[The restoration of the vocal possibilities for the laryngectomized patient with a tracheoesophageal prosthesis]. The experience reported concerning vocal rehabilitation employing tracheoesophageal prostheses (TEP) in laryngectomized subjects at the University of Milan is based upon 149 patients who underwent procedures for total laryngectomy from November 1986 on in nearly all cases (137), a primary procedure was followed in order to insert a Blom Singer prosthesis. Some technical modifications in creating the fistula during the reconstruction phase of laryngectomy reduced the number of postoperative and local complications of the fistula. The men phoniatric rehabilitation time is 38 days from the procedure. The most important aspects affecting the length of rehabilitation are the presence of lower respiratory tract disorders and contemporaneous postoperative radiotherapy. The mean lifetime of the prostheses is 92 days, the main restricting factor being the care taken by the patient. Microbiological studies showed the virtually constant association between fungi and Pseudomonas sp. Nevertheless, infection of the fistula and forced removal of the prosthesis occurred only in 1 patient. Other complications were as follows: granulation tissue at the tracheal side of the fistula into the trachea or oesophagus, 6 and 1 respectively; enlargement of the fistula, 5; others, 15. Fifteen percent of the patients does not succeed in achieving a tracheoesophageal voice because of respiratory insufficiency, difficult neuromuscular control or psychological problems.(ABSTRACT TRUNCATED AT 250 WORDS)


[The experience of early rehabilitation]. Functional laryngectomies permit a more or less ideal preservation of laryngeal functions whose recovery, especially in les conservative operations, occurs very slowly and depends on several conditions: post operative course, sensitivity and motility of the hypopharynx, patient's ability to restore swallowing mechanisms. The Authors relate their experience concerning use of a rehabilitative program partially based on the experiences of some French logopedic schools and partially original. They illustrate the steps and goals of this program which starts on the fifth post-operative day with respiration exercises immediately followed by eight days of exercises to re-establish arytenoid mobilization and swallowing movements. If deglutition is not completely recovered and important inhalation problems persist, the logopedic approach is integrated with surgical rehabilitation consisting of one or more injection of gax-collagen. It is possible to use the same surgical technique later, after hospital discharge, if a slight dysphagia is still present in spite of continuous logopedic rehabilitation. Voice restoration exercises are introduced in the last days of the hospital stay when the patient is tube-free and continues at the office or outpatient clinic for two or three times every week. Concerning removal priority (tracheotomy tube followed by nasogastric tube or vice versa), we propose a diversified strategy for each patient, depending on the anatomicofunctional postoperative situation. Up to now 25 patients have taken part in this rehabilitation program (14 cricohyoidopexy, 6 Cricohyoidoepiglottopexy, 5 supraglottic laryngectomies). The results with regard to the amount of time that nasogastric feeding as well as tracheal tube are kept and the length of the hospital stay, were compared to those ones of a similar number of consecutive cases operated at our institution (ENT Department of Modena University) before February 1990 but not rehabilitated. In the early rehabilitated group, we observe a quicker functional recovery with a shorter hospital stay (about a week).


[Functional recovery in subtotal laryngectomies]. Subtotal laryngectomy, a valid treatment for carefully selected patients, is a safe oncologic procedure which preserves the cricoid-arytenoid unit creating a successful "neo-larynx" with valid phonatory and deglutition functions. At the E.N.T. Clinic of "La Sapienza" University of Rome from Jan. 1984 to Feb. 1992, 85 subjects underwent subtotal laryngectomy, 50 of which then underwent phoniatric examination. The remaining patients were not suitable candidates because of the trachealis cannula (14), or because they were lost at follow up (16). A total of 50 male subjects were examined. Twenty-eight underwent crico-hyoid-pexia, while 22 patients underwent crico-hyoid-epiglotto-pexia. Attention is drawn to the results which appear to be extremely variable with regard to each study group. We obtained better results with crico-hyoid-epiglotto-pexia than with crico-hyoid-pexia and we guaranteed a good social re-insertion in all cases.


[The diagnosis and treatment of dysphagia]. The structures in the head and neck are important in respiration, deglutition and communication. The post surgical head and neck cancer patient will probably exhibit a variety of disorders in both speech and swallowing. This study examined swallowing problems in three groups of patients following ablative surgery for pharyngolaryngeal carcinoma: supraglottic laryngectomies, hemilaryngectomies and subtotal laryngectomies. A total of 28 patients were studied. Videofluoroscopic studies with liquid and thick paste were completed one week post initiation of oral feeding following surgery and during the rehabilitation treatment.


Bioavailability of methionine-hydroxy-analog free acid and S-methyl-methionine in the growing rat. The biological utilization of DL-methionine (MET), DL-methionine-hydroxy-analog and DL-S-methyl-methionine-sulphonium-chloride (SMM) was tested in rat growth assay. Weight gain, feed efficiency, protein efficiency ratio (PER), net protein ratio (NPR) and net protein utilization (NPU) were applied as criteria. A test diet containing soybean meal as sole protein source was fortified with MET, MHA or SMM at 1.5 and 3.0 g/kg levels, respectively. All fortifications had a significant (p < 0.05) positive influence on weight gain, feed conversion and protein utilization. SMM showed the highest activity. MET and MHA were almost equally well utilized at 3.0 g/kg fortification level, however MHA proved slightly less efficient at 1.5 g/kg level than MET.


[The definition of a reference protocol for the clinical study of vertigo drugs]. The aim of this paper is to define the problems that arise in the clinical evaluation of drugs for the treatment of vertigo. Among these are the objective criteria used in defining vertigo and those used in evaluating efficacy of the drugs. The resulting protocol for a clinical study of vestibular drugs is a document that clarifies the debated points in the field, and above all furnishes guidelines for establishing uniformity in clinical studies. This, therefore, may become the reference protocol in Italy for clinical evaluations of drugs for the treatment of vertigo.


Blood glutathione peroxidase enzyme activity as an index of selenium release from Permasel in ewes. Ten Merino ewes were given a single Permasel pellet (containing 5% of elementary selenium) orally and examined for the release of selenium in the reticulum by determining glutathione enzyme activity of the whole blood haemolysate over a period of 12 months. As compared to the controls, the treated ewes exhibited a significant elevation in glutathione peroxidase activity for 8 months, indicating an acceptable persistence of the product tested.


Improvement of the reproductive performance of sows by treatment with a GnRH superactive analogue. The effect of a Hungarian-made superactive analogue of GnRH (Ovurelin, D-Phe6-GnRH-EA, Reanal, Hungary) on the postpartal sexual function of sows was monitored. GnRH treatment was carried out on day 19 before weaning. The sows were inseminated at the first oestrus after weaning. GnRH treatment markedly increased litter size at weaning, substantially reduced (to 25 and 50%, respectively) the number of sows failing to come into oestrus after weaning, and increased the number of sows coming into oestrus within one week after weaning by 42.5% and 9%, respectively. These beneficial effects were particularly apparent on the far using closed management technology.


[Facial nerve paralysis and mandibular fracture]. The authors describe three cases of peripheral facial nerve paralysis in patients with a mandibular fracture. In two cases, in which the onset of palsy was uncertain, the facial nerve injury was contralateral to the fractured side. Topodiagnostic tests showed neural damage at the third intrapetrosal portion and at the genicular ganglion. In one of the two patients tomography revealed a fracture line through the anterio-superior wall of the external auditory canal homolateral to the facial palsy. In the third subject palsy set in immediately after the trauma and was ipsilateral to the mandibular fracture; the facial lesion was localized at the genicular ganglion. In the first two cases, functional recovery was spontaneous (40 and 0 days after the trauma respectively). In the third subject, the nerve was decompressed surgically with a complete functional recovery two months later. The functional and clinical findings of these three cases show that a contralateral facial palsy secondary to a mandibular fracture resolves spontaneously while the traumatic displacement of the mandibular condyle may determine a temporal bone fracture sometimes followed by a lesion in the intratemporal portion of the facial nerve. An event such as the latter may delay functional recovery and thus warrant surgery such as in cases of Bell's palsy.


Serum progesterone, oestrone and oestradiol in pregnant and non-pregnant red deer hinds. Changes in serum progesterone (P), oestrone (E1) and oestradiol (E2) concentrations were monitored in 34 female red deer (Cervus elaphus) shortly after the end of the breeding season and at mid-gestation. Pregnancy could be detected on the basis of serum P, but there were no significant differences between the pregnant and non-pregnant animals farmed animals in E1 and E2 concentrations. Twenty-five pregnant hinds captured in winter showed serum P levels similar to those found in farmed deer during the gestation period.


Guidelines for the eradication of infectious bovine rhinotracheitis in Hungary. The prevalence of infectious bovine rhinotracheitis (IBR) in Europe is reported. Possible methods are proposed for eradication of infection as well as for the maintenance and control of infection-free status.


Paratuberculosis vaccine in a large dairy herd. On a 500-cow dairy farm a total of 866 young calves less than one month old were vaccinated with a heat-killed oil-adjuvated bacterin against Mycobacterium paratuberculosis over a period of five years. The vaccinated calves were tested by faecal microscopy, bacteriology and serology on the day of vaccination, at the age of 3, 6, 9 and 12 months, at breeding age, and on the day of calving. A total of 721 bull calves and 379 female calves served as unvaccinated controls in two groups. The results were evaluated by trend analyses. Vaccination greatly reduced the faecal shedding of mycobacteria as demonstrated by the annual faecal microscopic examinations. During the last 6 months of the experiment only 9 of 612 samples were found positive by microscopy and by bacterial culture. The number of seropositive animals and the antibody titres demonstrated by the complement fixation test (CFT) and agar gel immunodiffusion (AGID) increased during the first three years. Later on, both the number of seropositive animals and CFT titres decreased.


Ochratoxigenic moulds and ochratoxin A in forages and grain feeds. The contamination of forages and grain feeds with ochratoxigenic moulds and ochratoxin A was examined. The investigations were carried out over a period of three years in all seasons. Feeds were found to be contaminated with moulds at a high level throughout the three research years. The highest percentage (95 to 100) of contaminated feed samples was noticed during the second year. Total viable counts of moulds established in 1 g of feed samples ranged from 0.5 to 7.8 x 10(6). Penicillium spp. were dominant in mycopopulations isolated from feeds. Ochratoxin-A producing moulds were present permanently. In the summer period of the second research year as much as 94% of the feed samples were contaminated by ochratoxigenic Penicillium species. P. verrucosum var. cyclopium P. verrucosum var. verrucosum, P. commune and P. chrysogenum, i.e. ochratoxin-producing moulds, were the most prevalent Penicillium species throughout the three-year investigation. Ochratoxin A was found in various feeds in all seasons, except in summer of the first research year. Concentrations of the toxin varied from traces to 400 micrograms/kg. It occurred consistently in the same types of feeds (hay, dried alfalfa, fresh alfalfa, concentrate, pelleted sugar beet pulp, corn silage).


Sphaerospora infection of American catfishes (Ictalurus punctatus and I. nebulosus) in Europe. The occurrence in Europe of a Sphaerospora species described in North America is reported. Based upon its morphological characteristics, the parasite could be identified with the species S. hankai described from brown bullhead in Canada. This parasite was found to infect channel catfish (Ictalurus punctatus) cultured in farm ponds in Italy and brown bullhead (Ictalurus nebulosus) living in the supply channels of fish ponds in Hungary. The spores and sporogonic developmental stages were situated in the lumen of the renal tubules. In the authors' opinion, S. ictaluri described from channel catfish can be considered synonymous with S. hankai.


Early damages to lung capillaries in enzootic pneumonia of rabbits. The present study is part of a series of investigations aimed at characterizing the "enzootic pneumonia" phenomenon in rabbits, both from the clinical-epidemiological and the pathophysiological point of view. All affected rabbits included in this study showed an acute injury to pulmonary microvasculature, similar to changes reported in pulmonary infections caused by Gram-negative bacteria. Similar alterations were not found in the control rabbits. The clinical and morphological findings revealed certain similarities between the Enzootic Pneumonia Syndrome of rabbits and Adult Respiratory Distress Syndrome (ARDS) of man. Therefore, it is suggested that, just as in the human syndrome, heterophils (PMN) are directly involved in the pathogenesis of the process. Many of the similarities noted between the two syndromes would make it possible to postulate the natural disease in rabbits as an eventual animal model suitable for extrapolating data to humans.


Teratological examination of the insecticide methyl-parathion (Wofatox 50 EC) on pheasant embryos. 2. Biochemical study. Fertile pheasant's eggs were treated with the insecticide Wofatox 50 EC (50% methyl-parathion) by injection technique on day 12 of the hatching period. Treatment consisted of inoculation of 0.1 ml of different concentrations of the insecticide into the air space of embryonated eggs. The following dose levels were employed: 0.00, 1.35, 13.5 and 135.0 mg/kg egg of active ingredient. Biochemical changes in the plasma were evaluated by micro (photometric) methods which rendered possible the determination of several blood plasma variables of the embryos. At the highest dose level applied, serum alkaline phosphatase (SAP) enzyme activity and inorganic P concentration of the treated embryos showed statistically differences (reduction) as compared to the control data. Macroscopic alterations were detected at necropsy.


Isolation of chicken anaemia virus from broiler chickens. Chicken anaemia virus (CAV) infection was demonstrated, by both serology and virus isolation, in 1- to 6-week-old broiler chickens originated from various parent flocks in Hungary. Total losses in the broiler flocks were estimated at 7 to 8% and about 25% of the chickens failed to reach target body mass by the 7th week of life. The clinical signs, postmortem lesions and histopathological changes of the affected chickens were similar to those of naturally occurring CAV-induced infectious anaemia of young chickens. In MDCC-MSB1 cell cultures, a chloroform-resistant virus smaller than 50 nm in diameter, resistant to heating at 70 degrees C for 30 min, and antigenically very closely related to the Cux-1 strain of CAV was isolated from the liver of naturally diseased broilers. This virus isolate was designated the Bia strain of CAV. Inoculation of susceptible 1-day-old SPF chicks with a CAV-positive liver extract from naturally diseased broilers caused pathological changes characteristic of CAV infection, namely impaired growth, severe anaemia with atrophy of the bone marrow, marked atrophy of the lymphoid organs and petechial haemorrhages throughout the body. A quite similar pathological syndrome was also induced by inoculation of 1-day-old SPF chicks with the MDCC-MSB1 cell-culture-propagated new Bia strain of CAV. The CAV was successfully reisolated from the livers of experimentally inoculated birds, and antibodies to the reference Cux-1 strain of CAV were also demonstrated by the indirect immunofluorescence test in sera of naturally diseased and experimentally inoculated chickens. No antibodies were found against infectious bursal disease virus, reticuloendotheliosis virus, Marek's disease herpesvirus as well as avian adenoviruses and reoviruses. The reported disease of young broiler chickens was associated with natural infection of a new isolate of CAV. On the basis of its physicochemical, antigenic and pathogenic characteristics, this virus is similar to other strains of CAV isolated from chickens in other countries.


[Estimated biological markers of progression in human immunodeficiency virus infection]. The biological markers for determining as early as possible the progression in the infection by the human immunodeficiency virus (HIV) are very important for the health care of patients, and to adapt their anti-retroviral treatment. Among those, four independent biological markers for predicting a pejorative evolution in the following 36 months are used in medical practice: two specific for HIV, p24 antigenemia and serum titre of antibodies to the p24 core antigen, and two non-HIV specific surrogate markers, the beta 2-microglobulinemia and the absolute number of CD4 T cell in blood. P24 antigenemia corresponds to an active retroviral in vivo replication. The cut off for detection is about 10 pg/ml. It is difficult to detect in black people, and in the asymptomatic or pauci-symptomatic stages of the disease. The apparition or the increase of the serum p24 antigen levels suggest the occurrence of opportunistic infections. P24 antigenemia decreases or disappears during the treatment by zidovudine. The diminution or the disappearance of serum antibodies directed to the p24 core protein are secondary to the deficiency of the humoral immunity, and to an increase of the viral replication, which occur at the late stage of the disease. The diminution or the disappearance of serum antibodies to p24 precede the occurrence of AIDS by several months. The increase of the serum beta 2-microglobulin level is associated with the severity of the disease. In the San Francisco prospective cohort, the progression to AIDS in 36 months was 69% when beta 2-microglobulinemia was more than 5 mg/l, 33% when it was between 3.1 to 5 mg/l, and 12% when it was less than 3 mg/l. The beta 2-microglobulin intra-thecal synthesis level could serve as a marker for the specific HIV encephalitis. The CD4 lymphocyte count constitutes an independent provisional marker for progression to AIDS, probably the most important, but mainly of statistical value. A lymphocyte count of 200 CD4/mm3 is considered as the threshold of full blown AIDS. Beside these classic biological markers, numerous other parameters have been evaluated, without knowing their practical interest. Although the predictive markers for AIDS have a real statistical significance, their interpretation could be difficult or hazardous when applied to a sole individual. In a relatively short delay, the actual biological markers will probably be completed or changed, in the routine medical practice, by the use of direct virological markers evaluating the viral load (plasmatic or cellular viremia).


A simple and rapid method for toxicological screening of 25 antidepressants in blood or urine using high performance liquid chromatography with diode-array detection. A high performance liquid chromatographic method with diode-array detection (HPLC/DAD) for simultaneous screening of 25 antidepressants is presented. After single-step liquid-liquid extraction at pH9.5 using chloroform/2-propanol/n-heptane (60/14/26, v/v), the substances are eluted on a Novapak C18 4-microns column (300 x 3.9 mm, id), with methanol/tetrahydrofuran/pH 2.6 phosphate buffer (65/5/30, v/v) as the mobile phase (flow rate 0.8 ml/min). Full UV spectra from 200 to 400 nm are recorded on-line during the entire analysis and may be automatically compared to spectra stored in a library. The analysis is performed in 14 min. The method is simple, rapid, and highly specific.


Quantification of red blood cell fragmentation: usefulness of heating cells and of automatic counting devices. Spontaneous red blood cell (RBC) fragmentation occurs in some membrane erythropathies like hereditary elliptocytosis (HE); this phenomenon is produced in normal RBC by heating at 49 degrees C, but not at temperatures below this limit; fragmentation is usually quantified by counting the number of fragments/1000 RBC under light microscopic examination. The present work demonstrates: i) that enumeration of fragments is performed more precisely with an automatic blood cells counter on the 'platelet' channel; and ii) that heating at 48 degrees C enhances the fragmentation of RBC when they have a severe disruption of skeletal lattice, like in HE.


[Measurement of dihydropteridine reductase activity in dried blood eluates: physiological and pathological implications]. Tetrahydrobiopterin deficiency in hyperphenylalaninemic babies has to be rapidly recognized since the disease requires a specific treatment. Although the measurement of pteridines in urine can detect most of tetrahydrobiopterin deficiencies, DHPR measurement has to be performed to circumvent the risk of missing DHPR deficiency, especially at the neonatal period. The possibility to measure DHPR activity in dried blood samples justifies itself by its convenience and simplicity. Expression of activity per mg of hemoglobin improves the precision of the assay by removing variation in the elution step (insufficient blood being loaded onto the filter paper, hematocrit variation, thickness of filter paper used). The distribution of DHPR activities, corrected from the progressive decrease with age, showed that 2.5% of the hyperphenylalaninemic or normal population have low levels of activity (below 50% of normal). This observation suggests that genetic variations may exist, as illustrated by the analysis of 11 families. Although blood DHPR measurement seems efficient for screening DHPR deficiency, the finding in a family of clinically normal subjects with zero activity illustrates the risk of false positive results of the enzymatic test.


[Stage T1 malignant tumors of the arythenoid. Analysis of a series of 26 cases]. 26 malignant tumours of the arytenoid classified as T1 according to the UICC 1987, were treated in the ENT and Cervico-Facial Surgery wards to Hospital Laennec between 1961 and 1990. The natural history of these lesions, locoregional efficiency of the different treatments used, the part played by chemotherapy, survival, causes of death and therapeutic modalities used as a last measure, have been analysed. The frequency of tumours with neuroendocrine has been emphasized. Such a diagnosis should be questioned when the initial biopsy does not diagnose a well differentiated epidermoid carcinoma. The use of argyrophil colouring in order to find neurosecretive granules helps in carrying out the diagnosis. The treatment of tumours, classed T1 N0 M0, of the arytenoid, is based on partial, laryngeal surgery associated with a preventive, jugulo-carotidian-ipsilateral ganglionary intervention.


[Adjuvant chemotherapy in supraglottic epidermoid carcinoma stage T3]. 92 squamous cell carcinomas of the supraglottic larynx classified as T3 were treated from 1977 through 1987 and retrospectively analyzed. All the patients of this series received chemotherapy as initial treatment (2 cycles). From 1977 through 1981 the combination of Vincristine-Methotrexate-Bleomycin (VMB) was employed; after 1981, the protocol: Cisplatinum-5 FU with or without Bleomycin (CF) was administered instead of VMB. All the patients were then surgically treated on the tumoral site and cervical lymph chains. At 5-year, there was no significative difference between the two chemotherapeutic regimen in term of locoregional recurrences and second primaries. 5-year actuarial survival rate was higher for patients treated with the CF protocol (71%) versus (54%) with the VMB regimen. Systemic metastases occurred less frequently after CF (4.5%) than after VMB (22.4%). These findings suggest that chemotherapy has substantially some activity against microscopic distant metastases.


[Results of the treatment of aspergillosis of the maxillary sinus by exclusive middle meatotomy approach]. Over a 3 year period the authors have managed 12 immune competent patients with aspergillosis of the maxillary sinus by intranasal sinus surgery using only a middle meatal approach. An enlarged middle meatal window was formed by resection of the superior surface of the inferior turbinate. especially designed curve suction tubes and forceps were used to reach all areas of the maxillary sinus in order to perform a macroscopically complete resection of all lesions. On no occasion Aspergillus was the alternative use of an inferior meatal window or a Caldwell-Luc approach necessary. The authors conclude that the use of a middle meatotomy for the surgical treatment of aspergillosis of the maxillary sinus makes it possible to assure complete resection, to adapt post-operative care and to permit prolonged aeration of the sinus.


[Inverted papilloma of the nose and paranasal sinuses. Apropos of 10 cases]. Authors report a retrospective study of 10 new cases of inverted papilloma of the nose and paranasal sinuses, observed during a 26 years period, with a 6.1 years average follow up. This group is marked by 2 cases of directly carcinomatous association, 4 cases of recurrence and 2 cases of later malignant transformation. The responsibility of different types of human papillomavirus in the origin of this tumor and its malignant transformation is suspected. Preoperative evaluation is based on clinical examination, CT scan and endoscopic method while diagnosis and prognosis depend on histopathologic finding of the whole tumor. The aim of surgical treatment is the most complete removal of the tumor with as limited after effects as possible. Lateral rhinotomy is the most favoured surgical approach versus mid facial degloving and intranasal endoscopy. No surgical patient, no removal tumor, inadequate limits, malignant papilloma and early recurrence are indications for external radiotherapy.


[Our experience of meatotomy in the treatment of paranasal sinus diseases]. Results are presented of patients treated by endonasal microsurgery in the ORL clinic of the Lille UCH between January 1986 and July 1990. The principal affections treated were: chronic sinusitis, aspergillosis and Killian's polyp. The objective of the technique employed, which has evolved progressively, was in each case to eradicate the infectious focus or its cause, and to maintain satisfactory ventilation and drainage of the maxillary sinus. The technique used is described, and results presented based on the responses received from a questionnaire sent to 164 patients.


[Cholesteatoma and petro-mastoid excision. Indications and results apropos of 36 cases]. An open operative technique was used in 36 (38%) of 95 patients with chronic cholesteatomatous otitis followed up by the same surgeon between 1986 and 1990. Although a good anatomical result was obtained in 88% of cases the functional result was less evident, since 57% of patients were left with a liminal tonal loss of less than 30 décibels. The reasons for using an open technique are analyzed, but in only 5% of cases could the possibility of using a closed technique be envisaged, making the classical discussion between open and closed methods of treatments of only academic interest. Petromastoidian evidement with reorganization of the cavity is considered to be effective therapy for cholesteatoma, but indications and technical procedures must be adhered to strictly.


[Lower turbinectomy with endoscopic guidance. Mid-term results]. The authors report about their experience with partial lower turbinectomy. Twenty-nine cases were followed up over an average time lapse of 2 years. Anterior rhinomanometry was performed pre- and postoperatively in all patients. The results include 26 successful operations (90%) and 3 failures, one case of hemorrhage on pack removal and one of synechia. In view of the 3 failures, the authors are presently favorable to subtotal lower turbinectomy.


[Treatment of simple snoring. Surgical pharyngoplasty vs. laser CO2 pharyngotomy]. CO2 laser pharyngotomy is a newly described technique used in treatment bronchopathy without sleep apnea syndrome. Retrospective results of 70 CO2 laser pharyngotomies and 63 surgical pharyngoplasties are studied and compared. All patients were SAS free snoring patients. The results were rated satisfactory by 54% of the CO2 Laser treated patients against 78% for classical surgery. CO2 laser pharyngotomy is an easy procedure done in the office. The complication rate is very low. The predictive criteria upon which one can select the best procedure for each particular patient remain largely unknown.


[Comparative study of cartilaginous and synthetic laryngotracheoplasty. An experimental study in rabbits]. The most significant advance in the treatment of laryngotracheal stenosis in children is the augmentative laryngotracheoplasty using a graft of autologous rib cartilage (ARC). In order to reduce the potential morbidity of this technique due to the additional surgical procedure, the use of a ceramic, hydroxyapatite (HA), implant was compared to ARC in a randomized experimental study in 99 New Zealand rabbits: 32 rabbits had ARC grafts, 33 had HA implants covered with a graft of perichondrium (HAP) and 33 had naked HA implants. At 3 months, immediately before necropsy, there was no significant clinical difference between the 3 groups of animals. Histological examination was performed in 81 animals. Implants were found in 54 specimens. More implants were found in the ARC group than in the HA groups (p < 0.003). No difference was noted between the 3 groups in the epithelial covering of the implant, the amount of inflammation, the analysis of the interface between the implant and the cricoid cartilage and in the viability of the graft. No implant was found in 27 animals. However, scar bands of approximately the same width as the implant were responsible for cricoid diastasis in 23 cases. Therefore, it seems that the missing implant played the role of spacer. While this experimental study does not eliminate HA as a augmentative implant in the subglottic region of the rabbit, the evolution of the scar bans must be followed for a longer period in rabbits before considering the clinical application of this technique.


[Hirudin and hirudin fragments].

[Hirudin and hirudin fragments]. Hirudin is a potent and specific thrombin inhibitor: compared with heparin thrombin inhibition occurs directly and does not require the presence of plasma cofactors. Recombinant hirudin is well tolerated in animals and in healthy volunteers. Its clearance half-life after IV administration range from 1 to 2 hours and its bioavailability after subcutaneous administration reaches 75%. In most of the experimental models the ratio of the haemorrhagic side effect against the antithrombotic efficacy is satisfactory. Hirudin analogs are mono or bivalent according to their recognition site on thrombin. Bivalent derivatives (Hirulogs) have been mostly evaluated: they exhibit pharmacologic properties similar experimental to that of recombinant hirudin and have been successfully used in several thrombosis models and in healthy volunteers. Taking into account these data the most appropriate use for hirudin and hirudin derivatives should be clinical situations where the role of thrombin is important or which are only partially controlled by heparin therapy.


[Complementary value of the isoprenaline test and high-amplification ECG in the diagnosis of arrhythmogenic dysplasia of the right ventricle]. Arrhythmogenic dysplasia of the right ventricle is a common cause of ventricular arrhythmia. It is important to reach a diagnosis, due to the risk of sudden death, particularly as this may be the first sign of the disease. Diagnosis is based on the angiographic demonstration of a morphological or structural abnormality of the right ventricle, and non-invasive tests are relatively insensitive. From a case investigated in 1984, the authors carried out a prospective determination of the diagnostic value of the isoprenaline test in 61 patients suffering from arrhythmogenic dysplasia of the right dysplasia confirmed by angiography. High concentrations (8-30 micrograms/min) of isoprenaline were continuously infused over a period of 3 minutes, regardless of the heart rate achieved. In a control group of 50 subjects with no myocardial disorder, isoprenaline induced monomorphic wave-burst arrhythmia in only one patient (2%). In the subjects affected by right ventricular arrhythmogenic dysplasia, isoprenaline induced one or more episodes of wave-burst ventricular arrhythmia in 52 patients (85%): one triplet in four patients, several episodes of wave-burst arrhythmia in 31 patients and prolonged ventricular tachycardia in 17 patients. Polymorphic arrhythmia occurred in 80% of cases, but left lag forms predominated. High-amplification ECG demonstrated late potentials in 66% of cases, i.e. in 80 and 62% of patients with and without prolonged VT respectively. The isoprenaline test or high-amplification ECG gave abnormal results in 58 of the 61 patients, with a cumulative sensitivity of 95 percent.


[Polyaneurysmal dystrophy (ectatic medial dystrophy)]. Polyaneurysmal dystrophy is a novel form of arteriopathy which specific clinical, angiographic, anatomic and surgical features which distinguish it clearly from multiple atheromasclerotic aneurysm. It should be considered to be a local, multifocal accentuation of megadolicho-arteries, which constitute the lesions during the early stages of the disorder (fairly general elongation of the elastic arteries, with thin walls and regular increase in the caliber and multiple tortuousness). Arterial angiography identifies polyaneurysmal dystrophy; in the context of a twisted and sinuous system of large arteries, multiple spindle-shaped aneurysms can be distinguished which are frequently bilateral and symmetrical. The usual sites are the trunks of the aortic group and internal carotid, the ileo-femoral trunks and terminal aorta. The progress of the disorder is characterized by the possibility of rupture or thrombosis (particularly in the subcrural territory). The treatment is always surgical. The indication for surgery is inevitable in cases of severe ectasia, but may be avoidable in extensive forms of megadolicho-arteries with no clearly defined aneurysm: annual ultrasound monitoring is then called for. The disorder is of constitutional origin (and totally unrelated to atherosclerosis). Delayed dilatation of the aneurysms is due to the hemodynamic forces brought to bear on the fragile walls over a life-time. Multiple aneurysms occur mainly between the ages of 50 and 70 years, with a predominance of aorto-ileac sites in men, even though these subjects do not show any general elastic dysplasia. Half of the 45 patient undergoing surgery were hypertensive.


[Effects of disopyramide on normal and pathological atrioventricular conduction]. Disopyramide is a Vaughan-Williams class Ia antiarrhythmic, which is distinguished by its anticholinergic activity, which is due to its active metabolite: mono-N-alkyl disopyramide. In cells with a rapid response, such as those in the His-Purkinje tissue, it depresses conduction. In slow-responding cells (sinus node and Tawara's node) direct depression of conduction and automatism, and anticholinergic stimulation have opposing effects. In terms of clinical electrophysiology, this is a Touboul class IIa compound: and action mainly on the His-Purkinje system involving extension of the conduction time and of the refractory time. Nodal conduction is improved according to measurement of the alternate Wenckebach; according to studies of the denervated heart in transplanted patients, there is a depressant effect on automatism and conduction at all levels, but the vagolytic effect corrects this activity at Tawara's node. Clinical trials have demonstrated the absence of any deterioration, and in some cases and actual improvement of nodal conduction disorders in response to disopyramide and good safety in the presence of non-major intraventricular conduction problems (such as bundle branch block). In practice, these properties mean that moderate nodal conductive disorders and simple bundle branch block do not constitute an obstacle to the use of disopyramide. In junctional tachycardia, it is particularly indicated for use in tachycardia involving an accessory pathway, but is also effective in intranodal tachycardia due to its twofold action.


[Acute hemodynamic effects of SIN-1 and isosorbide dinitrate in stable left ventricular failure: a comparative double-blind, cross-over study]. The acute hemodynamic effects of intravenous SIN-1 (1 mg) and sublingual isosorbide dinitrate (5 mg) were investigated in 12 patients (8 men and 4 women) between 38 and 80 years of age and suffering from stable chronic left ventricular failure (NYHA Classes III-IV) secondary to ischemic myocardiopathy (n = 5), hypertensive disease (n = 2) or idiopathic disorder (n = 5) corresponding to the following hemodynamic inclusion criteria: stable condition, cardiac index > or = 2 l/min/m2, mean capillary pressure > or = 18 mmHg and < or = 28 mmHg. Previous treatments were continued with the exception of vasodilators and diuretics which were stopped 24 hours earlier. The hemodynamic data from this cross-over, double-blind double-dummy trial were collected for two 60-hour periods separated by a washout period of 120 minutes. Simultaneously, venous samples were taken for the assay of plasma levels of SIN-1. The heart rate, cardiac output, pulmonary artery resistance and blood pressure were not affected by either SIN-1 or isosorbide dinitrate. An obvious reduction (> 15% of the basal value) in the mean capillary pressure, pulmonary artery pressure and mean right atrial pressure was observed in 10 subjects after SIN-1 and in 7 patients isosorbide dinitrate. A statistically non-significant trend towards a more marked effect (number of patients responding and maximum amplitude of pressure reduction) which occurred more rapidly and lasted longer was observed after SIN-1. Analysis of the relationship between the pharmacodynamics and pharmacokinetics of SIN-1 suggests that an active metabolites is involved. No adverse effects were reported.(ABSTRACT TRUNCATED AT 250 WORDS)


[Echocardiographic myocardial performance in the normal postpartum in black African women]. The authors have carried out a prospective ultrasound study of normal post-partum myocardial performance in black African women free from any systemic and/or cardiovascular disorder. The volume overload, reduction in ejection indices and increase in telesystolic constraint, which are significant essential changes observed immediately post-partum, return to normal values within two months. According to the authors, these disturbances reflect a transient change in myocardial function which expresses the potentially harmful effect of the natural changes during the normal post-partum phase.


[Determination of the anaerobic threshold in chronic cardiac failure. Value and limitations]. Anaerobic threshold was studied in 35 patients with cardiac failure present for more than 6 months, of primary or ischemic origin and New York Heart Association Stage II or III. Each patient underwent an exercise test of ergometric bicycle (increments of 10 watts/1 minute) with analysis of expired gases respiratory cycle by respiratory cycle (oxygen consumption, carbon dioxide production, respiratory oxygen and carbon dioxide equivalent, respiratory quotient). Anaerobic threshold was determined indirectly following Wasserman's recommendations. It was possible to determine anaerobic threshold in 25 patients (83.3%). The test was well tolerated. The two best methods for detection of anaerobic threshold were divergence of the curve of production of carbon dioxide in relation to oxygen consumption and an increase in respiratory oxygen equivalent while the carbon dioxide equivalent remained constant. In addition, oxygen consumption at the anaerobic threshold was statistically correlated with functional class (p < 0.05) and with the Weber classification based upon peak oxygen consumption (p < 0.001). Finally, anaerobic threshold occurred on average at 5.4 +/- 1.8 min from the start of exercise with a heart rate of 119.7 +/- 18 bpm, an oxygen consumption of 10.5 +/- 2.3 ml/min/kg (i.e. 43.2 +/- 12.1% of maximum oxygen consumption and 70.5 +/- 19.3% of oxygen consumption limited by symptoms) and a respiratory quotient of 1.07 +/- 0.08. In conclusion, analysis of respiratory gases during exercise in cardiac failure patients enables, with sub-maximal exercise and noninvasively, the determination in the majority of cases of anaerobic threshold, which is statistically correlated with New York Heart Association stage and the Weber classification based upon oxygen consumption at peak effort.


[Thrombolysis and massive pulmonary embolism: occasionally spectacular results]. The authors report the clinical history of a 47-year-old patient hospitalised as an emergency with acute respiratory distress complicated by cardiocirculatory arrest. The diagnosis of pulmonary embolism was rapidly suspected and confirmed by emergency pulmonary angiography. A definite diagnosis enabled the early prescription of fibrinolytic treatment in situ. The interest of this case lies essentially in demonstration of the efficacy of fibrinolytic treatment which enabled the rapid restoration of a stable hemodynamic status and normalisation of angiographic appearances within a few days.


[Spontaneous idiopathic pneumopericardium in young patients. Review of the literature. Apropos of a new case]. Spontaneous idiopathic pneumopericardium (SIPP) in young subjects is a rare disorder since, apart from the case described here, only 28 cases have been reported in the literature. It occurs mainly in young adults. The physiopathology of the disorder involves alveolar rupture, as described by Macklin. The symptoms of SIPP are dominated by chest pain, which usually develops suddenly and is combined with dyspnea. Clinical examination is not very helpful, cardiac auscultation detects either pericardial rubbing or a more suggestive metallic sound. Recovery usually occurs without treatment, but there is a risk of long-term recurrence. An unusual complication to be feared is aerial tamponade, which may be life-threatening and calls for emergency draining. The treatment of SIPP involves strict bed-rest, symptomatic treatment of the pain and clinical monitoring.


[Ergotism and ischemia of the limbs].

[Ergotism and ischemia of the limbs]. Clinical ergotism as seen today results almost exclusively from the intake of ergotamine tartrate in the treatment of migraine headache. Vasospasm of peripheral arteries is the leading clinical picture. Besides the formation of collaterals and a secondary thrombosis, the vasospasm is one of the specific findings in arteriography. Early diagnosis and withdrawal of the medication makes complete restitution possible. In all other cases intraarterial or intravenous infusion of sodium nitroprusside has turned out to be the most effective therapy. Balloon dilatation or operative intervention are an alternative therapy in those cases, where amputation of the limbs seems to be necessary.


[Preventive drug therapy of recurrence of atrial fibrillation]. Without treatment, about 60% of atrial arrhythmia patients suffer a relapse within 3 months and 70% within one year. Antiarrhythmic treatment intended to reduce this percentage is therefore justified, on condition that it is well tolerated. Several preliminary questions have to be settled before this medical prophylaxis: 1) Justification of antiarrhythmic treatment (sometimes pointless to deal with very occasional episodes); 2) Treatment of the underlying heart disease (valve disease, cardiothyrotoxicosis, etc.) or promoting factors (potassium depletion etc.); 3) Accurate assessment of any associated conduction abnormalities, which may constitute a contraindication to antiarrhythmic treatment (WPW syndrome in the case of verapamil and the digitalis-like drugs) or require additional treatment (pacemaker); 4) Definition of the mechanism (vagal or sympathotonic) inducing arrhythmia; 5) Evaluation of the hemodynamic parameters of the underlying heart disease (size of the atria, ventricular function, coronary or valvular lesions) which may limit the efficacy of the treatment. Once these parameters have been identified, the primary treatment should be type la or lb antiarrhythmics, which have been shown to be effective, despite the fact that they are not without arrhythmic risks (the Ib antiarrhythmics are less effective and have a poor safety profile). The beta-blockers have preferential indications (hypersympatheticotonia, hyperthyroidism, hypertrophic myocardiopathy, mitral prolapse, angina etc.) and can be replaced by verapamil or bepridil if there are non-cardiac contraindications (ulcers, asthma, diabetes). Amiodarone is extremely effective, but its poor extracardiac safety restricts its long-term use. Complementary treatments (digitalis-like, anticoagulants or anti-PAF and cardiostimulant drugs) should be added if necessary. Recurrences (to be confirmed by ECG or Holter) should lead to rigorous confirmation of therapeutic compliance and observance of simple hygienic and dietary measures (no excessive exertion, elimination of stimulants etc.). With strict clinical and ECG monitoring, it would then be possible either to increase the dose levels (accompanied by plasma determinations if possible) or to switch to a treatment with more effective, but more aggressive drugs (amiodarone, flecainide) or to use drug associations (la and lb, la and II etc.). Repeated failure of such attempts should lead to a non-medical approach to treatment.


[Hemodynamic study of intravenous milrinone in 26 patients with NYHA class III or IV cardiac failure]. The hemodynamic effects of milrinone (WIN 47203) were studied in 26 NYHA Class III or IV patients. The compound was administered intravenously using a protocol including an initial push dose of 50 micrograms/kg in 10 min, followed by a 24 hour infusion at the dose of 0.5 microgram/kg/min. Maximal response was obtained after 15 min and persisted during the infusion: cardiac index increased from 2.08 +/- 0.36 l/min/m2 to 3.09 +/- 0.68 l/min/m2, while capillary pressure fell from 25 mmHg to 16-17 mmHg. These variations were significant (p = 0.01). Heart rate was stable. Mean peripheral blood pressure fell modestly (6%). Systemic vascular resistance fell by 30% and pulmonary vascular resistance by 20%. All these results confirmed the beneficial effect of this inotropic agent administered intravenously. The increase in ventricular premature contractions noted by many justifies the careful surveillance of these patients by monitoring.


Light and electron microscopic study of vestibular sensory epithelia in 17 cases with acoustic neurinoma. Vestibular sensory epithelia were studied histologically and ultrastructurally in 17 cases with acoustic neurinoma (AN). The superior vestibular nerve (SVN) near the fundus was also histologically studied in 5 of these 17 cases. Histologically, severe fibrotic change of the vestibular sensory epithelia was found in 1 case, and severe fibrotic change of the SVN was also found in this case. Intra-epithelial cysts were found at the edge of the utricular sensory epithelia in 2 cases. The cysts consisted of the transitional epithelium and were filled with the darkly stained substances. Ultrastructurally, abnormal accumulation of darkly stained masses within the nerve ending and abnormal accumulation of the fibrillar material below the normal basal lamina were frequently observed. These morphological changes described above were regarded as the pathological changes due to AN. In addition, the relationship among the histologic changes, ultrastructural changes and clinical data were fully investigated, and some histologic and ultrastructural changes were regarded as artifacts or age-related changes.


A case of congenital ossicular malformation with mild auricular deformity: embryological and surgical considerations. A case of bilateral congenital conductive deafness with mild auricular deformity is presented, and the anomalous structure deformity of the ossicles was multi-focal in this case, and a previous report indicates that ossicular malformation in the ear with congenital conductive deafness is multi-focal when the external ear is only slightly deformed. Bilateral ossicular reconstruction with replacement of the stapes yielded satisfactory results.


Intratemporal facial nerve neurinoma without facial paralysis. A 38-year-old man was referred by his general practitioner to our department on 28 October 1991, with a 2-week history of vertigo. A left aural polyp was identified. The audiogram showed a moderate conductive loss on the left side. Computed tomography (CT) and magnetic resonance imaging (MRI) confirmed the presence of the expanding lesion in the descending portion of the facial nerve. However, there was no seventh nerve paresis. At operation, the neurinoma (Schwannoma) filled the middle ear cleft and extended from the genu to the stylomastoid foramen. The floor of the middle ear had been eroded, exposing the jugular bulb. Facial nerve paresis is the usual presenting feature of a facial neurinoma. The case is presented for the reason that the absence of facial palsy as a presenting feature is rather rare, especially in the cases with large tumor and extensive bone erosion.


Immunohistochemical detection of serous cells in nasal mucosa with monoclonal antibody against a component in human nasal secretion. Secreting mechanisms of secretory cells in nasal mucosa and the changes of nasal secretions in chronic inflammatory sinusitis have been studied by the biochemical and histochemical methods. These methods could not clarify the changes of quality and quantity of nasal secretions and secretory cells. In order to obtain the specific marker for the secretions in different cells, we have produced monoclonal antibodies against a component in human nasal discharge. One antibody was selected for further characterization, because it stained submucosal serous cells specifically. This antibody stained the components of serous cells with molecular weight of 14 kD specifically, and was sensitive to periodate oxidation treatment. This antibody will be useful for detecting the subpopulation in secretory cells of human nasal mucosa, and may be serve as a biochemical probe for secretory activity of particular secretory cell types.


Evaluation of provocation tests in tonsillogenic focal infection from the standpoint of fibrinolytic activity. In this paper, we carried out provocation tests by means of ultra-short wave stimulation in patients with focal infection including palmoplantar pustulosis and examined the changes in fibrinolytic activity of the circulating blood. In the positive group with palmoplantar pustulosis, the t-PA level was slightly increased after the provocation and the FDP level in the positive group was increased. On the other hand, the AT-III activity in the positive group with palmoplantar pustulosis was decreased and the antiplasmin activity in the positive group was increased. The changes of antiplasmin activity observed in this experiment did not correspond with the pathophysiological explanation of an increased fibrinolytic activity in the circulating blood. It was suggested that a positive provocation test is accompanied by an increase in fibrinolytic activity in the circulating blood of patients with focal infection of the tonsil, and the increase in fibrinolytic activity is closely related to the positiveness of the provocation test.


Electron microscopic study of vascular regeneration in rat tracheal mucosa following physical curettage. Transmission and scanning electron microscopic studies were made of regeneration of the vascular network of rat tracheal mucosa on 30 min to 8 hr after the mechanical curettage. The vascular network casts were made by infusion of Mercox resin through the aortic arch for scanning electron microscopy. At 30 min after curettage, vascular thromboses were observed, and terminal blind branches were formed in the injured blood vessels areas through SEM observation. Diapedesis of leukocytes appeared at 30 min after curettage from intact venules at the wound margins. Recovery from the loss of endothelial cells began at 30 min after curettage. At 3 hr after curettage, vascular indentation (protrusion) and vascular process (bud-like process) were developed from intact venules at the wound margins. It is concluded that the formation of thrombus and terminal blind branch vessels constitute the initial reparative reactions of the injured vascular network and that new vessels then begin to form by outgrowth of protrusions and bud-like processes from intact venules at the wound margins.


Tuberculosis of the parotid salivary gland. An interesting and rare case of tuberculosis involving a parotid gland is discussed. Although pulmonary tuberculosis is not uncommon in Turkey, primary parotid gland involvement is rare. The patient was treated by parotidectomy and antituberculous chemotherapy.


Nasal ciliary motility in retinitis pigmentosa. Normal in-vitro ciliary beat frequency is reported in a patient with retinitis pigmentosa. The significance of electromicroscopic ciliary defects in this condition is appraised.


Haemagglutination-inhibition technique for definitive diagnosis of rinderpest-virus-specific antibody. A simple and rapid serological method for the definitive diagnosis of rinderpest-specific antibody is described. The technique is based on adsorbing out the cross reacting antibodies to peste des petits ruminants antigens from a rinderpest immune serum, thereby leaving active the specific antibody to rinderpest which is determined by haemagglutination-inhibition test.


Typical repeat breeding and its improvement in buffaloes. Propagation problems in buffaloes are often not easily recognizable, particularly lacking are studies on the repeat breeding syndrome. In the present study repeat breeder buffaloes were inseminated 3 or more times within the same lactation period. The incidence of typical repeat breeders was 8.33% in the lactation herd. These animals had a longer lactation period and a higher number of services per conception than normal buffaloes. The correlation coefficients were significant between the number of services per conception and each of weight at birth and weight at first service. Repeat breeders significantly (P < 0.05) surpassed normal buffaloes in creatinine values and had contrary values in the serum albumin concentration, glucose, inorganic phosphate, and zinc. Progesterone in urine (efficacious progesterone) was significantly lower on the 10th day post estrus, whereas the non-efficacious progesterone was significantly higher in repeat breeders. Supplying the repeat breeders with sodium phosphate for 1 month 40 g/head/day in the diet and 500 ppm zinc acetate in the drinking water improved the conception rate by 80%.


Infection of proplast malar implants following dental injections. Two cases of late infections of malar implants are reported following dental work. Inadvertent inoculation of the implants by mouth organisms during injections for local dental anesthesia is implicated as the causative factor. Patients should warn their dentists that a malar alloplast has been inserted. Alternative techniques of maxillary dental anesthesia should be entertained, and antibiotic prophylaxis should be considered.


Accidental injuries and blood exposure to cardiothoracic surgical teams. A survey was undertaken over a 15-week period (62 working days) to find out the incidence and common mechanism of accidental injuries and blood exposure in cardiothoracic surgical teams. Two hundred and seventy events were reported: 70% glove penetrations, 18% skin punctures, 4% non-bleeding skin lesions and 8% lacerations with bleeding. Eye splashes occurred in 14% of the cases. The risk to the team was higher for cardiac surgery (1.6) than for thoracic surgery (0.5) and endoscopy (0.01). Most of the events were self-inflicted by experienced personnel. The surgeon's left index finger was most frequently injured, and the majority of the injuries were caused by needles followed by wire injuries during sternal closure. Prevention should be directed towards a safer technique for sternal closure, and protection of the surgeon's hands, especially his left index finger, should be found. Eye protection with goggles should become routine. This study demonstrates that open heart procedures carry a high risk of injury and frequent exposure to blood increasing the risk to the surgical team of acquiring viral infections (hepatitis-B and HIV) from the patients.


Praxilene (naftidrofuryl oxalate) as an alternative for the augmentation of femoro-distal bypass blood flow. In 30 patients undergoing femoro-distal bypass the effect of papaverine and praxilene on blood flow in the graft was measured. The mean resting flow was 129 ml min-1 (range: 91-167) and after papaverine was 202 ml min-1 (142-262) and after praxilene was 205 ml min-1 (143-267). Praxilene has a similar effect to papaverine in the augmentation of blood flow, and further investigation is needed to see if long-term praxilene administration might improve graft survival.


A new infiltration needle for rapid local anesthesia in retromammary breast augmentation. In the past, local field block anesthesia for retromammary breast augmentation has usually been performed with spinal needles. In this article, I present an alternative, a cannula-like needle that delivers large amounts of very dilute local anesthetic in an extremely quick fashion for retromammary breast augmentation. Besides being a time-saver, this needle also offers the patient better anesthesia and improved safety. Another advantage is that the retromammary pocket is partially hydrodissected by the large amount of dilute anesthesia delivered, thereby further decreasing intraoperative time. A description of the instrument, its usage, and its pros and cons are given.


Systems versus performance problems: a peer review organization's perspective. An analysis of Ohio's Medicare data base by the state's Peer Review Organization, using the most common diagnosis-related group in the Medicare population (heart failure and shock), from January 1, 1989 to January 1, 1991, identified 72 cases with confirmed quality-of-care problems. The analysis was performed to determine whether the majority of quality-of-care problems are related to systems or performance deficiencies. Study results indicated that health care workers are being inappropriately blamed for problems that are inherent in the health care system--74% of problems were related to inefficiencies in the health care delivery system, and 26% were determined to reflect performance problems.


Beta-endorphin concentrations in the peripheral blood mononuclear cells of migraine and tension-type headache patients. Levels of beta-endorphin in peripheral blood mononuclear cells have been studied as a new approach to investigating opioid tone in migraine and tension-type headache. Sixty-one patients with migraine without aura, 39 with migraine with aura and 23 with episodic tension-type headache were compared with 37 healthy controls. Peripheral blood samples were taken from patients not enduring headache attacks and not undergoing prophylactic treatment. A significant reduction in peripheral blood mononuclear cell beta-endorphin concentrations was observed in migraine patients with and without aura, but not in tension-type headache patients. Altered transmitter modulation to peripheral blood mononuclear cells may be the cause of this alteration, which could be part of a more diffuse opioid system derangement in migraine subjects.


Prevention of Lyme disease after tick bites. A cost-effectiveness analysis. In areas of endemic disease, the probability of Lyme disease after a tick bite ranges from about 0.012 to 0.05. Early treatment with oral antibiotics prevents most complications of Lyme disease, but antibiotics are generally not prescribed until rash or other symptoms develop. We used decision analysis to evaluate the outcomes, costs, and cost effectiveness of three alternative strategies to treat patients bitten by ixodes ticks in areas of endemic Lyme disease: empirically treat all patients with two weeks of doxycycline, treat only patients in whom erythema migrans develops, and treat only patients with erythema migrans or a positive serologic test for Lyme disease one month after exposure. Empirical treatment is the least expensive strategy and results in the fewest cases of Lyme disease and the fewest complications when the probability of Borrelia burgdorferi infection after a tick bite is 0.036 or higher. For probabilities of infection below 0.036, empirical therapy prevents most major complications, sequelae, and adverse events, but it incurs additional minor complications, especially as the probability of infection falls below 0.01. Empirical treatment of patients with tick bites is indicated when the probability of B. burgdorferi infection after a bite is 0.036 or higher, and this treatment may be preferred when the probability of infection ranges from 0.01 to 0.035. When the probability of infection after a tick bite is less than 0.01, empirical therapy is not warranted.


Syphilis in the 'unbooked' pregnant woman. To determine the prevalence of syphilis in the 'unbooked' pregnant woman attending King Edward VIII Hospital, Durban, mothers who had no previous history or record of antenatal care were studied over a 3-month period. One hundred and fourteen mothers were recruited, 35 (30.7%) of whom had reactive syphilis serology. None had clinical evidence of primary or secondary syphilis. Clinical evidence of congenital syphilis was found in 4 of the 35 (11.5%) babies born to mothers with reactive syphilis serology. While the fluorescent treponemal antibody absorption (FTA-ABS) IgG test was positive in umbilical cord and neonatal venous blood of all 35 babies, the FTA-ABS IgM test was negative in all specimens, including the sera from the 4 babies with clinical signs of syphilis. The FTA-ABS IgM test is therefore of little value for the laboratory confirmation of congenital syphilis. It also has limitations when it comes to screening asymptomatic neonates born to mothers with reactive syphilis serology.


Seasonal variation in the incidence of ruptured abdominal aortic aneurysm. This retrospective study was performed in order to correlate the season with the risk of rupture of an abdominal aortic aneurysm (AAA). From December 1968 to December 1990, 224 patients, 203 males (90.63%) and 21 females (9.37%), mean age 71 years, underwent surgery either urgently because of rupture or expansion (group A, 66 patients, 22.46%) or electively (group B, 158 patients, 70.53%) for AAA. Of the 66 patients in group A, 61 were male (92.4%) and five female (7.55%) with a mean age of 73 years. Of the 158 patients in group B, 142 were male (89.8%) and 16 female (10.1%). The frequency distribution of electively admitted and operated cases of AAA was shown to be similar during all seasons but the admissions of ruptured AAA were shown by non-parametric statistical analysis to increase during the autumn (p less than 0.05) with 43.9% of the cases being admitted during September, October and November. The male to female ratio and the ratio of the number of aneurysms ruptured to the total number of aneurysms did not change significantly. The explanation of this phenomenon is obscure and needs further epidemiological investigation to assess the seasonal variability or various parameters such as hypertension.


A comparison of valproate with carbamazepine for the treatment of complex partial seizures and secondarily generalized tonic-clonic seizures in adults. The Department of Veterans Affairs Epilepsy Cooperative Study No. 264 Group. Valproate is approved for use primarily in patients with absence seizures, but the drug has a broad spectrum of activity against seizures of all types. Partial or secondarily generalized tonic-clonic seizures are often difficult to control adequately with standard treatment, usually carbamazepine or phenytoin. We conducted a multicenter, double-blind trial that compared valproate with carbamazepine in the treatment of 480 adults with complex partial seizures (206 patients) or secondarily generalized tonic-clonic seizures (274 patients). The patients were randomly assigned to treatment with carbamazepine or divalproex sodium (valproate) at doses adjusted to achieve blood levels in the middle of the therapeutic range. Patients were followed for one to five years or until seizures became uncontrollable, treatment had unacceptable adverse effects, or both these events occurred. For the control of secondarily generalized tonic-clonic seizures, carbamazepine and valproate were comparably effective (in 136 patients and 138 patients, respectively). For complex partial seizures, four of five outcome measures favored carbamazepine (100 patients) over valproate (106 patients): the total number of seizures (2.7 vs. 7.6, P = 0.05), the number of seizures per month (0.9 vs. 2.2, P = 0.01), the time to the first seizure (P less than 0.02), and the seizure-rating score (P = 0.04). Carbamazepine was also superior according to a composite score that combined scores for the control of seizures and for adverse effects (P less than 0.001). Valproate was associated more frequently than carbamazepine with a weight gain of more than 5.5 kg (12 lb) (20 percent vs. 8 percent, P less than 0.001), with hair loss or change in texture (12 percent vs. 6 percent, P = 0.02), and with tremor (45 percent vs. 22 percent, P less than 0.001). Rash was more often associated with carbamazepine (11 percent vs. 1 percent, P less than 0.001). Valproate is as effective as carbamazepine for the treatment of generalized tonic-clonic seizures, but carbamazepine provides better control of complex partial seizures and has fewer long-term adverse effects.


Current management of rheumatoid arthritis. Rheumatoid arthritis (RA) is usually a relentlessly progressive disease leading to joint damage and disability. While the long-term value of disease-modifying drugs is still questioned, the quality of life of RA patients has improved, possibly reflecting the earlier more aggressive and multifaceted approach to management and/or the innate attenuation in the disease over recent years.


Reduced fertility among women employed as dental assistants exposed to high levels of nitrous oxide. Fertility is reduced in female rats exposed to levels of nitrous oxide similar to those found in some dental offices. Epidemiologic studies have suggested an association between exposure to mixed anesthetic gases and impaired fertility. We investigated the effects of occupational exposure to nitrous oxide on the fertility of female dental assistants. Screening questionnaires were mailed to 7000 female dental assistants, ages 18 to 39, registered by the California Department of Consumer Affairs. Sixty-nine percent responded. Four hundred fifty-nine women were determined to be eligible, having become pregnant during the previous four years for reasons unrelated to the failure of birth control, and 91 percent of these women completed telephone interviews. Detailed information was collected on exposure to nitrous oxide and fertility (measured by the number of menstrual cycles without contraception that the women required to become pregnant). After controlling for covariates, we found that women exposed to high levels of nitrous oxide were significantly less fertile than women who were unexposed or exposed to lower levels of nitrous oxide. The effect was evident only in the 19 women with five or more hours of exposure per week. These women were only 41 percent (95 percent confidence interval, 23 to 74 percent; P less than 0.003) as likely as unexposed women to conceive during each menstrual cycle. Occupational exposure to high levels of nitrous oxide may adversely affect women's ability to become pregnant.


Use of symptoms and signs to diagnose maxillary sinusitis in general practice: comparison with ultrasonography. To establish the incidence of maxillary sinusitis in general practice and the predictive value of symptoms and signs. Population based study. 9 general practices with 15,220 patients aged 15 years and older on the list. 400 patients with 441 episodes in whom practitioners intended to confirm or to exclude sinusitis. Results of ultrasonography and signs and symptoms associated with positive results. 212 of the 441 episodes were confirmed by ultrasonography. 15.7 episodes occurred per 1000 adults per year. The five symptoms beginning with common cold (beta coefficient = 1.035), purulent rhinorrhoea (0.996), pain at bending (0.950), unilateral maxillary pain (0.640), and pain in teeth (0.606) were associated with positive results on ultrasonography. General practitioners' clinical diagnoses were correct in 177 episodes, false positive in 88, false negative in 22, and uncertain in 154. With an algorithm using the five weighted symptoms 243 of the diagnoses would have been correct, but 110 would remain uncertain and 44 cases would have been missed. The five symptoms algorithm would improve diagnostic accuracy of general practitioners, but incorrect and uncertain diagnoses cannot be avoided.


Fatal lung abscess due to Lactobacillus casei ss rhamnosus. A fatal case of community acquired pneumonia due to Lactobacillus casei ss rhamnosus is reported. Clinicians should be aware of this type of pneumonia.


Trends in the relative frequency of histologically diagnosed epithelial dysplasia and intra-oral carcinoma in Northern Ireland, 1975-1989. Trends in the incidence of histologically diagnosed dysplastic lesions of the intra-oral mucosa have been investigated for the period 1975-89 in a well defined population of 1.5 million. These have been contrasted and compared with trends in the incidence of intra-oral carcinoma. Cases were ascertained from the records of all the histopathology laboratories that serve the Northern Ireland population. Over the 15-year period, there were 135 cases of histologically diagnosed epithelial dysplasia. In contrast to the significant increase in the incidence of intra-oral carcinoma, there was no significant change in the annual age standardised incidence of dysplastic lesions over the period. The ratio of malignant to dysplastic diagnoses rose from 2.5:1 to 5.4:1. Only 24 of the dysplastic lesions were known to have subsequently progressed to malignant carcinoma, representing 4.5% of all invasive tumours diagnosed during 1975-89. The results highlight a number of unresolved issues regarding the natural history of intra-oral carcinoma.


Construction and implementation of QRST-wave simulation model. Computer simulation study of the electrical activity of the heart is one of the frontier subjects of electrocardiogram (ECG) theory study. A new algorithm for simulating excitation propagation within the heart is presented in this paper. On the basis of this, computer simulation of QRST-wave is completed on an IBM PC microcomputer. All performance of the model is compared favourably with that of the models implemented on main frames or on high-performance work stations abroad.


Study on the nanosecond transient absorption spectra of hypocrellin A. In this paper, the nanosecond transient absorption spectra and the fluorescence spectra of Hypocrellin A(HA) are examined in solvents of varying polarity. There are three absorption bands in dilute HA solutions: Ia, IIa are defined as the triplet-triplet absorption of HA, the band IIIa is supposed to be the absorption of the solvent-separated ion pair (SSIP). In more concentrated solutions, only the absorption of SSIP was observed. The effects of solvent polarity on transient absorption spectra and fluorescence spectra of HA and the effect of oxygen on the intensities of the fluorescence of HA are discussed. Then a reasonable mechanism for the photolysis of HA is proposed.


Coronary vascular remodeling and coronary resistance during chronic ischemia. Our previous observations that minimal coronary resistance (MCR) decreases by 60% in a model of chronic ischemia suggest that angiogenesis and vascular remodeling occurred. To test this hypothesis we conducted quantitative morphometry on the arteriolar (ART) and capillary (CAP) beds of 14 pigs subjected to chronic ischemia. We induced chronic ischemia by ameroid occlusion of the left circumflex coronary artery for 2 to 8 weeks. We measured numerical densities (ND) and total cross sectional areas (CSA) of the ART and CAP in the ischemic regions. In the same pigs minimal coronary resistance (MCR) was measured during adenosine infusion, using a constant pressure coronary perfusion pump. In 8 other pigs we gave tritiated thymidine to determine the extent of DNA synthesis in smooth muscle and endothelial cells. At autopsy we injected colored silicone into the vessels of these pigs so we could evaluate the coronary collateral vessels as well as the other arterioles. After 3 weeks of ameroid occlusion, ART ND increased 45% above control, while ART CSA increased 21% above control. After 8 weeks of ameroid occlusion, there were further significant increases in ART CSA, but not in their ND. These changes corresponded to a decrease in MCR to 35% of control after 3 weeks of ameroid occlusion. After 8 weeks of ameroid occlusion, MCR had increased to 49% of control, however there was a further increase in ART CSA to 58% above control. DNA synthesis was occurring since endothelial and smooth muscle cells had total DNA labeling indexes of 1.2% (compared to 0.01% for controls) 2-5 days after ameroid occlusion, but were near control levels by 8 weeks. Many arterioles showed endothelial cell denuding and medial damage. Also capillaries showed degenerative changes and new sprouts. Silicone casts of the left circumflex bed vessels showed increased volumes averaging 55% more than controls. These data imply that angiogenesis is partly responsible for the decreased minimal coronary resistance seen in chronic ischemia. The loss of wall integrity in old arterioles and increased compliance in newly formed arterioles and capillaries also may contribute to the reduced resistance. Newly formed vessels are a significant portion of the total number of vessels. The combined effect of these changes is a reduced minimal coronary resistance that is modulated by 8 weeks. Measurements of coronary collateral growth paralleled the changes in the ischemic bed suggesting that angiogenesis factors controlling growth in both the bed at risk and its periphery are controlled by similar temporal events.


Antioxidants and the cardiomyopathy of Mg-deficiency. For several decades the animal models of Mg-deficiency have been studied with particular attention to the cardiomyopathy that develops due to dietary deficiency. In recent years we have studied the effects of nutrients and drugs with antioxidant properties on the development of the cardiomyopathy. We have found that treatment of the Mg-deficient animals with alpha-tocopherol, a naturally-occurring antioxidant, significantly diminishes the number and size of lesions. In addition, treatment with lipophilic drugs with antioxidant properties (probucol, propranolol) or water-soluble drugs that scavenge hydroxyl radicals (captopril, epicaptopril), also provided significant protection. In view of these findings, we suggest that chronic hypomagnesemia results in a pro-inflammatory condition leading to excessive production of oxygen-derived free radicals. Subsequently, the tissue antioxidant capacity is overwhelmed and oxidative tissue destruction results.


Effect of propionyl-L-carnitine on experimental induced cardiomyopathy in rats. The purpose of this study is to evaluate the ability of propionyl-L-carnitine, a carnitine derivative to prevent cardiac dysfunction induced by erucic acid and streptozotocin treatment in rats. Rats were fed for 10 days with normal or 10% erucic-acid-enriched diet with or without propionyl-L-carnitine injected intraperitoneally (1 mM/kg daily). Another group of rats was injected for 8-10 weeks with streptozotocin (65 mg/kg) with or without propionyl-L-carnitine intraperitoneally injected at the same dosage. Thereafter the animals were sacrificed and the hearts isolated and perfused aerobically. When isovolumic measurements of left ventricular function were applied, there was no difference in mechanical activity between treated and control hearts. On the contrary, when pressure-volume curves were determined in the paced hearts, the pressure developed by hearts from erucic acid-treated or diabetic rats was reduced. Propionyl-L-carnitine always produced positive inotropy. This was true for the control-saline treated rats that received the drug, as well as for the hearts isolated from cardiomyopathic animals. These data suggest that propionyl-L-carnitine, when given chronically, is able to overcome myocardial dysfunction caused either from erucic acid treatment or diabetes.


The creatine kinase system and cardiomyopathy. Changes in the creatine kinase system, cellular energetics, regulation of respiration and alterations in parameters of contractility in experimental animals (myopathic hamsters), and in patients with dilated cardiomyopathy were studied. 31P-NMR methods were used to show that cardiomyopathic hearts are characterized by decreased work index, lower tissue ATP, phosphocreatine, and total creatine contents and diminished creatine kinase activity and energy fluxes. In isolated mitochondria, only the creatine kinase activity was decreased. Both in cardiomyopathic hamsters and human hearts a share of mitochondrial creatine kinase in the total tissue enzyme activity was decreased from 33% to 18% and that of BB elevated from 5% in control to 20%, at an unchanged relative level of MM. In saponins-skinned cardiac fibers on cardiomyocytes creatine (Cr, 25 mM) decreased Km for ADP in regulation of respiration from 133 +/- 20 to 20 +/- 4 microM due to activation of coupled mitochondrial creatine kinase-oxidative phosphorylation reactions in control hamster hearts. In the case of cardiomyopathy it decreased Km for ADP only to 81 +/- 13 microM. In endocardial biopsy samples from the hearts of patients with dilated cardiomyopathy taken during angiography, creatine stimulated respiration was decreased by 36% of control value, which correlated well with increase of end-diastolic pressure and fall in ejection fraction. Thus, changes in mitochondrial creatine kinase expression diminished the efficiency of cellular regulation of respiration in cardiomyopathic hearts that may have functional consequences for hemodynamics or may be adaptive alterations in response to decreased contractility.


Exposure to free radicals alters ionic calcium transients in isolated adult rat cardiac myocytes. Oxygen-derived free radical production has been documented to occur on reperfusion of the ischemic myocardium. Intracellular ionic calcium ([Ca++]i) levels in isolated adult rat cardiac myocytes exposed to free radicals were evaluated using fura-2. The effect of different time periods of free radical exposure on altering [Ca++]i was examined. Myocytes were either exposed to the free radical generating system continuously or exposed for 5 or 10 minutes and then returned to the HEPES buffer. Myocytes maintained in HEPES buffer or the HEPES buffer containing purine and iron-loaded transferrin continued to stimulate, exhibited relatively uniform 340/380 nm ratios and maintained a rod shape. Continuous exposure to free radicals resulted in a significant increase in [Ca++]i. Myocytes became unresponsive to stimulation at 31 +/- 7 (SE) minutes and eventually exhibited contracture. Exposure to the free radical generating system for 10 minutes resulted in a response similar to continuous exposure. Myocytes exposed to the generating system for 5 minutes exhibited regular calcium transients for 55 +/- 5 minutes. Thus, even a brief period of free radical exposure alters calcium flux and may induce subsequent myocardial damage.


Contrasting effects of anoxia and graded hypoxia on single cardiac myocyte function. The hypoxic cardiac myocyte has been used as a simplified model of myocardial ischemia. Precise control of oxygen tension is possible in a system with limited diffusion barriers offering an advantage over tissue preparations. This system was employed to study the effects of graded reductions in oxygen tension on cell morphology, spontaneous and electrically stimulated mechanical activity, and [Ca2+]i in single adult rat cardiac myocytes. All of 10 resting myocytes exposed to glucose-free anoxia (pO2 < .02 torr) abruptly underwent rigor contracture, retaining a clear sarcomere pattern, following a lag period of 22.6 +/- 2.8 minutes. These cells relengthened at reoxygenation 5 minutes following rigor onset. In contrast, 5 of 12 cells exposed to graded hypoxia (1-3 torr) were partially rounded and displayed a disorganized sarcomere pattern during hypoxic exposure and further shortened at reoxygenation (p = .03). Spontaneous mechanical oscillations thought to result from spontaneous sarcoplasmic reticulum calcium cycling only developed in those cells exposed to hypoxia, and their frequency was markedly enhanced in 6 of the 12 exposed cells. None of the 10 cells exposed to anoxia showed an increase in spontaneous activity. When spontaneous mechanical activity and underlying Ca2+i oscillations were induced by raising buffer [Ca2+] in 3 indo-1 loaded myocytes, anoxia abolished these as well. Cells stimulated at 0.2 Hz demonstrated spontaneous calcium oscillations and a significant rise in [Ca2+]i (indo-1 fluorescence ratio) prior to rigor onset only when exposed to graded hypoxia. Thus moderate hypoxia may cause earlier calcium loading and more progressive cell destruction than occurs during anoxia.(ABSTRACT TRUNCATED AT 250 WORDS)


Binding of the Kunitz-type trypsin inhibitor DE-3 from Erythrina caffra seeds to serine proteinases: a comparative study. The effect of pH and temperature on kinetic and thermodynamic parameters (i.e., k(on),k(off),Ka,delta G0, delta H0 and delta S0 values) for the binding of the Kunitz-type trypsin inhibitor DE-3 from Erythrina caffra seeds (ETI) to bovine beta-trypsin, bovine alpha-chymotrypsin, the human tissue plasminogen activator, human alpha-, beta- and gamma-thrombin, as well as the M(r) 33,000 and M(r) 54,000 species of the human urinary plasminogen activator (also named urokinase) has been investigated. At pH 8.0 and 21.0 degrees C: (i) values of the second-order rate constant (K(on)) for the proteinase:ETI complex formation vary between 8.7 x 10(5) and 1.4 x 10(7)/M/s; (ii) values of the dissociation rate constant (k(off)) for the proteinase: ETI complex destabilization range from 3.7 x 10(-5) to 1.4 x 10(-1)/s; and (iii) values of the association equilibrium constant (Ka) for the proteinase:ETI complexation change from < 1.0 x 10(4) to 3.8 x 10(11)/M. Thus, differences in k(off) values account mostly for the large changes in Ka values for ETI binding. The affinity of ETI for the serine proteinases considered can be arranged as follows: bovine beta-trypsin > human tissue plasminogen activator > bovine alpha-chymotrypsin >> human alpha-, beta- and gamma-thrombin approximately M(r) 33,000 and M(r) 54,000 species of the human urinary plasminogen activator. Moreover, the serine proteinase:ETI complex formation is an endothermic, entropy-driven, process.(ABSTRACT TRUNCATED AT 250 WORDS)


Molecular recognition and self-replication. Self-replicating molecules stand at the very boundary of chemistry with biology. This review describes the development of synthetic structures capable of self-replication from studies in molecular recognition. The weak intermolecular forces--hydrogen bonds and aromatic stacking interactions--that characterize interactions of nucleic acid components were designed into synthetic receptors for adenine. Covalent conjugates of these receptors with adenines gave self-complementary structures capable of replication. The new systems feature autocatalysis, sigmoidal product growth and even mutation. General rules for the design of replicating systems are described and these suggest that the evolution of replicating molecules was an inevitable event.


Intermolecular interactions in type I collagens. X-PLOR modelling of collagen dimers containing Gly-Glu-Arg in each chain has been carried out. The interaction between molecules when two Gly-Glu-Arg are present on each chain is found to be substantially less than two times that obtained with one per chain, implying that relative tilting of two collagen molecules does not offset the disadvantages of misalignment of the interacting moieties. This implies that if multiple (Glu(-)-Arg+)3 interactions are important in fibril formation, their lateral separations must be large enough to insure that they act independently.


Strand orientation of [alpha]-oligodeoxynucleotides in triple helix structures: dependence on nucleotide sequence. The aims of the present theoretical study of the conformations of [alpha]-oligodeoxynucleotides forming triple helices with DNA duplexes are to understand the structural and energetic factors involved in [alpha]-triple helix formation by means of energy minimization, and to explain the experimentally observed dependence of strand orientation on the nucleotide sequence. It is found that the energetically preferred orientation of the [alpha]-oligonucleotide with respect to the homopurine strand depends on the sequence of the homopurine.homopyrimidine tracts. This is a consequence of the structural heteromorphism of base triplets in the intrinsically more stable reverse Hoogsteen hydrogen bonding configuration. Practical rules are proposed for determining the orientation of the nuclease-resistant [alpha]-oligodeoxynucleotide strand which will form the most stable triple helix.


[Quantitative analysis of oculomotor functions in various age groups of normal subjects]. The oculomotor functions were studied in 50 normal subjects aged 20 to 60 years. The experiments consisted of saccadic test, smooth pursuit eye movement and optokinetic nystagmus. The normal values and sensitive indicators of ageing were obtained. With increase in age, the latency of saccade was prolonged (P < 0.05) and its accuracy showed a tendency to decrease. There was no relationship between the velocity gain of eye movement and age during two amplitudes and velocities of smooth pursuit test, but its total harmonic distortion was increasing with ageing. With increase in optokinetic velocities from 10 degrees/s to 40 degrees/s the velocity gain of eye movement decreased in all groups, but its values in > 40 year-groups decreased more than < 40 year groups. During high velocity optokinetic stimulation, the gain was more obviously decreased in elder age group.


[Vestibular velocity step test and normal limits for the Chinese]. Vestibular velocity steps test (VVST) to impulsive stimulus of horizontal rotation (90 degrees/S and 180 degrees/S) were performed in 22 normal subjects. Gain (G) was defined as the ratio of the initial slow phase eye velocity (ISPV) to head velocity. The time constant (T) was the time to find the point where it was 0.37 of ISPV. Duration (D) of induced nystagmus was the time between first and final nystagmus. The directional preponderance (DP) for G, T and D was calculated from the formula, (R-L)/(R+L) x 100%. These normal limits were 0.37-1.09 and 0.27-0.83 for G, 8.0--20.4s and 6.5-17.3s for T, 30.4-65.0s and 30.0-54.4s for D, +/- 21.4% and +/- 21.5% for DP(G), +/- 24.2% and +/- 20.3% for DP(T), +/- 16.5% and +/- 17.9% for DP(D) of 90 degrees/S and 180 degrees/S, respectively. The advantages and shortcomings of VVST and its value were discussed.


[Value of bush spike wave in diagnosis of central lesions]. Bush spike wave was a kind of wave during ENG-Gaze test. We analysed 440 cases. The results showed that appearance rate of organic lesions of the brain was 55%, peripheral and other lesions were few. So bush spike wave might be of certain value in differential diagnosis of central lesions.


[Effects of biomicrosphere on the cochlear blood flow, blood pressure and heart rate in guinea pigs]. Cochlear blood flow (CBF) in guinea pigs was measured by Laser Doppler flowmeter and biomicrosphere method. The effects of dosages of biomicrospheres and time factor on the CBF, blood pressure and heart rate were observed. The findings suggest that 9 x 10(6). 10.5 x 10(6) biomicrospheres may be most suitable for measuring CBF with biomicrosphere method, and some physiological parameters of the guinea pig must be taken down within 2-10 minutes after microsphere injection.


[Degeneration and regeneration of olfactory epithelial neurons after olfactory nerve sectioning]. The morphological changes of olfactory mucous membrane have been investigated with light microscope and T.E.M. within a period of 3 days to 4 weeks after unilateral olfactory nerve sectioning. No obvious morphological changes of supporting cells and Bowman's gland cells were seen in any group postoperatively. A degeneration in some neurons began to appear on the third day following the operation and reached its peak about one week after operation. No changes of the basal cells were seen on the third day. After one week, however, they changed into globose type and some of which showed mitotic activity. Within 2-4 weeks, the globose cells differentiated gradually into mature neurons. Four weeks after the operation, the regenerated olfactory epithelium appeared similar to that of the control group. The main feature of neuron degeneration was the increase in plasma electron density. In serious cases, the organelle systems disappeared and the nuclei were pyknotic. The results obtained from this experiment shows that after the sectioning of olfactory nerve, degeneration and regeneration processes of olfactory neuron will occur; and the regenerated neuron may possibly be developed from basal cells.


[Repair of cerebrospinal rhinorrhea].

[Repair of cerebrospinal rhinorrhea]. The present paper describes a new method for repairing the CSF rhinorrhea from the sella turcica using frontal muscle--galea aponeurotica--periosteum flap with blood vessel pedicle through cranial-nasal approach. This new method possesses the following advantages: short approach, clear field of vision, nose injury, few complications and less cosmetic influence. The flap, led into the sphenoid sinus Via the frontal sinus or the anterior cranial base and nasal roof, Survived and grew well due to its sufficient circulation and strong resistance to infection. For all the five cases described in this paper, among which three had accepted two or three repairs before, the CSF rhinorrhea ceased after only one procedure.


[Significance of X-ray computed tomography analysis in invasion and lymph node metastasis and TNM classification of nasopharyngeal carcinoma]. From 1986-1990, 100 NPC patients, proved by pathology and CT scan before treatment, were selected for analysis to observe the relationship between CT features and clinical signs of NPC. The common routes of invasion and metastasis of NPC were analysed. Furthermore, advantages of CT on TNM classification of NPC were discussed.


[Serum beta 2-microglobulin determination in nasopharyngeal carcinoma patients. An analysis of 139 cases]. Serum beta 2-microglobulin (beta 2-M) was determined in normal adults, patients with chronic nasopharyngeal inflammation and nasopharyngeal carcinoma (NPC) by the radioimmunoassay (RIA). The mean value in normal adults was 2023.85 +/- 454.32 micrograms/L, that in patients with chronic nasopharyngeal inflammation was 3294.65 +/- 1320.89 micrograms/L. The mean value in patients with NPC was significantly higher than those in patients with chronic nasopharyngeal inflammation and normal adults (P < 0.01). But there was not significant difference between mean values of patients with chronic nasopharyngeal inflammation and normal adults (P > 0.05). It is suggested that the RIA of beta 2-M is a useful assay in the diagnosis of NPC.


Biologic esthetic restorations.

Biologic esthetic restorations. Cases of serious coronal destruction were treated by bonding parts of extracted teeth to the coronal remnants by means of adhesives and photo-activated composite resins. The long-term clinical results have revealed very satisfactory clinical performance of the compounded restorations. No detrimental effects have been identified.


Effect of cavity disinfection on bond strength to dentin. The application of a disinfecting step in cavity preparation and tooth restoration is gaining wider acceptance. This study examined the effect of two commercially available disinfecting agents on the shear bond strength to dentin using a fourth generation dentin bonding agent. The agent tested permitted an evaluation of both dry and wet bonding techniques. It was found that the commercial preparations did not adversely affect shear bond strength to dentin in either the dry or wet application.


Bonding composite to glass ionomer with adhesive resin cements. This study was to determine the bond strength of composite to glass ionomer using the following adhesive resin cements: Imperva Dual, CB Metabond, All-Bond, Geristore, and Panavia. All materials were mixed following the manufacturer's specifications. Bonded samples were thermocycled for 2000 x between 5 degrees C and 55 degrees C. Shear bond strengths were determined using an Instron Testing Machine. No statistical differences were noted between materials at the p < .05 level of significance. In addition, scanning electron micrographs were taken of the primed glass ionomer surfaces. These micrographs revealed varying amounts of matrix dissolution along with roughened surface topographies.


Clinical evaluation of castable ceramic veneers. Laboratory fabricated veneering of discolored or malformed anterior teeth is becoming a widely used technique. Etched Dicor and Dicor Plus ceramic veneers cemented with Dicor Light Activated Cement with Fluoride is one technique available to the practitioner. The purpose of this study was to evaluate the clinical effectiveness of castable ceramic veneers and the cementation system. Forty-three Dicor and 18 Dicor Plus veneers were placed in 12 patients. An intraenamel preparation was completed with a bullet-nosed diamond bur in an ultra-speed handpiece with air-water spray, and a polyvinylsiloxane impression was made. All veneers were fabricated on dies by the same laboratory technician and placed by one practitioner. The restorations were examined by two evaluators at baseline, 3 months, and 1 year, using modified Ryge criteria.


Bonding Ni-Cr alloy to tooth structure with adhesive resin cements. This study was to determine the shear bond strengths of Ni-Cr alloy to Ni-Cr alloy (Group I), Ni-Cr alloy to enamel (Group II), and Ni-Cr alloy to dentin (Group III) using Imperva Dual, DC Metabond, All-Bond, Geristore, and Panavia. All bonded specimens were thermocycled 2000 x (5 degrees C-55 degrees C) after 24 hours and subjected to shear bond testing on a Universal Instron Testing Machine. In all groups of the study, Imperva Dual and CB Metabond had significantly (p < .05) higher bond values than Panavia.


Quantitative analysis of six composite polishing techniques on a hybrid composite material. Determining the best technique for finishing and polishing composite resins is important to ensure longevity of the restoration and prevention of recurrent decay and periodontal disease. This study quantitatively compared the surface roughness of a small particle hybrid composite material finished and polished using six different techniques. Five composite samples were randomly assigned to one of six polishing techniques. Uniform composite surfaces were prepared by finishing samples with a 600-grit carborundum disk prior to polishing. The unpolished surfaces were analyzed with the Taylor-Hobson Talysurf 10 surface texture measuring instrument. The surfaces were then polished and analyzed again. There were no statistical differences among treatment groups prior to polishing. There was a statistical difference between treatment groups after polishing. The smoothest surfaces were obtained using Centrix System rubber points alone, Centrix System rubber points plus Caulk's Prisma Gloss fine and super-fine pastes, and Caulk's Enhance disks plus Caulk's Prisma Gloss fine and super-fine pastes. There was no statistical difference between these methods and 3M Sof-flex disks alone. The roughest surface was produced by the Enhance disks only without using the Prisma Gloss pastes. There was no statistical difference between this method, however, and the use of Sof-flex disks plus Kerr's Lustre Paste. Lustre Paste, included with Herculite kits, did not improve a surface polished with Sof-flex disks.