[Blunted growth hormone response to hGRF 1-29 NH2 in patients with non-insulin-dependent diabetes mellitus]. Basal serum growth hormone and response of GH to GRF in 10 patients with noninsulin-dependent diabetes and in 10 control subjects were studied. The basal GH level in NIDDM was higher than that in control subjects. There was a significant difference. After an intravenous bolus of hGRF 1-29 NH2 with the dose of 1 microgram/kg body weight, GH (Peak level-basal level) decreased in NIDDM patients in comparing with control group (P < 0.05). These findings may suggest that the pituitary GH reserve is reduced in patients with NIDDM. There exists some defect in central GH control in diabetics with enhanced somatostatin secretion and abnormal sensitivity of the GH secretion cells to a variety of regulatory factors including GRF, glucose, amino-acids, free fat acid.


[Continuous albendazole therapy in alveolar echinococcosis--evaluation of therapeutic effect with computerized tomography and ultrasonography]. Fifteen cases of alveolar echinococcosis were treated with albendazole in a dosage of 20 mg/kg/d x 30 days for 12-60 courses (25.8 courses in average) and were followed up 1-7 years (48 months in average) with computerized tomography and ultrasonography. Abdominal pain in all the cases, jaundice in 4 and hemoptysis in disappeared 2. In 13 of the 15 cases, the hepatic lesions reduced in size. Among 9 cases examined with computerized tomography, the hepatic lesions were completely calcified in 5 and enclosed with calcified walls in 3. Only one patient with huge and extensive hepatic lesions showed no apparent improvement. No severe adverse reaction was observed. Evidently albendazole was effective in the treatment of alveolar echinococcosis.


[Immunohistochemical localization and serum testing for ferritin in malignant histiocytosis]. Localization of ferritin with immunohistochemical staining was carried out in thirty six cases of malignant histiocytosis (MH). The positivity rate for ferritin was 100 per cent. Ferritin was found to exist in the cytoplasm of the tumor cells. Image analysis showed that ferritin level in the well-differentiated histiocytes (1.2314) was higher than that in the atypical histiocytes (0.7181) (P < 0.01). Ten MH patients showed surprising high serum ferritin concentration (1482.3 ng/ml) than that in normal. Our data suggest that ferritin is the tumor associated antigen in MH. The synthesis and release of ferritin by MH tumor cells is the important cause for the high concentration of serum ferritin in patients.


[Observation of prosthesis movement after implantation of the bipolar artificial femoral head]. The follow-up results of the movement of two components of hip prosthesis in 30 cases at different times after implantation of bipolar artificial femoral head were reported in this paper. It was demonstrated that the motion at both bearing surfaces in all cases was present 3 months-3 years after operation, and the motion range was not reduced with time. Therefore, the movement of bipolar artificial femoral head could be maintained within at least 3 years after implantation.


[Complications caused by artificial hinge knee joint]. Artificial hinge knee joint was used in 25 patients with bone tumors around the knee joint. 23 patients were followed on the average for 3 years and 3 months. Complication was noted in 10 patients including infection in 7 (5 short-term, 2 long-term), broken joint in 1 patient and loosening in 2. The causes for complication and counter-measures were discussed.


[An experimental study of the process of bony ingrowth into inorganic bone-particle impregnated bone cement]. A composite of inorganic bone particles formed with bone cement in certain proportion was implanted in the proximal femora of 15 New Zealand rabbits. The animals were sacrificed in batches at different intervals after implantation and specimens were sectioned for scanning electron microscopic (SEM) observation and push-out test. SEM showed that the bone particles in the composite were in contact with each other and forming bony pathways. The gaps between inorganic bone particle bone cement and cortical bone were filled at first with collagen fibrils which were interwoven to form collagen fiber bundles and then mineralized to assume woven bone. The bone particles became smaller in size and were enveloped, absorbed and replaced by new bone structure gradually reaching the depth of bone cement along the pathways formed by bone particles. The shear strength of the cement-bone interface was increased subsequently.


[The biological fixation strength of the bone particle impregnated bone cement]. This article reports the result of the comparative study on the biological fixation strength of two kinds of bone particle impregnated bone cement. Organic and inorganic bone particle impregnated bone cement were implanted into alternative side of the upper femurs of New Zealand rabbits. The cancellous bone and cortical bone segments of the implanted femurs removed at intervals of 1, 2 and 3 months after operation were subjected to push-out test. In cancellous bone segment, shearing strength of cement-bone interface was increased gradually, but no significant difference between these two kinds of cement after 3 months operation. In cortical bone segment, the interface shearing strength was lower than that of the cancellous bone, but it increased rapidly from 1 month, especially for the organic bone particle bone cement, after 3 months operation the interface shearing strength had a significant difference between the two kinds of cement. More prominent biological fixation effect showed in the organic bone particle group.


[Influence of vacuum mixing on mechanical properties of homemade bone cement]. Porosity, density and rotating bar bending fatigue life of homemade bone cement are analyzed with scanning electron microscopy for two different mixing techniques: manually vacuum mixing and manually non-vacuum mixing. By vacuum mixing the rotating bar bending fatigue life is increased from 0.98 x 10(4) +/- 0.31 x 10(4) to 1.33 x 10(4) +/- 0.17 x 10(4) (P < 0.05), density increased from 1.0638 +/- 0.0005g/cm3 to 1.1024 +/- 0.0068g/cm3 (P < 0.05), porosity reduced from 10.35% +/- 2.33% to 5.83% +/- 1.74% (P < 0.05), and incidence rate of big air inclusion reduced from 5.93% to 0.9%. We believe, vacuum mixing technique of bone cement should be recommended as a routine procedure to prevent aseptic loosening of prosthesis after total joint arthroplasty.


[The filling of bone-implant gaps with autograft, allograft/autologous red marrow and BMP/collagen in animal experiment]. In order to compare the abilities of autograft, allograft/autologous red marrow and bBMP/collagen of promoting ingrowth of bone in a gaped interface of bone/implant, 18 rabbits were used and randomly divided into 2 groups. Specimens were harvested at 2, 4, and 6 weeks. Undecalcified sections were examined with fluorescent microscopy, microradioscopy and analyzed with computer. The results implied: bone ingrowth occurred in all groups except in control group after 6 weeks. The percentage of porous layer occupied by bone in defects was statistically higher in BMP/Col specimens of 4 weeks (P < 0.05). There was no significant difference among the three experimental groups 6 weeks after implantation.


[Prevention and treatment of complications after portoazygous disconnection for portal hypertension]. From 1978 to 1990, 35 complications were encountered in 203 cases of portoazygous disconnection in our hospital including intra-abdominal hemorrhage, AHF, ARF, ARDS, and gastric or pancreatic fistulae. The mortality rate was 8% with Hassab's operation, and 38% with Sugiura's, respectively. Emergency operation carried with a mortality of 31.1%, Whereas selective operation only 2.5%. 3.2% of all cases in Child's A group succumbed Postoperatively and 62% in Child's C group. The authors discussed the causes of the complications and ways to prevent them.


[Selective vagotomy plus antrectomy and Roux-en-Y gastrojejunostomy in the treatment of duodenal ulcer]. From 1982 to October 1990, 284 patients with duodenal ulcer were surgically treated. Partial gastrectomy and Billroth anastomosis (PGB) were performed in 92 patients, selective vagotomy plus antrectomy and Billroth anastomosis (VAB) in 92, and selective vagotomy plus antrectomy and Roux-en-Y gastrojejunostomy (VARY) in 98. Follow-up showed that VARY was superior in many respects to PGB and VAB such as in decreasing gastric acidity, long-term complications and Visick grading of I and II (P < 0.05). We conclude that VARY can be used in the treatment of duodenal ulcer.


[The release of vasoactive intestinal peptide in patients with dumping syndrome and its clinical significance]. Plasma vasoactive intestinal peptide (VIP), blood glucose concentration and hematocrit (HCT) were measured in 15 patients after Billroth-II subtotal gastrectomy (B-II SG) and 8 healthy controls before and after oral glucose ingestion. In B-II SG group the rate of rise of VIP concentration was in positive correlation to the rate of rise of HCT (r = 0.501 P < 0.05) and to that of blood glucose (r = 0.715 P < 0.01). Also, the elevation rate of HCT blood glucose and VIP concentration was significant higher in B-II SG group than in controls (P < 0.05). It was found that the elevation rate of VIP concentration was much higher in patients with dumping syndrome after B-II SG than those without (P < 0.05). The results suggest that VIP may play a role in the pathogenesis of dumping syndrome.


[Surgical treatment of corrected transposition of great arteries associated with intracardiac anomalies]. From Nov. 1981, to Oct. 1990, 43 patients with corrected transposition of great arteries associated with intracardiac anomalies were operated on in our institute. There were 35 cases with type SLL, and 8 cases with IDD. However, 37 cases were associated with ventricular septal detect (VSD) and pulmonary stenosis (PS) or pulmonary atresia, 2 cases VSD, 2 cases PS, 1 case atrial septal detect and 1 case preexcitation tachycardia. The operative mortality rate was 9.3%. The operative experience demonstrates that for cases with type SLL corrected transposition of great arteries associated with VSD and (or) PS, satisfactory results can be achieved by repairing VSD via right atrium and mitral valve, and as far as pulmonary stenosis is concerned, pulmonary valvotomy or connection of left ventricle and pulmonary artery by using valved conduit can be adopted.


[Autogenous bronchial pedicle flap for tracheoplastic procedures]. Nine cases of large tracheal defect due to resection of tumor or scar were repaired by using autogenous bronchial pedicle flap. The symptoms of airway obstruction rapidly disappeared after operation. The normal part of the right main bronchus and bronchus intermediate was used as material for repair, both lower and middle lobes were preserved in one case, and the lower lobe was preserved in another. We believe that in tracheoplasty with autogenous bronchial flap for large tracheal defect is satisfactory.


[Microvascular anastomosis in replantation of 6 avulsed scalps]. From 1990 to 1991, 6 avulsed scalps (total avulsing in 5, partial avulsing in 1) were replanted successfully. Follow-up for over 6 months showed that the hair of the replanted scalps grew normally in all the 6 patients. We think that the key to successful replantation is to anastomose the vessels effectively. The scalp can survive just with its superficial temporal vessels on both sides and with an artery-vein ratio of 1:1. The management of postoperative complications is discussed.


[Changes of protein turnover in perioperative patients and effect of recombinant human growth hormone]. 15N-Glycine constant infusion method was applied to study the changes of protein metabolism after major abdominal operation and the influence of recombinant human growth hormone (GH). Our results showed: (1) under the support of total parenteral nutrition (30 cal/kg/d and 1.25 g protein/kg/d), the protein turnover rate (Q), synthetic rate (S) and catabolic rate (C) all increased significantly (P < 0.05) with an outstriping increase of C over S on postoperative day 3 in comparison with that on preoperative day 3; (2) with the support of hypocaloric parenteral nutrition (20 cal/kg/d and 1.00 g protein/kg/d), Q, C values also increased significantly (P < 0.05) comparing with that of the control group on post operative day 7 in patients treated with one week GH (0.15 iu/kg/d), but S value increased more significantly (P < 0.01), which indicated that the postoperative use of TPN plus GH is much better than giving TPN alone.


Enantiomers: implications and complications in developmental pharmacology. The majority of synthetic drugs with chiral centers are administered as racemates. Thus chemically, and to an even greater extent biologically, a racemic drug is not a single compound, but a 50:50 mixture of two enantiomeric drugs. No generalization can be made concerning whether and to what extent the activity, in either qualitative or quantitative terms, differs between enantiomers. It is not unusual for the enantiomers of a drug to have a high degree of enantioselectivity for one action but no enantioselectivity for another action. For instance S-propranolol is at least two orders of magnitude more potent than R-propranolol with regard to beta-adrenoceptor antagonism. However, the two enantiomers are equipotent with regard to their membrane stabilizing effect. It is often overlooked that enantioselectivity in the activity of enantiomers as determined in vitro cannot be extrapolated to the in vivo situation since enantioselective drug disposition can lead to an enantiomer ratio in vivo which differs substantially from that in the dosage form administered. Enantioselectivity in drug disposition seems to be the rule rather than the exception and, depending on whether the active or less active enantiomer is preferentially affected, there may be amplification or attenuation of in vivo as compared to the in vitro drug potency.


Expression and release of neuroregulators during development: monoamines and neuropeptides. The turnover of catecholamines (CA) was determined in the adrenal medulla and brain of rat fetuses and pups. In general we found a considerable increase soon after birth. The expression of mRNA for CA-synthesizing enzymes was also considerably enhanced in the adrenals shortly after birth. Furthermore, we demonstrated increased expression of neuropeptides after birth, increased synthesis of mRNA encoding for neuropeptide Y in the adrenals 24 h after birth; and considerable activation of the substance P gene in a respiratory nuclei of rabbit pups which had been breathing for 2 h as compared with fetuses at term.


Hypoxic-ischemic damage in the neonatal brain: excitatory amino acids. Perinatal brain damage is a major clinical problem. Recent studies suggest that excitatory amino acids (EAAs) may be important for the development of hypoxic-ischemic brain injury in the newborn. Experimental work demonstrates that the immature brain is hypersensitive to the toxic effects EAA ('excitotoxicity'), hypoxic-ischemia is accompanied by an extracellular overflow of EAAs and hypoxic-ischemic brain damage is reduced by EAA receptor antagonists. Clinical investigations demonstrate the presence of EAA receptors in vulnerable areas of the newborn human brain and the concentrations of EAAs in the cerebrospinal fluid are higher in asphyxiated than in control infants. Clinical studies are warranted to evaluate the importance of excitotoxicity for development of brain lesions after severe asphyxia.


Cytochrome P450-dependent metabolism of dextromethorphan: fetal and adult studies. Dextromethorphan undergoes O-demethylation to dextrorphan and N-demethylation to 3-methoxymorphinan. 3-Hydroxymorphinan, a didemethylated compound, is secondarily formed. The O-demethylation pathway to dextrorphan is polymorphic and under CYP2D6 genetic control. Adult and fetal studies were performed to characterize the cytochrome P450 families involved in dextromethorphan metabolism and their ontogeny. In adult volunteers in vivo and in vitro studies demonstrate that the O-demethylation pathway to dextrorphan is dependent on CYP2D6 and is predominant in extensive metabolizers and defective in poor metabolizers of the drug. The N-demethylation pathway to 3-methoxymorphinan is accessory and is dependent on the CYP3A subfamily. In human fetal microsomes, CYP2D6 protein and activity are not detectable until birth, while CYP2D6 RNA is present in significant amounts before birth. CYP3A activity is detectable in large amounts as early as the 17th week of gestation. Fetal and adult members of the CYP3A subfamily have close, although different, properties, as demonstrated by immunoinhibition studies.


Studies on developmental neurology in the human fetus. The development of the motor component of the embryonic and fetal central nervous system can be studied by observation of fetal movements, using real-time ultrasound. In this paper data on emergence and development of fetal movement patterns and behavioural states are reviewed in the light of the normal development of the nervous system, identification of disturbances in normal development and testing behavioural teratogenicity in the human.


Thrombocyte monoamine oxidase activity and behavior deviances in adolescence. The frequencies of patients with low thrombocyte monoamine oxidase (MAO) activity (defined as having an activity lower than 1 SD below the mean of a respective control group) were studied in 100 consecutive cases admitted to a clinic for child and youth psychiatry. 41 boys and 26 girls (group I) had behavior disorders, attention deficit disorders and/or alcohol and hashish abuse according to DSM III R. 16 boys and 17 girls had other diagnoses (group II). None of the 2 male patient groups differed significantly from the controls. A significantly higher percentage of the girls in group I had low activity of platelet MAO than in the control group (p = 0.015), while the girls in group II did not differ from the controls. Acting out, antisocial behavior and abuse is less accepted in women than in men. Therefore, the girls in the present study might be either more psychiatrically disturbed or have more deviant personalities than the boys, which might explain why our hypothesis about a lower thrombocyte MAO activity in the adolescents with externalizing symptoms (group I) was verified only in the girls.


Developmental aspects of the monoamine-degrading enzyme monoamine oxidase. In the rat heart, monoamine oxidase (MAO)-B activity was shown to predominate in 2- to 3-week-old animals, whereas MAO-A activity was reported to be very low in newborn rats and to increase considerably with age until it predominates. These results are in contrast with those found in the mouse heart, where an age-dependent increase in MAO-B activity with no changes in 5-hydroxytryptamine deaminating activity was found to occur. There is evidence that the adult values of MAO activity are reached early in development in rat kidney and liver. In the rat lung the adult values of MAO-A activity are reached by day 40, whereas MAO-B activity is still increasing by day 80. Important differences have been reported in the developmental pattern of the two forms of MAO in the rat and mouse brain, with a decrease in the MAO-A/MAO-B ratio during postnatal development. In the human brain, the ontogenetic development of MAO-A and MAO-B appears to parallel that observed in the rodent brain. It is worth noting that most of the available data have to be considered with reservation owing to many methodological problems. Further studies are clearly needed to get reliable information on the ontogenesis of MAO in mammalian tissues.


Functional changes implicating dopaminergic systems following perinatal treatments. A series of experiments, involving diverse perinatal treatments of either rats or mice, have been performed in order to investigate the effects of these treatments upon certain selected spontaneous and learned behaviors in the laboratory. Rat dams were administered either metallic mercury, organic tin or neuroleptic compounds, and the offspring of these dams was studied with behavioral tests at adult ages, prenatal studies. Newborn rat pups were administered either 6-hydroxydopamine (6-OHDA) (at various doses), or metallic mercury and then tested at adult ages. Newborn mice were administered either metaclopramide, an antiemetic compound, or haloperidol, a neuroleptic compound, and tested for spontaneous and d-amphetamine induced activity as adults. The behavioral battery the rats were tested with consisted of measures of spontaneous motor activity, including locomotion/ambulation, rearing, and head dipping behaviors, and a parameter under which diverse behaviors were collected, total activity. Alterations to instrumental maze learning performance were studied through application of the spatial learning tasks: the radial arm maze and the circular swim maze. Possible changes in dopaminergic pathways were assessed by measuring the effects of perinatal treatments upon d-amphetamine-induced activity. It was shown that prenatal metallic mercury, organic tin and the neuroleptic compounds, haloperidol and remoxipride altered various parameters of spontaneous motor activity, retarded maze learning in the radial arm maze and potentiated d-amphetamine-induced activity. Metallic mercury rats were not subjected to the amphetamine test and remoxipride rats were not retarded according to the learning task. Postnatal metallic mercury, 6-OHDA, haloperidol and the antiemetic compound, metaclopramide, also altered spontaneous and d-amphetamine-induced activity as well as radial arm maze performance, excluding in this case haloperidol and metaclopramide. None of these treatments altered performance in the circular swim maze, except for 6-OHDA where doses inflicting severe depletions (greater than 85% depletion compared to control values) caused notable impairments. One tentative conclusion from the pattern of behavioral changes, generally in the absence of any measurable neurochemical changes, observed after these treatments is that the functional development of dopaminergic systems had, to a greater or lesser degree, been altered.


Priming as a model of behavioural sensitization. Repeated exposure to drugs acting as direct or indirect stimulants of central dopamine transmission results in sensitization to their behavioural stimulant properties (behavioural sensitization). Priming provides a simple model of behavioural sensitization particularly suitable for studies of its neural and molecular mechanisms. The results obtained to date indicate that priming results in an increased responsiveness of postsynaptic dopamine receptor mechanisms in the caudate nucleus, possibly due to an increased affinity of the D-1 receptor for its agonist.


Biological markers of intrauterine exposure to cocaine and cigarette smoking. We describe hair tests for assessment of fetal exposure to cocaine and cigarette smoking. Cocaine and its major metabolites are incorporated into hair during the growth of the shaft and stay there for the whole life of the hair. Cocaine crosses the placenta and its metabolite benzoylecgonine, has been found in neonatal urine, meconium and hair. In order to utilize hair measurements of cocaine as a biological marker of systemic exposure, we conducted both animal and human investigations on the dose response characteristics of this phenomenon. Our data suggest that both maternal and fetal accumulation of cocaine and its metabolite follow a linear pattern within the regularly used doses. Similarly, a good correlation was observed in animals between maternal dose and fetal hair accumulation. To date, no biological markers have been identified that can predict the extent of fetal exposure to the adverse effects of toxic constituents of cigarette smoke. We measured maternal and fetal hair concentrations of nicotine and cotinine in mother-infant pairs. Smoking mothers had a mean of 21.3 +/- 18 ng/mg hair nicotine and 6 +/- 9.2 ng/mg of cotinine, significantly more than nonsmokers (0.9 +/- 0.8 ng/mg nicotine and 0.3 +/- 0.5 ng/mg cotinine, p < 0.0001). Babies of smokers had a mean nicotine concentration of 6 +/- 9.2 ng/mg (range 0-27.3) and cotinine of 2.1 +/- 3.7 ng/mg (range 0-12.2), significantly more than babies of nonsmokers (nicotine 0.6 +/- 0.7 ng/mg and cotinine 0.2 +/- 0.5 ng/mg; p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)


[Systolic hypertension in the elderly: Chinese trial (syst-China). Interim report]. Two thousand and seventy-one elderly isolated systolic hypertensive patients entered the multicenter, randomized, double-blind, placebo-controlled clinical trial (997 in the active treatment group and 1,074 in the placebo). The differences of age, height, weight, sex constituent and baseline blood pressure between active treatment and placebo groups yielded no significances. In the 30-month follow-up period, the systolic and diastolic blood pressure in the active treatment were lower than the placebo group (P < 0.05) since the third month of the trial; the side effects were mild and the compliance of the participants was good (97% of the participants in the active treatment was taking medicine punctually during follow-up period; and 96% of the participants in the placebo group did so as well). The average morbidity of isolated systolic hypertension in our country was 8.10%, and the morbidity in female was higher than that in male, based upon the results of our trial. The present trial is in progress and the final results will not be reported until the end of the trial.


[The effects of nitrendipine on the quality of life in the elderly patients with isolated systolic hypertension (ISH)]. By case-control study, we investigated the effects of nitrendipine on the quality of life in 100 patients who were participating in Chinese Trial of randomized double-blind systolic hypertension in the elderly. The results showed that the patients group had lower scores of quality of life than the matched normotensives (P < 0.05-P < 0.01). After 40-week treatment period, the active treatment group (45 patients) had satisfied blood-pressure control and improved physical symptoms. As compared with the active group, however, the control group (42 patients) scored significantly higher on physical symptoms (P < 0.05-P < 0.01), fewer on memory, vatality, vision, well-being and social activity (P < 0.05-P < 0.01). Our findings show that nitrendipine had some positive effects on the quality of life in the elderly patients with isolated systolic hypertension (ISH) and these can be meaningfully assessed with available psychosocial measures.


[Circadian blood pressure rhythm and its characterization in isolated systolic hypertension (ISH)]. Twenty-four-hour noninvasive ambulatory blood pressure (ABP) was performed in 131 consecutive elderly subjects (61 with isolated systolic hypertension, ISH; 19 with mixed/diastolic hypertension, MDH; 29 with borderline hypertension, BLH; 23 in the normotensive group, NT). It was found that in ISH blood pressure rised during awaking period and fell during sleeping period (P < 0.05); the circadian systolic blood pressure rhythm was similar to ones in MDH, BLH and NT. However, the circadian diastolic blood pressure rhythm was attenuated in ISH. We conclude that circadian blood pressure rhythm alters in ISH, which may be related to the ischemia in organs, especially cerebral ischemia.


[A prospective study on the effect of nifedipine of the cardiovascular complications in the elderly hypertensives]. The purpose of this single-blind, placebo-controlled trial was to assess whether long-term treatment with nifedipine can have a beneficial preventive effect on the cardiovascular complications in the elderly hypertensives. Randomization took place in 11 clinical centers between July 1987 and June 1988, and involved 1,666 patients, 60-70 years of age. 912 participants were assigned to nifedipine (N group) and 754 to placebo (P group). Follow-up time for each participant was taken as the time from randomization to either the study events or June 1990, with an average of 30 months (27-36 months). The results showed that the cumulative rates for all cardiovascular study events in the N group were significantly lower than that in the P group at 18 months (chi 2 = 5.278, P < 0.05), and the cumulative rates for stroke in the N group was significantly decreased at 24 months (chi 2 = 4.612, P < 0.05), at 27 months, 16.00% and 36.91% (chi 2 = 5.080, P < 0.05), respectively for the N and the P groups. The incidence of stroke in the N group was decreased by 57% within 2.5 years, but cardiac events were not significantly lowered (14%, P > 0.05) in comparison with the P group. The benefits of treatment in the trial seemed to depend on age at entry and were more obvious in male than in female patients.


[X syndrome--report of six cases].

[X syndrome--report of six cases]. Six patients (2 males and 4 females, mean age of 46 years) with X syndrome were reported in this paper. All patients presented with typical exertional angina pectoris. In 4 patients the angina had a variable threshold of onset, it often occurred at rest and occasionally nocturnally. The electrocardiogram during chest pain showed ST segment depression of more than 0.05-0.1 mV in all 6 patients. The treadmill or bicycle ergometer exercise test was positive in 4 cases (ST segment depression > 0.1 mV), equivocal in 1 (ST segment < 0.1 mV) in whom the 201Tl exercise myocardial perfusion scan showed sign of ischemia, and negative in 1 in whom atrial pacing at heart rate of 135 beats/min induced angina and ST segment depression of 0.1-0.15 mV. Echocardiograms and X ray chest films revealed no sign of ventricular hypertrophy or enlargement. The 201Tl exercise myocardial perfusion scan was performed in 5 patients, which showed signs of ischemia in 4 patients and suspected to have ischemia in 1. Left ventriculograms and coronary angiograms were normal in all 6 patients. Ergonovine provoking test (total dose of 0.4 mg) was negative in 5 patients, it was not performed in 1 in whom there was no evidence of coronary artery spasm by angiogram during appearance of electrocardiographic ischemic changes and chest pain. Left ventricular endomyocardial biopsy was performed in 1 patient, which showed significant smooth muscle cell proliferation in the medial layer of a small artery with diameter of 62.5 mu which produced narrowing of the lumen.(ABSTRACT TRUNCATED AT 250 WORDS)


[Surgical treatment of atrioventricular septal defect]. From April 1975 through November 1990, 184 patients with atrioventricular canal malformation defect were operated in our institute. Among them, 151 cases were partial form and 33 cases were complete form (including 7 cases associated with tetralogy of Fallot). Total mortality rate was 6.5%. 164 cases had been followed up for 3 months to 15 years. The results showed that 135 cases were in heart function of class I and 29 were in class II. To improve the results of surgical treatment of this cardiac anomaly, we consider the following points important: (1) Pathological anatomy of atrioventricular septal defect must be studied carefully. (2) The method of operation must be improved, including repairing ASD and VSD without damaging the conduction system and obstruction of the outlet of left ventricle, and without insufficiency of mitral valve as well. (3) Operation must be performed strictly according to the indications. (4) More attention must be given to the perioperative management.


[Surgical treatment of mitral prolapse with chordae plasty]. Surgical treatment of 8 cases of anterior mitral leaflet prolapse was reported. Of the 8 cases, chordae elongation was occurred in 2, chordae rupture in 6, and congenital in 6, rheumatic in 2. Chordae reimplanting was performed in 5 cases, chordae shortening in 2, chordae prosthesis with surgical suture in 1, and combined annuloplasty in 7 of the 8 cases. The result of mitral plasty was better in congenital mitral prolapse. Indications of this technique and postoperative management were listed.


[Evaluating active rheumatism with biopsy of the ventricular myocardium]. Endomyocardial biopsy (EMB) specimens obtained from ventricles in 10 patients with rheumatic heart disease were examined under light microscope. The results showed that typical Aschoff bodies and Anitschkow cells were found in 5 cases and Anitschkow cells only in other 2 cases. The positive detecting rate of active rheumatic lesion was 70 per cent. Active rheumatism was suggested clinically in 4 out of 7 cases with positive rheumatic lesions, whereas no clinical active rheumatism was suggested in the remaining three. The present study indicates that the active rheumatism lesions are frequently present in patients with rheumatic heart disease. Among the 3 cases without active rheumatic lesions, clinical active rheumatism was suggested in one, but no active clinical rheumatic evidence in the remaining two. In conclusion, the EMB technique gives limited value in assessing clinical active rheumatism in patients with rheumatic heart disease.


[A study of the antiarrhythmic mechanism of berberine on delayed activation potassium current by voltage clamp]. The effects of berberine (0.1-10 mg/L) on delayed activation potassium current (iK) of canine Purkinje fibers were studied with two-microelectrode voltage clamp technique. Berberine (Ber) significantly reduced the amplitude of iK in concentration-dependent manner. When perfused with 10 mg/L Ber, the amplitude of tail current of the Purkinje fibers decreased immediately and the inhibition rate was 73.6 +/- 4.5% (n = 9, P < 0.001). The inhibition effect of berberine on iK may explain its prolongation effect on action potential duration and its antiarrhythmic action.


[Effect of endogenous estrogen on plasma high density lipoprotein and total hydrosulfuryl group in membrane of erythrocyte in cholesterol-fed rats]. Under a cholesterol load, the effects of endogenous estrogen on plasma high density lipoprotein cholesterol (HDL-C), total hydrosulfuryl (T-SH) group in the membrane of erythrocyte and plasma total cholesterol were observed in female rats with a ovariectomized control group. The results indicate that endogenous estrogen might prevent the rats of atherosclerosis formation by keeping plasma HDL at higher level and increasing in T-SH group in the membrane of erythrocyte, and preventing the increase in total plasma cholesterol.


[Noninvasive estimation of left ventricular relaxation time constant by continuous wave Doppler echocardiography]. In order to develop a new method for estimating left ventricular relaxation time constant (T)noninvasively, continuous wave Doppler echocardiography (CWD) and left heart catheterization (Cath) were performed simultaneously in 25 patients with mitral regurgitation (MR). The MR velocities were recorded by CWD and digitized every 20 ms along the descending limb of the Doppler spectra to obtain the peak rate of decline of pressure gradient (-dPG/dt max) and the instantaneous left ventricular pressure (PO) at the time point of -dPG/dt max. T was then calculated as: T = PO/-dPG/dt max, and compared with T measured from pressure curves by Weiss's method. The result showed that there was a high correlation of T determined by the two techniques (r = 0.94, SEE = 4.36 ms) and there was no significant difference between the two methods. Thus, CWD offers a new and reliable approach to the noninvasive estimation of T in patients with MR.


Electrosurgery in restorative Dentistry: 2. Clinical applications. Electrosurgery techniques have been used in dentistry as an aid to soft tissue management for nearly 60 years. However, it was not until the late 1960s that the principles of electrosurgery were understood and improved equipment became available. Part 1 of the two-part series covered the theory behind using this technique. Part 2 will now discusses the clinical applications.


Prosthetic practice in the National Health Service: 1. Complete dentures. This two part series on the making of dentures in the National Health Service includes useful practical advice for the general practitioner. Part 1 discusses complete dentures, whilst part 2 will cover partial dentures.


Clinical aspects of occlusion: 2. The reorganized approach. This is the second of two articles which aims to familiarize the reader with essential occlusal principles and terminology and to give some guidelines as to which cases are suitable for crown and bridgework. The first article covered occlusal terminology and the conformative approach to crown and bridgework, the second describes the reorganized approach. In both articles, there are illustrated, clinical cases which demonstrate and overcome some of the occlusal problems encountered.


The use of visible light cured periodontal dressing after surgical exposure of palatal canines. A technique is described which utilizes a light-cured periodontal dressing (Barricaid) in conjunction with the surgical exposure of palatally displaced maxillary canines. The procedure is very quick and simple to perform, with some distinct advantages over alternative methods.


Stress and the dental team: a qualitative investigation of the causes of stress in general dental practice. Working closely together in a general dental practice can cause many stresses and inter-personal problems. Results are presented of discussions with groups of dental practitioners, their hygienists and dental surgery assistants, indicating stressors and complaints most common in each group.


Stress and the immune system.

Stress and the immune system. The centuries-old belief that stressed individuals are more susceptible to disease has gained scientific respectability in recent years. A new interdisciplinary science, psychoneuroimmunology (or as it is now more appropriately named, psychoneuroendocrinimmunology) has been born and, judging from the number of articles appearing annually, is thriving. In essence, stressors activate the neuroendocrine axis, which in turn influences the immune system. This is a bidirectional process, since chemicals are released by activated immunological cells which alter the functioning of the endocrine and autocrine nervous systems and influence our behaviour. This article examines these interactions.


Atopic eczema and orthodontic headgear.

Atopic eczema and orthodontic headgear. A case is reported where cutaneous irritation by orthodontic headgear was followed by a localized exacerbation of atopic eczema. It is suggested that care should be exercised when considering fitting such an appliance in an individual who suffers from atopic eczema.


Molecular biology of disorders of sex differentiation. Sexual ambiguity can be a difficult and sometimes confusing diagnostic problem in children. Recent developments in molecular biology have provided the opportunity to analyze the gene responsible for testicular determination, SRY, the androgen receptor gene and the gene encoding the cP450 enzyme specific for 21-hydroxylation, CYP21B, whose defects are responsible for congenital adrenal hyperplasia. Southern-blotting studies and PCR analyses of SRY, androgen receptor and CYP21B genes can be routinely used for the direct diagnosis of gonadal dysgenesis, androgen insensitivity syndromes and congenital adrenal hyperplasia, respectively. In sex-reversed XY females, several de novo mutations or deletions in the SRY gene have been reported. Defects in the human androgen receptor cause a spectrum of defects in male phenotypic sexual development associated with abnormalities in the receptor protein. Analyses of the androgen receptor gene structure have identified the causative mutation in some families: mutations that result in large-scale alterations of the structure of the androgen receptor, mRNA or gene mutations that alter the primary structure of the androgen receptor protein and mutations that alter the level of mRNA. The diversity of clinical phenotypes, apparent in 21-hydroxylase deficiency, is paralleled by a considerable degree of mutational heterogeneity in the CYP21 gene locus. Various changes causing severe 21-hydroxylase deficiency have been reported: point mutations, gene conversions and gene deletions. In conclusion, substantial progress has been made elucidating genetic defects causing sex reversal in XY females, the androgen insensitivity syndrome and congenital adrenal hyperplasia. Molecular genetics can also be applied for carrier identification and prenatal diagnosis.


Prevalence of autoantibodies to endocrine organs in girls with Ullrich-Turner syndrome aged 5-14 years. Endocrine function tests and a broad panel of autoantibodies to endocrine organs were assessed in 77 patients aged 5-14 years with Ullrich-Turner syndrome (UTS), who were included in the German UTS Multicenter Study. None of these patients had abnormal pituitary, thyroid or adrenocortical function, as assessed by the adequate hormone tests. Antibodies to thyroid microsomes were found in 3 of the 77 (3.9%), antibodies to thyroglobulin in 0/77, antibodies to adrenocortical cells in 1/77 (1.3%), gastric parietal cell antibodies in 2/77 (2.6%), and anterior pituitary cell antibodies in 3/77 (3.9%) probands. These prevalences were not significantly higher than those obtained in 154 age- and sex-matched normal control children when 2 control subjects were assigned to each patient with UTS. Our data do not show an increase in serological signs of endocrine autoimmunity in young patients with UTS suggesting that a putative association of these syndromes does not exist from birth and is not usually present in childhood. However, we cannot exclude the possibility that UTS is associated with factors that render these patients more susceptible to endocrine autoimmunity later in life.


GH assessment and three years' hGH therapy in girls with Turner syndrome. Fifteen girls with Turner syndrome (TS) were submitted to GH secretion assessment before undergoing hGH therapy. In the first 9 months, hGH was given at a dose of 0.5 IU/kg/week s.c. daily; afterward, the dose was increased to 1 IU/kg/week s.c. daily. The girls were prepubertal, with a mean (SD) chronological age (CA) of 12.5 (2.6) years, and a mean (SD) bone age of 10.5 (1.8) years. A clonidine stimulation test, 1-29 GHRH test and GH spontaneous nocturnal secretion assessment were performed in all patients. Results showed a variable pattern of GH secretion in 10 patients, in only 2 did we find all values definitely normal, and in 3 we found a total GH deficiency. Height velocity, expressed as standard deviation scores (SDS) for CA according to Turner references, during the first year of treatment increased significantly: 0.36 (1.15) -3.30 (2.87) (p < 0.001), and the increment remained quite unchanged during both the second and third years: 3.16 (2.96) and 2.55 (3.87), respectively (n.s.). Height, expressed in SDS for CA for Turner references, increased significantly throughout the whole period of treatment and reached the highest value at the end of the third year of therapy. GH secretion parameters poorly correlated with pretreatment auxological data or response to treatment. Our long-term study confirms that in TS GH measurement is not useful in indicating hGH therapy or in predicting the response.


Comparison of four computerized models to estimate 24-hour growth hormone secretion in girls with Turner's syndrome. Daily pituitary growth hormone (GH) secretion can be estimated from a 24-hour GH profile by various methods. We have used four methods to assess GH secretion in 36 girls with Turner's syndrome: the method described by Thompson et al., the Pulsar algorithm combined with the method of Hellman et al. and two deconvolution techniques. The number of detected peaks varied considerably among the methods. The mean (+/- SD) total daily secretion per square meter body surface was 0.53 (0.19) U/m2.day by deconvolution, in contrast to 0.31 (0.17) with the Hellman method and 1.06 (0.37) according to Thompson. The differences are explained by different assumptions about the metabolic clearance rate and various methodological aspects. Assuming a degradation rate of 50%, the growth hormone substitution dosage would be 1-2 IU/m2.day in GH-deficient children. The usual dosage in girls with Turner's syndrome is expected to lead to serum GH levels approximately 4 times higher than in the untreated state.


Pulsatility of growth hormone secretion and its relation to growth. 84 short children were submitted to nocturnal spontaneous growth hormone (GH) secretion tests and to provocative insulin-arginine tests. Discrepancies between the GH peak under the provocative test (I-AP) and nocturnal GH maximal peak (PA) and mean concentration (MC) were frequently observed, despite significant statistical correlation between I-AP and PA (r = 0.47; p < 0.02) and between I-AP and MC (r = 0.42; p < 0.02). Night profiles were evaluated by time analysis: 31 fitted a theoretical model, consisting of a cosine function of time (modelizable profiles). Spectral analysis, from Fourier transformation, indicated predominant periods after cluster analysis. The major predominant period in modelizable (n = 9) and in nonmodelizable (n = 28) profiles was close to 180 min and a secondary period was on average 122 min in modelizable (n = 20) and 105 min in nonmodelizable (n = 23) profiles. Two modelizable and two nonmodelizable profiles escaped this classification. The general, auxological and GH secretory status did not differ significantly between patients with modelizable and nonmodelizable profils. Growth velocity correlated with GH mean concentration (r = 0.36; p < 0.001), but not with plasma insulin-like growth factor-I levels nor with any of the pulsatility indices: number of peaks, main period, and pulse height index = mean GH peak/mean GH concentration. The relevance of GH pulsatility to growth is, therefore, unclear in humans.


The capacity to increase GH secretion at puberty reflects the severity of GH deficiency. This study evaluates the effect of the spontaneous pubertal increase in sex steroids on GH secretion in GH-deficient patients. Fifteen patients (10 boys, 5 girls) with idiopathic isolated GH deficiency diagnosed before puberty (GH peak < 8 micrograms/l after 2 arginine insulin stimulation tests) were reevaluated for their GH secretion using the same test after completion of their hGH therapy and puberty. Their ages at diagnosis and at the last evaluation were 8.2 +/- 0.7 (SE) (range 4.9-14.9) and 17.8 +/- 0.3 years (15-23), respectively. The data at diagnosis and at last evaluation showed that (1) the mean height increased from -4 +/- 0.3 to -2.5 +/- 0.3 SD (p < 0.01), (2) the mean GH peak increased from 4.4 +/- 0.3 (1.6-8) to 7.6 +/- 0.8 micrograms/l (2-13.2, p < 0.01); at the last evaluation, 8/15 patients had GH peak > 8 micrograms/l and (3) the mean plasma insulin-like growth factor I increased from 0.28 +/- 0.05 to 0.42 +/- 0.03 U/ml (n = 6, p < 0.05). The mean increase in the GH peak was 3.2 micrograms/l (-3 to 10.6). It was negatively correlated with the degree of growth retardation at diagnosis (r = -0.74, p < 0.005). We conclude that the increase in the GH peak at puberty in patients with GH deficiency reflects the severity of GH deficiency and that a corrective factor of the cutoff number is necessary for the diagnosis of GH deficiency in puberty.


Effect of growth hormone therapy on IGF-I, bone GLA-protein and bone mineral content in short children with and without chronic renal failure. Chronic renal failure (CRF) in the young is complicated by, among other conditions, growth retardation, hyperparathyroidism and uremic osteodystrophy. Many children with CRF are now being treated with growth hormone (GH). Since GH has a direct mitogenic effect on osteoblasts in culture, we studied the effects of GH therapy on osteoblastic activity, such as serum alkaline phosphatase (AP), bone GLA-protein (BGP) and bone mass density (BMD) in poorly growing children with and without CRF. Fifteen (4 girls, 11 boys) healthy children with short stature (SS) and 10 (3 girls, 7 boys) children with end-stage renal failure (CRF) 4.5-12.4 years of age were treated with daily subcutaneous injections of GH in a dose of 0.1-0.125 IU/kg/day for 1 year. IGF-I, BGP and BMD of the spine were determined before and after the year of treatment. During GH therapy, a similar increase in height velocity and IGF-I were noted in SS and CRF groups: 3.8 +/- 0.77 to 8.38 +/- 1.25 (p < 0.001) vs. 4.0 +/- 0.6 to 7.14 +/- 1.3 cm/year (p < 0.001) and 7.8 +/- 2.6 to 21.8 +/- 7.5 (p < 0.01) vs. 7.9 +/- 1.3 to 21.5 +/- 5.6 nmol/l (p < 0.01), respectively. AP increased from 205 +/- 27 to 274 +/- 50 IU/l (p < 0.01) in the SS group but not in CRF patients (223 +/- 58 pre- 218 +/- 51 IU/l post-GH therapy).(ABSTRACT TRUNCATED AT 250 WORDS)


Relationship between resting metabolism and hepatic metabolism: effect of hypothyroidism and 24 hours fasting. In this paper, we have examined the relationship between the changes in the resting metabolic rate (RMR) and the changes in hepatic metabolism induced by hypothyroidism and 24 h fasting. The results show that hypothyroidism induces a significant decrease in RMR, while 24 h fasting reduces RMR in euthyroid but not in hypothyroid rats. We have also measured oxygen consumption in isolated hepatocytes from euthyroid and hypothyroid rats, fed or fasted for 24 h. The results show that hypothyroidism is characterized by reduced hepatic oxygen consumption. On the other hand, 24 h fasting induces an increase in oxygen consumption in both euthyroid and hypothyroid rat liver cells, although the respiratory rates of hypothyroid rats were lower than those of euthyroid rats. The above findings, as a whole, show that hypothyroidism and 24 h fasting have similar effects on RMR but opposite effects on hepatic metabolism. In addition, a normal thyroid state does not appear to be necessary for the observed changes in hepatic metabolism due to 24 h fasting.


Effects of tartrate thyrotropin-releasing hormone treatment on serum thyrotropin, free triiodothyronine, free thyroxine and prolactin levels in patients with spinocerebellar degeneration. The aim of the present study was to investigate the pituitary-thyroid axis function during the long-term (30 days) intramuscular administration of 4 mg/day of thyrotropin-releasing hormone tartrate (TRH-T) in 15 patients with spinocerebellar degeneration. The study was performed as follows: (1) acute 4 mg TRH-T test with hourly prolactin (PRL) and thyroid-stimulating hormone (TSH) level evaluations for 6 h; (2) placebo; and (3) 4 mg/day of TRH-T administration for 30 days with TSH, PRL, and free T3 and T4 (FT3 and FT4) levels evaluated on days 1, 15 and 30. Hormone determination was performed just before and 1 h after placebo or TRH-T administration. The acute administration of TRH-T caused a sustained rise of TSH which lasted until the 6th hour and of PRL which declined after 1 h (p < 0.01). During placebo administration, no change of TSH, PRL, FT3 or FT4 was observed. On the 1st day of treatment, 1 h after the TRH-T injection, a significant increase of both TSH and PRL levels occurred (p < 0.01). As compared to the 1st day, a significant decrease of the TSH (p < 0.01) levels occurred on the 15th and 30th days before TRH-T: the TSH response to TRH-T administration was present although less than on the 1st day (p < 0.01). Moreover, throughout the whole period of treatment, no difference was recorded for PRL levels before or after TRH-T administration.(ABSTRACT TRUNCATED AT 250 WORDS)


Prolactin isoforms secreted by human prolactinomas. Prolactin (hPRL) secreted by human prolactinoma cells in culture was purified by gel filtration, lectin affinity chromatography and gel electrophoresis in order to identify the different isoforms of the hormone and to test their respective immunoreactivities and bioactivities. The nonglycosylated hPRL (NG-hPRL), unbound to lectins, was the major form and was a species (NG1-hPRL), of 23,000 (M(r)) apparent molecular weight. The lectin-bound glycosylated hPRL (G-hPRL) consisted of three forms, G1-, G2- and G3-hPRL, of identical molecular weights (25,000 M(r)). Endoglycosidase treatment indicated that these three forms differed by the heterogeneity of their carbohydrate chains. These G-PRLs proved to be 68% less immunoreactive and 50% less bioactive than NG-hPRL. It is concluded from these data that, in prolactinomas, the main variant of the hormone is the nonglycosylated form of PRL.


Reduced number and LH content of marginated secretory granules in pituitary gonadotropes of streptozocin-induced diabetic male rats. The transport of secretory granules towards the subplasmalemmal (SPL) region of the luteinizing-hormone (LH) gonadotrope is controlled by the LH-releasing-hormone-dependent pathway. The SPL granules contain the most readily releasable LH. To test the effect of diabetes on both the number and LH content of marginated granules, we studied by indirect immunogold-labelling pituitaries from control and streptozocin (STZ)-treated male rats. On electron micrographs we measured the areas of the gonadotrope nucleus and cytoplasm, counted all secretory granules, and counted and measured secretory granules in selected SPL regions. Furthermore, we counted gold particles (IG) on (a) the secretory granules of the SPL regions, (b) the intergranular SPL cytoplasm and (c) the region outside the cell. Finally, in order to evaluate possible diabetes-related changes of the pituicyte cytoskeleton, we measured by densitometry actin, tubulin, vimentin, and desmin in immunocytochemically stained pituitary sections. In diabetic compared with control cells of the studied pituitary region, we observed: (a) cytoplasmic atrophy; (b) the number of secretory granules per unit area increased in the total cytoplasm, and decreased in the SPL cytoplasm (lowered regulated secretion); (c) decreased IG labelling in the SPL granules (reduced amount of hormone transported by each granule towards the cell membrane); (d) decreased IG labelling in the integranular SPL cytoplasm (reduced constitutive secretion), and (e) strongly increased actin and desmin, yet unchanged tubulin and vimentin immunoreactivity. Our data indicate that both regulated and constitutive secretion are possibly reduced in gonadotropes of diabetic male rats. The cytoskeletal alterations may also contribute to the reduced regulated secretion.


Serum concentrations of ethinylestradiol, 3-keto-desogestrel, SHBG, CBG and gonadotropins during treatment with a biphasic oral contraceptive containing desogestrel. During a cross-over study, the pharmacokinetics of ethinylestradiol (EE) and 3-keto-desogestrel (KDG) were investigated on days 7 and 22 of one cycle of treatment with two biphasic formulations containing 50 micrograms EE (7 tablets) and 50 micrograms EE + 125 micrograms desogestrel (DG) (15 tablets) (50/50 EE) or 40 micrograms EE + 25 micrograms DG (7 tablets) and 30 micrograms EE + 125 micrograms DG (15 tablets) (40/30 EE). Peak serum levels and areas under the curve of EE increased significantly by 50% between days 7 and 22 of those taking 50/50 EE, while during treatment with 40/30 EE, no difference was found between days 7 and 22. Both formulations caused identical KDG levels on day 22. There were only slight differences in the effects of both preparations on sex-hormone-binding globulin (SHBG; +150 to +160%) and on corticosteroid-binding globulin (CBG; +130 to +150%) on day 7. On day 22, the changes were more pronounced with 50/50 EE (SHBG, +310%; CBG, +240%) than with 40/30 EE (SHBG, +250%; CBG, +180%). On day 22 after discontinuation of treatment, the SHBG and CBG levels were still significantly above the control values. Using both formulations, LH and FSH levels were significantly suppressed on day 22, while on day 7 no significant reduction was observed. The rise in the EE levels between days 7 and 22 of 50/50 EE intake and the time course of the EE concentrations during treatment with 40/30 EE appear to be due to an inhibition of hepatic metabolism by the contraceptive steroids, as EE is nearly exclusively bound to albumin which does not change.


Usefulness of CV 205-502 in a case of allergy to ergot-derived drugs. This study reports a case of allergy to ergot-derived drugs in a patient with a prolactin (PRL)-secreting microadenoma. The anamnesis revealed allergic reactions to the administration of analgesics and antibiotics. The administration of dopamine agonist drugs, such as bromocriptine (BRC; 2.5 mg) or lisuride (0.2 mg), induced after a few minutes the appearance of nausea, vomiting, postural hypotension, headache, edema of the glottis with dispnea and acroedema. The edemas disappeared a few hours after the administration of antihistaminic drugs while nausea, vomiting, postural hypotension and headache persisted for a few days. Therefore, the patient was tested with another dopamine agonist non-ergot-derived drug, quinagolide (CV 205-502), which did not cause side effects or allergic reactions. Furthermore, not only was the responsiveness to the drug optimal but it also normalized the PRL levels, and menses reappeared after more than a 5-year amenorrhea. This report suggests that ergot-derived drugs, such as lisuride and BRC, seldom induce allergic reactions apart from common side effects. Consequently, the feasibility of using a new drug with a different molecular structure (non-ergot derived) effective in the therapy of hyperprolactinemic syndromes represents a good alternative to conventional therapy.


A comparison of leakage of filling materials in demineralized and non-demineralized resected root ends under vacuum and non-vacuum conditions. A study was conducted to compare the marginal apical leakage of root-end filling materials under vacuum and non-vacuum conditions, and to assess the effect of demineralization by application of citric acid to the root ends on the apical marginal leakage of root end filling materials. The root canals of 148 extracted human canines and premolars were handfiled and sealed with gutta-percha and Roth's 801 sealer using cold lateral condensation. The teeth were divided into 8 groups that received retrofilling materials. The materials tested were amalgam, IRM and gutta-percha/sealer with and without successive application of citric acid. Half of the specimens were placed under vacuum conditions in methylene blue dye, and the other half were placed in the dye for the same time period without exhausting air from the flask. The teeth were split longitudinally and the extent of dye penetration was determined with a stereomicroscope and eyepiece micrometer. The most evident difference in dye penetration was found between the positive control groups. Under vacuum conditions, the positive controls showed complete penetration of the unobturated canal system with dye. With passive immersion only partial penetration of the unobturated canal system occurred. Application of citric acid to the root end did not adversely affect the seal of amalgam, IRM or gutta-percha/sealer.


Comparison of three imaging techniques for assessing endodontic working length. The accuracy of endodontic working length estimation was investigated using three imaging techniques: radiography (Rd), Xeroradiography (Xr) and Radiovisiography (RVG positive and negative prints). An in-vitro model of extracted single straight roots, mounted in wooden blocks with wax, was employed in the study. Optimum exposures were established for each of the imaging techniques. The magnification of the images was measured and the resolution of the RVG images was also investigated. Comparable Rd (D-speed film), Xr,RVG positive and RVG negative images were made of five roots with size 10 files in situ. Images of 10 standard files were made, ranging from 2.0 mm through the root apex to 2.5 mm short of the apex, resulting in 200 images. Six observers each assessed the working distance on 100 images, measuring the distance from the apical foramen to the file tip. After allowing for the magnification of the images, these results were compared with the 'true' file tip to apical foramen (measured with the aid of a reflex microscope). The inaccuracy of working distance estimations was considered to be of clinical significance (> 0.5 mm) in 6% of measurements made from Rd and Xr, 19.2% of measurements from RVG negative and 32.3% from RVG positive images. In addition, 14% of RVG images were too poorly defined to be assessed. The first-generation RVG system was used in this study. It was therefore concluded that the most accurate estimates of working distance were made from Xr and Rd images, and that RVG images, particularly the RVG positive images, were the least accurate and most difficult to read.(ABSTRACT TRUNCATED AT 250 WORDS)


Scanning electron microscopic study of the apical dentine surfaces lased with ND:YAG laser following apicectomy and retrofill. The purpose of this investigation was to study the effects of a Nd:YAG laser on the cut surface of teeth using scanning electron microscopy (SEM). Eighteen single-rooted teeth were cleaned, shaped, and obturated with gutta-percha and root canal sealer. The apical 3 mm of each tooth were resected with a diamond fissure bur, and the teeth were randomly divided into two groups of nine teeth each. The resected surface of each root in one group was lased twice. The duration of lasing and the number of pulses were recorded for each tooth. The teeth were air dried, mounted on stubs, sputter-coated with gold-palladium and examined under SEM. Application of the Nd:YAG laser caused melting of apical dentine surfaces. The melted material resembled the appearance of glazed interconnected droplets. Resolidification and recrystalization of the melted areas appeared to be incomplete and discontinuous. Some areas between the glazed regions appeared similar to those of non-lased apical dentine resected root surfaces.


Effect of thermal placement techniques on some physical properties of gutta-percha. Some clinical techniques for the placement of gutta-percha root fillings involve the application of heat. This study was undertaken to assess the effects of intracanal heating techniques on the following properties of gutta-percha: coefficient of thermal expansion, softening temperature, phase transition temperature and organic content. Samples from each of four products were prepared by three different methods. The materials were studied by thermomechanical analysis, simultaneous thermogravimetry and differential thermal analysis, and by measurement of weight loss on ashing. It was shown that the techniques of gutta-percha placement involving heating in the root canal caused reversible physical changes in the materials without any apparent change in chemical composition. The average coefficient of thermal expansion was 137 x 10(-6)/degrees C, the softening temperature was 55.5 degrees C, there were two characteristic phase changes, and the organic content was 25%.


A comparison in vitro of two ultrasonic root canal preparation techniques. Two ultrasonic techniques were compared for their ability to clean and shape root canals in extracted human teeth. One technique was recommended by the manufacturer (Cavi-Endo, Dentsply), while the other was a modification by the authors of the stepdown technique. Mesiobuccal root canals of molars were instrumented using these techniques, after which a silicone impression material was injected into the prepared canals. The roots were then split longitudinally and one half was stained for debris scoring while the silicone impressions were assessed for shape. The results showed that the modified technique produced significantly cleaner canals than the recommended technique. The shaping ability of both techniques was difficult to evaluate because of the complex morphology of molar root canals. The final shape of the prepared canal depended more on the initial shape than on the instrumentation technique.


Clinical detection of the minor mesiobuccal canal of maxillary first molars. One hundred extracted maxillary first molars from a South East Asian population were sectioned at a level below the roof of the pulp chamber. The detection of the minor mesiobuccal canal was determined on the pulpal floor using a size 08 file. When the canal was not detected by this technique, its presence or absence was then determined by sectioning the mesiobuccal root transversely, and the position of the extra canal was explored from the cut end. It was found that by modifying the outline of the access cavity, and by widening and deepening the groove running palatally from the major mesiobuccal canal up to a depth of 0.5 mm and a distance of 2.0 mm, the visibility of the extra mesiobuccal canal orifice was greatly improved. This study showed that more than 50% of maxillary first molars had a minor mesiobuccal canal, and 19% of these canals could not be detected clinically.


Periradicular healing and apical closure of a non-vital tooth in the presence of bacterial contamination. This case report addresses the periradicular tissue response and root-end closure of a maxillary central incisor in the presence of bacterial contamination. The implications for the control of bacteria through the use of calcium hydroxide and/or systemic antibiotic coverage are considered in the light of scientific evidence and clinical treatment.


A preliminary survey for human immunodeficient virus (HIV) infections in tuberculosis and melioidosis patients in Ubon Ratchathani, Thailand. A preliminary survey was conducted for the prevalence of HIV infections in pulmonary tuberculosis and melioidosis patients in Ubon Ratchathani province, in Thailand, the second largest province in population which supplies labors to Bangkok metropolis. In this province, tuberculosis is prevalent in a higher rate than in most other provinces and melioidosis is endemic. Four HIV-seropositives were found in a total of 551 suspected and culture-positive cases of pulmonary tuberculosis, while no HIV-seropositive was found in 121 melioidosis patients. In view of the rapidly expanding HIV-infections in Thailand, a strict watch will be needed on the future epidemiological status of HIV-infection in tuberculous patient.


Outbreaks of paralytic poliomyelitis and polio surveillance in Shandong province of China. Widespread outbreaks of paralytic poliomyelitis occurred in Shandong province, China, starting from 1988. In 1989, 484 cases were recorded, which was the peak during the past 4 years. Although emergency immunization with trivalent oral poliovirus vaccine (OPV) was carried out in selected counties in 1989 and 1990, control of the outbreak was not satisfactory. OPV mass immunization campaigns were introduced to cover the whole province in early 1991, and the number of patients with paralytic poliomyelitis decreased to 95. In addition to this new immunization strategy, we began to construct new polio surveillance systems. These were a network for case-negative reporting and an immediate reporting system of acute flaccid paralysis (AFP). As for the case-negative reporting, presently more than 90% of counties have been reporting presence or absence of new AFP cases. Monitoring of AFP immediate reporting has also shown a gradual improvement in several aspects. These polio surveillance activities are crucial to polio eradication programme management.


Molecular regulation of hematopoietic cytokines: implications and indications for clinical use in pediatric oncology. Proliferation and differentiation of hematopoietic progenitor cells are regulated by a network of stimulatory and inhibitory cytokines. An understanding of the molecular mechanisms of growth control may provide a physiologic basis for the innovative therapy of bone marrow disorders. Among various accessory cells, bone marrow T lymphocytes are capable of stimulating, as well as inhibiting, hematopoietic progenitor cells. We have now elucidated molecular mechanisms regulating the differential expression of T cell genes encoding for the stimulatory and inhibitory hematopoietic programs. Stimulation of hematopoiesis requires granulocyte-macrophage colony stimulating factor (GM-CSF), whereas inhibition requires interferon-gamma (IF gamma). Both cytokines can be induced by interleukin-2 (IL2). The T cell IL2 receptor consists of a 75 kD chain (p75) mainly expressed on a subset of resting T cells and a 55 kD chain (p55) which is strongly expressed upon T cell activation. P55 and p75 associate on activated T cells to form a dimeric receptor molecule exhibiting high affinity for IL2. The p75 monomer has an intermediate affinity for IL2. Expression of p55 in the context of the high affinity IL2 receptor constitutes a requirement for T cell IFg release. In contrast, p75 alone is capable of mediating the production of GM-CSF. Thus, T cells may be capable of selective production of cytokines with specific effects in hematopoietic growth control. Utilizing a human peripheral blood leukocyte genomic library, we identified various clones containing the entire GM-CSF gene, including coding and regulatory regions. Cloning of the GM-CSF gene allowed clinical studies utilizing recombinant DNA-derived GM-CSF. Chemotherapy-induced neutropenia contributes to both complications of cytotoxic therapy as well as increased relapse incidence of underlying disease. In a prospective randomized study, we have demonstrated that GM-CSF abrogates neutropenia following aplasiogenic chemotherapy in children and adolescents with solid tumors, and that GM-CSF may reduce the duration of infectious episodes after cytotoxic therapy. Next, we escalated the cumulative doses of cytotoxic therapy in an ablative regimen followed by hematopoietic stem cell transplantation to treat patients with poor prognosis pediatric tumors. Morbidity of this highly toxic ablative regimen depends on the duration of myeloid aplasia. Median duration of aplasia following hyper-VAMP was 13 days with CM-CSF and 29 days without GM-CSF. In addition, we have employed p55 blocking monoclonal antibody for prevention of graft vs. host disease in bone marrow transplantation. The understanding of specific molecular mechanisms of hematopoietic immuno-regulation can thus be utilized to provide novel approaches to the treatment of bone marrow failure and cancer.


Treatment of de novo acute myelogenous leukemia with recombinant granulocyte macrophage-colony-stimulating factor in combination with standard induction chemotherapy: effect of granulocyte macrophage-colony-stimulating factor on white blood cell counts. GM-CSF is a major regulator of myelopoiesis. Recombinant human GM-CSF (250 micrograms/m2 per day i.v.) was used prior to chemotherapy ("3 + 7" scheme) to recruit leukemic blasts in vivo (de novo AML patients, n = 20) into the chemotherapy sensitive phases of the cell cycle. The stimulatory effect of GM-CSF on peripheral blood AML blasts was associated with a rapid redistribution of leukemic blood cells and with an increase in "S-phase positive" cells. Standard induction chemotherapy ("3 + 7") following GM-CSF induced complete aplasia in 19/20 patients. In the same patients, rhGM-CSF (given after chemotherapy) was found to shorten the time of complete aplasia compared to historical controls whereas post-chemotherapy- and follow-up data suggest no significant differences for CCR and survival. Together, our studies show that GM-CSF can safely be administered to AML patients in combination with induction chemotherapy to recruit leukemic cells into the cell cycle.


Biology and pharmacology of hematopoietic growth factors. Several glycoproteins that control blood formation have recently been characterized. Through their overlapping, synergizing, and antagonistic effects, they regulate hematopoiesis in a highly differentiated network. Large scale production of these colony stimulating factors (CSFs) has been made available by recombinant DNA technology, and a series of clinical studies in a variety of indications has been finished. In general, the subcutaneous application seems to be superior to the intravenous injection and causes less toxicity. Erythropoietin has been shown to be a highly effective treatment for anemia in patients with chronic renal failure. Granulocyte colony stimulating factor and granulocyte-macrophage colony stimulating factor are capable of ameloriating the chemotherapy induced neutropenia, and to abbreviate the time span of myeloaplasia after bone marrow transplantation. The potentials of other colony stimulating factors like Interleukin 1 and Interleukin 3, and combination regimens of several CSFs will be discussed.


Use of GM-CSF in children after high-dose chemotherapy. The toxicity and efficacy of recombinant human granulocyte-macrophage colony-stimulating factor (rhuGM-CSF) is established in adults, but limited information is available on its use in children. The profound myelotoxicity induced by cisplatin (40 mg/m2 daily x 5) and etoposide (150 mg/m2 daily x 3) provides a model to test the clinical value of recombinant human granulocyte-macrophage colony-stimulating factor in pediatric cancer patients; myelosuppression occurred (absolute neutrophil count [ANC] < 500/microL) during 99 of 118 (84%) courses given to 44 children with refractory solid tumors. Fifty-nine courses (50%) resulted in hospitalizations for fever. Subsequently, rhuGM-CSF was added to this treatment regimen to: (i) determine the dose-limiting toxicity of this agent in children; and (ii) to determine whether it can decrease the duration and severity of neurtropenia and attendant complications. Here we summarize and update our experience with this glycoprotein in children with relapsed solid tumors.


RhGM-CSF in bone marrow transplantation: experience in pediatric patients. RhGM-CSF is a hematopoietic growth factor which stimulates the proliferation, differentiation and functional activity of neutrophils, monocytes and macrophages. It also stimulates proliferation of endothelial cells and induces the production of other cytokines, such as interleukin (IL-1), tumor necrosis factor (TNF), interferon, prostaglandin E2, and plasminogen activating factor which affects both hematopoietic and non-hematopoietic cell activities. Initial clinical studies in 1987 generally excluded experimental therapy with rhGM-CSF in pediatric patients (age < or = 17 years) unless life threatening illness related to neutropenia and infection developed (i.e., patients with graft failure). Serious complications of patients undergoing autologous bone marrow transplantation (BMT) related to pancytopenia include infection and hemorrhage. Other regimen related complications include venooclusive disease, pneumonitis and mucositis. As a result of these complications, patients require intensive medical support including antibiotics and hyperalimentation. Initial hospital duration following marrow reinfusion is generally 4 to 5 weeks. Hematopoietic growth factors have been administered to patients undergoing autologous BMT as an attempt to reduce regimen related toxicity.


Interleukin-3 and granulocyte-macrophage colony-stimulating factor in combination: clinical implication. The multilineage hematopoietic effects of IL-3 appear to be most important for its clinical use comprising especially leucocyte and platelet responses. This was demonstrated to be dose dependent characterising doses of 250 to 500 micrograms/m2/day subcutaneously as hematopoietic effective and well tolerable. Since preclinical data suggest synergism between IL-3 and GM-CSF hematopoietic effects of their sequential administration were evaluated in 15 patients with preserved hematopoietic function. An enhanced stimulation of megakaryopoiesis combined with more pronounced stimulation of granulopoiesis than IL-3 alone could be demonstrated. The cytokine combination of IL-3 and GM-CSF was thus used during chemotherapy induced myelosuppression. Data indicates beyond the known amelioration of myelosuppression by GM-CSF additional chances to enhance platelet recovery which can be of important clinical impact.


[Monitoring of somatosensory evoked potentials during surgery for aneurysms of the sylvian artery]. Per-operative use of S.E.P.s for vascular disease is based on: 1. The relationship between electrical cortical responses and cerebral blood flow. 2. The existence of a reversible threshold of cerebral ischemia. Intra-operative monitoring S.E.P.s were used during 30 procedures for aneurysms of the middle cerebral artery (M.C.A.). In 18 cases, a temporary occlusion of M.C.A. was necessary. Occlusion times ranged from 1 to 30 minutes. The central conduction time delay (C.C.T.), i.e. the delay N14-N20 and the cortical peak (N20) amplitude, elicited by median nerve stimulation was bilaterally monitored. A prolongation of the C.C.T. by 1 millisecond (compared with the baseline induction value) and a progressive decrease or a disappearance of the N20 peak were considered as "significant" changes. In response to these changes, immediate corrective actions (interruption of temporary M.C.A. occlusion (T.O.), repositioning of brain retractors, reapplication of aneurysm clips ...) were implemented. The reversibility of the S.E.P.s alterations during surgery was correlated with the post-operative outcome. Significant changes were found in 20 cases (including 13 T.O.). They were totally reversible in 11 cases: 5 of them developed a new but transient immediate post-operative deficit, none had a definitive deficit, and 6 patients had no new deficit. In 9 cases, the per-operative S.E.P.s alterations were not reversible: 3 cases (including 1 T.O.) had a transient deficit, 4 a permanent deficit, and 1 died (aneurysm rupture during craniotomy). An irreversible N20 peak disappearance predicted a permanent post-operative deficit in 4 of 4 patients (100%), whereas an isolated irreversible C.C.T. increase was only followed by a transitory deficit. Only 1 of 9 patients with no change in S.E.P.s (during a 15 min. T.O.), had a transient hemiparesis: this "false-negative" case will be discussed. This study confirms that S.E.P.s monitoring provides useful warning during aneurysm surgery. Median nerve S.E.P.s reflect the functional integrity of cortical M.C.A. territory; it is the pathway a risk during M.C.A. aneurysm surgery. S.E.P.s changes are not real-time information (an average of 500 responses need about 2 min), but these delays allow the surgeon to reverse the situation by immediate intra-operative adjustment, especially during temporary M.C.A. occlusion.


[Cervical meningocele and meningomyelocystocele. Apropos of 4 cases]. Published cases of cervical dysraphic lesions are rare. Their estimated proportion is about 5% of the entire group of spinal dysraphism. Four cases are reported, representing 2 types of lesion: 2 meningoceles with a simple fibrous band fixing the posterior aspect of the cord to the skin and 2 meningomyelocystoceles with other associated anomalies (hydromyelia, hydrocephalus, Chiari II, Peter's ocular anomaly). The clinical presentation is that of a soft posterior cervical mass without marked neurological impairement. The surgical treatment is simple, consisting in the resection of the lesion, intradural exploration to untighten the cord if fixed by a fibrous band, and drainage of the hydrocephalus. Neurological outcome is generally good immediately but may need sometimes secondary surgical exploration.


[Multiple intracranial aneurysms. Endovascular treatment by coils]. The authors report the case of a 30 years-old man presenting with 3 intracranial aneurysms, which were treated by endovascular techniques. The aneurysm responsible for two previous subarachnoid hemorrhages was a giant supracavernous left internal carotid artery aneurysm. Endovascular therapy using coils caused intraoperative rupture which was successfully managed by balloon occlusion of the internal carotid artery. The two other aneurysms (basilar top, and right middle cerebral artery) were small and asymptomatic; complete obliteration of both aneurysms was achieved by selective coils embolization. Persistent occlusion of the three aneurysms was documented ad six months angiographic follow up.


[Distal aneurysm of the postero-inferior cerebellar artery. Anatomical and surgical considerations]. A patient with a rare peripheral aneurysm of the posterior inferior cerebellar artery (P.I.C.A.) was treated by microsurgery. Anatomical features and surgical procedures are discussed. The aneurysm was located in the retromedullary, tonsillomedullary segment of the right P.I.C.A. and formed a caudal or infratonsillar loop in the cisterna magna close to the inferior part of the tonsil. The operation was performed with the patient in the sitting position using a median suboccipital approach through a cervical 1 (C1) laminectomy. The widened neck of the aneurysm was clipped successfully and the post-operative course was completely asymptomatic. A vertebral angiogram control showed the P.I.C.A. to be patent. The surgical approach should be related to the site of the aneurysm. Those affecting the telovelotonsillar segment of a P.I.C.A., forming cranial or supratonsillar loops, and those involving its cortical segment can be effectively operated using the same median suboccipital approach. Aneurysms arising from the anterior or lateral medullary segment of a P.I.C.A. should be approached through a unilateral suboccipital craniectomy extending down to the foramen magnum. Although clipping the neck of the aneurysm is preferable, trapping is possible for lesions arising from or distal to the telovelotonsillar segment, this preserving the small arteries arising from the lateral and posterior medullary segments.


[Cerebral alveolar echinococcosis. Apropos of a surgically-treated case. Review of the literature]. The authors present a case of a cerebral echinococcosis in a male farmer operated upon 9 and 6 years ago for pulmonary and hepatic localisations of Alveolar Echinococcosis. Cerebral lesions were diagnosed by CT scan and MRI and were totally removed. The follow-up was uneventful. A review of the literature revealed only eighteen previously reported surgical cases. The authors comment the epidemiology of this endemic parasitic disease, and the particular aspects of its cerebral localisation.


[Primary Meckel's cave lymphoma. A case and review of the literature]. A rare case of Meckel's cavity lymphoma is presented. Only two other cases of identical localization have been presented in the literature. The symptoms consisted of sensorimotor impairment of the Vth nerve associated with slight exophthalmos. C.T. scan showed a hyperdense lesion in Meckel's cavity. After total surgical removal, histological analysis diagnosed a B-lymphocyte non-Hodgkin's lymphoma. The patient received both radiotherapy and chemotherapy and at one year follow up, the clinical course was good. The lesion had no clinical or radiological specificity. Its prognosis appears to be identical to that of other intracranial lymphomas.


[A rare case of intramedullary epidermoid cyst diagnosed by MRI]. Intramedullary epidermoid cysts are rare entities. A case recently seen on MRI led us to review the literature on the subject. A 9 year old boy developed in a four month-time a spastic paraparesis with a T7-T8 sensitive level. The MRI showed a widening of the spinal cord at the T6 level with an area of decreased signal on T1 weighted images, and a homogeneous round shaped area of increased signal on T2 weighted images. The authors discuss the contribution of MRI to the diagnosis of this lesion. The number of cases of intramedullar epidermoid cysts, like dermoid cysts, diagnosed with this neuroradiological method, is still very limited and the literature only mentions isolated cases.


[Contribution of ultrasonic cavitation--CO2 laser combination in the excision of panmedullary ependymoma]. The authors report an uncommon case of panmedullary ependymoma (C2 to T12), totally removed in one stage with the use of ultrasonic cavitation and CO2 laser. The preoperative topographical diagnosis without M.R.I. was very difficult. CO2 laser in addition with ultrasonic cavitation allows the removal of the tumor without any prohibitive tractions on the spinal cord. The stable course with a long follow-up period (seven years) confirms the good prognosis of such a pathology.


[Religious delusion 13 years after brain injury]. We report here with a case of religious delusion in a 39 years old woman. She had suffered a head injury with right temporal concussion 13 years before but had no earlier history of psychiatric disorder. In view of the fact that this acute psychiatric state lasted for a short duration of time and that personality and affects were preserved, this incident is compared to the schizophreniform disorder of the type DSM-III-R. The hypothesis of an acquired predisposition due to head injury has been put forward as an explanation.


Trypanosomiasis control in Boran cattle in Kenya: a comparison between chemoprophylaxis and a parasite detection and intravenous treatment method using isometamidium chloride. Two methods of trypanosome control in Boran cattle kept under very high trypanosomiasis risk were compared: the traditional intramuscular isometamidium chloride prophylaxis with a parasite detection and intravenous isometamidium chloride treatment method. The results were related to a control group under diminazene aceturate treatment. Isometamidium chloride at 0.25 mg/kg as routinely used by the ranch was of little benefit by either method, with breakthrough infections occurring as early as one week after treatment. When isometamidium chloride at 1 mg/kg was used, the curative intravenous method appeared to be superior to the intramuscular prophylaxis with regard to cost of drugs and to a 31% higher weight gain over a 30 week period. Weekly infection rates in the intravenous group decreased over time, despite an increasing trypanosomiasis challenge, with a mean interval of 6.4 weeks between treatments as compared with 4.3 weeks in a diminazene aceturate control group. It was concluded that isometamidium chloride given intravenously had not only a very good therapeutic but also a considerable prophylactic effect of not less than four weeks.


Anaplasmosis in Uganda. I. Use of dried blood on filter papers and serum samples for serodiagnosis of anaplasmosis--a comparative study. The suitability of blood collected on filter papers in comparison with corresponding conventional serum samples in the diagnosis of bovine anaplasmosis was studied using the complement fixation test, DOT-ELISA, Western immunoblot and rapid card agglutination test. Dried blood on Whatman filter paper no. 1 was eluted in PBS 0.05% Tween 20 giving an initial dilution of 1:10. The reactivity of the eluted samples in both DOT-ELISA and Western immunoblotting were similar to those obtained with the corresponding straight serum sample dilutions. Filter paper samples gave lower reactivity in the remaining tests when compared with corresponding serum samples. There was no significant difference in the reactivity between the eluates from filter papers stored at temperatures ranging between 15.5 and 24 degrees C and those kept refrigerated. Storage at 15.5 to 24 degrees C did not significantly affect reactivity for up to six months. Eluates from filter papers stored for six months at 15.5 to 24 degrees C continued to give similar reactivity as those from freshly prepared filter papers in both DOT-ELISA and Western blot, and in the rapid card agglutination test. It is concluded that collecting blood on filter papers is a suitable technique for large scale seroepidemiological studies on anaplasmosis and offers many advantages in developing countries where transport and cold chain facilities are a major constraint.


Epidemiology of sheep myiases in São Paulo State, Brazil. A survey of Diptera species causing cutaneous myiases on sheep in Botucatu, São Paulo, Brazil was made to determine seasonal incidence, predilection sites and the factors predisposing to infestation. Sheep were checked daily for myiases for one year. At two week intervals larvae from wounds were collected for identification. Only larvae of Dermatobia hominis and Cochliomyia hominivorax were found. Myiases due to C. hominivorax were observed during the whole year with high incidence from January to April. The feet, vulva, tail and scrotum were most frequently infested. Wounds were the commonest predisposing factor.


An evaluation of serologic tests used to diagnose brucellosis in buffaloes (Bubalus bubalis). Five serologic procedures were evaluated in buffaloes and results compared with cultures of 64 udder secretion specimens. The rivanol test was superior to all other methods in specificity. The card, rivanol and complement fixation tests identified all infected cows. Many sera had complement fixing antibodies while agglutinins were absent. It was concluded that these were false positive results. A new procedure, the particle concentration fluorescence immunoassay, was a sensitive screening test but lacked specificity. On a limited number of samples, the tube agglutination test lacked sensitivity and was not a very useful procedure for the diagnosis of brucellosis. All 18 isolates of Brucella abortus were biovar 1.


Control of brucellosis in Kuwait by vaccination of cattle, sheep and goats with Brucella abortus strain 19 or Brucella melitensis strain Rev. 1. In Kuwait, approximately 12,000 dairy cows were vaccinated with a reduced dose of 3 x 10(9) Brucella abortus strain 19 and approximately 350,000 sexually mature sheep and goats with a reduced dose of 10(7) B. melitensis strain Rev. 1. Using the criteria of prevaccinal and postvaccinal incidences of antibodies, abortions, and human cases of brucellosis, the programme was very successful. Widespread vaccination of adult animals is the most effective method of controlling brucellosis among cattle, sheep and goats in many countries.


Seasonality of cattle feed sources in Pabna, Bangladesh. Cattle feed sources were studied at village level in Pabna district, Bangladesh. A large quantity of feed was offered. In the monsoon the average amount of DM fed to a mature animal of 210 kg was 7.1 kg d-1, consisting of about equal amounts of straw, weeds and leaves. In winter animals grazed for an average of 3.7 hd-1 and were supplemented with 3.9 kg DM d-1 (two-thirds straw). In summer they were offered 5.4 kg DM d-1 (one-third straw and two-thirds weeds and leaves) and they grazed for 0.5 h d-1. The major limiting constraint on cattle production is the quality of the feed offered, particularly in the monsoon period when animals cannot graze. In future, feed quality will become even more of a problem because grazing lands are gradually disappearing.


Effects of parasitic infestation on the productivity of alpacas (Lama pacos). A trial was carried out in alpacas (Lama pacos) to determine the economic benefit of controlling both external and internal parasites using ivermectin (Ivomec, Merck, Sharpe and Dohme). After four months the treated male alpacas had gained on average 3.1 kg more than the untreated males and their fleece weighed 0.36 kg more. Treated females gained 1.9 kg more than the controls but their fleece weighed 0.03 kg less. This resulted in a net financial benefit to the farmer of US$3.54 for each male alpaca and US$1.36 for each female.


Prevalence of Babesia bovis and Anaplasma marginale at selected localities in Sri Lanka. Sera were collected from a minimum of 20 cattle aged nine to 36 months at each of 14 localities in five climatic zones of Sri Lanka. Sera were tested for antibodies to Babesia bovis and Anaplasma by an indirect fluorescent antibody test and a card agglutination test, respectively. Antibodies to B. bovis and Anaplasma were detected in all samples tested from each of 14 and 12 localities respectively. In general, prevalences were consistently high among localities below 1,200 m and lower and more variable in the hill country. Management practice rather than climate was considered to be the main factor influencing prevalences. Management is discussed in relation to the risk of disease outbreak.


[Midline granuloma and Wegener's granulomatosis]. Necrotizing lesions of upper respiratory tract have always been among the most enigmatic diseases of the head and neck region. Nowadays a great deal of nosographic confusion still remains along with numerous doubts concerning diagnostic and therapeutic strategies to be followed in dealing with many diseases often erroneously defined "midline granuloma". In fact, a large variety of diseases appear or may appear as midline destructive lesions in the upper respiratory tract. Each of these, including infections, immune and neoplastic disorders, obviously requires a different therapy. The clinician must have a very good knowledge of the problem in order to make a rational approach to diagnosis and therapy. Wegener's granulomatosis is quite different from "midline granuloma" and must be diagnosed promptly so that an appropriate therapy may be determined as soon as possible. Unlike in the case of "midline granuloma", a prompt therapy is often very effective and gives long periods of remission. In this disease, nevertheless, the etiopathogenesis of both diseases is unknown, precise protocols for diagnosis or treatment do not exist (every case must be considered separately) and prognosis is very poor. On the basis of their personal experience and of an accurate review of Literature, the Authors present a systemic and up-to-date monographic study focusing particular attention on the most recent diagnostic techniques, such as immunohistochemical techniques which utilize monoclonal antibodies, indispensable in the cases of "midline granuloma", and immunofluorescent techniques searching antibodies to cytoplasmic antigens of neutrophil granulocytes, of great value in dealing with Wegener's granulomatosis not only in establishing an initial diagnosis, but also in making prognosis and in controlling the evolution of the disease. The paper also discusses differential diagnosis of midline destructive disorders, highly important for a correct and rational initial approach in diagnosis. Every disease described in the section concerning differential diagnosis must be excluded in order to make an accurate diagnosis of "midline granuloma" in that no typical histopathologic or clinical signs of this particular, destructive disorder. Finally, the authors focus their attention on new etiopathogenetic hypotheses and their therapeutic implications. The most interesting of them are surely those that consider "midline granuloma" the manifestation of a malignant lymphoma as well as those that explain the recent success obtained in treatment of Wegener's granulomatosis using trimethoprim and sulfamethoxazole asserting a possible essential role of infections in the etiology of the disease.


Treatment of testicular relapse in childhood acute lymphoblastic leukemia. The experience of rescue therapy for 6 patients of childhood acute lymphoblastic leukemia (ALL) with testicular relapse is reported. In two patients, testicular relapse occurred 1 and 4 years off therapy, respectively. Two patients had testicular relapse on therapy. The remaining 2 patients had testicular relapse after premature discontinuation of therapy by the parents. Isolated testicular relapse was found in 2 patients. The rest of the testicular relapses were concurrent with either bone marrow (BM) or central nervous system (CNS) relapses. The rescue therapy included bilateral testicular irradiation 24 Gy, and systemic reinduction chemotherapy, followed by maintenance therapy as that of TCL 821 or TCL 842 protocol for high risk patients of ALL. CNS prophylaxis, which included intrathecal medication and/or cranial irradiation 18 Gy (if not given before), was also given. After testicular relapse, one had subsequent BM and CNS relapses and received more aggressive chemotherapy. Another one had subsequent CNS relapse 4 months after another premature withdrawal of treatment. One patient, who presented with CNS leukemia at diagnosis, had concurrent testicular and CNS relapses and died of CNS leukemia 3 months later. The remaining 5 patients remained in continuous complete remission for 26 to 95 months with a median duration of 54 months.


Clinical use of single-dose surfactant TA therapy for premature infants with severe respiratory distress syndrome. A single dose of surfactant TA was given as rescue therapy to four small premature infants with severe respiratory distress syndrome requiring mechanical ventilation. Birth weights ranged from 810 to 1200 gm. The dose of 100-120 mg/kg was given at the mean age of 5 hours, with range of 3 to 7 hours. Following surfactant therapy, there was a significant improvement (p < 0.05) in a/APO2 (raising from 0.11 +/- 0.05 before treatment to 0.34 +/- 0.19 at 6 hours after treatment). There was also a significant reduction in the severity of respiratory distress syndrome at 24 hours post-therapy. One baby died of sepsis at 40 hours of life; one survived without complications. The other two cases developed severe bronchopulmonary dysplasia later. We concluded that early use of exogenous surfactant is beneficial in small premature infants with severe respiratory distress syndrome.


Auditory brainstem responses in term neonates treated with gentamicin. Seventeen infants who had been treated with gentamicin on the first day of life as prophylaxis for prolonged rupture of membranes or maternal fever. Twenty-seven weight-matched healthy infants were used as controls. The auditory brainstem responses were evaluated on the third day and again on the tenth day of life. Latencies of components V, intervals I-V and III-V were significantly prolonged in the gentamicin treated group when compared with the control group. This prolonged latencies reversed itself on the tenth day of life. The concentration of peak and trough levels of gentamicin were related to latency of interval III-V. These findings emphasize that a short course therapy with gentamicin in essentially healthy infants can alter the central transmission of auditory brainstem responses transiently.