[Examination of cortisol and insulin levels in serum of patients with primary hyperlipoproteinemia and phenotype IIa and IIb during lovastatin treatment]. Serum cortisol and insulin concentrations were determined in 30 patients with primary hyperlipoproteinemia (HLP) phenotype IIa (20 persons) and IIb (10 persons) during treatment with lovastatin. Lovastatin dosage varied from 20-80 mg daily. Serum insulin concentration did not change significantly after lovastatin treatment. Serum cortisol concentration significantly increased after 12 weeks of treatment. Cortisol concentration changes were different in HLP IIa and IIb patients. In HLP IIa cortisol concentration increased from 21.9 micrograms/dl to 28.1 micrograms/dl after 12 weeks of treatment, in HLP IIb cortisol level decreased from 31.3 to 24.1 micrograms/dl after 4 weeks of treatment and increased to 32.3 micrograms/dl after 12 weeks of therapy. Mean cortisol concentration was significantly higher in HLP IIa than HLP IIb patients. LDL-cholesterol concentrations changes after treatment correlated significantly with baseline cortisol concentration in HLP IIa group (r = -.34), changes in HDL-cholesterol concentration with baseline insulin levels in HLP IIb patients (r = -.54).


["White coat hypertension" syndrome in resistant essential hypertension]. The study population included 51 patients, aged 34-67 years with essential arterial hypertension treated with 3-5 hypotensive drugs at the Outpatient Antihypertensive Department. Based upon frequent measurements of elevated arterial blood pressure values they were found to be therapy resistant. 24-h ambulatory blood pressure monitoring recorded at one hour intervals (Space Labs) excluded 8 patients (15.7%) from the resistant hypertension group as the number of values > 140/90 mm Hg did not exceed 25% of the measurements. In these patients white coat hypertension was the reason for diagnosing resistance. In 18 patients (35.3%) the initial diagnosis was confirmed as the number of increased values was 80-100%. The severity of eye fundus changes, higher blood pressure values and male predominance characterized the resistant group. The use of long-term noninvasive automatic blood pressure recording helps us to exclude pseudo-resistance and avoid further intensification of treatment.


[Levels of beta-endorphin in serum of patients with chronic renal failure on conservative treatment during insulin-induced hypoglycemia stimulation testing]. beta-endorphin (BE) and other opioid peptides participate significantly in the development of the uremic syndrome. In patients with chronic renal failure (CRF) an elevated serum BE level and lack of a twenty-four-hour BE-secretory pattern were found. In 14 patients with CRF on conservative treatment with serum creatinine above 500 mumol/l and in 14 healthy subjects serum BE was evaluated after intravenous insulin injection. An adequate hypoglycemia was obtained in every subject. Basel serum BE concentration was significantly higher in patients with CRF than in healthy subjects and correlation positively with creatinine. After 60 min. from insulin injection in both groups the peak BE level was observed here after 120 min. it returned to the initial values. The curve of BE concentration in patients with CRF ran significantly higher than in healthy subjects. A total secretory answer of the pituitary measured by the area over basel value of BE was similar in both groups. It seems that BE secretion by the corticotropic cells of the pituitary is unchanged in patients with CRF. Impaired BE elimination by the kidneys is probably responsible for hyper-beta-endorphin levels in those patients.


[Experimental study of external fixation of femoral fractures. Mechanical properties of different kinds of fixation. Clinical implications]. An in vitro assessment of the mechanical performance of 10 types of external femoral stabilization allowed the amplitudes of fracture site displacements during the initial loading phase of a comminuted fracture treated by external fixation to be established. The largest displacement to load ratios were observed in the sagittal plane for all tested configurations. The highest fixator stiffnesses were obtained by using large diameter tubes and pins. The most rigid fixators have a derigidification system which creates the problem of choosing the ideal time to change the rigidity.


[Femoral and tibial bone torsions associated with internal femoro-tibial osteoarthritis. Index of cumulative torsions]. Among the hypothesis about pathogenesis of medial knee osteoarthritis, the participation of modifications of the alignment of the limb in the frontal plane is known. The participation of the femoral and tibial torsions had been assessed by a few authors. In this study, the torsions have been measured by computerized tomodensitometry. The global torsional morphology of the limb has been defined by the measure of the Index of Cumulated Torsions. The values of torsions have been compared with the angle deformities measured in the frontal plane. The effects of the bone torsions on the position of the lower limb during the weight-bearing phase of the gait and the consequences about the knee have been studied.


[Total knee replacement after valgus tibial osteotomy. Technical problems]. Forty total knee replacements following valgus tibial osteotomy were analysed. There were 38 patients (10 men and 28 women) with a mean age of 72 years at the time of the joint replacement, at a mean of 8.5 years after osteotomy. Mean follow-up was 3 years (1 to 5 years). Performing a total knee replacement after valgus tibial osteotomy posed some specific problems due to asymmetrical bone cuts, residual ligament laxity, loss of bone at the tibial plateau, and especially when there was a malunion of the previous osteotomy. The functional results were good. A group of 208 patients with total knee replacements for untreated osteoarthritis acted as a control for comparison. In the group with an osteotomy the results were worse in respect of the walking distance and flexion angle achieved after joint replacement compared with primary replacement (p < 0.001). However the GUEPAR and HSS score 77.2 +/- 2.3 were very similar. Using unilateral weight-bearing X-rays, 18.8p. 100 demonstrated opening from ligament laxity and 40.6p. 100 had radiolucent lines under the components, which was the same as in the control group. The tibio-femoral mechanical axis using long-leg films had a mean varus angle of 0.7 degrees.


[Post-operative iatrogenic hallux varus. Surgical treatment. Apropos of 19 cases]. The post operative iatrogenic hallux varus associates varus, big toe's dorsal flexion and supination. The pathogeny is dominated by musculo-tendinous lack of balance created by the initial operation and excessive exostosectomy. The authors have nineteen times surgically corrected this deformation. The procedure included in all cases, a medial arthrolysis; five times associated with a screwed capito-metatarsal osseous shelf (or graft) (when there was a metatarsal's head maiming); thirteen times associated with a metatarso-phalangeal arthrodesis (in cases of impaired joint surfaces). The authors analyse, besides, without excluding them the other surgical procedures for hallux varus, and particularly tendinous transfers. The results show the necessity of a perfect etiopathogenic analysis of the deformation.


[Old fractures of the lateral humeral condyle (lateralis capitellum humeri) in children]. The authors report their experience of 19 cases of non recent fractures of the lateral humeral condyle in children. The delay from the initial trauma to the first clinic was: minimum, 45 days (this delay defines a non recent fracture), maximum 7 years. 18 patients sustained an operation, 15 non-unions and 3 malunions; 1 patient was not operated on. The mean follow-up was about 5 years. The authors have determined two groups of patients according to the delay of treatment, less or more than 6 months. In the first group, 13 procedures out 14 allowed fusion of the condyle without necrosis. In the second group, the severe malalignments of the elbow required a varus or a valgus osteotomy.


[Spinal deformities in Marfan disease].

[Spinal deformities in Marfan disease]. Spinal deformities are frequent in Marfan's disease. 37 patients were examined at the average age of 11 years. 32 showed a spinal deformity. The treatment of the spinal deformity was a brace in 15 cases, surgery in 16 cases (including 5 cases after brace-failure). 7 cases were just followed-up without treatment. Bracing was efficient only for mild curves, this treatment was satisfying 4 times out of 11 with adequate follow-up. The surgical treatment in 16 cases was a posterior fusion twice associated with anterior fusion. We used the same technique as for idiopathic scoliosis with Harrington instrumentation 5 times, Harrington with sublaminar wires 4 times and Cotrel-Dubousset instrumentation 7 times. The correction of scoliosis was achieved in 48.2 per cent. The use of segmental instrumentation compared with the use of the Harrington instrumentation can explain the small number of non unions and the improvement of the lateral spinal balance. We did not note any cardiovascular complication during or early after the operation. Aortic lesions were responsible of one death in the long term, three patients went through a surgical replacement of aortic valves or the aorta.


[Surgical treatment of spinal deformities in Duchenne muscular dystrophy]. Forty seven Duchenne Muscular Dystrophy patients, operated on for spinal deformity with segmental spinal instrumentation according to Luque's technique, are reviewed with a mean post-operative follow up of 4 years 4 months. The study of the results obviously showed the interest of Luque Galveston technique for the treatment of severe curves with pelvic obliquity, whereas Dove's rectangle is an interesting choice for the early instrumentation. A total spinal arthrodesis can probably be avoided in these patients, which often demonstrate a satisfying spontaneous fusion after instrumentation. The general and mechanical complications are described, according to the consequences they have on the management technique of these patients.


[Preoperative embolization of cervical bone metastasis with radio-controlled direct puncture]. Surgery of vertebral hypervascular metastasis can take advantage of preoperative embolization to make the surgical procedure easier to perform. Usually, embolizations are executed by vascular tract. We report a case of one cervical metastasis located in C4 for which embolization was executed with direct puncture of the vertebra. This method has the advantage to be feasible whatever tumoral vascularization, and more particularly in case of departure of radiculo-medullary artery or any other cephalic vessel from the tumoral site.


[Treatment of recurrent or neglected clubfoot by Ilizarov's appliance]. Nine cases of severe, multioperated clubfeet in children and adolescent have been corrected with Ilizarov apparatus. The two first patients have been treated by midtarsal osteotomy plus progressive correction. One poliomyelitic foot have had a slide lengthening of Achilles tendon and a plantar release. Six did not have any open procedure. One ring and two half circles were linked by five threated rods, in order to allow multi axial correction. Seven wires were introduced in the bones; the correction was obtained in a mean time of two months, the device was maintained one more month, then replaced by a walking cast during one month. The results have been seven times satisfactory, with an average follow up of nineteen months after the end of treatment. We did not note any early complication. One more procedure have been performed for flexum of the toes. The ankle range of motion have always been the same as the preoperative one.


[Plasma lipids in reflex sympathetic dystrophy. A study apropos of 90 cases]. Plasma levels of cholesterol, triglyceride, HDL-cholesterol, and apolipoproteins A1 and B were assayed in ninety patients (sixty-four male and twenty-six female) with reflex sympathetic dystrophy and in ninety controls matched for age, sex, and body mass index (BMI). No significant differences were found between the two groups for the proportions of patients with increased plasma cholesterol levels (6.6% versus 4.4%) or increased plasma triglyceride levels (40% versus 30%), as defined by Turpin's age and sex-specific criteria, or for mean values of these parameters. In the 38 patients with reflex sympathetic dystrophy of less than 3.5 months duration, plasma triglyceride levels were significantly higher than in the 38 matched controls (1.24 + 0.57 g/l versus 1.02 +/- 0.91; p = 0.04). In patients (n = 52) with disease of more than four months duration (range 4-39), plasma triglyceride levels were similar in the two groups. Lipidemia was similar in patients and controls regardless of age, sex, topography of the disease, clinical manifestations, and whether or not the disease was due to an injury. This study, in contrast to previous reports, failed to disclose an association between reflex sympathetic dystrophy and hyperlipidemia. Transient hypertriglyceridemia may occur during the first 3 1/2 months of the disease as a result of initial immobilization.


[Coccygodynia: value of dynamic lateral x-ray films in sitting position]. In coccygodynia, pain is most severe in the sitting position. This prompted a study comparing lateral roentgenograms of the coccyx taken with the patient lying on the side. In this prospective study, eight of 30 patients had posterior subdislocation of the coccyx which caused pain and was visible only on the films taken in the sitting position.


[Candida tropicalis arthritis of the shoulder associated with articular chondrocalcinosis]. A case of infection of the scapulohumeral joint following articular infiltrations is reported in a female patient with alcohol-related cirrhosis of the liver. Joint destruction occurred despite appropriate treatment with fluconazole. Candida tropicalis joint infections are seen mainly in immunocompromised hosts and usually cause little destruction of the joint. Most are the result of dissemination via the bloodstream. Preexisting chondrocalcinosis in the patient reported here may have been a contributing factor to the development of extensive joint destruction.


[Meningeal melanocytoma or multiple pigmented meningioma of the spinal canal. Report of a case. Review of the literature]. In a 64-year-old male with pain and weakness of the right lower limb, investigations disclosed a cervical tumor, several dorsal tumors, and tumoral infiltration of the lumbosacral area. Histological and, above all, immunohistochemical and ultrastructural features were suggestive of meningeal melanocytoma. Before the use of immunohistochemical and electron microscopy techniques, meningeal melanocytoma was designated by the term pigmented meningioma because its histological features bear some resemblance to those of meningioma. However, only a few cases of meningeal melanocytoma have been documented by immunohistochemistry and electron microscopy. Previously reported patients with meningeal melanocytoma had solitary tumors. In contrast, a review of the literature showed that multiple intraspinal or intraspinal and intracranial meningiomas are not exceptional, although meningiomatous infiltration is considerably less frequent. Treatment of such cases rests on surgery, radiotherapy, and chemoimmunotherapy.


[Persistent pain following discal sciatica: reflex sympathetic dystrophy, an unusual complication to be examined. Apropos of 4 cases]. Four patients who developed unilateral reflex sympathetic dystrophy of a lower limb associated with a bout of sciatica due to lumbar disc herniation are reported herein. In two cases, reflex sympathetic dystrophy developed after resolution of the sciatica, whereas the two conditions were concomitant in the two other patients. In all four patients, the diagnosis of reflex sympathetic dystrophy was missed. Surgery to release the root was considered in two cases. The reflex sympathetic dystrophy resolved within 1 to 3 months in every case. In view of the incidences of these two conditions, their concomitant occurrence seems rare. To avoid unwarranted therapeutic procedures, reflex sympathetic dystrophy should be considered in patients with chronic painful manifestations accompanying root involvement.


[Polyarthritis revealing hairy cell leukemia]. A female patient simultaneously developed hematologic evidence of hairy cell leukemia and marked but short-lived inflammatory involvement of a number of joints. Both these groups of symptoms resolved simultaneously and rapidly under alpha-2 interferon therapy. This course suggests that the arthritis was a rheumatologic manifestation of the hematologic disease. The concomitant occurrence in this patient of arthritis, splenomegaly and leukopenia was suggestive of Felty syndrome: these two conditions need to be differentiated.


[Lupus, sicca syndrome and chronic interstitial nephritis. Apropos of a case]. A female patient from the French Antilles developed renal failure due to pure chronic interstitial nephritis six months after the onset of systemic lupus erythematosus (SLE) for which she was taking hydroxychloroquine. Over time, results of biologic tests became suggestive of concomitant Gougerot-Sjögren syndrome, but neither the clinical nor the histologic findings were consistent with this diagnosis. The diagnosis of overlap syndrome between SLE and Gougerot-Sjögren syndrome was established only six years later when the patient developed ocular and oral sicca syndrome with enlargement of the parotid glands.


[Arthritis and polyenthesitis after viral pleuro-pneumopathy due to Coxsackie virus]. A sixty-one year-old male developed subacute polyenthesitis one month after the onset on pleuropulmonary disease. This last manifestation resolved completely six months later, whereas the enthesopathy ran a subacute course, improving over time. Three years after onset, the patient had monoarthritis of the left elbow and tendinitis of both Achilles tendons. During the course of the disease, neutralizing antibodies against Coxsackie virus A9 rose significantly then returned to normal when clinical manifestations improved. This finding suggests that viral infections may cause enthesopathy.


[Bone and visceral manifestations of lipoatrophic diabetes. Apropos of a case]. Lipoatrophic diabetes, known by pediatricians as Lawrence-Seip disease or Berardinelli lipodystrophy syndrome, is an infrequent condition of which approximately one hundred cases have been published to date. A case in a 24-year-old female with a fifteen-year follow-up is reported. Manifestations included acanthosis nigricans, generalized lipoatrophy, hirsutism, muscle hypertrophy, and intellectual impairment. Biologic tests revealed insulin-resistant diabetes mellitus with major diet-dependent type V hypertriglyceridemia. The patient had nephrotic syndrome (focal and segmental endocapillary proliferative glomerulonephritis without dense deposits). Phosphorus and calcium determinations were normal, as were the endocrinologic tests. Roentgenograms of the bones disclosed increased density of axial bones and large epiphyseal defects with increased bone density as determined by osteodensitometric studies. The bone manifestations of this syndrome have been documented but are often overshadowed by the severe metabolic alterations.


[Parsonage-Turner syndrome complicated by sympathetic dystrophy syndrome with adhesive capsulitis of the shoulder. Apropos of 2 cases]. Two typical cases of Parsonage-Turner syndrome with reflex sympathetic dystrophy syndrome and adhesive capsulitis of the shoulder are reported. The rarity of this combination is discussed.


[Comparative efficacy of ketoprofen related to the route of administration (intramuscular or per os). A double-blind study versus placebo in rheumatoid arthritis]. Evidence of the analgesic effects of nonsteroidal antiinflammatory drugs in human diseases is easy to collect. However, demonstration of differences in the activity of NSAIDs according to the route of administration is considerably more difficult. Forty patients with rheumatoid arthritis were given either one intramuscular injection of 100 mg ketoprofen with two placebo capsules or one intramuscular injection of placebo with two 50 mg ketoprofen capsules. Analysis of changes in pain severity over the six-hour study period failed to disclose any statistically significant differences between the two groups. However, time to peak effectiveness (Tmax) was significantly shorter with the intramuscular route (194 +/- 118 minutes) than with the oral route (276 +/- 111 minutes) (p = 0.029). Although intramuscular NSAID therapy is rarely warranted in RA patients, these findings suggest that RA may serve as a clinical model for evaluating the effectiveness of a NSAID according to the route of administration.


Long-term results of pylorus-preserving gastrectomy for gastric ulcer. The postoperative results of pylorus-preserving gastrectomy (PPG) for gastric ulcer performed in 134 patients during the past 25 years (mean postoperative period, 16.6 years) were studied. The incidence of postoperative complications was low. Dumping syndrome occurred in only 4.4% and 0% of cases as assessed by questionnaire and interview, respectively. Four (5.4%) of 74 patients available for this study had ulcer recurrence. In one of these four patients concurrent gastroduodenal ulcer was suspected from preoperative gastric analysis. The site of recurrence was found in all cases to be the remnant antral gland area along the greater curvature between the proper gastric gland area and the duodenum. Basal and maximal acid outputs at the time of relapse were significantly higher in patients with recurrence than in patients without recurrence. The fasting and postprandial serum gastrin levels were high in one patient with recurrence, whose antrum was preserved as long as 3 cm proximal to the pyloric ring; this was longer than that described in our original method of PPG. In two other recurrent cases the serum gastrin levels were not different from those in nonrecurrent cases. Immunohistochemical examination of the residual antrum showed no increase in the G-cell density in patients either with or without recurrence. These results suggest that the long-term quality of life of patients treated with PPG remains favorable. Recurrence rate can be further reduced if PPG is strictly indicated for gastric ulcer only and carried out by meticulous surgical techniques. In the pathogenesis of the ulcer recurrence the role of gastrin release from the residual antral mucosa seems to be limited.


Immunohistochemical study of the sympathetic and sensory innervation to the blood vessels of the dog forepaw. Immunohistochemical staining of arteries supplying the dog forepaw showed a dense distribution of nerve fibers which were immunoreactive to tyrosine hydroxylase (TH), neuropeptide Y (NPY), vasoactive intestinal peptide (VIP), substance P (SP), and calcitonin gene-related peptide (CGRP) around the vascular walls. The density of each immunoreactive fiber tended to increase in the peripheral branch of the vascular tree. Retrograde axonal tracing with Fast Blue from the artery revealed that these immunoreactive fibers originated from NPY-containing catecholaminergic as well as VIP/SP/CGRP-containing non-catecholaminergic neurons in the stellate ganglion and SP/CGRP-containing neurons in the dorsal root ganglia of segments C7 to Th1. After stellate ganglionectomy, TH-, NPY-, and, VIP-immunoreactive fibers disappeared completely from the arterial walls while approximately 40% of SP- and CGRP-immunoreactive fibers remained. The present results indicate that the artery of the dog forepaw receive triple innervation of adrenergic sympathetic, non-adrenergic sympathetic, and sensory fibers, and suggest that about 40% of SP- and CGRP-immunoreactive fibers are of sensory origin.


Purification of a new anticoagulant protein, calphobindin III, from human placenta. The Ca(2+)-phospholipid binding proteins in human placental tissue were investigated with the binding of a placental EDTA extract to liposomes composed of placental phospholipids. A new Ca(2+)-dependent phospholipid-binding protein different from calphobindin I (CPB I) and calphobindin II (CPB II) was isolated from the EDTA extract, and the purification procedure of this protein was established. The yield of the purified protein was about 1.2 mg from one placenta. The protein prolonged the clotting time of normal plasma when coagulation was induced by tissue factor and ellagic acid. This protein had an apparent molecular weight of 32,000 as determined by sodium dodecyl sulfate-polyacrylamide gel electrophoresis under reducing conditions, and its isoelectric point was 5.8. Because of its ability to bind phospholipids in the presence of Ca2+, this protein was designated as calphobindin III (CPB III).


Changes of fibronectin in the right and left ventricles of rats exposed to chronic normobaric hypoxia. Changes of fibronectin (FN) in the right and left ventricles of adult rats exposed to chronic normobaric hypoxia were observed by a peroxidase immunohistochemical stain technique and analyzed quantitatively by a point counting method. Fifty-six rats were randomly divided into control groups of day 0 (immediately prior to the experiment), day 5, day 15, and day 30 and hypoxia groups of day 5, day 15, and day 30. Rats of the hypoxia groups were put into a normobaric hypoxia chamber with oxygen concentration adjusted to 10 percent. The rats of the control groups breathed room air. From day 5 on, the ratio of the weight of the right ventricle (RV) to that of the left ventricle (LV) plus interventricular septum (SP), RV/(LV+SP), and the ratio of the weight of the right ventricle (RV) to the body weight (BW), RV/BW, in the hypoxia groups increased significantly as compared with those of the control groups. The amount of immunoreactive FN in the right ventricle increased significantly in the hypoxia groups after exposure to hypoxia environment for 15 days (10.31% +/- 2.15%, mean +/- S.D.) and for 30 days (9.55% +/- 1.65%) as compared with those in the day 0 control group (3.05% +/- 1.15%, p < 0.01), the day 15 control group (3.26% +/- 0.83%, p < 0.01), and the day 30 control group (3.19% +/- 0.51%, p < 0.01). However, there were no significant changes in the amount of immunoreactive FN in the left ventricle of the hypoxia groups as compared with the control groups. These results suggest that chronic hypoxia may lead to an increase of FN in the hypertrophied right ventricle but not in the left ventricle, which indicates that pulmonary hypertension induced by chronic hypoxia rather than chronic hypoxia itself is a major cause for the increase of FN in the myocardium. The increased FN in the right ventricle may accelerate the accumulation of collagen and, in turn, contribute to the increase of the myocardial stiffness and eventually to the diastolic dysfunction of the hypertrophied right ventricle induced by chronic hypoxia.


Methods of semen preparation for intrauterine insemination and subsequent pregnancy rates. Semen for insemination, either intrauterine or in vitro, must be prepared to remove seminal plasma products and/or select the healthier population of sperm prior to use. Traditionally, a double wash technique is performed, with or without subsequent swim-up to isolate the motile fraction if necessary. More recently, the use of the SperPrep filtration method has gained acceptance, with the benefits of removal of leukocytes and seminal debris from the specimen as well as enhancement of overall sperm quality. In the current study we compared the traditional double wash method without the swim-up to Sperm-Prep filtration. Intrauterine inseminations (IUI's) were performed in 307 cycles on 148 infertile couples at two different infertility centers in the USA. After complete diagnostic evaluation the couples were offered IUI before proceeding to any other form of assisted reproductive technologies. Semen samples were prepared in human tubal fluid media supplemented with 5% human serum albumin (HSA; location 1) or in Ham's F-10 media supplemented with 3% HSA (location 2), either with the SpermPrep filtration method (ZBL, Inc., Lexington, KY 40523, USA) or the double sperm wash (SW) procedure. Similar sperm numbers were used for the IUI procedure in both treatment groups and locations. The Sperm-Prep method resulted in significantly higher pregnancy rates (PR) than the SW procedure, independent of location. The clinical pregnancy rates per cycle were statistically lower (p < 0.05) in the SW group (20-22% vs. 9-10%). Of significant clinical importance, almost twice as many cycles were required in the SW group to achieve these pregnancies when compared to the SpermPrep group of patients.(ABSTRACT TRUNCATED AT 250 WORDS)


Locoregional control for esophageal carcinoma treated with irradiation following surgery. Locoregional failure was analyzed in a total of 34 esophageal carcinoma patients treated with postoperative prophylactic irradiation following curative surgery. All patients had squamous cell carcinoma and no prior treatment. Twelve patients had subsequent lymph node metastasis in the follow-up period. In the 12 patients with node metastasis, there were 5 instances of supraclavicular node metastasis, 7 instances of thoracic inlet node (uppermost part of mediastinum) metastasis, and 3 instances of mediastinal node metastasis. Three patients had 2 metastatic nodes and 9 patients had 1 metastatic node. Intervals between surgery and recurrence were a median of 12 months for mediastinal nodes, 19 months for thoracic inlet nodes, and 26 months for supraclavicular nodes. Ten (52.6%) of the 19 patients treated by using a 12-MeV electron beam had metastatic involvement at the supraclavicular and thoracic inlet nodes. On the other hand, 2 (13.3%) of the 15 patients had the above-described lymph node metastases when treated by using 15-MeV electron, 18-MeV electron, or 10-MV photon beams. The difference in the metastatic rate between these two groups was statistically significant at the level of p < 0.05 (chi-square test); this seems to be attributable mainly to the dose level at deep region. Doses of over 50 Gy to the thoracic inlet and supraclavicular nodes at deep location were necessary to reduce metastasis.


Eucapnic hyperventilation-induced bronchoconstriction in rabbits. We examined whether eucapnic hyperventilation with dry air produces the bronchoconstriction in anesthetized, non-sensitized rabbits and in ovalbumin sensitized rabbits. Eucapnic hyperventilation challenge with dry air containing 5% CO2 at room temperature was performed with 4 non-sensitized and 7 sensitized rabbits by mechanical ventilation for 15 min (120 breaths/min, 7 ml tidal volume/kg body weight). Total lung resistance (RL) and dynamic compliance (Cdyn) were measured before and 0, 5, 15, and 30 min after hyperventilation. In non-sensitized rabbits, RL and Cdyn did not change significantly. However, in sensitized rabbits, RL increased maximally by 48.9% +/- 9.0% at 5 min, and then decreased to the baseline level at 30 min after challenge. Cdyn decreased maximally by 12.5% +/- 3.5% at 15 min after challenge. These changes were significantly different from the baselines (p < 0.05). Furthermore, to investigate the role of histamine on hyperventilation-induced bronchoconstriction (HIB) in sensitized rabbits, we performed the hyperventilation challenges in 5 sensitized rabbits with the pretreatment of H1-receptor antagonist (chlorpheniramine, 1 mg/kg, i.v.) and found that the maximum increment of RL was suppressed to 24.2% +/- 7.4% of the control, which was significantly lower than the maximal RL in nontreated sensitized rabbits (p < 0.05). We concluded that HIB occurs only in sensitized rabbits and that histamine may play an important role in the development of HIB in sensitized rabbits.


Effect of methylene blue on the vesicourethral function in the rats. The bladder and urethral activities during the rhythmic bladder contractions were evaluated before and after the intraarterial administration of methylene blue, which prevents the activation of soluble guanylate cyclase. The methylene blue produced an increase in the bladder activity and a decrease in the urethral smooth muscle relaxant response induced with bladder contraction. The L-arginine/nitric oxide pathway seems to modulate the vesicourethral function.


Making the World Health Organization work: a legal framework for universal access to the conditions for health. Improving global health conditions has been one of the most important and difficult challenges for the world community. Despite concerted efforts by international organizations, like the World Health Organization, great disparities in health conditions remain between developed and developing countries, as well as within those countries. The World Health Organization has achieved some successes through its Health for All strategy; however, it can and should encourage member nations to enact national and international laws to protect and promote the health status of their populations. A comparison to the lawmaking efforts in other areas by international organizations indicates that WHO may have the authority and the means to institutionalize efforts to improve global health conditions.


The Estelle medical professional judgment standard: the right of those in state custody to receive high-cost medical treatments. This Article discusses the rights of prisoners, pretrial detainees, and the involuntarily committed to receive high-cost medical treatments. More specifically, the Article analyzes U.S. Supreme Court and lower court case law dealing with the medical care rights of those in state custody and argues that, under a proper understanding of this case law, the financial considerations of states should play no role in determining the rights of these people to receive high-cost medical care. Finally, the Article defends the current medical care standard against various critiques.


Aid-in-dying: should we decriminalize physician-assisted suicide and physician-committed euthanasia? Recent news stories, medical journal articles, and two state voter referenda have publicized physicians' providing their patients with aid-in-dying. This Note distinguishes two components of aid-in-dying: physician-assisted suicide and physician-committed voluntary active euthanasia. The Note traces these components' distinct historical and legal treatments and critically examines arguments for and against both types of action. This Note concludes that aid-in-dying measures should limit legalization initiatives to physician-assisted suicide and should not embrace physician-committed voluntary active euthanasia.


Pushing the environmental regulatory focus a step back: controlling the introduction of new chemicals under the Toxic Substances Control Act. Environmental destruction and its attendant effects on the animal world, including human beings, has moved to the forefront of United States and worldwide policy. The effect of this deterioration on human health is unclear. Much debate focuses on the cases of cancer, along with other diseases, that are environmentally induced. Congress has responded with various environmental laws. These laws focus primarily on controlling chemicals placed into the environment, largely by industry. This Note proposes that such a singular focus is inadequate and ultimately costly. A more sensible and efficient strategy to environmental protection places emphasis on controlling inputs to the productive process before the need arises to contain such substances. The Toxic Substances Control Act of 1976 ("TSCA") takes this approach. This Note reviews the means by which TSCA attempted to accomplish its goals and concludes that TSCA's implementation has largely been ineffective. The Note then discusses three possible explanations for TSCA's failure. Finally, the Note proposes how TSCA might be made more effective in regulating new chemicals.


[The role of electrochemical techniques in the understanding of the mechanism of drug actions. Example of an anti-Bilharzia agent]. In order to gain an interpretation of the schistosomicidal effect of 4-methyl-5-(2-pyrazinyl)-1,2-dithiole-3-thione (Oltipraz), chemical, electrochemical and enzymatic hypotheses are discussed from a pharmacological standpoint. The enzymatic hypothesis is in good agreement with experimental results which ascertain that Oltipraz behaves as a prodrug.


[Contribution of capillary electrophoresis in the analysis of molecules with pharmaceutical and biotechnological value]. Capillary electrophoresis entails a variety of separation modes which are: capillary zone electrophoresis, capillary gel electrophoresis, micellar electrokinetic capillary chromatography, isoelectric focusing and isotachophoresis. Many applications are already reported. The fundamentals of the various modes are discussed along and typical separations in the pharmaceutical and biotechnologic fields are presented. The advantages and disadvantages in comparison to other analytical techniques are also discussed.


[Multiparameter analysis of pharmacological specificity of 3-benzylchromone (homoisoflavone) derivatives on different pharmacological tests in vitro]. For access to structure/activity/specificity of a serie of eight 3-benzylchromones (homoisoflavones), the authors used multivariate analysis. The obtained results allow to envisage the synthesis of molecules more specific of one of the three types of activities studied: angioprotective, antihistaminic, antiallergic.


[Study of the turnover or the release of brain dopamine in rats after administration of N-linoleyl dopamine]. Wistar male rats received N-linoleyl dopamine (L-DA) at doses of 10, 50 or 100 mg/kg (i.p.). 2 h after these injections they were decapitated and dopamine (DA), 3,4-dihydroxyphenylacetic acid (DOPAC), as well as the ratio DOPAC/DA, which could represent the DA turnover, were determined in the striatum, the frontal cortex or the hypothalamus, while homovanillic acid (HVA) as well as the ratio HVA/DA, which could represent the DA release, were determined in the striatum by high performance liquid chromatography (HPLC). Except a small rise of DA and DOPAC in the hypothalamus, at high L-DA doses, no significant modifications in DA, DOPAC, DOPAC/DA, HVA or HVA/DA were observed in the other brain areas studied. These results, in good agreement with the recent data obtained with other dopaminergic agonists, could show the absence of correlation between the hypomotility, on the one hand and the decreasing of the turnover or the release of the brain DA, on the other hand. Together with the data obtained recently by scandinavian and italian authors, they could raise questions about the position and the role of dopaminergic autoreceptors.


[Correlations between the different criteria of late potentials and results of programmed ventricular stimulation after myocardial infarction]. Five to ten per cent of survivors of acute myocardial infarction die within two years. The majority of these deaths are sudden and are attributed to a lethal ventricular arrhythmia. This is usually ventricular tachycardia degenerating to ventricular fibrillation. These post-infarction tachycardias are generally due to reentry. They require an anatomic arrhythmogenic substrate, a zone of delayed conduction. This can be detected as late potentials on signal averaged ECG. The triggering of a significant ventricular arrhythmia by ventricular stimulation is closely correlated to the occurrence of a severe ventricular arrhythmia in the months following infarction. Programmed ventricular stimulation could, therefore, help to identify patients requiring close follow-up and/or preventive antiarrhythmic therapy, but cannot be offered to all patients because of its invasive nature. Seventy nine post-infarction patients were studied prospectively. All underwent coronary angiography, signal averaging electrocardiography, and programmed ventricular stimulation at least 15 days after infarction. Fifty five patients had at least one criterion of late potentials (QRS duration > or = 110 ms and/or amplitude of the last 40 ms < 27 microV and/or duration of potentials of under 40 microV > 37 ms). Twenty four patients had no late potentials. The results of programmed stimulation were estimated to be positive when sustained or unsustained monomorphic ventricular tachycardia was triggered, and negative when ventricular fibrillation, ventricular flutter unsustained polymorphic ventricular tachycardia or no arrhythmia could be induced. Programmed ventricular pacing triggered 15 significant events, 17 unsustained polymorphic ventricular tachycardias, 13 ventricular flutters and 11 ventricular fibrillations. The exploration was negative in 23 patients.(ABSTRACT TRUNCATED AT 250 WORDS)


[Holter monitoring of ventricular arrhythmia during the 24 first hours of myocardial infarction treated with intravenous thrombolysis]. The aim of this study was to assess ventricular arrhythmias after intravenous thrombolysis for acute myocardial infarction and to determine their relationship with coronary artery patency. A 24 hour Holter recording was started 3.1 +/- 0.2 hours after the onset of pain in 40 patients (age 54 +/- 1.6 years, 42.5% anterior infarcts) treated by streptokinase (42.5%) or tissue plasminogen activator (57.5%) within 3.3 +/- 0.2 hours of the beginning of symptoms. The arrhythmias were analysed on a Marquette 8000 computer. Coronary angiography was systematic and was performed 26.7 +/- 2.5 hours (within 4 hours in 60% of patients) after the onset of pain to define coronary artery patency (TIMI 2 and 3: 72.5%) or occlusion (TIMI 0 or 1: 27.5%). Ventricular arrhythmias were common and generally well tolerated (one defibrillation for ventricular fibrillation). Accelerated idioventricular rhythms and ventricular tachycardias were equally prevalent in patients with patent arteries (90% and 83%) as with occluded arteries (82% and 73%). The prevalence of sustained ventricular tachycardias (> 15 complexes) and of early accelerated idioventricular rhythms (< or = 6 hours) was significantly higher in patients with patent coronary arteries: 38% versus 0% (p < 0.05) and 76% versus 18% (p < 0.01). These arrhythmias may be considered to be non-invasive markers of early coronary reperfusion, with a sensitivity of 38 and 76% and a specificity of 100 and 82%. Coronary patency was associated with higher numbers of ventricular extrasystoles, ventricular tachycardias and accelerated idioventricular rhythms by a factor of 14, 13 and 32 respectively.(ABSTRACT TRUNCATED AT 250 WORDS)


[Anatomoclinical study of 100 cases of hypoplasia of the right ventricular muscle (including 89 unexpected sudden deaths). Relation with Uhl's anomaly]. The authors present the pathologist's view of Uhl's anomaly based on 100 cases recorded over 31 years, 89 of which came from medico-legal autopsies following sudden unexpected death in young subjects. The anatomic diagnosis is made by macroscopic examination of the whole heart in diffuse forms (parchment heart) and from transverse sections of the mid third of the ventricle in incomplete forms, showing absence of myocardium in the juxta-septal anterior wall of the right ventricle. The wall entirely made up of adipose tissue, may retain its normal thickness. On microscopy, normal adipose tissue is observed between the epicardium and endocardium, sometimes with islets of myocardium dispersed in the subendocardial layer and with, in about half the cases, subendocardial bundles of non-hyalinized collagen without any inflammatory cellular infiltration. Other structural histopathological lesions may complicate the malformation, involving the intraseptal arterioles or the conductive system. In addition to the 89 cases of sudden and unexpected death before the age of 50 (preceded by some modification of the patient's life style in 29 cases), 11 cases were symptomatic and 5 were transplanted with a good result. The clinical diagnosis of Uhl's disease is important because of its consequences: ventricular tachycardia and possible sudden death, more rarely cardiac failure with age. Histological analysis should take into account the constant presence of adipose tissue in the right ventricle, and should only interpret excessive quantities with associated myocytic aplasia as pathological.(ABSTRACT TRUNCATED AT 250 WORDS)


[Percutaneous mitral valvulotomy: comparison of 2 techniques in 100 matched-pair patients]. The results of percutaneous mitral valvulotomy by the Double Balloon and the Inoue Balloon were compared in 100 patients referred to Marie-Lannelongue Hospital between 7/11/86 and 8/3/91, paired for age, sex and echocardiographic features of the mitral valve. The transvalvular diastolic pressure gradient at catheterisation or Doppler echocardiography decreased significantly and similarly with the two techniques: -65 +/- 19% versus -64 +/- 15% (p = 0.10) and -66 +/- 22% versus -58 +/- 23% (p = 0.20) for the Double-Balloon and the Inoue Balloon techniques respectively. Similarly, the mitral valve surface area measured by planimetry during echocardiography or calculated from the Gorlin formula increased by 0.9 +/- 0.39 cm2 with the Double Balloon and by 0.88 +/- 0.32 cm2 with the Inoué Balloon (p = 0.91) or by 0.98 +/- 0.62 cm2 versus 0.87 +/- 0.45 cm2 (p = 0.42). The number of commissures opened was the same with both techniques. The evolution of mitral regurgitation after dilatation was similar: stable or less severe in 61% dilated by the Double Balloon and 68% by the Inoue Balloon; aggravation by more than one grade in 7 and 5% respectively (p = 0.17). Complications were rare and comparable with both techniques. The results with the two methods were the same if patients with an optimal indication and those with more severe mitral valve disease were considered separately. The rapidity and simplicity of percutaneous mitral valvulotomy with the Inoué Balloon make it the technique of choice.


[Current role of intra-aortic diastolic balloon counterpulsation in heart surgery]. Intra-aortic balloon counterpulsation (IABP) is a relatively non-invasive method of circulating assistance, easy to use and which has benefitted from a number of technological improvements in recent years. This retrospective study over 4 years was undertaken to analyse the results of IABP and to determine its role in therapeutic arsenal against cardiac failure. Sixty five patients, 57 coronary and 8 valvular cases, with an average age of 61 +/- 10 years were included. The indications of IABP were: a bridge to transplantation (3 cases), complications of coronary angioplasty (4 cases), and low cardiac output after cardiopulmonary bypass (58 cases), where IABP was curative in 85% of cases and prophylactic in 15% of cases (patients with risk factors of low output state after CPB). Beforehand, 65% of patients had poor left ventricular function (LVEF < 40% and/or CI < 2.2 l/mn/m2). An Aries Medical M700 console was used. The percutaneous femoral approach was feasible in 87% of cases. The results were: improvement with discharge from intensive care unit in 60% of cases, transient improvement in 7% of cases, no improvement in 15% of cases and cardiac transplantation in 8% of cases. The outcome was worse when the preoperative LV function was poor and when high dose inotropic agents had to be used. Survival was 100% in those patients in whom IABP was a prophylactic measure. The average duration of IABP was 72 hours, survival being significantly lower in those in whom IABP was continued for over 3 days. The complications (12.7%) were thromboembolic.(ABSTRACT TRUNCATED AT 250 WORDS)


[Prevalence and description of cardiac involvements in primary antiphospholipid syndrome]. In order to assess the prevalence of cardiac involvement in the primary antiphospholipid syndrome (PAS), a syndrome which associates thromboembolism, recurrent abortion, the presence of antiphospholipid antibodies and thrombocytopenia, transthoracic (TTE) and trans-esophageal echocardiography (TEE) was performed in 15 patients, 10 women and 5 men with a mean age of 38.8 +/- 11 years, with the PAS but without systemic lupus erythematosus. The presentation of the PAS was a thrombotic event (6 arterial and 7 venous) in 13 cases, and recurrent abortion in 3 cases. Twelve patients had high anticardiolipin antibody levels (> or = 15 U GPL) and 12 had a raised anti-prothrombinase antibody title. Valvular heart disease was detected in 9 patients (60%) as a valve thickening (> or = 5 mm for the mitral and > or = 3 mm for the aortic valve) or nodule. Mitral regurgitation was observed in 4 cases both on TTE and TEE and was mild in 3 cases and severe in 1 case. Aortic regurgitation was diagnosed in 6 patients, in 3 cases by TTE and in 6 cases by TEE. It was mild in 5 cases and moderate in the other cases. Pericardial effusion was observed in 3 patients (20%), alone in 1 case and associated with valvular disease in the other two cases. No abnormality of left ventricular systolic or diastolic function could be demonstrated. In conclusion, cardiac involvement seems to be common in the PAS, and TEE is a sensitive and accurate method for describing the valvular, especially aortic valve, abnormalities.


[Evaluation of the size of thrombolysed myocardial infarction by serum myosin determination]. The prognosis of myocardial infarction is very dependent on the size of the infarct. The measurement of the infarct size after thrombolysis remains difficult despite the large number of methods available, all of which have drawbacks. This parameter is however essential to assess prognosis and the efficacy of thrombolytic therapy. Serum beta heavy chain myosin determination is a recently introduced method of evaluating infarct size; there are relatively few published studies, especially concerning post-thrombolytic patients. A prospective study was undertaken in 40 patients (37 men and 3 women: average age 55.6 years) with a primary myocardial infarction treated by thrombolysis. Myosin levels (peak and area under curve of 5 samples in 10 days) were compared with other methods of assessing infarct size: electrocardiogram (number of leads with Q waves, ST segment analysis), cardiac enzymes (peak and release integrals of CK abd LDH), contrast ventriculography (segmental asynergy score, ejection fraction), coronary angiography and resting MIBI myocardial scintigraphy. The peak and integral of myosin release correlated well with the other methods (p < 0.01): a correlation was particularly apparent between the integral of myosin release and MIBI scintigraphy scores (r = 0.77, p < 0.001). Complex myosin release kinetics were observed significantly more often in patients with large infarcts (p < 0.01) or in those with occlusion of the artery responsible for infarction at coronary angiography on the 6th day (p = 0.001). In conclusion, with 5 blood samples over a 10 day period, it is possible to estimate the infarct size after thrombolysis in everyday cardiological practice: this method could help identify high risk subjects (complex kinetics of myosin release and high peak myosin levels) and also could be used to assess efficacy of thrombolytic therapy in large scale trials.


[Cardiology in general hospitals. A cooperative survey on medical teams, technical means and activity]. A national enquiry carried out in 1990 in the departments of cardiology of general and private non-profit making hospitals established the status of these departments and the evolution of their personnel and equipment since their creation. The enquiry involved two thirds of the cardiology departments of the general hospitals (119/180) and showed that most (66%) were established between 1974 and 1988. Implanted in fairly important cities with catchment areas of 100,000 to 400,000 people, they have an average of 32 beds (range 11 to 100) and 7.25 coronary care beds (range 4 to 19); 347 doctors work full (211) or part time (136) in these departments. These two types of work are allowed in the majority of these units (64/119). Specialist certified cardiologists practice in 62 departments (56%). The usual technical equipment is available in 80% of the units (Doppler echocardiography, exercise stress testing, Holter monitoring, right heart catheterisation). Permanent pacing is performed in 65% of these hospitals, more so in the provinces than in the Paris region. Coronary angiography is only available in 21%, radioisotopic investigations in 15% and coronary angioplasty in 12% of these centres. A prospective study performed in 1990 concerning 110 hospitals recruited 1,030 myocardial infarctions, which enabled the total number of infarcts hospitalised in the coronary care units of the general hospitals to be estimated at about 21,000 (60% of French myocardial infarctions).


[Should mitral valve diseases, without or with few symptoms, be treated surgically?]. Our approach to the treatment of valvular heart disease, and mitral valve disease in particular, has been deeply modified by the experience acquired since the introduction of cardiac surgery and the technical advances in this field in the last decade and by new methods of investigative and interventional cardiology. In pure severe mitral regurgitation alone, the treatment of choice is reconstructive surgery. In the experience of our group, 191 patients out of 342 operated since 1970 for this type of valve lesion were referred for reconstructive surgery. Taking the results into consideration (72% 15 year survival), it is now justified to refer patients at a stage when the valvular disease is asymptomatic or pauci-symptomatic. A certain number of factors has to be assessed to evaluate the surgical indication: the experience of the surgical team, the etiology of the mitral regurgitation, the type of anatomical lesion, the stage of the cardiac disease and the patient's age. In mitral stenosis, in preference to surgical commissurotomy, percutaneous mitral valvuloplasty may be proposed in certain asymptomatic or pauci-symptomatic patients if the stenosis is severe, if the anatomical lesions are optimal and if there is a hemodynamic (pregnancy) or thromboembolic risk (arrhythmias, spontaneous contrast on transoesophageal echocardiography). In mixed mitral valve disease or very calcific stenoses, analysis of long-term results of valve replacement indicates that the late prognosis depends more on the stage of the cardiac disease at the time of surgery than on the type of prosthesis. It is advisable not to wait until an advanced stage before operating these patients when the valvular dysfunction is severe and there are hemodynamic consequences.(ABSTRACT TRUNCATED AT 250 WORDS)


[Should asymptomatic aortic valve disease be treated surgically?]. The problems posed by asymptomatic aortic valve disease with regards to surgery differ according to whether the lesion is aortic stenosis or regurgitation. In stenotic lesions, even severe, the risk of spontaneous evolution is very small when the subject is totally asymptomatic. However, the quality of the results of surgery in asymptomatic or pauci-symptomatic patients and the increased difficulties in the very elderly are incentives not to differ surgery when the stenosis is severe, and especially when left ventricular function begins to degrade. In aortic regurgitation, the risk of progression is also low in asymptomatic patients but left ventricular dysfunction may develop before symptoms occur: this explains the necessity for regular clinical, echocardiographic and eventually radioisotopic examination of patients with severe aortic regurgitation. In dystrophic aortic regurgitation, an aneurysm of the sinuses of Valsalva and/or of the ascending aorta, or progressive fusiform dilatation of the ascending aorta are reasons for not postponing surgery for replacement of the aortic valve and the ascending aorta.


[Pro-arrhythmia effect of pyridostigmine. Apropos of a case]. A coronary patient with myasthenia gravis with a previous myocardial infarction presented with severe ventricular arrhythmias after the replacement of neostigmine by pyridostigmine for the treatment of the myasthenia. These arrhythmias were resistant to antiarrhythmic therapy associating betablockers and amiodarone throughout treatment with pyridostigmine but regressed when this drug was withdrawn. A test of reintroduction of pyridostigmine under medical surveillance led to the reappearance of the ventricular hyperexcitability, so confirming the responsibility of this drug. This would seem to be the first reported case of severe ventricular arrhythmias due to a proarrhythmic effect of pyridostigmine. The possible mechanisms of this effect are discussed.


[Myocardial infarction caused by thrombosis of the common trunk of the left coronary artery without collateral circulation. Treatment by intra-aortic counterpulsation and subsequent heart transplantation]. The authors report the case of an acute anterior myocardial infarction due to occlusion of the left main coronary artery without a collateral circulation. The patient survived after intraaortic balloon pumping followed by cardiac transplantation.


[Rupture and extravascular migration of a vena cava filter. Apropos of a case]. The authors report the case of a 68 year old woman who underwent implantation of a Greenfield vena caval filter for recurrent pulmonary embolism. Migration of the filter out of the vena cava into the perivenal fat was discovered two years later during another embolic episode. One of the spokes of the filter had migrated into the iliac fossa. This case illustrates two possible complications of caval filters: rupture and migration. The increasing number of cases reported in the literature indicates the necessity of keeping a register of the complications encountered with different models to avoid the most dangerous ones.


[Radiofrequency ablation of atrioventricular conduction during the 5th month of pregnancy]. The authors report the case of radiofrequency ablation of atrioventricular conduction in a 5 months pregnant woman who had hypertrophic cardiomyopathy. The indication of this procedure was a poorly tolerated resistant supraventricular tachycardia with foetal distress. A dual-chamber rate-assisted pacemaker programmed in the VVIR mode was implanted during the same procedure normally, with normal delivery of a healthy child at 8 months' gestation.


[Respiratory allergies in the Flegrean region]. The Authors value 407 consecutive outpatients, with rhinitis, conjunctivitis and asthma, coming from Flegrean area. In the patients with prick test positivity for pollen or inhalants the results were compared with clinical symptomatology. The data obtained, confirm the importance of inhalants persistent in asthma, and the rilevance of seasonal pollens in rhinoconjunctivitis and episodic asthma. In this homogeneous population, never the olea positivity was demonstrated as a single, whereas ambrosia (ragweed) was founded.


[Effects of transdermal nicotine as an adjunct in smoking cessation therapy. A double-blind randomized study controlled with placebo]. To assess the smoking cessation efficacy of transdermal nicotine patches an adjunct to low-intervention therapy, we conducted a double-blind, placebo-controlled trial in 158 smokers. Participants were randomly assigned to one of the following three study regimens that required daily application of two 15-cm2 patches: 1) 24-hour nicotine delivery, 2) nicotine delivery during wakeful hours only, and 3) placebo. The impact of the three regimens on smoking cessation rates and tobacco withdrawal symptoms was examined. During the last 2 weeks of the trial, 39% of the 24-hour nicotine regimen delivery group, 35% of those on wakeful hour nicotine regimens, and 13.5% of the placebo treatment group achieved abstinence. Self-reported quit rates for the two nicotine patch-wearing regimens, as compared with that for the placebo group, continued to be significantly higher at 6 months. Moreover, compared with placebo, the transdermal nicotine patches significantly reduced tobacco withdrawal symptoms during the first few weeks of quitting. The differences in quit rates and tobacco withdrawal symptoms between the to active groups were not statistically significant. The patches were well tolerated both topically and systemically. We concluded that transdermal nicotine, when used as an adjunct to low-intervention therapy, significantly reduced tobacco withdrawal symptoms and enhanced smoking cessation rates.


Microvascular pressure profile of serosal vessels of rat trachea. The distribution of intravascular pressures within the pulmonary airway microcirculation is an important determinant of transvascular liquid balance. Intravascular pressures were measured in the serosal vessels of the trachea in anesthetized, ventilated rats. The ventral portion of the trachea was surgically exposed and suffused with warm (37 degrees C) Krebs-Ringer bicarbonate. The serosal microvasculature was observed with a video microscope, and microvessel pressures and diameters were measured using the servo-null technique and video calipers, respectively. Mean arterial pressure (MAP) was monitored from the left femoral artery and averaged 106.1 +/- 5.2 mmHg (n = 14). The highest pressure (77% of MAP) was measured in a large (95-microns diam) transverse arteriole. As arteriolar diameter decreased from 39 to 11 microns, pressures fell from 62 to 18% of MAP. Capillaries drained into venular networks that formed extensive arcades. Pressures in these postcapillary venules (20-75 microns diam) were 7.7 +/- 5.5% of MAP (n = 9). These vessels in turn drained into large venous sinuses (120-425 microns diam) where pressures averaged 5.7 +/- 2.3% of MAP (n = 7). A four-parameter logistical model of these data predicts that capillary pressures range from 27 to 15% of MAP. We conclude that 1) a substantial resistance exists across precapillary arterioles less than 40 microns diam and 2) a small pressure drop occurs between systemic arteries and primary feed arterioles in this tissue.


[Aerosol thymopentin in the prevention of relapse of chronic bronchitis]. In this study the Authors have verified the efficacy of Thymopentin administered via aerosol in the prevention of recurrent catarrhal episodes in the patients affected by COPD during the winter season, compared to the previous winter. In October, 1 phial of Thymopentin was administered via aerosol to 15 patients affected by COPD, daily, for 10 consecutive days; all patients were evaluated at monthly clinical control for 4 months and all patients were invited to keep a diary of daily variations. After 4 months from treatment a net improvement was observed in the clinical parameters studied: sputum (volume and purulence), cough and dyspnoea, but the most interesting datum was the total absence of recurrent episodes of infection, associated to the reduction in quantity of antibiotics, mucolytics and number of days of illness and with noticeable improvement in the quality of life of the patients.


[Changes in spirometric values induced by nasally administered beclomethasone dipropionate in patients with perennial allergic rhinitis]. Authors showed that it's possible to control the asthmatic component in patients with persistent allergical rhinitis without bronchodilatory drugs. AA. compared two groups of ten patients: Group A has been treated with antihystaminical drugs or ketotifen per os and Disodium chromoglycate per nasal spray, Group B has been treated with the same drugs and Beclomethasone Dipropionate per nasal spray more (400 mcg a day). Respiratory functionality tests (FEV1 and MEF75) have been carried out at the beginning and at the end of the trial and the subsequent clinical parameters have been considered: dispnoea attacks, rhinorrhaea, sneezes, lost working or school days. The results of the study showed after three months of therapy a statistically significant improvement of FEV1 and MEF75 in Group B only; moreover the patients of the Group B had lower number of asthmatic attacks then patients of the Group A.


[Quality of life and psychologic features of subjects with chronic respiratory diseases]. The aim of this study is to verify the psychological attitude and the quality of life in patients suffering from chronic respiratory insufficiency. Taking for granted that a bad quality of life is connected with the symptom of a depressed state (loss of appetite, quality of sleep, sexuality, psychomotor slowing down, loss of energy, weariness, reduced interest for the external world, feelings of self-devaluation, reduced working and concentration capacity, complainings of turning over type) we have taken as index of "normal quality of life" the lack of these attitudes correlating them to the clinical symptoms and/or the patient's functional troubles and verifying how much they can affect the psychological features and how much the deterioration of the quality of life. For this reason a questionnaire, taken from the MMPI test (Minnesota Multiphasic Personality Inventory), restricted to the items related to the D scale (depression scale), has been given to one hundred COPD patients who had been examined previously from a clinical functional point of view. In the end, we have drawn our results both on the ground of the answers given by the patients to the single questions and on the grounds of the total score D (= depression index) and relating the previous data with the clinical-functional ones. Finally we have compareted these data with those ones connected with non selected population. So we have succeeded in outlining a psychophysical profile of the patient suffering from chronic respiratory diseases. Such a profile is marked by an objective element, that is pathology, and by a psychological element inserted into the organic one as there is an inter-dependence between pathology and psychological features. From the collected data, we have noted the behavioural spheres which are more upset are working capacities, sleep and mood and these features are directly proportional to the seriousness of the pathology. From a practical and therapeutic point of view, all this can be of great importance.


[Multiple carcinomas: considerations on several cases with synchronous/metachronous involvement of the respiratory tract]. The authors report their observations on 7 cases of multiple malignant tumors during the period 1988/1992 (frequency of 0.03 x 100). They report that primary malignant tumors involved the laryinx and the wang, and both the lungs in a synchronous or metacronous way. They suggest that pathogenesis of multiple malignant tumors may be very similar to that of multiple endocrinous neoplasms.


Assessing physicians' estimates of the probability of coronary artery disease: the influence of patient characteristics. The authors assessed physicians' probability estimates of coronary artery disease (CAD) in 250 patients undergoing a screening exercise stress test. True likelihood of disease (prevalence) was derived from the literature. Discrimination and calibration were assessed by comparing physicians' probability estimates and prevalence using pairwise comparisons, rank correlation, and linear regression. There were differences in the discriminative abilities of the physicians based on patient characteristics. For example, the physicians had better discriminative ability for patients with typical cardiac chest pain compared with atypical chest pain. The physicians were able to predict the prevalence of CAD in broad groups of patients. However, they overestimated probabilities for patients with low prevalence of disease and underestimated probabilities for patients with high prevalence of disease. The authors conclude that physicians make consistent errors in the use of probability estimates. The quality of these estimates depends on patient characteristics such as type of chest pain and true likelihood of disease.


Infant acceptance of postexercise breast milk. The purpose of this study was to observe the infant acceptance of postexercise breast milk. Twenty-six lactating postpartum women exercised to maximum (maximum oxygen consumption = 35.1 +/- 9.2 [SD] mL min-1 kg-1) on a treadmill. Breast milk was collected via self-expression at rest before exercise and at 10 and 30 minutes postexercise and analyzed for lactic acid by enzymatic methods. Following exercise, infants were presented with their mothers' pre-exercise and postexercise milk in a double-blind design. The mother rated the infant's acceptance of the milk samples. There was a significant difference in acceptance of pre-exercise and postexercise milk as analyzed by analysis of variance. Maximal exercise resulted in a significant increase in lactic acid concentration in breast milk that may be high enough to affect the taste of the milk. The decreased acceptance of postexercise milk was associated with increased lactic acid concentration. Suggestions to circumvent the decreased acceptance are offered.


Time trends in gastric carcinoma: changing patterns of type and location. To determine whether there have been major changes in various aspects of gastric carcinoma, we reviewed the records of 302 patients with gastric cancer diagnosed between 1973 and 1989. Patients were divided into two groups: group I, 1973-80 (n = 163), and group II, 1981-88 (n = 139). On admission, no significant differences in presenting symptoms and physical signs were found, except for an increase in dysphagia (p less than 0.005) in group II. Endoscopy with targeted biopsy and biphasic-contrast examination were of equal merit in detecting malignancy (99.7%). A significant increase in the proportion of patients with cardia carcinoma was noted in group II (p less than 0.02). The proportion of patients with early gastric cancer decreased from 11% to 7.2%. The proportion of patients with intestinal-type carcinoma decreased in period II (p less than 0.05), accompanied by an increase in the proportion of patients with diffuse-type carcinoma during the same period (p less than 0.01). The overall 5-yr survival estimate was 17%. Independent prognostic variables were T stage (p less than 0.0001) and N stage (p less than 0.001), whereas Lauren type and tumor site were only significant in univariate survival analysis (p less than 0.05 and p less than 0.005, respectively).


A simple and safe technique of left ventricular venting. Left ventricular venting has many physiologic and practical benefits. A venting technique is described that employs a simple, closed system which allows the perfusionist to monitor left ventricular distention. By monitoring the left ventricular volume the perfusionist can regulate the degree of negative pressure on the vent and thus reduce the chance of air entering the heart.


High-dose intravenous immune globulin therapy for hyperbilirubinemia caused by Rh hemolytic disease. We conducted a multicenter controlled trial to test the hypothesis that high-dose intravenous immune globulin (HDivIG) therapy can modulate bilirubin production and reduce the frequency of exchange transfusions in newborn infants with Rh hemolytic disease. Thirty-four patients with Rh incompatibility proved by positive direct antiglobulin test (Coombs test) results were randomly assigned to receive conventional treatment including phototherapy, with or without additional HDivIG therapy at 500 mg/kg given for a 2-hour period as soon as the diagnosis was established. Exchange transfusions were performed if serum bilirubin concentrations exceeded the modified curves of Polácek by more than 2 mg/dl. Two patients were excluded because of protocol violations. The results in 32 infants were analyzed. In the HDivIG group, 2 (12.5%) of 16 children required exchange transfusions, whereas it became necessary in 11 (69%) of 16 children in the control group (p less than 0.005). Bilirubin levels in the HDivIG group were lower despite reduced frequency of exchange transfusions. No side effects of HDivIG treatment were observed. We conclude that HDivIG therapy by a yet unknown mechanism reduces serum bilirubin levels and the need for blood exchange transfusions in children with Rh hemolytic disease.


Does the type of anomalous arrangement of pancreaticobiliary ducts influence the surgery and prognosis of choledochal cyst? A new classification of the anomalous arrangement of pancreaticobiliary ducts (APBD) has been proposed following amendments and modificiations of the previous one. Fifty-one cases of choledochal cyst complicated with APBD were extensively examined and analyzed for clear visualization of the APBD system to make a standard classification. APBD were classified broadly into three types: type I, type II, and type III with their subtypes. Type I of APBD was seen in 18 (35.3%), type II in 11 (21.6%) and type III in 22 (43.1%) cases, respectively. A radical operation, including complete excision of the dilated biliary duct followed by reconstruction of the biliary tract was the surgical treatment of choice, because the reflux of the pancreatic juice into the biliary tract is prevented. However, a dilated common channel or accessory pancreatic duct, according to the new Komi type Ib, IIb, and IIIc3 of APBD, could be the cause of relapsing pancreatitis leading to chronic pancreatitis, due to the formation of a protein plug or pancreatic calculus in the dilated duct, even after this radical operation. In two complicated cases of type IIIc3 of APBD in choledochal cyst, we performed a pylorus-preserving pancreatoduodenectomy as one of the operative methods of choice. Long-term follow-up, more than decades, is essential to evaluate the results of surgical procedure for choledochal cyst, especially in those complicated cases with type Ib, IIb, and IIIc3 of APBD according to the new Komi's classification.


Storage and transfusion of platelets collected by an automated two-stage apheresis procedure. Platelets collected by using a two-stage automated blood cell separator were evaluated after 5 days of storage. The procedure caused no unanticipated physiologic changes in donors and produced greater than 3 x 10(11) intact platelets in 200 mL of plasma, plus an additional 400 mL of plasma with intact coagulation factors. Posttransfusion recovery of autologous radiolabeled platelets was comparable to that seen in platelets prepared by manual centrifugation techniques. Corrected count increments in 14 patients showed results similar to those with control transfusions. This device, which involves a collection time of less than 90 minutes, provides an option for platelet-pheresis in a variety of settings including blood mobiles.


Subtotal splenectomy in Gaucher's disease: towards a definition of critical splenic mass. Partial splenectomy is currently the favoured surgical approach for Gaucher's disease. Preservation of splenic tissue is indicated to prevent susceptibility to overwhelming postsplenectomy sepsis, to delay the massive deposition of glucocerebroside in the liver and bones, and to relieve symptoms of hypersplenism. Controversial issues and technical problems related to partial splenectomy for Gaucher's disease are discussed and a definition of critical splenic mass considered.


Functional imaging of peripheral vascular disease: a comparison between exercise whole-body thallium perfusion imaging and contrast arteriography. Whole-body thallium scintigraphy was used to study leg muscle perfusion in 12 healthy individuals and 31 patients with peripheral vascular disease. Subjects were scanned immediately after exercise and 4 hr later. Buttock, thigh and calf perfusion were measured in terms of fractional uptake relative to whole-body activity, percent change in fractional uptake over 4 hr and interextremity symmetry ratios. The results were compared to contrast arteriography on a region by region basis. The overall sensitivity and specificity of thallium scintigraphy were 80% and 73%, respectively. The results suggest that thallium scintigraphy may provide useful information about the hemodynamic significance of noncritical anatomic lesions.


Effect of one hour of passive cigarette smoking on lung function and airway responsiveness in adults and children with asthma. We exposed 18 adults with bronchial asthma, 16 healthy controls and 11 children with asthma for 1 h either to ambient air (AA) or to environmental tobacco smoke (ETS). Exposure was performed at rest in an exposure chamber. Before and after exposure symptom scores and lung function were determined. After exposure bronchoprovocation tests with methacholine (adults) or histamine (children) were performed to determine the concentrations causing a 100% increase in SRaw (PC100SRaw), and a 20% fall in FEV1 (PC20FEV1). In adult asthmatics mean (SD) SRaw before and after Sham was 8.8 (3.6) and 8.4 (3.6) cmH2O.s, and mean FEV1 (SD) was 3.18 (0.97) and 3.14 (0.9) 1, respectively. Before and after passive smoking mean SRaw (SD) was 7.5 (3.0) and 7.2 (2.7) cmH2O.s, and mean FEV1 (SD) was 3.31 (1.0) and 3.21 (0.88) 1, respectively. Geometric mean (SD) PC100SRaw and PC20FEV1 after Sham were 0.38 (4.5) and 0.29 (4.1) mg/ml, after passive smoking 0.39 (5.1) and 0.36 (4.7) mg/ml, respectively. In healthy controls there was no consistent effect on the respective parameters during exposure. In children mean (SD) SRaw before and after Sham was 8.7 (3.6) and 9.0 (3.2) cmH2O.s, and mean FEV1 (SD) was 1.97 (0.32) and 1.98 (0.40) 1, respectively. Before and after passive smoking mean SRaw (SD) was 10.4 (5.3) and 9.4 (3.3) cmH2O.s, and mean FEV1 (SD) was 1.95 (0.37) and 1.94 (0.35) 1, respectively. Geometric mean (SD) PC100SRaw and PC20FEV1 after Sham were 1.39 (3.0) and 0.70 (2.7) mg/ml, and after passive smoking 1.65 (2.5) and 0.96 (2.3) mg/ml, respectively. There were no significant differences in lung function and airway responsiveness between exposure to ambient air or ETS.(ABSTRACT TRUNCATED AT 250 WORDS)


What proportion of isotope injected does the child receive in dynamic renal scanning? Because of significant difficulties encountered in the manipulation of data from 99Tcm-DTPA and 99Tcm-mercaptoacetyltriglycine (MAG3) renogram studies, it was decided to try to improve the percentage dose of radioisotope injected and thus the number of counts obtained by using a minimum dose volume of 1 ml for all injections. This resulted in an improvement in the percentage dose injected. However, difficulties were still encountered in the younger children. 18.7% of children aged less than 3 months, received less than 50% of the injected dose, showing little or no improvement using the newer method. The difficulty of injecting small babies seems the most obvious reason. During the interpretation of the findings in paediatric radioisotope studies, it is important to remember that not all children may have received an adequate percentage dose to constitute a reliably diagnostic study.


Catatonia on the consultation-liaison service. Catatonia is a syndrome that requires both nonpsychiatric medical and psychiatric evaluation. The authors report on six patients with catatonia that were seen by a psychiatric consultation-liaison service. Five of these patients had medical conditions reported to cause catatonia. Treatment recommendations included the following: 1) subcutaneous heparin for deep venous thrombosis prophylaxis, 2) a trial of lorazepam, and 3) transfer to a medical/psychiatric unit or locked psychiatric unit. Catatonia was most parsimoniously attributed to the primary psychiatric illness in five of the patients and to corticosteroid treatment in the sixth patient. These findings suggest that clinicians should use the proposed criteria, past psychiatric history, physical exam, and laboratory and radiological studies when evaluating patients with symptoms of catatonia.


Quality of life following surgery for abdominal aortic aneurysm. Repair of abdominal aortic aneurysm (AAA) carries a considerable rate of morbidity and mortality, but little information exists on the quality of life following this procedure. During 1988 and 1989, in two hospitals, 211 patients (186 men and 25 women; median age 74 (range 48-87) years) underwent surgery for AAA. There were 77 ruptured aneurysms and 134 electively repaired. Of these, 38 patients died in hospital (27 ruptured, 11 elective); by the time of review a further eight (one ruptured, seven elective) had died from unrelated causes. Of the 165 survivors, 131 (45 ruptured, 86 elective) were reviewed and questioned as to their physical and mental state before and after surgery. Using the Rosser index, a value for quality of life before and after surgery was calculated (1.0, good; 0, dead). The value for the elective group was 0.94 before operation and 0.96 after, but in the ruptured group fell from 0.98 before surgery to 0.87 afterwards. This study shows that patients undergoing elective surgery for repair of AAA retain good quality of life. By contrast, patients surviving emergency surgery following this procedure seem to suffer a deterioration in life quality, which must be endured for the same expected lifetime as that for the elective group. These results support the need for a national AAA ultrasonographic screening programme.


Outcome of White pump shunt surgery for neovascular glaucoma in Asians. We compared the effect of seton (White pump shunt) surgery (16 eyes) with that of trabeculectomy and 5-fluorouracil (31 eyes) in treating 38 Asian patients with medically uncontrollable neovascular glaucoma. We found the probability of long-term success (intraocular pressure < or = 26 > or = 5 mm Hg) of seton surgery (53.0% at 3 years) to be similar to that obtained following trabeculectomy with adjunctive 5-fluorouracil (45.4% at 3 years). However, 3 years postoperatively, the probability of the preservation of visual acuity was significantly greater following trabeculectomy than seton surgery (67.1% vs 23.1%; P < .05). In addition, the prevalence of postoperative complications was higher with the seton procedure (P < .001). The loss of endothelial cells 6 months postoperatively was more marked with seton surgery than with trabeculectomy, whether the shunt device touched the cornea (P < .000001) or not (P < .0005). In conclusion, White's pump shunt was effective in lowering the IOP of eyes with neovascular glaucoma. However, care must be taken to prevent postoperative complications, the incidence of which exceeded those observed following trabeculectomy with adjunctive 5-fluorouracil.


Use of the Palmaz stent in ostial celiac artery stenosis. The author reports a case in which a 20-mm balloon-expandable Palmaz stent was used with percutaneous transluminal angioplasty to treat a stenosis of the proximal celiac artery in a patient with mesenteric ischemia. The stent was dilated to 9 mm, eliminating the stenosis. The patient made an uneventful recovery and remains asymptomatic at 4 months.


Indomethacin treatment in children with daytime frequency of micturition. Thirty children with daytime urinary frequency (DUFC) were randomly divided into two groups. The first group was given oral indomethacin, 1 mg/kg per dose, three times a day for 7 days. The frequency of urination fell from 26.3 +/- 2.3 to 11.7 +/- 2.8 at the end of the treatment period. The second group was treated with oral chloramphenicol, 30 mg/kg per day, in four divided doses for 7 days. Their urinary frequency did not change. They were then treated with a 1-week course of indomethacin and responded in a similar manner to group 1 patients. The use of indomethacin was accompanied by significant increases in plasma carbon dioxide-combining power, urine osmolality and urine pH; urine sodium and potassium levels decreased. These results show that a short course of indomethacin, in low dose, improves DUFC. We propose that it acts by inhibiting prostaglandin synthesis which modifies tubular function and increases urinary pH.


The value of water-soluble contrast radiology in the management of acute small bowel obstruction. A series of 127 consecutive patients with symptoms and signs and radiological features suggestive of acute small bowel obstruction underwent water-soluble contrast small bowel follow-through examination. A dose of 100 ml of Gastrograffin in adults, or 20-50 ml in children, was injected via a nasogastric tube and supine plain abdominal radiographs were taken at 30 min and 4 h after administration. If contrast passed to the colon a non-operative course was followed. If there was a clear cut-off in contrast level in the small bowel or if contrast failed to pass into the large bowel by 4 h, patients underwent laparotomy. Based on these radiological findings 15 patients (11.8%) underwent surgery and all had established small bowel obstruction at laparotomy. The remaining 112 patients were successfully managed conservatively. Water-soluble contrast radiology is safe, easy to use and to interpret, and is a major benefit in differentiating mechanical from other causes of small bowel obstruction. Our experience indicates that this underused technique is of significant value in identifying those patients who require urgent surgery.


Prevention of malalignment during non-reversed femorodistal bypass. A simple technique is described using a Doppler flowmeter to prevent malalignment of a vein graft during femorodistal reconstruction. In 63 non-reversed vein bypass grafts, this technique has been used and no evidence of malalignment has been found on subsequent completion arteriography.


Comparative plaque removal efficacy of three toothbrushes in two independent clinical studies. Two independent studies were conducted to evaluate and compare the clinical performance of three toothbrushes on plaque removal. Both studies were carried out under the same protocol. A total of 73 adult male and female subjects who met the inclusion/exclusion criteria completed Study I and 78 different subjects completed Study II. Subjects were initially screened for dental plaque eligibility. After plaque was scored on the facial and lingual surfaces of all natural teeth using the Rustogi, et al. index, qualifying subjects were randomly assigned to one of three groups on the basis of initial plaque scores and number of teeth. Subjects were then dismissed and scheduled to return for Visit 1 a week later, having abstained from all oral hygiene procedures for a prior 24-hour period. At Visit 1, each group was evaluated for plaque before brushing with their assigned toothbrush for sixty seconds. They were again scored for plaque after brushing. Subjects were dismissed and instructed to resume their normal routine and return to the clinical site for two more weekly visits. At each visit, a different test toothbrush was assigned to each group in a cross-over design. Plaque evaluations and brushing procedures were performed as in Visit 1 of the study. In both studies, the Colgate Precision toothbrush was significantly more effective (p < 0.01) than both the Oral-B 40 and Reach Full-Head soft toothbrushes in reducing the whole mouth plaque scores, as well as plaque at the gumline and at interproximal areas. The Oral-B 40 and Reach toothbrushes were not significantly different from each other with regard to plaque removal.


Clinical studies regarding the plaque removal efficacy of manual toothbrushes. Two independent cross-over design studies were performed to compare two toothbrushes for their ability to remove plaque. In Study I, the Colgate Precision toothbrush was compared to the Oral-B 40 toothbrush; in Study II, the Colgate Precision toothbrush was compared to the Reach Full-Head soft toothbrush. A total of 54 and 72 adult male and female subjects who met the inclusion/exclusion criteria completed Study I and Study II, respectively. In each study, subjects refrained from brushing for 24 hours, and were screened for dental plaque on the facial and lingual surfaces of all natural teeth, using the Rustogi, et al. index. Based on mean scores and number of teeth, qualifying subjects were randomly assigned to one of two groups. Subjects were then scheduled to return one week later, having again abstained from all oral hygiene procedures for a 24-hour period. At this visit, each subject was evaluated for plaque, then brushed with his/her assigned toothbrush for sixty seconds, and was again scored for plaque after brushing. Subjects were instructed to resume their normal routine and return to the clinical site one week later. At this visit, a different test toothbrush was assigned to each group in a cross-over design. Plaque evaluations and toothbrushing procedures were again performed. In both studies, the Colgate Precision toothbrush was significantly more effective (p < 0.01) than either the Oral-B 40 toothbrush or the Reach Full-Head soft toothbrush in reducing whole mouth plaque scores, plaque scores at the gumline, and plaque scores at interproximal areas.


Comparative laboratory evaluation of three toothbrushes regarding interproximal access efficacy. A new toothbrush from the Colgate-Palmolive Company, called the Colgate Precision toothbrush, was compared to the Oral-B 40 toothbrush and Reach Full-Head soft toothbrush using a laboratory device designed to simulate clinical toothbrushing motions and pressures. The toothbrushing time was sixty seconds for each vertical or horizontal brushing motion and for each of the three brushing weights tested, 250, 500 or 750 grams. Interproximal access efficacy was determined by measuring the maximum width of the brushing stroke measured on pressure sensitive paper placed around the simulated anterior or posterior teeth. Twenty-four toothbrushes of each design were evaluated for each toothbrushing motion, tooth shape and toothbrushing weight for a total of 864 measurements. In all studies conducted, the Colgate Precision toothbrush had statistically superior total interproximal access efficacy scores compared to the Oral-B and Reach toothbrushes. In several assessments the Reach toothbrush was superior to the Oral-B 40 toothbrush.


Refinement of the Modified Navy Plaque Index to increase plaque scoring efficiency in gumline and interproximal tooth areas. To improve the assessment of plaque present on teeth, a new index, based on the original Modified Navy Plaque Index, has been developed. The primary modifications to the original Modified Navy Plaque Index were: (1) extending areas F (distal) and D (mesial) into the region just below the interproximal contact point, and (2) extending areas C and A so as to increase the gumline (or marginal gingiva) region. The new index assesses the amount of plaque in the tooth area bounded by the tooth contact, the free gingival margin, and mesial or distal line angles. The use of this new index enables the examiner to evaluate and record both the gumline (or marginal areas) and interproximal areas of the tooth, thus giving these an anatomical areas an increased importance. A pilot clinical assessment study was conducted to utilize this new index in evaluating the plaque removal efficacy of five manual toothbrushes. The results from this pilot study indicated that, when the new plaque scoring index was used, significant differences between pre-toothbrushing and post-toothbrushing plaque scores (as well as among toothbrush groups) could be demonstrated. Further, these differences (plaque removal efficacy) were demonstrated on an interproximal (mesial and distal) basis and a gumline (or gingival margin) basis, as well as on a whole mouth basis.


Effect of fluoridated milk on caries: 10-year results. The aim of the study was to assess the caries-preventive effect of fluoridated milk after 10 years of consumption, including a two-year interruption. DMF mean values of 162 institutionalized children aged 7- to 14-years were compared to DMF mean values of 139 institutionalized children (control) of the same age. The test group children consumed 200 ml milk daily, implemented with 0.4 mg-to 0.75 mg F, depending on their age, continuously for six years. Following a two year interruption, the children again got fluoridated milk or cocoa-milk twice a week for four years. In the test group the average ratio of caries-free children was 10% more than in the control group. The caries prevalence in the permanent dentition showed a clinically and statistically significant reduction: 36.78% on DMFT, and 40.02% on DMFS mean values.


Thirty-day evaluation of the Stimu-gum gingival stimulator and tooth polisher for clinical safety and efficacy. Two clinical studies have been performed to assess the intraoral safety and efficacy of a mechanical device containing a rubber cup polisher and interdental stimulator (Stimu-gum). In the first study the potential for producing irritation of the oral mucosal tissues was evaluated in 19 subjects when the Stimu-gum product was used in an exaggerated manner, i.e., five times a day for seven days. No untoward effects attributed to use of the Stimu-gum product were observed or reported at anytime in the study. A thirty-day study on 64 subjects compared the Stimu-gum device with an Oral-B 35 manual toothbrush for safety, plaque removal and gingivitis evaluations, at baseline and after 15 and 30 days of product use. The Stimu-gum product and the Oral-B toothbrush were equally effective in removing overnight plaque. The Stimu-gum device was significantly more effective than the Oral-B toothbrush in reducing gingivitis scores at 30 days and bleeding on probing at 15 days. Bleeding on probing scores continued to be lower in the Stimu-gum group at 30 days; however, differences were not statistically significant compared to the Oral-B mean scores.


The clinical effect of a dentifrice containing triclosan and a copolymer in a sodium fluoride/silica base on plaque formation and gingivitis: a six-month clinical study. A six-month, double-blind clinical study was entered into by three hundred twenty-five (325) male and female adult subjects to assess the efficacy of a dentifrice containing 0.3% triclosan (Irgacare MP, Ciba-Geigy Corp.) and 2.0% of a copolymer of methoxyethylene and maleic acid (Gantrez, ISP Corp.) on supragingival plaque formation and gingivitis, compared to a placebo dentifrice over a six-month period. Each dentifrice, the triclosan and the placebo, contained 0.243% sodium fluoride in a silica base. Only those subjects who were free of periodontal disease (no pockets > 4 mm), demonstrated a level of at least mild gingivitis (modified Loe-Silness score > or = 1.0) and had a modified Quigley-Hein Plaque Index score of > or = 1.5 were admitted into the study. Baseline plaque and gingivitis scores were used to stratify the subjects into two balanced groups. A thorough oral prophylaxis was administered to all subjects. They were then assigned either the triclosan/copolymer dentifrice or the placebo dentifrice to use for the next six months. Evaluation for gingivitis and supragingival plaque formation was made after three and six months. Evaluations made after six (6) months demonstrated a 17.0% statistically significant (at the 99% level of confidence) reduction in supragingival plaque formation was provided by the triclosan/copolymer dentifrice, compared to the placebo dentifrice. An 18.6% statistically significant (at the 99% level of confidence) reduction in plaque formation on the tooth surfaces with the highest plaque formation was provided by the triclosan/copolymer dentifrice, compared to the placebo dentifrice.(ABSTRACT TRUNCATED AT 250 WORDS)


Characterization of volatile sulphur compounds production at individual gingival crevicular sites in humans. The present investigation describes a method for collection and analysis of volatile sulphur compounds (VSC) from gingival crevicular sites in humans. Tenax-GC trapping devices were used to adsorb and concentrate VSC from crevicular air at -55 degrees C, which were then thermally desorbed at 120 degrees C. Gas chromatographic (GC) analyses were performed using a Tracor 550 GC equipped with a flame-photometric detector and a Teflon column packed with 5% polyphenyl ether and 0.05% phosphoric acid on 30-40 mesh Teflon. Sulfides identified from crevicular sites include hydrogen sulfide [H2S], methyl mercaptan [CH3SH], dimethyl sulfide [(CH3)2S], and dimethyl disulfide [(CH3S)2]. Of the seventeen patients studied, crevicular sites that were either deep (P.D. > or = 4 mm) or inflamed (BoP = 1) exhibited significantly larger CH3SH to H2S ratios than corresponding crevicular shallow (P.D. < or = 3 mm) sites (p < .10) or noninflamed (BoP = 0) sites (p < .05). Similarly, total sulphur in deep and inflamed sites was significantly higher than in corresponding shallow (p < .01) and noninflamed (p < .05) sites. This is the first known in vivo study to quantitate VSC directly from individual gingival crevices.


The interleukin network and lymphoid development. Lymphoid development differs sharply between the primary and secondary lymphoid organs. In the former, lymphocytes arise from precursors by antigen-independent processes under thymic or bone marrow microenvironmental influences and undergo extensive selective processes before being allowed to leave. In the latter, lymphocytes with receptors relevant to particular antigens undergo a second wave of proliferation and differentiation leading to the emergence of immunocytes with effector functions. Each of the two sets of events are profoundly dependent on cellular interactions. In the primary lymphoid organs, the "action" centres on stromal cell-lymphoid precursor interactions, and artificial systems permitting B cell formation are much more advanced than those for T cell development. For B cells, IL-7 and c-kit ligand (KL) are clearly important but so are as yet undefined stromal cell-derived activities. For thymic development, only fragments of the complex 3-week process of T cell formation can be mimicked in vitro and no IL has unequivocally been shown to be critical. Within the secondary lymphoid organs, where lymphocytes react to the antigenic universe, the key to regulation lies in interactions between accessory cells (dendritic cells, macrophages and their various relatives) T cells and B cells. Efforts to squeeze the relevant cytokines into sharp compartments such as activation factors, growth factors and differentiation factors have been largely unsuccessful.(ABSTRACT TRUNCATED AT 250 WORDS)