 ml.kg-1. The duration of reduced volume and acidity was shown to be greatest from two to four hours after drug administration. Thirty-three percent of subjects receiving oral ranitidine, 2 mg.kg-1 hydrochloride as a single dose demonstrated no measurable effect on gastric pH and volume; 28 of those subjects had adequate ranitidine serum levels.


Carbon dioxide reactivity and local cerebral blood flow during prostaglandin E1- or nitroglycerin-induced hypotension. The aims of this randomized study were to determine the effect of prostaglandin-(PGE1) or nitroglycerin-(TNG) induced hypotension on local cerebral blood flow (LCBF) and carbon dioxide reactivity during isoflurane anaesthesia in 20 patients after subarachnoid haemorrhage (SAH) scheduled for aneurysm clip ligation. Mean arterial blood pressure decreased immediately, after giving either PGE1 or TNG. The LCBF, measured using a thermal gradient blood flowmeter, was unchanged after PGE1, while the LCBF increased after TNG infusion (control; 47.6 + 10.0, 60 min after infusion; 55.1 +/- 6.5 (P < 0.05), before clipping; 55.5 +/- 7.8 (P < 0.05)) but returned to control values after its discontinuation. Carbon dioxide reactivity, calculated from % delta LCBF/delta PaCO2 was unchanged during PGE1- or TNG-induced hypotension (PGE1; 2.13 +/- 0.9, 2.48 +/- 0.68 and 2.31 +/- 0.79%/mmHg for before, during and after hypotension respectively) (TNG; 2.08 +/- 0.68, 2.17 +/- 0.64 and 2.02 +/- 0.69%/mmHg for before, during and after hypotension respectively). Carbon dioxide reactivity correlated with presurgical neurological status (rs = -0.7, -0.648 and -0.458 for before, during and after hypotension respectively) and the initial LCBF (rs = -0.605). These results suggest that both PGE1 and TNG are useful drugs for induced hypotension for cerebral aneurysm surgery, because neither decreased LCBF.


EMLA partially relieves the pain of EMG needling. The aim of this study was to evaluate the efficacy of the topical analgesic cream EMLA in alleviating the pains caused by needling in electromyography (EMG). During the course of regular neurophysiology clinics, 34 Caucasian patients of both sexes, aged 21 to 69 yr (mean 38.5 +/- 11.4 SD), scheduled for electromyography, were studied. The EMLA was spread thickly on two EMG sites on each arm: E site, on the lateral dorsal aspect of the forearm and A site, on the thenar eminence. Randomization was pre-established. Whenever EMLA was applied blindly on one of the sites of the arm, the placebo was applied on the homologous site of the other arm. After at least 45 min of application (range 45-145 min, mean = 72.3 +/- 22.2), the needle was inserted into the skin and into the muscle. Then the electromyographist asked the patient to score his degree of pain on a visual analogue scale (VAS 1-10 cm) for each level of insertion. The results showed that on the skin of E site, the pain was less after EMLA than placebo (VAS = 0.75 +/- 1.36 vs 3.10 +/- 1.75, P = 0.0001). The untreated E site (placebo) was less sensitive than the untreated A site (VAS = 3.10 +/- 1.75 vs 6.09 +/- 1.96, P = 0.0001). Muscle insertion on E site was less painful on the EMLA sites than placebo (VAS = 2.83 +/- 2.45 vs 5.73 +/- 2.30, P = 0.0001). The VAS scores for skin and muscle insertion on A site were identical whether EMLA or placebo had been applied.(ABSTRACT TRUNCATED AT 250 WORDS)


Laparoscopic cholecystectomy: the anaesthetist's point of view. Although the surgical advantages of laparoscopic cholecystectomy (LC) have been reported, the anaesthetic problems associated with this new technique have not been well described. For the first 101 patients undergoing laparoscopic cholecystectomy at our institution, we prospectively documented intraoperative critical observations and adverse outcomes in the PACU (Post-Anaesthetic Care Unit). In order to put the magnitude of these problems into perspective, we compared, in an identical manner, the anaesthetic management and outcomes of two more familiar surgical groups, cholecystectomy by laparotomy (C), and laparoscopy for gynaecological examination (LG). For this new procedure LC, intraoperative hypotension (12.9%), and PACU hypothermia (31.4%), nausea and vomiting (12.9%) and desaturation (10.9%) were common but excessive pain (4.0%) was rare. Patients undergoing C, who were older and less healthy, tended to have fewer incidents of OR hypotension (3.4%) but in the PACU experienced more desaturation (25.9%) and excessive pain (12.9%) (P < or = 0.05). The younger and healthier LG group had fewer problems, less OR hypotension (0.4%), and less PACU nausea and vomiting (5.7%) and desaturation (1.3%) (P < or = 0.05). However, the LG group had a similar incidence of excessive pain (4.4%). We have documented considerable postoperative anaesthetic benefits for patients undergoing laparoscopic cholecystectomy compared with conventional cholecystectomy. However, there is still considerable perioperative morbidity compared with gynaecological laparoscopies. Now that specific problems have been identified, they may be amenable to specific anaesthetic interventions.


Alfentanil-midazolam anaesthesia has no electrophysiological effects upon the normal conduction system or accessory pathways in patients with Wolff-Parkinson-White syndrome. The effects of alfentanil-midazolam anaesthesia upon the electrophysiologic (EP) properties of normal atrioventricular (A-V) and accessory pathway (AP) conduction were studied in eight patients with Wolff-Parkinson-White syndrome during accessory pathway surgical ablation. The presence of an AP was confirmed by preoperative EP studies. Anaesthesia was induced with alfentanil (50 micrograms.kg-1) and midazolam (0.15 mg.kg-1) and maintained with an alfentanil infusion (2 micrograms.kg-1.min-1) and intermittent boluses of midazolam (1-2 mg q 15 min, PRN). Following sternotomy, a baseline EP study was performed which consisted of effective refractory period (ERP) and shortest cycle length (SCC) measurement during antegrade conduction in the AV and AP, as well as during retrograde conduction in the AP. Comparison with preoperative EP studies indicated that the administration of alfentanil-midazolam anaesthesia had no effect upon conduction or ERP in either pathway. Haemodynamic stability occurred throughout the surgical procedure with no tachyarrhythmias. We conclude that a combination of alfentanil-midazolam is suitable for general anaesthesia in patients undergoing ablative procedures for accessory pathways.


Perioperative haemotherapy: II. Risks and complications of blood transfusion. Major life-threatening complications following blood transfusion are rare and human error remains an important aetiological factor in many. The infectious risk from blood transfusion is predominantly hepatitis, and non-A, non-B and hepatitis C (HCV) are the most common subtypes noted. The risk of post-transfusion hepatitis (PTH) appears to be decreasing and this is attributed to both deferral of high-risk donors and more aggressive screening of donated blood. Screening for HCV is expected to decrease this risk further. The risk of HIV transmission following blood transfusion is negligibly small. There are data to suggest that perioperative blood transfusion results in suppression of the recipient's immune system. Earlier recurrence of cancer and an increased incidence of postoperative infection have been associated with perioperative blood transfusion although the evidence is not persuasive. Microaggregate blood filters are not recommended for routine blood transfusion but do have a role in the prophylaxis of non-haemolytic febrile reactions caused by platelet and granulocyte debris in the donor blood. Patients should be advised when there is likely to be a requirement for perioperative blood transfusion and informed consent for transfusion should be obtained.


Endothelial vasomotor regulation in health and disease. The purpose of this review is to provide the anaesthetists with a comprehensive update on the endothelial-cell control of local blood flow. This single cell layer was originally thought to represent only a passive barrier. It is now evident that it plays an active role in a broad variety of biological functions. Since the discovery of the endothelial-derived relaxing factor (EDRF), it has been the subject of a considerable amount of research. It is established that EDRF is secreted continuously at a basal state and that many physical stimuli as well as vasoactive substances can modulate its secretion. Evidence presented indicates that the endogenous vasodilatation produced by EDRF is similar to that of the exogenous nitrovasodilator nitroglycerin and nitroprusside (i.e., nitric oxide). Aside from EDRF, the endothelium produces other vasodilating as well as vasoconstricting factors. A review of the physiology of the endothelium regarding the local control of blood flow is provided along with its influence upon several pathophysiological states. Also included is an overview of the influence of anaesthetic agents on endothelial function. These findings linking vasomotor control to endothelial function will help to explain pathophysiological process and may lead to new therapeutic modalities.


The divergent actions of volatile anaesthetics on background neuronal activity and reactive capability in the central nervous system in cats. The effects of halothane, isoflurane, and enflurane on background neuronal activity and reactive capability in the central nervous system were studied in cats. The background neuronal activity was assessed by midbrain reticular cell firing, which was measured by the method of multi-unit activity, and the EEG in the cortex, amygdala, and hippocampus. The reactive capability was assessed by evoked responses in the visual neuronal pathway. All anaesthetics studied suppressed reticular cell firing in a dose-dependent manner, and the suppression by halothane (43.8 +/- 10.3% of control, mean +/- SD) was less than isoflurane (66.5 +/- 5.8%, P < 0.01) and enflurane (73.1 +/- 8.8%, P < 0.05) at 1 MAC. Spontaneous EEG spikes developed at 4.8% isoflurane and 3.6% enflurane anaesthesia. Phasic activation of reticular cell firing was associated with EEG spikes during isoflurane and enflurane anaesthesia, and the activation during enflurane anaesthesia was greater than during isoflurane anaesthesia (P < 0.01). Photic stimulation provoked EEG spikes and repetitive stimulation induced seizure activity only at 3.6% enflurane anaesthesia. Halothane and isoflurane suppressed stimulation induced responses in the visual neuronal pathway. The amplitudes of N1 in visual cortical evoked responses induced by photic stimulation were suppressed to 70.1 +/- 24.5% of control at 2.4% halothane and 39.3 +/- 27.3% at 4.8% isoflurane. Enflurane, at 3.6%, augmented the evoked response induced by photic stimulation (398.4 +/- 83.0% of control in the amplitude of N1). These results indicate that all the agents studied had suppressive actions on background neuronal activity in the order halothane < isoflurane = enflurane. The effects on reactive capability were divergent among agents, e.g., enflurane enhanced, halothane suppressed, and the actions of isoflurane were intermediate. We conclude that the anaesthetic effects on background activity and on reactive capability are divergent and that suppression of reactive capability is a factor in determining the ease of clinical application of the anaesthetics.


Influence of desflurane, isoflurane and halothane on regional tissue perfusion in dogs. The actions of desflurane, isoflurane and halothane on regional tissue perfusion were studied using radioactive microspheres in dogs chronically instrumented for measurement of arterial and left ventricular pressure, global (left ventricular dP/dtmax) and regional (percent segment shortening) contractile function, and diastolic coronary blood flow velocity. Systemic and coronary haemodynamics and regional tissue perfusion were measured in the conscious state and during anaesthesia with equihypotensive concentrations of desflurane, isoflurane, and halothane. All three volatile anaesthetics (P < 0.05) increased heart rate and decreased mean arterial pressure, left ventricular systolic pressure, and left ventricular dP/dtmax Myocardial perfusion was unchanged in subendocardial midmyocardial, and subepicardial regions by the administration of either dose of desflurane. No redistribution of intramyocardial blood flow (endo/epi ratio) was observed during desflurane anaesthesia. Although regional myocardial perfusion was reduced (P < 0.05) in a dose-related fashion by halothane and by isoflurane at high concentrations, redistribution of intramyocardial blood flow was not observed during halothane or isoflurane anaesthesia. All three volatile anaesthetics reduced blood flow to the renal cortex, but only desflurane produced a decrease in renal cortical vascular resistance. Hepatic blood flow decreased in response to halothane but not desflurane or isoflurane. Concomitant decreases in hepatic resistance were observed during administration of desflurane and isoflurane. Dose-related decreases in intestinal and skeletal muscle blood flow were observed during halothane and isoflurane but not desflurane anaesthesia. The results suggest that desflurane maintains myocardial, hepatic, intestinal, and skeletal muscle blood flow while halothane and isoflurane decrease regional tissue perfusion in these vascular beds to varying degrees during systemic hypotension in the chronically instrumented dog.


The output of four modern vaporizers in the presence of helium. It has been previously demonstrated that the output of calibrated vaporizers is influenced by the concentration of nitrous oxide in the carrier gas. This study was performed to determine whether helium in the carrier gas affects the output of modern calibrated vaporizers. A factorial design was used to determine the influence of carrier-gas helium concentration, carrier-gas flow rate and vaporizer dial setting on the output of four vaporizers: Ohio Calibrated Enflurane, Ohio Calibrated Isoflurane, Ohmeda Isotec 4, and Dräger Vapor 19.1 Isoflurane. Three vaporizers of each model were tested. Output was converted to % of baseline so that different dial settings could be compared. For a given dial setting, baseline was defined as the output at a carrier-gas flow rate of 3 L.min-1 and helium concentration of zero. The data were analyzed using multiple linear regression. There was an effect of helium concentration on vaporizer output in all models. None of these changes was clinically important, since vaporizer output did not vary by more than +/- 10%, except at high flows and at high helium concentrations with the Ohmeda Isotec 4. It is concluded that these vaporizers can be used safely with helium.


[The effect of acupuncture on high oxygen pressure-induced convulsion and its relationship to the brain GABA concentration in mice]. This paper reports the effect of acupuncturing "Renzhong" (GV26) and "Chengjiang" (GV24) points on OHP*-induced convulsion in mice. The results are as follows: 1. Convulsion induced by 6 ATA OHP were accompanied with a decrease in the brain GABA concentration. 2. When electro-acupuncture was applied for 15 minutes prior to exposure to hyperoxic chamber, the latency of convulsions was lengthened and the symptoms of seizures were alleviated. Besides, the brain GABA concentration was also elevated remarkably. 3. Administration of vitamin B6 enhanced the effect of acupuncture on convulsions and increased brain GABA concentration. 4. The latency of convulsions was well correlated with the GABA concentration of the brain (r = 0.9867). The above results indicate that acupuncture may elevate endogenous GABA levels in the brain and prevent the hyperbaric-oxygen-induced the decrease in the brain GABA content. Therefore. It is of protective effect against oxygen convulsions. Vitamin B6 may facilitate the effect of acupuncture by improving the GABA metabolism in the brain. In short, the effect of acupuncture against oxygen convulsions may be closely related to the increase in the brain GABA levels.


[Pasting acupoints with Chinese herbs applying in infant acute bronchitis and effect on humoral immune substances]. This report described the clinical observation of pasting acupuncture with Chinese herbs applying in 72 infant acute bronchitis cases and regarding to the humoral immune substances such as IgA, IgM, IgG, Complement C3 The result shows high cure and improve rate. The curative effect of infantile group is higher than that of childhood one (x2 = 6.501, 0.05 > p > 0.025). All indexes of humoral immune substances, especially IgA, were increased after treatment (t = 10.50, p < 0.01).


[Effects of moxibustion on experimental gastric ulcer in rats]. This study was designed to determine whether moxibustion at "Shenjue" plays a role in protecting gastric mucosa in rats. The areas and histological changes of gastric ulcer were examined. The results were as follows: 1. Moxibustion pretreatment within 3 weeks significantly prevented the formation of gastric ulcer. 2. As gastric ulcer had formed, moxibustion couldn't shorten the period of recovery of gastric ulcer. The results suggested that moxibustion pretreatment at "Shenjue" had a protective effect on gastric mucosa. After the experimental ulcer had formed, however, the moxibustion had little protective effect on it.


[Effect of circadian rhythm on the action of acupuncture to prevent the formation of experimental gastric ulcer]. Taking rats and mice as subjects, observation had been made on the protecting action of acupuncture to prevent the gastric mucosa from experimental injury. The pH value (by accurate test paper), gastric acid output (by titration), the secretion of PG in gastric mucosa (by radioimmunoassay) were observed altogether at 1-3h, 5-7h, 9-11h, 13-15h, 17-19h and 21-23h. All of the above indices were changed along with the alternation of day and night. And the effects of acupuncture on these indices were different when giving acupuncture at different times. The action of acupuncture to prevent experimental gastric ulcer was also different at different times. It is the general regularity that puncturing at the acrophase of circadian rhythm, the effect was mainly inhibitory, while puncturing at the valleyphase, the effect was mostly excitatory. Therefore, utilizing the influence of the various phases of circadian rhythm on the acupuncture effect, to choose the optimum time giving acupuncture could be one way to promote the acupuncture curative effect.


[The segmental distribution of the afferent neurons of the "zusanli" point and the caecum in rabbits--a study with the horseradish peroxidase method]. Ten adult rabbits were used in this experiment. A solution of 10-20% HRP (sigma IX, RZ = 3.2) was injected into the "Zusanli" point and the subserosa of the caecum. The uptake and retrograde transmission of HRP in the afferent neurons of both the somatic and visceral nerves were traced to the spinal ganglia. The results showed that: 1. Labelled afferent neurons from the region of "Zusanli" point were found in the spinal ganglia T12-S2 with a higher concentration in L4-S2. 2. Labelled afferent neurons from the region of the caecum were found in the spinal ganglia T2-S2 with a higher concentration in T12-L2. 3. The ranges of distribution of labelled afferent neurons from the regions overlapped in the segments T12-S2.


[Experimental study on the influence of acupuncture and moxibustion on interleukin-2 in patients with rheumatoid arthritis]. Rheumatoid arthritis (RA) is referred to the category of Bi syndromes in traditional Chinese medicine. It is regarded as an autoimmune disease, but the pathogenic mechanism is still to be clarified. In order to observe the effects of the treatment of RA with acupuncture and moxibustion on IL-2, 41 patients were divided into warming needle and point injection groups at random, and 19 healthy subjects as control group. The results showed that the IL-2 levels in two RA groups before treatment were obviously lower than that in control group (P 0.05). After treatment the IL-2 level in control group was unchanged, but increased considerably in two RA groups (P 0.01). Generally, IL-2 is considered as a very important signal for regulating immune response. Our results have shown that the decrease of IL-2 in patients with RA should be one of main causes of internal environment disorder, acupuncture and moxibustion as a stress stimulation exerts an influence on the immunity system through neuroendocrine system to improve the IL-2 production.


[Effect of electro-acupuncture on cortical and hippocampal EEG in adjuvant arthritis rats]. Adjuvant arthritis (AA) rats were used as the chronic pain model. The cortical and hippocampal (HPC) EEG were recorded. The behaviour and local inflammatory reaction were observed. The results showed an arousal response of desynchronization of the ECoG and HPC EEG in the AA rats, the delta waves were decreased and beta waves increased significantly. However, the inhibited effect to the desynchronization were showed could be inhibited by the electro-acupuncture (EA) on bilateral Zusanli points and morphine in the AA rats. The results suggested that the cortex and hippocampus participate in the modulating action of chronic pain, and the EA has an analgesic action.


[Observations on the changes in plasma pH and kalium content and the effect of acupuncture on them in the rats with hemorrhagic shock]. In the present work, the changes of pH and the kalium content of blood and the effects of acupuncturing "Renzhong" on these changes were observed in rats with hemorrhagic shock. The experimental rats were randomly divided into three groups: surgical control group, shocked control group, shocked acupuncture group. The blood pH was significantly decreased at maintaining shock for one hour (n = 30), P < 0.01; there was no change in surgical control group (n = 15), pH decreased continually with the shock time, (n = 14). But pH tended to going up again after acupuncturing "Renzhong" for 15 min (n = 16). The content of blood kalium was increased at maintainually shock for one hour (n = 26). The content of blood kalium was significantly increased with the prolonging shocked time (n = 12) or acupuncturing "Renzhong" (n = 14), P < 0.05. But there was no clear change in surgical group (n = 15). The results suggested that the acidosis condition was slightly rectified by acupuncture via modulating the respiratory function and reducing the acidic metabolites in blood of the rat with hemorrhagic shock. But the hyperkalemia produced by shock was hardly rectified by acupuncture.


[Effect of oxytocin and cholecystokinin octapeptide (CCK-8) on electroacupuncture (EA) analgesia]. The effect of oxytocin (OT) and cholecystokinin octapeptide (CCK-8) on EA analgesia was studied in rats. The increase of 20.8-39.8% and 9.0-45.0% in pain threshold was observed respectively when ICV of CCK-8 or naloxone was combined with EA, these increases were lower than that in saline-EA group significantly, while the simultaneous ICV of OT and CCK-8 or OT and naloxone in combination with EA produced the increase of 76.2-116.6% and 41.8-104.5% in pain threshold separately. These results showed that only a small part in the role of OT enhancing EA analgesia was blocked by CCK-8 and naloxone. The data suggest that the role of OT in EA was not entirely dependent upon the endogenous opiate peptides.


[Observation on 63 cases of facial paralysis treated with acupuncture]. Sixty-Three cases with facial paralysis were treated mainly by acupuncture combining with point injection. The main points selected were Yangbai (GB14), Wai Jingming (BL1), Sibai (ST2), Yingxiang (LI20), Dicang (ST4), Jiache (ST6), Quanliao (ST18) and Qianzheng. The points were used alternatively. Auxiliary points: for type of deficiency of both qi and blood, Zusanli (ST36), and Sanyinjiao (SP6) were added: for type of disharmony between Ying and Wei, Fengchi (GB20) and Hegu (LI4) were added; for type of stagnancy of qi and blood, Weiguan (TE5) and Taichong (LR3) were added; for type of wind-heat stagnating collaterals, Yifeng (TH17) and Yanglingquan (GB34) were added. 10 out of 60 cases, which showed no remarkable effectiveness after two courses, injection of vitamin B1 and vitamin B12 to facial points combined with Hegu (LI4) point on opposite side was performed. Therapeutic results: 31 cases (49.2%) were cured, 15 cases (23.8%) markedly effective, 16 cases (25.4%) effective and 1 case (1.6%) ineffective.


[Comparison between of acupuncture and epidural anesthesia in appendectomy]. It was a clinic comparative observation of the effects between acupuncture and epidural anesthesia in appendectomy. Eighty patients with appendicitis were randomly divided into two groups, each of 40 Patients. The results were no significant difference between two groups in successful rate. It is convinced that acupuncture on Zusanli points (ST36) has analgesia. There were less respiratory depression, hypotension, cardiac arrhythmia and less amount of liquid infusion needed than that of the epidural block during operation. Furthermore, in the group of acupuncture anesthesia, the intestinal gas excreted earlier, the analgetics and antibiotics administered were less and the rate of the wound infection were reduced after operation. These postoperative effects were significantly better than the controls. As it is of clear-cut effects of anesthesia by acupuncture with main points Zusanli and auxiliary points Hegu (LI4) and less interfered life sign in the operation, thus it is desirable to use acupuncture anesthesia in appendectomy.


[Effect of electro-acupuncture on the nociceptive responses of SI cortical neurons in the rat]. 1. The effect of electro-acupuncture (EA) on the responses of single SI cortical nociceptive neurons to peripheral natural stimuli were observed in unanesthetized and paralyzed rats. 2. After EA, the responses to noxious mechanical and/or thermal stimulation reduced markedly in 14 (70%) out of 20 neurons tested, and slightly increased or unchanged in the remaining 6 neurons, as compared to the responses before EA. 3. In contrast to the variation of nociceptive responses, the responses to innocuous mechanical stimulation increased in 9 neurons and unchanged in other 9 neurons, while deceased in only 2 neurons. 4. A small portion of the neurons were activated by EA stimulation, while their responses to noxious stimulation were inhibited. 5. It is considered that the selective inhibition of the nociceptive responses of SI cortical neurons might be a part of the mechanisms of acupuncture analgesia.


[Inhibitory effect of electro-acupuncture on penicillin-induced amygdala epileptiform discharges]. Epileptiform discharge induced by microinjection of penicillin in the rat's amygdala was attenuated after acupuncture of certain "acupoints", as revealed by reduction of frequency and amplitude. The effect of acupuncture was reversed by microinjection of naloxone or 3M-P into peritoneal cavity, thus suggesting the participation of endorphin and GABA in antiepileptic action of acupuncture.


[Involvement of acetylcholine in corticofugal modulation of pain]. We have found that after intraperitoneal injecting atropine the analgesic effect of both stimulating Sm I cortex and acupuncture were decreased. It suggests that acetylcholine (ACh) may be involved in the corticofugal modulation of pain. In order to elucidate this idea the effects of stimulating Sm I cortex on tail flick latency (TFL) after ventrical microinjecting atropine were investigated. The experiments were carried out on Wistar rats. Under the state of anaesthesia a pair of silver ball electrodes were put on the dura for electrical stimulating Sm I and the ipsilateral ventricle was cannulated for microinjecting atropine. Recordings were made 5-6 hours or 24 hours after operation. Immediately after cessation of stimulating SmI and 1', 2', 3.5', 5', 7.5', 10' and 15' later TFL were measured consecutively. The results were as follows: 1. The mean value of TFL was 2.44 +/- 0.11 sec (n = 20). It was prolonged (p < 0.05) within 0'-5' after stimulation of SmI. Therefore, it indicated that analgesic effects were produced by stimulating SmI cortex. 2. It was found that under the background of microinjecting atropine (10 micrograms/2 microliters) TFL remained unchanged after stimulating SmI cortex (n = 10, P > 0.05). There was a significant difference between the two treatments: simple stimulating SmI and atropine plus stimulating SmI at the same animals in TFL (P < 0.05) within 0' and 1' after cessation of stimulating SmI. It indicated that the analgesic effects of stimulating SmI cortex were decreased by blocking M-receptors. 3. Under the background of microinjecting normal saline.(ABSTRACT TRUNCATED AT 250 WORDS)


Neonatal correction of transposition of the great arteries: the Connecticut experience. The treatment of transposition of the great arteries, a common congenital cardiac defect, has undergone significant development. Prior to 1989 a surgical approach which repaired the transposition at the atrial level (Senning's operation), but did not restore normal anatomy, was the procedure of choice. Since 1989 a surgical approach that restores normal anatomy (Jatene's arterial switch) has been followed. Forty-four patients have been corrected since 1979 (N = 26 Senning's operation, N = 18 arterial switch). The arterial switch patients are corrected at an earlier age, have a longer, more complex operation without a significant increase in operative mortality, intensive care, or duration of hospitalization. The prevalence or frequency of normal ventricular function and normal sinus rhythm is significantly increased over the repair at the atrial level. The frequency of pulmonary stenosis is increased. The duration of follow-up for these patients is significantly shorter than for those with atrial level repair.


Multivessel coronary angioplasty.

Multivessel coronary angioplasty. Multivessel coronary angioplasty is currently a revascularization alternative in selected patients with suitable anatomy. The literature on two- and three-vessel coronary angioplasty is reviewed with respect to both immediate success and long-term outcome. A therapeutic strategy for performing multivessel coronary angioplasty in the individual patient is outlined.


Can pharmacological therapy influence the mortality of chronic congestive heart failure? The prognosis of patients with advanced left heart failure is fairly dismal. It was not until recently that studies were conducted demonstrating the poor prognosis can be modulated by drug therapy. Of the many vasodilators tested, positive data have emerged only from trials of high-dose nitrates with hydralazine and, most importantly, angiotensin-converting enzyme inhibitors believed to constitute the biggest step forward in the treatment of chronic heart failure. The agents included in this group improve the symptomatology, increase exercise tolerance and improve the prognosis. At present, they are indicated in cases of severe heart failure, and the potential of their use in the more severe forms as well as in patients after myocardial infarction is being intensively investigated. Still, diuretic remain the mainstay of drug therapy. The role of digitalis in the treatment of heart failure is being currently reviewed; its administration is unnecessary in most patients, especially those with maintained sinus rhythm. A number of other positive inotropic drugs, both catecholamine-based agents and phosphodiesterase inhibitors (amrinone, milrinone, xamoterol, enoximone) have been tested. Their effect in the chronic form, unlike acute failure, is controversial, and there is no evidence documenting improved prognosis; some studies even show an adverse trend. As almost 50% of patients with heart failure die suddenly, it would have been only logical to administer antiarrhythmics to them. However, no data demonstrating an improved prognosis are available either. Results of studies conducted to date have proved to be rather disappointing, and a study with the most promising antiarrhythmic drug--amiodarone--is still under way.


Cardiac arrhythmias in chronic heart failure. It has been proven that treatment of chronic heart failure (CHF) with some modern drugs is able to reduce mortality in groups of patients with the severest grades of this disease. The risk of sudden death has been unchanged, however. Out of 49 patients on long-term follow-up, 28 patients are surviving (group A) and 21 died (group B). 52.3% of the dead patients died suddenly. Eight patients in NYHA classes I-II died, all of them suddenly. Contrary to this, sudden death was the cause of death only in three of 13 patients in NYHA classes III-IV (p < 0.001). More severe heart failure was present in group B (NYHA class 2.95 +/- 0.96 vs. 2.18 +/- 0.48 in group A--p < 0.1). Antiarrhythmic drugs were given more frequently in group B (in 47.6% of pts vs. 17.9% in group A--p < 0.05). It is concluded that the occurrence of sudden death is higher in patients with less severe forms of CHF and has not been reduced by the means employed. Use of antiarrhythmic drugs may be dangerous and their indication should be based on results of a comprehensive examination. Use of the implantable cardioverter-defibrillator seems to be the most promising approach in indicated cases.


Radiologic changes in chronic heart failure. The relationship between chest X-ray findings and NYHA classification or haemodynamic parameters (ejection fraction, end-diastolic and end-systolic volumes by echocardiography, right atrial pressure--RAP, pulmonary artery pressure--PAP and pulmonary wedge pressure--PAWP by right heart catheterization) was evaluated in 44 and 22 patients with chronic congestive heart failure, respectively. In chest X-ray, the cardiothoracic index (CTI) and authors' own classification of pulmonary congestion (PCG) of classes 0, 1 and 2 were used. A significant correlation was found between CTI and NYHA classification or haemodynamic parameters, and between PCG (classes 0 and 2) and echocardiographic parameters or right heart pressures (EDV, ESV, RAP, PAP, PAWP), but there was no significant relationship between X-ray and left ventricular ejection fraction. For a PAWP higher than 18 mmHg and PCG class 2, the sensitivity of X-ray was 86% and specificity 80%. The authors conclude that chest X-ray provides reliable information about the haemodynamic parametres, comparable to echocardiographic and catheterization data.


Nursing care of a child following an arterial switch procedure for transposition of the great arteries. The restoration of the left ventricle as the systemic pump and the lack of sinus node dysfunction (assessment with the Senning or Mustard procedure) have been suggested as the major advantages of the arterial switch procedure. Although the results are encouraging, children will require follow up to assess: long-term left ventricular function; coronary ostial growth; aortic and pulmonic anastomosis growth; long-term aortic valve (anatomical pulmonary valve) dysfunction. A learning curve is inherent to a new surgical procedure. During this learning period, both surgical technique and patient selection criteria improve, resulting in reduced morbidity and mortality. The arterial switch procedure for TGA is certainly not an exception. Expert nursing assessment and intervention during the postoperative period is imperative and may reflect on the long-term outcome of these children.


Cardiovascular disease in the elderly.

Cardiovascular disease in the elderly. The current worldwide explosive increase in the numbers of older persons is unprecedented in history. In the 1990s and beyond, the preponderance of patients with cardiovascular illness will be elderly, with a substantial subset among the frail elderly, 85 years old and older. Cardiovascular disease remains the leading cause of death and disability in this population, and cardiovascular risk increases steadily with age. Pascal defined old age as "just a time that is farther from the beginning and nearer to the end." Elderly persons, with and without cardiovascular disease, vary widely in their physical, behavioral, cognitive, and emotional functioning; severity of illness; and expectations from medical care. The challenge to the clinical and research communities alike is to delineate the appropriate components of preventive, diagnostic, and therapeutic care for elderly cardiac patients in our society, interventions that are likely to relieve suffering, restore function so as to limit disability and dependency, and maintain a dignified and meaningful life-style for the end years of life. Major societal strides have been made in redefining both the onset of old age and its limitations. The eighteenth century poet, Robert Burns, wrote of his fears that he would be 45 years old at a time when life expectancy was 40 years; he saw himself as being weary, wrinkled, creeping, and joyless. For, ance that five-and-forty's speel'd, See crasy, weary, joyless Eild, Wi' wrinkled face, Comes hostin', hirplin', owre the field, Wi' creepin' pace. Burns died at the age of 37 years. A more attractive option is offered by Abraham Joshua Heschel, 1907-1972. According to all the standards we employ ... the aged person is condemned as inferior. ... Conditioned to operating as a machine for making and spending money, with all other relationships dependent upon its efficiency, the moment the machine is out of order and beyond repair, one begins to feel like a ghost without a sense of reality. ... Regarding himself as a person who has outlived his usefulness, he feels as if he has to apologize for being alive. May I suggest that ... old age be regarded not as the age of stagnation but as the age of opportunities for inner growth. ... The years of old age ... are indeed formative years, rich in possibilities to unlearn the follies of a lifetime, to see through inbred deceptions, to deepen understanding and compassion, to widen the horizon of honesty, to refine the sense of fairness.


Effect of probenecid on the pharmacokinetics of DQ-2556, a new 3-quaternary ammonium cephalosporin antibiotic, in humans. A total of 5 healthy volunteers were enrolled in a crossover study on the dose dependency and the effect of probenecid on pharmacokinetics of DQ-2556. They were administered intravenously 0.5 and 1.0 g of DQ-2556, and 1.0 g of DQ-2556 with oral administration of probenecid. The linearity in pharmacokinetics of DQ-2556 was confirmed up to the dose of 1.0 g. In the case of 1.0 g of DQ-2556 with probenecid treatment, the area under the serum concentration-time curve was larger, and total and renal clearances were less than those in the case of 1.0 g of DQ-2556 alone (by approximately 15% for each parameter, p < 0.01). These results demonstrated that DQ-2556 is secreted in the renal tubule, although it is excreted mainly by the glomerular filtration.